Wednesday, 21 February 2007

Fighters

I was approached by a young, well dressed man and asked a question:

"Can homeless people join the army?"

"Erm, no...probably not". I was caught out so I answered with the confusion I felt.

"I'm just wondering because they keep asking me for money and I thought they should just join up instead of living off us all!"

So, Mr. Blair, there's your answer. Give them all guns and send them to Iraq. Easy.

I often hear things whilst on stand-by and, as I have done so in the past, share them with you all. I'll be able to look back at this and remember what I experienced too. Like the guy who passed the car with his headphones on, happily singing 'Whisky in the giro'. He too, was serious.

I went to a very poorly old lady with DIB. The doctor on scene described her condition as a "slight exacerbation of her COPD (chronic obstructive pulmonary disease)". I thought this was an understatement when I went upstairs to her room at the nursing home. She was on her last breaths and needed to be in hospital.

An earlier call took me to a man 'collapsed, unconscious' in the street. Passers-by had tried to rouse him but got no response. They dialled 999 and waited for me to turn up. I went to the little crowd that had gathered around the collapsed male and I recognised him immediately. He was one of the 'faces' of that area and was a known alcoholic. I tried to get him to respond but he was refusing to play the game, so I entertained the doubt that he might not be faking and set about getting obs whilst thanking the people around him and gently ushering them away.

I took his BM and temp and all the other stuff I need to identify an obvious problem. Apart from a slightly low BM, nothing shouted at me. I checked his pupils and they were pin-point. I considered the possibility that he had taken something other than booze for breakfast but when I checked his pupils again, they had returned to a normal size. The light can play havoc with a pupil test.

I waited with him for ten minutes. I tried again and again to make him see sense but all he did at most was swing his arm out at me. I was still convinced he was play-acting. When the ambulance arrived the attendant walked over to him, shook him once and he instantly recovered. He thrashed out, told us all to f*** off and marched away to his next corner.

I wonder if some of the homeless can join the army after all?

I went to check on a ? fractured hand and the patient, whose hand certainly looked broken, requested to be taken to a specific hospital which was out of my area of operation. I explained this and he insisted that he was too stressed and depressed to go anywhere but where he felt comfortable. I was standing in the front room of a dark and untidy little basement flat which he, his mates and a well behaved dog shared. I noticed that there was a great deal of extra strength lager available at this host's abode. Incidentally, I have noticed that street-people have extremely well behaved dogs. It must be the bond created when you have to rely solely on one person to feed you and keep you warm. I know of one guy who begs for money in the street and has his dog lie there with a baby's dummy (pacifier) in its mouth! It attracts all the girls and he gets enough money for food. He is a nice guy and I often stop and talk to him, as I do with some of the others but he has more cheek.

Back to my patient. I asked him how he came to have a badly swollen and bruised hand and he simply said that he couldn't remember. His friend said he had been fitting on the floor and that he might have smashed his fist on something. I concede that, being an alcoholic, he may have had a fit and he could have smashed his fist whilst fitting but his friends were at odds with each other from the start and he was very shy about going to the local hospital for some reason.

I offered him my best deal. In order to save the trouble of calling an ambulance, which I won't do for a job like this, I took him and his mates to the nearest bus stop so that they could head on up to their favourite hospital. They thanked me when I dropped them off and they meant it, so I was happy to lend a hand without pandering too much.

A muddy resus on a building site got me, my kit and my colleagues rather dirty at the start of a shift. I was called initially to check on a 'male having a fit'. En route this was changed to 'possible MI'.

I walked on to the site and saw a builder compressing the chest of a work mate who was lying flat in the mud. I took one look at him and I think I muttered something I shouldn't have said under my breath. Whilst the builder continued compressions at my request, I began taking care of the airway and ventilating the patient. I was working alone with the guy for only a few minutes when another colleague arrived and work began in earnest. Soon there was another crew on scene and a further first responder.

During the resus, the patient's heart began to beat again. Then it stopped. Then it started and he breathed spontaneously, albeit slowly, for a few minutes. Then he stopped breathing and we lost his pulse again. He was definitely fighting.

We got him into the ambulance after slogging our way up muddy slopes and a narrow set of steps. On the way to hospital his pulse returned but stopped when he got into the resus department. Everyone there worked on him and they too kept catching him and losing him. When I left to get on with my next call, he was on a ventilator and had a pulse but was in poor condition. He is still, as far as I'm aware, in the Intensive Care Unit in a stable condition.

I went to see the guy who started resus on him and sat and chatted over a cup of coffee about his role in saving the man's life. He admitted he was scared of the situation and wasn't sure what to do. I reassured him and told him that all of us finish a job like that with some self-criticism. Something we forgot or could have done better. I think I left him feeling less upset about it. I hope I did.

Then, wouldn't you believe it, I got a RED3 call for an abcess! Talk about contrasts. The only reason it was given as a Category A was that the guy had agreed to the question "do you have any difficulty in breathing". Whenever I have dental trouble (and I agree an abcess is a painful thing) I don't consider my breathing to be a problem or part of the equation at all.

So I went to see him and gave him the number of his nearest emergency dentist. Needless to say I cancelled the ambulance. I would have been given a LOT of grief for continuing that particular run!

One of my last calls on my run of early shifts was to a lady who had a very slow pulse and was vomiting. Sure enough, as the GP had said, she was bradycardic - her pulse was consistently below 40bpm and she had been vomiting a lot. She didn't looked well. Her blood pressure was dropping and she felt 'drowsy'. I gave her metoclopramide to stop her feeling sick - this would also make her more manageable when moved by the crew when they arrived. I also gave her atropine to bring her heart rate up and thus, I hoped, her blood pressure. Both drugs worked well and by the time the crew arrived she was stable enough to move. Still very unwell but stable and manageable. She kept her sense of humour throughout, even though she told me she was scared.

Of course I also dealt with the usual run of chest pain calls that were nothing of the sort and a few minor cuts and bruises but my last job was to a man who had been bitten by a dog and had lost a bit of his finger. I made my way there and asked control to ensure that the dog was out of the way. I was told that the dog had been fitting when it bit the man. I joked that I might need to give the animal rectal diazepam to settle it down!

In the event, the man's injury was quite serious. He had attempted to give the dog a drink but it began to fit again and chomped down (reflex) on his finger, biting the end. He had pulled free and torn the entire top of it off. He had the presence of mind to keep the part and put it in a plastic bag while he waited for me to arrive. I got his friends to place the bag into a separate bag of ice (you should never expose live tissue directly to ice) to keep it alive, hopefully.

His amputated finger was bleeding heavily and I took care of that with a tight dressing. I elevated his arm and took him directly to hospital in the car. No time to waste if there's any chance of recovering his finger. I would want the same urgency shown if it was me who had lost a body part, as I'm sure you would.

He went straight into resus where they began the process of salvaging what they could of his ravaged digit. Poor bloke.

Someone collided with me while I was on a call. Lights were on, sirens were blaring but he just kept going until his vehicle stopped my vehicle. Minor damage to both cars and neither of us hurt but I feel vindicated in my concerns about a collision being on the cards for me. It was my first RTC in 20 odd years of driving. I found myself driving at a stupidly slow speed for 999 calls after that. I'm sure I'll get my confidence back eventually.

Be safe.

16 comments:

Anonymous said...

Hurray! I was beginning to think you had given up writing! Nice to read a long account of your work, once again!

Fooyum :-)

Xf said...

Hi Fooyum

Down, not out. Sometimes I just need a rest and sometimes I wait for a few days before I write. My writing, whether I like it or not, has become a carefully thought out procedure. Takes more time.

petrolhead said...

Ouch, sorry to hear about your RTC. I was also involved in a minor(ish) RTC yesterday, a 3-car shunt, while driving between patients' houses for work. The two cars behind were both write offs, but mine (well, the Hospice car) was OK, all it needs is a new light cluster!
Don't worry, your confidence will come back soon. :D

Anonymous said...

Wow. A bystander actually DOING CPR- I find it incredible how many people have no idea where to begin. Amazing. Glad you got to have a chat to him. Although I think the comment about 'saving his life' may have been a bit prem though, we all know the stats re. out of hosp cardiac arrest....! At least the poor guy had/has a chance due to his colleague's (and yours, naturally) actions.
Dr W

gjmoomin said...

Well said Fooyum! Nice to see some of the old flow back again too. I understand why your style changed but it was a bit like reading my NVQ candidates care plan entries.'Proceeded to sleep well throughout the night.' I had to resist the temptation to ask did they snore in an orderly fashion!
Take care. Gill

Otana said...

What possesses people to just ignore emergency vehicle sirens? Do they have an overinflated ego, or is it just those horrible bass systems that drown out all noise, I wonder.

Anonymous said...

I'm surprised you've admitted giving a patient and friend a lift in the FRU to a bus stop. Are you supposed to do such things? I thought at the end of the day, they take the nearest A&E or make their own way. Wouldn't you be encouraging people like this is expect lifts from other Paramedics or Technicians in future events? Not very wise.

Xf said...

Anon

I don't mind 'admitting' it because I called it in, as I always do and my ulterior motive was to take him near to the hospital that I wanted him to go to in the hope that he would change his mind. He didn't, so I dropped him and his mate off at a nearby bus stop. No harm, no foul. The decision is up to the FRU driver and if EOC clears it, its fine.

Xf said...

Gill

I think my writing reflects my mood and after my recent rough ride I wasn't really enthused. A fictional diary would have given me more scope to write and much les aggro!

Xf said...

Dr W

I hear what you are saying but I believe a life has been saved if there is still viability. After all, he could still survive and if he doesn't his family will be able to say goodbye while he is still alive, albeit on a ventilator in hospital.

The guy knew what I meant when I said he had helped save him. Any bystander or first aider who starts CPR is saving a life until all efforts fail, don't you think?

gjmoomin said...

Wasn't meaning to criticise- far from it. I had gathered you were pretty low and was concerned you were going to stop writing altogether...the last entry had that original spark back and it was lovely to read. Long may it reign & hope the rotters leave you alone & aim their criticisms at a more deserving cause.( a case of self reflection maybe?) Take care. Gill

Xf said...

Hey Gill

I can always take a bit of criticism so don't worry about that. I'm thicker skinned than they think but I felt low because I had offended and that's what I hope to have resolved.

Anonymous said...

keep up with the blog, is interesting reading even if each entry does make me feel a little more useless lol. Seriously though, I have a good deal of respect for you and all those doing your job.

bagpuss1964@aol.com said...

Sorry to hear about your crunch, hope you are ok. Please keep up your journal, you seem to get more feedback than i do lol, Guess folks just don't want to read about something as mundane as life with MS no matter how wittily you write!. Seriously though, you and your colleagues do a fantastic job which is greatly appreciated by the vast majority of people. Despite your 'regulars':) !!

Anonymous said...

Hi
Great to have you back and i agree your last post does seem to have the old spark back in it.
Sorry to hear about your accident, glad your ok though.
I think its fantastic that you took the time to go back and speak with the chap that done CPR and i'm sure you made him feel better and reasured that his efforts helped.
Doing the long shifts that you work must be very tiring but its good to have you back and writing again, Your journal is always a interesting informative read please keep it up when you have the time.
Regards
Lynn

Dave the Ambo said...

We have "Work for the Dole" in Australia. Unemployed being made to basically community service to get their welfare. Maybe we could have "Fight for the Dole" and send them to the army too.

Glad to hear you were OK after the RTC. Over the years I've developed the goal to myself and my partner back home at the end of shift in one piece. Hence, I don't all that fast to calls.