A life of solitude

I went on a home visit yesterday to an old lady. The district nurse had asked a doctor to see the scar from a vascular operation. ?keyloid, the referral had said. I drove round and rang the bell. The lovely old lady let me in. She lived alone. Her lay-about son, who sponges off the state for benefits, lives a while away and isn't much help. Her husband died 12 years ago.

She underwent an extensive vascular operation to open up the arteries in her leg a few months ago. The scar was well healed. Not keyloid, but slightly hypertrophied I do agree. She was exquisitely painful around the scar, even to a gentle wisp of a hand over the skin. This was neuropathic pain, I explained, probably from the nerves knitting together after the op. It should settle on its own, if not we can use some medicines (amitriptyline/gabapentin for the medics among you). No thank you doctor, I'm not much of a pill taker. Sensible woman.

While in hospital, practically immobile, she had developed a terrible pressure sore on her heel. She told me how she had asked the nurses to move her leg around, to relieve the pressure but she was ignored.

Dr Genesis can easily believe this. It's not that the nurses are malicious. But they are tied up in paperwork and spend most of their time at the nurses' station, data gathering and ticking boxes. They would almost certainly have asked this old lady her religion, her marital status and her dietary requirements. But they could not stretch to simple nursing care like washing and moving a patient. There is no form for that.

The pressure sore went black and needed debridement. The helpful district nurse has attended to it very well. It has nearly healed, three months after the operation.

Dr Genesis enjoys home visits as a GP registrar. It is a real privilege to be allowed into people's homes, when it is truly necessary of course. As we said goodbye, we exchanged some pleasantries about the area and had a little chat. Then Dr Genesis swooped out the maisonette and back to his busy life.

I did feel a little sad that this nice old lady spends most of her days alone.