Monday, January 28, 2008

four o'clock

Bill is twenty-one stone. Even his beard looks heavy. He is sitting on the floor of his narrow hallway, wedged like an elephant in a box, with one of his vast, bandaged legs bent underneath him. He can’t get up.

‘Can you be quick, boys? I’m getting pressure sores on my arse.’

I go back to the vehicle to fetch the mangar – an inflatable lifting aid, its stack of four cushions designed to gradually raise the patient up to a standing position, or at least to a height where we can help them transfer to a chair. I also grab the manual handling bag, full of straps, sliding sheets and other stuff that we might need in this case.

Back in the overheated flat, Frank has managed to free up Bill’s bent leg, and untangle the catheter and bag.

‘You wouldn’t want that to burst,’ he says. It certainly is full. Frank finds a jug from the bathroom and empties the noxious brown fluid into it whilst I start unpacking all the kit.

‘It’s my own stupid fault for getting up to go for a shit,’ Bill says amiably, to fill the time. ‘Pardon my French. I don’t go that often. Once every five days or so. But when I go – well, it’s like the world falling out of my arse. The Old World. Gondwana. Dinosaurs, volcanoes and all.’

We stand discussing the best way of getting him up. Like so many of the jobs we go to, it’s an exercise in improvisation. Bill tells us that he can’t rock from side to side and shuffle himself backwards onto the mangar, so we decide to get the sliding sheet underneath him, and then use that to drag him onto the cushions.

‘So I had an unenviable choice to make. Either lay in bed and shit myself, or try to make it to the loo.’ He thinks about this as we grunt and sweat trying to get the sliding sheet into position. ‘The other thing that crossed my mind was – I might get halfway, collapse in the corridor, and then shit myself.’

The sheet is in place. We agree that this option was probably the cleanest, if not the easiest.

We step over Bill and each other and fumble around for hand grips, and then one, two, three – haul him back onto the cushions.

‘There she blows,’ he says. I plug in the air hoses to the four cushions, and when Frank has himself in a position where he can stabilise Bill, I start inflating. He rises up.

‘It’s a miracle!’, he says, ‘A levitating saint! God, that’s easier on my arse.’

The cushions reach their maximum height and the job is looking more manageable. Bill says he doesn’t feel confident about standing up and walking just yet, but he doesn’t want to go back to bed, either. He says he wants to go into the front room and sit at his computer. He says the best way to do this would be to bring his office chair through. He can transfer onto that, and we can wheel him in.

When we get him into the office chair, it bends precariously.

‘Are you sure this is a good idea, mate?’, says Frank. ‘I don’t think this chair was ever designed to cope with – er – loads like this.’

‘Are you saying I’m fat?’, he says with mock indignance. ‘Well of course I’m fat. I’m a rotten old tub. But there you are. Things are what they are. Wheel me in, then. Mush!’

We pull and push the chair, which creaks alarmingly but holds. In a minute or two, he is in position before a well-ordered computer desk. I go back into the hallway to pack away the equipment. When I re-join them in the front room, Frank is completing the paperwork and Bill is telling him about his life.

‘I used to teach the trumpet. Played in bands, taught, travelled the world. But age and this fucking arthritis took over and gradually, gradually…’ he holds up his right hand, whose fingers are quite grossly deformed. He wiggles them a little, then puts his hand back on his lap. ‘I had a beautiful instrument. Made in 1911. Worth quite a bit. The last time I played it was May the eleventh, nineteen ninety six. Four o’clock in the afternoon. Then I put it in its case and gave it to a good friend of mine. Because an instrument like that was built to be played, not just dusted off now and again.’

Frank gets a signature on the form and we stand to leave.

‘Thank you gentlemen,’ he says, ‘I know you’re busy. I hope I shan’t be needing you again.’


Anonymous said...

So did he not want a shit before sitting at his desk then?

Ben said...

Sounds like a good job Spence. Patients like this must put the time wasters to shame.
Sounds like he had an excellent sense of humour as well "The Old World. Gondwana. Dinosaurs, volcanoes and all." that had me laughing! If I ever reached his physical state I'd hope I could retain a sense of humour about the situation.

Spence Kennedy said...

Anonymous ... Maybe you're missing the point a bit? Anyway, I think he was on his way back from the toilet.

Ben ... absolutely right. It was an interesting job in that our first reaction on seeing him wasn't that positive (!) but by the end of it we liked him and didn't mind all the trouble.

BenefitScroungingScum said...

Having been in the unenviable position of having to make the decision of risk of falling vs need for a pee on more occasions than I care to remember even though I'm barely a 3rd Bill's weight I know only too well the kind of mental and physical battle that would have gone on before he called you out.
Like I said previously, how people get to where they now are.
Excellent post and care for Bill. BG

Jenny said...

Reminds me of my neighbour - used to be a very active tennis coach, now i see him walk with a stick to the boot of his car each day, take 2 bottles out of the collection of wine carriers in there, put one in each pocket and struggle back inside.

makes me wish i could do something but i guess you can't stop the body ageing.

Robot Dancers said...

I stumbled upon your blog and i think it's fantastic. You have an great writing style and i will definitely be back to read more.

BenefitScroungingScum said...

Hope it's ok Spence I linked to this post when I wrote this one as you inspired it.

cogidubnus said...

I assume he's struggling to continue with an independent life, and calls only if he gets in the cack...what a grand old fellow...does he get any regular help, do you know?

(Sez he, fearing the answer is probably no...)

Spence Kennedy said...

He does get regular help - with cleaning the flat, getting him up in the morning and settled in at night. Probably help with shopping and such. I think he's managing quite well. I don't think he has the ambulance out that often, either. So in terms of some of the places we go to, he's not doing too badly...
Still a tough call for him, though!
I know he doesn't help himself with his poor diet, but I think he was probably large all his life, and when you think what's been taken from him in the last few years...

Anonymous said...

Not to highlight my ignorance, but how many pounds are there in a stone?
-- a stupid american

Spence Kennedy said...

Well - I had to look it up... but apparently there are 14 pounds to the stone. So that makes him 294 pounds!
It's funny - but if I think of a 21 stone patient I think of stress and strain, but 294 doesn't sound too bad.
Don't even ask about kilogrammes!

Anonymous said...

6.35 kg per stone, or 2.2 pounds per kg - making him about 133 kilos all up.

But of course you have different types of heavy - the small guy built like a brick outhouse, or the large jelly monster from hell.

And when you have to take some care and time in lifting them (as opposed to simply hoiking them up by the scruff of their neck)the strain would be incredible

Anonymous said...

Lucky you! We had a 46 stone patient today! We had to call the trumpton for backup! Britains getting bigger, watch out world!

Love your blog btw, I was guided here by neenaw and have been hooked since!

Oooh, I almost forgot; I am warning everyone not to waste their money watching CLOVERFIELD, it's the worst movie I have ever seen! Just thought you should know!!

Spence Kennedy said...

Superman - 46 stone is pretty vast! How did the firebrigade help out in the end?

A little while ago we had a young adult / behavioural diffs / inco / who was about that weight (XXL whale) who had a ?#ankle, was upstairs and unable to get down. If the family had decided to have him taken to hospital for an xray, it would've meant taking out an upstairs window and having him hoisted out with a cherry picker! They decided to stay at home, and if it didn't improve, tempt him down the stairs on his bottom by leaving a trail of crisps...

Thanks for the tip about Cloverfield, btw. I was tempted - all the online stuff got me going a bit, and Chris Moyles certainly seemed to rate it. But on second thoughts, I can quite believe it may be a crock.

Thanks for reading the blog!


Selina said...

Sorry Spence, that first comment was from me and was ment to be in tongue in cheek,I suppose working for the NHS gives me a weird sense of humour.
No offence ment.
Selina x

Spence Kennedy said...

Hi Selina,
Don't worry about it! I wasn't sure whether it was meant seriously or not, but in case it was, I thought I'd stand up for Bill. Anyway, thanks for putting me straight.

BTW - please keep your blog going. It would be great to hear about your experiences as a midwife.

All the best,

Anonymous said...

"How did the firebrigade help out in the end?"
They helped us to lift him out of a window! Luckily our patient was downstairs, so we didn't need to call in a minature crane! We had to smash a window in the front room, then we strapped him onto two spinal boards (the second one was for reinforcement!) and passed him out through the hole in the wall! It took 6 firemen and 3 paramedics to lift him and get him safely onto the ambulance! Luckily he only had injuries which weren't life threatening, otherwise the 90 minutes spend evacuating him may have been too long! Maybe we should have tried your crisp method, although I doubt whether he would have fitted through his own front door!
Trust me on Cloverfield! Chris Moyles is an idiot if he liked it, and I usually agree with his favourite films! Maybe he was joking, I think that's the only logical reason why any sane man would rate it! One reviewer put it into words that I can only describe as too true!: "You remember The Blair Witch Project – tight, low-budget, you-are-there horror movie? You also remember Godzilla – flabby, big-budget, why-am-I-here creature feature? One Hollywood bright spark has had the idea of crossbreeding the two, and Cloverfield is the name of its spawn." I couldn't have put it better myself!! I think I would recommend renting it (or borrowing it for free-certainly don't waste valuble pennies on it) if you want a good laugh, without giving to much away, half the characters are invincable; surviving a high rise flat collapse (they were inside), a metal rod through their heart, and a helicopter crash from over 500 ft in the air! Then she dies from a brick landing on her! It is truly insane!
When are you going to post again? I'm getting impatient!! Lol!

Spence Kennedy said...

Definitely a job for Superman!

That reminds me of a job - we had a forty two year old woman who'd arrested in her galley kitchen, and she was so huge she completely filled the floor space. The resus didn't go well. She'd been down a little while with no CPR, the paramedic couldn't intubate - just getting into a position to do any compressions was virtually impossible, and the logistics of moving her meant that a speculative move to the hospital was out of the question.

I'll wait to see Cloverfield on DVD, then. That Moyles - I think maybe he was bought off!