Monday, 20 August 2007

A Tale of Two Ninnies

A lot of people hate hospitals. I never counted myself one of them, although that could change. Two patients today were quite the opposite: desperate not to go home.

Reg is a nice guy. His neighbours come to visit him in hospital, he's polite and he doesn't give the nurses any trouble.
He holds court at the centre of Male Bay 2, advising the younger men on life and love, and gently harassing the prettier doctors.

He has diabetes, which his specialists have struggled to control with tablets and insulin injections.

They've struggled because - whatever they prescribe - Reg doesn't take it. He says he does, but he doesn't.

It's not like Reg is unaware of the consequences. He's lost most of the feeling in his legs because of the diabetes.

But whenever he goes to his diabetes clinic, an air of collective madness descends. He says he takes his drugs, and the doctors believe him. And then they prescribe bigger doses. Perhaps they take some happy pills at the same time.

This is all well and good. But when Reg came into hospital, the nurses gave him the doses of insulin he was supposedly taking every day. And his blood sugar dropped dangerously low, because his body had never seen that much insulin before.

These attacks of low blood sugar can cause permanent brain damage if untreated. Reg would rather risk that than be honest with us.

I find this side of Reg extremely odd. But he's got so used to lying to his doctors that I'm certainly not going to be the one to change him. He seems to take great satisfaction from "outfoxing" the medical profession. Even if it kills him, he's sticking to his story.

Charlotte is a young woman with a religious husband and a small child. Despite her appendix operation having gone well over the weekend, she didn't want to leave. She begged the consultant, "Can't I just have one more scan?". She pleaded with the nurses. She tried to enlist the other patients' support.

And, when everyone else left, she asked me not to send her home.

I couldn't understand what the hell she was on about. She was clearly feeling better, walking around the ward, eating and drinking. I felt myself struggling to keep my frustration in check. I had a thousand things to do, and spending more time with her wasn't going to earn me any brownie points with the Mountain Goat or the Giant.

It took several exasperating conversations throughout the day before I even had an inkling what the problem was.

She was worried how she'd cope with having to look after her baby, feeling drowsy and under the weather. With no help from the husband or his parents, she couldn't leave the hospital until she was 100% better.

A desperate, annoying young woman with a legitimate grievance. No-one tells you how to deal with this.

I can write a prescription for paracetamol (if you give me about 20 minutes), but there's no section in the BNF on prescribing for family inadequacies.

I did what I could. I offered to talk to her husband about the support she'd need after such a major operation. I also took time going over with her - at great length - the two drugs she'd need to take home, because, in addition to her emotional issues, Charlotte was a bit slow.

They eventually left for home, Charlotte and her husband, without looking back. I hope they don't complain that she felt forced out of hospital before she was ready.

Patients like Charlotte and Reg leave a sour taste in my mouth. It's easy to dismiss them as malingerers, medical time-wasters. It's so tempting to dream of the other patients I could have helped instead of the fruitless discussions about drugs that Reg pretended to take, or why Charlotte felt tummy pain when she poked her stitches.

But the reality is that I couldn't help them. I didn't even scratch the surface of what made them tick. Even if they'd been my only patients, I'd have been at a complete loss. That's the real frustration. So I wish them well.


Antigonos said...

Welcome to the "real" world of medicine.Over 40 years ago, when I was a student nurse, I remember Bessie, an old woman with diabetic leg ulcers, who tore off her dressings as soon as she got home, in order to be readmitted when the ulcers became infected. She lived in a tiny flat, alone, fifth floor walk-up. Caring for herself and shopping were major ordeals. Being in hospital meant she had other patients to chat with, and someone looked after her.

And, as a midwife, I can't tell you how many women have come to L&D after having "fallen" when in fact they have been the victim of domestic violence, or fear it. You can tell from the reluctance to go home after you tell them the fetal monitor is fine, etc.

They don't teach you, in either nursing school or medical school, how to treat fear and/or loneliness. These aren't "diseases".

Anonymous said...

my diabetic wife would love to see a consultant or hospital doctor, her condition is complex, and the issues need deep medical understanding

however these days the nhs forces the GPs to deal with all, and occasional access to specialist nurses

she is literally kept alive by the advice she gets from consultants she is able to see when abroad

the nhs is a fucking shambles and the sooner it melts down the better

why oh why am i taxed so much to pay for such crap service?