Thursday, September 11, 2008

getting out

The patient’s house is easily identified by the ambulance standing outside. I park where I can – this is a crowded little red-bricked estate with cars up on any horizontal surface that will have them. But the first ambulance is already blocking the street for anyone at the end, so I don’t worry too much about leaving the way clear.

The front door stands open. We can see a trolley set up in the hallway. Going inside I hear the crew that has called for help chatting pleasantly in a bedroom off to the left. Walking round into the doorway I see an enormously heavy man standing supporting himself on a reproduction Georgian bedside table, something I expect to explode into splinters any moment. He is leaning forwards on his swollen arms, legs planted at shoulder width. His legs seem to have morphed into great, bandaged elephant trunks, patches of rotten brown skin flaking off on the inner aspects of his thighs. His body - a thirty stone reservoir of pendulous fat – sways in the gap between man and table. He smiles across at us, his pouty mouth underlined by a stack of chins.

‘Hi guys,’ says Frank. ‘This is Peter. Peter’s been seen by his GP this morning with an on-going cellulitis problem. The GP wants him into the hospital today to have a thorough-going look at that, and a few other bits and pieces. Obviously we needed a little help – erm – with the trolley.’

Frank smiles at me and taps the clipboard on his chest.

‘Go on, you can say it,’ Peter says, hauling one of his legs forward half an inch. ‘I don’t mind if you call a spade a spade. I’m a big fat bastard. There. It’s out. And I’m sorry to trouble you all.’

Someone leans on their horn in the street.


BenefitScroungingScum said...

Goodness! How do you manage to lift patients who have that level of obesity and is there any support if you were to be injured?

Anonymous said...

I love the honesty, its a difficult subject to navigate sometimes.

It confuses me how people get into this state, then again having seen the ques at the chippy and off licence up here it should come as a huge surprise.

Yuki said...

Really enjoy reading your blog - You have a very engaging style and know how to relate the stories most touching and human components.

Spence Kennedy said...

It certainly took the four of us to get him away on the trolley - and that was with him waddling slowly into position. If he had fallen on the floor for any reason, it would definitely have been a job for the fire brigade.

There is a measure of support if you get injured - a few free osteo sessions, being put on light duties etc. I suppose it's an occupational hazard, especially over time. Wear and tear. An actual claim for damages would probably be lost on the basis that you're supposed to do a risk assessment, and take alternative action if the patient is really too big.

Certainly takes some dedicated eating to get that big. I would guess that there's a tipping-point (no pun intended) : years of over-eating - meaningful exercise increasingly difficult - weight gain accelerates - comfort eating thru' depression - house bound - enormous.

I felt sorry for Peter. It seemed like a slow kind of suicide. He was pretty cheerful, though.

Thanks for your comments!

S :)

mumof4 said...

How do you respond to a patient who says something like that though - just change the subject, agree or what? Poor bloke.

Spence Kennedy said...

We all laughed! (Sounds cruel, but he was okay with it and laughing too). I suppose it's that terrible, but in this case quite apt, cliche about 'the elephant in the room' - the most obvious thing that no-one seems to be commenting on because it's so obvious.

Anonymous said...

Had a similar problem myself on a Cat A call. I was FPOS and the guy was having difficulty in breathing whilst lying on his bed. A crew arrived shortly afterwards, leaving three of us (and I'm only a Responder, without the lifting training) to get this bloke on to a trolley.

The bedroom was small and the trolley could only be brought in at right-angles to the patient.

We also had no light (it was about 16.30 just before last Christmas) because the light socket was what my electrician friends would call "buggered".

Called in for another crew, but none were available in the forseeable future. We had to get Trumpton.

Those guys have the most amazing lights and we could actually see what we were doing. We got the patient on a slip sheet and turned him 90°, then just launched him on to the trolley. With eight of us round him and another guy steadying the trolley it was dead easy.

I learned a few things on that case:

The Fire Service are not used to slip sheets, or at least getting someone on to one.

They are a helpful bunch in situations like that, and have some great kit.

You should never let a fireman drive an ambulance trolley - they can't steer!

Caroline said...

Bariatric care is quite the coming thing - we have three patients who are allocated four carers at the moment. I am trivial and vain enough to enjoy the fact they make me feel like a skinny little thing :o) I always find myself imagining them as a newborn and wondering how they got from that perfect little body to here....It's a disability but one that gets no sympathy and that isn't fair because it's not entirely the person's fault - some people could eat 24/7 and not get fat at all, genetics and environment and illness all play a part but it is one of the few disabilities that is socially ridiculed. Great post Spence.

Spence Kennedy said...

Hi Caroline
You're right about bariatric care becoming more prominent. We do come across a lot of patients whose weight is a considerable factor - and some where it actually leads to a poor outcome, just through the logistics of the event.

I'm sure it's true that genetics and such play an important part. To get to these colossal sizes, something more than an affection for treats is probably at play - and for the entire lifetime of that patient.

Who knows what the answer is. Education of course, to narrow the field. But in terms of care provision - it's an enormous burden on the NHS (pardon the pun).

Hi markuk,
I'm a big fan of firefighting kit (but don't take that the wrong way). I particularly enjoy RTCs when they rip the car apart. Last time I was holding some guy's head in a car whilst they were doing their stuff, lights blazing (fantastic) - then there was smoke coming out of the dashboard, and I said to the chief 'Should we be worried about that?' and he sniffed and said 'Nah mate' and then had us sprayed! Great. I'm also a big fan of slidy sheets - I suppose you mean the ones that are like a tube, that slide on themselves, rather than the single layer ones? Excellent.

Sad that the fire brigade are called out increasingly for patient extractions from home. Amazing it ever gets to that. It won't be long before we have to run a specialised bariatric ambulance (the STV is standing in for that at the moment I suppose). Gulp.
:) S