Wednesday, February 19, 2014

what to do

I haven’t been to William before, but that’s the thing about frequent flyers – no matter how prolific they might be, it’ll be some time before you can cross them all off your list.

William’s front garden is a raw patch of grass and weeds. A stone heron lies beak down in a pile of rubble; a line of perished Christmas lights hangs down in front of the kitchen window from the last remaining clip.
‘Don’t be tempted inside,’ says Rae as we walk up the path. ‘We’ll be there for hours, and the outcome’ll be exactly the same. I’ll try to tempt him out.’
She knocks, and knocks, and eventually William comes to the door, a middle-aged man so plump and soft and white it’s like she’s coaxed him out of the furthest chamber of the deepest burrow.
‘I don’t feel right,’ he says, bunching his t-shirt up. ‘I’ve got chest pain.’
‘Let’s get you out to the ambulance then, William and we’ll do all our tests there.’
‘Couldn’t you do them here?’
‘We could, but the advice would be the same – to come to hospital for a check-up. You’ll need a blood test for one thing.’
‘But I don’t want to go to hospital.’
‘We always advise it for chest pains, William. You know that. You’ve done this before.’
‘I know, but how’ll I get back?’
‘Maybe you could walk. It’s five minutes away. If that.’
‘What about my medication?’
‘Take it with you.’
‘But it’s all set out in the kitchen.’
‘I can put it in a bag.’
‘I need to take the next tablet in half an hour.’
‘Take it at the hospital.’
‘I have to take it with tea.’
‘They serve tea. Or water.’
‘It has to be tea.’
‘I don’t know. I don’t want to go.’
‘What did you expect would happen when you dialled 999 and said you had chest pain?’
‘I don’t know.’
‘The only other thing is to see your GP.’
‘He won’t come out any more.’
‘Well he’s even closer than the hospital.’
‘I know but how will I get there?’
William shakes his head.
‘I haven’t been out in ages.’
‘How do you get your shopping?’
‘Dad takes me.’
‘Can’t your Dad take you to the surgery?’
William shakes his head.
‘He says he won’t do it anymore. What should I do?’
‘You know what we think you should do, William.’

He shifts his weight from side to side and plucks at the loose flesh beneath his chin.
After a while he says: ‘But can’t you do all the checks here?’
‘Our advice is that you come to the hospital for a review, William. If we did an ECG right here and it was clear, we’d still say you should come.’
‘So you could do it here.’
‘Yes. But say we did do an ECG and it showed you were having a heart attack. Would you come then?’
He shakes his head.
‘Why not?’
‘Because I can’t wait hours up the hospital. I know this is just anxiety. It’s how I am. And all this is making it worse.’
‘I think you’re right. I think it is anxiety. Have you had all your meds this morning?’
‘I haven’t had my Diazepam.’
‘When do you take that?’
‘In half an hour.’
‘Well I think you could safely bring that forward and have it now.’
‘But the kettle’s not boiled.’
Rae sighs.
‘We’ve been down this road before, William. Haven’t we? We’re just going round in circles.’
‘What’s the point in going up the hospital? They’ll do all their checks and find nothing wrong.’
‘You don’t have to come with us, William. You could always see your GP.’
‘But he won’t see me no more.’
‘He won’t come out to see you. But you could make your own way there.’
‘I can’t. My dad won’t take me.’

Rae sighs and steps away from the door.
I try my luck.

‘Do you have a support worker, William?’
‘Maybe you could call them and see what they say.’
‘I can’t keep calling them. I’m too stressed. What should I do?’
‘That’s when you should call them, when you’re stressed.’
‘They can’t do nothing more for me.’
‘What do you think they’d tell you to do if you told them you had chest pain?’
‘Go to hospital.’
‘And that’s what we think you should do. So that’s all of us saying you should go to hospital. Come on William. Sooner you go, sooner you can come back.’

He shifts his weight, foot to foot.

‘What should I do?’ he says. ‘I’m all confused.’
‘Come to the hospital and speak to someone there. Maybe they’ll have some ideas.’
‘But how will I get back?’
‘I haven’t go no money.’
‘He doesn’t drive.’
‘Not without Dad.’
‘Give him a call?’
‘He won’t go up the hospital.’
‘The GP, then.’
‘Or them.’
‘The main thing is, William, you don’t feel well. You were worried enough to call an ambulance. I think you should do whatever you have to do to get checked out and reassure yourself everything’s okay, and then worry about how you’re going to get home later.’
‘But my medications…’
‘We’ll put them in a bag.’
‘They’re in a box.’
‘We’ll put the box in a bag. It’s a big bag.’
He strokes his head, shuffles from side to side.
‘What should I do? I don’t know what to do.’
‘William? We really need to make a decision,’ says Rae, stepping back again. ‘We’re an emergency ambulance and we might be needed on another job. What’s it going to be? Hospital or GP?’
‘I don’t know. The GP won’t see me.’
‘I’m afraid we’ll have to go then, William.’

He stands at the door watching us walk back to the truck, anxiously stroking his head from the nape of the neck to the forehead and back again.

By the time I’m in the cab, he’s speaking on the phone.
I catch his eye.
He holds up an index finger for me to wait.
I wind the window down.


tpals said...

Good grief.

Spence Kennedy said...

And that was a (very) condensed version! :/

Jane said...

I used work for a council co-ordinating bin collections. I had a customer who would ring me in a complete spiral of despair - she wanted her rubbish collecting, but couldn't bring herself to touch her bin, because it had been touched by the refuse collectors.
I literally used to spend hours of my life having a convoluted 3 way conversation between her, her social worker and her sister to try and find solutions. My heart used to sink when I saw her number, but I always used to feel sorry for her - how sad to be *that* terribly anxious about a mundane everyday occurance. Exhausting!

Spence Kennedy said...

Exhausting's the word! Like you say - awful to get in such a state about something so trivial. And dreadful to think how that must be played out across all the other social interactions of her life, too. So incapacitating. It was good of you to take such trouble for her, especially considering how busy you must've been with everything else. (BTW - I suppose you suggested gloves... ;0) )

I really don't know what the answer is for William. The ambulance is certainly not what he needs (or the hospital, come to that) - but it puts us in a difficult situation when he rings up with chest pain. Even though the likelihood each time is that the pain won't be cardiac, still he must be in a high risk group, so one day it probably WILL be. I suppose the bottom line is he's not coping with life, but quite where he goes from here I don't know. In the meantime, having an ambulance pretty much every day is an expensive (and frustrating) option.

Jane said...

Maybe some worry beads and sessions of CBT would help William?! Poor man, what a life. And poor you as well, what a use of your skills and time.

Gloves were no good for this lady - mostly because once she'd taken them off, she'd have to touch the bin to put them in... and so it went on. I co-oidnated half a million bin collections, but she took more time than everyone else put together. And that includes the man who tried suing us after he broke both legs jumping up and down on his wheelie bin to fit more in....

TomVee said...

Hey Spence!
At least Sisyphos made it almost to the top before the ball rolled back down, whereas with William it is basically rolling around in a distressingly tight circle.
A drain on resources and I can't begin to guess what a drain on nerves it must be dealing with him. Nevertheless, he is a patient and needs something - but what?
I had the sneaking suspicion that in a sorrowful and not at all conscious way he wants attention, but doesn't know what to do with it once he has it - only that he wants it.

jacksofbuxton said...

Made me think of last night's Inside Number 9 (which is utterly brilliant)

Well played for not offering to do any number of painful body cavity checks.

Beautiful Things - Cathy said...

Freedom can sometimes be a scary thing. All that choice without the confidence in yourself to trust that you'll do the right thing.

Hats off to you, I couldn't deal with someone like this.

Cassandra said...

Dear sweet merciful heavens! I could barely make it through the written, condensed version. HOW you handle those folks is beyond me, Spence. I'm glad I found your blog. Now I know never to become an EMT. Good god…

(Of course, I ran into my share of those types when doing door to door Christian book selling. We called them "devil's rabbits" lol. And you get some of those working with the abused population as I do, so I know what it's like. But oh… SO VERY FRUSTRATING! I seriously wanted to punch him while reading this.)

Spence Kennedy said...

Jane - I think CBT would definitely be helpful. I see what you mean about the gloves - although maybe a bin with a pedal to open the lid might have worked ... (see how I'm getting sucked into their world? - help!) Love that detail about the man suing the council for 2 broken legs whilst jumping up and down in the bin. That's No Win No Fee for you. A great scourge of public services.

TV - I think you're right about the attention thing. The long and the short of it is that he has a mental health problem, and it's manifesting itself in repeated use of 999 (and GP services by the sound of it). He needs to be the focus of a multi-agency case study, to see what else he might need in the way of help, and to avoid him repeat offending (if you see what I mean). It'd be worth everyone's time & money to invest a little in some pre-emptive attention!

Jack - Thanks for the heads up about Room no 9. I saw it advertised but missed out (def one for catch-up).

BT - It's dreadful to see someone so entirely imprisoned by their own mind. Very difficult to deal with, because it's hard to resist falling into a series of 'practical suggestions' which are completely ineffective (especially on the doorstep), and actually just make him worse.

Cass - 'Devil's rabbits'? That's hilarious! I can just picture it (them). BTW - it makes me feel a whole lot better to know that even Christians sometimes feel their knuckles whitening on some doorsteps... :)

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Thanks very much for all your comments.