‘’Allo, Doc. We’ve got a right one for you’ere. Mad as a box of frogs. We found ’im running down the middle of the dual carriageway completely starkers and shouting in gobbledygook.’
It was 3 a.m. on a cold February night and I was on call for psychiatry. The police had picked up my latest patient and, after diagnosing him with being ‘as mad as a box of frogs’, a common police diagnosis, they kindly dropped him off at the psychiatric ward for me to assess. The man, who we later found out was called Peter, was in his early twenties and looked fairly frightened. He was shouting in an unfamiliar language and was miming being attacked and chased. He gave the policemen each a hug (very much unappreciated) and they left him in my less than capable hands. Peter was wrapped in a blanket kindly donated by the local constabulary and given how cold it was outside, I wondered quite how he had survived any length of time being completely nude out on the dual carriageway in the middle of nowhere.
The most likely diagnoses going through my mind were some form of paranoid psychosis, possibly drug induced or maybe schizophrenia. He may have been having some form of manic episode but without him seeming to understand a word of English, the assessment was very difficult. We sat in a quiet room and I tried in vain to communicate, as did he, but we got nowhere. He had no clothes, no wallet and absolutely nothing to identify himself with. I admitted him to the psychiatric ward. What else could I do?
The next morning, I took my consultant to see him. Peter was a bit calmer, but still gesticulating and shouting. My consultant tried speaking to him in French, which gave me the giggles as it just made an odd consultation even more ridiculous, especially as my consultant’s French was terrible and the patient was clearly from Eastern Europe somewhere. We do have interpreters available but we had no idea where this guy was from so didn’t know where to start. After nearly an hour of getting nowhere, Ludmila, the ward’s Polish cleaner, came into the room to empty the bin. The patient took one look at Ludmila and then said a few words to her and gave her a smile and a wink. Despite the language barrier, it was obvious to us that Peter was speaking the international language of leering and bad pick-up lines. Ludmila gave him an icy look and turned to us. ‘He is of Belarus. He is not mad, just drinking too much wodka. Always the same is man from Belarus. Too much drinking, gambling and chasing of womans. Not enough working. They have bad reputation in my country.’
My consultant looked annoyed. ‘Ludmila, do you actually speak his language?’
‘No, just recognise he is of Belarus. All men from there are the same. Not mad, just drunk.’
‘Thank you, Ludmila, but perhaps it might be best to leave the psychiatric diagnosis to me.’
Ludmila shrugged, gave Peter another icy stare that made the whole room shiver and left. We phoned up the interpreting service and found out that it was going to be five days before a Belarusian translator would be available. We still weren’t sure if he was having paranoid delusions and needed some form of psychiatric medication. He had no money and didn’t seem to know anyone here so we kept him on the acute psychiatric ward. Most of our young male psychiatric patients spent their time on the ward sleeping, eating, watching TV and occasionally masturbating. Peter was like a breath of fresh air. He enthusiastically joined in the ward’s activities, going to the cooking morning, creative-painting day and Sunday morning yoga class. He also didn’t let his failure to be understood prevent him from trying all his favourite Belarusian chat-up lines on the female patients, staff and visitors.
Eventually, the translator arrived and we crowded into the interview room to finally conduct a proper consultation. Peter launched into a long monologue in Belarusian and, with the help of the interpreter, we were finally able to find out a bit more about how Peter had ended up on our ward.
It turned out that Peter had arrived in England the previous week to find work and make some money. He met some Lithuanians at the coach station and they said that they could find him some work on a farm picking cabbages. To celebrate his first night, they played cards and drank vodka. He got very drunk and remembers losing his money and then his clothes in the game. He didn’t remember much else but thinks he then got into a fight with one of the Lithuanians and they chased him naked from the farm. He was a bit cold but he assured us it was nothing compared to Belarusian winters. The police picked him up after an hour or so and he was very impressed that they were kind and didn’t beat him. He also thanked us explicitly for our kind hospitality during his stay. He found that English people were very nice but some of the residents here were a little strange. He had decided to return to Belarus, as travelling wasn’t really his thing. He then invited us all to stay at his home at any time and told us that we would all be made very welcome. Apparently, his mother made the best goulash in the whole village. Peter gave us each a kiss on both cheeks and left. I dread to think how much it cost the NHS to keep him on an acute psychiatric ward for five days but probably more than Peter could earn in a year back home. Ludmila was very smug. ‘Like I am saying, all Belarus man the same. Lithuanians man even worse.’
Granny dumping
Granny dumping is the act of getting your elderly relative admitted to hospital in the build-up to Christmas so that the rest of the family can have a less stressful holiday period. I remember the more senior doctors moaning about granny dumping in the build-up to my first Christmas after I qualified. I didn’t believe that it could actually happen, but every year before Christmas there is an influx of elderly patients whose families can’t cope with them any more or who are jetting off to a converted farmhouse in Tuscany that doesn’t have a stairlift.
Granny dumping is a very harsh expression and the actual individual cases are more complex. Being a full- time carer for a family member is an immensely difficult and often thankless task, but crises always seem to occur at Christmas and all too often lead to an unnecessary hospital admission. This is exactly what happened to one of my elderly patients one Christmas Eve. I was covering the afternoon session at a small surgery where I didn’t know the patients. It was nearly 6 p.m. and I was looking forward to getting home to start celebrating Christmas with my family.
The phone rang as I was just seeing my last patient of the day. A distraught daughter was crying down the phone: ‘It’s my father. We can’t cope any more. He’s got Alzheimer’s and he’s getting frailer. My mother had a stroke two years ago and can barely look after herself. We need some help.’
‘It’s 6 p.m. on Christmas Eve,’ I unhelpfully pointed out.
‘I know!’ wailed the daughter. ‘I’ve got my own family to look after and my sister is away skiing. Dad gets confused during the night and wanders around the house. He just needs someone to sit with him overnight. Someone to make sure he doesn’t fall. My mother can’t be expected to do it, she’s too frail. I’ve got my daughter and her young family staying at ours so I can’t do it myself. If you can’t arrange something, he’ll have to go into hospital.’
I hate these situations. I was being made to feel responsible for this person’s difficult situation. It wasn’t fair to admit him to hospital when he wasn’t actually unwell; however, I could see the daughter’s viewpoint. She had her own family to look after and didn’t want to spend Christmas Eve chasing her confused father around his house. What I couldn’t understand is why this always seems to happen just before the holidays start. Couldn’t something have been organised weeks ago?
This was a social problem rather than a medical one. Other than take him back to my house and have him spend Christmas with me, I didn’t really know what I could do. I ‘Googled’ the telephone number for the local emergency social services and gave it to the daughter. I told her that they might be able to organise some sort of emergency care overnight. Her dad didn’t need a qualified nurse, just a caring person to sit with him and guide him back to bed when he got up and started wandering. There were enough carers in this town who would probably appreciate the money and plenty who weren’t Christian and would happily work on Christmas Eve.
Half an hour later I phoned the daughter back to see how she had got on. She told me that she had dialled the number I had given her but no one had answered. After ten minutes she called 999. The ambulance had just taken her dad to A&E. Another Christmas granny dump delivered to the NHS. Once in A&E on Christmas Eve, there was no way that he would get home. The cost of the ambulance, A&E treatment and ward admission would be thousands of pounds and I just hoped he didn’t get a bout of MRSA with his hospital mince pies. Someone sitting with him overnight would have not cost more than ?100. What a waste.
Some areas have wonderful emergency social services with a team of physios, carers and social workers on call to provide urgent assessments and vital care to people who desperately need it. They keep people out of hospital, saving money and preventing people from catching MRSA and other hospital bugs. Unfortunately, most emergency social services teams are terribly underfunded, understaffed and suffer from low morale. They might not
