11h45 on Sunday morning...the second day of a three day holiday weekend.
The Unit is jammed with a three hour wait.
Because I'm the Charge Nurse, because we're short of staff, and because ShufflingBob is overwhelmed at Triage, I keep a weather eye on the Triage List on my computer to make sure that nobody slips through the cracks.
Imagine then that you are 89 years old...
...you're sitting hunched in a wheelchair unable to move.
You apparently have 'profound dementia'...
...? Alzheimer's
...?? vascular
...??? some other cause...
No one knows for how long you've had the dementia...
...or what you used to do...
...or if you ever sat in the sun with a woman you loved and drank rough red wine.
You live in a little room in a 'residential care home'...
...you apparently have no living relatives...
...or so your carer believes...
...but since you've "only lived there for three months", he's not really absolutely sure -
- and nor is the nurse in charge back at the care home...
...(they think you have a friend who is your next-of-kin...
...but they're not sure and don't have a phone number for the friend anyway)...
...the same nurse who also doesn't know what medications you take, or if you're allergic to anything...
...and who refuses to fax over your notes due to the 'data protection act'.
You've been sent into a minor injuries unit because you can't stand by yourself...
...in fact you haven't been able to stand or mobilise at all since the staff found you lying on the floor next to your bed on Friday morning.
But now its Sunday...
...and a long-weekend and the care home is short of staff...
...they don't have four people to help you stand...
...there are too many other old folk who really need help...
So they fold you into a taxi and send you to me.
The carer doesn't know anything except that he has been on days-off for the past three days and nothing has anything to do with him...
...certainly he is in no way responsible for you not being able to walk...
...or stand...
...and he doesn't feel it incumbent upon him to talk to you...
...or help me undress you...
...or put you onto a trolley...
...or hold your hand when I unfortunately hurt you during the exam...
...or even stay in the room with you.
He certainly doesn't understand why I want him to do 'mouth care' on you...
Fortunately for you I am well versed in the statistics of emergency gerontology and know where to start my examination...
...and your left leg,-(even more fortunately for you)-, is obviously both shortened and rotated, the classical signs of a broken hip.
After a quick primary and a more detailed secondary survey , I decided that a probable broken hip is your primary injury and order a pelvis x-ray...
...I sign the consent form as you has no idea of who I am or where you are despite me telling you several times throughout the examination.
Your hip is indeed broken...
...an intra-capsular fracture...
...that will require you to have a hip replacement.
The orthopaedic surgeons are more than happy to accept you and ask me to keep you 'nil by mouth' so that you can go straight to the operating theatre.
Imagine that all that information gets explained to you...
...that some strange man in a uniform has told you that you need an operation......that the ambulance could take up to four hours to transfer you to the main hospital...
...(it took three hours in the end)...
That the same strange man sticks a needle in you arm and runs some blood tests...
...and gets DevonGirl to do an ECG...
...and keeps refusing to give you anything to eat or drink...
...and your carer stands at the door to your room , busy on his cell phone, ignoring your cries of anguish and despair.
Imagine at some point...
...perhaps in a moment of lucidity...
...perhaps just due to some random neural activity...
...as the paramedics wheel their stretcher into your room...
...that you grab my hand...
...and say...
..."Please kill me...I don't want to live like this anymore..."
And I have to refuse.
Imagine all that.
What a poignant, heartbreaking but amazingly accurate depiction of what it's like to be severely demented and consigned to a nursing home. Whenever I think I just can't take care of my mother any more, I remind myself of what would happen if I "placed" her and suck it up, because I couldn't live with myself if I did that to her. Poor, poor thing.
ReplyDeleteThe picture got my attention, but the article was a well-written and informative. Thank you.
ReplyDeleteMan, you are a great writer.
ReplyDeleteA book. Write one.
ReplyDelete