Thursday, June 13, 2013

who pays the ferryman

Jimmy is lying in bed, rolling a fag.
‘I’m not going in, so don’t ask.’
‘Please don’t smoke whilst we’re in the room, Jimmy. We’ll stink of fags all night.’
‘Suit yourself.’
He leans over and takes a swig from his vodka and coke instead.
I can’t help laughing.
‘What’s so funny?’
‘It’s not exactly funny, Jimmy. It’s more bizarrely frustrating. You’ve got chest pain. You call the ambulance. We come and have a look at you, we say: yes, you’ve had an MI in the last twenty-four to forty-eight hours and you need to come to hospital, and you say no. I must admit I don’t get it. Why did you call if you didn’t want help?’
He shrugs, puts the fag in his mouth, then remembers what he’d said and takes it out again.
‘I don’t know,’ he says. ‘I thought maybe you could do the bloods here and that’d be that.’
Jimmy had an MI last year. He knows exactly what’s involved.
‘That’s not something we can do on the ambulance,’ I tell him.
He smiles and shrugs again. ‘Then I’m sorry for wasting your time.’
He closes his eyes, laces his fingers behind his head, and leans back against the headrest. His expression is one of complete satisfaction, like a giant cat that’s just finished snacking on a delicious bird. He’s infuriating and entertaining in equal measure.
‘Look. Jimmy. Let me be as clear as possible.’
‘Fire away,’ he says. ‘It won’t make a blind bit of difference.’
‘You’ve got a history of MI. You’ve had chest pain and shortness of breath for the last day or so, and the GTN hasn’t helped.’
He nods, but keeps his eyes closed.
‘Now you’ve started getting pins and needles in your left arm and a funny feeling in your neck and chin.’
‘Yeah, it’s weird. That’s what freaked me out a bit. I didn’t get that last time.’
‘Okay. Fine. Our ECG shows you’ve recently had an anteroseptal MI. We haven’t picked up anything more acute than that, but like I’ve said, this ECG isn’t definitive. You need to go to hospital for bloods and further tests. Otherwise…’
‘How will I get back?’
‘How will you get back?’
‘Yeah. I know for a fact those tightwads won’t get me a taxi.’
‘Jimmy – that’s the least of your worries. You’re heart’s under a lot of strain at the moment. You could have a cardiac arrest and die. I don’t mean to worry you…’
‘Oh! I’m going to die! Thanks for not worrying me.’
‘I’m just trying to be clear, Jimmy. If you don’t come to hospital you might well suffer a cardiac arrest and die. So what do you think about that?’
‘About what?’
‘About staying here and dying.’
‘Fine by me.’
‘It’s not though, is it, Jimmy?’
‘Look. Thanks for coming out and everything. I appreciate it. But I just thought you could do the bloods here and I wouldn’t have to go to the hospital. I’m not hanging about for hours with the doctors coming by every so often scratching their nuts going hmm and ok-aay and interesting and all that, just to turf me out in the middle of the night to walk home in my onesie.’
‘The thing is Jimmy…’
‘Go on, then. Tell me the thing.’
‘…the thing is, our jobs are on the line.’
‘How’s that?’
‘You’re having a heart attack…’
‘You just said I wasn’t.’
‘No I didn’t. I said you’d had one recently and you might well be brewing another.’
‘In your opinion.’
‘In my opinion.’
‘So how’s your job on the line?’
‘Because we’re the last clinicians to see you. And when we’re called up in front of the Coroner to explain why we didn’t take you to hospital, he’s not going to be too interested in us saying Oh, well, Jimmy didn’t really want to come because he was worried about getting home again. He’ll say Maybe Jimmy didn’t understand what you were saying, God rest his soul. Maybe you could’ve tried harder to convince him. Maybe you should try some other line of work. And he’ll throw us out on our ear. For what? For a ten pound taxi fare?’
‘You’re not going to give me ten pound, are you?’
‘No. I’m not.’
Jimmy shrugs.
‘I’m staying put, then.’


Sabine said...

Finicky lad, this Jimmy. Would you really get into trouble?

Anonymous said...

Praying for patience and crossing your fingers in the hope that someone will give him a slap for you.
Hope he was ok though.

Spence Kennedy said...

Sabine - Yep! The call's been logged (Chest pain, previous history of MI &c). You're the last clinician to see them alive. The very least you'd try to do is get someone else involved, directly or indirectly, so there's some kind of buffer between you and the coroner. It's all a bit weird, though. I mean, surely capacity means the right to refuse aid even if no sane person would? Which is catch 22, I know...

Verity - We had to dig very deep for patience - and it paid off eventually. We refused to budge unless he came with us - and in the end he did, just to shut us up, I think!

Becca said...

It's a bugger, though - because if you already know that there isn't £10 in the house, or in your bank account (if you've even got one) then the prospect of finding yourself needing to get home, not up to chancing the bus but not poorly enough for PTS... it's really, really scary. And if you layer that up with having some sort of ongoing reason not to care that much about yourself, maybe a few prior A&E trips where you've ended up feeling like you were wasting their time... well, I can see how easily it'd happen.

I've caused consternation by refusing transport before - but usually by way of telling a visiting GP not to bother the ambulance service. I'd have to be in a very bad way indeed before the risk/benefit balance tipped in favour of a hospital trip out of hours!

Daniel Rutter said...

I think your best options the next time this situation arises would be:

1. Whip out your smartphone or whatever and record yourselves explaining the situation and the patient clearly and cogently opting for suicide-by-inaction. Probably violates some privacy law, but you could just stick the videos in encrypted Zip files or something and keep them in case you end up in court.

2. Make nuisances of yourselves until the patient gives in, as you did in this case, but do it in so peculiar a way that the patient is persuaded very quickly AND nobody will believe what he says you did.

"But they did! They both mooned me and farted in my face! Then one of them started singing One Direction songs while the other one sang Justin Bieber! Then they blew up rubber gloves and rubbed them to make that awful squeaking sound!..."

jacksofbuxton said...

I wouldn't be surprised to see Jeremy Hunt introduce charges to patients for taking them in,never mind finding the money for a cab home Spence.

We've got a volunteer centre here in Buxton that does runs to the nearest hospital (Stockport,22 miles away) that only charges about £10 for the run to/from Stepping Hill,is there anything similar your way?

jacksofbuxton said...

Speaking of taxi drivers,I'm not sure if you're old enough to remember Ken Clarke when he was health secretary (back in the Thatcher years) referring to Ambulance teams as "glorified taxi drivers" so maybe you should have offered him a lift home for a fiver.....

Spence Kennedy said...

Becca - Funnily enough, that exactly sums up Jimmy's situation! He has been in a few times, and each time (with nothing particular having been found or done) he's been faced with a long walk home or a ride he can't really afford. Plus the fact he does seem to be on a bit of a 'slide' with the drinking &c. So I do sympathise. It's just extraordinary to see someone with a genuine problem that really needs A&E attendance, who point blank refuses.

Daniel - The phone idea's interesting. I'll have to ask around on that one. We did make a nuisance of ourselves, but not as far as Beiber, because I think that's tantamount to murder. I like the idea of doing something so outrageous no-one would believe it (until the patient shows the film clip from the phone/webcam...) :/

Jacks - I don't think it'll be long, esp. given the pressure on A&E &c, and given that they already floated charging for GP visits (thrown out as far as I can tell).
They do have volunteer drivers - no charge to the patients, and the drivers only get 'mileage & wear&tear'. I think it's the kind of trip that's pre-booked, though.
I am old enough to remember Ken as HS, but I didn't know he'd called us the T word. Lovely. If I ever pitch up to him when he's having a heart attack, I'll stand over him and ask him where he wants to go...

Cheers for the comments!

Anonymous said...

some jurisidications require the patient sign for refusal to transport.

Spence Kennedy said...

Yep - We do here, too. But there've been incidents when the patient has signed, a little while later taken a turn for the worse, and the signature hasn't been enough to keep the crew out of trouble. A lot of the time, if you think the pt needs to go in, you simply have to make a nuisance of yourself and do everything short of kidnap to ensure that they do go in.