Not counting the knock on the door or the ringing of the bell, it’s always the fifth thing I do.
The first is to introduce myself. Hello. I’m Jim, from the Rapid Response Service. Affecting a friendly but trustworthy demeanour, ready to show my ID, ready for a variety of responses, friendly to hostile, indifferent to anxious, hilarious to who the hell are you… Sometimes I’ll add a you know – the hospital, if they look nonplussed. The Hospital sounds serious and sensible, carries weight. Everyone knows what a hospital is; Rapid Response can sound like the Marines.
The second is tell them what I’ve come round for. To see how you are, check your blood pressure, temperature, that kind of thing. I’ll probably follow that up with a So – how are you feeling? as I put my bag down and orientate myself to the place, and the circumstances of the visit. Get the relatives on-side. Any pets.
The third thing is to ask if they’ve got a Yellow Folder. The Yellow Folder is the holy bible of the health visitor round here (the care folder, that other really useful book, is almost always blue). The Yellow Folder will have all the notes and obs charts, discharge summaries and clinical assessments, ambulance reports and ECGs, and most helpfully of all, the record sheets each clinician fills in when they visit. Some folders are so thick, covering so many years and conditions, you have a job to open them without everything pitching out on the floor. Others are sweetly arranged, with coloured dividers, and an index in the front. It’s quite an art handling these folders. When things are going well you can talk to the patient about their current situation whilst discreetly filter-feeding information from the various sections. When things aren’t going so well, you feel like throwing the folder out of the window and starting from scratch.
The fourth thing I’ll do is get my stuff ready. The obs kit, stethoscope, anything else I’ll need. I try to put it all out in such a way that I won’t forget it, an ‘equipment dump’, like I’ve seen the fire service run at chaotic scenes. I’ve also got a plastic folder of paperwork, the different sheets I’ll need to fill out. Who knows how many times I’ve said It’s all about the paperwork! as I lay them out in a row, like the NHS version of The Tarot.
And then the fifth thing, the main event, running the obs. I’ll start off by putting a SATS probe on one finger, and reaching for the pulse on the other wrist.
It’s a pivotal moment, when the visit turns from something almost business-like to something more deeply personal. And I’m often struck by the change.
There are lots of reasons why you should physically take a pulse. The SATS probe is just numbers, easily thrown off course by an irregular heartbeat, lurching crazily from slow to fast. Palpating the wrist and counting the beats gives you a clearer idea of the general rate, and you can also tell a lot from the quality of the pulse. But there’s something else, beyond the merely clinical. It’s a visceral thing, a basic but very human kind of contact. It’s interesting, how such a simple action can have such a profound effect on the relationship. Even with the most difficult patient. Much more than hello, how are you or where’s the folder.
A gentle squeeze at the base of the thumb.
You can feel their heart beating.
Who’d have thought?