Dr Amar MashruAll patient identifiable information has been changed.
The Physician Response Unit (a community medical emergency response team) was tasked by 999 to see a 20-year-old female who had had a serious allergic reaction to a bite which resulted in a rash. The doctor and paramedic drove to the patient’s residential home in North London. They were invited into the front room, where the patient was sitting and fortunately looked well. The doctor took the history. The patient seemed to have been bitten by something in the garden and now had a very swollen outer aspect of her right thigh with a rash. The degree of swelling had frightened her and she had called 999. The medical team completed the full history, took her observations and examined her.
Whilst this was going on, two children were running up and down stairs, both seemed to be under the age of 10 and very interested in what was going on.
Another woman who appeared to be in her 40s was also there. She seemed appropriately engaged, caring for the 20-year-old patient and was asking questions. She stated that she was the patient’s aunt and that her mother was in Pakistan, where they were from. Her niece, the 20-year-old, was living here whilst she studied at college.
The medical team were very comfortable that this patient was clinically stable. It wasn’t a life-threatening case of anaphylaxis or an emergency and so they provided reassurance and a management plan.
As part of that, the doctor asked the patient where she had been in the garden, so that they could see if there was an obvious trigger of the allergic response, for example, a plant that would need to be removed. “Let’s go to have a look”.
In the garden, on the left hand side, was a wall. Around 3ft up the wall was a large long horizontal shelf with spaces underneath and wooden doors closing certain compartments, almost like large outdoor cupboards. In one of the spaces, a woman was sitting and washing clothes by hand. She appeared to be ethnically different from the family, possibly southern Indian.
The doctor smiled at her and said hello. She smiled back. The aunt then came out into the garden saying “oh, she doesn’t speak English” The doctor asked this lady, “are you family?” The family laughed at this question and the aunt said “no, no, no, she’s working.”
The medical team then finished up their plan with the patient and left. During the debrief in the car driving away, the medical team reflected – who was that woman? What was their responsibility to her and why something about that outdoor shelter made them uncomfortable?