Reflective Practice

Written by Richard Trotter

I had the opportunity to care for a woman who had overdosed on Tricyclic antidepressants earlier this week. She is 33 and the mother of two. She is married and works in construction. She was prescribed the antidepressants because she was having trouble sleeping and was having flashbacks after a co-worker was killed working the same job that she does, but on a different shift. She said that she didn't really want to die, she just wanted to take a long sleep and have some time away from the pressures in her life.

When she came in to the ER she was barely conscious. Her heart rate was up and was accelerating. We were expecting her blood pressure to crash. She had a rash that covered her torso and she was agitated. These are all effects of tricyclic OD. Four of us had to hold her down to put an IV in her. Her husband helped. Then we gave her charcoal to drink, with a simple ultimatum, "Drink it or the four of us will hold you down again, force a tube up your nose and into your stomach and then we will pour the charcoal into you." She chose to drink the charcoal. I lied to her and told her that it didn't taste bad. I told her the truth, the Nasogastric tube hurts.

I knew that I was both lying to her and telling her the truth because I had been there. Not in the same ER; not having overdosed on tricyclics; not really for the same reasons. In March 1992, I took 26, 300-mg tablets of Lithium. I was talking to a girl that I had been seeing (and living with). Our relationship had ended, or was ending. The girl was in Vancouver. I was in Mississauga. She asked me what I was doing and, when I told her she asked to speak with my grandmother. My grandmother called my mother at work. My mother called "911", then came home. The police came to the house and one officer sat with me in the living room and told me how stupid he thought I was. Another officer spoke with my mother. My sister came home. I don't know who called her to tell her what was going on, but she knew. She ran at me; she was angry. The police officer that was speaking with my mother tackled my sister and every one went into the kitchen except the police officer who thought I was stupid and I. I was told that an ambulance was coming and that I had a choice. I could go with the paramedics peacefully or I could refuse and the police would take me to the hospital with force if necessary. I agreed to go with the paramedics. I was upset, not stupid. I read the information package that the pharmacist had given me when I bought the lithium. I could expect an itchy rash, palpitations, cardiac dysrhythmias, nausea and vomiting. The Drug Company was right.

When the paramedics arrived they did whatever it was that they did. I don't remember this clearly. My level of consciousness was changing. I vomited in the ambulance. The paramedics asked if the tablets were green. They were green and yellow. I arrived in the ER, and for the first and only time in my life did not have to wait to see a doctor. The doctor ordered the nurses to "pump my stomach". That is a misnomer. They don't "pump" anything. People held me down. I kicked one of them in the back of the head. More people held me down and they forced me to swallow a hose. I remember it being as big as a garden hose, but I looked at one when I was working my patient. A gastric tube is about as thick as my baby finger. Once the tube was in the nurses poured normal saline into it. The saline filled my stomach until I vomited. Then they did it again, and again, until all that came out was clear. Then I drank the charcoal.

Charcoal is bland. It tastes like chalk, but with grit in it. It is black and it stains everything. Teeth, lips fingers, face, then later your bowels, and feces. It makes you flatulent and takes about three days to clear through your system.

I spent those three days in room on a cardiac monitor. Lithium causes abnormal heart rhythms, potentially lethal ones. Then I was transferred to an acute psychiatric floor, with big blue doors. This was partially by choice. The psychiatrist would have released me once I was medically cleared if I had pushed for it. I didn't. I wanted to stay in the hospital for a few days. It seemed like a safe place. I had scared my family and myself. I had a little room and could do pretty much as I pleased. I just had to follow the rules. I did and the psychiatrist removed any restrictions on me. My family visited and so did a few friends. For them I am grateful. As much as I had scared myself I think the blue doors scared them, but they came anyway. One friend told me to look around and then asked me "What the hell do you think you are doing?". That question stuck with me. The next day I asked to leave. The psychiatrist discharged me and I went home.

It took two years before I dated anyone after that. In the mean time I hung out with friends, worked and most importantly decided what I wanted from life. I went back to school.

My patient spent one day on a cardiac monitor in the ER, and then was transferred to a bed in the hall. She stayed there for two more days waiting to see a psychiatrist. Her family visited her in the hall. She agreed to stay because she wanted help. Her bed in the hall was just outside of the room with the cardiac monitors. I was the nurse responsible for the cardiac suite, on night shift, two days after her overdose. I had four patients to care for, but they were all stable and slept for most of the night. I spent most of the night standing in the doorway talking to someone who understood what I was saying, and whom I understood. It was a good night. I think I might have made a difference for her. I hope I have. I hope she learns as much about her as I did about myself. I hope she helps someone else who needs it.