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The Paramedics & The Mortuary

The events of Sunday 23rd August 2015 are forever etched in my mind. This was the day that Jake took his own life and the day that time became irrelevant, as it will always seem like yesterday. I want to share something in this blog about  the paramedics who attended Jake’s death, what one of them said to me and why I will be forever grateful.

I won’t talk now about the events leading up to me finding out that Jake was dead, I will cover that detail in a future blog. but once I received the phone call, I had to make some quick decisions around whether I would drive to the house where Jake lived or whether my brother would pick me up.  Anyone who knows me, knows that I don’t like driving at the best of times.  I decided that I would drive as it would take too long for my brother  to drive all the way to my house to then drive all the way back.  My husband has a neurological disorder that stops him from driving and he would have given anything to have been able to drive for me that morning.

I don’t remember much about the journey other than I kept trying to get my breath as I felt panicky and that we had the windows down because it was a warm and sunny day. Throughout the journey we were preparing ourselves to go into the house and to see Jake no matter what.  As we got closer to the house I just remember my husband saying to me ‘just stay focused and when we arrive at the house don’t get out of the car, just take in the surroundings, gather your thoughts and we will get out when we’re ready’.  When we parked up, the scene was surreal.  There was at least one ambulance a police van and other police cars, there were 3 female paramedics, 2 uniformed officers and 2 plain clothes police, my brothers and some of the neighbours.  I felt sick.

The first thing I noticed was  the faces of the 3 paramedics.  One of them was quite young and she looked shocked, she didn’t speak to me, but I didn’t take that as being rude because I actually thought she does not look good*I found out 2 days later that this paramedic had to be taken into the ambulance for some time, as she was very distressed*. One of the plain clothes Police Officers came over to me on the driveway and just started to ask me questions that I was trying to answer in full view of the whole street ‘when did you last see Jake?’  What time did you leave him yesterday?  Who else saw him yesterday?’  I really did not care for him too much or his side kick who did not speak, she just looked me up and down and stared at my face.

I told the police that I wanted to go into the house and that I wanted to see Jake, I had psyched myself up for this and I was going to do it.  I can’t remember what the police officer said, but one of the paramedics looked at me square on, she put her hands on my shoulders and said ‘as a mother I would advise you not to go in there’  I replied immediately ‘no, no it’s fine, I really want to do this it’s fine my husband is coming in with me’. This conversation must have repeated itself at least 3 times.  At this point the paramedic, re-positioned herself, held my shoulders even stronger, she looked me in the eye and said ‘I am talking to you as a mother you don’t need to go in there’  The penny dropped and I said to her ‘you’re a paramedic and you’ve been in there as a paramedic not as a mother haven’t you?’ she replied ‘yes I have’ I then said ‘so I don’t need to go in there do I?No, I would advise that you see Jake tomorrow’. I can’t thank this paramedic enough for this advice. I will go on to explain why as I continue with this blog.

At this point the plain clothes officer informed us that he was waiting for ‘Top Dog’ (his words not mine) to arrive, assess the scene and rule out any suspicious circumstances. So instead of standing on the driveway for what I now know would have been several hours we were taken to my brothers house which was only a few mins. away and that is where we waited whilst ‘Top Dog’ did his bit. Jake’s body was found at 10.00am on that Sunday morning, it was not until after 5.00pm that his body was moved from the house to the mortuary.  Those hours were difficult.  Just after 5.00pm the plain clothed officer and his side kick came to my brothers house to tell us that all the activity at the house was complete and that Jake’s body had been moved.  The next thing he said made me feel angry, ‘he belongs to the Coroner now’ and I just thought, no he doesn’t he belongs to me.  His side- kick continued to stare at my face and my reactions.  She spoke once to say ‘mental health is very complex’ whilst shaking her head.  Patronising Idiot.

THE MORTUARY

So, taking the advice of the paramedic I waited until I could see Jake in the mortuary.  A friend of ours offered to drive us there as the hospital was not that close to my home. Now this friend did not know how Jake had died, it wasn’t a secret by any means but he just hadn’t asked and the conversation during the car journey was anything that would distract us from thinking about viewing a body in the mortuary. We arrived and were shown to the reception area and were introduced to Tony the Mortuary Technician.  Tony had a very broad northern accent (maybe Bolton).  My husband went to the gents, which left me and our friend just waiting.  To break the silence Tony came out with ‘Eeeehh, it’s terrible in’t it, me friends daughter she ‘ung herself 6 week ago, shocking’.  Well, I can laugh about this now, but at the time I cried and our friend nearly fell off his chair.  You really couldn’t make this up. Tony then explained that as Jake belonged to the Coroner, he would have to stay with me and my husband when we spent time with Jake’s body.  For goodness sake.

When we entered the room we both gasped, as seeing Jake lay on the trolley (he was completely covered up to the neck and looked like he had been tucked in bed for dear life). We were both struck by how tall he looked laid out.  Once we composed ourselves we were able to take in the situation and we each sat down next to Jake.  Tony stood at the foot of the trolley.  We took in everything about Jake’s face and his hair, he really did just look like he was sleeping.    Jake had very long eyelashes and these stood out  (Jake was very proud of his eyelashes).  We asked if we could touch him and I tried to feel for his hand under the blanket.  We started to chat with Tony about mental health and young people.  When we both left the room we both said that we could have sworn Jake moved.  Of course he didn’t, but the fact that he looked so restful really was like he was just asleep and appeared to just flinch slightly.

So, back to the advice from the Paramedic.  This experience of seeing Jake in the mortuary was so positive that I made up my mind to not see Jake at a later date at the Funeral Directors.  I felt very strongly that I wanted this to be the last physical image of Jake and I did not want anything to spoil or change this.  I focused on the image of him tucked in for dear life with his long eye lashes when we buried him, I draw on this image when I visit his grave and I use this image to replace any imagined image of how he died.

I am eternally grateful to the Paramedic.  What our emergency services see and do is incredible and even in the most tragic and difficult circumstances it’s the little things that can have a long lasting effect.  I guess I need to give Tony the Technician a mention for bringing some unintentional humour into our mortuary experience. Some things are just unforgettable.

#AfterSuicideBlog #TheParamedic&The MortuaryBlog #BBCAmbulance #NWAS #SuicidePrevention #StartTheConversation

Start the conversation ‘Are you not feeling good today?’

Just ten weeks after Jake died the most surreal thing happened. It was November 2015, I set off for a walk on a route that I was familiar with along a nature trail. I was walking along deep in thought when I noticed something which made me pause and think. A young man was sat on a bridge facing the water. I noticed that he had a bottle of vodka in his hand and an elderly lady was talking to him. I thought that’s odd, but thought they must know each other. I carried on walking for a short time but something stopped me and I paused, looked back and watched the situation for a few moments. The elderly lady looked a bit troubled and she reluctantly walked away. The area was reasonably busy with dog walkers, joggers and local school children using the path as a short cut home. I decided to walk back towards the bridge and the young man. Don’t get me wrong it wasn’t high drama, there were railings that he was leaning against and it’s not a particularly high bridge. As I approached the young man he had his back to me and had earphones in. I looked around and everything just seemed normal, but I felt I had to ask if he was ok. I tapped him on the shoulder, he took out one of the earphones turned around and instantly tried to dismiss me by saying ‘there’s nothing you can do or say, just leave me.’ I tapped him on the shoulder again and said ‘are you not feeling good today’? I can still see the response and his face to this day. It was like a light switch, and he started to talk to me. I said to him ‘I lost my son to suicide 10 weeks ago and I have to live with it’. At this point I had his full attention. He started to tell me his situation, he had recently been released from Prison as he had been involved in a fight and served 18 months of a 3 year sentence. He had previously been a promising cricketer (he was 22) and he was struggling to fit in with his friends who he thought had all moved on. He told me that he had drank the vodka and had pills in his pocket (he showed me Sertraline). He also showed me that he had only taken one of the tablets since the prescription because he believed that his friends would think he was weird. He also said that this was the first time that he had actually taken action and that he was at stage 3 (I kind of knew what he meant). I said to him if you fall or jump from this bridge you will probably break both your legs and be hugely inconvenienced for weeks. At that point the elderly lady who had previously been talking to him appeared and she said to me there’s a bench over there. I suggested that we sit on the bench and assured him that I would continue to talk to him. He agreed and we sat down. To be honest I was getting worried because it was late afternoon and it was beginning to go dark, there were people around, but I thought my husband will wonder where I am. I asked him where he lived and when he told me it was literally a 10 minute walk (and the direction that I was heading). I said ‘would you like me to walk you home’? He said ‘would you mind? I smiled to myself and thought thank goodness for that. We started walking and his mood started to lift he seemed more upbeat and we chatted about more general things. As we got close to the avenue where he lived he suddenly stopped and said ‘oh no my Nan’s outside, she’ll have a heart attack if she knows what’s gone on’. I agreed to leave him at that point. I got my shopping and went home. My husband was at the door wondering where I had been. I told him the story feeling like I had done a good deed for the day, I felt quite hyped up. As the hours went by I started to worry and my safeguarding head kicked in. This was a young man, who left his home in the morning and did not know where that day was going to end and like I said it was not high drama and he wasn’t about to jump but he was not in a good place. I overheard some school kids say look at him attention seeking. I kept thinking that he is someone that could do it. I thought about contacting his probation officer, the Health Centre where he god his meds prescribed (he showed me the box) and I even thought, shall I go and speak to his mum. It was bothering me. My husband said to me you are far too vulnerable to get involved and just the chance meeting and the conversation that we had will stick with him and mean something. Over time I realised that this was right. Every time I walked close to where he lived I would look at the house and if the cat was sat on the bonnet of the car it would make me think that all was well in the world (no idea why). I actually passed him on the path about a year later and he said hello to me. I am not sure if he fully remembered me or it was just that I looked familiar. It made my day because he looked really well and upbeat. The family seem to have moved so I no longer need to look for the cat…lol. I will never forget that conversation or the look on his face when I asked ‘are you not feeling good today?’ I would like to think that the conversation means something to him too.

Missed Opportunities & Lessons Learned

How many times do we have to keep hearing these two phrases after Investigations and Inquests?  I received a copy of the Regulation 28 issued by the Coroner (recommendations to prevent further deaths) after Jake’s inquest Dec 2015.   The Regulation 28 was sent to 3 organisations, 1) The Chief Executive Greater Manchester West Mental Health Team, 2) The Medical Director of the Greater Manchester NHS Area Team and 3) The Practice Manager at a Health Centre which I will not name.  I was absolutely stunned to read in the Coroners Report, ‘This has happened before and lessons have not been learned’. I felt sick.  I studied very carefully, each of the 3 responses, I asked further questions and sought clarification.  What I found, I will include in future Blogs under various headings.  In my quest to find out what this comment (above) was referring to, I wrote to the Medical Director of NHS England (the organisation who this comment was directed at) and I asked the question “Why did the Coroner feel the need to include this in Jake’s Regulation 28?” The Medical Director of GM NHS Area Team wrote to me inviting me to meet with him.  I have to say that he was extremely generous with his time and I found him to be sincere.  He talked me through his responses and I felt re-assured that a thorough job had been done of responding to the Coroners findings and recommendations. He made the following recommendations:-

  1. A Dual Diagnosis Steering Group has been set up as a result of Jake’s death.
  2. Services that offer different services, but work together (shared care) need to improve their relationships and communication to avoid ambiguity (structured Management needed)
  3. The Community Mental Health Team (who had assessed Jake over the phone as high risk) have since Jake’s death been advised to attend jointly appointments with other organisations to improve engagement and assessment for Jake.  Such simple changes could make a huge difference to the lives of other.  It also in my opinion could save the NHS money. The Coroners words were ‘be more imaginative’. Jake never actually got to meet with the CMHT.  In fact I phoned them on Monday 24/08/15 to say that he was dead and would not be needing the appointment on Fri 28/08/15.
  4. A letter was sent to all GP’s outlining best practice when sending urgent correspondence. This is a contractual obligation which will be monitored by the Commissioner.
  5. Guidance on suicide prevention i.e. the need to always note the risk, irrespective of any previous understanding by the recipient (basically, don’t assume that other know the risk, always make it clear)
  6. Review policies and procedures for vulnerable patients who miss appointments
  7. To undertake a review of systems in place to track and to establish the lessons learned from any incidents and near misses.

Now back to  ‘This has happened before and lessons have not been learned’.   I asked Dr R. Patel a direct question “was this comment referring to an organisation (who I will not name) where a letter went missing?”  Dr. R. Patel was able to answer without breaking any confidentiality.  The comment was referring to the case of a vulnerable individual who moved address several times and the issue was with systems that are not joined up/updated.  I was able to stop being haunted by my own workings out in my head and was assured that this issue had been addressed and had no direct influence on Jake’s death.

As I continue to blog, one of the key things that am determined to do is to follow up point 7. (above) To undertake a review of systems in place to track and to establish the lessons learned from any incidents and near misses.  Regulation 28’s must not be dealt with in isolation for individuals.  They must be cross-referenced, monitored and audited.  Jake did well for a 23 year old young man to share everything with me his mother and without this insight Jake’s case would have been an open and shut case and there would not have been a Regulation 28 changes would not come about.

Dr R. Patel told me that after Jake’s Inquest the Coroner requested a meeting with him to discuss cases across GMW and she said to him “Your systems are baffling”  They are indeed……

#suicide prevention  #after suicide blog