No hot water. Night isn’t just falling, more like sharpening its claws. The elderly woman is frail, lonely, isolated, frightened, no family or friends.
There's nothing overtly medical wrong with her, but social services are far, far away; it’s just you and her, and you think to yourself, 'F*** it, she can’t stay here, I have to do something.'
Social reasons aren’t supposed to be grounds for admission, but what’s right and what’s necessary aren’t always the same thing.
What your patient needs right now is a hot bath, a decent meal, a comfortable bed and some human kindness. A gentle touch, the brush of a human hand, the silent, reflex-level affirmation that someone is near, that someone cares; a refuge, a sanctuary against the cold and the darkness.
But the NHS has no overt facility for this kind of acute care, and hospitals like to think of themselves as high-tech centres of excellence, dealing with fancy stuff, diabetic keto-acidoses, thyrotoxic crises, transplants, big trauma.
So we are forced to construct a flimsy Trojan horse of plausible medical grounds, invent something we can sell to the admitting doctor. These lies rise blithely to our lips; our moral compromise is slow but implacable, and such invention and dissimulation become easy with practice.
So many illnesses accompany neglect that it is only a matter of choosing the handiest one. Our admission letters are not downright lies; they are only half-truths, harmless little fibs in pursuit of the greater good, and if the admitting doctor is experienced enough they’ll be able to read between the lines.
Medical intervention, though a nice optional extra, is usually way down on the patient's list of needs, but the patient will still have to endure the charade of being quizzed, poked, and prodded as the admitting doctor has to play the game out to the bitter end.
And then, eventually, your patient will receive the care she needs.
- Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell