A Fox Lake Blog

Can You Apply the Cream?

My tweets one day from my second hospital went as follows:

Lady with dementia just wrestled her way out of bed to phone her husband ‘to tell him where I am’. I explained that he’d only just left.

Lady with dementia just wrestled her way out of bed again to phone her husband ‘to tell him where I am’. I explained he’d only just left.

Lady with dementia just wrestled her way out of bed yet again to phone her husband ‘to tell him where I am’. I explained he’d only just left

Lady with dementia just wrestled her way out of bed to phone her husband ‘to tell him where I am’. I said ‘Good idea’.

I didn’t know she was trouble as soon as she walked into the room but I had a fair idea within five minutes when I heard her daughter say, in tones of dismay “Oh no, I’ve forgotten her anti-psychotic drugs” – always a comforting thing to know about the person who’s spending the night in the bed next to you when you are paralysed from the neck down.  

It was November, winter and its various ailments was upon us and the hospital was on what they call a ‘reap five’. REAP = Resourcing Escalation Action Plan and level five is ‘critical’. In other words the hospital was full up with all the beds in the entire place occupied and targets – whether in 999 ambulance response or in A&E – being missed left, right and centre.  Unfortunately, illness, infirmity, bad luck and downright carelessness don’t take much notice of such things so A&E was still receiving a huge influx of people, some of whom were not fit to be patched and dispatched but needed to be somewhere safe, supervised and medically ready to roll for at least one night.  There were of course absolute cases that no-one would argue with stashing in a hospital, such as those who have really done themselves a mischief or whose major organs have decided to give up the ghost but many of them fell into a ‘need definite supervision but are not ill with something that is going to kill them imminently or, perhaps more crucially, with a problem that the hospital was equipped to sort’.  The largest group of these were vulnerable elderly people.

Talking to the hospital staff, the big issue was that there was nowhere else to safely put them.  Many elderly people needing help are still living at home with carers coming in several times a day to check on them.  Sometimes those carers are privately funded and sometimes they are paid for by social services but, in either case, putting them in a home is astronomically more expensive, whoever is paying the bill and, with council cuts driving ever deeper, places are few.  Of course, many would rather eat their own arm than go into a home but relatives are not able to be there all the time due to their own commitments and carers are usually only there for a maximum of three calls a day and not overnight.  So, what do you do if your elderly relative falls late one afternoon and hurts/upsets themselves enough that they cannot be left overnight alone?  You call for an ambulance and they get taken to hospital where, once admitted and obviously vulnerable, they cannot be hoofed back out into the dark night to an empty house. Now, you have to find them a bed.

Down on the spinal ward, with our collection of uniquely vulnerable and work intensive inmates, we were supposed to be the last resort for hospital managers on the prowl.  Despite this I was warned by staff that, if I got taken out for the evening,  I should make sure that I was back by 10pm or face returning to find someone ensconced in ‘my’ bed for the night.  I laughed.  They didn’t. 

With my neighbour gone, the empty bed next to me became a revolving carousel of various  people, none of whom had a spinal injury but most of whom had mental illnesses that rendered them the worst people to attempt to share a night’s sleep with.  The lady whose daughter had forgotten to pack her anti-psychotics started off well enough with complete silence behind her flowery curtain until 2am.  At this point she commenced wailing “Nooooooo! NO! NO, no no no no noooo!” which she continued until 7.30am when the arrival of breakfast and the insertion of some Weetabix restored calm.  By this point, I was the one that needed the anti-psychotic drugs. 

Then there was the elderly lady who, in the middle of the night, decided she needed to go somewhere.  Her attempts to leave were foiled by the cunning manner in which her bed curtains overlapped.  Unable to find a clear gap through which to make her exit, each time she wrestled manfully with the material, muttering to herself until, sprung free, she took two steps and promptly entangled herself in my curtains, whereupon she repeated her escape manoeuvre and then was utterly bewildered to find herself back inside facing a bed, apparently exactly where she started.  It was lucky for me that she was a determined type as, at that point, had she given up and decided to go back to bed it would have been my bed, still containing me, that she would have been clambering into. 

Another was terribly upset that her husband didn’t know where she was and would be worried about her.  Every quarter of an hour or so she would suddenly start crying, genuinely distressed and wanting to find a phone to ring him.  There were two problems with this – first, she was in hospital because of a bad fall due to being very unsteady on her feet and not supposed to be moving about on her own and second, her husband had been with her all evening and had only been gone half an hour when the first episode started.  My attempts to reassure her on this latter point worked but only for the fifteen minutes it took for the cycle to repeat itself.  Eventually, I gave up and let her totter out to the corridor and the nurses’ station where I hoped someone who knew more than me would be able to reassure her. 

However, none of our female ward visitors even came close to Jack. 

Jack arrived just before Christmas, presented by his relatives at A&E with a rash in a delicate area. Of course, A&E is not the place to go just for a rash but Jack was also in the throes of severe dementia and the staff were pretty sure (and they’d seen it before) that the rash was just an excuse for dropping Jack off for the holidays so that they didn’t have to deal with him over Christmas. 

Physically (apart from the rash), he was in fine fettle.  A big, strong man despite his age, he was well over six foot but harboured a deep distrust of anyone in uniform and a burning desire to escape and go home.  This combo made him extremely tricky to deal with for the nursing staff, who were already under pressure with all of us lot. 

Jack was put into a male ward next door to ours and joined five other spinal patients in there. Three of them were relatively mobile paraplegics – guys with lower injuries and able to move themselves around pretty quickly.  One was a man who came in for a persistent UTI requiring intravenous antibiotics but was also carrying a pressure sore when he arrived. Under the circumstances the dressing didn’t get changed so the sore turned gangrenous and, faced with the prospect of losing his leg, he sunk into a deep depression and refused to move, speak or eat.  Finally there was Nigel.  Ill with a stomach bug he had fainted in the bathroom and fallen, breaking his neck high up and leaving him completely immobile from the chin down when he came in.  These five were now joined by the robust, extremely ambulatory, presumably itchy and very angry Jack who staged his own version of the Great Escape every night, usually by trying to smash one of the large floor to ceiling windows and climb out of it.  The first few times this happened the staff would run in and try to dissuade him but with his hatred of uniforms this only enraged him further and led to a Benny Hillesque chase around the ward and surrounding unit until the fun stopped one night when he turned on one of the Healthcare Assistants and punched her in the face.  As I’ve said, he was a very big bloke and there were usually no more than two ladies on duty (there should have been at least four). There was no way they could restrain him on their own and it was reaching the stage when someone was going to get badly hurt. At this point, heroically and chivalrously, the inmates of the ward stepped, as it were, into the breach and told the nurses to leave Jack to them and they would try and reason him down on their own when he started his breakouts.  This worked better although was not foolproof and was complicated by Jack’s decision that, of all of them, Nigel looked the most sympathetic.  Hence it was that Jack then took to presenting himself at the immobile Nigel’s bed in the middle of the night, pyjama trousers around his knees, tackle out and pot of ointment in hand, asking Nigel to apply the cream.  Obviously, the other guys had a few helpful suggestions as to how he might do that without hands but, after they had stopped laughing they gently steered Jack back to his bed and fetched a member of staff who, hiding her uniform temporarily with a coat and armed with the ubiquitous gloves, would soothe the savage rash.

As you can imagine, everyone breathed a sigh of relief when Jack was eventually discharged on the 28th December.  Happy New Year.