Welcome Home

A grand old house, maybe a century old, maybe even older, stands at the top of the long, dark road. Balloons and a Welcome Home sign hang over the front door, but once inside, more traditional decorations greet visitors walking into what looked from the outside like a stately manor, but inside was yet another nursing home. A tree in the corner, tinsel around the door handles and frames, cards strung from one side of the dining room to the other. The staff were all in a jovial mood, some wearing festive hats, many wearing badges and gimmicky trinkets on their uniforms. Even the dozen or so residents seemed to be enjoying themselves.

A carer meets us by the door and shows us to Mr Hella's room.

"He is unconscious. He's diabetic and his sugar is low. We've tried to give him glucose tablets and that gel stuff, but nothing is working, so we've had to call you."

"No problem. That's what we're here for." We notice the spotless carpets, the freshly painted walls and the furniture that looked either brand new or just very well cared for. "Nice to see a home where people actually take time to look after the place! Have you had it done up just for Christmas?"

"Something like that. We're trying to keep it that way and hopefully it will last." He points to the room at the end of the corridor and tells us that the nurse is there to help us further.

"Oh, good. You're here. We've tried everything to bring him round, but nothing's working. Hope this isn't a waste of your time."

Mr Hella's blood sugar has dropped so far, that the machine won't even give us a reading. A digital "LO" flashes up on the screen, although we didn't really need to check it. All the classic signs were there. A thready, rapid pulse, sweat pouring off him in buckets and an odd sounding snore when he breathed.

"We've only known him three days, he's a lovely chap and nearly ninety, but this is the second time he's done this to us in two days. Last time we managed to bring him round. He's not on insulin, just tablets, but they must be too strong for him."

"Good work!"

As we find a vein and draw up some glucose to feed his blood with some much needed sugar, we have time to talk to the nurse, complimenting her and the staff again for keeping the care home so clean, making the effort, and especially for being helpful to ambulance crews. Too often when we're called to care homes we're met more by apathy and resignation than by helpful, knowledgeable staff. Assuming, that is, that we're met at all. Sometimes we have to guess which of the rooms is hiding our patient, often having stood outside the building for some time before anyone let us in. 

This place was a timely reminder that not all care homes are the same. 

"Good to see that you seem to have a system that works well when you call an ambulance." 

"You think it works?" 

"Well, we were met at the front door, given a brief idea of what's going on, shown the way to our patient, and had a handover from someone who knows the patient and their condition. I'd say that's a pretty good system." 

"Isn't it the same in all these places?" 

"You're kidding, aren't you?" 

"Well, I'm glad you think it works. You're our first ambulance." 

"Today?" 

"No." 

"This week?" 

"No. First ambulance ever." 

"What? You've never had to call an ambulance before?" 

"No. Never." An amazingly rare feat for any care home, and a record to be proud of.

Mr Hella starts to come round, the sugary water coursing through his blood and up into his brain. 

"Who are you?" 

"Ambulance service, sir. It seems you gave these people a bit of a fright." 

"Oh, I'm so sorry. Did my sugar level drop again?" It seems that he's more used to his condition than the staff who are looking after him. 

"Just a little. They seem to take good care of you here." 

"They are truly amazing. I only wish I could have moved here sooner." 

"When did you move here?" 

"Three days ago. My family have been trying to convince me either to move in with one of them or move into a home ever since my wife died. I needed someone to care for me when I pulled these sorts of tricks." 

"So what took you so long?" 

"First, I'm a stubborn old fool, and proud of it. Secondly, all the places I looked at were awful. Or worse. But I had a look around here when they were just putting it together and when they opened, I jumped at the chance!" 

"Jumped?" asked the nurse with an amused grin.

"Well, gently moved in a positive direction." 

We all laughed. "I think, since this is your second attempt at being difficult in as many days, we should probably get you checked at hospital. Just to make sure you're going to behave." 

"Hospital already? I've only been here five minutes!" 

"But," said the nurse, "you do have the distinct honour of being our first ever ambulance patient." 

"Well, that's no surprise, is it?" 

Confused, I had to ask the obvious question. "Why isn't that surprising?" 

"Well, they've only been open for three days. I was their first ever customer!" 

No amount of pleading would convince him to take a seat on our wheelchair out to the ambulance. "I'll walk, thanks. Just get me my frame. I might be old, but I'm not that elderly. And you," he said, looking back to the nurse, "make sure you look after the place until I get back. Can't have my new home going to ruin whilst I'm away." 

"Don't worry. We'll keep the sign up just for you, Mr Hella." 

Care?

If you're a carer in a care home, your job is to care, and all that your caring entails. 

If you're a nurse in a nursing home, your job is to nurse, and all that your nursing carries with it. 

Don't you dare tell me you've only known one of your residents for only a few weeks, or a few days, or even a few hours, as an excuse for your inaction and lack of care. 

I only get to know my patients for seconds, literally seconds, before I have to decide and act on their needs, and be able to do so with care and compassion.

You may only be temporary staff, but your nursing diploma stretches as far as giving a patient oxygen when they need it, whether you know them well, or not. 

You may be new to this particular establishment, but your nursing experience should tell you how unwell your patient truly is, and that now's the time to act. Now's not the time to lean over the bed with your hands in your pockets and your head in the sand.  

Don't you dare excuse your mistreatment by claiming to not know the resident well enough - abuse and neglect can never be excused. 

I know my patient for only moments, and I still treat them like human beings, not like bed-filling, revenue-raising, income-generating pieces of unimportant meat. 

Damn you for making me care so much as to make me hate you and your actions - or lack of them. 

Damn you for being so blasé about the desperate needs of those in your care. 

Damn you for choosing a caring profession, when clearly you just don't care. 

Norma

Norma is usually a bundle of laughs, a handful, and was a real joy to meet. Bed-bound she may be, but her physical restraint had left her mind sharp. At least that was the case the last time we met. That first time, she was trying to escape the nursing home that had become her prison. She knew she would never make it past the bed guard. She'd never really recovered from the faint that led to her falling and breaking both hips. No longer able to walk unaided, she'd been forced out of her lifelong house and into the care of the nursing home.

She sat on the floor, refusing to accept in her heart that which her head was already telling her.

"I'll get up and walk. You ain't taking me to no hospital!" That before I'd even opened my mouth to greet her. Something told me that this battle of wits would be good natured rather than nasty, but it looked like it may well be protracted. As we checked Norma's injuries, it was difficult to know whether what we were seeing, and hearing for that matter, was from the previous fall or this one.

"I'm a war veteran y'know!" she said at one point.

"Which war was that then, Norma?"

"The Forty Year War!"

I had to admit that I'd not heard of it, which was a little surprising. You'd think that something that went on for that long would have registered somewhere in my brain during history lessons.

"Enlighten me", was the best I could come up with.

"Forty years it took me to realise that I wanted shot of that man! In the end, I took him for everything he was worth! Now he's got the kids, the grandkids and our house, and all I've got is a prison warden for a nurse!" She laughed the sort of infectious laugh that you can't help joining in.

I looked back on the information sheet that gave all Norma's details and saw that her next of kin was her husband.

"How come it says here that you're married then?"

"I didn't say I got divorced, did I? I just kind of moved out!" Another burst of laughter, but this time it hurt her hip when she moved. I just raised an eyebrow in her direction, and didn't dare say another word for a second or two.

"Alright", she growled, half joking, half serious, "you can take me to hospital. I promise to behave now!"

And behave she did. Before we moved her, I decided that it might be an idea to give her some morphine to help with the pain, and explained about putting a needle in her arm to be able to give her the medication.

"You miss this vein", she threatened, "and I'll pull the needle out myself and jab it in your eye!"

No pressure then.

Soon the needle was in, the morphine coursed through her veins and provided the much needed relief enabling us to get her to hospital as comfortably as possible. After we'd moved her onto the hospital bed, Norma even managed a thank you, put out her hand to shake ours, and gave each of us a kiss on our fingers as if we were each the Pope. At least. "You lot should be treated like royalty, not like bloody cab drivers!"

I smiled and wished her good luck. We left Norma at the hospital, and by the time we came back, she'd already been moved to a ward.

Now, Norma and I were meeting for a second time, this time I was alone, at least initially. There was none of her wit, no sharp tongue to contend with, none of the feistiness that made her such a pain in neck, yet a pleasure to help.

Norma was unconscious. The nursing home staff told me that she was diabetic. They checked her blood sugar which they found to be dangerously low, and so decided to force feed her a sugary drink to try to help.

Not such a great idea with an unconscious patient.

The rest of her basic observations weren't so good either. A pulse and blood pressure so low that they were barely readable, with an ECG that confirmed what I already knew - her heart was really struggling. She was hypothermic as well, her body temperature dangerously cold despite being in a room that was so hot I was sweating from the moment I stepped in.

The crew backing me up turned up after a few minutes. I'd made sure they were updated before they arrived as to what was really happening, and the fact that it wasn't exactly as the call had originally been sent. In fact, it wasn't even close. "Diabetic problems, patient conscious and dizzy" was what I had initially expected, although I'd learnt long ago that not everything the call-taker is told is what is really happening. The patient calling for an ambulance because their own heart had stopped is a real, if a little far-fetched example.

As they came in with the stretcher, Norma's breathing became erratic, the oxygen in the mask now needing some external assistance to make its way into her lungs. We moved her across from the nursing home bed to ours, with the staff complaining that we'd taken their sheet with the patient. If it had been some sort of expensive bedding, I might have had some sympathy, but it was nothing but a regular hospital sheet. We were followed out to the ambulance by two members of staff, one carrying an envelope with the photocopies of Norma's details and drugs, the other empty handed.

"Is one of you coming with Norma? If so, we'll be going in a couple of minutes."

"No. We're not coming. We don't usually send anyone, just the letter."

We load the trolley into the ambulance, and as the hydraulic ramp closes, a voice calls out.

"Can you please make sure you bring that sheet back?"

Incredulous, just as I'm about to shut the other door, I look out the back at the two people charged with the care of so many, but couldn't muster an ounce of understanding between them.

I open the cupboard at the rear of the ambulance, find a spare sheet, and throw it out at them, leaving them fumbling over the cascading linen.

Looking back at Norma, I'm left wondering what her sharp tongue would have replied. I'm sure she'd have found the words at a time when I was fuming, but completely speechless.