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…