Blocking a bed

A long time ago, when the NHS was younger and quite a lot of things worked quite well, there were ways of getting things done. If a toilet was blocked you got a plumber. If a bed was blocked you got a geriatrician. In theory it was all quite simple, though it had to be said that our plumbing colleagues probably had a higher success rate.

It really was a long time ago. I was a locum registrar in geriatric medicine, back in my teaching hospital after a couple of years wandering, and the doctor on the phone who was upset about the blocked bed was new to me. He worked in the poisons unit. He too was a locum, one of the then current wave of antipodeans. Let us call him Dr X.

“Took some kinda overdose. Uh, diazepam. And not a lot. Like, something between a gesture and a fair night's sleep. And now he's fine. Or rather he should be. He should be outa here. But he's just lying there, blocking an acute bed. You gonna do something?”

There wasn't much going on so I went over straight away. The poisons ward was just as I remembered it from house jobs, when several times a night for months I went over to do stomach washouts, a procedure so deadeningly mechanical that towards the end I sometimes wondered if I would eventually manage to go across and do one and make it back to the residency without waking either myself or the patient. It was odd to be there in the afternoon.

Dr X was waiting. We walked down the ward together towards the offending patient, who lay on his bed like a crusader on a tomb, his hands clasped, his eyes staring, his face almost a death mask. “See,” said Dr X. “He's not doing anything. And he's blocking a bed.”

The man could scarcely turn his head towards us. His voice was soft, his speech slow. His forehead shone greasily. Even a locum registrar in geriatric medicine knew what to do next. Muscle tone at the elbow was indeed abnormal. Cogwheel rigidity wasn't just palpable, it was visible. To his credit Dr X clutched his brow and shook his head.

I felt quite sorry for him. In 30 seconds or so his patient had been transformed from least favoured status, that of geriatric bed blocker, to something completely different: a newly diagnosed case of a clear cut neurological disease for which effective treatment—this was 1975—had just become available.

“Parkinson's,” he groaned as we walked up the ward. “Gee, shit, doc. Shoulda got it. Really sorry to bother you.”

A middle aged lady with a shopping bag was waiting outside the doctors' room. She turned out to be the patient's wife. I asked her about her husband's recent health. Yes, he had slowed up a lot. And he shuffled. And sometimes he just stopped when he was going through a doorway, as if he was stuck to the floor.

Though clearly of modest education, she was an ideal witness: observant and concise. After a while she politely interrupted my string of questions. “Doctor,” she said. “D'you think he could maybe have a touch of Parkinson's disease?”

Poor Dr X clutched his brow again and this time turned quite pink. I mentioned that he and I had just been discussing that very diagnosis, complimented her, and asked what had made her think of it. “I suppose I know a wee bit about older people,” she said. “You see, doctor, I've got a part time job.” She smiled proudly. “I'm actually a home help.”