Our third call was to the local council estate for a middle aged man who was, apparently, feeling depressed and suicidal. Now I like psychiatric patients. Maybe it’s because I’m a bit nuts too, but I seem to have a certain affinity with them and often find myself having long, drawn out chats with them on quiet night shifts.
We rang the intercom and Raymond, our patient, unhurriedly let us in. Silently, he beckoned us into his bedroom, flopped on to the bed and sighed. I wasn’t surprised he was depressed; his bedroom was one of the most depressing places I have ever been in. Walls stained nicotine brown, carpet sticky, furniture ancient, it was severely in need of a make over.
“So, Raymond, what seems to be the problem today?” said Steve cheerily.
“I’m feeling very depressed,” said Raymond in a flat drone. “Worn out and worthless. I shouldn’t be here. I need to be in a home. With people looking after me.”
“Well, I’m afraid we can’t take you to a home,” said Steve. “Do you want to go to A+E? Or have you been an inpatient at a psychiatric hospital before? We can contact them and see if they will take you back?”
“I don’t want to go to A+E,” whined Raymond. “They can’t do anything for me. And you have to sit there for hours. And I’ve been in the psychiatric hospital too. I don’t want to go back there. I tell you, I need to be in a home.”
I couldn’t see any reason why Raymond should need to be in a care home, but it is not the ambulance crew’s job to question this, so Steve suggested to Raymond that he should see someone who could arrange a care home - his GP. Steve’s crewmate rang the GP for an urgent appointment, and Steve told Raymond that we’d run him up to the GP surgery in the ambulance.
“Can you take me back home too?” muttered Raymond.
“Sorry, no - we’ll be sent on another job as soon as we drop you off,” said Steve.
“I don’t think I’ll go, then,” huffed Raymond. “It’s too far to walk. And I can’t afford a taxi.” The GP surgery was actually five minutes’ walk away, and Raymond had no noticeable mobility difficulties.
“Well, what would you like us to do then?” said Steve. “Is there someone we can call for you or something else we can do?”
“I’ve told you,” said Raymond. “I need to be in a home. I don’t know why I bothered calling you. You can’t help me. No one wants to help me. The whole NHS is useless.”
“Raymond,” said Steve, with an admirable show of patience. “I can’t help you get into a care home, because we’re an emergency ambulance crew and we take people to A+E. But I’ve told you how you might be able to get into one, and you don’t seem interested. We can’t help you unless you want to help yourself.”
“No,” said Raymond. “Thank you, but I don’t think I’ll bother. It’s just not going to work out.” And he opened the door and motioned for us to leave.
Since we’d made the appointment with Raymond’s GP, we decided to go anyway, even if our patient was not with us. We piled into the surgery and a very harassed looking GP sat us down, pulled Raymond’s details up on his computer and turned the screen round to face us. I could see that Raymond rang the surgery several times a day, usually demanding to be put in a care home but occasionally wanting other things done for him too. He had a history of not taking his medications and of accusing the doctors of mistreating him in various ways. He would be deliberately misleading about what the other doctors had said to him on previous visits, and because of this he was now only allowed to see one doctor (who I assume drew the short straw).
“Raymond’s been assessed and we don’t believe he needs to be in a home,” said the doctor. “He needs to comply with his care plan and start taking responsibility for his own health. I’ll give him a call when you leave, but it’s nothing he hasn’t heard a thousand times before.”
I found Raymond to be a most perplexing character. On one hand, I know it is the nature of depression that patients feel everything is hopeless and won’t work and that would partly account for why he was so unco-operative. On the other hand, and I know this is a total cliche and supposedly the worst thing you can ever say to a depressed person, but I really did want to say “Pull yourself together! Take some responsibility for yourself! You don’t need looking after, you need to look after yourself. No one else is responsible for the way you feel but you!” I know how the whole argument goes, Raymond can’t help being depressed, it’s an illness, you wouldn’t say that to someone who had cancer, would you? The thing is that while I agree that it is and illness and he can’t help having it in the first place, he can change the way he deals with it. You wouldn’t say “pull yourself together” to someone with cancer because you don’t need to. Anyone I’ve ever known who has had cancer has been determined to fight it. They grasp any opportunity to make themselves better and take any treatment, however painful or expensive. Whereas Raymond just wanted to lie back whilst someone else sorted out his life. Perhaps I should be more sympathetic. Perhaps I couldn’t possibly understand unless I was in his position. But then I thought back to Elaine, the old lady with the broken hip, and how brave she was and how thankful she was for our help, and I didn’t worry about Raymond any more.
May 11th, 2008 at 10:35 pm
“You wouldn’t say “pull yourself together” to someone with cancer because you don’t need to. Anyone I’ve ever known who has had cancer has been determined to fight it.”
But that’s the point - IANAdoctor, but I suspect that if you are determined to fight depression then you’ve already beaten it. It’s getting the determination, or indeed any motivation, to do something that is the hard part…
May 11th, 2008 at 10:39 pm
Well, he certainly had the motivation to call his GP and 999 several times a day - it’s a shame he couldn’t channel that motivation elsewhere.
May 12th, 2008 at 12:20 am
Though I understand how annoying it can be to have to try getting through to someone who seems not to want help, what else do you expect? It’s irrational of course but depressed people are by definition not thinking as rationally as most. Not that rationality is an especially common quality.
“Well, he certainly had the motivation to call his GP and 999 several times a day”
Could that perhaps be as much as he can currently manage? If this has been happening for a while then maybe he is not getting the help he needs. It sounds like he might be falling between two stools: not ill enough to be sectioned but not well enough to start the enormous task of getting better on his own. That’s not your fault but it wouldn’t be his either.
“The GP surgery was actually five minutes’ walk away, and Raymond had no noticeable mobility difficulties.”
Did you ask him whether he feels anxious about going outside? Have local teenagers been making life difficult for him? Does he believe that everyone can see his imagined worthlessness? Depression and anxiety, particularly social anxiety, often go together.
May 12th, 2008 at 3:03 am
I always find it difficult to deal with pyschiatric patients. I’ve had some family issues with similar, and always try to offer help based on that experience. While every mental health nurse / pyschiatrist I’ve ever spoken to has been wonderful, it’s not always the same with GP’s or people who don’t deal with it every day (not all GP’s I hasten to add - some are also wonderful). Perhaps the fear of dealing with people who do not understand or appreciate the particular situation could have an affect on the patient.
I always feel rather impotent when in this situation, whether road staff feel the same I’m not sure, but it’s one of the few situations where I feel I can and should try and make a difference by my attititude and demeanour. Certainly reading a full AMPDS script without deviation doesn’t offer anything.
The idea of help differs greatly from person to person. One may seek help from any avenue possible, another may take refuge in drugs, alcohol etc, another may (as in the case above), cry for help but not actually act upon it when offered, perhaps because they feel they aren’t getting what they need from their GP, or are scared by the aspects of getting help.
The post above mine from mc1rvariant is excellent, particularly:
Depression and anxiety, particularly social anxiety, often go together.
It’s too easy to pigeonhole mental health patients and ignore the fact that the majority genuinely want and seek help. The fear of seeking help in a first person scenario is much greater than when speaking to a nameless figure following a 999 call.
May 12th, 2008 at 3:57 am
I’m a counsellor… I hear you!!
Great to have you blogging again, too, Mark.
May 12th, 2008 at 3:57 am
I’m a counsellor… I hear you!!
Great to have you blogging again, too, Mark.
May 12th, 2008 at 5:21 am
Did you ask him whether he feels anxious about going outside?
Yes - he goes to a local day centre and does his own shopping so we were confident that wasn’t the problem. When he refused to go with us to the surgery, we also offered to bring the GP to him instead but he refused that too, hence us going to see the GP on our own.
I know what you’re saying - that Raymond was so obstinate *because* he was depressed but it was so frustrating the way he turned down everything we tried to do to help him, and only seemed to have called us out to tell us how useless we were!
May 12th, 2008 at 9:43 am
Hurrah for care in the community, eh?
If Raymond is not taking his medication and getting worse because of it, then he is not capable of looking after himself. It doesn’t matter if the reason for not taking it is because he forgets, or because he dislikes the side-effects, or because the toaster told him not to. He needs someone to tell him, every day, “Raymond, take your medication now”. Without that, he doesn’t take it, the problems get worse. In other words, he’s functional enough to not need constant watching or restraint or a secure ward, but he does need to be in a sheltered environment of some kind with people looking out for him, rather than shut in a grotty flat on his own.
I agree you were the wrong people for him to call, it’s not like you could have realistically done anything about any of this mess. But I’m not sure who the right person for him to call would be. The instinctive answer is: the GP, but I’m not surprised he didn’t want to see the GP. He’d know perfectly well that the GP would simply tell him off, and then tell you what a waste of time and resources they consider him to be. Not going to build confidence. It’s a problem of his own making, sure… but he might not have created the problem if he got the right help.
I can’t help thinking it’s not so much that Raymond “doesn’t need a care home” as that he doesn’t meet the increasingly stringent requirements for being put on the list for one of the increasingly limited places available. He slides through the Care In The Community gap until such time as he dies, gets better, or gets spectacularly worse.
May 12th, 2008 at 1:08 pm
Hmmm. I see what people are saying - and you have readers than I am - but I do think there comes a place where you have to explain to patients that they have to take responsibility for themselves. I like seeing depressed patients because actually it’s very rewarding watching them improve and get better. However…lots of patients who self-diagnose depression and then get treated for it don’t really have depression imo, they have “crap life syndrome”. Lots of people have really awful miserable lifes where they have no education or no intelligence to get the education or had an awful childhood and live in awful flats and feel they don’t have the ability to get out and change anything… And no amount of anti-depressants or GP time or medical intervention is going to help any of that. I don’t mean to be rude but I would have been royally pissed off if I’d had a call from an ambulance crew to visit a patient who was well enough to get to a day centre or out to do his shopping but couldn’t be bothered to get in to see me…. As if I don’t have enough to do…
May 12th, 2008 at 1:09 pm
Sorry, I meant to write “readers that are way kinder than I am”
May 12th, 2008 at 7:49 pm
[...] a GP and me « “What are they teaching them in schools these days?” So whose job is it? May 12, 2008 I’ve been reading Neenaw’s blog again recently (he had a break and hasnow come back to blogging again) and somehow I’ve found myself commenting rather controversially and slightly irritatedly on it - which isn’t like me. I must truly be in need of a holiday - but this post in particular interested me… It reminded me of a recent encounter whilst I was the on-call doctor for the emergency out-of-hours service. [...]
May 12th, 2008 at 8:18 pm
Some really interesting and thought provoking comments here from both sides of the argument! geepeemum, I see what you’re saying - I guess the thing is that no ambulance crew would want to leave a patient who’d been talking about suicide without doing *something*, and in cases like this the GP is the only person involved in the patient’s ongoing care that we can get in touch with. We weren’t demanding the GP went out to him or anything, just furnishing him with all the relevant information so that he could decide himself whether a visit was needed. It must seem like you’re being dumped on with all the difficult cases, so I can understand why it’s frustrating!
May 13th, 2008 at 9:30 am
Actually a GP can’t arrange a care home for someone, but we can refer to social services (for example) for an assessment to see if someone needs a placement of some sort, or even just respite.
I would imagine (having never met him of course) that Raymond has access to other services, but chooses not to engage with them. Which of course brings us back to the motivational comments already made above.
As geepeemum said, some people just have crap lives and don’t deal with them (though most of them could if they wanted to). Options for intervention in those instances are limited: if they won’t engage, you’re unable to help, which of course feeds back into their self-destructive cycle.
May 13th, 2008 at 11:46 am
Not sure whether that’s funny or sad…
Sounds just like a cantankerous old man, but one who wants to die and doesn’t have any will to live. It’s…just sad…
May 14th, 2008 at 12:53 am
While I haven’t had the chance to discuss with Raymond his choices about his depression, it sounds like he has not chosen to end it.
I have depression, you see, and even with all the services the modern world provides the mentally ill, I did not improve at all until I chose to. That one action did more than all of the pills I was perscribed and did not choose to take, more than all the lectures that were given that I didn’t choose to listen to, and more than all the disablity payments that I didn’t choose to fill out the paperwork to receive.
The best course of action is to place the responsibility for improving this patient’s condition squarely on his own shoulders. Ask him “Do you choose to end your mental illness?” Followed by either “Then this is what will best help you” or “Don’t bother calling again until you change your mind”. (Polish it up a bit so it doesn’t get you fired, if you’re on duty, but use the various forms of “choice” as often as possible.)
And please don’t go into the overused and incorrect clichè of equating a failure to choose any course of action with the choice of no course of action. e.g. “If you don’t choose anything, you choose nothing” Wandering aimlessly is not the same thing as standing still, even if neither one gets the laundry done.
May 14th, 2008 at 11:32 am
I’m amazed the crew went as far as visiting Raymond’s GP after he refused all the help they offered him. What people don’t realise is just how much of this ambulance crews have to put up with. People abusing the service. For example, being sent to “patients” with minor complaints that expect to be treated by the crew in the comfort of their own home and when it turns out that this won’t happen they refuse to go to hospital. Usually because they realise they won’t be fast tracked through A&E and will actually have to wait with everyone else in the waiting room. Or perhaps they realise they won’t get their lift home from A&E by the ambulance service. People using ambulance crews instead of waiting for their carer to visit. Or perhaps they didn’t want to go to bed when their carer was there to do it so they just dial 999 when they’re good and ready. I agree with one comment above. People like Raymond need to take responsibility for themselves. He’s depressed? Then use the right pathway available to you, starting with your GP. What on earth is an A&E department going to do for him? The NHS is not a limitless resource. GP’s have waiting lists, clinics have waiting lists, there are only so many ambulances on the road. Drives me mad to hear people condeming the NHS like spoilt children - “the whole NHS is usless” The whole NHS is under a huge amount of strain and actually has an awful lot of good hard working people within in. When you take pity on poor old Raymond who apparently has nothing better to do than moan and whinge to the emergency services, spare a thought for the genuine more needy patients being deprived of an ambulance through his time wasting. Rant over.
May 14th, 2008 at 2:49 pm
The problem we had is that a) I don’t know Raymond - it was the first time I’d met him, so didn’t know his full history, b) as it turned out, he’d not been entirely truthful to us - but we had no way of knowing this because again, we’d only just met him, and c) had we left him and done nothing else, and he’d then carried out his threat to commit suicide after we’d left, I would have had a bit of explaining to do to the coroner.
Therefore, I felt it prudent to go and see his GP anyway, who was very helpful, and documented chapter and verse on what we had done.
As someone has already said, A&E would have done absolutely nothing for him - because he wasn’t physically ill.
Yes, he is ill - mentally, so I did what I could to try and get him some help. He doesn’t want it at present, but he doesn’t yet see that he needs it - maybe the help will help him to recognise that he does need it.
It’s easy to rant on and whinge that we were wasting our time and that there were people who deserved the ambulance more (if only I had a pound for every time I’ve heard that I’d be a very rich man!) with the benefit of hindsight, but at the time, we felt that while Raymond didn’t need an ambulance, he may need something.
To geepeemum - while you may be rather annoyed at an ambulance crew asking you to contact a patient (I more often than not ask for the GP to ring the patient first, then make the decision whether they need a visit) remember that we don’t know your patient as well as you do. We only meet them on a rare occasion in most cases, so its not unreasonable to take them at face value.
We did what we thought was best for the patient, and I have no regrets.
Now, Mark’s obviously making you all wait for the last job to keep you in suspense - let’s just say we got a bit of trauma…
May 14th, 2008 at 3:43 pm
Welcome back - missed the blog!
And since I can comment easily here, please would your 2 colleagues in the LAS who also blog (Tom and the nameless paramedic) who seem all to be suffering from NHS-related stress syndrome to one degree or another (it’s not post-traumatic, it’s ongoing!) please, please, please think about moving!!!!! I decided this morning that the only person I will ever vote for again will be the one who promises NOT to mess about with the NHS. I don’t want to hear another “we’ll make it wonderful for the patients” until they’ve made it better for the workers. I’m getting tired of screaming at the TV - it makes me feel as if I’m really going mad!! Does anyone know of somewhere where people can still take responsibility for their own life? Where they don’t expect someone else to solve all the less attractive problems of daily life? Where it’s OK to be sad about horrid things? Or am I just being over optimistic? It wouldn’t be so bad if the entire family hadn’t decided to ignore the warnings and join the NHS!
Rant over!
May 14th, 2008 at 11:05 pm
Steve I wouldn’t have been at all annoyed at being asked to contact the patient. (Most of my similar patients I’m asked to contact very very often anyway!) But being asked to visit puts me in a difficult position. If I decide not to then I feel that I’m not respecting the request and advice of another health professional - and that’s not just me being careful of litigation though that comes into it - it’s also just a respect thing. if a physio/nurse/OT/carer for example asks me to see someone I will even if I think there’s no point… So I’d rather be asked to make contact and then use my judgement than asked to visit where I then feel I really have to do what I’ve been asked otherwise I feel as though I’m effectively saying to the patient that that ambulance crew didn’t make the right judgment call. Not sure if that makes sense?
May 16th, 2008 at 8:06 pm
test comment
May 17th, 2008 at 1:26 pm
it works Mark
May 17th, 2008 at 3:31 pm
Physical illness, be it trauma or medical, is viewable. So people find it easier to sympathise. But the pain of mental illness shows itself very differerntly. Too many use that phra ‘why don’t they just pull themselves together’. Easier said than done. And with the way the NHS is going the only workers who’s attention the public will get will be the ambulance service. And we’re probably the worse trained in dealing with mental issues. In short, it’s pathetic.
When you are in the middle of depression it’s a whole other world. It’s a dark pit from which there appears to be no escape. And making that 999 call is about the limit of ones energy. Clinical depression is deep and heavy duty and logic and rational goes out of the window.
Well done to Steve and Mark and other crewie for trying their best.
1. they made the right call
2. the patient was in such a mind maze that making a ‘right’ decision was beyond him
Depression is not all about placement and drugs. Drugs only alleviate symptoms temporarily but they do not cure. Counselling is the way forward but we don’t have nearly enough available on the NHS.
I had a ‘dose’ of reactionary depression following a few incidents and was fortunate that my surgery has a counsellor attached tho her hours are few and far between and have been cut back to enable some work to the structure of the surgery.
Far more money is needed to address the vast and complex issues that manifest from mental illness.
May 21st, 2008 at 4:12 am
In the ambulance service I work in, if a patient states they are suicidal, then I have no choice but to take them hospital. If they don’t want to, the police will come around. The option of leaving them at home isn’t there.
May 25th, 2008 at 1:11 pm
I found this post and comments quite illuminating.
I have profound depression, suicidal ideation, agoraphobia, complex ptsd. It wasn’t always this way. In fact, I had a great life (with an income that even GPs would be interested in) until my life, through external circumstances, was thoroughly trashed by public services.
There I was poddling along quite happily when, out of the blue, I started to be stalked and harassed by some obsessive sociopath whom I’d never had any contact with before. The police have been unbelievably incompetent: I’ve been subject to abusive rants, cover-ups of their incompetence, deliberate distortions of the facts, destruction of evidence…I could write a book about their perverse refusals to fight crime and protect the victim. Three years on and two IPCC investigations that upheld my complaints and the offender is still offending unchecked.
Meanwhile, the NHS in all this? I had what I suppose might be called a breakdown 18mths ago. GP? Prescribed meds that had a severe side effect, told me not to burden my family with any of it and melted away. I’ve desperately needed counselling support: there is none available. According to CMHT, I’m not mentally ill, not delusional or psychotic or a threat to others or a substance abuser thus not a worthy recipient of their decreasing services. The problem, as they see it, is with police inactivity/lack of support and CMHT has contacted them several times to try and get them to pull their fingers out. No luck.
Police meanwhile, now that I’m so badly affected by stalking, can and do excuse themselves: they spin the actual criminal damage and harassment as something that I’m somehow imagining because they’ve covertly diagnosed me as mentally ill!! (Despite the fact of a successful but useless prosecution against this obsessive offender and an admission in IPCC report that they have failed to deal with this harassment properly…)
Kafka isn’t in it! If you weren’t disturbed before then you will be once you’ve had experience of our once fine public services.
I’ve been down the o/d >EMT>A&E route three times in the last year. EMT chaps have been great, wonderfully sympathetic, just like NHS Direct staff: both sya they’ve seen this so many times, it’s sadly common.. A&E? The duty psych, when you eventually get to speak with her/him, throws up ihands ncredulously, tells you to complain to all and sundry vociferously - which is very difficult on a number of levels: not least is the merrygoround obfuscation and distortions you get back from the CEO of whatever agency.
You go home after half a day hanging around in A&E only to find yet another little criminal calling card from the stalker - as if to say ‘hehe, I know what effect I’m having on you! I saw the ambulance!’ - and the police ignore it because there’s ‘no proof’.
New GP? Yes. Her intelligent take on it all is ‘Stitch in time…’ - in other words, if the police and/or NHS had offered effective remedy earlier on then my conditions would not have developed. She has spent hours/days/weeks now - three years since this harassment began and a year and a half since I became severely poorly - begging the PCT for treatment funding….I know she’s sticking her neck out for me, and I know that, as a young GP with a career in front of her, she will only go so far.
It’s no wonder that my state of ill health is worsening by the day. If there are no effective interventions soon, I probably will end up the subject of a coroner’s inquest. Who, in their right mind, wants to live in a society where public services actually encourage crime and medical neglect (and subject victims to secondary victimisation) innocent, decent, law abiding citizens?
And all the while, managers and senior officers simply lie - yes, I have material evidence, in black and white, on paper - in their efforts to cover up their incompetence and the fact that they do not want to spend their precious resources on you. It’s no wonder I feel worthless - every message I get from public services tells me so, in quadruplicate, daily.
I paid my taxes for this? As I said, Kafka doesn’t begin to compare to this scenario.
I have to underline that I’m not alone in this experience - I now find that their are many, many people who have the same experience of public service ruination of their lives. I just happen to be more articulate than most and less scared of ‘authority’ than most. I am, however, more courteous than most. It has often been suggested to me by my advocates that I would have got effective NHS attention and effective police investigation if I’d been obnoxious, loud and violent.
Look, guys, I do understand the pressures under which you labour. (The very painful irony in all this is that, up to three years ago or so, I was on your side of the equation - I have lost my practice, income, savings, employees have lost jobs…). And I know how extremely difficult it is to understand things from a service users’ POV, especially when you know that you are doing your best within an increasingly flawed system.
But this is not about whether service users or providers are ‘to blame’ (for the most part). This is about a government which has sacrificed standards and ethics for the sake of tick boxes and short term cost-’efficiency’ and which has encouraged a culture of cover up masquerading under a banner of spin. And so they have very effectively set us against each other.
You know what would really help people like Raymond and me? I invoke Nuremberg here….it would be really good if you service providers would actually stand up to the politicos (in the PCT as well as Whitehall) and Just Say No! No more cuts, no more devastatingly expensive wacky initiatives, no more massaging the statistics, no more short-termism, no more fatuous tick boxes. These have all made you (and formerly me, I confess with shame) into agents of a power that has no real interest in widespread good quality of life but a lot of interest in creating profit opportunities for global corps and in pursuing military adventures. The results speak for themselves surely? I’m no longer a human being - as a direct result of chronic public service failure, despite individuals’ good intent - I’ve been thoroughly mauled and trashed. I’m not alone.
June 4th, 2008 at 2:12 am
I’m not convinced that people can’t help their depression. Most aren’t as bad as the infantile idiot you describe, many just want a magic pill. It does take a lot of self-honesty and and accepting responsibility for one’s thoughts and behavior to deal with depression (which actually can come on from misery or from joy!), but few can be bothered. The problem is we’re such an affluent society that life is relatively easy and we’ve been told for a few decades that nothing is our fault…always someone else’s. In centuries past if a person just gave up on taking care of himself he’d likely just die because others were too busy ensuring their own survival.
June 4th, 2008 at 11:57 pm
Peggy-
Yes, people can “Help their depression”, but in rather the same way as they can “Recite the digits of pi to three thousand places”. The kicker for depression is that it literally IS the fact that the afflicted CANNOT follow through on a productive course of action. Depression is not that they are lazy, or believe that others are somehow obligated to do it for them. (Although some depressed people do feel that way.)
Ah, the “Magic pill” line. To me, we have a “Magic pill” for just about everything. Exceptions can be narrowed to a rather short list. (If you disagree, name 20 significantly different diseases for which there is either no standard treatment, or for which the standard treatment does not reliably work) For depression, the standard treatment is mind-altering drugs. This fails about 40% of the time, not counting those who ’self-medicate’ Nierenberg 2006.
Yes, in centuries past, people with severe depression would often die from exposure/malnurishment/neglect. And so would someone with a broken leg. But today, you would not tell someone with a broken leg to walk to a hospital, yet you would tell someone with depression to heal themself, or to navigate the apathy of the maze of healthcare, alone and with little hope.
Don’t talk about the dark ages like they were in the past.
June 14th, 2008 at 12:58 pm
[...] Source: Observance Shift: 3 - Down [...]