Someone else’s problem

Annie had come from a neighbouring psychogeriatric hospital with a huge, infected pressure sore. She was in her 80s, doubly incontinent, and demented. Dressing changes were a great challenge to the nursing staff, owing to Annie’s combative skills including a formidable ability to spit several feet. However, after several months the wound was clean and healthy. The visiting plastic surgeon decided that she was now ready for skin grafting and asked me to arrange it.

As a keen new houseman I blithely said that I would, not foreseeing the difficulties that lay ahead. Theatres would be undergoing routine maintenance on the day in question and all operations were cancelled. I tracked down a free orthopaedic theatre at another hospital, but, unfortunately, no general surgery was done there, so I had to find lodgings for Annie. The acute trauma ward seemed the only suitable place. I eventually received permission from a staff nurse for Annie to go there for her immediate preoperative and postoperative care, and, yes, we would take her back as soon as possible. I now needed a doctor who would be willing to adopt her temporarily. I spoke to an orthopaedic registrar who said that he doubted whether the ward would be prepared to take her. Assuring him that they would he reluctantly obliged. Sorted, I thought.

I should not have been so optimistic. The first problem arose when Annie arrived at the trauma ward. The sister rang me up to demand, “What business have you sending your crumble to my ward?” I assured her that it had all been arranged, and with earnestness asked if she would please look in the diary. There then followed an unedifying dialogue on the inappropriateness of demented crumble being on an acute trauma ward. Eventually, she was persuaded and Annie was allowed out of the ambulance. She was later taken to the operating theatre as planned, but I had not reckoned on the malevolence of the on call orthopaedic registrar. Annie’s graft took four hours and when she was finally ready to come back to the ward, it was after 5 pm. He was also disdainful of crumble and refused to allow Annie back to the ward. Uselessly, I pointed out that it had all been agreed and, in any case, the anaesthetist had forbidden her transfer back to us until the following day. “Where is she supposed to go?” “That’s your problem.” Eventually, my registrar was able to negotiate a bed on the gynaecology ward.

It had been a long day, a day of stress and disillusionment. I realised that some people did not matter. A frail, demented old lady had been maltreated because she was crumble—in other words, unimportant, inconsiderable, and, in fact, loathsome. My bleep went off. I was surprised, as I was not on call and it was now 9 pm. “Annie’s back,” the surgical staff nurse laconically informed me. The gynaecological senior house officer, who also disliked crumble, especially other people’s crumble, had discharged Annie shortly after her arrival from the operating theatre.

Of course, I was naive. I have come across this attitude many times since then, although I still find it baffling and surprising. There is a eugenic streak in some NHS staff that excludes unworthies such as Annie from receiving the care they deserve, and indeed, have paid for. Unless and until attitudes change, the elderly and frail will continue to receive such treatment at the hands of those who would be more at home in Nazi Germany than in the modern NHS.