It was supposed to be a simple job, pick the little old lady up off the floor and either take her to hospital, or leave her at home. Unfortunately there were a number of complications.

The first complication was that there wa a powercut in the area. As it is the middle of the night the whole place was pitch black. We have lovely torches in our ambulances. Well... It turned out that we had 'A' torch. It wasn't working.

Brilliant, all our actions would be under the light of our pentorches.

We managed to find the house quite easily, there were two candles in the window. The paitnet herself doesn't open the door, she's too scared. Instead one of her neighbours has a key and lets people in. He wasn't much younger than the patient herself and had been drinking a little.

We arrived and, under feeble torchlight, managed to determine that she had a black eye, a cut on her shin and a small cut on her face. She refused to go to hospital. All she wanted to happen was to be put back to bed.

I looked around, I couldn't see a bed.

The patient sleeps on the sofa because she is too frail to climb the stairs to her bedroom. So she puts lots of pillows on the sofa and throws a blanket over herself. Because of the powercut she didn't have any heating either.

Like Ms Nightingale before me, this (ex)nurse was forced to clean and dress the patient's wounds under candlelight - my crewmate did a good job of holding the candle only dropping it the once.

Still the patient refused to come to hospital.

I asked her if she had any carers, she told me that her son comes every couple of weeks to stock her cupboard with food, but other than that she has no social services/care input at all. This is partly why she was sleeping downstairs on the sofa, she hadn't been offered to have a stairlift put in.

I wasn't very happy to leave the patient at home, but she had the capacity to refuse treatment so I had no choice. In a case like this I like to have a GP come to visit to make sure that I haven't missed anything important (I know my limits). Unfortunately the emergency GP couldn't give us a time when he would be able to visit - as the keyholder was going to be going to bed (it was edging on to 11pm), there would be no-one to open the door for them.

So with some regret I arranged to have the patient's own GP come out to visit them in the morning. It was basically the best I could do for the immediate future.

Then the patient needed to use the toilet, my (female) crewmate took care of this for me (for which I'm very thankful). It was about now that I realised that the light on my pocket pc/camera made a really good torch.

For a longer term look at her care I filled in a 'vulnerable adult' form. This got faxed off to our Control who then deal with any concerns that we raise. In this case they will speak directly to the local social services and hopefully they will provide some help to enable this patient to live safely in her own home.

I have to do all this, it's how I get to sleep at night. If I'd just left her and crossed my fingers then I'd be worrying for days about her. By doing all the above I've done all that I can, and it is now up to the GP and Social Services to do their job.

A conscience is a terrible burden sometimes.

Of course it would have all been a lot easier if there hadn't been a powercut, if it wasn't during the hours of darkness (when the regular services all vanish) and if she opened her own door.

Actually it would have been much easier if I'd been able to persuade her to go to hospital.