Slippery slope

I went to a 'care centre' / hostel for alcoholics yesterday. I was on a call for a 'male vomiting blood'. This individual had a history of gastric ulcer and so vomiting blood would be a fairly regular occurence for him (if he didn't take care of himself).

I walked in to a tirade of abuse from a small, very loud alcoholic man who was remostrating with one of the carers about having called an ambulance for his mate who was "suffering". My patient was sitting in the corner smoking a cigarette. Obviously suffering.

I quietened the little man down and then turned my attention to my patient. The staff had not called an ambulance for him because they had seen nothing untoward. His little loud mate had made the call. His loud mate, incidentally, took pride in telling me that he went to America when he was a child and fought in the American Air Force and was a paramedic in the States. It's so difficult to tell whether they are fanticising or telling the truth. I looked suitably impressed I think so he sat down again.

I spoke to my patient (after requesting he put his cigarette out) and he asked me if I could cure him. He told me he had an ulcer and had been vomiting blood.

"How long have you been vomiting blood?", I asked.

"Five years", he replied.

"You must feel weak then", I said.

"I do indeed", he said. Then he took a swig of his extra strength lager for comfort.

I did my usual obs. and discovered he was a healthy(ish) alcoholic. There was no evidence of recent vomiting of anything, let alone blood, and I discovered (shock, horror) that he did not take his medicines regularly. In fact, the carer said that she had been trying to persuade him to downgrade onto a weaker brand of lager so that he didn't feel so ill! Even I could see how lost this cause was.

All the while my patient was hic-upping in my face. Not pleasant but a whole lot better than having him belch or cough at me. Close proximity in these jobs is limited to about arms length unless a life is at stake or you are stupid.

I can't judge these people but my opinion is that they have chosen the life they lead. They rarely seek, or want help and the existence of institutions like this simply remove the problem from public view and tuck it away in a corner of society. We get to see all corners of society. We know where all the secrets are kept.

At the end of my examination I decided he didn't need to go to hospital and I could imagine the looks I would get from the nursing staff if I did take him in. He didn't really want to go anyway, he just wanted me to produce a miracle for him.

"So can you cure me or not?"

"No, I can't and if you carry on, which you will, you'll kill yourself and I'll see you again."

"Oh."

He took another swig of his breakfast and shook my hand. Perhaps he hadn't been told the truth before. Maybe he already knew the truth.

As I left I watched a parade of 'residents' walking in with plastic carrier bags, each containing four cans of Special Brew extra strength (guaranteed to kill) lager. I bid them all 'good morning' and headed off to my next call. They didn't hear me, didn't know me, didn't care. It was ten in the morning.

Be safe.