Sunday, 11 April 2010

Age concern

Day shift: Eight calls; two by car; one treated on scene; one arrested; two left at home; two by ambulance.

Stats: 2 Vomiting people; 1 Generally unwell; 1 False alarm; 1 Hyperventilation; 1 Damaged toe; 1 Sprained knee.

An 18 year-old Portuguese girl complaining of vomiting on and off for the past few days called an ambulance to her hostel and I was sent to investigate and convey if necessary. Actually, it wasn’t necessary for her to go to hospital at all but, as a visitor to the country and with a bunch of concerned teenaged friends lolling around on the bunk beds in the room, I felt it best just to take her in. She’d have ended up there anyway I think because they would have thought there was no other option.

She’d been throwing up for three days and believed it was probably milk she’d ingested that had done it. Apparently she cannot digest the stuff well and had mistakenly drunk some. Now she was ‘collapsing’, although I soon made that less of a problem by reminding her that vomiting did not remove the ability to walk... nor did it cause eye problems, so she stopped walking around with her eyes shut.

Another vomiting female who thought an ambulance was appropriate was the 38 year-old Spanish woman who was on her way to work when she felt ill, cold and threw up once in the street. She had no past medical issues and no allergies and, when I checked, no obs problems. All she seemed to want to do was flop over onto her bed as I attempted to get BP and BM readings, making life awkward. I knew she’d do this in hospital but she wouldn’t be going because she probably had a viral infection and that could be self-treated at home. The last girl I took in is still waiting in the front area of the hospital, so it’s pointless taking person after person in for these minor ailments.

I got her agreement about staying at home – she wanted to sleep anyway – and went to do the paperwork but when I tried to get back to her for a signature and to give her a copy of her PRF, there was no answer at the door. Neither her, nor her neighbour, who had let me in, bothered to come and let me in again. Nice to be loved.

You know that point in your life when you reflect on becoming old and infirm or you see others in poor old age condition and you think (or say out loud) ‘I’m never going to get like that’ – in fact, I’ve told my wife to shoot me before it happens – well, somewhere along the line it happens anyway. I was asked to assist an Urgent Care crew to ‘sign off’ their patient, a 94 year-old man who’d fallen. He lived in a squalid little flat, surrounded by carbohydrate foods like crackers and bread and sat in a chair all day in his front room with no entertainment or diversion. He suffered dementia but was otherwise without a medical problem that needed constant care. He did, however, look extremely dehydrated and malnourished – his bony frame and weak musculature was more the consequence of his limited diet than his age and for that reason I wanted him to go to hospital. He refused, however, and even though his capacity to do so was limited, we weren’t about to drag him away from his home, no matter how bad things seemed. He simply didn’t want any help.

I’ve seen this many, many times (as have my colleagues) and it’s a real predicament for a professional carer to be in. I asked to speak to his GP but was called back by the out-of-hours service instead. In the evenings and at weekends this is what we have left in this country, visiting doctors who neither know, nor have too much time for patients they call on – there’s just too much going on. So, the man was left with paperwork (there were many PRF’s from previous visits) and a promise from the doctor’s service that someone would come and see him later on.

Around his walls were photographs of family and I was surprised to learn that this Jewish man was receiving no visits from relatives at all. I may be ignorant about the culture but I believed that Jewish families had stronger bonds than that. He’d also received a ‘good citizen’ award back in the ‘90’s from the Council, so the man had substance and yet, there he was, sitting alone with only his thoughts and one visit per day from a care service. We have a lot to answer for in this country, especially when we are currently bickering about how much we should spend on things that, in the shadow of this, really don’t matter.

A false alarm to Shaftesbury Avenue where police had just arrested a man for being drunk and disorderly. I had been called because he had been on the ground shaking and people thought he was fitting but apparently he was just mucking about. One of the cops – the one who marched him into the van – was the tallest police officer I’ve ever seen. His colleagues told me he was over 7 feet and the tallest cop in the world (apparently). I needed a step or two just to talk to his chest.

Immediately after this another call was generated for the 94 year-old man from earlier. I knew this would happen and it was made worse by the fact that the doctor visiting him had to report him as ‘collapsed behind locked doors’ and that was because the ‘care’ company who’d been asked specifically to get a key holder on scene when the doc called - didn't. However, try as she did to contact them, the call was not being answered or she was being referred all over the place. This is a disgusting situation and fairly typical of the so-called care we give the elderly.

The police had to break his door in and he was sitting pretty much where I’d left him but this time he was definitely going to hospital. It was tricky because he still refused and he even grabbed my hands, pleading and saying ‘please don’t force me to go there’. It was heart-breaking but after he’d been lifted into the chair he accepted what was happening and it was therefore easier to take care of him. I wish it didn’t fall to us to carry out these ‘enforced’ hospitalisations but with no capacity and him being a vulnerable adult and a danger to himself, there wasn’t much choice. The GP agreed, the crew on scene with me agreed and the police agreed.

Three armed cops, two Fast Response Units and one ambulance is probably over the top for a 40 year-old female who had been told by her GP that she was prone to panic attacks and who was now hyperventilating in Covent Garden. She asked the police officers to help her and they kindly put her on Oxygen and sat her in the back of their car to await us but because it was a Red call for DIB and tight chest, everything was seemingly sent. Never mind, the eight minute target was reached, so all’s well and all that.

As I did the paperwork for that call a young lady wandered up to the car and asked for help with her poorly foot. She worked in the local pub and had dropped a heavy beer keg onto her big toe, crushing the nail but not breaking the bone (well, it was unlikely and even if it was broken, very little could be done). She smiled bravely in the back of the car as I put another dressing on to replace the one she’d treated herself with. She didn’t want to go to A&E and so she got advice about pain relief and elevation...oh and wearing the correct shoes when carrying heavy beer kegs.

It all ended with a slightly sprained knee that came in as a possible broken leg, caused during a game of football. Considering that the 24 year-old Moroccan man had sustained the injury five hours previous to the call, it was unlikely from the off that it would be broken. I took him in the car. Of course.

Be safe.


Anonymous said...

Regarding the slightly sprained Moroccan football knee, you never can tell.

39 years ago in my 20s I was kicked on my knee during football training. That evening I had difficulty walking so I started out for A&E. Half way there the pain & mobility eased. I thought of the wait in Newcastle A&E amongst the drunks and others and decided to return home. Several months later I had problems walking. Hospital consultant said I had a split cartilage & waiting time for operation was minimum 3 years. A student – after 3 years I was no longer there. I had problems thru the years. This millennium some months I have pain and difficulty walking. 2005 MRI in Zurich showed torn meniscus, Osteoarthrose and possible ruptured Baker’s cyst. Told an arthroscopic investigation was needed; however I am thrombophiliac on anticoagulation, Lupus anticoagulant with other factors probably masked by medication. V high risk of death from thromboses & complications after arthroscopy, Doctor drew finger across throat and started talking about quality of life.

Now I’m out in the UK backwoods. One bus an hour in either direction from the village for part of the day, evenings forget it.

Just from a kick in training which I thought wasn’t worth a wait in A&E.

Anonymous said...

Jews are pretty much like everybody else. Some people's families step up (when the people have families) and some don't. I think that most families do, but I might be biased. ;)

Tom said...

With regard to the elderly jewish patient you attended there is indeed a network available in the community to help him.

One useful point of contact is via the chaplaincy network at his local hospital. Alternatively you could email me at, and I will furnish you with some contact numbers.

Please keep up the good work.