Left At Home

First off a private message – Thanks Darren, the gift is very much appreciated, you shouldn't have.

I've written a bit about not wanting to leave people who I am called to at home, but there are times when for one reason or another patients do get left behind.

Take for example the fifty year old woman who had supposedly suffered from a stroke. We had turned up and she was lying on the floor not talking to anyone. Her husband and son were standing over her, obviously worried.

It was tricky to assess her – English isn't her first language and she wasn't speaking much anyway. So I checked all the usual things including some basic neurological tests. Everything was normal.

There is a thing that some people do, some cultures more than others, when they find themselves losing an argument they 'collapse'. Normally you can tell these straight away by the telltale symptoms of faking a collapse such as keeping your eyes screwed shut when I try to lift an eyelid.

This was the feeling that I had from this woman. She didn't want to go to hospital and the son was very sensible – I explained everything to him and he agreed to keep an eye on his mother. You never know when something simple might turn out to be some bizarre illness.

So she was left at home.

The other person that day who I left at home was a young woman who has a terminal disease. We arrived and the FRU responder had already treated her. Luckily the FRU pilot knew her, apparently she never wants to go to hospital (and to be honest I can't blame her) and will normally recover somewhat after our treatment.

The slight problem with this is that she had been drinking a bit, did this reduce her ability to give or refuse consent? I'm sure that this was one of those jobs that if something bad happened to her I could be hauled over the coals by my management or the coroner.

but…there was someone with her, she seemed competent enough to me and there was a documented history of her not wanting to go to hospital, so I made the decision not to try and have her dragged off against her will.

Once more, I do things so that I can live with myself. Even though I'd rather take people to hospital so they can see someone brighter than I.

6 thoughts on “Left At Home”

  1. I'm a community paramedic in a FRV . We are sent to every type of job and only get backup when I ask for it. We take or send people to hospital if that is the most appropriate action , a lot of people are left at home if after a GOOD examination they may only need paracetamol or reassurance . Always “safety net” by writing on the Report Form ” call us , a GP or NHSD if you are at all worried later on.

  2. Well, A&E isn't a great place to be when you're feeling crap and already know the reason why.Especially if you have reason to believe that all they can do is, after a few uncomfortable and highly boring hours, tell you to make an appointment with your GP in the morning, and discharge you, leaving you to figure out how to manage the unplanned journey home at 9pm with no car, no money for a cab and no energy/capacity to walk.If it's really nothing unusual for you to have fallen over/passed out/lost an arm, then better to cut out the hospital middlemen and just have the ambulancepeeps tell you to find someone you can spend the next 24 hours with, and to make a GP's appointment in the morning, or call them again if it gets worse.Unfortunately it's hard to find the right point in a friendship to say “If I do this, this or this, please don't panic, don't call ambulances, don't try to manhandle me to hospital, it's nothing to worry about, just get me some water and my handbag.” It's hardly a good opening gambit, you know? “Fancy a cuppa” goes down much better.

  3. Klondyke sorry to disagree with you but its my experience, and many others upstream from the Thames from London that NHSD ( NHS Direct a form of Nurse led Telephone advice service ) are about as much use as a chocolate tea-pot! So many of my patients say they have spoken to NHS Direct and have mentioned the word 'chest' and 'pain' in the same paragraph only to find two ambo bods at their front door. Or they tell the nice nurse that they had an angina attack 10 years ago but now they have a painful wrist. Only to get big yellow ambulance with accompanying crew with a dispatch code that states the call has come from 'a third party caller- not with patient'. They are often referred to here as NHS Re-Direct.

  4. That happened to me – 13+ years ago, cracked a rib near my breastbone in the moshpit at Brixton, and let someone (who was in love with me, and therefore paranoid about my preciousness) talk me, over the phone, into going to my local A&E.Nagged, cajoled, bribed, threatened with dire tales… so, I did.

    Sounds good, except it involved me – car-less and skint at that time – painfully lugging an overnight bag on foot 2 miles to the hospital, only to sit in reception for 3 hours, get prodded about a bit and told it's not even worth doing an X-ray (which I agreed with) and sent home…

    And then of course, walking 2 miles, by then more like 1am, with a painful upper body, in the pouring rain – I'd have been far better off going to bed with a f***ing paracetamol, because I'd felt the bone crack, and apart from the obvious pain at the site, hadn't coughed blood, felt dizzy, had newts coming out my nostrils, or anything truly worrying.

    It was honestly one of the bleakest evenings of my life, and the only good to come out of it was, it hardened my faith in my own judgement.

    So to sum up, I can see how people get ambulances shoved upon them, when even if they need some EMT treatment, they don't need a pointless trip to hospital and would in fact suffer more if forced to go.

    Another good call it seems, Tom.

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