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.

86. Nurses - Much more than just Carers

I spent last Wednesday night in hospital.  The only time I’ve been in hospital before was in Fort Lauderdale, Florida when I was in for 3 months following my transplant.

Here is a brief history of one of the most interesting 36-hour periods I’ve ever had in my life:

Wednesday
2:00 am	I get out of bed and have to stop to rest three times walking the 20 paces to the bathroom because I am so breathless.  I am coughing up buckets of phlegm, I’m hot and I feel terrible.
10:30 am	Caroline insists that I visit the doctor but I am so weak and tired that I tell her I can’t.  She phones the surgery.
12:30 pm	The doctor arrives for a HOME VISIT!!!   My temperature is 39.7°C, my blood pressure is 71/47 and my oxygen level is 86%. Very quickly, I am diagnosed to be suffering from pneumonia.
3:00 pm	I am admitted to Milton Keynes hospital and go through an hour of tests and x-rays.
4:00 pm	I go to a ward in the MAU (Medical Assessment Unit).  All the medical wards are full.  There are 3 beds on either side of it. 4 men, two of whom are younger than me, occupy the other beds.  There is one empty bed. 1 On the far side of the ward, to my left, is John.  He looks very old and is either asleep or unconscious. 2 Directly opposite me is Peter (possibly 35) who is sitting up in bed, staring intently at me with both his hands shaking on his lap. 3 To his left is a middle-aged man reading a magazine. 4 To my right is an old man who is lying on his back and staring at the ceiling. The bed to my left is vacant.
4:45 pm	Peter, who has been staring at me most of the time, speaks to me: “Got a cigarette?”  I shake my head.
6:00 pm	John gets out of bed, shouts and starts to walk, very unsteadily, away from it.  The nurses try to get him to return but he ignores them and sits on the bed of the Magazine Man who has been taken to X-Ray.  John is shouting continuously.
6:30 pm	Magazine Man is back from X-Ray and tells John in no uncertain terms to, “Get off my fucking bed”. Eventually, John does that and walks towards his own bed.  At the last moment though, he evades the nurse shepherding him and goes to stand by the large open window.  As the nurse walks towards him, John raises his fists and tells her to, “Fuck off,” or he’ll hurt her.  She stops for a moment and then moves towards him.  John swings a fist at her but misses.
6:45 pm	Dinner is served.  I just have orange juice, as I’m not at all hungry.  John refuses anything brought to him and Peter says he’s not hungry but he wants a, “very big vodka.” “How am I supposed to stop my hands shaking?” he asks the nurse.  “Get me a drink.”
7:30 pm	I notice that John is standing in a large puddle on the floor.  Two new nurses, who have just started their shift, try to get him to move so they can clean up.  He refuses to move and shouts, “I’m 83.  I was in the army and fought the Germans.  I’m not frightened of you two.” The man to my right shouts out, “To pee or not to pee?” and laughs loudly at his joke.
8:00 pm	I try to be helpful. “If he’s 83, he was only 15 when the war ended,” I tell the nurse, “and so he couldn’t have fought the Germans.” The nurse says, “Thanks,” but rather coldly.
8:30 pm	John removes his wet pyjama trousers and stands by the window, stark naked, shouting at the top of his voice.  The nurse hands him a urine bottle. “It’s empty,” says John, looking aggrieved. The nurse tries to explain what the bottle is for but he shouts at her and doesn’t listen.
8:40 pm	A Nurse brings clean, dry pyjamas for John.  He must be cold standing by the open window.  He sits on his bed and puts them on.
8:45 pm	Why don’t you lie down John?” says the nurse.  “You must be tired.” “Fuck off,” he yells at her. “Will you fucking shut up,” screams Magazine Man.
9:00 pm	John has been shouting at the top of his voice for 4 hours.  Surely he’s getting tired?  No he isn’t - not at all.
9:05 pm	“To pee or not to pee?” the man to my right shouts again.
9:15 pm	John leaves his bed and walks towards the ward entrance.  Beyond it, I can see the Nurses’ Station with all its office equipment.  The two nurses stand in his way but with fists raised, he walks through them. “I had very little sleep last night,” I am thinking.  “If I were at home, I’d be going to bed now.”
10:00 pm	John is standing in the corridor.  I can’t see him but the noise from his shouting is deafening.
11:45 pm	I ask if we can have the ward lights turned off.  They are.
Thursday
1:00 am	At last!  The nurses call Security and two uniformed guards arrive.  I know this will exacerbate things because John thinks that they are police.  “Fuck off pigs,” John yells at them.  “Go catch some crooks.”
1:30 am	I hear a tremendous crash from the corridor.  John is knocking over as much of the furniture as he can.
1:45 am	A nurse tells me that they’ve asked John’s daughter to come in, hoping that a familiar face will calm him.
2:00 am	I'm told that his daughter has said that she can’t come because she has to be up early for work.
3:00 am	There has been a standoff for 2 hours between John and the guards.  When they get close, John spits at them. The guards have managed to get John just into the ward but he is still 20 feet from his bed, shouting and swearing all the time.
3:15 am	The nurses and the guards have obviously concocted a plan:  1. While the two guards try to talk to John, the nurse slips around behind.  2. After a second or two, she taps him on the shoulder.  3. John turns round and immediately, the two guards grab his arms and pinion them.  4. Quick as a flash the nurse produces a hypodermic syringe and injects him in the arm. John yells louder than ever and is trying to wrestle with the guards but they are too strong for him.  One guard grabs and lifts his legs, while the other lifts him at the chest.  They carry him over to his bed, place him on it and then raise the bottom of the bed so John’s feet are some 3 feet above his head.
3:30 am	Every 5 seconds John, who is now trapped in his bed, is shouting, “HELP” at the top of his voice and he also yells out that he has wet himself.  I wait with bated breath and then it comes: “To pee or not to pee?”   Oh,   come on mate!  It’s not that funny!
3:35 am	A nurse approaches John who is lying awkwardly on his bed.  She tries to soothe him but fails.  She gets too close and he lashes out and kicks her hard in the head.
3:40 am	Magazine Man stomps over to John and shouts at him, “If you don’t fucking shut up, I’ll fucking do you.”
3:45 am	The nurse who had been kicked in the head comes over and asks how I am. "I'm all right," I say.   "I'm just tired but what about you?  That was a hard kick.” She smiles and sighs. "I'm fine.  It's part of the job.”
3:50 am	A different nurse comes and stands by my bed and tells me that they are trying to find spaces in other wards for us. “How are you feeling?" she asks me. "Very tired," I say. "You'll be OK in the end," she says calmly and gently. "When you die." "WHAT!"  That woke me up. "NO, I'm not.  What are you talking about?" She bends down and whispers, "We're all going to die and be with Jesus." She pauses.  "We're just passing through."
4:00 am	Magazine Man is wheeled off to another ward.  “So long, Suckers” he shouts, gleefully, as he leaves.  John shouts out, "HELP!" again very loudly and is showing no signs of tiredness.
4:10 am	To Pee Or Not To Pee is taken away too.  That leaves Peter and me in the ward with John.
5:40 am	The sun has risen and is shining through the open window.  The ward is getting brighter but John is still shouting very loudly.  “I can’t understand it, the nurse tells me.  “We gave him enough to knock out a horse.  We thought he’d sleep for 10 hours.”
5:45 am	A new patient is brought into the vacant space to my left. “How long has this been going on?” he asks me as John is shouting more than ever.  “About 12 hours,” I sigh.
7:00 am	I have my blood pressure, temperature and oxygen level taken. “That’s a lot better.” The nurse smiles at me.  “You’re almost normal.” “Thanks,” I say.  “That’s the nicest thing anyone’s ever said to me.” In future, I’d like to be known as, ‘Almost Normal Terry’.
7:00 am	Breakfast.  I just have a cup of tea.  John won’t say what he wants and Peter has Rice Krispies.
7:30 am	Peter can’t eat his cereal.  His hand shakes so much that the Rice Krispies all fall off the spoon before they reach his mouth.  A nurse feeds him.
8:05 am	John is getting quieter.  He’s still shouting but not with the regularity or intensity of before.  New Arrival leaves his bed and pulling the stand holding his drip with him, is walking towards the open window. “Where are you going?” asks the nurse. “To the window for a smoke.  You wouldn’t want smoke in the ward,” he says. “You can’t smoke here,” the nurse says.  “There’s oxygen around.  It would be dangerous.  I’ll take you outside when I’m not busy.” ”Make it quick then,” New Arrival grumbled.  “I’ve normally had 5 or 6 by now.  I’m a heavy smoker.”
9:00 am	John is quiet.  Maybe he’s asleep.  Obviously, I’m still awake. Peter is having an animated discussion with someone at the end of his bed whom only he can see. “All right, I’ll get some,” I hear him say. Peter leaves his bed and walks directly towards me.  He stops at the end of my bed and starts to pull at the curtains that surround it.  Half the curtain is already off. “What are you doing?” I shout at him. “There’s a shortage,” he tells me.  “They’ve put out a call for curtains.”
9:30 am	The nurse goes over to New Arrival and tells him she can take him out for a smoke now. “About time,” he says.  They are passing the foot of my bed. “Give us a cigarette then,” he demanded of the nurse. “I haven’t got any,” she says, looking surprised. “OK,” says New Arrival, “I’ll give you some money and you can go to the hospital shop and buy me some.” “They don’t sell cigarettes.  This is a hospital.”            “You give free food.  Why not free tobacco?” he moans at the nurse.  “I’m a heavy smoker.” “Got a fag?” he asks, looking straight at me.
11:00 am	A doctor comes to see me and apparently, I really am a lot better. “Can I go home then?” I plead. You’re receiving antibiotics intravenously and you should continue to do so for another 24 hours.  So no.” “But I can’t face another night like last night in here.” I whinge.
11:15 am	After a great deal of pleading, begging and insistent beseeching on my part, he finally agrees that I could take the antibiotics in pill form.  That, however, will mean that I’m discharging myself from hospital care against advice.  I have to sign a form absolving the hospital of any responsibility if anything goes wrong. Of course, I agree.
12:35 pm	John wakes up and starts shouting that he’s wet himself.  I don’t care anymore.  I’m going home!
2:00 pm	I sign the self-discharge form.
2:30 pm	Caroline comes to collect me. “How are you, really?” she asks me. “I’m well, I think.  Just very tired.  I’ll tell you about it later.”

I’ve read a lot in the newspapers recently about poor quality care given by nurses, especially to the old and the frail.  I suppose that those stories must be true but I can’t believe Milton Keynes Hospital is in any way exceptional or different from most. 

Not only would I not want a nurse’s job, but I also 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.

What can be done with patients like John?  He is clearly suffering from dementia, as he had absolutely no idea where he was, what was happening or what he was doing.  He was constantly bewildered and very frightened.  I can’t even start to think of a solution. 

Another thing:  Every nurse that I met in those 24 hours spoke with a foreign accent, and came from Eastern Europe, The Far East or the Caribbean,

I wonder what UKIP would have to say about that.

22/5

David, whom I was at school with and I have mentioned several times in the past, left the following as a 'Comment'.

I don't think many people read the comments and so I have put it here.  It amuses me hugely.

I was in hospital in the orthopaedic ward, in May 1971 having knee surgery.  On Saturday afternoon, just before kickoff, the patients were taken (wheeled/carried/lifted) into the TV room to watch the Cup Final between Arsenal and Liverpool.  Because of the hospital’s location, virtually all the patients were Arsenal supporters.

It was 0-0 after 90 minutes.  Liverpool scored in extra time.  The room went very quiet.  10 minutes later, Arsenal scored.

My companions, in the euphoria of the moment, forgot why they were there.  They leapt to their feet, arms raised and then came crashing down.  It was like watching a room full of dominoes collapsing.  5 of them had to be helped up from the floor by nurses and 3 of them had to have their plaster casts reset.