Invisible in A&E: What Jack’s Story Teaches Us About Ketamine Stigma
Written by Jo Moore, Registered Manager and Safeguarding Lead at Birchwood Residential service, Kaleidoscope
When working with ketamine clients, one aspect of care that stands out for me is the lack of knowledge and increased stigma that occurs. I feel this comes from a lack of experience and awareness around ketamine. The clients we see today are very different from the ones we have cared for over the last 2 decades.
While caring for Jack, a young man with a history of ketamine use, it became apparent, very quickly that we were faced with a huge obstacle. If these young people were trying to access treatment for ketamine addiction and there was a lack of urgency and understanding, then it would be an uphill battle from the start. A battle not everyone has the fight for.
One night I sat in Accident and Emergency with 24-year-old Jack, waiting for an urgent review due to deranged liver and kidney functions alongside a dangerously low body mass index. We sat for many hours, the pain worsening, while Jack was passing urine every 5-10 minutes, the hope and the spark lost from his eyes as his body was failing. I went over to reception, at this point Jack was doubled over in pain, and I could see he had not reached the toilet in time. I asked to speak to the nurses in triage or a doctor. They allowed me through where I was able to talk in private about my concerns and the potential severity of the situation. The staff had no idea about ketamine related harms and reluctantly they came to do bloods and clinical observations. More time passed and I asked for pain relief for Jack as he was unable to cope with the excruciating pain and discomfort, even the pain of sitting down due to Jacks low weight and loss of muscle mass was unbearable, he begged me to get him a bed as he wasn’t able to sustain this posture.
The staff could hear the moaning and yelps coming from the bathroom and walked past without a thought , I asked again for someone to assist with the complex situation , I asked a nurse if I could send a presentation to her for the doctor to have a better look at what ketamine can do to the body and escalate this situation . With the email sent, I felt heard and started to have more hope for Jack. No one came again to see us after that.
Jack, covered in urine and immersed in pain decided to return home as he had lost faith in accessing urgent care. No one tried to intervene after 11 hours of waiting in discomfort. On return home I was uncomfortably shocked to see how Jack was dismissed and ignored. I remembered times that his GP had asked him to “just stop” taking ketamine, as if it was that simple. The whole reason Jack got to this poor physical state was due to stigma, being ignored and overlooked as poor engagement meant Jack could not access services, no service had adapted care and support around his needs, so Jack missed out on vital community interventions to reduce the risk of long-term damage.
I was not going to give up, yes Jack gave up on A&E several times, but this was due to him not feeling understood or worthy of treatment. The doctor openly googling ketamine, nurses saying they had never heard of it just pushed Jack further away. Jack was tired and ready to die as he ran out of fight. He has endured months of people not seeing him as a person. I asked Jack to attend our service two days later so we could assess his current health needs, I sat him down with his mother and told Jack that we had no time left – It was now or never, and we needed to go back into hospital, or he would die. Jack at first refused to attend A&E, he was done and not entertaining anther failed admissions where he was made to feel invisible. I called another hospital and spoke to the substance use team, I said that all we need is a bed for him to rest on, they asked us to come in and they would meet me there in A&E.
The triage nurse saw Jack straight away, she looked on the system and she could review the bloods taken two days prior by the first hospital, she looked very shocked and rushed out of the room. Very quickly everything changed. Jack was rushed to resus within minutes of being in the hospital, a fear on the eyes of the staff who were shocked at his emaciated appearance. The bloods were so concerning that Jack was in multi organ failure. This meant that no one from the first hospital thought to escalate these concerns, no one cared that he was dying at home and had self-discharged. How could this happen?
Jack was placed in his own urgent care room; the team started their medical interventions immediately and at this point I knew he was in safe hands. The sister on duty asked questions about ketamine, even though their knowledge was limited they were invested in knowing more and asked us to direct the doctor in how to prescribe for ketamine symptom management. The staff followed our processes, and Jack is here today due to the fast actions of people who looked outside of the normal circumstances and saw the person behind the drug. 8 days in hospital then Jack moved on to detox and rehab where he was able to recover.
The story ended well for Jack; he now works full time and went from 6 stone to over 12 stone post detox support and rehab. Yes, there are life changing consequences that Jack will need further treatment for, overall, a dramatic change to his life and Jack gripped hold of the recovery journey and ran with it successfully. I knew that this would not be the case for others, those with daily use, with little to no support due to archaic processes.
It is time for fundamental change – the one difference with ketamine is that we do not have time to allow for many mistakes. During the waiting period the body is becoming irreversibly damaged and the window of opportunity is fading. I see a new era for community services, one which understands ketamine better with ketamine-only support services and highly trained staff who know how to adapt around the needs of ketamine clients. The younger cohort requiring much more nurturing than offered previously. The inability to partake in community sessions causes barriers to inclusion. Services now adapt and provide face to face home assessments, online sessions to assist when leaving the house becomes a challenge or incontinence is overbearing and embarrassing to those who need interventions. I see services modifying procedures, assisting with clinical waste bins in bathrooms, providing incontinence aids and wipes. When looking at group work, the worker understands that engagement can be sporadic, loss of engagement is common, short term memory issues and group disruption due to toileting is normal.
We know that early intervention and harm reduction is key, inpatient stays will not be appropriate for everyone with ketamine use, it’s not sustainable. I believe we have along way to go but hopeful that the improvements around the UK are having a positive impact.
We also need to see improvements around the terminology used. “Its not addictive,” “just stop,” and “they are not engaging” the question we ask is has everything been done to adapt around the needs of the client , with social anxiety and neurodiversity being so prevalent – there is more we can do to understand loss of interest and engagement. Jack did not engage; I had to go to him. As soon as he trusted me to help, he allowed the help and support to take place. Under the exterior there was a vulnerable man who wanted to get better but had no clue how to find his way. If we can learn anything, it’s about being an advocate and pushing the boundaries of our normal processes. Be confident to change and continue to be an advocate. When I look at those who used ketamine as a crutch and now ketamine free, I see strong, intelligent young adults with a wealth of knowledge which I still learn from today with many more school days out there for us all.
