Sunday, April 26, 2009

daniels then and now

Daniel then

I was born into this world on the thirteenth day of March, 1770, may it please you, received into the sure and respectable arms of the Lambert family senior, in the county seat of Leicester. My father, John, in stature and in public life a substantial and hospitable man, keeper of the Bridewell jail, redoubtable servant of the county of Leicestershire, breeder of dogs and fighting cocks, held me to his heart a boy of grace and opportunity, heir designate to the modest fortunes he had so assiduously acquired. I grew strong like him, swimming in the Stour, hunting and fishing, taking all of life that I could with an appetite born of a naturally expansive mind and a temperament which demanded of all experience the simple necessity of sampling as much of it that I could. By virtue of this temperament, in the most part the result of an indulgent heritage, by which I mean a father who wished me all the things he was denied in his youth, and a mother for whom bread and game, pies, puddings and pitchers of ale marched on through the household as like the very blood of the body Lambert – by virtue of this temperament, as I say, the weighty proclivities I was born with, and the idiosyncrasies I can only claim for myself, I grew in circumference as much as in height. The love people bore for me, my family and friends, indeed the very prisoners who were given into my charge when I succeeded my father as president of the gaol, all the love that orbited me in my heavenly path through life, seemed to act on me in much the same way as food.

By the time I was pensioned from my job in 1804, I was of considerable girth, my clothes specially made, and the furniture in my house reinforced by craftsmen without whose skill and ingenuity my comfort would have been in jeopardy. I grew to be such the celebrity in my home town that I would be followed about by crowds of rowdy boys, riding in my wake like so many bottles bobbing about behind the progress of a ship. Without work to maintain me, and with a pension grown exhausted by the demands placed upon it, I thought about the ways in which I might earn an extra sixpence or two, and struck upon the idea of charging admission to look upon me, five shillings per person, with a reduction for large parties. Though it pained me to exhibit myself in this way, it allowed for the fitting of a special carriage, and sundry other life essentials.

On the twenty first of July, 1809, I had repaired to the races at Stamford, and taken up lodging at an Inn in that fair town. It was there that my heart and my life finally acceded to the strains placed upon them. I fell asleep, and did not open my eyes on this world again.

The inn keeper and his men looked at the situation all of the morning and some of the afternoon, scratching their heads and pacing the circumference of my bed, taking measurements, gauging material strengths, angles and probabilities. Finally it was decided that the only way to remove my mortal remains was to take out the window adjacent to the cot, partially demolish the attendant wall, apply planks of wood as a bridge to a waggoner’s cart judiciously parked in the courtyard, and slide me out by means of ropes.

At my funeral, twenty pall bearers bore my coffin into the ground, and there it was, dear reader, my life’s adventure found its end.

Daniel now

We hear an obstructed rattle from the front room as the son leads us in to his father.
'He was like this yesterday, maybe not quite so bad,’ he says, pushing open the door.
A glutinous landslip of a figure, Daniel is not so much sitting in the huge electric chair as spilling out of it, his massive legs planted either side of a belly so enormous it would take a team of tailors with ladders to clothe it; as it is, he seems to be wearing a shower curtain as a nightshirt. The cupid features of his face float on an indeterminate mass of mottled flesh, the lips tinged with blue. I take up the controls to the chair and adjust his position, tipping him back enough to open his airway and stop him snoring. The cyanotic mottling gradually fades, his level of consciousness rises, but there is a crackle from his lungs.
‘How long’s his chest been like this?’
‘A few weeks. He normally has problems with his breathing, but it’s getting worse.’
We put an oxygen mask on him, check him over. His sats come up to an acceptable level, but he seems to be running a temperature, and his breathing is obviously compromised by infection. There is no blood pressure cuff available outside of London Zoo that would fit around his arm, but at least he has a good radial pulse.
The son stands watching us, his hands hooked in the back pockets of his jeans. He seems nervous, scooped out by things. I wonder when he ate last.
‘Normally with a chest infection like this we’d simply take your dad to hospital,’ I tell him, putting the clipboard to one side.
‘I don’t want to go to no bleedin’ hospital. I hate them places,’ wheezes Daniel, pulling off our mask and putting on his own nasal cannula instead. ‘They’re full of sick people.’
‘He won’t go if he doesn’t want to. He’s a stubborn old git.’
‘The thing is, even if he did want to go, it wouldn’t be an easy thing, given his weight. What – about thirty two stone, would you say?’
‘Charming,’ Daniel says, adjusting the cannula.
There is a knock on the side of the open door and a bright young woman hellos her way into the room.
‘Hi Keith. Everything all right? I saw the ambulance.’
‘Yeah. Thanks Jean. Dad took a bit of a turn’s all. We’re just figuring out what to do with him.’
‘Send me to the knackers,’ says Daniel. ‘Make a bit of money.’
‘Oh you,’ says Jean. ‘Well – just thought I’d check in. If there’s anything you need…’ And she goes.
‘It’s just a logistical problem, that’s all,’ I say to Daniel. ‘We’d need at least a second crew here to help with the lift, but then you won’t fit on our trolley anyway. So we’d have to arrange for a special truck to come out, and I’m not sure how soon that could be. I think the best thing is for the doctor to come out and have a look at you here – which is what you probably want anyway. See if this chest infection can be handled at home. And if the doctor thinks a trip up the hospital is definitely needed, then at least we’ve got a bit more of a run up to organise things. I’ll call Control and give them a heads up. What do you think?’
Keith sits on a stool, fishes a pack of cigarettes and a lighter out of his top pocket, then hands me across the phone.

‘They know us there,’ he says. ‘It’s on speed dial 3. Tell him I’ll be here all day to let him in.’


Wren said...

What a difficult and humiliating predicament for the present-day Daniel, who is no doubt truly terrified of being ill and because of it, forced to exhibit himself to all and sundry in hospital. He knows he disgusts people, and it hurts him, but can do little about it. At his weight, the metabolism basically stops and exercise is mostly impossible.

I've a dear friend in much the same condition -- she's vastly, morbidly obese and just about everything she does requires special lifting equipment and prior planning. It's a horror for her. Her weight has caused a variety of other physical and medical issues, like diabetes, injured knees that cannot be fixed, and breathing problems. Like Danial, she hates and fears going to hospital -- her immune system is badly compromised and a hospital stay is not only embarrassing, it can be as dangerous in the end as not going at all. She gets sick easily.

And yet she is a dear, sweet person, full of love and compassion. She's bright and creative and cares deeply about the wide world outside her room, which she is now mostly confined to, day after day, month after year. She's a human being who, when she's out in public, is treated to stares of incredulity and disgust and terrible, cruel rudeness that would make even Gandhi take a swing at the offender.

As her friend, I offer her all the encouragement, kindness, love and care that I can, but really, unless and until she drops hundreds of pounds -- a near impossibility, as she weighs over 500 pounds today -- she will never be well and never able to live a normal life.

It's truly heartbreaking.

I know it's quite difficult for first responders like yourself, too, Spence. Providing medical care to a person so massive is a logistical nightmare, even as you (and her friends and family) want only to help.

The way you wrote about Daniel's problem -- and yours, as an EMT -- was interesting and thought-provoking. Thank you. Perhaps Daniel's story will inspire someone out there to get help before they find themselves in such an untenable situation. Or perhaps it will remind others to try to feel some compassion and empathy when they encounter someone like Daniel or my friend.

(you needn't post this comment, if you'd rather not. I know it's long and rambling.)

Grace said...

I think that you must be a naturally compassionate person. Thank you for letting me see things through your eyes.

Spence Kennedy said...

Hi Wren
It's certainly a difficult problem for everyone concerned. I think there's a critical point in weight gain beyond which treatment becomes very much more difficult. If the problem could be anticipated in good time, these extreme situations could be avoided, along with many of the attendant problems you mention.

In Daniel's case, it was apparent that he was a well loved man, both by his family and by the neighbors. It must be a terrible position for him to be in, on so many levels.

From our point of view, it's another practical problem to be solved. In acute situations, it undoubtedly contributes to a poor outcome. In Daniel's case, for example, if we had found him in cardiac arrest we wouldn't have been able to do effective CPR, as we wouldn't have been able to get him on the floor. And if we had needed to get him to hospital we would've needed specialist equipment, which of course introduces delay - and delay makes all the difference.

You're right about the need for compassion faced with this problem. It's easy and trite simply to say they brought it on themselves. It's a complex social problem that needs co-ordinated action from the health authorities as well as better levels of understanding amongst the general public.

BTW - I didn't think your comment was rambling! I thought it was great! Thanks. x

Hey Grace!
Thanks for that. I don't know about being naturally compassionate, but it's very kind of you to say so.

I'm not a religious person, but certainly the Christian refrain of 'judge not less ye be judged' has a great deal of power. It's a difficult position to maintain, of course, but worth aiming for. I've made mistakes. I would hate someone to pass judgement without compassion or insight.

Thanks for your comment. Sx

Anonymous said...

Hi Spence,

I'm not sure if I've commented on your blog in the past, but I wanted you to know that yours is by far the best ambulance blog out there that I have come across, and I eagerly look forward to each entry. You have a natural talent for capturing both the mundane and the bizarre from our odd occupation and a fabulous turn of phrase. "Glutinous landslip" indeed!

Keep up the good work!

James (Paramedic, Melbourne)

Anonymous said...

I might also mention that last time I attended a "Daniel" I ended up nearly being crushed by 160kg of toppling flesh during a transfer to a stretcher. The assistance of three other paramedics and one student observer helped keep him upright, which was of particular benefit to me as the part of his anatomy which had been aimed at my head was his faecally stained and thoroughly unwashed pelvis.



Spence Kennedy said...

Thanks v much James!

Euch! That reminds me of the scene in Borat where the two of them are wrestling on the hotel bed.

It is so awkward doing these moves sometimes. We've just had a manual handling refresher course, and whilst there was some useful stuff there, the difference between a classroom scenario and the real thing is huge. You do what you can to minimise the risks, but sometimes you do just find yourself nose to tail, legs in the air, seconds from disaster...

Thanks for reading the blog.


Petrolhead said...

We once had a job on the screen for 6 hours, we had to use 3 ambulances and a couple of fire crews to get a particularly obese patient out of their house. The poor thing must have been so embarrassed, but sometimes a lot of people are needed to lift obese patients. If things go the way they're going, we're going to need a lot more bariatric ambulances!

Spence Kennedy said...

Hey PH!
I heard of a case round here where they had to have the upstairs window taken out and the patient removed by the fire brigade with a cherry picker. Imagine the crowds!
We definitely need some bariatric capability round here. As it is, the only specialist truck I know about is in a neighbouring county.

Pat said...

I visited an ambulance control centre and a fire control centre in Amsterdam about 10 years ago, while I was on holiday (yeah, I know, that makes me a bit of a 'keener' eh? Sad...).

The houses along the canals in Amsterdam are extremely narrow and tall, 3-4 storeys, so moving furniture is extremely difficult. That being so, there are large hooks at the top of the building, to which ropes are attached in order to lift furniture up and into the flat windows. It helps that the homes also have a bit of an outward 'lean' so that the heavy pieces don't crash against the windows.

The fire control operators told me that they use the same hooks to rig up their high angle equipment in order to lower a large patient to the waiting ambulance below. No need to enlarge the windows either, as they are made large in order to accomodate large furniture!

Neat idea eh? Mind you, these are the same firefighters who get called out to rescue cows who've fallen into canals...I wonder how they'd dispatch that one?

Spence Kennedy said...

I've always admired the way that the Dutch incorporated overhanging pulleys into the design of their town houses in Amsterdam. It shows such good sense.

It'd make life in the ambulance so much easier if people organised their lives with half as much foresight. How many times have we been to large (and extra-large) patients, often with chronic illnesses, who still have their bedrooms upstairs? How do they think they'll be taken out of the house in an emergency? You don't need to be a Dutch town planner to figure out that in some cases the only way out is going to be through the window!

How do you rescue a cow from out of a canal? With the uddermost care, I should think :0}