If the first job of the night points the
way to the rest of the shift, I may as well go home now.
I call Control.
‘I was just wondering how many ambulances Vera
has had today.’
Control doesn’t have the information to
hand. Which is surprising. Vera is so prolific, you’d think they’d have a big
portrait on the wall, where the eyes flash when she calls and a big electronic
counter flips round.
We don’t run red to the job, because in all
conscience we do not want to put any other road users at risk unnecessarily. We
probably miss the Category A time, which in auditing terms makes whatever
happens next a failure, but then of course everything about this job is a
failure. One frail old woman, the resource profile of a major incident, money
wasted, nothing done.
Even if a multi-discipline meeting between
health, social services and the housing trust cost a couple of thousand to
organise – even if they held it in the plushest hotel with the finest coffee
and biscuits, free gold pens and a table magician – if they finished the day
with a handshake and a workable solution it would still represent a saving of hundreds of thousands.
But if there’s one thing Vera is good for
it’s to demonstrate the fatal lack of continuity in the system, the lack of resolve
between the various agencies. Despite being a prodigiously expensive irritant
to everyone from the carer to the local GP, Vera still gets endlessly wheeled
around and around, insulting and assaulting and goading and absorbing and
causing havoc as she goes. Defiantly untouchable.
Vera is sitting in her chair watching TV:
Fiona Bruce investigating the life and works of J M W Turner.
‘I’m in pain! I’m in pain!’ says Vera, over
and over, but her eyes remain as hooded and watchful as they always do, her
hands placed lightly on the arms of the chair. Vera has three distinct voices –
the first and most used is a piping-falsetto for pain and distress; the second
is a lower, huskier tone for threats, insults and instruction, the third is the
least often heard - a wheedling kind of whisper, for saying how sorry she is. She
seems to use each voice instinctively, blindly sensing the advantage in the air.
She is like some malign porcelain doll, playing through her voices on a loop
until she gets what she wants.
She looks sideways at me and says in Voice Two:
‘Don’t you mess my sofa up.’
The carer is trembling, red in the face, putting
her coat on.
‘The other ambulance crew only left about
half an hour ago. They’d talked to the out of hours doctor and she’d arranged
for a visit later on. But then Vera picked the phone up again. What can you
The carer smiles as best she can and then
shrugs. ‘She threw a can of coke at me, you know.’ she says. ‘Anyway. It’s all
logged. Do you need me for anything else? Only I’m behind on my calls.’
She leaves, with a grim, backwards nod to
us from the hallway as she closes the door.
We turn our attention to Vera.
‘I’m in pain! Help me! You’re not doing
‘Where are you in pain, Vera?’
She flutters a hand over her middle.
‘My chest. Around my heart. My legs. Help
Rae picks up the last ambulance sheet to
read what actions they took.
Fiona Bruce is in Margate. Apparently
Turner had a mistress there. She holds up an old photo, and points to a house
marked with an X.
‘Turn that off,’ says Vera. ‘It’s my TV.
Turn it off. This is my house. Get off my sofa.’
As she talks she reaches to the table at
her side and another can of coke.
‘Don’t you be throwing that, now,’ says Rae,
lowering the ambulance sheet. ‘I’m serious, Vera. If you throw your coke at us
we’ll have the police here to arrest you for assault.’
Vera withdraws her hand.
Voice Three: ‘I wouldn’t do that. You’re such
kind people. I wouldn’t hurt you.’
‘Didn’t stop you throwing it at that poor
carer, though, did it?’
‘I’m in pain! I’m in pain!’
She carries on crying out whilst we decide
what to do. The most common way of dealing with Vera is simply to load her up
and take her in. It’s the most emotionally aerodynamic method. Everyone has
attempted to go down other routes, but it gets more and more tortuous and
anyway the outcome is always the same – another call from Vera, another
attendance. The dull, default position is that if emails, phone calls and
reports are ineffective, maybe constant appearances at A&E will inspire
some other more definitive action. But it’s the beginning of the shift, we’re
fresh and optimistic and still up for an attempt at the right thing to do.
Rae calls the out of hours service. The
doctor tells us not to take Vera into hospital. Someone will be with her in an
hour or so. I call Control to log the discussion and our visit, but the
Dispatcher routes us through the Duty Despatch Manager, who refers us to the
Duty Com for a discussion about the implications of the call. The worry is that
Vera may actually collapse with an MI or something, and as the last clinician
contact, we’d be liable. After all, Vera is
complaining of chest pain. It might be
real this time. Her ECG does show some anomalies, the kind of thing you might
expect to see in an elderly woman, but still, not perfect.
‘Emphasise the concerns you have about her
mental capacity,’ he says. ‘We’ll log everything and see if we can sort it out
in the morning.’
Fiona Bruce is standing on the sea wall at
Margate, holding up a laminated copy of one of Turner’s paintings, trying to
identify the landmarks.
I glance across to Vera. She has the phone
in her hand. Whilst I’ve been chatting on the mobile to Control and Rae has
been writing up her sheet, Vera has dialled 999 again.
‘Yes, I know, we are still here,’ I say to
the Duty Com. ‘I think she’s going for a record – how many crews she can fit
into her sitting room at the same time.’
We take her in.
Behind the nurse station at A&E majors,
the bed board is as busy as the Tote on Derby Day . Our arrival with Vera is
greeted with a dismay bordering on hysteria. It transpires Vera currently has
an ASBO served on her for racially abusing staff, the result being that only
white Anglo-Saxon nurses can attend to her. As a political move more than
anything, we’re bumped round to minors where there are fewer BME staff working
The nurse running the desk there is dabbing
a tissue at her eyes and nose.
‘Shall I give you a moment, Stacy?’
She looks up and smiles sadly.
‘Nope. No. I’ll be okay. Phew. Now. How can
‘I can’t tell you how sorry I am to bring
this patient to you.’
‘Who? What do you mean?’ she says,
straightening a little.
For a second she flames as brightly as a
roman candle. But the white heat of her anger almost seems to cauterize the
sorrow that was overwhelming her a second ago. She takes a deep breath; her
fire burns blue and cold. She reaches up and gently brushes a strand of hair
away from her forehead.
She calls out to a young HCA called Steve, one
of only a few staff in the department who are able to deal with Vera.
‘Guess who’s in again,’ she says. Steve
slowly puts down the sheets he was carrying, and walks over.
In the A&E reception I get some stats:
one hundred and seventy five A&E attendances this year alone, which necessarily
means at least double that in ambulance call-outs, five of those tonight. We
drive back to base to complete the paperwork – an untoward incident form, a vulnerable
adult form, supporting emails and faxes – any angle we can think of to raise
Vera’s profile and get something done. Three hours start to finish. We have a
cup of tea, realign ourselves with the night, and carry on.
Half an hour before the end of the shift,
we get our final job.
Exhausted, we make our way back into the
cab. Read the MDT.
There’s no conversation, none at all when
we turn up at her flat. We are clinical operatives, delivery people. We put her
in our chair, load her onto the ambulance. She toggles through all of her
voices, desperately looking for an angle, a point of leverage, but we are cold
The department has pretty much emptied when
we go in through the automatic doors.
A black cleaner working his broom in tired
A Filipino nurse.
Vera watches them