We have a number of policies concerning the care for patients, what we should do to them and what should happen if we don't take them to hospital. Sometimes we come across situations that fall outside our policies – it's for that we have to rely on our experience and our common sense.

We were called to a sixteen year old with 'learning difficulties' who was refusing to eat. The address seemed familiar and, sure enough, as we pulled up outside the door I recognised that I had been here a few days ago.

On that first visit the girl was complaining of leg pain, she was lying on the floor and very upset. I'm no expert but it seemed that the mental age of this girl was somewhere around that of a four year old. She was looked after by her mother, the father hadn't been seen since the birth of the child. She was screaming in pain and seemed, at first, to be inconsolable.

That all changed as we looked after her, she brightened up and was laughing and joking with us by the time we reached the hospital. The pains in her legs seemed to have vanished. She doesn't have good mobility at the best of time, so it's always hard to assess any change.

So we were returning to the same girl. This time her mother was telling us that she wasn't eating, the girl was lying on the same spot on the floor covered with a blanket and crying. As soon as we walked into the room a large grin broke out across her face and she started laughing. It seemed pretty obvious that the girl wasn't sick.

Her mother told me how the girl had cried when she had to leave the hospital. She had returned to hospital twice more in the last two days, so it seemed that this was a repeating pattern.

It seemed pretty obvious to me that the girl was manipulating her mother so that she would go to hospital where she was the centre of attention. Of course this was all assumption and I wondered if there was any way I could get proof of this.

I get on really well with the receptionists at our local hospital, they are all *extremely* lovely people. So I phoned them up and asked me what the girls previous medical notes said. This is probably going against a whole load of guidelines and protocols, but I needed to know if, by taking the patient in, we would be reinforcing her behaviour.

The medical notes basically agreed with my assessment of the situation – she had told the doctors that she liked being in hospital because, 'home is boring'.

The hospital was arranging for a follow-up appointment with the paediatricians and were also liaising with the social services to get the mother and her daughter the help that they needed.

So after some discussion with the mother we came to an agreement that we would leave her daughter at home, her mother would keep watching her and we would see if it could break the pattern. We agreed to help the mother wash her daughter for bed, even though her daughter was now throwing a 'bit of a strop' as she now knew that she wouldn't be going to hospital.

So she was left at home, a risk for us because if she were to drop dead it'd be us to blame – even if it were for a completely unrelated cause. But I'm of the mind that sometimes you have to be cruel to be kind.

(And kudos to my crewmate – as the female in our party got the job of helping the mother clean her daughter while all I had to do was talk on the phone).

We had another 'returnee' that same night. A twenty year old man who called us with abdominal pain. He didn't tell me that he had been to the hospital earlier that day but had left after ten minutes. I think he'd have a bit more waiting to do after that particular abuse of the service…

10 thoughts on “Returnee”

  1. Wow, nice going on catching that! I would have probably missed an important even like that and just to cover my butt would have taken her to the hospital (you don't get much legal reprieve here in the states either…) Hope the rest of your shift went ok!Eug

  2. It's all a game to her. People with learning difficulties can surprisingly pick up patterns of behaviour very quickly. He mother is a hero too – having to tolerate her 27/7.Tom, You are not paid or appreciated enough. Your writings make more impression on than the writings of any any spin doctor.

  3. I have two sisters who are disabled. They're lates 30s/40s but mentally about teenage.If we try and go on family days out they kick up a hissy fit and scream. One sister won't go through doors of buildings because it “might be dark” on the inside. However, if someone who works in said building were to come out and say it's alright she will go through.

    It's attention seeking because they are bored with the family they've been with all their lives. They want to have a social life and friends outside.

    However, with the closing of many social groups for disabled people like this due to lack of volunteers to run it, or funding, there is less chance.

    The other trouble is that it is rare to find a doctor or a social worker who will understand this. The sister that won't go through doors is a hyperchondriac. Dizzy spells. tummy aches. back ache etc. Doctors only throw pills at the situation and the social care has given up because there's nothing more to do for her that we aren't already doing.

  4. In an ideal world they wouldn't need to rely on “special” segregated social groups that are solely for disabled people, but would be accepted and supported within regular social groups like sports clubs, yoga classes, art groups, book circles, photography clubs, or the local pub. 🙁

  5. She has learning difficulties, she doesn't see the world through the eyes of a 'normal' 16-year-old. The kid probably doesn't know that hospital staff are overstretched, she just sees the hospital as somewhere she can go where she knows people will be nice to her.

  6. I agree batsgirl. In my 20's I attended college and there were some students there who were physically not much younger than me but had a much younger mental age. They seemed to fit in very well, and obviously feeling part of a group in this way benefited them greatly – and everyone else. I think people need to learn that everyone is different and although some people have limitations they should still be valued as individuals.

  7. Aaah the frequent flyers. They provide such us with such different look on society, whether they are regular callers for good, bad or indifferent reasons. Sounds like you were working hard to make sure the girl and her mother got the type of care they need, instead of just taking easy way out, and running them up to hospital again.

  8. Very much agreed. I went to dance school as a young teen and we had a girl with Downs Syndrome; she was in her late twenties but had the mental age of about a four year old. Still, we all loved her to death, she was better than all of us at remembering the steps and she always looked so happy when everyone said hi to her.

  9. In EMAS we have people (like me ) who go on a course and learn to examine a patient in great detail then make a differential and a working diagnosis . After that we (I) make a decision as to the most appropriate course of action for that person . They may be referred to care teams or other agencies or told that there is nothing wrong and they should stay at home and not drink so much!All the examination and findings are documented in great detail and , here is the “safety net” you write on the form “If you are very concerned about your problem later you should contact NHSDirect, Out of hours GP or call 999”. Our Service is committed to reducing inappropriate A&E attendances br 25% also as an FRU if a person needs to go to hospital and I know that they will sit in an ambo , they go in my car, the whole point is to keep crews free.

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