Wednesday, March 04, 2009

running on empty

Bill does not so much stand in the room as continue to remain upright, like a condemned tower overdue for demolition. With a series of jerky little corrections to the vertical, his eyebrows raised and his eyelids half-lowered - the Stan Laurel School of Concentration - he tightens the cord of his towelling robe and sniffs around the perpendicular a few minutes more.
‘Bill? Hello – it’s the ambulance. How are you feeling, mate?’
An absent, smacking of the lips, the effort of which shutters down his eyelids even further.
‘Do you know where you are?’
The question soaks away without effect. But suddenly he says: ‘Bill.’ And then tightens the belt some more.
‘When we got here, he was standing in the hallway, naked. There’s something very wrong.’
The District Nurse is an active, busily thin woman who leans forward as she talks, whiskering out levels of dedication as vital as her own. She has an assistant, a fleshy faced young guy as squashy as she is sharp edged. He smiles, his ginger hair sticking out all angles, and shows us the blood sugar test he has just taken: normal.
The District Nurse tells us what’s happened.
‘Bill was discharged yesterday following investigations for oesophageal varices. There was also some mention of Korsakoff’s syndrome – you know, that dementia-like thing when heavy drinkers don’t get enough thiamine and lose brain function. But other than that, I don’t have much else to tell you, I’m afraid. I must say it looks as if he was discharged without too much thought to his living situation. It’s weird. He’s lined up all his TTOs on the kitchen table, but he’s thrown all the bedclothes off his bed into the corner. I can’t make it out. And he’s not saying anything to help. He doesn’t smell of drink. His obs are okay. I don’t think he’s had a stroke.’
Bill stands in the middle of all this, as massively absent as before.
‘Do you know who we are, Bill? You see our green uniforms? Who are we, do you think?’
I reach up and tap him on the shoulder. He opens his eyes, tightens his belt.
‘Bill,’ he says.
He does have a slight tremor underneath his eyes, the kind of twitch you get after a few late nights or a stressful difficult weekend. He doesn’t seem to respond to pain in the usual fashion, though, so this, in combination with his lack of orientation, has us mark his GCS down.
‘Let’s see if we can walk him down to the vehicle.’
‘Well this I must see.’
Bill is six feet something, a great hairless bear of a man, and his flat is on the third floor. It will take a second crew to help with the lift if we need to carry him out.
‘Come on, Bill. One foot in front of the other.’
I give him a gentle tug on his robe; the distribution of his weight changes, and somewhere deep inside him, some primitive place intact enough to be able to register gravitational shift and make appropriate compensations, sparks off a message to his left leg. It swings forward. Another tug and another step towards the door. In this way we operate him down the staircase.

When we reach the hallway, Rae goes on ahead to reverse the ambulance nearer to the door, fetch the trolley out and position it at the bottom of the concrete steps.
We step outside the front door. It’s like stepping onto the threshold of a vast world of perspective and movement. The early morning flaps about us; the trees in the park lean over, and volleys of birds don’t fly so much as tumble chaotically through the air. Bill stops and grips hold of the iron banister.
‘Harraph.’ He leans forward, supports himself on his left knee. ‘Harraph.’
We have just enough time to stand further round to the side when he empties his stomach. The watery vomitus splatters down the steps. Holding onto his arms, both me and the District Nurse peer into the mess as if we might divine an answer there. Rae comes hurrying up with a bowl and a wad of tissue paper.
‘Let’s get you on board, Bill.’
We move him down the steps, a machine called Bill, running on empty.

3 comments:

loveinvienna said...

Goodness! What an odd case. Poor man :( Di you find out what the problem was or is it another 'never-know'? :)

Liv xxx

Claire said...

That's really sad. Do you have any idea what was wrong with him or had his brian really gone for a holiday?

Spence Kennedy said...

They were very slow getting the results of Bill's blood test - but it did look like an alcohol related problem / thiamine deficiency causing a loss of brain function. Not sure about the mechanics of that one (must look it up!)