First off a private message - Thanks Darren, the gift is very much appreciated, you shouldn't have.

I've written a bit about not wanting to leave people who I am called to at home, but there are times when for one reason or another patients do get left behind.

Take for example the fifty year old woman who had supposedly suffered from a stroke. We had turned up and she was lying on the floor not talking to anyone. Her husband and son were standing over her, obviously worried.

It was tricky to assess her - English isn't her first language and she wasn't speaking much anyway. So I checked all the usual things including some basic neurological tests. Everything was normal.

There is a thing that some people do, some cultures more than others, when they find themselves losing an argument they 'collapse'. Normally you can tell these straight away by the telltale symptoms of faking a collapse such as keeping your eyes screwed shut when I try to lift an eyelid.

This was the feeling that I had from this woman. She didn't want to go to hospital and the son was very sensible - I explained everything to him and he agreed to keep an eye on his mother. You never know when something simple might turn out to be some bizarre illness.

So she was left at home.

The other person that day who I left at home was a young woman who has a terminal disease. We arrived and the FRU responder had already treated her. Luckily the FRU pilot knew her, apparently she never wants to go to hospital (and to be honest I can't blame her) and will normally recover somewhat after our treatment.

The slight problem with this is that she had been drinking a bit, did this reduce her ability to give or refuse consent? I'm sure that this was one of those jobs that if something bad happened to her I could be hauled over the coals by my management or the coroner.

but...there was someone with her, she seemed competent enough to me and there was a documented history of her not wanting to go to hospital, so I made the decision not to try and have her dragged off against her will.

Once more, I do things so that I can live with myself. Even though I'd rather take people to hospital so they can see someone brighter than I.