Wednesday, December 10, 2008

a difficult man

We are waved over to the corner bungalow of the close. It’s a tight squeeze past a builder’s lorry; a Desperate Dan lookalike in cement spattered tracksuit bottoms, check shirt and woolly hat, folds back the offside mirror so we can squeeze past. He nods sternly as we roll by, gives us a mug-at-arms salute.

The door to number 9 stands open. Outside are two elderly women. One of them is sitting on a low garden wall. She looks pale and distressed. The other is standing beside her with a hand on her shoulder. From this slightly tentative contact I would guess that they don’t know each other that well.
‘Are you okay?’ I ask the seated woman.
‘I’ll be all right. I just can’t stand the sight of it. The smell. Urgh.’
‘He’s in the bedroom on the floor,’ says the other woman, a thoroughly tweeded specimen with metallic white hair and a frank smile. ‘I think he’s been there some good while.’
‘Any relatives around?’
‘No. His sister lives up country somewhere. He’s a difficult character. Doesn’t want help. Unfortunately he’s put a good few people against him in the close.’
I walk inside.
George is lying on his front on the floor of a cluttered little box-sized bedroom, in the narrow space between the bed and the wardrobe. One of the ladies has draped him with a blanket from the bed. Carefully I pick out a place to stand near his head and squat down.
‘George? George? It’s the ambulance.’
He seems utterly inert. I pull back the blanket to check for breathing – and yes, there is some minimal stirring there. He is wearing a cardigan and shirt, but his bottom half is uncovered, with his trousers and pants down by his ankles. His skin has a dreadful, mottled white appearance, ice-cold to the touch. Then – inconceivably – he moves his right arm and lets out a noise, a thin, spidery scribble on the surface of the air, the kind of noise a spirit might make, reaching across the void to contact the living.
‘George. Have you hurt yourself?’
I’m worried that he’s fallen and injured his neck, but he can’t tell me, and a quick examination doesn’t seem to cause any pain. He needs oxygen, warming, lifting off the floor, getting off to hospital as quickly as possible. I ask Rae if she could bring the scoop stretcher and get the trolley as close as possible to the door.
I get some oxygen running, cut off his trousers and pants, put a thermal blanket sandwiched between a couple of ambulance blankets over him, then stand up to plan the route out. It’s a logistical challenge.
I clear a space at his head and feet as best I can, carrying a mahogany cabinet out into the hallway, lifting a rickety white wooden occasional table and all its contents up into a far corner of the bed. Rae comes in with the scoop and shuts the door behind her. She estimates George’s height, extends the scoop, unclips it along its length and hands me one half. I place it on the floor next to him, we roll him gently up onto his right side and over onto his back, raise him up again sufficiently to slip the other section in, then snap the two halves back together. We attach straps to keep him in place, lift him on to the bed, then I stay with him there as Rae opens the door again. The angles are such that we just have enough room to scrape through into the hallway and then on into the garden, the trolley waiting on the pathway, head towards us.

The elderly woman on the wall has gone. The other woman is still there. As we pass I ask her to get together as much information on the patient as she can; she hurries away to do that.

Once on the ambulance we take George off the scoop, snapping it apart, Rae taking it to stash away. I reposition George’s oxygen mask again. It keeps riding up because the left side of his face is flattened, rubbed red and raw by the pressure of his time on the carpet. It has left him with a tortured expression, like a man caught in the side of the face by a sulphurous blast. In fact, he has terrible pressure sores all over his body, just as if a devil, to illustrate the poor man's agony, had pressed a flaming brand to each point of contact, and then – as a ghastly flourish – destroyed his penis, blackening the foreskin to the root.
Rae steps back aboard and we work quickly around each other. I cut his arm free of his cardigan and shirt, wrap the blood pressure cuff on him, attach the sats probe. His temperature is unreadable, his blood pressure so low it’s a miracle he can make any noise or movement at all. Rae cannulates his right arm with a large bore cannula, I prep a warm bag of CSL and unwrap the giving set.
There is a knock on the ambulance door. The elderly woman has returned with a piece of card she has torn off a cereal packet. On it she has written the two things she has found out: his approximate age, and the phone number of the woman who helps him with shopping once a week. We thank her for her help.
‘Is he going to be all right?’ she says. ‘I’m sorry we weren’t able to do more, as neighbours. You know. But he was just – is just – such a difficult man.’
‘Don’t worry. We’ll do what we can. Thanks again for helping out.’

Rae passes the ASHICE through to control, and we head off. I reposition the oxygen mask again, and stroke the hair from his face. His one good eye opens, then closes again.

He dies in MASU a few hours later.


Anonymous said...

thanks for letting us know the outcome

Spence Kennedy said...

Hi Anon,

I hope it's not too much of a shock that George dies. Frankly it was incredible he'd survived that long, and lucky he was discovered when he was.

I know I'm pretty bad at following up cases, and not letting you know the outcomes. But in a way, that puts you in the same position as me. For the most part, I don't know the outcome either. I suppose the difference is that each shift I work is made up of a number of calls, so the impact is diluted, in a way. So on the day that we went out to George, we also covered seven other cases. None of them as severe, but still serious in different ways.

So apologies if it's frustrating reading this blog! I will try harder to find resolutions to these more dramatic cases.

Thanks again for the comment.

loveinvienna said...

It's fine as it is Spence :)

Poor George... must just have been 'his time' but such a sad way for it to happen. At least he had people caring for him in the hospital when he passed on :) That's a comforting thought.

Liv xxx
PS. Thanks for your comment, am feeling much better now :) Nearly Christmas!

Spence Kennedy said...

Hey Liv!
I think the whole incident serves as an advert for CareLink. If he'd only been wearing one of those red buttons round his neck...

We get called out to so many geriatric falls at home, the majority through agencies like CareLink. Without the alarm, there'd be a few more sad stories like this one.

But like you say, at least George died in a comfortable bed, warm and with people around him.


ps Glad to hear you're well. And three, sparkling, tree-sized Yo Ho Hos for Christmas! I'm so looking forward to it - with a decent amount of time off, too. ;)

Anonymous said...

Sometimes its just not possible to follow up on cases so it is nice to know the outcome when available.

Its a shame he didn't have any other care structure in place, but sometimes if people refuse long enough there is nothing anyone can do.

At the very least he will have died in a warm bed with people around him rather that alone and cold on his bedroom floor.

Grace said...

This one made me cry. Your sensitivity just amazes me ... you are a good man and I wish more people were like you.


Spence Kennedy said...

Hi Louise
It's awful when people like George slip through the net. It's true that he didn't help himself overmuch, and alienating the neighbours was really unfortunate. But it was also apparent that despite his curmudgeonly behaviour, there was still enough goodwill around to make sure that he didn't die alone.

Hi Grace
Thanks for that. It's very kind of you to say so.

I think that the majority of my colleagues are the same - toughened up by repeated exposure to these things, professionally detached most of the time, but always human enough to respond to the distress. The thing that motivates me through these situations is pretty much the same: what if it were me? Or someone I loved?

Thanks for the comments.

Lesley said...

Lovely that he had such sensitive and non-judgemental care from you. Perhaps he believed he was already with the angels? Well done!

Anonymous said...

sorry, I meant it was nice to hear the outcome. I'm a coastguard so we never get to hear - I imagine a lot of your cases are the same. It's always sad to hear a casualty died, but at least you know

Anonymous said...

I guess there's a moral in there. All of us live near a George (or Georgina) (perhaps without knowing it)or perhaps [url=]whichendbites Pensioner P[/url]. Especially as Christmas approaches perhaps now is the time to pop by and say hello.

Anonymous said...

What does ASHICE stand for?

Spence Kennedy said...

Age, Sex, History (What happened to them - e.g. Left sided chest pain since 0600; car vs pedestrian; fell off ladder blah), Injury (What's wrong with them - e.g. any fractures or significant probs), Condition (baseline obs incl. GCS), ETA to ... (hosp. code)