Pitch Black

It was supposed to be a simple job, pick the little old lady up off the floor and either take her to hospital, or leave her at home. Unfortunately there were a number of complications.
The first complication was that there wa a powercut in the area. As it is the middle of the night the whole place was pitch black. We have lovely torches in our ambulances. Well… It turned out that we had 'A' torch. It wasn't working.

Brilliant, all our actions would be under the light of our pentorches.

We managed to find the house quite easily, there were two candles in the window. The paitnet herself doesn't open the door, she's too scared. Instead one of her neighbours has a key and lets people in. He wasn't much younger than the patient herself and had been drinking a little.

We arrived and, under feeble torchlight, managed to determine that she had a black eye, a cut on her shin and a small cut on her face. She refused to go to hospital. All she wanted to happen was to be put back to bed.

I looked around, I couldn't see a bed.

The patient sleeps on the sofa because she is too frail to climb the stairs to her bedroom. So she puts lots of pillows on the sofa and throws a blanket over herself. Because of the powercut she didn't have any heating either.

Like Ms Nightingale before me, this (ex)nurse was forced to clean and dress the patient's wounds under candlelight – my crewmate did a good job of holding the candle only dropping it the once.

Still the patient refused to come to hospital.

I asked her if she had any carers, she told me that her son comes every couple of weeks to stock her cupboard with food, but other than that she has no social services/care input at all. This is partly why she was sleeping downstairs on the sofa, she hadn't been offered to have a stairlift put in.

I wasn't very happy to leave the patient at home, but she had the capacity to refuse treatment so I had no choice. In a case like this I like to have a GP come to visit to make sure that I haven't missed anything important (I know my limits). Unfortunately the emergency GP couldn't give us a time when he would be able to visit – as the keyholder was going to be going to bed (it was edging on to 11pm), there would be no-one to open the door for them.

So with some regret I arranged to have the patient's own GP come out to visit them in the morning. It was basically the best I could do for the immediate future.

Then the patient needed to use the toilet, my (female) crewmate took care of this for me (for which I'm very thankful). It was about now that I realised that the light on my pocket pc/camera made a really good torch.

For a longer term look at her care I filled in a 'vulnerable adult' form. This got faxed off to our Control who then deal with any concerns that we raise. In this case they will speak directly to the local social services and hopefully they will provide some help to enable this patient to live safely in her own home.

I have to do all this, it's how I get to sleep at night. If I'd just left her and crossed my fingers then I'd be worrying for days about her. By doing all the above I've done all that I can, and it is now up to the GP and Social Services to do their job.

A conscience is a terrible burden sometimes.

Of course it would have all been a lot easier if there hadn't been a powercut, if it wasn't during the hours of darkness (when the regular services all vanish) and if she opened her own door.

Actually it would have been much easier if I'd been able to persuade her to go to hospital.

36 thoughts on “Pitch Black”

  1. Dear Worrals, (How are Biggles, Algy, and Ginger these days?),In this particular case, the lady – a sociable soul – had no family nearby, and no “direct” family at all; she was heart-sick of being alone. There was no pressure; she was happy to move. My own mum, on the other hand, is coming 91, and has been dealt a really good hand in life's lottery. Despite a shoulder which hardly works, and a GK-nailed hip, she is still a “going-about wee body” (Self-explanatory Scots expression). She is mobile, she has good neighbours, and she walks at least a mile a day when the weather is good. We all keep in touch with her, and we visit when we can. (One in Spain, one in Ulster, one in Canada, and me in Scotland) She still has living friends whom she meets for tea in Edinburgh's “posh” department stores, and her mind is still annoyingly sharp. Other than the last attribute, the patient in the story had none of these.

    Horses for courses.

  2. Reminds me of a job I went to last year. A neighbour who always bought fish and chips for his elderly friend next door, could,nt get an answer from them. When he went round the back and looked through the rear window he could see her collapsed on the floor unresponsive.On our arrival we had to break down the front door to get to her. Going through the main hallway and past the front room, everything about the house looked normal…until.

    In the back room the patient was lying face down in pure filth and lots of cat sh*t with no heating/fire and only a bare light bulb switched on.

    Thinking the worst we approached her and felt for a pulse at which she moved! After gently coaxing her round we sat her on her one grotty armchair. She was in a real mess, no obvious injuries but very bad leg ulcers and appalling dirty soiled clothes. Turned out she was an ex midwife with a previous fearsome reputation. She was refusing to attend hospital point blank.

    A quick search of the house uncovered 17 cats and masses of cat sh*t all over the place apart from the hallway and front room which were immaculate.

    The neighbour was very distressed at not realising the state she lived in. So I called the out of hours Social Services team (it was nearly midnight). Eventually getting in touch with the on call team leader I relayed my fears and concerns for the lady. To my amazement he said that he was busy and could the neighbour take her in! This was not possible as he was due at work in a few hours time and anyway she was “off legs”.

    I made my concerns known to control and asked for a time scale for a response from the Social Services which was “….sometime tomorrow”. We gave the lady all our blankets off our vehicle and wrapped her up and made her a cup of tea, the neighbour secured her front door and we left completing an Incident Report back at station. Sometimes people do slip through the net. As you say…if only she,d gone to hospital then at least she would have been looked after in the short term.

  3. It's what makes you the good person you are. You care about people, something we need more of in this world. It's appalling that you, as an EMT, have to perform all of these steps while it seems that no-one else is willing to make the effort but yet again, you've done everything you can to ensure that someone gets the help they need.

  4. I don't know what sort of torches you normally use, but anyone who has ever been camping or caving could tell you that you need a head torch, preferably one of the tiny LED ones. Lights where you're looking, keeps your hands free.

  5. Its the good people like you that we realy on to help us in our hour of need, but i do understand about people not wanting to go to hospitsl its called independance and it runs very high in a lot of the older generation my neighbour has been ill for some time but wont accept help its just as well her sons help her a lot or she would be on her own but you can help if they wont let youJill

  6. On the other hand…..We were called by the police to a small house on a council estate in a nearby village; the resident – a lady in her late 80s – had activated her “Carecall” alarm, and the police had forced entry. The lady had fallen out of bed about two days previously and had lain on the floor since then; the duvet had fallen with her, and she had wrapped herself in it. Eventually, she had managed to knock over the bedside table, and get hold of the alarm button. However, when we arrived, we found the lady in bed drinking tea, because……

    After breaking in, the two police persons (oh, all right, policewomen) had first ascertained that the lady was uninjured. They had then: cleaned her up, found another duvet, stripped and re-made the bed, and put the patient back in it – all before calling us! The soiled bedclothes and clothing were going around in the washing machine.

    We felt the lady was “at risk” and so persuaded her to come with us; she was a “social” case, and therefore not really grist to A&E's mill, but we were are fortunate in that nearly all of our Casualty staff are angels, and she was admitted overnight. My partner spoke to the patient's GP in the morning (the hospital had apparently already called); the lady was moved to the community hospital that day and on into residential care within a week.

    The joys of rural ambulance work.

  7. TomI am a VERY regular reader, but a rare commenter (I have your book ordered for Christmas by the way!) Thanks for a very interesting and fascinating read.

    As for using your PDA as a torch – I do this myself – there are free utilities out there to do just this very thing – try these links to see what you think….

    http://www.pocketgear.com/software_detail.asp?id=2954&associateid=9

    And

    http://www.pocketgear.com/software_detail.asp?id=11191&associateid=9

    Hope this is of help to you

    Steve

  8. In our rural area, this is one the the biggest problems we have. There are so many elderly people living in truly horrible conditions with little or no help or support system. Society really does abandon its old people. The sad part is that there is very little that we can actually do if there's no emergent issue. Even persuading the patient to take a ride to the hospital doesn't gain much. They're often home within 3 hours and get landed with a bill from the Ambulance service, a bill from the ED AND have to pay a taxi to get home if they don't have a family member.Many people don't have health insurance at all, and don't have regular healthcare to begin with. Many will not eat so that they can save money to buy their meds, or take their meds sparingly to afford food or heat.That's an additional complication with the lovely healthcare system in the US. The NHS may suck sometimes, but it does have some (minor) financial benefits to the patient.

  9. A conscience might be a terrible burden, but it allows you to hold your head up and not be another slimeball hitting the Tennant's Super, or your loved ones, or innocent people in the street, so as not to have to face the self-disgust.JMO.

  10. I hear you Ratchick, but outside the caring professions, it's hard to do anything. We could all be walking past the front door of someone like that every day on our way to work or the shops, and not know, and unless we start randomly bothering elderly people in the street (which, potential for IMMEDIATE abuse) then it's hard to know who needs help on your own street.My view would be, look after your own family, and any neighbours that'll let you. But more than that is truly difficult, because elderly people are often so defensive or proud (and understandably so) or self-effacing that it's hard to find out what they really do need. And I donate to Help the Aged, because they seem to do good work (informed opinions on that welcome?)

    The gulf between the fit young people who call an ambulance for a broken toe, and the frail elderly ones who will die of the cold because they don't want to claim any help, is further proof that the human race have not developed our intellect as far as we like to think.

    We're all just lemmings in joker's hats, jingling our bells and waltzing merrily towards the cliff edge, each thinking our own dance is the best one to do….

  11. I was going to say that in Britain, unlike the US, at least you have social services that you can hope will help matters. But VTEMT beat me to it and did a much better job.

  12. I have read some of your posts and replies with interest. Especially comments regarding other Healthcare professionals, just a quick question then does the LAS now have a code of conduct?I ask this as someone who worked for the LAS for six years and now has moved into Nursing.Regards

  13. But this is why the elderly don't want to ask for help. They like their independence and don't want to go into residential care. I'm proud of my Gran who is still in her own home at the age of 87. Long may she continue. The bad thing is, my Mum had to fight Social Services tooth and nail to get the care/assistance she is entitled to. What happens to all those who don't have a Linda Snell type family member (sorry Mum)?

  14. Would it really have been better to take her to hospital?Would the hospital staff have been aware of the issues, and dealt with them as competently as you did? Would they have known that she was sleeping on her sofa because she could not get up her stairs, that she was too scared to open her own door, that

    Why would someone refuse to go to hospital? Well, I believe that, while anyone is permitted a trip in an ambulance if they demand it, they are then charged for the privilege. I may be wrong, but if I am, then it's probably a common misconception.

    And then the stay in hospital will be deeply unpleasant, even traumatic. Mostly you'll spend it on hard chairs in a cold waiting room, in a strange place surrounded by scary, aggressive drunks. You'll sleep a high bed that you might fall out of, with a cold metal frame. Everything will be hard, clinical, sharp, loud, bright, cold, fast, and uncaring, not like the soft, warm, familiar and unthreatening furnishings at home. And bad things happen there – not just MRSE, though that is a risk. You go in with a bad back and come out diagnosed with a deadly ailment and a leg chopped off. People with the power to get you “put in a home” will examine you, will judge your fitness to survive in society, and may find you wanting.

    Is that a typical picture of UK hospitals? Maybe not, but it's probably a typical picture of people's fears of them.

  15. Yes but that's a tad different to being on a limited income and looking at six year's repayments for one emrgency trip + treatment. And most Americans get taxed in the >20% range, just like us.

  16. Tom,It is your *burden* that makes you the wonderfull human

    being that you are.

    and why people like me are hooked to your blog.

    BTW I was a night care assistant for 8 years, mayb i was

    unlucky where i worked, but i wouldn't wish it on any realtive.

    keep up your good works, hold your head high.

    best wishes

    xx

  17. Is this the kind of situation where one of the Third Sector organisations can be called in? Would Help The Aged or a similar charity be able to provide some sort of short term (or even long term) support to this lady?

  18. Hi Tom,Great blog.

    I would just like to support the guy who said you should buy a head torch. I'm surprised they don't issue you with them already. My brother put me on to them and I actually bought mine in London at Ellis Brigham in Covent Garden, its a Petzl Tikka Plus, silly name, great gadget, cost 30 quid but that was 6 months ago so probably cheaper now. Runs on three AAA batteries for many hours as it uses LEDs. It's brilliant for so many things, powercuts obviously, crawling round the back of the TV or computer to connect wires to the right sockets, working on the car, walking to the pub along unlit roads at night, etc., and I would think, bandaging old ladies in the dark.

  19. The ideal solution would be more sheltered housing like my Nan went into last year at the age of 98. She's got her own flat and front door but there's a warden on call 24/7 for when she needs it – reassurance for her and for us. The flat is also designed to be 'senior friendly' so she's less likely to have accidents despite being a little wobbly on her pins these days. Together with a daily 15 minute check-call and a hot meal once a day from meals on wheels this is all my proud old gran needs to keep her independence and dignity. When I grow up I want to be just like her 🙂

  20. Bleedin' newbies – you better keep that 'sense of humour' in check.Besides, there was only one torch, and no spare. Make ready have already put in an order for a new one.

  21. Thanks Steve. The thing is, my PDA has a camera and a 'flash' on it. The flash is actually an incredibly blinding torch that would burn your retina if you get too close to it. So I can use that rather than the torch utilities you mention.(Although I did have one of those utils when I was stil using my Dell PDA)

  22. Not as far as I know…Nothing formal as far as I'm aware, Paramedics might have one as they are part of a 'professional body'.

  23. “…apart from all their working lives in the form of National Insurance contributions, of course…”Ummm not really Donkey – National Insurance pays for your pension (or more actually it's supposed to!) – not for the NHS, which is funded from normal taxes.

    Steve

  24. I think perhaps you misunderstand me. I wasn't suggesting that people should pick random old people on the street to make sure they're coping! Believe me, I know how hard it can be to get the care where it is needed – but you raised exactly the issues that I was referring to about people not caring.People don't look out for their families and neighbours any more. Of course there are exceptions, but how many people actually know the names of their neighbours any more, let alone watch out for them? And these days, family has changed too – people live farther away from elderly relatives, and don't necessarily have the ability to watch over them or help out all the time.

    However, with friends and family with social services and care work histories, some of the stories I've heard make you cry. Not the ones of people who can't manage to support their elderly relatives alone and need to ask for help. But those who don't care, those who actively resent, neglect and abuse needy elderly relatives. Those people who are paid to look out for them (e.g. care workers, social workers) where their indifference constitutes neglect and abuse. Where someone can't get a shave for two weeks because they say they're too busy. Where they don't get to eat because no-one will help them.

    There will always be those who put up a brave facade and who will refuse help all the way. That can be difficult for everyone involved. But if there were more of a neighbourly feel in the world these days, I suspect a lot of it's problems might be reduced (not just this). However, I might just be harking back to the “good old days” I can vaguely remember from childhood.

  25. Dear Kevinmillhill,I'm sorry if I sounded judgmental. I assumed your particular old lady got the right treatment, but there seems to be a horror of residential care that leads to amazing levels of help-avoidance from the elderly. I don't know what the answer is, especially when (see further up the page) there are cases of neglect and abuse so bad they make you cry.

    Oh, and Biggles and Co are doing just fine.

  26. I'm currently on Pharmacy. I love it, and sometimes feel like I make a difference to people's days. But I got really frustrated yesterday [I have only been on the job for 3 days] because nothing went right, I couldn't pronounce any rugs right and just felt like I'd forgotten anything I'd learnt the previous week. Today was better as I actually did something right and got a response from people. I know I'm only young and just starting out but I wasnt to know basically everything even now. And sometimes it's making my days bad!I'm unable to get a Placement with the Paramedics; Insurance!

  27. Dear Worrals,Thanks for your time. I've thought this one through, and discussed it with many over the past few years. (That's what happens when you're getting old and rickety (I am) and you see what this job shows you.) The care homes hereabouts are nearly all excellent; if they were hotels, I'd have to pay serious money to stay in them, but – as everyone knows – that isn't the point. I, and everyone I know in the local healthcare industry (including the workers in the homes themselves) fully intend saving up our sleeping pills, pieces of rope, or lengths of hosepipe (well, not if your car has a catalytic convertor) rather than become residents. Throughout our lives we depend on others in one way or another; so I feel that the issue isn't so much one of independence as of social relevance – once you feel that you are no longer contributing, and that (worse still) you have become a burden, life becomes intolerable. I'd happily lie all day on a Pegasus Bed, with tubes here, there, and everywhere if people were still seeking my opinion or asking me to do mental work for them; look at Prof Hawking. But to be helpless – and irrelevant. No, I'd rather be dead.

    I live in a cottage, 1000yds from my nearest neighbour; I intend my epitaph to be “Yes, we thought we hadn't seen him for a while, but we thought that the funny smell was just the drains.”

  28. Really? I've learnt something then! I'd always assumed it was NIC that paid for the NHS, but I must admit I can't remember ever bothering to check! (“,)

  29. Sadly, you're not the only one. As I said, some of the situations I've heard of are enough to make you cry (or explode with fury). As someone else said, just about everyone I know who deals with the current system has every intention of ending things before they become dependant on that kind of care. And while there are some amazing residential/nursing homes around with great staff, there are plenty more with disinterested, overworked, understaffed and/or untrained staff.The two areas of healthcare probably more neglected than any others are psychiatric and geriatric services. If you have a mental illness or you're old, you can easily end up with second class care. God forbid you have both – you might end up being isolated from your family for 6 months because they literally lose you and don't know what care facility you've been moved to (one my family experienced personally).

  30. Ooops, wasn't misunderstanding, was more agreeing. And hypothesising. :-)Be quite funny if we could legally pick people up randomly from the street though – “So, Mr Gorgeous, you say your girlfriend meets all your needs? Aha, but I know better!”….

    Getting back to serious mode, I agree w/the rest of your post.

    But it's also up to us (as the ones with reasonable mobility etc) to be approachable and neighbourly enough, and I'm not sure I've always been that way in my 20's, so now am working more to do so.

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