Katie Wright
First year clinical student,
Sheffield Medical School

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"And then the dog vomited on the carpet ..." Vera hisses before bursting into wheezy hysterics, and showering the bed with assorted nuts. I've been taking a history from 91 year old Vera for about an hour and a half, a far cry from the 20 minutes we have in our clinical exam. She can't remember her previous illnesses, her drug history is of the "small white ones and a big blue one" variety and she had a little accident somewhere in the history of the presenting complaint so we were delayed changing her sheets. She has a whisper of a voice which makes her difficult to understand. And she keeps trying to feed me Brazil nuts after she has sucked the chocolate coating off. "My teeth can't cope with them hard bits, but don't want 'em wasted," she murmurs into my ear. "Consultant's always right grateful, eats 'em all up!" I cackle out loud at the thought of him chewing away, not realising they are second hand. Despite our difficulties, I am having a wonderful time, and thoroughly enjoying her stories, and not at all minding if we lose the thread occasionally. She is an incredible small old woman, having reared a large family single handedly when her husband was killed in an industrial accident. She has outlived her four eldest children, having nursed them through various debilitating illnesses. She has numerous great grandchildren and recited to me their birthdays and ages. I was understandably shocked therefore on seeing the reaction of the house officers to Vera. They seemed to spend as little time as possible with her and appeared to be uncaring. Vera is a talkative woman, but she was practically ignored by all those on the ward round that afternoon. I couldn't understand their approach and asked them about their impressions of her. I received a lengthy and complex medical problem list, in a tired and disheartened voice. It became clear to me that as I had all the time in the world and no responsibility, Vera was a lovely old dear. To the house officers managing her illnesses and ultimately being accountable for her, she was hard work. They simply haven't the time to hear the dog and carpet story. They have 20 other patients, ward work, and are on take this weekend. I also hadn't realised how advanced Vera's various illnesses were, and that she probably would never leave hospital. I was amazed to hear that she had a no resuscitation order, and realised why the other reason health workers don't become as attached to their patients as they might otherwise do. There was little that could be done for her, and given her character, this was hard to accept, and frustrating for those who tried to help. I am glad I had the time to get to know Vera for the woman she was, rather than for her medical problems.