by Stuart Gray
An American tourist summed it up for me as I was kneeling over a vomit-streaked girl in Whitehall a while back. ‘Jeez,’ he said. ‘You have a lot of drunk people in the UK, don’t you?’
We do, and it’s not just bad for the drunks, or for tourism. It’s also bad for the NHS - it’s costly, of course, but it’s killing morale. Not many of us joined this profession desperate to wade through as much drink, vomit and stupidity as we could. Most of us are here to care for people who really need it, not selfish self-harmers who go out of their way to blitz the system with their lifestyle problems.
My colleagues and I stand in the wasteland of other people’s lives and watch as they destroy themselves in a bottle.
OLD
WE DON’T TAKE care of our elderly in this country. Many people live in the most appalling conditions - either at home, or while being abused and ignored in the less reputable ‘care homes’ - and very little is done about it. Apart from the odd Panorama-type programme to highlight the atrocities faced by our elder generation, not much is even said, publicly.
In 2003, the then Health Minister John Hutton stated that draft national rules on improving care standards in both the public and private sector would make ‘horror stories of badly-run homes a thing of the past’. In my profession, I have seen and continue to see too many examples of neglect and abuse to believe his rules are working. In fact, a more recent report, published by the Joint Committee on Human Rights, said it was ‘shameful’ that a fifth of care homes in the UK were failing to meet minimum standards. Rhetoric changes nothing in the real world; no doubt our politicians and their parents will be well looked after, though.
Two calls I attended stick in my memory. Both of them were to nursing homes, and each involved a bed-ridden female who was on her last breath of life. On one of these calls, there was no proper hand-over, no medical care had been given, or had been attempted, and the patient smelled as if she had been lying in her own urine for days. The curtains had been drawn around her bed and she was left like this, as if she didn’t exist, until we arrived and took her to hospital. She died later that day.
Another lady I went to when I was on lates had been left for hours with breathing problems before staff ventured to call an ambulance. Their excuse was that they didn’t know she was having problems until they noticed her colour had changed (she was virtually blue by the time I saw her). My colleague had to intubate her in the back of the ambulance, and we made every attempt to recover her, but she, too, died in hospital after our fruitless resuscitation attempt.
We put in an official complaint but I don’t think anything ever came of it. The old woman probably had no relatives to complain on her behalf.
LATES: These shifts start from lunchtime onward. Starting at 3pm has the benefit of allowing you to take your time getting ready for work. Unfortunately, you are jumping right into the middle of the day and will probably get called out the minute your feet touch the station floor.
It’s not just in some privately-run homes that our elderly are being abused. Researchers from the King’s Institute of Gerontology in London spent two years collecting data on the problem and uncovered a horrifying figure of more than 700,000 cases, many of which occurred in the person’s own home. The attitude of the ‘carer’ towards the person being cared for often deteriorated from simply being dismissive or ignoring the person’s needs, to ever-increasing levels of abuse, including physical harm.
I was called to a house where an old man lived alone. He had chest pains and some difficulty breathing. I was working alone on the FRU, so I couldn’t take the gentleman to hospital until an ambulance arrived. He was in his bedroom and I was led to him by a young ‘carer’, hired by the local authority to attend to the man’s needs on a regular basis. She left me with him and wandered off without referring to me (or him) again.
I treated the man with oxygen for his breathing problem and I explained that he would have to wait for an ambulance. He became panicky and claimed that if he left the house, the carer would ‘do things’. I didn’t know whether his mild dementia was talking or he was being sincere, but he looked genuinely frightened and he went on to claim she was abusing him. I couldn’t do anything to help because I had no proof. All I could do was record his claim on a form and submit it to my bosses. I had to leave him with the ambulance crew, but I could still hear him refusing to leave his home while she was still there.
Many of our elderly live in conditions that defy belief. I visit many houses where the access is blocked by rubbish and decades of ‘collecting’. Useless items and boxes containing spare parts fill every room. I’ll often find the patient behind, among or underneath these mountains of junk. Such situations increase the vulnerability of these people because they are unable to move around safely and can trip and fall at any time, often becoming lost in their household debris. The search for an injured old person can take a long time, especially when they’re behind locked doors.
Add to this that they often live in conditions of poor hygiene and it can be extremely depressing. I’ve treated many elderly people who have been sitting there, covered in their own excrement. You don’t need visual clues when you walk into a house like that; all you need is a rudimentary sense of smell.
* * * * *
One of the most vulnerable old ladies I ever came across refused to go to hospital and was left at home to her fate. My crewmate and I had been called to a house in north London to investigate a possible collapse. There was no reply from the front door, no matter how hard we banged on it, so we went around to the back. The police joined us and we peered into the sitting room through the patio doors.
There was an elderly lady slumped in a chair. She looked unconscious but when we rapped on the window, she looked up. We called in for her to come to the door but she motioned that she couldn’t move. We tried to get in through the double glass doors but they wouldn’t budge, so we ventured back round to the front.
The police officer tested the door to gauge how much of a kick it would need, but it was a shoddy, weak affair and as soon as he leant on it there was a creak and it gave way. No security. Anyone could have shouldered it in with little effort. Once inside, we went straight through to check on our patient. She was sitting in her armchair and looked terribly pale. She told us that she didn’t need an ambulance and that she wanted to be left alone. She allowed a cursory examination and my crewmate found several bruises, caused by falling. She had damaged her hip (more than likely fractured it) and had soiled herself so badly that her dress stuck to the sofa. It looked like she had been in this position for days. Her bed was nearby, and she hardly left the room - her meals were delivered. The rest of her house, which was a fairly substantial four or five bedroom place worth a lot of money in the right hands, was falling into neglect. I stood looking at her, thinking how easily she could be robbed or worse while she slept. She was very vulnerable.
We asked her to prove that she could fend for herself and didn’t need to go to hospital. ‘Can you stand up and take a few steps?’ I said. This was a risky strategy because if her hip was broken this could increase her pain and suffering. Reluctantly, she agreed, and stood on shaking legs. She tried to move, but she was completely unable to take a step and, as her pain increased, she collapsed back into the chair. She was injured and needed proper care, but she steadfastly refused.
‘I want you to leave me alone,’ she said. ‘Just go away.’
We persuaded her that she wouldn’t be forced to do anything, and that we just wanted to stay until we’d helped her. Meanwhile, we called her GP. He arrived after an hour or so and started trying to convince her she needed to go to hospital. But despite his best efforts, she wouldn’t budge. As I looked at her face, wrinkled with age and pain, I realised that we were witnessing her fear; she was afraid that if she left she would never return. I understood that. She had probably lived here for 50 years, and the unknown was terrifying. I felt hopelessly inadequate.
I chatted with the police
officer about removing her against her will, but she obviously had mental capacity: that meant she had the right to decide for herself what she did, and we’d be breaking the law if we tried to force her out. The paradox, of course, was that - objectively - the best thing for her was pain relief and medical attention.
We found her phone book and some family members were listed. Calls were made, but all efforts to get any of them down to help failed. None of them wanted to come. They didn’t seem to care. I wondered why.
In the end, we left her with her GP but it looked like she was going to stay put. We were out of the loop now. It’s an awful admission, and it felt like failure at the time. But I had envisaged her screaming and thrashing on the trolley bed as she was taken from the house and I imagined the faces of the hospital staff when we arrived with our stubborn patient. That wasn’t a realistic way to treat anyone, so it didn’t happen. I doubt she survived the night alone in that house, and if she did I very much doubt she lasted the week.
On a few calls, the result of a lack of care for the elderly is more subtle.
I was asked to go and assess a 93-year-old lady whose GP had requested a trip to hospital for an x-ray on her arm. When I got to the house and went in, the old lady’s carer (and friend) took me to her and described what had happened. She’d bent over a few days earlier to pick up her post and had stumbled - something that’s not at all uncommon in old folks. She’d fallen onto her arm, fracturing the humerus in the process. The humerus is a fairly big bone and a fracture to it can lead to serious complications. I consider it a potential emergency, especially in the elderly.
Nevertheless, she had been taken to hospital, examined and given a very simple, semi-rigid splint - the type of splint that is not sufficient to keep a bone absolutely still. She was sent home with some pain killers, and that was that. A day or so later, she had developed an uncomfortable swelling at her elbow below the site of the fracture. She’d asked her carer to remove the splint because the pain was increasing. This was done and it was never put back on. The carer called the specialist who had operated on this lady’s shoulder previously and asked for advice about this new situation. She was told that as long as the old lady remained still and did not move much, the arm would get better on its own. It didn’t; it got much worse.
When I examined her, I found a definite distortion of the shape of her mid-shaft humerus and saw that the swelling was a large and painful-looking haematoma. A haematoma forms when blood leaks into the tissues under intact skin; the fracture had moved and was now leaking blood, and possibly bone marrow, into her tissues - all of which was gathering in a large pool in her elbow. She had been sleeping on it, walking around with it and trying to live with it for four days.
I called an ambulance for her and made sure she got to hospital before the limb became too damaged to save.
When I took her blood pressure, I had to use a tiny child’s cuff because she was so small and frail. ‘Can you manage all right?’ she asked me, as I adjusted it. It reminded me of the last time an old lady had shown concern for me. I’d been treating her for a suspected heart attack. I hadn’t been doing the job long and I must have looked more nervous than she was.
ACTS OF VIOLENCE
AS I’VE SAID, in the ambulance service we are exposed to violence on a regular basis. Mostly, it’s directed towards someone else but, occasionally, it’s aimed at us. I’ve been kicked, bitten and threatened whilst attending to the medical needs of patients, and in most cases alcohol was to blame for the aggressive behaviour. (Well, the aggressor was to blame, but the alcohol was a factor.) Sometimes we get assaulted simply because we represent something the patient doesn’t like; uniforms, authority, the system. I don’t know. Maybe it’s the colour green... who can say?
It had been quiet on this particular day, and then Jack, a regular caller, called had rung in from the West End. I tracked him down to an alley in Chinatown. He’d called for chest pains again, though he never has them. He’s very well-known and has a notorious history of exploiting the ambulance service. He’s even gone as far as to fake his own stabbing to get the attention of all three services (I have no idea why the fire service turned up on that call).
On this particular night, I was working alone on the FRU and, since I knew Jack from many of his previous calls, I felt I could deal with him on my own. He has a violent streak, but he’d never been openly aggressive to me, so I didn’t feel particularly worried. I was, however, determined to call his bluff and avoid wasting yet another ambulance on him.
His pattern of behaviour is always the same. He gets a member of the public to call 999, either by faking an illness or an injury, or simply by lying down and not moving for long enough to catch someone’s attention. When the ambulance arrives he’ll size up the crew; if they’re new and they don’t know him, he’ll put on an Oscar-winning act of pain and suffering until he is taken to hospital. He was so good at this the first time I encountered him that I gave him IV pain relief.
QUIET: Actors never use the word ‘Macbeth’. We never use the word quiet, at least not while we’re on duty. If we do, a barrage of calls will suddenly come in for no logical reason whatsoever.
Once at hospital, he will demand food and immediate attention. If he doesn’t get what he wants, he trashes his cubicle, threatens and insults the nursing staff, and then storms out. He has done this in at least three different hospitals in Central London. You may think he has ‘problems’. Yeah, right. He has called ambulances out as many as times five times in one day. Next time you need one urgently, remember that.
So, here I was standing in this alleyway telling him that he was not going to hospital this time because he was drunk and nothing else was wrong with him. He wasn’t happy with me at all.
‘You’ve got to take me to hospital, it’s my right,’ he said.
‘No, I don’t, Jack,’ I said. ‘You abuse your rights.’
‘I’ll call another ambulance when you go,’ he said.
‘No you won’t, because I’ve told Control that you would probably do that.’
‘F**k off then.’
He made as though to shuffle off, but suddenly turned and rounded on me, shouting in my face. I could smell the booze on his breath, and my face was flecked with his spit. I was nervous: he has convictions for assault and, so the story goes, did time for murder a long while back. ‘I’m gonna call you lot every hour of the day,’ he shouted. ‘I’m gonna make sure you f**king ambulance people get what’s coming to you.’
Then he spat at me.
I backed off a little and as I did so he ran to a wall and picked up a bottle. He headed back towards me, brandishing it like a club. Either he was going to smash it over my head, or it was all front; I stood my ground. It wasn’t bravery; I had nowhere else to go, to be honest.
‘Put the bottle down!’ I shouted, loud enough to attract the attention of pedestrians on the road outside the alley. ‘Don’t be stupid.’
He hesitated.
‘Put it down!’ I said again, as firmly as I could.
This time, only feet away from me, he relented, choosing to swear some more at me instead. It was a close call, and it made me much more wary of him whenever I saw him again, but he never gave me any more grief afterwards. He still calls ambulances, and I suspect he is behind a lot of hoax calls received from his ‘patch’.
You’re probably wondering why we don’t ‘do something’ about Jack. Well, I’ve called the cops to him a few times, and they come and pour his drink down the drain and get him to move on. They don’t bother arresting him and I can understand that - all he’d get is a week in the cells and it’s not worth the hours of paperwork to put him there. But lately, he’s been calling in and asking for all three emergency services and then hanging up. So I race round to an empty phone box, and by the time I get there he’s called in again from somewhere else. We end up playing a game of 999 hopscotch with him around Soho. We know it’s him, but proving it is hard.
So why do
n’t we just refuse to go? Well, the bosses are scared that someone is going to drop dead after we have told them that we are not coming out. Personally, I think that would be a bonus - it’s only a matter of time before he costs someone else their life, after all. I went to one of his hoax calls recently. I got to the call box; he wasn’t there so I greened up. Immediately, up popped a call that had been waiting for 10 minutes. It was to a four-year-old girl, DIB, on the other side of town. Thank God the kid wasn’t serious, but if she had been, and she’d died, Jack would have been directly to blame. And there’s not a damn thing that we could have done about it.
* * * * *
Domestic disputes often spill into real violence when drink is involved, and I have treated a number of women who have been the victims of their partner’s fury or drunken aggression. Some of the injuries I have treated have been serious. The Home Office says domestic violence accounts for 16% of all violent crime in England & Wales and claims the lives of more than 100 women a year (and 30 men). The cost is enormous - more than £23 billion a year.
Women who receive grievous injuries still try to defend their aggressor (it’s usually their husband or partner), though nowadays the police can prosecute without the need for the victim to press charges.
We received a call to a young woman at a block of flats in the dead of night. She had allegedly been assaulted and the police were not yet on scene. We went in, blissfully unaware of what had happened. The flat was eerily quiet and there was broken glass around the hall.