It's cold and dark, and for the next few days I'm working nightshifts, this will either result in a 'sense of humour failure'* on my part or I'll suddenly find myself sobbing in the corner of the room. Place your bets on what it'll be…
With it getting cold it becomes 'Homeless season' for the ambulance service. People who are normally happy** sleeping rough, drinking the day away on a park bench and having a nap wherever they can suddenly realise that it gets a bit chilly and that their normal lifestyle is a bit… uncomfortable.
So, as a service, or at least in my part of the world, we find ourselves being called to more homeless folk than is normal, at the risk of sounding politically incorrect let me just define 'homeless' for the purposes of this article as those people who are long-term homeless, normally due to alcoholism (caused in some part by the lack of 'wet' hostels for them) or the mentally ill (caused in some part by Thatcher). I'm not referring to the homeless who seek to improve their condition, but instead the outliers who either refuse help or who cannot keep the rules that are expected of them.
An example of how things change with the weather – in the last cold snap I was queuing up to hand over my homeless patient, also queuing up were another three ambulances with patients similar to mine. One was incontinent while waiting and another had been incontinent in the ambulance. Actually incontinent is perhaps the wrong word, one of the men whipped out his 'member' and urinated up the wall of the department.
Welcome to the world of healthcare.
But, you know, the homeless are people as well and they deserve as much care and consideration as anyone else, even if their sole contribution to society seems to be limited to turning cider into urine.
My patient, for example, told me that he had been vomiting blood – something that can be the sign of something serious, especially in the alcoholic patient. I listened to his history in the back of the ambulance, took his vitals and started my paperwork. I looked him up and down and wrote 'Patient complaining of vomited blood, no evidence seen'.
I stopped and looked at what I'd just written.
There wasn't any sign of blood or vomit on the man's clothing so what I had written was factually true. What stopped me was wondering if I would have written such a thing if I'd picked this patient up from a clean house? If he hadn't been an alcoholic?
I'd treated him with respect, I'd done all the same things that I would have done for anyone else complaining of the same thing, but still I'd written those words on my report form.
I may as well have written 'patient says he vomited blood but I don't believe him'.
So we took him to hospital. When we got there I started handing over to the nurse, as soon as I mentioned the vomiting of blood she turned round and asked me, “Was there any evidence of this?”.
This isn't a 'harsh' nurse, she's pretty good actually – caring and considerate and definitely hardworking, yet she'd also asked me the same thing that I'd written down on my paperwork without thinking.
The patient went out to the waiting room.
I wonder if he would have been put out into the waiting room if he hadn't been homeless.
It's not a criticism of the nurse, trolleys are in short supply in the A&E department and the handover nurse has to make decisions between who gets to stay in the main department to be seen soon and those who can go out in the waiting room. While the various professional organisations that look after nursing and ambulance people would have us treat every word that comes forth from the patient's mouth as complete truth, there comes a time when you start to watch for people trying to 'trick' you for whatever reason they have.
It might be the junkie looking for narcotics, it might be the person playing up their illness in an effort to get seen sooner or it might be the person who lies about not being able to get an appointment at the GP as the reason for dialling 999.
One of the 'classics' is the patient who tries to convince you that their pain score is 'ten out of ten', and as the NMC*** say, 'pain is what the patient says it is', which is hard to believe when the source of their pain is a tiny shaving cut…
While I can normally tell a lie, I'm more than happy to give the benefit of the doubt to a patient, regardless of their background. I'd rather give analgesia to a junkie than withhold relief from someone in genuine pain.
Which is why I wondered why I wrote 'no evidence seen' on my report form.
*Sense of humour failure is a term that some people use to indicate losing their temper. I may well be using it in a similar way…
**'Happy' is perhaps the wrong word here.
***Who live in happy fairy land it would seem and when I was a nurse seemed to publish a lot of twaddle about any old rubbish. They may have got better. I doubt it though. They'd be very unhappy about me calling everyone either 'Luv' or 'Mate' for instance.