Personal, personal.

So, Friday was my other meeting with Dr L. First off was really simple – Yes, she’s willing to do the referral, they just need to take bloods for a variety of hormone levels and things like that. She took a quick mental health history (Mine, and close family), re-checked my relationships with my friends and my family, and asked if I’d ever self-harmed; Not asking to see the results, just asking if I had. I, of course, told her, listed methods, and she didn’t judge me at all – She seemed unsurprised, actually. Best possible response. She also did an assessment of “Sexual characteristics” which I assumed would have been something scientific, but was actually “Breasts are present… One piercing… Armpit hair…” So it felt more like a check of “Are you conforming to gender stereotypes?” than “This is a proxy for your existing hormone levels”. If she was actually looking for something like an intersex condition or PCOS, I’d have assumed she’d want to see things like hair growth on stomach, or unusual presentation of genitalia. So I have no idea what that was all about, but she was pleasant and professional and laughed when I said that there had been two piercings, but the cat took objection to the other one. So no fault there.

I then went to get bloods taken, and was lucky in that the nurse on-duty had a slot free immediately, so straight into the room we went, with two tiny butterfly needles. She’d asked “Good vains or bad veins?” and my response was “Crappy veins. Rolly, collapsy, deep and narrow. Paeiatric needles if possible.”

She’d been pleasant about that, seeing what the smallest needles she had were (21g) and being reasonably inquisitive about why I had awful veins. I was happy to chat about EDS-HM, let her stretch up the skin on my right forearm, offered to let her try bending my fingers back to see what a “boggy” joint felt like, but she declined since she was “Risk averse and didn’t like hurting people”. All so far, so normal, in fact fairly positive.

She listened to me when I told her where the good vein was, and I’d taken off my overshirt (leaving me in a vest) so as not to risk getting blood on my cuffs – Regular readers will know that the “one good vein” is a massive sanguine superhighway on the back of my right hand, which bulges clear of the line of the skin on either side of the anatomical snuffbox when I flex. It’s a beautiful thing to behold, a testament to the combination of good muscle development in my forearms, and to the terrifying paper-thinness of my skin. She punctured near it, managed to miss the vein (even though I could feel the tip of the needle brushing against the side of the vessel, and I was happy to tell her to just pull back by half a millimetre and have a second go) then withdrew, leaving it bleeding and with a bruise rising up. She put a cotton swab over it, held my hand to the desk with her thumb to put pressure on it, and waited for the immediate bleeding to stop to try again.

And then things got awful.

Now, you probably all know that I have extensive self-harm scars. They’re all on my left arm (Not the arm she was meant to be looking at), they’re all fairly obviously healed and they obviously (to anyone who knows what wound healing looks like) range from about six months to decades old. I don’t habitually cover them up, firstly since I dislike wearing long sleeves and I don’t think that I should have to hide any part of my body to make someone else more comfortable, and also because I think it’s probably helpful to youngsters who self-harm to see an older gent who basically has his life all in order, and has obviously also done so. I distinctly remember being a young teenager and despairing of the idea that, by self-harming, I’d be stuck forever in teenagehood, somehow. That I’d always be “emotionally immature” and that I’d be hated and thought of as disgusting or pitiable whenever someone saw my arms. I’m not exactly inviting a conversation, but I’m setting a little radio beacon on the numbers-station of non-verbal-communication, that people can have their histories and that their histories aren’t all they are.

But the nurse breached all possible bounds of good taste. Whilst we were talking about something completely unrelated, with her holding my right hand pretty firmly to the desk, she reached out with her free hand and touched my scars. No asking permission. No “Are they a sensitive subject, or can I ask you about them?” Just straight-off-the-bat touching them. And not a brief poke with a finger to indicate what she was talking about, as she asked “What made you do that?”, no, she actually traced them with her finger. Following the longest lines, exploring the texture on the crosshatching. I was so shocked that I froze, which effectively stopped me from pulling my arm away quickly enough.

By the time I unfroze, probably only a few seconds but it felt like forever, I responded with “Because my life is horrible.” and then quickly tried to divert. I could see that she wasn’t going to stop looking at them, or stop asking about them (Just fill in the silences here with inane and incredibly personal remarks like “Don’t you already have enough pain and problems?” and “I can never understand why people would do that” and “That looks like it must have been so painful”) I diverted onto the mechanical nature of them – Indicating the difference between an atrophic and hypertrophic scar, which ones were hyperpigmented, how the difference between a full-thickness lesion and a partial-thickness lesion affected wound healing basically doing the same lecture on immune function and cell growth that I would have given to a nursing student, but with specific reference to the unusual qualities of EDS-HM skin, and with my arm as Exhibit A, instead of a collection of slides.

It was the best I could do, she wouldn’t stop looking at my arm, and she had my other hand pinned to a table so I couldn’t put my overshirt back on.

Eventually, a whole fucking lifetime later, she tried a second venipuncture, but by now I was so tense and nervous that what should have been an easy stick was impossible. Another hole, another bruise. Come back on Monday, get someone else to try.

I left, feeling utterly fucking violated, and despairing of the training of some nurses. How much special knowlege does it take to not ask someone about something that is so obviously personal? I’d never even dream of asking someone how they got a road rash, even though I know that the answer would probably be “Came off my bike, skidded a bit, was fine”, because there’s always the horrible chance that they were riding pillion and the driver wasn’t so lucky. Fuck, I’d never dream of asking someone how they got so much as a papercut. So how did she think it was all right to ask someone, who was already in a very vulnerable situation, in such graphic detail about something which was an obvious symptom of mental illness – Especially when the person doing the asking was pretty obviously not about to sit around for a three-hour unburdening of the soul about the mental and physical pains which might cause someone to self harm (see: apply topical irritant) for relief.

Unsure whether to write an anonymous note saying “Hey, so, your nurse did this, and it was a bit out of line, and she didn’t mean to be intrusive but it made me really uncomfortable, could you ask her to not do it again to anyone else?” or whether that would trace straight back to me and make me the pariah of the practice.

Also, this is at least part of the reason that I’ve been fighting the urge to self-harm so badly for the last couple of days – If people are going to make free with the healed stuff, maybe actual blood-on-skin might make them think twice about touching, or asking, or generally bothering. I know that it won’t help, but that’s how my brain went about it. It’s been a long couple of weeks.

For the record, I’ve not self harmed.

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7 thoughts on “Personal, personal.

  1. If I were you, I’d seriously consider a complaint, by whatever means (I too would opt for the anonymous feedback, as the less stressful). She touched your body in a way that was completely unnecessary given what she was doing, and not in a way to comfort or steady you. If it had been a completely different kind of scar, that still would have been over the line.

    I find the sight of other people’s self-harm scars quite upsetting – not offensive, but saddening. However, if I recognise scars as such, it would have to be a very close friend before I said anything and what I said would be something like, “I’m so sorry you went through that.” as opposed to a question.

    I’ve heard horror stories about some nurse’s reactions to fresh self-harm wounds when they need medical attention, but if they’re scars, it’s really none of anyone’s business.

    Well done for resisting the urge. Hope the next few weeks are much easier.

  2. Oh Percy I am horrified. I think personally you are quite right to show your scars. Why should you hide them as something to be ashamed of? I have a dear friend with Excoriation Disorder, and often she harms very badly, so I accept it is part of some people’s lives, though it makes me terribly sad.

    As for a complaint? I wonder if you could let PALS deal with this? It feels wrong to let it go, because it was so totally out of order, but on the other hand you’ve suffered enough,and may not want to dwell on this matter any longer.

    Really really sorry some health professionals are so crap. 😦

  3. Not great for the nurse to be that intrusive, as it has no relevance to taking some blood.

    IME general nurses’ knowledge of and attitudes towards self-harm are limited and not helpful (disclaimer: in my nursing incarnation I was involved in many things to do with training around self-harm, including to general nurses).

    Some class of comment, whether you want to go so far as a formal complaint, would seem to be in order.

    • I’m thinking of just a short note saying;

      “Dear [whoever handles the comments box],
      Recently I had a routine procedure done by a nurse at this practice. The nurse in quesion thought it was appropriate to both touch, and then ask in-depth questions about, my self-harm scars. I did not give consent, or in any way indicate that this was welcome. It was also irrelevant to the procedure. Please remind your staff that mental health issues and self-injury are often a sensitive topic for patients, and not a suitable topic for initiating small talk.”

      I might just ring PALS and see what they say. If nothing else, a confirmation that the NHS thinks it’s out of line as well will probably help.

      Possibly I’m just really strange, but I can’t imagine being so gauche and intrusive as to ask someone about something to personal. I get nervous before telling someone I like their nail varnish!

  4. Your proposed comments seem entirely reasonable to me.

    You weren’t seeing that bod for anything to do with MH stuff; even if you were it still might not be relevant nor appropriate to talk about self-harm, which would still require your consent. F’rinstance in my day unit days I had a patient who, amongst other things, had significant bulimic type problems; we didn’t talk about them, much to the annoyance of some of my colleagues, as she didn’t want to. That turned out to be the correct strategy, as she grew to trust me and that I would listen and take her seriously.

    And personally I regard it as – errrr not sure how to put it – just not right to go around touching people like that.

    This now ex bit of the NHS would not regard the above as OK.

  5. When I walk with my service dog, I get asked “what does he do for you?” … I’ve started replying, “I’m not comfortable discussing my disability.” For the most part, it shuts people up here in the genteel South. Occasionally, someone will continue to press, and I find it horribly invasive and rude.

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