Tuesday, February 01, 2011

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.’
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.’


Jane Brideson said...

I remember when you wrote about her last year I think you were suspicious then?
Like you say it would save a lot of time & energy if her family would clue you in.
Amazing story - I wonder why Susan does it?

BB said...

AT least she isn't making the daughter suffer with Munch. by proxy. That would be much worse. Hasn't anyone ever suggest psychiatric care? It goes on and on doesn't it?

Baglady said...

Brilliant. That last sentence was comedy genius. Fab observations as ever Spence.

Spence Kennedy said...

Jane - It was good to finally know for sure that the whole horse episode was fake, incredible though that is to think about. I don't know much about Munchausen's, how conscious it is or not. You'd think it was just for attention, but the fall-out from all this pretense is beyond that, I think. Her family seemed absolutely normal - but just not really connected with what she was doing. As trained as she is, in many ways.

BB - You're right - that would be worse. At least it's just Susan being needled / gassed etc. I've no idea what the 'management plan' is. I should find out!

BL - Thanks! Rachel's brilliant. So strong and funny.

Cheers for your comments! :)

Ambulance Amateur said...

Rachel sounds great to work with, and perfectly capable of dealing with this patient!

Unknown said...

Oh my goodness. I KNEW, as soon as I read that she said she'd been kicked in the head by a cow where you were going with the whole thing.

The lengths some people will go to! I remember you saying in your previous blog that her employees all knew she was faking it, and that she waited for the trainee to be there alone.

I agree with the above comments. You think they'd get her on a placebo or something.

How rare it is that you actually hear back about the patients! It's kind of neat when it all comes full circle.

Hannah said...

HAHA! This part is definitely my favorite:

"‘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.’"

Who needs fiction when you have reality. I love people.

R said...

Oof. I think I used to know someone just like that. Wonder if/how it's treatable?

For those who are wondering, this is Spence's last encounter with Susan.

tpals said...

I remember the pseudo-horse kick post too. I'm curious if there are any treatments; the cost to your NHS and time must be enormous already.

RapidResponseDoc said...

I loved your last comment. Made my secretary sit through me reading the whole entry, just for that line. And it was worth it!!!

jacksofbuxton said...

At least the horse "incident" is explained away now.Still,you did your duty to the best of your ability.

Tell Rachel to stay away from Asda for bras as well.Mrs Jack bought a couple,and they went back the next day.

Unknown said...

My mother was/is like that. She didn't go to the extreme of pretending to be kicked by a horse, but she has "had" a couple strokes, a few heart attacks, various back issues..etc. I don't actually speak to her anymore because she was driving me batty with her need for attention. Lots of therapy is needed, for Susan and my mother. :)

Spence Kennedy said...

AA - She is - and she is!

MBJ - A focused and thorough-going plan is what she needs, meds and psych/social, to stop her soaking up so much acute resource. Of course everyone's afraid that she'll be denied an ambulance when she really needs it, but that's a risk that seriously needs explaining to her. I think some kind of punishment, too, for calling frivolously.

Hannah - Yeah - I'd love to have been there when she was wheeled in through the doors all strapped up...

Becca - Thanks for that. I should've put some sort of link in.

tpals - The costs just don't bear thinking about - esp. if you take it over the last ten years...

RRD - Thanks! Apologise to your sec on my behalf. Tell her I'll try to make the posts shorter in future :)

JoB - We're the grunts of the NHS. We keep our heads down and do what we're asked. But you do wonder, sometimes.

Thanks for the ASDA bra tip. They're such fiddly things, I'm glad I don't have to wear them (during the week, at least).

HT - Sorry to hear about your mum. I think sometimes it happens that a patient gets a taste for the attention that an acute admission brings. It must be tempting to dip in and out of that scenario now and again - everyone running around, everything provided. Therapy would def be beneficial. Hope things work out.

Cheers for all your comments!

SarahFrancesYoung said...

God she sounds like a handful - and a waste of time when someone in need could be waiting elsewhere for help!

I did find it a bit amusing though... how come you did not recognise her?

Spence Kennedy said...

An incredible waste of time and money.

She did seem a little familiar, but I couldn't think from where. My only excuse was that the stable was dark and the scene very confusing. :/

Miss Adventure said...

I really enjoy your posts, they're beautifully observed and yet still deeply respectful of your 'clients'. But, reading this new post, I wondered, are you in need of a holiday? Fishing seems to be on your mind :)

Keep writing, there's a book in there.

Spence Kennedy said...

Thanks MA. Well - always in need of a holiday (seldom in line to get one... bah). BTW - That 'carp' quote was as said - but I admit it looks like a mistype ;) Maybe there is a book in there - a sticker book, with plenty of little cardboard kit items to hang off the hands of the EMT, and dodgy characters sliding in right and left. :/

argentwolfwing said...

I love your blog, and the stories are so real. Great sense of humor! Thanks for your insights on the real life of humans

Spence Kennedy said...

Thanks v much, argent. Appreciate the comment.

Chaz said...

I could read your stuff all day and never get tired of it. I think we're all ready for something a bit longer now, and surely you have the material for a 100 full length books?

You write it, I'll buy it. Promise.

Spence Kennedy said...

Thanks Chaz. My challenge this year will be to step it up a little - write some longer, more substantial pieces. As far as a book goes, I've got one on the go at the minute that's taking up my time - just about to start on a major re-write - so that's soaking up my 'book head'.

Thanks for the encouragement, Chaz. If I ever do get anything published, I'll bung you a free copy!

Wordfiend said...

I doubt a placebo would work: it's all about an inordinate need for attention. I think you hit the nail, Spence: she needs a comprehensive management plan. She is ill, but (as with a lot of mental disorders, like anorexia) the treatment needs to be holistic, and long-term.

And I echo Miss Adventure: your posts are well written, respectful, a pleasure to read, gently insightful. I don't mind the variety of lengths. Sometimes a short vignette is just the thing. I do save up reading your blog for the weekends, when I have more time.

Spence Kennedy said...

Thanks Wordfiend
I ought to make an effort to find out exactly what she meant by 'management plan'. Hopefully it would call on quite a few agencies - but I def think that some coordinated approach would benefit everyone. I'm sure that this patient isn't just a problem for the health service!

Thanks v much for reading the blog, WF, and for the encouraging comment! :)

Fat said...

Rachel could so easily have been me in mty days in A &E. Just substitute cheap bra for tight pants.

Spence Kennedy said...

Hey Fat! I can't think of anything worse. You've got to have room to move...