Jasper’s Koan.

Jasper first presented to our Emergency Department one Friday evening after being found laying unresponsive on the footpath outside a local nightclub with a deep laceration to her lower leg.

I wouldn’t say she was aggressive, lets just say she was spiritedly belligerent. A wild, uncoordinated, bad-mouthed handful-and-a-half to manage for the nurses looking after her.

After a thorough assessment of her physical and neurological condition it became evident that Jasper was (aside from the laceration and some other minor bruising) only suffering from acute alcohol intoxication.

Her wound was cleaned and closed, and Jasper was monitored overnight and most of the morning until she sobered up. She was then reassessed, reviewed by our mental health and our drug and alcohol support nurses… and found competent to be discharged.

Jasper was back that night.
Some passers by called an ambulance after finding her sitting below a bridge in a storm-water drain. She had an empty bottle of Bourbon in her lap. She was covered in urban detritus and semi-digested Subway.

Again she was assessed, cleaned up, and cared for until safe and sober, given breakfast and discharged with an agreed plan to seek professional help detoxing.
When she was (finally) sober, Jasper was intelligent, co-operative (a far different person to earlier) and denied any wishes to self harm.

Later that evening she represented via ambulance.
Semiconscious, soaked in her own urine. Drunk.
This time her stay was prolonged by the fact that just prior to discharge she was found re-drunk after draining a bottle of Vodka that had been secreted in her bag.

Eventually she was discharged. She did not wish to speak to a mental health nurse, nor a social worker, and there were no grounds on which to hold her. We tried to contact family, but they seemed less than engaged. She promised that she would get herself into detox as soon as possible.

The next day was a Jasper free shift.
But the following afternoon she was back.
The ambulance was called to extract her from a local sports club. Where she had fallen spectacularly down their main stairway.

This time we confiscated her bag.
No matter to Jasper. Early in the morning nurses found her in the staff toilet drinking a bottle (or was it two) of alcohol based hand sanitiser.

Later, under the cover of the multiple emergencies unfolding around her, she absconded from the department.
No sooner had we completed a search of the toilets than a Code Blue (medical emergency) went off  over at radiation oncology. Jasper had been found by one of their nurses laying smashed and akimbo in an outside flowerbed.
We sent a team to retrieve her.
She sobered up uneventfully. And left.

Forty-eight hours later she was back. No obvious injuries. Just very drunk.
This time she was decanted from the ambulance stretcher and sat unceremoniously in the waiting room. There were many others that had been waiting for medical attention before her. Jasper required a lot of time and human resources. Bed-spaces were at a premium and she was not going to take one up in a hurry.
We were beginning to lose our patience with Jasper.

Among a great many other things, Jasper is an alcoholic.

Those many things include being a respected academic with a high paying job in the public service.
Jasper is mother to two grown children.
Jasper is a accomplished musician.
Jasper is ex-wife to a professor with a doctorate in sound and vibration.
Jasper has traveled the world extensively.

But we were to see few of the things that defined the majority stretch of Jasper’s rich life …and a whole lot of the things that illuminated her in a far lesser light.

For us Jasper had become a sort of a living Koan.

A Koan is a Japanese word meaning literally ‘public case’. It is a sort of paradoxical or nonsensical story used in Zen Buddhism to bypass or break through cognitive understanding in order to experience insight into the truth of the matter.

You may be familiar with the well known Koan (made even more famous when it was solved by Bart Simpson): “what is the sound of one hand clapping? [1]

So the Koan of Jasper for me was: “Jasper wants to get drunk. This is probably going to kill her.  What does it look like to help her?”

What is our responsibility to Jasper?
There is undoubtedly a lot more going on here than her simply getting drunk and ending up under our care. Care she seems not to much care for.
What does it look like to help her?

For us this Koan is a paradox in progress.

fiction_alert


  1. The actual Koan is translated more accurately as “Two hands clap and there is a sound, what is the sound of one hand?”  ↩

One thought on “Jasper’s Koan.

  1. Sadly there is no quick answer and frequent intoxicated presentations wear what little empathy is first experienced by staff. Hard to understand and know how to intervene to make a difference. MDT input, a key worker to develop therapeutic alliance and sound management plan for the crisis presentations

    Like

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