"40 year old female, abdo pain, in supermarket cafe"
Now the country is in the grips of winter 6am starts seem all the more cruel. We'd done one job but I was still struggling not to yawn and was rocking out a thumping headache. My issues aside, we got another job so fake smile in tow, we headed the 600 yards from the hospital to the job. We made our way through the hordes of christmas shoppers to find our patient, head in hands, staring at her coffee. We introduced ourselves and were met with a voice full of apathy. Her hair was scraggly, she was wearing odd slippers and a Mickey Mouse t-shirt. The combination was a bit bizarre but who am I to judge?! The conversation that ensued epitomised everything wrong with this country.
"Where the hell have you been, i've waited ages"
"You only called 10 minutes ago! Anyway, how can we help you?"
"My tummy hurts, I can't walk"
A brief history told me she was kicked in the stomach with a 'flying ninja kick' by a Philippino nurse. She was discharged from the hospital 45 minutes ago and had a pain score of 3/10. No known mobility problems and denied any leg injury. The described pain raised no red flags so as far as I was concerned she was well enough to walk to the ambulance. Before suggesting that I did a quick battery of tests and they all came back normal.
"Shall we pop you to the ambulance?"
"I might not be going to hospital. I haven't decided where you are taking me yet"
(Brief pause to take in what she had said) "Well, whatever we decide i'd like to check you over fully on the ambulance, it is more private after all"
"Well I can't walk"
"How did you get here, what is stopping you walking?"
"Just get me the supermarket wheelchair. It is by the tills"
(Someone has had one before!) "If you can't walk, we will have to take you to hospital anyway"
"Just get me the chair"
I didn't have the energy to make my point so the chair was fetched and we wheeled her to the ambulance. Once on board it became apparent hospital was the last thing she wanted.
"Right, i've decided I want you to take me home"
"I'm sorry, but we are not a taxi service, if you are unable to walk we will have to take you to hospital"
"Which hospital?"
I gave her a choice of the 3 nearest to us. She refused them without a valid reason other than not wanting to go. I read out the list of the nearest 9 hospitals and their distances away. She refused them all.
"Give me some morphine. It's my right"
"I'm not giving you morphine"
"But i'm in pain and can't walk"
"Then I will try you on Entonox first, and we will take you to hospital"
"Just take me home, what is your problem, the hospital won't provide transport so how am I going to get home?"
"I'm sorry but we aren't a taxi service, you can't just call an ambulance because you want a lift home"
"This is a disgrace, i'm going home"
With that, she got up and walked off to the bus stop and jumped on a bus. That was that. She could walk, and didn't even have a limp! I had consulted our clinical support during the conversation as to her request and was told her only option was the nearest hospital if she couldn't walk. This is why the ambulance service struggles to cope at the best of times. This is why A & E departments are at bursting point. It transpires she was ejected from the hospital for abuse to staff. She had been to hospital 16 times in the last month, always after shopping and every time had requested transport home. Luckily for the tax payer, she had been refused every time. Speechless.