Sleeping with the patient

24th January 2011 by Judith Harvey

Improper relationships with patients are in the news.

Mrs M was the patient. She might or might not have been dementing, but she seemed confused and was certainly prone to wandering. She might or might not have been in severe pain from her arthritis , but she certainly had a flail leg after failed surgery. All of which made it difficult for her to live in her isolated cottage with its steep narrow staircase. Somehow her medication had reached alarming levels and might or might not have been making things worse. She was in the cottage hospital for evaluation. Essentially this meant taking her off her psychotropics and titrating her pain relief. After several days no-one was sure what was going on. Does paracetamol take effect within half a minute? Was she skipping down the corridor when she thought no-one was watching? Was she attention-seeking? She was certainly much more peaceful when someone spent time with her.

I was a GP registrar, and on call. The previous evening the cottage hospital had not been busy and the nursing staff had popped in regularly to see Mrs M. Everyone had had a quiet night. Tonight the staff were occupied with a dying  patient. At intervals through the evening they rang to say that Mrs M kept struggling out of bed and falling, and asking what could be done. In line with the agreed plan, I authorised further doses of major tranquilliser as I went from visit to visit.

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