The Fall (And Rise) Of Medical Care

(About ten years ago, I worked on an island off the Dutch coast in a nursing home. This happened on one of my night shifts. Note, at that time there were no helicopters allowed to fly at night. It’s just after 12 when I get a call from a resident. I can’t hear her, so I run as fast as I can to her to see if she needs help. The moment I step through the bathroom door, I can see she’s broken her hip. As she’s quite a big woman, my coworker and I can’t get her off the ground, so we call the local GP, who sends the ambulance to help us out. I ask him what medication she should be given, as she’s already in a lot of pain. The GP replies that I can give her paracetamol and call him if it’s not enough. Ten minutes later, the ambulance is onsite and they lift the resident into her bed. I give her 1000 mg paracetamol and cross everything in hopes it’ll at least do something. Forty-five minutes later, it’s clear it didn’t do anything — not surprising, really — and I call the GP again. He tells me to give her another dose of paracetamol and he says she’ll be transported off the island on the quick ferry around 8:00 am. I tell him that I don’t think paracetamol is going to cut it, but he insists. Another 45 minutes later, I call him again, saying it didn’t help and her condition is worsening due to the immense pain she’s in. I can see her getting a fever, amongst other things. He tells me to give her paracetamol again. By this time, she’s had 3000 mg in just over 90 minutes! It’s not good, but I’m not allowed to give her anything else, nor do I have the right papers to decide on anything else. I’m really frustrated and get the feeling the GP is not listening to anything I say. I go and have a look at the medication cabinet and find an unopened bottle of morphine that was described to a resident that died two weeks ago. I call the GP again and ask him to allow me to give her morphine, instead. He says yes, go ahead. Then, the following conversation takes place.)

Me: “All right, if you’ll send me the prescription by fax I’ll get right on it.”

GP: “Yeah, just give her [dose]; I’ll write the prescription in the morning.”

Me: “No, you know I’m not allowed to do that; it’s morphine. I need that prescription.”

GP: “In the morning!” *hangs up*

(I call right back.)

Me: “[GP’s First Name], I’ll give you exactly five minutes to write and fax that prescription, before I’ll head over to your house, grab you by the hair, and drag you out of bed to write it. Understood? Your time starts now!” *hangs up*

(It’s not nice of me, I know, but I’m really tired and I feel unheard. I walk over to the fax and within three minutes, the prescription has arrived. My coworker — who’s been doing all the work I should have been doing in the meantime — and I give the resident the morphine and within ten minutes I can see it’s finally working and the pain gets a bit less by around three in the morning. I start doing some other work, like writing a report for the hospital and packing a bag for the resident. At around five, I get a phone call.)

GP: “Hi, [My Name], since you haven’t called again I gather the morphine has started working?”

Me: “Yes, it has. She’s doing a bit better; she’s still in pain, but the edge is taken off.”

GP: “Yes, well, you know I said she’d be getting on the quick ferry? I’m having a problem as I need that spot for a woman in labour.”

Me: “So… she’s flying at dawn?”

GP: “Well… no. The helicopter is standing by for a man with heart problems.”

Me: “Right. So, normal ferry it is?!”

GP: “You see, that’s the problem. There’s nobody at the ferry headquarters who can accompany her. I can’t do anything other than hope to get her on the next ferry at noon.”

(That would be over 12 hours after she’s taken the fall and I know she’ll get worse if this takes too long.)

Me: “You know, I’m on the normal ferry this morning. I can accompany her.”

GP: “Really?”

Me: “Yes, if [Ferry Company] allows it, I can do it.”

GP: “I’ll call them and let them know.”

(They did allow me to accompany her; they even reimbursed my ticket and gave me breakfast! In the end, I did report my behaviour to my boss and told her what I’d said to the GP. She laughed it off and told me not to worry, as she thought it was hilarious.)