Exactly the sort of thing one needs to read when thinking just how faded one’s health has become in three or four years. And has intermittent abdominal pain.
This is the state of health “care” today for the old and frail. Under the command and control of a “caring” government.
Today I have had people ask whether I think the honours for cash waters are creeping around the Prime Minister’s feet. This article, I’m afraid, was in the forefront of my mind when I answered what I wished was lapping at his toes.
Thursday 13th July
Arthur is 90 years old. He started work aged 14 as an office boy in one of the large UK insurance companies and remained with them until he retired aged 65. He never rose above middle-management, but he retired with an excellent pension. The annuity providers will have lost money on him. During World War II he was in the infantry. He was at Dunkirk, and returned to France with the allied invasion. He went in on “D” Day. Thus he fought for King and Country for six years. He must have had a charmed life. He was unscathed throughout.After retirement he and his wife travelled extensively and both remained in good health until their mid-eighties. Then osteo-arthritis, hip-replacement, benign prostatic hypertrophy, cataracts and increasing frailty. Doreen, his wife, is much the same. She does not have prostate trouble, but still has urge and stress incontinence. They manage. They do not call doctors. I have only been to the house twice in twenty years.Arthur’s arthritis is severe. He has a permanent urinary catheter. With help, and his Zimmer, he can get to the stair lift. He does not believe in staying in bed. He has finally agreed to let his son get some domestic help. A lady comes in every morning to help him get up, and washed and onto the stair lift.Three days ago, Arthur got diarrhoea. Some people will pick up the phone and summon medical help for a bit of damp wind. Not Arthur. So by the time he called this morning, I knew there would be a problem.I arrived to find Doreen downstairs washing trousers and sheets. I squeezed upstairs past the stair-lift upon which there was a smear of faeces. I found Arthur lying on his bed with a pyjama jacket on and no trousers. The sheets and pads upon which he was lying were smeared with faeces. He stood up to empty his leg bag into the bucket at the side of the bed. As he did this, there was a violent, explosive farting sound which seem to go on for ever, but probably only lasted four or five seconds. A little semi-formed faecal residue tricked down the inside of his leg.He sat down again, and looked at me. “She can’t cope much longer.”This is modern general practice in the UK. What can I do for this problem? What can I offer?Well, first of all, I can "check him over". I am a doctor. I do things like that. The diarrhoea is in fact much better than yesterday, and I suspect it is settling down. He is not “unwell”. No temperature. Not dry. Normal blood pressure. Abdomen soft. Not impacted, rectum nearly empty apart from a little soft faeces. Anal sphincter tone virtually non-existent. Shit on his legs. Shit on his sheets. Shit on his blanket. A large plastic bucket of urine by the side of the bed.I can slip into doctor mode. I can send off a stool specimen, and check his chemistry and pronounce on his general physical state. That will make me feel like I am doing something and will make me feel much better.Arthur and Doreen are not coping. Shall I send him into hospital? I can try, but they will not take him. If I speak to the on-call physicians they will say this is a social problem, and they do not want someone in hospital with diarrhoea unless it is medically unavoidable. I can insist on them seeing him, that is my right. But that will mean fourteen hours on a trolley in Casualty before being sent home, quite probably at eleven o’clock at night.Arthur and Doreen need to be in a nursing home. I started the ball rolling on that four months ago and nothing has happened yet. They will only go if they can go together. That makes it more difficult.I can (and have) arranged for more nursing support. The nurses will go in two or three times a day, and the twilight nurses will go in at night. But they will only stay ten minutes, and they do not wash sheets (“not part of our job”). And diarrhoea characteristically occurs just after the nurse leaves, not just before she arrives.I can phone social services. They will give me some numbers to phone to get some paid help in. The family have already done that.Twenty years ago, when I started, I could have arranged an acute geriatric admission for nursing care and rehab. That has all gone now. Hospital beds are full of patients having their varicose vein and hernia surgery done to meet the government’s six month target. There is no slack in the system. There is no compassion. And in any case, with the lack of hospital nursing care, Arthur is safer at home.“Can’t you give me something to make sure this wretched diarrhoea does not come back, Doc?”I wish I could.As I leave the house, I feel ashamed. I feel stressed. This does not fit in with the medical school “problem-solving” hardwiring which, despite insight, I still cannot over-ride.Oh, and I did not stay to help Doreen wash the sheets either. Why should I? It’s not part of my job, you know.
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