Something must surely have happened today, something big. Or at least, a public announcement in the shopping centre, or maybe a plane dragging a banner across the sky: Come to hospital! Now! Everyone!
The department is overflowing, overwhelmed, bursting at the doors with patients and relatives - an expectant press of people, stewing dangerously like commuters at rush hour, all looking in the same direction, the desk at the centre, that plucky little veneered emplacement of computers, filing trays, dry wipe boards and coffee cups, the Rorke’s Drift of the A&E, where everyone, from ward clerk to registrar, are fielding requests and making decisions faster and more decisively than they ever thought they could, but saving the last canula for themselves.
I queue up to handover.
Ron, the Kiwi Charge Nurse, outwardly as smooth and unflappable as ever, is working so quickly his Maori tattoos seem to ripple up and down his arm like waves on the ocean.
‘Hey! Surfer Nurse!’ I shout.
He looks up and smiles. ‘I’m out there soon, mate’ he says. ‘I can taste it.’ He smiles with the shine of a wet board for a second, then he’s back in to it, crooking a phone to his ear, writing a name on the board, passing out an X-ray request to a porter and nodding to a patient’s relative who has begun shuffling dangerously behind us, foot to foot. I check the time. We need to finish promptly tonight, and I mentally pattern out the likely run of events: how long to handover, how many crews on tonight, the likelihood of copping a late job. I look back across that wretched stretch of humanity and catch Frank’s eye from where he waits with our patient. He is so focused, even at this distance he makes his opinion clear with nothing more than a gentle tilt of his head.
‘Okay. We can do this one and still finish on time. Buckle up.’
I put the truck in gear and edge forwards, but the A&E car park is impassably jammed with ambulances, taxis and cars. Frank surveys the scene for a second, then unclips his seat belt again and leaps out. He strides up to three cars in turn, giving firm directions to each. They follow the pattern he lays down – back up a foot; turn into that space; reverse into there; you, forward an inch, stop. Then he jumps back in the cab. ‘Go,’ he says, and calmly crosses his legs; we cautiously shimmy out through the channel like a ship through pack ice.
Mr Montague’s son, Jerry opens the door to us. A man in his thirties, he smiles with the wide, peg-toothed simplicity of a child. ‘Hello!’ he says. ‘My dad is on the floor. I did what the lady said. I did what the lady said to do on the phone.’
‘Okay Jerry. Through here, is it?’
‘Yes. Through that door, there. He’s on the floor, but I left him there, like she said.’
You would think the flat had been abandoned years ago. The bulbs are unshaded, the filthy curtains hang limply across the window frames, the carpet is tacky with ingrained dirt. The air has a rancorously sweet cut to it; it swirls around us as we move through, like the inside of a chocolate swiss roll.
Mr Montague is lying on the floor beside a ruined sofa, feebly clawing up at a plain wooden kitchen chair. His pyjama bottoms have ridden down, and the hollow scoops of his pelvis stand out like a dreadful signifier of his decrepitude.
‘How long has he been on the floor like this?’
‘I left him there like she said to leave him.’
‘Jerry? When did you see him up and about last?’
‘I did my jobs today. He hasn’t been very well.’
‘No? What’s been the matter?’
‘I don’t know. Not very well.’
‘Does anyone come in to help?’
‘Do you get any help?’
I go back down to the truck to fetch a chair. A neighbour from one of the ground floor flats comes out to see me, smoking nervously and clutching the pink towelling bathrobe around her.
‘Sorry to butt in, but – can I have a word?’
‘Is he all right?’
‘I don’t think he’s great. He might have been on the floor a while. We’re taking him in to hospital.’
‘Good, ‘cos it can’t go on like this. We’ve been on the phone to just about everyone, and no-one seems to take us seriously. They’re not coping. His son’s got learning difficulties and they’ve always lived together, but have you seen the state of the place these days? Well of course you have, you’ve just been up there. Just last week Mr Montague was walking about in the gardens in a right old state, didn’t seem to know where he was. He’s refused help time and time again and you can’t force someone, can you? And the doctors and whatnot just seem to take the attitude that unless he asks for help they can’t do much. But it can’t go on like this, can it? You’ve seen what it’s like.’
‘We’ll do our best to get things going. I think you’re right. Something needs to happen.’
‘I mean – it’s a shame. But enough’s enough.’
‘Thanks for your help.’
‘You’re welcome. Just make sure they get the picture.’
But the picture I get is of us wheeling the decrepit husk of Mr Montague in through the A&E doors, Jerry shuffling along beside the trolley holding his hand, as we excuse our way in through that melee of competing claims, to bid for a bed, to bid for attention, and a quiet place in which to give it, for everyone to have a clear chance, Mr Montague, Jerry, the other patients, their anxious friends and relatives, the overworked hospital staff, and us, the ambulance crew, cleaning up as quickly as we can and hauling our exhausted frames back to base, to finish another long, long day at a reasonable hour, and make it back home.
So sad to think that there are families like the Montagues up and down the country.I do hope you can nudge social services in their direction Spence,for both of their sakes.I'm afraid to say that the more the Coalition cut,the more likely we are to hear of stories like this.
Spence, you sound like you /really/ need a holiday.
I hope you were finished at a decent hour. It's amazing how composed medical professionals are able to be in the middle of all of that chaos.
I would imagine that with everything happening in such a flurry, and pressing emergencies rating first attention, sometimes, situations such as Mr. Montague and his son must certainly get pushed back for later review.
It's so pathetic to hear that people live like this yet thy do don't they?
I just want to say I love the way you write. The stories are of special interest to me as I am a Registered Nurse in the states. Keep up the good work. I love it!
Another sad story. Glad you made it back in good time.
I'm a Kiwi - loved your description of Ron the Maori nurse:)
When the caregiver begins needing care, things go downhill hard and fast... Sounds like the kind of day when everyone could have used some respite. Hope yours had a nice, cold beer on the other end of it, at least!
Glad you got him to the hospital. Can he be put into a home without his consent? Clearly he's senile or just getting too old to take care of himself. His son won't be able to help either. Is there a way for power of attorney to be assigned to a relative? I suppose these are more questions for public assistance clerks.
JoB - We put in a 'vulnerable adult' form, so that'll add to the pressure for action to be taken. It is shocking how many families & individuals live in situations of real deprivation.
'big society'? big con!
MD - I think I need a sabbatical! Somewhere hot.
Nari - Yeah, we got off pretty much on time.
It's incredible how cool under fire the hospital staff are. Esp. Ron - cool surfer nurse riding the wave.
BB - It still shocks me to see how some people live. Positively Dickensian.
Sharene - Thanks! Respect due to another cool nurse. Hope everything's good with you.
Alexia - One day I'll make it out to NZ. A biker tour of the islands. Sigh.
Stacy - That's so true. Def a case for re-evaluation / respite. Maybe they can carry on living together independently - just with much more outside involvement.
Hey - a cold beer! You read my mind.
VMSP - If his mental capacity is compromised, he can be forcibly detained, but only after a thorough-going medical/legal review. We only got a brief snapshot of the situation, so I don't know if any other relatives are involved. (If they are, it's at a distance - I can't imagine anyone with a shred of compassion leaving those two to live in those conditions for any length of time).
Thanks very much for all your comments :)
Thanks, Spence, for another fabulously evocative post. I especially liked the car park issue with Frank’s composure and spatial relationship ability.
He's a great driver, no question. And always so relaxed with it. Like a salmon swimming upstream (although I don't suppose salmon are all that relaxed...) :) x
Some people are left to cope by themselves in a world they don't have a chance in. You do all you can.
You do wonder what will happen sometimes. But what else can you do but press the usual buttons and hope for a positive outcome?
My wife and I used to live next door to a mother and daughter. They were younger than the Montagues by some way, but even then we could see where they were going to end up in another 20-30 years.
They would sink a little further every year, the mother reinforcing the daughter's peculiarities, the daughter reinforcing the mother's.
They really needed professional help, but of course they were of "sound mind" and perfectly within their rights to not seek help. And to refuse it if it had been offered. And when they reach the point of being "unsound", then they'll be beyond helping.
It's one of the downsides of free will. If people "choose" to slide, then they have to be left to do it. It's still not pleasant to watch, though.
These situations are really difficult to witness. I got the impression with the Montagues that lots of people were aware of the situation - from the neighbours to the social services - but were unable to intervene because the father wouldn't allow any help. In his case I think the moment has come when he won't be able to refuse it any longer. Hopefully he'll see that it wasn't quite as frightening as he thought it was going to be.
But personal freedom does mean the freedom to live how you want to, even if that means in a way most people would find unacceptable. Sometimes the distinction between normal behaviour and mental health problem is really difficult to determine.
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