Saturday, May 12, 2012

notorious

Vera is eighty two.
At least once a week for the past six years or more, Vera has been calling 999 for an ambulance. And getting one.
I’ve been out to Vera a half dozen times, but even though I know her personal details off by heart, her motivation is still as incomprehensible as the voice she puts on – a febrile twittering, strangely at odds with her appearance, like hearing a bulldog squeak instead of bark.
To say she does it for attention doesn’t seem enough. I think there must be something else she gets from the whole procedure, from the pressing of the three nines to the sound of the diesel truck pulling up below her window; from the sound of the lift arriving on her floor to the ringing of the bell and the clunking and fumbling as the key safe is opened; from the sound of heavy boots walking in to the medical shtick of the cuff, the monitor, the SATS probe, the thermometer; from the taking of the history to the collecting together of the drugs, the setting up of the carry chair to the three minute ride to hospital, from the wheeling in through the automatic doors to the pat slide onto the bed – something from all that ritual of fuss, something semi-magical, that feeds her ambulance addiction and keeps her coming back for more.
 Vera obviously doesn’t like the hospital side of things, though. She’s barely half an hour on an A and E bed before she’s bum-shuffling down to the end, hopping off, striding through the department, bad-mouthing the staff as she hurries outside to car-jack a taxi home.
Notorious. Prolific. Loathed or loved, depending on your mood.
It’s not as if I don’t understand the loved aspect. If a crew is dealing with Vera, in her well-kempt flat, they’re temporarily sheltered from the potential horrors of other patients. Vera doesn’t live in a crack house. She’s not drunk and throwing up everywhere. She’s continent, cute, biddable. But just lately I’ve stopped thinking about Vera as a quirky character with lovable ways and started thinking about her as a damned nuisance.
Maybe she’s my bellwether, my emotional compass. Maybe Vera is pointing to the exit. Because now when I read her address on the screen I don’t see a lovable rogue. I see a person who is wasting resources that might be needed for a genuine emergency.
I guess she’s unhappy. I wish I could understand what the problem was so I could help come up with a solution. But probably because there is nothing obviously wrong – her flat is warm and comfortable, the doctors have deemed her mentally competent, her health is reasonable and well-provided for, materially she has everything you could want – because it’s difficult to identify the problem, it’s difficult to come up with a solution. And anyway, there isn’t a procedure for dealing with nuisance callers. They’re treated exactly the same as someone ringing for the first time, which flies in the face of common sense, but stands nonetheless. All in all it amounts to an endless procession of ambulances to this address.

Tonight when I step out of the truck I feel as if a valve has been loosened in my heel and all my patience has run out over the road.
‘I don’t think I can do this any more,’ I say to Frank as we walk up to the main entrance.
‘Yes you can.’
‘No I can’t.’
‘Yes you can. Look. Someone told me this technique for dealing with stuff you find difficult.’
‘I can’t wait.’
‘No. Come on. Listen. What you do – you think about someone you admire already, someone you think of as really cool and competent. Okay? Picture them strongly in your mind. Got it? Now – all you do is, you imagine what they would do if they were here, and you do the same.’
‘Right.’
I tap in the code. We let ourselves into the building. Up in the lift, to the front door, to the key safe.
And into the flat.
Vera is in the living room, artfully placed in front of her armchair, kneeling on one leg, squeaking that her legs have given way.
We help her back into the chair, then I drop myself onto the sofa and throw the board aside.
‘You can’t keep doing this, Vera.’
‘What?’
‘You can’t keep calling the ambulance out.’
‘I’m sick. My legs have gone.’
‘No they haven’t.’
‘They have.’
‘I’m not taking you to hospital, Vera.’
She stares at me.
‘I’ll put in a complaint against you,’ she says.
‘I don’t care. I’ll be in good company.’
‘My legs have gone. I’ve got pain all over. My chest hurts.’
‘No it doesn’t, Vera.’
‘How would you know?’
‘Vera. I want you to be happy and well, I really do. But this can’t go on, can it?’
‘What?’
I get out my phone.
‘What are you doing?’ she says.
‘I’m phoning Control. I’m going to speak to an officer.’
‘I will complain,’ she says. ‘You have to help me.’
Frank sits down on another chair, folds his arms and nods pleasantly.
‘Just a minute whilst we find out what’s happening,’ he says.

When I eventually get through to the Duty Manager he asks me how I’m doing.
‘Not well,’ I say. ‘Not well at all. I’m with Vera.’
‘Yes. I saw.’
‘I hardly know what to say.’
‘It’s difficult.’
‘Seriously. I don’t know what to say. I haven’t the words. I think I’m losing my mind. I simply don’t understand why something isn’t done. I don’t understand why we keep sending ambulances.’
‘Yes, yes. I know what you mean. But we have to be sure everything’s okay, because one day she might really be unwell.’
‘So on that basis I could call the Fire Brigade every day from now until I’m ninety, and they’d be happy to attend because one day there might be a fire.’
‘It’s not like the fire brigade.’
‘Why?’
‘It’s just not that simple.’
‘And whilst we’re tied up here we’re not available to help someone who might really need us.’
‘I hear what you’re saying, Spence. And I sympathise. But our hands are tied. Look. I’ll tell you what. Check Vera over. If she seems okay, don’t take her to hospital. If she calls again, we’ll tell her she’s had her attendance today and she won’t be getting anyone else.’
‘That’s something at least.’
‘All right?’
‘Good.’
‘When you get back to base – if you get back to base – put all this in writing and send it to the COM. It’ll all build into a case of sorts, and then maybe something’ll get done.’
‘I’ll do that.’
Vera is frowning at me as I hang up.
‘What’d they say?’ she says.
I open my bag.
‘Vera? I’m giving you a quick check-up, then we’re leaving.’
‘I want to go to hospital.’
‘I don’t think you need to.’
‘But I want to.’
Her obs are fine.
She squeaks as we close the door.

By the time we’re back in the truck, the radio sounds.
‘Guess who’s on the phone?’ says the Dispatcher. ‘But don’t worry. We’ve put her through to the clinical desk.’
‘Finally.’

An hour later we’re at the hospital, handing over our latest patient.
‘Vera’s been on the phone to Reception and the A&E desk,’ says one of the nurses. ‘She’s wild tonight.’

Back outside, the crew that were here before us clear up and get sent a job immediately.
Vera.
I climb back in the cab, ring Control and ask to speak to the Duty Manager.
‘Hi Spence,’ he says. ‘I bet I know why you’re calling.’
‘It’s just that I notice another crew has gone out to Vera. I thought you said you wouldn’t be sending anyone else tonight?’
‘Well – she kept calling and calling and we kept bouncing her into the long grass. But in the end we thought we’d better send someone just to check nothing’s happened since you were there.’

‘I think we should start sub-contracting these difficult cases out,’ says Frank, passing me a cup of coffee through the window. ‘How far west do you suppose the Mafia reach?’

22 comments:

Becca said...

I wonder if there's any sort of befriending service or similar offered by local community organisations - could the ritual of paramedics, pat slide and obs be replaced by one of tea, cake and photographs of grandchildren?

She needs SOMEONE, that much is obvious. But not you. Nowhere close. What does her GP say?

I'm Hannah said...

Hooray for Spence!
I bet your a great dad... all those boundaries and sensible explanations of course it's all undone when the misses comes in and undermines your authority...
How frustrating!
oxox

Spence said...

Hi Becca
That sounds like a really good idea. A lot more tenable. Because you're right - she does need someone, just not us.

I don't know what the GP's said about it. It'd be interesting to know - they can't be unaware of the amount of call-outs.

Hi Hannah
Ouch! That sounds harsh! Do I come across as very authoritarian, then? (Or have I misunderstood your comment - I must admit I'm a bit confused by it).

The fact is, Vera calls out the ambulance all the time, for no reason, and it's incredibly frustrating that nothing's ever done about it. I feel sorry for her, but it's a waste of time and money - and could be dangerous. I'd hate to think of anyone having to wait for an ambulance because the nearest one was tied up like that.

tpals said...

You go, Spence!

Nothing will change unless someone speaks out and even little old ladies should have to face the consequences of their actions. Here she would have been charged for every one of those trips to the hospital and very few can afford a hobby like that.

Steve'nLubbock said...

I live in a complex with elderly, and some are 'at sea' so to speak. One lady gets lonely, and calls 911 at least weekly. The first responders talk to her for a few minutes, then she's good for another week. Meanwhile, 8 responders and two trucks are idling around, unavailable for others. Maybe we should start charging her (and Vera) so much per call????

I'm Hannah said...

No, no seriously. I bet you are literally a great dad!!!!
You explain to Vera why her behaviour is unacceptable, you talk her through the consequences, you set up a clear protocol for how her behaviour will be dealt with and set appropriate limits!
You actually come across as ever patient and compassionate!
The story kind of reads like Veras a child looking for the limits, one parent sets them just to be undermined by the other....
Sorry Spence! My online sarcasm translator must be broken..

Anonymous said...

I'll bet that post struck a chord with lots of other ambulance staff, all over the country. Frequent Flyers is the kind way of referring to them, and every station has at least one. There is no answer to the problem, as if you dont attend then one day Vera will have corked it, and the press will have themselves one of their favourite stories. You're dammed if you do, and dammed if you don't. You have my deepest sympathy....which helps not one jot.

Spence said...

tpals - I think there should def be some penalty for frequent flyer / hoax / inappropriate calls. I'm sure we could work out a useful system that protected genuine cases. Worth a try at least!

Steve - It's like these cases have fallen between the cracks of comm health / social services / MH teams. But they do soak up a lot of resource, so it's worth setting something up. I mean - they're obviously unhappy and in need of something.

As a side note - I'm amazed that the neighbours don't make more of a fuss. These calls are often in the early hours - it must be horrendous to have a never-ending series of noisy diesel trucks with slamming doors and beeping ramps waking you up all the time.

Hannah - Very sorry I misinterpreted your comment. I'm a grumpy & paranoid bear late at night (plus, normally if I'm not sure about a post or a comment, I'll run it past Kath, because she's much better at reading these things than me. She's away for the weekend though, so I was flying without a safety net. A lesson there for me.

I think you're right about the inconsistency of approach. Some crews def make a fuss of her, which makes it worse. Like I said, I can understand why they do it - you're first responsibility is to your crew mate and your own mental health, so you do what you have to do to protect yourself from the effects of stress; you relax / take comfort where and when you can - which sometimes means kicking back on the sofa of a frequent flyer & taking a slow trip up the hospital.

I feel like I'm losing my reserves of patience, to be honest. The more you engage with these long-running problems, the more frustrated you become. I think I need a career change, or a sabbatical at the very least!

Anon - I'd say we have about a half dozen hardcore FFs in our area. When one dies, there's always another to take their place. I think the Trust should make much more of an effort to target them, but at the moment it takes a phenomenal level of calls before there's any sense of movement at all - and even then, that's often just a series of ineffectual group emails describing the problem and offering advice. But still the calls go on, still Cat A Chest Pains or whatever, and when you question it you're told that the call taker cannot be certain that this particular call isn't a real emergency, so we have to attend. Even though a crew was round there just an hour ago. It's enough to send you mad, I tell you. Maaaad. *sigh* *meds* *zzzz*

***

Thanks for your comments. Very much appreciated!

I'm Hannah said...

Spence, you do a really demanding job, really well!
I have no tips for dealing with frustration, but a glass of wine in the evening does do wonders, for my nervy self!
oxox

jacksofbuxton said...

I think we can all rely on Frank to provide the coup de grace to these sorts of events Spence.I don't envy you,the boy who cried wolf and all that.I think you handled it the correct way and Control (always makes me think of John Le Carre) got it wrong by sending another crew out.

I don't know what the answer is.Maybe Vera should be taken in,put into somewhere we she can't discharge herself and keep her in overnight.Lots of tubes and wires and cables.But then that wastes other peoples time I suppose.

Frank's advice of think what someone else you admire do might work.Daniel Craig,walther ppk?

Spence said...

Cheers Hannah (quite literally). That's the thing - a big glass of wine, prn.

Hi Jacks
Vera is absolutely the modern version of the crying wolf story. Except I think in the story the villagers stop going to help after a while. We never seem to learn. I like the wolf aspect though. Maybe next time Vera calls we should send in a wolf dressed in ambulance uniform - maybe that would dampen her enthusiasm.

Anyway, I def think Vera needs the situation made plain, whatever that takes. As far as competency goes, a doctor at the A&E had it right when he said the multiple attendances should be proof enough that she's not behaving rationally. :/

northern stretcher monkey said...

I find thinking new and inventive methods of dealing with regulars is a good way of getting through these jobs. They're a nightmare, it does seem as though when one goes another pops up in their place it's as though there is a waiting list somewhat akin to a council housing list!

Spence said...

Hi NSM
I'm sure there is a waiting list. An advert in the back of The Daily Pain - Wanted, Frequent Flyer, must have some acting experience. Props will be provided. &c &c. :/

Anonymous said...

Spence

In the 80's I used to do dog visits. Taking my dog to people who no longer had pets. Once we got a request by a Doctor to visit a Lady whom he felt needed something.

When Claire took her dog for a visit(we used to do it weekly), she had their ear talked off(we where all SJA cadets).Claire suggested to this Lady that she visit a lunch club and kept on being told no, in the end Claire told the Lady that the lunch club was looking for help and would she mind helping and she agreed. 3 weeks later she dropped off the list as the Lady was spending 4 days a week "helping" at the lunch club and felt our visit would assist someone else more.

The reason the Doctor asked for the visit was the same as Vera, our Lady stopped calling 2 weeks after we started visiting. A year later Claire got a message the lady had mentioned her in her will and left her a letter. In the letter the Lady said that Claire was the first person she had seen in 3 years to talk to.

My experance taught me that there is a lot of lonely people out there.

Lydia said...

I am bemused as to why there isn't some kind of system to say after x number of calls in y time period, you will be charged z amount for any which are non-emergencies... *sigh* well done you. keep going!

Spence said...

Thanks Anon. I think you're right - social isolation and loneliness cause an awful lot of suffering, which often manifests itself in high use of social & health services, either directly through multiple attendances, or indirectly through the effects of over-eating & drinking. It's also true that plain ol' human interaction is pretty much all that's needed to get them back to normal.

And I'm sure you're right that loneliness is an important contributory factor with Vera. I don't think it explains it completely, though. I know that Vera's had plenty of contact with various social agencies, many of which would no doubt have tried to steer her in the direction of clubs &c. But Vera obviously gets something else from repeated 999, something she can't get anywhere else. I know she's elderly, but the staggering volume of her calls must surely count as sociopathic. If she was just lonely, why would she go to such lengths to feign immobility / ill health / pain - to the extent she gets wheeled into A&E, and then half an hour strides out to a taxi? Surely she'd stay longer in A&E at the very least! That's four or five hours in the company of others, right there!

A difficult problem, and one that needs sorting out. Obviously we want Vera to be happy, as much as we want her to stop calling. No-one's getting anything out of the current set-up.

Thanks for the comment, Anon. That dog-visiting thing sounded like a lovely thing to do.


Lydia,

You and me both! :/

Anonymous said...

We had loads of frequent flyers when I worked in A&E.

One woman would call 999 every time her daughter went shopping, claiming chest pain. Her daughter would land in the dept, they'd refuse all tests and walk out, after a sandwich and a cup of tea of course! She'd be in 3 or 4 times a week.

Another man would be in almost everyday, complaining of aches and pains all over. One day he was found in the town in cardiac arrest... Ended up in ITU before they pulled the plug.

We also had loads of regular OD'ers, never taking enough to do any damage either.

Spence said...

Hi Anon
I suppose it must be the same in A&E depts across the country. Accounts for an awful lot of wasted resource.

The thing is, with a lot of these patients, their lifestyles often do make them very susceptible to sudden illness. We had one bariatric FF who did eventually die of a PE. Not all that surprising, but Control would point to that particular episode and say: 'Well, she was definitely in trouble that time. So it goes to show that we should treat each call seriously.' Frustrating.

Super Earthling said...

I happened to see a link to your blog on someone else's blog and clicked it out of curiosity. What a fabulous surprise!

I just loved this article. It was so interesting to get a glimpse into your profession and thought process. :)

--Susan

Spence said...

Hey thanks, Susan!

BTW - Re. your piece about writing female characters (http://superearthling.blogspot.co.uk/). I think Bella in Twilight prob falls into that TSTL category! I just caught the second film - New Moon - and I felt sorry for Kristen Stewart (apart from her millions). It struck me what a woefully sappy part she had in it. Maybe it's just me. Further proof I'm not a teenager any more... :/

Baglady said...

So pleased that you put your foot down. I wonder if she realises that you've had enough of pandering to her.

I can't make any useful suggestions (I have no medical or social experience) but I am impressed that you refused her wishes. Sounds like it's time for someone else to step in and give her the support she actually needs.

Spence said...

Hi BL
It's difficult to know whether any of what I said got through to her. No - wait - strike that - none of it had any effect, because she was on the phone again the moment we were out the door. And the frustrating thing was, despite Control's assurances that she wouldn't get anyone else out that night, barely an hour later another truck was being dispatched!

I think the crux of it is - whilst she's still deemed to have capacity, she can call 999 with impunity on the basis that no-one can tell if she really needs help or not.

Like I said somewhere, I do feel sorry for her. I don't think the system as it stands is doing anyone any favours.

Lovely to hear from you, BL. Hope all's good with you.