vera, first to last

If the first job of the night points the way to the rest of the shift, I may as well go home now.

Vera.

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 do?’

‘Unplug it?’

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 anything!’

‘Where are you in pain, Vera?’

She flutters a hand over her middle.

‘My chest. Around my heart. My legs. Help me!’

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 tonight.

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 help?’

‘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.

‘Vera.’

‘Jesus Christ!’

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.

Vera.

Rae drives.

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 to her.

The department has pretty much emptied when we go in through the automatic doors.

A black cleaner working his broom in tired loops.

A Filipino nurse.

Vera watches them both.