All Patients Great and Small

There’s nothing quite like an eccentric character to make the long shifts more bearable. Dick was a perfect example, and epitomised what makes a tightly knit small community a unique place to work. Before retirement Dick had been the village gravedigger, a role which he was extremely proud of. Before a decline in his health affected his mobility he was often to be found in the local graveyard surveying the newly dug graves with the scrutiny of one who knows the intricacies of such a craft. Prone to ‘embellish the truth’ shall we say, Dick’s stories were classic and my, medical and nursing colleagues alike looked forward to his latest ramblings. My first encounter with Dick was to assess an itchy foot rash. My GP colleague had passed the responsibility to me, as often happens in District Nursing, smelly feet are not high on a GP’s agenda it would appear. On this occasion it was a wise move on his part as the inside of Dick’s boot was not a pretty sight. The odour was enough to knock even the strongest ‘Cast Iron’ stomach off course. As I unlaced his boots and slowly and carefully removed his sodden socks, it occurred to me that Dick’s feet hadn’t seen daylight in a good while. Faced with what I can only describe as terribly neglected feet, which were both pungent and wet, Dick excitedly proceeded to give me his considered diagnosis. Patients often offer their own suggestions regarding possible diagnosis and clearly as the ‘patient knows best’ they are usually somewhat accurate. Dick had the most expressive eyes which danced with delight when he was in full flow. His extremely bushy eyebrows appeared to have a mind of their own and they played a huge part of communicating his excitement. “Trench foot” he exclaimed with a confident certainty, “That be it sister, saw plenty of it in the war!” The more excited Dick got, I was to discover that, he would repeat things rapidly and often add an ‘aye’ or an ‘ahh’ at the beginning or end of a statement. “Aye that’s what it is”, followed by an “ahh that’s it". Being relatively confident that I was confronted with a fungal foot infection I felt Dick’s diagnosis sounded more dramatic and news worthy. On reflection whilst explaining to Dick my findings I did indeed agree, that despite initially having a different diagnosis, that indeed ‘Trench foot’ and fungal foot infection were one and the same. It gave Dick huge kudos with his elderly male pals to be able to tell them that ‘Sister’ had agreed with his diagnosis. I was to become a regular visitor at Dick’s on and off during the next few years and I never once tired of his ‘tall stories”. Knowing that Dick was, some would say gullible, his son in law regularly fed him snippets of prefabricated stories, which he would then eagerly share with me and my team during our regular visits. On one occasion I vividly remember him informing me that our senior GP colleague had been included in the New Year’s honours list for his work within our local community. It appeared somewhat unlikely I felt, as I had minutes before left him finishing a morning surgery session. During our coffee break I felt sure such news would have been shared over the digestives whilst he signed the prescriptions and we shared out the patient visits. Dick became totally convinced by the validity of his son in laws stories, and no amount of discussion would change his opinion. It certainly brought a smile to the GP`s face in future when we referred to him and his wife by their rightful titles: - Sir Barrie and Lady Sheila. Like so many patients of Dick’s generation a decline in mobility often means that the visit of the nurse is an important part of their lives. Loneliness and isolation in the elderly is an increasing issue with an aging population and the erosion of traditional established family units. Many elderly people, particularly in isolated locations, live their latter years largely alone. Dick like a great many of his contemporaries looked forward to his visits from both the Nurses and GP’s. One of the most challenging aspects to providing care at home is not to force your own standards upon that of your patients. In Dick’ s case this was quite a test. The commode chair, which often doubled as an oversized spittoon, was often in pride of place in the lounge, where Dick directed his conversations from. Dick enjoyed nothing more than to greet me as I entered his home with his latest in depth personal bowel update. The front door opened directly into the lounge, and I became accustomed to being greeted directly from his ‘throne’ so to speak. As any Nurse will confirm the current state of their patient’s bowel pattern is often their dominant line in conversation. Accompanying grunts, groans and contorted facial expressions only added to the picture Dick graphically painted. I often wondered if he had a permanent seat mark across his buttocks considering the amount of time he spent ensconced on his ‘throne’. Despite an extremely supportive daughter it was not easy to provide the amount of care he required as his declining health caught up with him. Remaining in the home that he was born in was hugely important to this engaging gentleman, who we all secretly had a soft spot for. We offered as much help and support as we could in accordance with his wishes. Like many people of his generation he was determined that his family should inherit the family home. Despite feeling he would be far better cared for in a residential/ nursing setting we ultimately had to respect his decision to end his days at home. When a patient is of sound mind as Dick was we may feel uncomfortable leaving a patient in this situation, but ultimately it is a decision we must accept.