One of our staff recently said over tea that she hadn’t seen Sam recently.
This was indeed unusual as he was to be found around the department most days. He’d been coming for years, initially as an aggressive drunk, escorted by the police to get his head stapled after a bottle fight, and latterly for somewhere warm where he could sit.
Sometimes a concerned citizen would find him slumped unresponsively on a pavement, and call the ambulance. To be honest this was a bit of a nuisance, as he usually woke or sobered quickly and then threatened staff and caused mayhem resulting in him being arrested for disruptive behaviour.
Over the years his general condition deteriorated with admissions with liver failure, and the inevitable Wernicke- Korsakoff mental and physical deterioration no matter how often he accepted thiamine injections.
Staff befriended him as best they could with clean dry clothes from the bottom of their husband’s wardrobe, warm food from the hospital canteen and a wash when he would permit it. One even managed to get him into the decontamination shower for a proper clean, and then treated him to a haircut and shave.
In wet or cold weather he would often drop in, and if challenged by security because a waiting patient complained about the smell, would declare himself to have chest pain.
Over the years chest pain became a reality and he was rarely without a chest infection. Obviously, he didn’t take prescription medications and wouldn’t engage with services and therefore became a frustration to those who had come to care about him.
He slept in the hostel when quiet and in a police cell when disruptive, or in the emergency department or on the streets when in-between.
Once, when thrown out of the police station into the rain, he broke their window with a brick, thus ensuring a dry bed and regular meals for a week. There have been occasional absences before, usually of two to three months’ duration when Her Majesty was extending her hospitality to him, but no one could recall recent bad behaviour or newspaper reports of a court appearance.
Winter isn’t kind to rough sleepers, particularly when they have chronic medical conditions, poor reserves of strength and hide away in quiet parts of the town to avoid detection by the youths who had fun at his expense, and passers-by who might help with a kind gesture or a 999 call.
This winter has been of arctic proportions in the frozen wastelands of the North. I know this because even taking the dogs out for a quick race around the garden has been a challenge resulting in retreat inside to the central heating on, full blast.
So, how anyone could survive outside with no shelter is beyond me, and sadly was also beyond Sam, who was apparently found by someone taking their dog for a longer walk than mine have had for a while.
RIP Sam, aged 42.
Charles Lamb is a consultant in emergency medicine. He writes under a pseudonym
It sounds like you played a significant role for this 'frequent attender'. This sort of care should be recognised and encouraged. Don't let a mean-minded Government put pay to such important human interaction.
It should indeed. When I was training, there was an effective way of engaging a tripartite team - social care, medical and pastoral, but it seems to have wasted away to be replaced by bigger asks, and an eroded sense of accountability to care for all those in need.
I am an immigrant British Citizen from a developing country and living here for nearly 40 years. I am familiarise with extreme poverty and poor but when I see a young guy ( appears quite healthy ) in the pavement , I wonder and do not understand why he is lying in the pavement in the first world country. Is it society, culture , family, money, government ? I will be happy to know.
I have a relative who spends significant time as a rough sleeper. I am NOT suggesting his story is typical but he spent time as a rough sleeper when provided with accommodation - which he sublet. He is not alcoholic and AFAIK is not a drug user. He is sometimes diagnosable with psychiatric illness, often appears psychotic, and often appears paranoid. He is also intelligent (graduate education) and articulate and disengages from psychiatric services at the earliest opportunity. As well as the statutory services many family members have tried to help but in the end my relative has always preferred (for 30 years as he's in his 50s now) to go his own way.
Sam is at peace now, I hope he finds any afterlife easier than he clearly found this one, but we all owe a debt to those who help the troubled and unlucky. None of us are immune.
This is a piteous condition that calls for attention on how we evaluate and assess complex health needs of similar issues. My personal experience has shown that every man has physical body, soul and spirit. This man would have needed support and interventions in those realms of his existence. He has unmet needs in his physical health, social, emotional, mental and perhaps spiritual health domains. I read an article in the NEJM a while ago that doctors may need to be observant and be trained in skills and understanding of these domains of health.
Charles Lamb is another unsung hero.
He did what he could.
What he was allowed to do - and more.
Can anyone comment n the number of complex MH patients quietly starving in their housing association flats whilst their PIP benefits are stopped?
Makes you proud to be British!!!!
This ain't what I trained for.
PIP benefits are often stopped following on from poor quality Health Care Assessments performed by DWP employees who do not understand mental health. It can take many months, sometimes over a year for PIP to be reinstated via a Tribunal appeal. In the meantime there can be a massive amount of financial hardship and deterioration in mental health. It is not so much the Benefit system per se that is at fault, but the quality with which the Benefit system is applied. Supportive medical documents, letters, GP reports etc etc can all be very helpful for these very vulnerable individuals at the time of their renewal application. In most cases PIP benefits are reinstated via the independent Tribunal system, but this is too late to avert the terrible toll on the individual, services and society.
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