The incontinent old lady.
Incontinence is a curse for the elderly. Whether it is incontinence of urine, or faeces, it is uncomfortable, embarrassing, and often painful. It is very common of course, so no surprise to discover someone suffering from it, when you work in health care. There are many causes of this condition, and though some are minor, and easily treated, others may require surgery, and even be life-threatening. Doctors called to elderly people at home, will often send them into hospital, for a diagnostic referral by a surgeon, or further investigations; perhaps scans, or barium x-rays.
One day shift, we were called to the home of an elderly lady, in the Shepherd’s Bush area of West London. She had been experiencing stomach pains, and some incontinence of faeces for a few weeks, and had finally called in her G.P. He suspected that she might have an obstruction in the intestines, and arranged for an ambulance to take her to the nearby hospital, leaving a letter behind with a home carer, and asking us to attend within an hour, as a non-emergency. At the time, I was comparatively new in the job, though on that day, I was working with one of the most experienced men in the area.
Entering the house, it was obvious that this was the home of someone who found it difficult to cope. The whole place looked shabby, and felt unloved; many years had passed since any improvements had been attempted, and the carpets appeared to be approaching their first century. As was often the case, the elderly resident, in her mid 80’s, lived in just one room of this three bedroom house, never venturing outside of the small parlour that had become her entire world. She spent all her time on a single bed under the window, with a commode chair nearby for convenience. An ancient dressing table dominated the opposite wall, with a small, dusty television resting precariously on its edge. What clothes she ever intended to wear again, were on hangers behind the door, and a small bedside table was groaning under the weight of the assembled medications. It was unlikely that the window had been opened for years, and the carer was only tasked to give the lady a cursory wash, and prepare a small meal, before leaving the unfortunate woman to a long, lonely night. So, no housework was ever done, no clothes washed or ironed, and the lady had to fend for herself, as best as she could, for most of the time.
Approaching the bed, I could see that the patient was a tiny lady, no more than four and a half feet in height. Her once larger frame had been reduced, by years of poor nutrition, lack of exercise, and osteoporosis compressing her bones. Her lank white hair had been brushed until she concluded it was acceptably smart, and she was wearing a clean nightie, at least the cleanest she had available. Her skeletal fingers clutched the doctor’s letter, which she was determined to hand to us herself. I knelt by the bed, smiling and chatting to her, soon realising that she was also very deaf, so had little idea what I was on about. My colleague left, to fetch a small stretcher from the ambulance, and I explained, very loudly, what we were going to do. Once she had handed over the letter, she was happy to place herself in our hands, and the carer also left, to go to help others on her ever-growing list.
When my partner returned with the stretcher, he had to place it outside, as access to the room was impossible. I advised him that I would just pick the lady up from the bed, and bring her to him. After all, she was incredibly light, and small enough to allow me to make the turn at the door. He said that we should wrap her in a blanket first, then use a two-man lift as normal. I thought that he was adding unnecessary work, and repeated that I would just pick her up. As she was not wearing underwear, I pulled down her nightie for modesty purposes, and placed one arm under her legs behind the knees, and the other around her back, and under her left arm. She was as light as I had suspected, and no harder to lift than a child. I gathered her up into my arms, and turned from the bed towards the door. I noticed that my fellow crewman had retreated into the hallway, and I presumed that this was to allow me room to place her onto the folding chair. My presumption was incorrect, it was years of experience that had prompted his move.
As I hefted her higher, for her legs to clear the door frame, she gave a small cry, and a fountain of diarrhoea exploded from her bottom. This came out with the pressure of a garden hose, and was watery in consistency, like a hot chocolate drink. It was everywhere, splashing between her body and mine, and continuing to pump out, seemingly from a limitless source. I could not put her down on the floor, and I had no time to return her to the bed. I just had to stand still, until the episode subsided. When I eventually got her onto the folding chair, conscious of the uncontrollable laughter of my colleague, I was covered from breastbone to knees in the foul liquid; it had got inside my trousers, and emanated a terrible stench. The lady apologised profusely. She had been unaware of any desire to go to the toilet, and blamed it on being ‘pulled about’. I could find little to help me in her sparse kitchen, and had to make do with using paper towels in the ambulance, to clean up as best as I could.
I had to spend almost the next hour in this awful state, as we drove her to hospital, then handed her over to the nurses, who were all hysterical with laughter at my condition. I eventually got back and showered; I had to change all my uniform, and complete the last part of the shift without underwear. But I did learn a valuable lesson.
When someone a lot more experienced suggests that you do something his way, take that advice.