Old and small

Assessing a person’s level of confusion can be quite a tricky task. It is surprising how ‘normal’ a very confused patient can be, yes there are scoring tools but even those can be misleading. I am one of those people that despite a few years in the ED, tend to believe everything the patient tells me, especially if they are old and small.

Doris was 94, about 4ft 11 and weighed about 6 stone. She had curly white cauliflower hair, dark twinkling eyes and bilateral hearing aids that whistled loudly. As she lay compliantly on the trolley I completed my assessment. She had given me a full history and a plausible reason for being out in the street in her dressing gown, she had been putting the bins out. Given her small stature I thought this a bit odd but during my neuro exam I had discovered she was also inordinately strong, I asked her to squeeze my finger and actually thought she was never going to let go. She then proceeded to proudly kick her legs up with such force it was only by chance she didn’t kick me in the face. It was only the mention of Nurse Sam and his dark tan that had alerted my suspicion to her mental capacity.

Sam had recently returned from 3 months in Gambia. He had been all over the world but had manage to avoid being one of those annoying traveller types. We’ve all met them. The ones who find any excuse to regale tales of how they ‘saved the Africans.’

Doris had asked me who was the ‘shifty looking Arab’ who kept asking her about, who she lives with and does she have any pets or pressure sores. I had thought it was a bit of a strange comment. As I was weighing up whether this was simply generational racism or confusion I noticed a tuft of white curls float past the workstation. I got up to investigate and I realised Doris was making her way along the ambulance corridor at an alarming rate.

“Doris… DORIS … Where are you going?????”

Doris had stealthily manoeuvred passed numerous staff and was making her way slowly but surely to the exit. Despite her advancing years she appeared to have the vigour of a child on their way to find Santa. As Doris made her way passed the triage nurse I stopped in awe of her athleticism although the potential consequence of Doris’s adventure along the ambulance corridor became all to real as the Nurse in Charge appeared at my side.

Sharon was one of those salt of the earth types and had worked in the ED longer than anyone else. She knew everything and ran a tight ship. She was not impressed, she looked sternly at the computer and then at me before letting out a long sigh.

‘She’s not had a falls assessment! This is going to end in a datix!’ she muttered disapprovingly.

I was just relieved I had been fortunate enough to have spotted the white perm strolling past the workstation. If she hadn’t of been my patient or if I hadn’t noticed the flapping of her hospital gown revealing her vest and pants I wouldn’t of stopped her. She moved with such intent and looked like she knew where she was going.

Slowly but surely Doris continued to totter down the corridor towards the sliding doors of freedom. I was at a loss of what to do next, my shouts had fallen silent on her whistling hearing aids. I called to one of the paramedics coming out of the kitchen door.

‘Stop her will you.’

Mike was carrying two cups of tea and cradling a packet of bourbon biscuits in his mouth. To be fair what happened next was his only option. Mike assessed the situation stuck his foot out and down Doris fell. Doris didn’t move, she just lay there. Spread eagled on the floor Tena pants displayed for the world to see. I rushed to her side glaring at Mike who shrugged his shoulders and nonchalantly wandered over to the ambulance reception and placed down his cups of tea, before checking she was ok.

I knelt down next to Doris, checking her over and internally praying to every god I could think of that she hadn’t broken something. Doris looked at me, white hair stood on end, bright eyes starring into mine…

‘What are we doing on the floor dear? We haven’t got time for sitting around…The Chinese are coming!’

And it was at this point I realised Doris has significantly less marbles than I had initially thought. From that day on I vowed to stop believing everything patients told me no matter how old or how small they were.

MJ

XOXO