The good, the bad and the obnoxious

My second of three early shifts proved very busy. I dealt with a man with rheumatoid arthritis at a busy train station early in the morning. He was at work and it struck him suddenly, inflaming his knees, making him collapse onto the floor. He couldn't get up and an ambulance was called. He was in a lot of pain and I felt very sorry for him. I gave him entonox, which eased the discomfort and helped space him out a little, then I persuaded him to hobble to the car.

By the time I got him to hospital he was in less pain. His main grievance was the way in which his condition was being passed on as 'mysterious' by one doctor to another. He was being given pain killers but nothing else - not even a more definitive diagnosis. He is only 29.

Then I was asked to go a long way out of my sector to attend an elderly woman (91) who had fallen the day before and was now complaining of shoulder pain. I got to her rather smart flat in a leafy part of London and had just threatened the door with my knuckle when she opened it, ready to leave. I persuaded her back inside so that I could carry out an exam and chat to her first and she duly obliged. Some people, especially the active elderly, just want to get on with it and don't want to fuss around. She was that type and it doesn't bother me in the least but I have a pace I need to work at and I have to control the patient and the environment to a degree in order to get things done.

So, I asked her what had happened and she explained that she had fallen and hit her shoulder. She had broken the same shoulder a few years previously and it was 'playing up' again. I asked her if she knew what had made her fall and she told me she couldn't even remember falling. This is worrying. It suggests she is falling, possibly as a result of a medical problem, more often than she is telling me. They have specialist nurses for this problem in the elderly.

I checked her shoulder and it did look swollen and out of place. I left her arm as it was - I firmly believe in leaving simple fractures alone. If the patient is comfortable holding it themselves then I won't move it. I checked for a pulse and all the other stuff I needed to do. Apart from the visual change in shape, her limb was fine. She probably had a fracture but it was up to the hospital to determine that.

I took her blood pressure and found it to be quite low for her age. If her BP is consistently low, this may explain her fall. Her pulse was also quite slow. Otherwise she was quite able to get into the car and travel with me to hospital. This was a Green2 job and, unless I asked for one, no ambulance would come for this lady. It wasn't necessary anyway.

During the journey to hospital, I spotted a man standing on the corner of a busy junction with a big green parrott on his shoulder. The creature was nibbling his ear like a lover! I drew my patient's attention to it and she was just as amused as I was. We had a nice long conversation and she turned out to be a very sharp and well-tuned old lady. She was a miss; had never married and had no intention to. I wonder if all spinsters live to a good old age?

She had letters that needed posting, so I did that for her at the hospital once I had booked her in. It was a pleasure.

From there I was directed South of the river to a block of flats for a 'diabetic male, unconscious, hypo'. These calls tend to be straightforward. The person is either not diabetic nor unconscious, is diabetic but not unconscious, is diabetic and is unconscious.

I arrived on scene and took the lift to the millionth floor to find that he was diabetic and he was unconscious. I got some response to mild pain so it wasn't too bad. He was breathing noisily and his father told me he had not been eating properly. I began my obs and discovered my BM meter wasn't working properly. It was fine earlier but now it didn't want to play. Typical.

Fortunately, a crew arrived as I struggled to get the damned meter to oblige. Unfortunately, they had not brought theirs up with them as they had seen my car and assumed I knew what I was doing. The patient's dad brought his own (the patient's) meter in but it didn't work either. Now that worried me.

Just as I was about to treat as hypo anyway, my colleague managed to get my meter to play ball. His BM was 2.2 - too low. We had him on Oxygen and I injected 1mg of Glucagon into his arm. This hormone facilitates the release of stored glucose from the Liver. It takes about 10 to 20 minutes to work and will only be effective if there is any Glucose in the Liver at all.

Ten minutes later and luckily for us, he began to respond. He swore a LOT during his recovery but he was never physically aggressive. It took a full 20 minutes for his condition to improve enough for him to be lucid. He sat up in bed, wolfed down a chocolate bar and started sucking on those plastic nicotine things that supposedly stop you smoking. He was back to normal. His BM was now in the high 5's.

There remained the problem of future management, however. My colleague knew him more than I did and he was a fairly regular caller (well, he wasn't but his dad was). He was frequently going hypo and we all thought there must be a problem somewhere. It turns out that his Insulin dose may be far too high and so the crew stayed behind to arrange a visit from a GP to solve the problem. Otherwise, one of these calls is going to be for a dead diabetic.

Then what do you know? I am deep in the South and don't have a clue when I get a call for 'woman lying on pavement. Wants to sleep'. Yeah, wants to sleep it off I thought. I scooted to scene, pressed 'on scene' and realised I wasn't - the mapping system had sent me around the back of the shops on that particular High Street, so I had to adjust my position by means of U-turn and a short drive around the block.

I saw her lying on her side with two Community Officers standing with her. Not near her, just in the vicinity of her. I soon found out why. I went over to her and she stared right at me.

"Hello, what are you doing lying there?", I asked politely

"F**K off!", she replied (politely)

The conversation beyond that is full of expletives and ridiculous comments about her being Jewish and therefore surrounded by people who hate her. There I was, standing in a predominantly Black area of London, trying to see that connection.

She had downed at least two bottles of Vodka and was happily pouring it down her throat as she lay there abusing me and anyone who passed by. She even had a pop at a woman and child who walked past. I decided not to bother with this and to get reinforcements. I asked Control to send the police.

She was insistent on being taken home and, you know what? I would have done if she had been less abusive and annoying or had bothered to give her address. Every time I asked her where she lived I got a stoney look and a nonsensical answer.

The police arrived and she gave them the same treatment. They were getting nowhere until one of the Officers decided to lure her to the police van by holding her plastic bag, containing the Vodka bottles, in front of her. She followed it like a hypnotized sheep. She still wouldn't help with her address and so they arrested her for being drunk and disorderly.

I dealt with two seriously cut fingers today. Partial amputation is a more apt description for them. The first was at a building site where a young man had lifted a manhole cover and it had slipped, slicing his finger all the way through to the bone. It was still hanging on but only just. It had been well dressed by the site first aider, so I left it as it was and only saw the damage sustained when I got the patient to hospital. The second call for a finger injury came almost immediately after. This time it was a young woman, working in a fast food restaurant. She had sliced her finger through with a baguette knife. She was in a lot of pain and very distressed. Quite a bit of bleeding had occurred with this injury and she was looking a little pale. Both patients should hold on to their digits (no pun) and should recover fully.

My last job of the shift was to a pretty dancer who had twisted her ankle. She had a decent sprain and could only hobble to the car with assistance. See? The job isn't bad all the time!

Be safe.