Picture the scene.
You are in a house that hasn’t been cleaned in years – the walls are filthy, there are carpets rolled and stacked in the stairways. The occupant, our patient, lives alone in a tiny room at the top of this house. His heating is a paraffin burner and there are half full cans of fuel dotted around the room. Actually, I nearly hang myself on a bit of string stretching from one corner of the room to the other. I can’t see the carpet because of all the rubbish on the floor.
Our elderly patient has obviously been wearing the same clothes for weeks on end.
The patient’s ex-wife is the one who called us, she is pawing at me, telling me not to let him die. He isn’t going to die today, his blood sugar is low and he has had a diabetic collapse. We give him some sugar and he comes around.
There is something ‘not right’ about him. I don’t think that it will be safe to leave him here, besides his diabetes there is a good chance that he’ll burn the place to the ground one day. He seems somewhat confused, he won’t talk to me although his wife is clear that he can speak English. We’ll need to take him to hospital.
So it boils down to ‘capacity to refuse’; does he have enough presence of mind to refuse treatment and be left at home. I tell him this, and he doesn’t answer me. I explain that if he wants to stay at home he just has to talk to me – he just says ‘No’. We recheck his blood sugar level and it is back to normal, there is no obvious medical reason for him to be ignoring us. I consider that he may have something neurological going on inside his head, that or psychiatric.
Without him answering me, I can’t tell that he has capacity to refuse. This means that in the patient’s best interests I can forceably take him to hospital.
I don’t like doing this.
Actually I REALLY don’t like doing this.
So after half an hour of trying to persuade him, during which he blatantly ignores me we realise that we will have to get him out via other means.
If his house wasn’t such a tip we could maybe wrap him in a blanket and strap him to our chair and carry him out. But the amount of rubbish in the stairwells means that we’d probably break our necks.
So we have to try and drag him out. This is also something that I don’t like doing. It’s night-time, there is no-one else around besides the police at this time of night. I really hate getting them out in order to help us get a sixty-five year old, five foot nothing tall man out of a house.
(That and they’d probably send two five foot nothing female police officers to assist us – which damages my ego even if I do know that either of them could kick my arse without breaking a sweat).
So we drag, pull and try to get him to let go of the door handle – he finds that just by sitting down we are unable to move him. We get to the point where I’m considering doing painful things to him out of spite. Then the FRU (who was first on scene and had left to do his paperwork) returns. I explain what we are trying to do.
“Mr Smith”, the FRU says, “come downstairs into the ambulance”.
And of course he does.
So then he sits happily in the back of the ambulance, still ignoring us and we take him to hospital.
We tell the nurse we handover to about the situation at home, we tell the nurse in charge of the department – I advise them that he’ll need some sort of input from the Social Services before he gets discharged. You know, the sort of thing that I would do as a nurse.
So when we see him being wheeled out to the private ambulance to go home without any apparent social service input we fill in the LAS ‘Vulnerable adult’ form detailing the self neglect and the fire hazard. We’ll make sure that he gets help.