Saving Superman

Don't be a pigeon in Trafalgar Square.

Ten emergencies; all required an ambulance.

After a slow start this morning things got hectic and I reached the end of my shift tired and ready to go home. I spent the morning on stand-by and chatted to my friends on Trafalgar Square; the security staff and the lady who keeps this pigeon-scaring hawk under control. Rain threatened but didn’t arrive until later on, so it was a pleasantly warm start to the day and the tourists seemed to appreciate that.

When I got my first call, it was already well into the morning and I was off to deal with a male who was fitting in the street. I arrived to find a van load of armed cops standing around a shivering man who had lost bladder control (whether that was a result of a fit or his new close friends, I don’t know). An off-duty consultant neurologist was on scene and handed the patient over to me. I thought this was fortuitous indeed – how handy was that for the patient?

The fitting man was Polish and didn’t speak much English, so communicating with him about his condition was difficult. My weekend in the Ukraine hasn’t helped me achieve much in the way of Russian translation (either way) obviously, although I was able to reassure him by using the Russian term for ‘OK’ – only to be told by my 'A' level Russian language speaking colleague (the crew were on scene a few minutes after me) that I was pronouncing it incorrectly. Next week – Chinese language lessons.

I was asked to go to a patient whose on-call doctor had decided he needed an emergency ambulance. The patient had a fast heart rate and was generally panicky. Apart from that, he looked absolutely fine and had no specifically relative medical history for his current state. There was no chest pain and no other physical problem associated with his tachycardia. I could see his carotid artery bouncing up and down in his neck, even when he sat still, and there are a number of medical conditions that will cause this – anxiety is one of them. I have to admit I was thinking along cardiac lines initially and the GP had me convinced that there may be cause for concern – even though I wasn’t persuaded that this was life-threatening but he’s the doctor, so I listened and checked the man out. I could find nothing obviously wrong in any of my obs.

The crew arrived to take him to hospital and an ECG was carried out, along with a repeat set of obs., again nothing obvious jumped out. The on-call doc had left the scene by now and the patient allegedly confessed that he had been taking his own blood pressure, convincing himself that it wasn’t normal. This made him anxious about his health and probably resulted in today’s racing heart rate and a trip to hospital. Talk about self-fulfilling prophecy.

My next call was for a 16 year-old male with DIB. I got on scene at the same time as the ambulance crew and so I left them to it. I expected them to come out of the building with a young, healthy panic-stricken boy. Instead they appeared with a much older man – he was 60 years-old. Someone had misheard this over the ‘phone I think.

I went north for a Greek woman with arthritis next. She had stated chest pain on the ‘phone and that’s what I was originally running to. When I got there and started my obs I quickly realised the ‘chest pain’ was being stuck on for good measure. Her pain was all in her leg, so it was the arthritis playing up and nothing more. She had been discharged from hospital a few days earlier and given tables for her pain but she insisted she needed to go back because the drugs didn’t work.

The crew took her back to hospital, after having to lift and wheel her all the way down from her fourth floor flat – we never rule out chest pain, even if we can see little evidence of discomfort, so every patient confirming they have it is moved by chair to the ambulance. This can be hard work, dangerous (narrow stairwells and trip hazards) and is no good for the lumbar spine, regardless of the education we get on logistics and lifting techniques. I can’t walk around for more than a couple of hours these days without low back pain.

Of course our Greek lady would have needed support and a chair for her painful arthritic leg in any case, so some lifting was inevitable.

Then south again for an elderly lady who was described as becoming 'confused' by her son, who made the 999 call. When I got there he was helping her on the toilet. He thought I might want to check her out while she was sitting there. I declined the offer and politely requested that he bring her into the front room. It took an age to achieve this as she was very, very slow moving. I tried to help but the corridor was a little narrow and her son was at her side already, so I waited patiently in the front room.

Eventually she arrived and sat down. She seemed a little confused and not quite with it so I set about getting some basics – she had high blood pressure, a high temperature (+38c) and a high BM (+21). She hadn’t been drinking fluids often enough according to her son and she had a recent history of ‘mini-strokes’, known as TIA’s. It was possible she had experienced another of these but it was more likely that she had an infection, probably a UTI. She had been going to the loo frequently and there was a tell-tale smell hanging around. Actually, there were two smells – she had been doubly incontinent.

The lady went to hospital, accompanied by her anxious son.

I don’t know, you can go for days without seeing a single off-duty doctor and then they all arrive at once. My next call was to a 36 year-old who had fainted in a large department store. I found her lying on a pile of expensive-looking cushions that the staff had provided by cannibalising a nearby (expensive) sofa, currently on sale. Beside her were her husband and an off-duty G.P. who gave me a hand-over and left the scene shortly after to continue her shopping.

The patient was pregnant (halfway there) and was concerned about her unborn child, even though it was fairly obvious that she had nothing to worry about. She had fainted and was recovering well until she decided to become dazed and floppy again. Her husband became increasingly concerned about her and I continued to reassure him until assistance arrived in the shape of a colleague on the cycle response unit. Together we managed to keep the patient conscious with oxygen and conversation. All her obs were normal and a recent scan had given the baby a clean bill of health, so why she was fainting repeatedly was a bit of a mystery. She was also periodically very tearful – I think her hormones were playing games with her – physically and emotionally.

Another doctor passed by and asked if she could be of any assistance - this time I recognised her as one of the SHO's I knew from a few years ago when I was working in A&E at St. Thomas' Hospital. I chatted with her and discussed the patient's situation briefly before she too moved along to finish her shopping. This was a popular store for the medical profession.

The ambulance arrived after ten minutes and she was taken to hospital, just in case.

Here’s a believable call description. ’52 year-old male, chest pains, says he is famous and will wait near a call box in Whitehall’. Hmm, I thought, had the PM snuck out for a Mars Bar and a can of coke and got caught short by dodgy coronary arteries? Was I about to be implicated in saving the life of our Premier (Blair, not Brown – although you could have swung this either way)? I could see my Knighthood being awarded by King Charles (she can’t last forever).

I raced to the scene and saw...nobody. Every phone box in the location was empty and no-one was hanging around. There were lots of curious tourists but they didn’t look famous. I went back to the car and read the updated information I had received. Now it stated that this famous person wanted to be taken directly to Buckingham Palace. Maybe one of the Queen’s corgis (the one that can make phone calls) had escaped, run up the Mall and developed chest pains along Whitehall as he attempted to return via the park. I didn’t know and it was just a theory, so I called in and asked for the callbox number so that I could track down the patient more effectively.

More information appeared on my screen: ‘claims he is Superman’. Right.

I was back on the radio and about to call this a ‘no trace’ when a small man with a wild face appeared at the window of the car. It was Superman.

I had a long conversation with my famous friend and discovered his chest pain was a myth. He just wanted to get to Buckingham Palace. He told me he was an agent of the Queen and that he had to return immediately. It was raining now and I wasn’t pleased to be having this conversation with a wet head (I've just had my hair cut short, so I can feel every cold droplet). I asked him if he had anything on him that could harm me or himself (I didn’t know him and I wasn’t letting him in the car – I also didn’t know if he was psyched enough to use a weapon in order to have his demands met). He said “Of course not, what a stupid thing to ask”. I conceded his point but I still looked in the bag he was carrying. He was in possession of a bunch of lethal looking bananas. He proudly boasted that he had only paid £4 for the lot. I really didn’t know if that was a bargain or not to be honest – I eat them but I can’t remember the last time I went out and bought some.

The ambulance crew arrived after a short wait and he was packed into the back for his short trip (he could have walked – or flown – in less time than it took him to buy those bananas) to hospital.

I think I smiled all the way back to the car. I'd rather have an entertainingly mad time-waster any day of the week than some of my usual suspects.

A 23 year-old female with acute abdominal pains next. It was her birthday and she had been out celebrating – although not drinking. She couldn’t move for the pain so I gave her a little entonox and she took to it fast. I had to wrench the mouthpiece out of her hand when the ambulance arrived and she was giggling like a school girl as the crew walked her into the vehicle. Once inside her first request was for some more gas. Well, at least she was happy.

I wasn’t required for my next call – a 64 year-old with chest pain - so I excused myself and greened up after completing my paperwork. It was almost going home time and I made my way across the river but my evil plan to do 12 hours and no more was foiled when I was dragged back across the bridge and into the West End to deal with a 52 year-old female who had fainted an hour earlier and was now in the back of a private ambulance, still recovering.

I spent 20 minutes with the patient, during which time she continued to recover, although she remained very pale. Her BP had initially been low but only when she sat up (postural hypotension) but this improved over time. She was still taken to hospital so that a thorough examination could be carried out.

The Heavens opened up as I drove home and people were running for cover. I don’t know why because the clouds had been heavy and black for a good ten minutes – adequate warning to get out of the impending rain I suggest.

On the way I saw a man dragging his unwilling big fat brown dog through the street. Obviously the man had been soaked enough and wanted to get home. The dog, however, had other ideas and wasn’t quite finished with the outside world. I thought a lesson in life was staring this man in the face: never buy a dog that is too big to lift up and run home with.

Be safe.