Tuesday, June 12, 2012

nightmare on nice street

‘Oh – come on! I was only here yesterday,’ says Rae, taking down the address off the computer and then tossing the clipboard disdainfully onto the dash. ‘Fucking hell.’
‘This one’s a real pain. A colossal waste of time. I mean – don’t let me prejudice you in any way.’
‘No, no.’
‘But honestly. She needs shooting.’
‘Watch yourself. She’s a nasty piece of work. She’ll turn on a sixpence and her daughter’s no better. What a pair of psychos. Frequent flyers –harpies, more like. They’ve put in loads of complaints against just about everyone you can think of – ambulance, doctors, Mother fucking Theresa, you name it. They’ve got a dreadful reputation. Frank’s actually banned from going there. They said he planted a bag of crack cocaine in the kitchen.’
‘Yeah, well – that’s Frank for you. He’ll always find a way.’
‘I’m amazed you haven’t heard of them.’
‘We’re a bit up-country but yeah - I’m surprised, too.’
‘It’s how it goes. Just bite your lip and keep a low profile. I’ll turn this around as quick as I can. Hopefully she’ll blow and we can run straight out. Jesus Christ. Talk about the grunts of the Health Service, Spence. We just have to go in and deal with this shit regardless.’
I drive steadily.
Rae folds her arms. After a while she leans forwards and spits her gum out into the rubbish.
‘And they never tell you any of the back story. They’re quite happy for you to go in blind. Imagine if you were working on the car and didn’t know,’ she says. ‘At night. On your own.’

I turn into the street. A nice enough place, freshly painted houses a strimmer-swipe back from a line of freshly painted hedges. Caravans on blocks; recycling bins; kids on bikes. A regular, two-up two-down Sunday morning migraine kind of street. The only thing that distinguishes our house from the others is a certain pall of neglect that hangs around it, like the greying glaze on a rotten tooth in an otherwise wide and self-satisfied smile. The windows haven’t been painted or even opened in a while, the hedges are as yellowing as the curtains, and the pebbledash rendering has blown.
As I pull up outside an elderly woman walking past catches my eye and smiles sympathetically. I fully expect to see her cross herself, but she merely shakes her head from side to side in a ‘that’s too bad’ kind of way, and hurries on.
Rae hugs her clipboard and walks up the path to the door.
A shout from inside, a complaint, a vicious curse, another shout – then heavy thumps along the hallway boards. The door flies open.
A lumpen girl in a Nike tracksuit stands staring at us, her face doughy and pale, her hair drawn back in a ponytail so tight it stretches her eyes.
‘Take her away, she’s annoying me now,’ she says, then steps aside.
The house stinks of fags and wet dog.
‘I locked the mutt in the back garden,’ she says, closing the door behind us. ‘He won’t hurt you, though. I told the stupid woman on the phone. I said he’s about a hundred years old, darling. What’s he going to do? Gum them to death?’
‘Through here?’ says Rae.
‘Haven’t you been here before?’ the girl says. ‘I think you’ve been here before. I recognise your face. I’m getting to know them all. Not you though,’ she says to me. ‘You’re new.’
She follows us into the sitting room and throws herself down onto the sofa, holding the position she lands in, legs wide apart and arms right and left along the back. ‘Carry on. Don’t mind me.’
Her mother is sitting on an armchair in the bay window. With her swollen feet planted in a pair of decaying slippers, her legs pushed aside by the swollen mass of her belly and her hands placed on either knee, she could be a statue of the laughing Buddha, except for the expression on her face, the chilling opposite to celestial joy.
‘I’m not going to hospital,’ she snarls. ‘So now what are you going to do?’
‘Hello, Rita,’ says Rae. ‘I was out to you just yesterday. Something about some gastric pain, wasn’t it?’
‘Oh yes. I remember,’ says Rita, with a ghastly smile. ‘You said the doctor would be in touch.’
Rae looks at me.
‘Rita’s been having this pain for a few months. Yesterday when I came I tried to persuade Rita that she should come to hospital to have it investigated there, but she refused. So I referred her on to her GP.’ She turns back to Rita. ‘That’s right, isn’t it?’
‘GP!’ says Rita. ‘He says he never wants to see me again. He says he couldn’t care less if I died. He says I’m a rude and aggressive person – rude and aggressive! Me!’
‘You’re the third ambulance today,’ says the daughter from the sofa, reaching for a cigarette.
‘Do you have any of the ambulance sheets?’ says Rae.
‘Take your pick, luv,’ says the daughter, nodding over to a sideboard, where a bundle of PRF’s have been stuffed into a letter rack. I take them out whilst Rae carries on talking to Rita.
‘So when did the last ambulance come out to you?’
‘I told you. About an hour ago.’
‘And was that for stomach pain, too?’
‘It’s all about stomach pain, dear. I’ve got stomach trouble. It’s what I suffer with. The doctor knows. He’ll tell you all about it – if he can be bothered. Which he can’t. He says he never wants to see me in his surgery again. Which makes life a bit difficult, don’t it? I need a camera down me to see what’s what. How am I going to get a camera down me if the bleeding doctor won’t even come out?’
I turn to the daughter.
‘Would you mind not smoking whilst we’re here?’ I say to her. ‘Only we’ll stink of fags the rest of the shift.’
There’s a dangerous pause, but luckily the moment passes and she seems to accept the request.
‘Oh. Excuse me,’ she says, putting the cigarette back in the packet. ‘I wouldn’t have done it if I’d known. You see I’m not like some. I fully respect people’s human rights. I know it’s not nice to breathe in someone’s smoke if you’re not a smoker yourself. I never would’ve gone to light up if I’d known. We’re not like that, Mum and me. We respect people’s rights. Don’t we, Mum?’
Rita nods.
‘Yes we do,’ she says. ‘And I know mine. I know that doctor has no right to refuse me a visit. I’m going to get him struck off. How else am I supposed to get this sorted?’
Rae takes one of the forms and quickly scans through it.
‘It says here you had an appointment for an endoscopy earlier in the week. Didn’t you go?’
She looks down and picks fluff off her knee.
‘Why not?’
‘I missed the transport.’
‘How did you miss the transport, Rita?’
The daughter sits up.
‘She couldn’t just leave me here on my own, could she? I’m agoraphobic and I get panic attacks. I’ve been diagnosed with acute anxiety disorder and chronic depression, irregular periods and irritable bowel syndrome. I can’t just be left. And I can’t just go out into the street, neither. I’d fucking keel over, mate.’
Rae turns back to Rita.
‘So couldn’t you arrange for someone to stay here with your daughter whilst you went up the hospital? A friend or relative or someone?’
‘Who? Who can I trust?’
‘I don’t know, Rita. But otherwise we’re all at a bit of a stalemate.’
‘No. It’s not a bit of a stalemate. It’s up to the doctor to sort out a treatment that’s right for me and my circumstance. I can’t be expected to think of everything.’
‘You can’t very well have an endoscopy at home, Rita.’
‘You have to go to the hospital.’
‘Which is something the doctor has to sort out.’
‘But he did already sort it out, Rita. It’s just you missed the transport.’
‘He says he won’t see me any more because I’m rude and aggressive. He says he wants me to fuck off and die.’
‘I’m sure he didn’t say that, Rita.’
‘That’s what he meant.’
Rae looks at me and sighs. Then she looks back at Rita.
‘So what are we going to do with you? As an ambulance crew we’re a bit limited. We can either take you to hospital or refer you to your GP. We’re quite happy to do either of those things. But what you can’t do is just keep refusing hospital, sending crews away and then ringing treble nine again.’

Both Rae and I know that if Rita sends us away and we tell Control exactly what the situation is – that Rita is in dispute with her surgery, that she is repeatedly calling 999 specifically to cause a nuisance – we both know full well that if she calls again, another ambulance will be sent without question, and even more resource will be wasted.

‘No?’ says Rita. ‘Well what else am I supposed to do, if the doctor won’t see me?’
‘Rita? I’ll ask you again. Are you going to come to hospital with us?’
She narrows her eyes and studies us.
Eventually she says: ‘Do you know where Marston House is?’
‘Yes. I do.’
‘Then I’ll come with you on one condition.’
‘What’s that?’
‘You drop by there and pick up some legal papers I’m waiting on from my no-good cousin. If you do that, then I will come to hospital with you.’
‘What about Amy?’
The daughter jumps up.
‘I’ll get me coat,’ she says.


tpals said...

However much they pay you, it isn't enough.

Spence said...

It is difficult to take, that's for sure. At no time did Rita or her daughter think it was inappropriate to call us or any of the other ambulances; at no time did they stop to think they might be depriving someone of a vehicle who might really need it. But the system as it stands lets them do this with impunity. All we can do is try to remain neutral, treat it all as just a part of the job, and make a (pointless) protest to the Dispatcher afterwards. Extremely frustrating.
Cheers for the comment, Tpals.

Sabine said...

And Jesus wept! You have my full respect here, Spence. AND I love the way you describe the street, will be looking out for painted hedges now.

Alexia said...

Poisonous people. As tpals said, they do not pay you guys enough.
I love the painted hedges, too.

Hope you have a good day today.

Spence said...

Thx Sabine. I suppose you just have to be philosophical about it. It's a situation we're not able to affect all that much so we have to shrug it off. Difficult though. :/

Spence said...

You're right, Alexia (I mean about the people - the money too, maybe). And I got the impression the rest of the street wasn't too thrilled about them, either. What they must think about the constant stream of ambulances...

Becca said...

Yikes. Tough crowd, I think you handled them really well.

I do sympathise, desperately, with Rae but I was also wincing reading through her litany of negativity about the patient before you arrived. It made me wonder how many opportunities (however faint!) for one of you guys to establish some sort of rapport have been destroyed before you even got in through the front door, by the (well justified nonetheless) negativity of your colleagues.

I'm not even trying to suggest that they shouldn't say it - because frankly I'm not sure many people could avoid saying all that at such a point - just wondering/fearing that it might be counterproductive.

I've read a few articles about projects, I think all USA based, that deal with 'superusers' of emergency medical care, and targetted specifically those individuals/families who were overtaxing the system unnecessarily - seems like the projects had all had good effect, both in terms of reducing the inappropriate use/abuse of emergency services, but also about getting these very challenging patients to access proper care and therefore achieve better disease/symptom control. I'd love to see such projects over here, especially in the biggest and most deprived cities (Birmingham, Manchester, Bradford etc). What do you think - could it work, with how our system currently functions? Think there's any chance of persuading the funding for it out of somewhere (even though it'd certainly save money, the start-up costs seem a big barrier for this stuff!)...

Hannah said...

I cant stop laughing...
I know your writing isn't satirical but it could be and I wish it was...
I agree, you need a raise,

Spence said...

Hi Becca

It's a symptom of stress - and it is stressful, pitching up to those frequent flyers who you know are abusing the system and who carry on doing it without any comeback. It makes you feel powerless - something that's difficult for ambulance crews to deal with, because they're used to going into situations and affecting positive change. They want to help!
In fact I toned down the talk in the cab on the way to the job. It's difficult to write this stuff without making the people sound rude or uncaring. In this case, Rae was preparing me for the awfulness of the situation (something else I toned down as well - again, for difficulties in communicating the specifics without coming across as judgmental or uncaring), as well as venting high levels of stress.

We don't get that many hardcore frequent flyers, which makes it all the more difficult to take, actually. We absolutely need those 'superuser' projects here. It seems common sense - to target resources, to makes sure the patient is getting the help they really need, to save money and to better allocate resource. I simply don't understand why more isn't done in this respect. To be honest, I think along with focused attention there needs to be some form of deterrent. I'm sure a fine could be imposed with appropriate safeguards in place. It seems crazy that an ambulance can be dispatched again and again and again on the basis that the call may be genuine this time. It's just not common sense!

Thanks v much for the comment, Becca.

Thx Hannah
I do try to lighten these pieces up where I can. I'm conscious it'd be a grim read otherwise!

jacksofbuxton said...

I'm not sure if it's the picture of Frank that you paint Spence,but I considered it for a moment.

As for the family?You played your cards very well there Spence.I'd have been tempted to grab a rubber hose and a torch and told Rita it was endoscopy time....

Eileen said...

Funny how the daughter suddenly was able to come with you - so what was different from patient transport?

Becca - Deprivation has little to do with the sense of entitlement and lack of personal responsibility that is the source of this behaviour. When it comes to deprived you need to consider what people had, say, in the 50s and look at what is regarded as "deprived" today. It's the same with "I'm bored". These people suck the life out of those who are sent to assist them. And block treatment time for people who do take some responsibility for themselves.

Spence said...

Great idea, Jacks. I should try that approach. All it would take is an extra kit bag with some appropriately painted fancy dress costumes & props. 'NHS cut backs' I could say, pulling on some washing up gloves. 'We're encouraged to reduce the waiting times and have a go ourselves. Now then - where did you say it hurt?'

Eileen - yes, funny the miracle cures we manage, sometimes.

I think that vociferous sense of entitlement would be easier to take if it was balanced with some evidence of self-motivation and restraint. We do see a great deal of real deprivation and social isolation, but although Rita & daughter were obviously suffering some of that, they didn't seem to be doing much to help themselves. And certainly going to war with their local GP surgery and winding-up ambulance crews was never going to be a good move.

Cheers for the comments.