case solved

‘A blue tag? Not heard of that before. Patient has history of exaggerating illness or injury for pain relief. Lovely.’
This street is so narrow and the terraced houses so tightly packed together it’s a good thing all the PVC doors open inwards. Frank has to drive half on and half off the pavement to make any progress.
‘This is it.’
He manages to leave just enough room to lower the tail lift, but at these angles it’s debatable whether we could ever really use it. I can see a young girl waiting for us by an opened door, hugging herself against the chill, watching us park up, smiling sweetly.
‘It’s my mum, Susan,’ she says, stepping aside to let us in. ‘Top of the stairs on the right.’
She quietly follows us up the narrow stairs, then stops outside the first bedroom on the landing, a teenager’s purple retreat: Twilight posters, CDs, school books.
‘I’ll be in here if you need me.’
‘Thanks.’
She tucks herself away with practised economy.

Susan is groaning beneath a voluminous caramel coloured duvet, the back of her left hand pressed melodramatically to her forehead.
‘Oh god, it hurts.’
She slaps the bed with the flat of her other hand, submitting to the pain, wrestler-style.
Frank makes his introduction; Susan squints, then says: ‘Help me’ as soon as he finishes. ‘Please. Do something.’
‘So. Tell us what’s been happening, Susan.’
‘I’ve got this excruciating pain in my groin. Here. It goes all the way down. And now it’s starting up the other side.’
‘How long have you had it?’
‘Two weeks, but it’s much worse tonight.’
‘Have you seen your doctor?’
‘A few days ago. He wanted me to have a blood test, but I just forgot. I’ve been so tied up I didn’t get round to it.’
‘Why did he want you to have a blood test?’
‘He thinks the pain is tissue damage related to my anaemia.’
‘Oh? I’ve not heard of that before. And when you say tied up, what do you mean?’
‘My brother’s dangerously ill in ITU. I just haven’t been able to think about anything else. And then today the pain got worse and worse. So I came to bed, and now I can’t move.’
She looks at us with a doughy expression of need. ‘Help me.’
We’re both mindful of the blue tag, but she seems quite plausible.
‘I’m going to be sick.’
Susan suddenly sits herself up in the bed and makes a flapping gesture of urgency in the air. Frank passes her a bucket from the side of the bed; she dips her face into it, her lank, yellow hair effectively curtaining the event, and makes a noise like an angry bear growling in a cave.
Eventually she pulls back, wipes her mouth with a tissue, drops it in the bucket, places the bucket back beside the bed, then flops back inertly onto the pillows. I move over discretely and glance down. There doesn’t seem to be anything in it.
‘Have you had any diarrhoea?’
‘No. That’s normal,’ she says, breathing rapidly. ‘Aren’t you going to do anything? I don’t know how I’m going to get down the stairs,’ she adds, squeezing her eyes shut and rolling her head from side to side. ‘This pain is unbearable. I can’t move my leg at all.’
‘We’ll help you,’ says Frank, moving round to her side and feeling her pulse. ‘There’s no rush.’
I step back onto the landing and knock on her daughter’s door. When she comes out she’s unhooking a pair of iPod earphones, smiling benignly.
‘Is she going to hospital?’ she asks.
‘Well, she’s in pain, so hospital’s really the only place,’ I say, studying her response, shambling and innocent as Lieutenant Columbo.
‘I’ll get her meds and slippers,’ she says, and moves quietly downstairs.

I glance back into Susan’s room. She is sitting up on the edge of the bed holding on to Frank’s hand. They hold their position and look out at me, framed through the doorway like a moral Victorian painting.

‘I don’t think I can take any weight on it,’ she says, waggling a plump foot in the air.
‘You can always shuffle down the stairs on your bottom,’ says Frank. ‘There’s no rush.’

***

At the hospital, Frank waits with Susan whilst I go round to the nurse’s station. Susan reclines on the trolley, an entonox mouthpiece clamped between her teeth, drawing on the regulator like a professional diver.
‘Shan’t be a moment,’ I say.
Frank folds his arms and gives me a level smile.

Rachel, the Charge Nurse, is complaining to a student doctor about her bra strap.
‘It’s been chafing like a bastard all night,’ she says, squirming on her office chair. ‘I’ve wrapped some gauze round it, but honestly, I’m fit to kill.’
‘Where did you buy it?’ I ask, laying my clipboard on the counter.
‘Primark. Though what it’s got to do with you I don’t know.’
‘Primark? Buy cheap buy twice.’
The young doctor nods sagely. ‘That’s true,’ she says. ‘He’s got a point. Primark’s carp for bras.’
‘Anyway. What’ve you brought us? Something nice?’ says Rachel. ‘Jesus. Honestly. I’m going to scream.’
‘Well. I have to say this is a strange one.’
‘You’re not selling it.’
‘There was a blue tag on this patient’s address.’
‘Whatever that means.’
‘I know. I’ve not heard of it, either. But it seems to be some kind of warning. It said the patient acts up for pain relief. I’ve not come across her name before, but I wonder if you have.’
‘What is it?’
She swivels the board round and reads the name.
‘Yes – do I know Susan!’ she says. ‘It’s one of her aliases, anyway. I’ve been treating Susan since I started my training here, and that’s a long time. Munchausen’s. She fakes it. There’s nothing wrong with her. Have you given her anything?’
‘Just Entonox.’
‘Take her off it.’
‘So tell me about Susan.’
‘She’s a phenomenon. I’m surprised you’ve not met her. Just under the name Susan she’s had four hundred attendances in the last couple of years alone. What’s she come in with today?’
‘Groin pain.’
‘Yep. Seen that. But you know her favourite thing is to wait in a field for some ramblers to walk past, then lie down and pretend to have been kicked in the head by a cow. Fits, unco, the works.’
I feel a sudden chill.
‘Or maybe a horse?’
‘Yep. Horses. She’s been kicked in the head by a horse a few times.’
‘Was she brought in by helicopter just before Christmas?’
‘Why? Were you on that one?’
‘Me and a dozen others.’
Rachel shakes her head.
‘It’s outrageous. I thought there was supposed to be a management plan in place.’
‘So what happened when she was choppered in that time?’
‘A full trauma call went out and the team was waiting in resus. When the trolley came in, the consultant took one look and said “Oh, for fuck’s sake – it’s Susan”. Then they all threw off their aprons and walked out. She was sat up and out of the department in under ten minutes.’
Rachel leans forward, arching her back and shoulders to get relief.
‘The weird thing is, her family are absolutely lovely. You’d think they’d give some sign this was all a bizarre charade – but I suppose they’ve just grown up with it, and it’s a part of their lives.’
‘I’ll bring her round.’
‘Do. I look forward to seeing her,’ says Rachel, grimacing. ‘But don’t go using pat slides – she can transfer perfectly well herself. And take her off the Entonox. And tell her to cut the amateur dramatics because Rachel’s on duty, she’s tired, she’s in a cheap bra and she’s in no mood to fuck around.’