132. Sorry about that, Neville

Although we are only seven miles from the centre of Milton Keynes, this is an area that is unquestionably rural. Wavendon, the nearest settlement, has a population of 800 but it isn’t a village in the strict geographic, nomenclatural sense as it has no services or functions.  There is a church but there are no longer any shops in Wavendon, or businesses, or commercial premises and importantly, there is no doctors’ surgery.

The nearest surgery to our house is in Woburn Sands, a small town of about 3,000 people, two miles from Wavendon and that is where Caroline and I are registered.  This practice serves 11,000 people spread over 20 square miles. 

Many patients without cars have difficulty getting to the surgery.  Bus routes are few and services are (I’ve been told) erratic and anyway, the nearest bus stop to the surgery is a quarter of a mile from it - too far for someone with mobility problems.  Because of this, there is a framed notice in the waiting room asking if people with a car will give lifts to patients who do not drive or who need assistance. 

I have been giving lifts for the past year.

I have come across many people whom I would not otherwise have met.  They all have certain features in common.  Their most noticeable characteristics are that they are all white; they are all quite old - I would guess that they are all well over 80; nearly all of them are women and they all seem to live alone although just less than half of them live in sheltered housing.  Those who don’t, appear to be quite lonely.  

Many of those who don’t live in sheltered accommodation are housebound and live much further than walking distance from the nearest shop.  They rely on their relatives or neighbours to bring them the essential things they need.  One woman told me that the only time she leaves the house is to go to the doctor or to the hospital and this was the first time she’d been out for two months. 

One old lady opened the door before I rang the bell.  She had been sitting by the door for 45 minutes because she looks forward to her rides to the doctor so much. 

Nearly all of them have lived in the area for several years and some for all their lives.  They delight in telling me about the old times and I have learnt a lot about recent history of the area.  Every one of them is chatty and friendly, and their gratitude is almost embarrassing.

After we’d been travelling for a few minutes one day, a man asked me where I was taking him.  He regularly goes to three clinics at the hospital in Milton Keynes as well as to the GP.  All he had written down was that he was being collected at 10.30 and he was confused as to where he was going.

When I first started helping, I asked for the patients’ telephone numbers.  I thought that as I sometimes had to collect three people with the same appointment time but who lived up to four miles apart from each other, I would phone those who I would be picking up late and warn them.  However, not one of them ever answered the phone.  I have asked why, but I’ve never had a satisfactory answer.

One Thursday last month, I had six patients on my list to take to the surgery.  The first appointment time was at 10.10 and the last one was at 10.35.  It was clear that getting all of them there on time would be impossible but the doctors are aware of this and always fit them in.

Judith, the first person I collected that day, lives only 600 yards from the surgery.  I knocked on her door at 9.55 to allow enough time for what is often a slow business of getting the man or woman into the car.  Many of them have some kind of walking aid that needs to be stowed in the boot and they often need help and support to actually get into the car.

We set off and as I turned on to the main road I found that the route into Woburn Sands towards the surgery was closed to all traffic because of resurfacing.  The necessary detour was six miles and took more than twenty minutes.  Consequently, I was immediately way behind my planned schedule.

Maureen and Neville live near each other in the village of Aspley Guise.  They live two miles from the surgery and they both had appointments at 10.20 but I didn’t manage to drop them off at the surgery until after eleven.

By 12.30 I had managed to deliver all six patients to the surgery and had taken three of them home.  As I walked into the waiting room for the last time, I saw Maureen chatting with two women and a man.

I don’t ever really see the people I pick up.  They usually want to sit on the back seat but I immediately recognised Maureen because had sat at the front on the way to the surgery and she was wearing a distinctive, yellow jacket.  Maureen, the other woman and the man stood up when they saw me and I gestured to them to follow me to the car.  I put two walking frames into the boot and we set off.  

First, I drove to the village of Husborne Crawley and dropped off the other woman.  Then I was on my way home at last.  Aspley Guise, where I had collected Maureen and Neville, was on my way.  We reached Maureen’s house and they both got out.  “He’s coming in for a cup of tea,” she told me.  Pleased that I was going to be spared another five minutes driving, I set off home.  I had driven more than forty miles and had been driving virtually non-stop for three hours.

At 1.30, as I was watching the end of the lunchtime news, my cell phone rang.  It was the receptionist at the doctors’ surgery.

“Will you be collecting Neville soon?  He says he’s been waiting more than an hour.”

I realised immediately what had happened.  The man who went for a cup of tea with Maureen wasn’t Neville, the man I had picked up some three hours earlier but he did live in Aspley Guise.  Maureen must have told him that he could join her for a lift home.

Neville wasn’t at all annoyed or resentful at being overlooked.  He told me that he’d had a really enjoyable time chatting to the other patients and with the receptionists.

Of course, I will be wrong in most cases but I’ve never seen any sign of illness in any of the people I have taken to the surgery.  None has ever mentioned a particular complaint.  It seems to me that they only ever go for check-ups.  I suspect that as most of them look forward to their appointment with happy anticipation, the main motive for many of them is the social aspect of it all. 

When I was a boy, pupils at my school were asked to help at the “Over-60s Club” after school.  Over 60s!  That isn’t considered old today.  Fifty years ago, times and life expectations were different.  There are organisations around here today for old people but I wonder if they are for the over 60s?  Their notices say that they cater for “older people” and I’d be very surprised if anyone in their 60s joins.

The surgery asks that patients always book appointments with their usual GP to ensure continuity of care.  If I want to book an appointment today with my usual GP, the next available slot is in 19 days time. 

I once suggested to my doctor that apart from when someone requests an emergency appointment, she can never see anyone who is actually ill - anyone with an acute illness.  She smiled and her response was non-committal. 

In many ways, loneliness must be the worst kind of social poverty.  It is very sad for lonely people and there are knock-on effects that indirectly affect all of us.

123. The Right Place

In May 2013, click to see, in a post on this blog, I wrote:

I couldn’t do a nurse’s job. No words can convey the admiration that I have for those I met.  They were wonderful, patient, caring and kind.  Nurses tolerate the intolerable.  They work in impossible conditions and I think they are almost saint-like.

Let me be very clear, there are 175,000 nurses working in NHS hospitals and I think that 174,999 of them are wonderful. 

I’ll get to why I think that one of them isn’t in a minute, but did you see what I did just then?  I started the sentence with, “Let me be very clear.”  That opening is the thought-gathering prelude of choice for most of today’s politicians.  It has replaced, “Let me say this: ….” 

I heard John McDonnell, the Shadow Chancellor, being “very clear” in an answer to a question as to why the UK should stay in the EU. 

McDonnell’s “very clear” response to the question was that labour voters should join with big business and vote to remain in the EU so that once firmly established within the European Union, the Labour Party could plot to overthrow capitalism.  At least, I think that was what he was saying. 

If I got it wrong perhaps he wasn’t being as “very clear” as he thought.

I was at hospital yesterday to have pre-operation checks before I have surgery on my ankle.  They have to make sure that I am fit enough for a general anaesthetic.  I have been given a date for the operation and it will be on June 23^rd. 

So, while you lot are all voting to leave the EU, I will be having my ankle bones cut and screwed together to fuse the joint.  By the new year I should be walking pain free.

I think the nurse was Portuguese.  I usually manage to make nurses smile or even laugh but this one was in deadly serious mode and was obviously not in the mood for any banter.

“We will start by taking blood,” she said and then she told me that the blood was to come from the inside of my wrist.

“It is to measure the gases,” I was told, “and the blood has to come from an artery, not a vein.  It’s going to hurt a lot and it will be much more painful than when you take blood taken from inside your elbow because there are lots of nerve endings around this area of your wrist.  When you feel the pain, you mustn’t move your arm.  That’s very important.”

I couldn’t think of anything amusing to say about that and so I kept quiet.  No nurse has ever been so brutally honest before and so I sat, trying to relax my arm and wishing that she hadn’t said anything about the pain.  I stared at a clock on the wall as I never look at the needle when they take blood.

“You are going to feel a sharp scratch,” she said.

“It’s not a scratch,” I muttered, grumpily.  “It’s a prick.”

I watched the second hand move from the 7 to the 10.  Nothing had happened.

“Well that wasn’t too bad,” I said, hoping to lighten the mood with a little joke.  “I didn’t feel a thing.”

I looked at the nurse and saw that she was staring at me, stony faced. 

“What are you waiting for?” I asked.

“An apology,” she said.

“What for?” I asked, in genuine amazement.

“Your rude language,” she said.

“My what!”

 “After I said you would feel a scratch.”

“What?  Are you serious?  A scratch is a long, narrow wound.  A needle makes a prick, not a scratch.  Sleeping Beauty didn’t scratch her finger.  It was pricked.”

She continued to stare at me.  “OK, I’m sorry,” I said.  It didn’t seem the right time to have a semantic discussion on the difference between a scratch and a prick.  I felt the needle go in and it really was painful.

“Don’t move your arm!” she shouted at me.

“I couldn’t help it.  It was involuntary.”

After about a minute, I asked if she was finished and she said that no blood was coming because I had moved my arm and so it was my fault.

“My fault was it?  Could it possibly have been yours?”

“No, you moved.  Your fault.”

I told her that I couldn’t guarantee not to flinch the next time and so she decided to take blood from my ear lobe instead.  (Don’t ask me!)

Two minutes later and after four “scratches” she had filled a narrow, transparent straw with blood from my ear lobe.  She put the tube into a machine and I watched as the blood started to be sucked out.  Then it stopped.

“It’s not working,” the nurse announced.  “It is clotting too quickly.”

“I suppose that’s my fault too?” I suggested. 

“We’ll do the walking test instead,” she said.  “You walk as fast as you can for six minutes while I monitor the oxygen level in your blood.  Are you right or left handed?”

“Why do you need to know that?” I asked.  “Do left handed people walk faster or something?”

“You have a walking stick.  If you hold the stick in your right hand, I will put the monitor on your left wrist.”

“Do you really think that right handed people always hold the stick in the right hand?  You hold the stick in the hand that helps the bad leg.  My left ankle is painful and so I hold the stick in my right hand to take some of the weight off my left ankle.  It’s nothing to do with me being right handed.  I would have thought you knew that.”

The nurse was not happy.  “If you continue to be rude, I will stop these tests and discharge you back to the consultant who referred you.”

“I won’t say another word,” I said. 

I was pretty sure that she couldn’t do what she threatened but I couldn’t take the risk that an operation I’ve been needing for four years would be postponed because of a silly squabble with a nurse.

I didn’t say a word for twenty minutes during which time I blew into various tubes and had an electrocardiogram. 

Then she took out a stethoscope and held it to my chest to listen to my heart.  I didn’t say anything but I knew she was going to have a problem.

“You’ve got a pulse but you don’t seem to have a heart,” she said at last. 

“That’s a bit harsh.”

“All I can hear is gurgling and bubbling from your oesophagus and stomach.”

I wasn’t surprised but I said nothing.  A year ago a doctor tried to listen to my heart and couldn’t find it.  Eventually he did find it about seven centimetres lower in my chest cavity than it should be.  It seems to have been chucked about and moved during my liver transplant procedure. 

When I told Caroline about my misplaced heart, she thought it was hilarious. 

“No one will ever be able to defend you again by saying that at least your heart’s in the right place,” she giggled.  “Because it isn’t.”