Thursday, April 19, 2012

raphael

The art deco block sits back from the street behind a pair of substantial iron gates. Rae gets out and rings a number on the entry panel. Eventually the gates swing in. We park up, grab the bags we’ll need and go to the main entrance. There’s no-one there to meet us, so we ring again.
A hesitant voice, sobbing in the background: Yes?
‘Ambulance.’
‘Oh. Yes.’
The door buzzes.
We go through into a wide, bright hallway. Even though the building was converted into flats years ago, the black mosaic floor tiles still reflect the crystal chandelier that hangs from the domed ceiling four storeys above our heads.
A door opens across the hall and a young man waves.
‘Please. Here.’
He goes back inside.

The flat has the conspicuous untidiness of a hotel room, with laptops and keys and fast food cartons on the circular table by the window, and a stack of coats draped over the back of the sofa.
There are two twenty-year-old women sitting at the table, crying and tearing kitchen towel from a roll.
Another, slightly older woman lies unconscious on the sofa.
‘So who’ve we got here then?’ says Rae, leaning over her and taking her hand.
The girls reach out to hold onto each other.
The man says: ‘Repeat, please?’
All the people in the flat are foreign students. The man is the only one who speaks English at all, so we direct our questions to him. It soon becomes apparent that he doesn’t know the patient himself – she’s a friend of his girlfriend, Teresa, staying with them for a few days after splitting up with her partner. But when he relays our questions to Teresa, she’s either too upset or actually not so close to the woman that she can give us much.
‘She is called Luisa,’ he says, flicking the hair out of his eyes and leaning forwards. ‘Teresa say she think she have the low eh-sugar.’
I test her blood. Normal.
The wailing from the two girls increases every time we do any procedure, even innocuous things, like putting on a stethoscope and listening to Luisa’s breathing.
‘What exactly happened with her?’ asks Rae. ‘How did she end up on the sofa like this?’
Raphael spreads his hands wide and shakes his head.
‘She sleepy and very, very sad. She sleep it out for a while before and after we come. I think maybe it is her eh-sugars, yes?’
‘No. But something’s happened. Has she taken any pills you know of?’
Raphael speaks quickly to his girlfriend; still crying, she runs into the bathroom and comes back with a plastic sandwich bag half-filled with yellow and white tablets.
‘She have from Sao Paulo,’ says Raphael. ‘I don’t know for what they are. Teresa say is possible for the heart?’
‘We’ll take them,’ says Rae. ‘And I think we’ll have that chair now, Spence.’
I go back out for it, using my rolled-up gloves to keep the door from closing shut behind me.

When I set it up ready for the transfer from the sofa, Rae goes over the obs she’s made. Everything appears normal, but Luisa’s still flat. Her eyes are half-open, but her pupils scan backwards and forwards like a robot shorting out.
‘I’d put money on an overdose,’ says Rae. ‘Let’s get her out.’
The girls are standing by the window, arms around each other and crying as we strap Luisa onto our chair and manoeuvre her towards the flat door. Raphael hovers around us ineffectively, and has to be guided firmly to open doors, carry bags and so on. Still, he follows us out to the ambulance. I send him back to see if Teresa can find out Luisa’s date of birth at least. Whilst he’s gone and we’re about to transfer Luisa to the trolley, she becomes rigid and starts shaking. Blood jumps and bubbles out of her mouth as she clamps down on her tongue. We keep her positioned so she doesn’t choke, and help her ride out the fit in the chair. It passes quickly; we lift her onto the trolley, clean her face and as Rae preps her for the journey and subsequent fits, I meet Raphael at the door.
‘Teresa thinks Luisa has maybe twenty and four years,’ he says. ‘I’m sorry we don’t know the dates or where she lives, but she make study in London. Her boyfriend also. But she – erm – she came stay for few days because they finish boyfriend girlfriend no more. How is she?’
‘She’s just had a fit. My guess would be she’s taken an overdose of something, but that’s just a guess. We’ve got to get going now, Raphael.’
‘May I come too? Erm – Teresa she ask me to keep with phone and to give people informations at hospital. Is okay?’
‘That’s good of you, thanks.’
‘Okay. No problem.’
He rides with me up front.
‘If she wake, I can translate for you,’ he says.
‘That’s a help. Thanks.’

At the hospital Raphael waits outside making calls whilst we wheel Luisa through to resus. We give the team what we know; I book her in at reception and go outside to tell Raphael what to expect next.

I hop into the back of the ambulance to start tidying up; whilst I’m in there, I hear one of the receptionists come outside to speak to Raphael.
‘Did you come in with that girl? Luisa, is it?’
He lowers his phone, flicks his hair back and leans in, exactly as he did in the flat.
‘Sorry please?’
‘Did you come in with that girl? Only we need her date of birth. Her date of birth? When she was born?’
‘I’m sorry. That is all I have.’
‘So you can’t even tell me her last name?’
‘No. I’m sorry.’
The receptionist lowers her paperwork.
‘Well, what on earth’s the point of you coming in with her then if you can’t even tell me the basics? I don’t know why you bothered.’
The phone rings in his hand. The receptionist gives an irritated little shake of her papers and turns back inside. He pauses, flicks his hair again, uncertainly, then raises his phone to speak.

I go inside to speak to the receptionist.

‘You shouldn’t be so hard on him, you know. He’s only trying to help. He can relay information to us if his friends find anything out, and he’ll be there to translate if she comes round. All that for someone he’s never met before.’
‘Hm,’ says the receptionist. ‘Well. Hm.’

13 comments:

Wayne Conrad said...

Yikes.

You were much kinder to her than she deserved, but what she deserved would not have been helpful.

Spence said...

I must admit I was really surprised. The receptionists are usually so smart and dependable. Normally if they have a question they come to us rather than the patient. But maybe there was something else going on I wasn't aware of. They get horribly pressured, just like the rest of us - worse, actually, because they can't drive off at speed like we do.

But it did take me aback. Poor Raphael - he was doing a really noble thing, and suddenly getting a hard time for it! But that's life, I suppose...

VM Sehy Photography said...

I feel for you. What a mess. It's bad enough to be in the middle of something like this much less when the patient doesn't speak English and you have to deal with her hysterical friends. I admire your ability to remain professional. Hopefully, she can get her act together. It's kind of sad when you think about it. She was ready to end her life because of a break up.

jacksofbuxton said...

I have a lot of sympathy there for all involved except the receptionist.I realise being a receptionist at an A and E department is a little like the labours of Sisyphus,but even so that doesn't really excuse her outburst.

Good of Rafa to try to help,especially in such circumstances.

I admire your restraint there Spence,I'd have used a little more Anglo-Saxon language in your position.

Hope the girl is fully recovered.

Spence said...

VMSP - It's so much more difficult when you can't easily ask the most basic questions. As far as the hysterical friends go, in those situations you have to wear your professionalism as a kind of cold armour!

Jacks - The reception staff do work extremely hard under difficult circumstances, and they're a vital part of the team. An incident like this doesn't happen often - which is why it stood out, I suppose.

I did tick the box on the form that said: Pt unwilling/unable to give details. So much for box ticking!

I'm afraid the last I heard the girl was up on ITU. Don't know what the prognosis is, unfortunately.

Karen Martin Sampson said...

Thank you for all you do in your difficult job. I love this blog...don't comment often, but I do appreciate it so much!

Spence said...

That's very kind of you, Karen. Thanks for dropping by. :)

Becca said...

Rafael was doing a kind and generous thing. Unfortunately I'm not nearly so surprised as you at the receptionist's conduct - I'd guess at about a third of the receptionists I've ever encountered are like that. Such attitudes (in many varied members of staff) goes a long way to explaining why even people like me, with complex healthcare needs, will do almost anything to avoid an A&E trip, even with a potentially life- or wellness-threatening problem.

Spence said...

Hey Becca

Sorry to hear you've had so many bad experiences of A&E. Not making excuses, of course, but I'd say that a lot of it comes from stress. At our main hospital, they're working at full stretch for most of the time and significantly beyond for the rest. I've seen staff go into a Fukishima-style meltdown before my eyes - and sickness rates are at an all time high. Like I say - not meant as an excuse. It must be horrible to attend a place like that and be faced with rudeness, hostility or any other thing. I wish it were otherwise.

I hope you're doing okay, Becca. And don't take any cr*p. Be polite and firm - and use PALS (extremely effective and responsive, I find).

:) x

Joliet said...

Like Becca, I'm not surprised by this receptionist's attitude. In my experience NHS receptionists think themselves equivalent to the doctors providing the treatment. They will ask impertinent questions and dismiss your concerns with a "what do you want me to do about it?" attitude.

Funnily enough, unlike Becca, I've found A&E receptionists to be nothing like this. Mainly those at GP surgeries and those that "greet" patients when you go to hospital for appointments.

Spence said...

Hi Joliet

I hear what you say. I've been mauled by a few severe GP receptionists in my time. I think some of that is in response to the overwhelming claims that are made on GP's time. I think they act as gatekeepers, dampening down demand with a severe word or two, along the lines of: well if something's really wrong they won't be put off. Not defending it, of course. Just trying to understand!

As far as hospital receptionists go, they have to process so many people these days it's a wonder they stay sane at all.

But having said that, I was still uncomfortable with this particular response.

Thanks v much for the comment, Joliet.

Becca said...

Spence - I'm quite sure you're right. Unrelenting stress is a horrible, disabling condition - especially in the presence of other mental health conditions.

The very worst I've encountered - the nurse who walked away saying "I don't have time for this" while I was spelling out on a board that my brand-new PEG felt Horribly Wrong - might or might not have been experiencing, say, long-term stress, but certainly weren't showing signs of it during my interactions with them - perhaps compassion fatigue or something, because what primarily came across was just a big fat dose of "don't-care". Don't care that you're in pain, don't care that another hour on this trolley and we're talking pressure sores, don't care that I've brought this friend into A&E because forty-five minutes ago she near as dammit stopped breathing, right in front of me. (the latter turned out to be laryngospasm and has been safely resolved)

It's a big mixture of issues but I think at the base of it is that somehow, somewhere along the way, having power over someone's access to medical care has become a weapon rather than a sort of custodianship.

Thank goodness it's (mostly) not spread to front-line hands-on caregiving staff like paramedics!

Spence said...

I know things can be pretty bad sometimes, Becca. It's uncomfortable to hear these reports, but absolutely vital, to help us keep things in perspective, and remind us what the job should be about.

Of course, I can only speak from this side of the fence, with all the partiality that brings. I know how terribly stressed A&E nurses get. I've seen them in tears being pepped up by their colleagues; I've seen them smoking furiously outside. None of this is to excuse bad behavior, of course. The medical profession has just as many poor practitioners as any other. But I know how besieged our local A&E department is - a large number of those cases being inappropriate referrals, intractable social problems, alcohol & so on. It takes a determined effort for the staff to stay open to the genuine cases that come in.

I get the feeling that the system's under grave stress, and the practitioners working in the system are acting as conduits for that stress. There are many untenable demands being made on the NHS currently - demands that the recent NHS bill will do nothing to ease, by the way.

Absolutely no excuse for the bad treatment you experienced, Becca. I hope you made a complaint. Do contact PALS - one department I've no hesitation in recommending!

Thanks for the comment, Becca. Hope you're okay.