Column

Where are the coughs and colds?

Rosa Hudson, healthmatters’ doctor at large, takes a look at the patients ‘unseen’ by the government’s white paper

Following the social security benefit changes last year I wondered how long it would be before we had to find money for somebody to live on. When I crossed the waiting room and saw Tom the penny did not drop. In all the years I had known him he has never been on time for an appointment and today he was an hour early. Was this just another Monday morning?

Tom was ‘ill’ last Christmas, partly because he ran out of money and was totally alone. The hospital shot him out in the new year because he was ‘hard to handle’ and showed no signs of mental illness.

When I complained at this turn of phrase the registrar apologised: ‘we know he has simple schizophrenia but he isn’t very co-operative and there’s nothing we can do for him’. Just a label and back out on the street.

I’ve known Tom 10 years. When he first came to see me he would not speak but looked wildly round the room at things unseen to me. He has never been keen on treatment and has never been ‘ill’ enough to be forced to have it. He has not been hospitalised enough to become part of ‘care in the community’, or to qualify for the local MIND scheme which provides a supervised flat with a weekly visit from a kind of helper/befriender/social worker.

He has not even been ill enough/bad enough/ dangerous enough to get a visit from a community psychiatrist nurse now and then.

He has few friends, no close relationships, and no ties with his family, having drifted to Liverpool from Wales after a psychiatric admission in Cardiff and his attempts to do something (0-levels, art courses, etc), have failed because he can’t concentrate for long enough. He is banned from his local day centre because he is a ‘handful’ and can be very angry and aggressive when he doesn’t get his own way.

But Tom is not bad. Sometimes he is naughty and plays on his illness, but he is ill and lonely. He is one of an increasing number of ill and lonely people who ‘survive’ in the urban jungle. His only escape is to use dope which makes him paranoid and empties his pockets of cash.

When I ask him why he does this he just shrugs. But there is a reason: he smokes it with friends and it provides a few short hours of shared intimacy in a long cold life.

Tom had run out of money he tried to do French at evening class and had to give up. One of his few mates got a job and moved away and Tom is depressed. He is never organised at he best of times and now he cannot manage. The electricity board is coming to disconnect him and he has no money to last till Giro day on Thursday.

He has forgotten that the woman from the CAB is in the health centre each week to give advice, though he has seen her before. We even managed to get him a community care grant last year when his thoughts were more organised.

Now he is unable to organise himself but not sick enough for hospital or day hospital. He is one of the forgotten ones, marginalised in the inner city. Being male makes it worse: he has no small child to make him subject of case conferences and continuing support. Who would really care if he took an overdose tomorrow?

I would care. I’m fond of Tom. I want him to get his o-level. I want him to be content. I suffer to see him unhappy. This morning I gave him some thioridazine (a strong but non addictive tranquilliser) to calm him down and help him sleep. I’m sure we can sort out his electricity and some petty cash from the practice will enable him to eat for the next few days. More and more, I am coming to see that as my role. I am the last resort. When other agencies wash their hands I have to remain the befriender.

Our practice is full of Toms and the psychiatrists tell us that their beds are to be cut again by half in the next few years. Even the Christmas crisis refuge will cease to exist. Sadly the community cannot care and the buck stops with me.

The future... we have asked our practice nurse if she will run a befriending/monitoring service for people like Tom. Luckily she trained originally as a community psychiatrist nurse. But she is working hard already and we are over our limit on ancillary staff.

Tom does not vote. He is unseen by the present government. The white paper on the NHS doesn’t mention him at all. If he does kill himself he would be just another statistic.

Recently I took part in a discussion on morality in a meeting about the way forward from Thatcherism. I don’t want to see Tom in a hospital bed or in the River Mersey. I want to see him cared for, understood and enabled to live a dignified life at home as best the can. As well as being his friend and supporter it is my duty to speak out for him, but where do I find the strength and the space?

At lunch time our trainee GP said to me ‘why can’t just one patient have an ordinary cough or cold?’ I came to work in this health centre 10 years ago. ‘Ordinary coughs and colds’ are few and far between.