Choices, choices...

Pancreatitis. Not a funny condition at all. Very, very painful. If you suffer with it, you have my sympathy.

I attended four pancreatitis-related calls during my last run of shifts and one of them was particularly severe. The gentleman was in extreme pain. The sort of pain you know at-a-glance is not being put on, faked or exaggerated in any way, shape or form. He was as white as a sheet and sweating for England. He couldn't move without screaming out in agony.

I gave him morphine and he needed 10mg before he settled down. It took three attempts for me to get a cannula in him though. The first attempt was a rubbish vein (which I could have assessed better before attempting it), the second came out when he jumped up in a spasm of pain but the third stayed where it was needed and gave me access to his bloodstream for analgesia. I also had a clinical decision to make. There was no ambulance available just yet and I had to make the best of his stability whilst the morphine had an effect. So, while he was able to walk I took him to the car and sped to hospital with him. It took me 7 minutes. I may have waited up to 20 minutes otherwise. This was a green2, so low down on the priority for a vehicle.

I'm not going to whine about the system, it's pointless. Instead, I'm going to exercise my professional ability to make clinical decisions about conveying patients. I'll call it in - I always do - but if it's a choice between a patient waiting in pain and one that gets to definitive care quickly, then I will do it, provided there is no obvious risk to the patient. That's my job, isn't it?

I was asked to go and assess an elderly leukaemia patient who wasn't feeling well. She had an appointment at the hospital for treatment but didn't make it as far as the bus stop. I went to her home, where she had been waiting with a worried neighbour for 40 minutes (green2), and carried out a thorough assessment (I really need to consider doing my ECP training. I might as well). She wasn't well at all. Very low BP, pale, sweaty. Shocky. I contacted Control and asked that the call be upgraded because we had all been sitting in her little hallway for almost an hour now and I had run out of things I could actually do to help her. Even conversation tends to become stinted when there is nothing left of relevance to say. I could hardly discuss the telly with her in the state she was in.

The crew arrived and removed her to hospital as quickly as I would have done myself. Obviously, there was no way I was moving this lady by car - even though I was tempted. She couldn't walk and just didn't look like she was going to survive an upright journey.

I have touched on this clinical decision making subject before, I know, but I truly believe that it is why we are trained to think in the first place. Surely we are skilled enough to see the obvious and deal with it appropriately? None of it is about being better or best. It's all about the patient.

You may have noticed that I am now using links where relevant. I hope you don't mind this and find it useful. It saves me rambling away from my main point in order to explain something in greater detail. It's also a good educational tool if you need it!

I went to Kiev a few weeks ago (I know, I didn't tell you) - I was incognito. I spent a few days there discovering the old Soviet fingerprint of structure and architecture (which is pretty amazing) from the bad old days of the Cold War. I also went to learn some Russian and educate myself. I didn't know that there was a Russian language and a Ukranian language. You see, I learned tons. Anyway, I saw the ambulance pictured and thought you might be interested in seeing it.

I might publish a few more of the photo's I took (they won't be relevant to any entry but they will be pretty to look at!). You don't mind, do you?

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