Some jobs are just *hard*, not because the patient is heavy or even particularly ill but just because of the circumstances.
We were called to a care home, one of the good ones in the area which deals with people with learning difficulties, ('learning difficulties' is one of those politically correct terms that seemingly came from nowhere as a way to describe people who we used to call 'mentally handicapped'). The patient was a 50 year old man with a nasty case of pneumonia, the GP had been out to see him and had decided that hospital treatment would be in the patient's best interest. We were called to transport the patient to hospital.
Our problem was that the patient point blank refused to go to hospital. We tried persuading him, the staff tried persuading him, I tried reasoning with him and the staff even tried bribing him. I may have even thought about threatening him. He would sit there, coughing occasionally, and refusing to go.
What we have to determine in a case like this is if he has the 'capacity' to refuse treatment. I often tell patients that I'm not allowed to kidnap anyone and this is true. If you were to take a fatal overdose and refuse to go to hospital knowing full well what the overdose would do to your body then I couldn't force you to attend hospital*
However, this relies on the patient having the capacity to understand what a lack of treatment would do, in this patient's case I wasn't too sure. He'd been in and out of hospital for much of his life, he knew what would happen should he go there – but did he have enough understanding that without treatment there was a reasonable chance that the pneumonia could kill him?
If the patient doesn't have capacity then we can force a removal to hospital, normally with police assistance – this is something that we don't like to do as it isn't very nice on the patient, nor on their relatives. So we do everything we can to avoid this. It's not very good to have half a dozen coppers frog marching a sick person out to an ambulance.
Well, in situations like this there is/should be an officer around to come and advise us on what to do. It also means that we have someone who is paid more than me taking responsibility for the patient, so should that patient die I know I've done everything I can and it's the officers 'fault'. So I trotted out to the ambulance to radio Control to find us an officer.
I was waiting for them to come back to me when my crewmate, wheeling the patient on our carry chair, came trundling out of the house.
I was astounded, it had looked like the patient had no intention of travelling and yet my crewmate had managed to get him out of the house. In awe I asked him how he'd done it.
He told me that the carers had told the patient that they wanted to change his clothes, he did have a bit of a problem with drool being coughed down his jumper. They had stood him up, changed his top, put a coat on him and then sat him straight back down into our carry chair. Good thinking on their part and on the part of my crewmate. As he was wheeled out he realised what we were doing, he wasn't hugely happy but seemed resigned to going to hospital.
It's not nice to take someone to hospital against their will, but he really needed to go. Some people might think that it's bullying to do this, but without the mental capacity to understand what might happen to him, we sometimes have to be cruel to be kind.
*A simple version and there are tricks around this, some of which I've mentioned before.