Monday, September 01, 2014

back to bear

Joseph would make a passable bear. A grumpy, greasy, not-afraid-to-talk-his-mind kind of bear, most active in the small hours, crashing about in his cave whilst the city lies cold, blue and anonymous a million miles away at the bottom of the world. There’s definitely a sense of isolation in Joseph’s cave, a sense that the ornaments in his sparsely decorated cave are a little too dusted, a little too symmetrical (so much so that the millimetre difference between the three bronze owls with the wildly staring eyes on shelf one, and the identical owls on the shelf immediately below, is as shocking as if someone had taken a hammer to the place).
‘Have you had any contact with the Community Respiratory Team, Joe?’
‘We had words. They’re not coming no more’ he growls, shifting his position in the chair to free up a paw. ‘I’ve always been independent. I’m not about to stop now.’
The fact that his independence is equivalent to at least one ambulance a day, frequently more, and numerous (pointless) attendances at hospital, is something he cannot or will not grasp.
Each call takes exactly the same path. He hyperventilates. He self-nebulises over the course of a few hours with Salbutamol and Atrovent, until his anxiety is pumped tight as a balloon with the black word ANXIETY expanding and distorting bigger and bigger till it’s fit to bust – then he dials 999.
Just about everyone has made the journey up to this cave. They’ve all sat on this brown velour rock, had the same conversation, made the same calls. They’ve all tried to take it further, ramping it up to the level of vulnerable adult, sending off emails, leaving messages. But there’s only so many times you can do this and see that nothing changes before your enthusiasm to make a fuss wanes.
And of course this pro-active approach is dependent on the time of day. Early on in the shift you have the energy and ambition to pursue these things. Later on in the twelve hour stretch when your inner resources are depleted, when you’re too tired and greyed out to think about the bigger picture, that’s when you cut the conversation, set up the chair and haul him off to the ambulance, knowing full well he’ll self-discharge after a couple of hours, knowing full well he’ll lose his meds and other property, and grump his way back to the cave, paws heavy by his side, hairy palms backwards, when he’ll ride the lift back up to his cave, and slowly shut the door, and call again after a few hours.
‘It was a bad COPD yesterday,’ he growls, putting together another one of his home nebs. ‘A bad one. Them Community nurses, they don’t care I’m dying. We’ll be out in a couple of hours they say. What’s the good of that?’
He snaps the caps on a couple of vials of salbutamol and squeezes their juice into the acorn of another neb.
‘Don’t forget, COPD is a chronic condition, Joe. The respiratory team are there to help you cope at home.’
He straps the mask on, then jabs the table top with a finger to emphasise each word.
‘They – don’t – understand!’ he shouts through the mask. ‘They’ve got – to take – me seriously!’
‘Joe? Remember what we said? You really shouldn’t be using these nebs. You don’t need them. It’s only making things worse.’
He stares at me over the rim of the mask, his most severe, grumpy bear stare, then he reaches out and flips on the compressor with a claw.
The vapour spits and hisses out of the sides of the mask. He stares at me through the mist, his fury with the world made visible.
 ‘I’ll get the chair,’ says Rae.


md said...

I saw this on the BBC web site a few days ago - I found some of the numbers hard to believe but I guess that you probably wouldn't find them too surprising ...

jacksofbuxton said...

Ever decreasing circles Spence.

Spence Kennedy said...

Thanks MD. Interesting article. You're right - the figures aren't surprising (depressing, yes).

In Joseph's case, he's had plenty of offers of help from various agencies (GP, Comm Resp Team etc). But his anxiety stops him from taking advice or using the medication properly, so it's redundant. He does have mental capacity, though. The fact that he calls 999 all the time is not evidence of a lack of capacity. So nothing can be done.

Our roster of FFs is as shocking as the West Midlands. I'm sure every service is the same. What it represents nationally in money and lost resources I couldn't begin to imagine.

Ambulance Control treats each call as a potential incident, regardless of how many times they've picked up the phone that day. Just because they've rung four times today, doesn't mean to say they're not having a heart attack'. Which is true, of course, but you would hope the system could initiate a special response when a FF rings - at least a chance to investigate over the phone whether there really is anything new happening, and whether a vehicle really is required. But unfortunately the call takers don't have any latitude to do this. Some calls do get triaged to 'Hear and Treat' - an effective stand down - but if Joseph is on the phone saying he can't breathe, he will always get a vehicle, regardless of his history. There is nothing at all to stop anyone from dialling multiple times over a number of years.

You would hope that as soon as a FF was identified, a case would be made for a special, multi-agency approach to address the problem. After all, it's not just the ambulance & hospitals who are suffering. I'm sure his GP is exhausted by him, along with the Comm Resp Team and others. I don't think we're great at those cross-party efforts, though. A more joined-up approach might save everyone a lot of expense & heartache!

Thanks very much for the comment & link, MD.

Cassandra said...

Man, that's hard and super frustrating. I know what it's like to feel invalidated with a chronic illness (or three), but taking meds that you're not supposed to and making yourself worse and REFUSING to accept the help that's repeatedly been offered… I just can't sympathize with that. I've had to fight tooth and nail for every bit of help I've gotten, so to see someone wave away help that's being held under their noses is absolutely infuriating. I understand that anxiety affects people in weird ways, and can be totally crippling (been there, done that), but at some point you have to realize that a change is necessary.

For your sake, and his, I hope he comes to that conclusion soon.

Spence Kennedy said...

Jack - Definitely! Chasing our tails (and his). Round and round and round. :/

Cass - He's non-compliant and no mistake! All driven by anxiety, of course - and exacerbated by his isolation. It's a horrible situation for him. A form of torture, actually - convinced he's going to die from shortness of breath, when all he needs to do is put into practice the guidance he's been given (and take the meds in an appropriate way). It's a mental health problem, but Joseph doesn't see it. And as long as he continues as he is, living in that grey area between mental capacity and compulsory section, I can't see an improvement any time soon.

Kathy said...

(just found your blog) and wondering why nebs are contranidicated in a COPD pax? google is not very enlightening here and my experience with asthma (COPD-lite) is absolutely the opposite...

Spence Kennedy said...

Hi Kathy

They're not contra-indicated. It's just with this patient, he was using them inappropriately due to anxiety - and all it did was exacerbate his feelings of heart racing, tight chest, SOB etc.

Cheers for the comment! Thanks for reading :)