One of the ‘joys’ of being an ECP is that you get asked to go and assess patients; those that the call takers have triaged as non-life threatening but are unwell and whose symptoms are non specific. There are plenty of euphamisms in the English language for ‘unwell’: off colour; not feeling myself, come over all funny, don’t feel right. And so it was that I was asked to go and visit Arthur the other weekend; a patient whose legs felt funny.
Sadly, not the nicest part of town; broken fences, crumbling plaster work, guttering hanging off and all that sort of stuff. I knocked at Arthur’s; no answer. I hollered through the letterbox; no response. A neighbour came out.
“Are you looking for the old man?”
“Well, whoever lives at number 45 certainly.”
“Try round the back. The door’s always open. That’s the way the others get in. Strange bloke, we never see him.”
“Thanks” and I traipsed round the back; over some upturned dustbins and through a gate that was only hanging on by a wing and prayer. As the neighbour had said, the back door was open.
“Hello!” No answer.
I went through the kitchen into a sitting room. The fire was on ‘furnace‘ and the TV on full blast but no sign of anyone. Out into the hall; “Hello?!” Was that a muffled response? I tried down the hall and in the front room. There was Arthur curled up on a bed, still in his jim-jams, even though it was mid afternoon, with an old holey jumper on top.
“Hello, did you call for an ambulance?”
“No I just pressed my button (his CareLine alarm) because I don’t feel right”
“What’s wrong then? What does ‘don’t feel right’ mean to you?”
“My legs feel funny”
“In what way do they feel funny?”
“I don’t know, they just feel funny.”
OK, so this is going to be one of those types of call. So much for 80% of your diagnosis is obtained from the history. I tried another tack.
“Have you got pains in your head/chest/tummy? Have you got, or had, constipation or diarrohea? Are you eating OK?, getting about alright? Anything happened to you recently, like a fall?”
Everything was “No.”
O. K. There was a lot of scratching my head at this point.
“What are you under the doctor for?”
“Do you have to take any medicines each day?”
“I think so”
You think so. Oh boy!
“Where do you keep your medicines?”
“Over there” waving in the general direction of mounds of tatt piled in the bay window and around the walls.
“Mind if I have a look?”
And so commenced a rather fruitless search for medications of any kind. I checked the tables, the sitting room, the kitchen, the bathroom; couldn’t find a thing. For a 92 year old gentleman not to be on anything, not even a 75mg aspirin a day, is very unusual. What I did find though was a letter from social services, dated some weeks earlier, outlining that following Arthur’s admission to hospital and subsequent transfer to a care home, he was now deemed ‘well enough’ to go home.
I went back and talked things through with Arthur. He couldn’t recall why he’d gone into hospital. He did confirm though, that he’d spent some time in a care home and had returned to his own house about 3 weeks earlier. He said he felt ‘fed up with life’. Supposedly a nephew came in each morning to see him.
“Did he come this morning?”
“When did you last see him then?”
“Don’t know, probably a few days ago.”
So he doesn’t come in each day then.
“Do you have any carers come in to see you?”
“No.” Somehow this didn’t seem quite right.
I did all the examinations I could; pulse, blood pressure, blood sugar; I percussed and auscultated his back, did a 12 lead-ECG, palpated his abdomen and finally examined his legs. Everything normal.
We talked some more. He said he was just fed up. Did he get out much? Never apparently. He said he used to go to an ex-serviceman’s club, was even the president at one time, but not any more.
“Don’t feel like it.”
Now I’m not an expert in any way on mental health but I just got the feeling Arthur was depressed: negative attitude, self neglect (hadn’t shaved for a few days, still in his pajamas), socially withdrawn, feelings of hopelessness. And who could blame him. He’d gone from being cared for in hospital, to being able to socialise in the care home, and now was isolated in the community.
There wasn’t a lot I could do for Arthur. I got him to agree that he’d get up, get dressed and go down the club, though I knew he wouldn’t. In turn I wrote a letter to his GP outlining my concerns and requesting that someone pop round on the Monday and do a proper assessment. I felt guilty leaving him but there wasn’t anything else I could do. I drove round and dropped the letter, and a copy of my clinical report form, off at the GP’s before I ‘greened up’.
Would the GP act on my letter? What would happen to Arthur? Normally I’d never find out but things were a little different this time…….
*Picture by Diane Fenster