Sad or Depressed?

It's so easy to overlook, to underestimate. "Cheer up, it might never happen." It's easy to say. Often easy to do, too. Sometimes, however, suggesting that a smile will cure all ills, only shows a lack of understanding. Sometimes it takes a big name, a celebrity, a high-flying politician to be affected enough by something that whatever that something is, suddenly hits the news. 

Gary Speed, a well known footballer and football manager, took his own life. The news only broke today so one can only assume, at this very early stage, that Gary was trying to cope with some unenviable hardship. He was a man who seemingly had everything to live for, a loving family, a place in the history books of both national and international football, a career and direction in life envied by many. And yet, somewhere in the deep recesses of his mind and soul, a dark, endless depression loomed. 

It's a tough one, depression. I see patients practically daily on anti-depression medications. Depression is the only illness named and described with the same word. Diabetes is an illness where a person's sugars are out of control. Hypertension is when blood pressure is too high. Asthma is when the lungs aren't working properly. 

Depression is when a person is depressed. 

The other problem is that depression is a word that is bandied about all too freely. People are depressed when they miss out on a good night out, they're depressed when their boss tells them off, they're depressed when their football team loses. But depression isn't sadness or upset. It's a state of mind caused by one of many factors and triggers, some physical, some chemical, some emotional, where a person can appear happy and content with their lives, and yet not be able to cope with all that is happening around them. 

Often, in the depths of these depressions there is only one viable option, and that's the option that Gary Speed seems to have taken. Some will claim that this is a selfish option, but to be honest, my uneducated mind tells me that for something to be selfish, there needs to be conscious and coherent thought. Depression allows for neither. The mind's inability to cope, to rationalise, to comprehend, leads the body down a path of self-destruction. 

It's also not something that we can solve in a twenty minute meeting in the back of an ambulance. Sometimes, however, just being able to spot the first signs, may be the trigger that leads a patient to treatment and save them and their families heartbreak in the long term. Most of the knowledge I have about depression isn't from books or classrooms, it's from witnessing it first hand. It's not something we're taught as paramedics to really deal with, because most of the time we're dealing with the consequences, not the disease itself. 

We can bandage wounds, or we can pronounce death. Understanding that there's a stage before this, a stage that we should be able to spot, may be the most life-saving action we can perform out on the front line. 

Zapped

The alleyway's smell would linger for a long time. It seemed to cling to my uniform, my boots, the ambulance, and in particular, my nostrils. Boxes of discarded food, bags of waste, animal waste, probably human waste too. And in amongst it all stood Larry.

"Come one step nearer, and I'll kill you. Then I'll kill myself!"

The machete in his hand proved the seriousness of his threat. I'd met Larry before, only once, at a nearby bus garage. Just another homeless man in the sea of misery and despair that still shocks me in a first-world city such as ours. Looking twenty years older than the early forties he really was, all he wanted then was somewhere warm and dry to spend the night, and we obliged. Much to the disgust but resigned acceptance of the local hospital. They placed him in the waiting room where he slept the night away, awkwardly perched on one of the wooden seats.

This time was different. He was angry, frustrated by the cards that life had dealt him. He was desparate.

"I just want to end it all. You can't help me, and I don't want you to try!"

I didn't dare open my mouth yet. There was a line of police officers between Larry and us, each carrying a shield and covered in body armour. The absurdity that the only people who regularly carry weapons in this country are the criminals, seemed all the more frightening as we waited for the armed response unit to arrive. One of the officers, taking on the role of negotiator tried to talk to Larry, eliciting nothing more than threats that were becoming more real by the minute. We heard more sirens in the distance, the distinctive sound of the armed unit's cars speeding their way through the streets, and as they arrived, there was a definite change in the atmosphere around us.

We had no idea he was armed until we turned up on scene. All we had was a call to a distressed male threatening passers by. No one bothered to tell us that the threats were more than just verbal, and when we were told that the police were on scene, we expected nothing more than a panda car and a couple of local officers.

The police seemed to have a little more information, but it never reached us, and as we pulled up to see several vehicles and a dozen officers dressed ready for battle, we realised that the call was a little more than the initial disturbance we'd assumed. As he started swinging his arms at the cordon, we finally saw what we were dealing with. The alleyway was a dead end, but humans when frightened and cornered, just like animals, will try to battle their way out. Larry could only see one way out, and he seemed determined enough to take it.

He took one swing with the machete towards the line of officers, more a threatening gesture than a real attempt at causing harm. The entire line shuffled a step backwards and erupted into loud calls to put the knife down. Larry laughed. A manic, full-bodied laugh that turned unexpectedly to tears.

"Go away," he sobbed, "and leave me alone to get on with it! I don't want to hurt anybody. I just want to die!"

Two armed officers had joined the ranks, with several others a row behind, using the shields already present for their protection. The standoff tensed, and the sight of a dozen armoured personnel standing over a lone, tormented soul, protected by nothing more than a t-shirt and frenzied arm-waving, turned almost surreal. Negotiations continued, Larry shouted some of his replies, whispered others, and intermittently threatened to put the knife to its intended use.

We stood there for over an hour, a dozen or so paces behind the front line. Crowds of people had gathered at all the police tapes, trying to catch a voyeuristic glimpse of the drama unfolding on their streets. Dozens of police cars and vans were both inside and on the edges of the cordon, along with a solitary ambulance. The presence of the large yellow box on wheels looked almost symbolic rather than functional in the sea of silvery-blue.

In an instant, the mood changed. A chorus of voices yelled at Larry, and two red laser dots appeared on his chest. Over the top of the line of officers, a glint of steel reflected the blue LED lights from the police cars and seemed to come a little nearer. Larry screamed back, frantically flailing and warning the police to stay back. A combination of stupidity and curiosity made us take a few steps forwards, just in time to hear more warnings in both directions, hear a crackle through the air, and see Larry's torso get hit by two spikes. 

The moment he was hit, Larry let out an almost primeval shriek, his body stiffened, the machete fell one way, and he the other. Seconds later, it was all over. Half a dozen officers were on top of Larry, securing him, ensuring his safety and theirs. The knife was removed and placed in a large plastic tube, and Larry was carried face down onto the back of the ambulance. I'd only had the training two days earlier on how to remove Taser barbs, and was probably inappropriately pleased to get the chance to use the training so soon after.  

Larry was sat up on the trolley bed, restraints in place around his legs, handcuffs holding his wrists behind his back. He was no threat to anyone now, least of all and most importantly to himself. We removed the barbs from his chest, at which he flinched but hardly made a sound. Two officers were stood by the top of the bed, ready to pounce in case he made an unlikely and frankly impossible dash for freedom. Once the barbs had been removed, we lowered the head of the bed down a little, allowing Larry to lay on there a little more comfortably, on his side facing us, easing the pressure off his cuffed hands.

As we took Larry to hospital with what seemed like a battalion of police officers accompanying us, there was an eerie quiet, each of us mulling over everything that had just happened. I was writing notes, the officers were standing guard. Only the noise of the sirens made any impression on the surroundings. Finally, Larry broke the silence, as he turned to one of the officers.

"Are you the guy that zapped me with that thing?"

The reply was gruff, pointed, matter of fact. "Yeah, it was me. What of it?"

He broke down again. "Thank you for saving my life."

And I thought that was our job.