P.S. My wife has just read this and has reminded me that this book is based on reality not fantasy. I must confess I hadn’t done any fitness training, I was playing shit and we were 3–0 down and playing third from bottom – we are bottom. There was no singing from the crowd, just a bark from a random stray dog. The goal I scored was an own goal, which hit my bum as I fell over after my contact lens fell out. Sorry for the misinformation. The bit about the IKEA furniture and shoulder were true though. What is also true is that we both got back in time to join everyone for drinks. One perk of my job is that my mate bought my drinks for me to say thanks.
It was 6 a.m. and the canteen was closed. I was feeling hungry, having been on shift for 10 hours already. I went to help myself to a couple of pieces of toast. Admittedly, yes, technically it is for patient use, but it is one of the small perks of the job that we can get some free toast and tea in the early morning. This morning, on the front of the cupboard door, there was a new sign warning us that taking bread was theft and could end in disciplinary action.
Come on, who writes such ridiculously rude notes? Why, when managers are trying to save money, do they do pathetic things like take away tea and coffee and bread, and not look at really serious issues? I bet they had muffins at the meeting where they decided on this money pinching measure. If they are going to take away our bread, then let us have their muffins.
For some unknown reason, I am on an eco-drive. I have spent a fortune on energy efficiency lights, become keen on recycling and started to come to work by train. I feel like an eco-warrior (a middle class one who is scared of climbing trees let alone living in one with a bloke called ‘Swampy’, but still in my eyes an ‘eco-warrior’). I feel good about myself. These feelings vanish, however, as I get off the 8.42 train …
When I walked off the platform, there was a group of inspectors standing round a lady who was carrying a ridiculous number of bags. At first I thought she was shouting down a mobile phone. Then I realised that wasn’t the problem.
‘WHY DON’T YOU GET RID OF YOUR KNIVES?’ She screamed in the general direction of the ticket inspectors.
‘I KNOW WHY YOU WANT ME DEAD. BUT I DIDN’T CAUSE THE TRAIN CRASH.’
I approached and was told to stand back as she was apparently dangerous. She was very unwell, but, no, she wasn’t dangerous. I recognised her straight away. She was in her 40s and was a known regular at A&E. She had mild learning difficulties and psychotic paranoia and depression; a diagnosis of schizophrenia had been made in the past. She had a problem with alcohol (i.e. she drank more than her doctor) and her coping mechanism for whenever she got stressed was to self-harm. For years she had been in and out of psychiatric hospitals, and was now receiving ‘care in the community’.
In the past, patients like this may have been institutionalised, but they now are more likely to be cared for at home by community psychiatric nurses. However, these services are often under-funded and patients can slip through the ‘care’ bit of the ‘care in the community’ programmes. Instead, their ‘care’ is often provided by homeless shelters, police stations and A&E departments. This lady was one of these patients. She didn’t cooperate with any of the programmes they had tried to involve her with. She was getting sicker living in the community, but there was little anyone seemed to be able to do for her. As a result she had been to A&E 78 times in the last four years.
I approached the ticket inspector who seemed to be in charge.
‘What’s going on?’ I asked.
‘Stand back. She is dangerous,’ he told me, then started shouting at her: ‘Lie on the floor with your hands on your head’.
‘Bloody hell, she is clearly unwell but she’s not a terrorist suspect,’ I thought. She started screaming in fright and was scratching and biting herself to the point of bleeding. I intervened and called the police. I explained to the 999 control that this lady needed sectioning under 136 powers (i.e. the police could take her to a place of safety). When I explained that I was a doctor and not someone who needed sectioning themselves, they sent round two burly looking officers.
They were absolutely brilliant. They calmed her down and put her in the car while I unfolded my new bike and cycled to work – I really was on an eco-drive.
On arrival I explained why I had been late and that I had brought some work with me. This didn’t go down well. As ‘punishment’, my task was to go and see the patient that I had just arranged to come in with the help of the boys in blue. As I went in to see her, I nodded in appreciation of their work earlier and started to speak to the patient.
‘Hello. My name is Nick. I am one of the doctors here. What happened today?’
I said it in my most reassuring of voices, but it hadn’t seemed to calm her down or helped with her paranoia at all.
‘You aren’t a doctor. You’re a ticket inspector. I DIDN’T CAUSE THE CRASH. NOW GET OUT.’
Later that day, she was readmitted to a psychiatry ward. I saw her two weeks later, after another episode of self harm. It is a situation that we see all too often. In our current world of political correctness and not offering institutionalised care, there seems little we can do. As always, when there is a crisis, A&E is the point of call, but we cannot offer the long-term solutions that they need.
I was sitting at the desk when this quite rude 45-year-old man marched up and moaned about how long he had waited and demanded to know if we were fulfilling government targets. (The answer, I thought to myself, was that he had not waited long enough as he should have been put to the back of the queue for being so pompous.) However, as he had a tie on and an aristocratic voice, everyone seemed to be getting a bit worried and I was asked to go and see him next. He had been suffering from pain in the wrist for three weeks. He had been doing a lot of typing recently and was suffering from ‘tenosynovitis’ (inflammation of the tendons). The treatment is a splint and painkillers.
I was a bit fed up that he had come to A&E with a chronic problem, so I asked him if he had looked at the sign outside and which bit of an accident or emergency he had. (OK, I didn’t ask him that; I wanted to, but he had a suit and tie on and a posh voice and I didn’t want a complaint letter. In fact, I just advised him that in future he went to his GP for this type of problem.)
I was a bit shocked when he told me what had happened. He went to his local GP and saw the receptionist, who demanded to know what was the matter with him. He told her and then she advised him to go to A&E as it wasn’t ‘the sort of thing’ GPs do, despite his protests that he didn’t want to go to A&E. (Despite being a doctor, I also get intimidated by GP receptionists demanding to know loudly what is wrong with you so the whole of the waiting room can hear. I once responded, ‘I have got a growth on my dick, genital herpes and want a sex change, how about you?’ and now they seem to let me see my GP without a CIA-type interrogation. This man wasn’t so fortunate. He failed the interrogation and ended up in A&E – without an accident or emergency.) I had no option but to phone the GP. I got through to the receptionist and the conversation went a bit like this.
‘Hi, could I speak to the duty GP please?’
‘I am afraid he is on home visits all day, and then in a meeting so you won’t be able to speak to him till