Friday, 18 February 2011

Blame the fat man...everybody else does...

I have some compassion left…
...I know a lot of my colleagues and most of my patients don’t believe that…but its true…
...of course I keep it safe in a matchbox at the bottom of my rucksack,under some old gym laundry ;a much thumbed copy of The House of God;some NYC subway tokens;an almost empty bottle of Mrs Balls chutney; and an inflatable sheep I received a few years ago for Christmas…from a grateful ex-patient.

Probably grateful that he was an ex-patient!

It is true though that by about 0815 in the morning…when I've been at work for about 15 minutes,that I am already irritable and short tempered,already thinking of the first donut of the day.

I saw a patient on Tuesday…a vicious alcoholic and drug user...who is a frequent-flyer…at my St the Out Of Hours doctors service…and at St FruitandNuts,the local psychiatric hospital.

I am one of the few people 'designated' to treat him because he (a) routinely assaults medical staff (b) is on the sex offenders register.

I have previously spoken to him in words of one syllable and he knows how little I care about him as an individual...but he also knows just how few people there are who are willing to treat him in our Health Authority region...its catch-22 for both of us really!

And of course he is unemployed and on benefits.

He takes hours to treat and process and invariably requires lots of input from several different agencies or services.
Tuesday was no exception…one of his many pathologies is that of being a “self harmer” and so he presented with more than 20 superficial lacerations to both forearms…,-mostly on the left arm because he is right-handed-,...some new…some old…some infected.
None of them required suturing although a few needed to be glued.
We cleaned them and dressed them and I wanted to give him some antibiotics…but he threatened to overdose on them.

Since it was raining and by now about 20h00 and he is homeless,he then asked for a referral to the mental health intervention team…knowing that they would go "ahh shame...poor misunderstood fellow" and provide him with a hot meal and a warm bed.

We are not able to access Mental Health from our Unit however as we are not on any “pathway”…and our esteemed leadership can’t be bothered to resolve this problem.

I explained this to him…and he countered by telling me that he had allegedly been assaulted earlier that morning…that he had been kicked in the head…had been knocked unconscious…and now felt nauseous.

Now we have strict head injury guidelines …and if you have been (-or tell me that you have been-) knocked unconscious...and if additionally,you are homeless...and have no family or friends to care for you...then we have to get you admitted to St Vulvas for observation.

I knew he was lying.
The Consultant knew he was lying.
The ambulance crew knew he was lying.
He knew we knew he was lying...but because his human rights have to be protected there was nothing any of us could do.

And so he spent 18 hours at St Vulvas before being turfed out on the street and left to find his own way home.

Except of course,he is homeless.
And so he phoned his girlfriend....because..."yes dear reader" this guy has a girlfriend who doesn't care that he is on the sex offenders list.
Unfortunately for him though,whilst he had been in hospital for 18 hours she had met and fallen hopelessly in lust with some other degenerate and told my patient to never darken her door again...
...because although she is also unemployed and an alcoholic,the council have of course given her a flat to live in.

And so on Thursday morning he again attended our Unit using the excuse that his dressings were dirty and that they needed to be changed.

So I saw him again and got his dressings sorted out and advised him that he could go...

And then he told me about his girlfriend and asked me to contact the mental health team.

I reminded him of our conversation on Tuesday and that I couldn't refer him...but that since it was early in the day that he could simply walk over to St FruitandNuts about a mile away and see the duty fact...I was so keen to turf him so that I could have my morning latte that I even offered to pay for the taxi...well,to get the Unit to pay...but its the same thing! which his response was that he would either (a) self-harm again..."seriously this time that you have to admit me"...
...or (b) that he would simply go to his ex-girlfriends flat and attempt to kick the door down...she would then phone the police...who would then arrest him -he hoped.

I suggested that there were probably more reasonable alternatives to his plans but he insisted that I had simply given him no was all my fault that he had no options in life.

And with that,he jumped up and stormed out of the building shouting about the callous nurses who didn't care about him and who wanted him to kill himself.

Well...maybe he could get some part time work as a psychic?


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