Sugar and spice

Six emergency calls. One treated at scene, one conveyed and four taken by ambulance.

My shift started out with an introduction to a feisty ninety seven year-old Irish woman who was suffering from heart failure. Despite her DIB, swollen ankles and obvious discomfort (“I’ve been better” she says when I ask how she feels), she is still able to rail against the inevitability of her condition.

I climbed into the back of the ambulance after carrying out my initial obs at her bedside and prepared a diuretic for her. This would ease her breathing and during the treatment she made a request, after complaining about the needle in her arm:

“Can I have some brandy in that?”

If it was legal and I had any, she would have been more than welcome to it.

I completed the paperwork on my aged Irish comedienne, left the scene and got about a mile down the road before I was asked to turn around, go back and assist with a crew who were working on a suspended alcoholic.

He was only 45 years-old and had been found in bed at his hostel, vomiting blood as a result of a massive internal bleed (gastro-intestinal). This brought about a cardiac arrest in front of the key worker who was trying to help him. When I arrived the crew were busily working on him on the floor. There was a good deal of blood around and his airway was a mess. The paramedic was attempting to intubate and I could see it wasn’t an easy job for him but he got the tube in and secured it while I set about gaining IV access and preparing the drugs that would be needed. I have to say that there are some jobs you just look at once and decide there is little or no hope. This was one of those jobs.

We frantically ventilated, compressed and drugged him until another crew arrived to help with the removal to hospital. I had been on scene for about ten minutes and there was absolutely no change in the man’s condition. The ECG showed persistent PEA and the prognosis was poor.

We prepared to move him down stairs (he was a large man and the stairwell, as usual, was very narrow) and tidied up our equipment. I asked the key worker and another member of staff to help carry the bags as we moved the resus effort from upstairs to downstairs and then into the ambulance. The first crew on scene conveyed the man to hospital and I took the key worker in the car so that he could pass on next-of-kin details to the hospital staff.

In the Resus room, work continued and many more people got involved but it was called by the doctor in charge and the man was pronounced dead forty minutes after he arrested.

I went back to the flat with the key worker because I had forgotten one of my bags and the place looked like it had been raided, the detritus of our effort was everywhere and there was plenty of evidence of recent death; blood on the floor, a crimson pillow on the bed and a little trail of the stuff leading from the flat to the outside world. In the bathroom, the man had prepared his shaving kit for the next day, not knowing that he would not live to see it. I always find those poignant little things very sad.

The doctor at the hospital told me that he was glad we had been working on him first because he would have found the job too messy and very difficult to manage. He praised our team, which is rare.

After a short interlude to replenish my drugs and equipment, have my much needed coffee and complete my VDI (I had no chance when I came on duty) I wandered back to my home station north of the river. I had just set foot in it when I got a call for a diabetic who was possibly hypo at his workplace. It was late at night but a lot of people work through the night in London, especially printers and graphic designers, who find the relative quiet and lack of traffic a reasonable alternative to the rat race. In fact, I have been called to quite a few diabetic problems in workplaces at odd times of night.

When I arrived and entered the premises I could see four men; one who was working at his computer, one who was thrashing around, looking ever so pale and sweaty and two who were holding him down and trying to reason with him. I'm not sure if the guy at the computer even knew there was a commotion two feet behind him.

After establishing whether or not the thrashing man was capable of aggression or had been violent, I checked his BM – 1.4 – not good at all. I set about preparing Glucagon; he was far too active to tolerate an oxygen mask and his friends had already tried to make him eat but he had almost bitten their fingers off. I decided to use Glucagon to start the ball rolling, raise his sugar levels and then give him something sweet. It usually works very well.

He struggled against me but I gave him the injection with the help of his restraining friends and stepped back to wait for a result. Glucagon takes between ten and twenty minutes to have an effect but within a few minutes I was able to give him oral glucose. He nearly bit through my finger and caught my glove whilst chomping down on the plastic tube but he ate almost all of it (the glucose, not my glove).

After a further five minutes he began to relax and recognise his surroundings. He took a little more glucose and I asked his friend to pop out and get him a sandwich or crisps so that he had the necessary ‘slow burn’ carbohydrate to finish the job. All the time I worked alone. No ambulance was available at first and I cancelled it after the first ten minutes when I realised progress was being made. Recovered diabetics usually refuse hospital treatment (and don’t need it anyway) after an uncomplicated hypo.

I rechecked his blood glucose level and it was now 4.3 – much better. He was making sense, although still unsteady on his feet and he told me that he probably doubled up on his insulin injections today, which would explain his condition. It’s likely, I suggested, that he was already becoming hypo when he injected his first dose of insulin. This would have made him even more hypo and the confusion would have led him to believe that he needed more insulin. Or he had simply forgotten.

He was fully recovered and quite embarrassed when I left him half an hour later. I like hypo calls; I can do something about them almost immediately and in almost 100% of these jobs we gain a certain satisfaction about having ‘saved’ someone. It’s one of the easiest life-saving procedures we carry out and it is extremely common.

Back up to my home station for a break then out to a 52 year-old man with urine retention. He was in a lot of pain when I arrived and he apologised for calling an ambulance because he knew that this was not really an emergency. He was already being treated for a UTI and his retention amounted to nothing more than difficulty peeing. However, I recognised his discomfort and he wasn’t play-acting, so I thought a trip up to the hospital (ironically where he works in the finance department) wouldn’t do any harm.

This call had come in as an ‘aggressive diabetic’ but the only aggression I perceived was aimed at CAMIDOC who had failed the man. He had tried calling them for help but the line was ringing out, so he had no recourse but to dial 999. It’s a familiar story.

I conveyed him and his wife in the car after cancelling the ambulance (there weren’t any available anyway). Once I handed him over I reminded him that he should consider releasing some of the money upstairs for the nurses and doctors who were currently putting him out of his misery. I think he smiled but it may have been a painful grimace.

A few hours sailed by – well, they never sail when I hit a quiet patch, they crawl on arthritic limbs – and I was sent to King’s Cross station for a female with chest pain. I searched and searched but couldn’t find her. Nobody waved at me and the crew, who turned up a few minutes after I did, had the same problem. Just before the ambulance pulled up, a man wandered over with half his finger hanging off and blood dripping onto the pavement.

“Can you put something on this, or shall I get it dealt with at hospital?” he said drunkenly

I glanced at his partially-amputated digit and decided chest pain over-rode it. I told him I had another patient to deal with but he was persistent...and bleeding near my boots. So, as I scanned the area for a possibly dying heart-attack patient, I bound his exuding extremity in a dressing and pointed out the hospital (at the end of the road), instructing him to go to A&E and get his finger stitched back on.

The distraction meant that the crew were somewhat confused and bemused. They left me to deal with Mr. Finger whilst they searched inside the station. It occurred to me that I hadn’t even bothered to ask the man how he had come about ripping his limb off in the first place.

I joined my colleagues in the station but they were looking lost. It was quiet; rush hour was still an hour away, so it should have been easy to spot a lady in agony. Nothing.

Then, as we all made our way to the exit, a woman, who had been sitting on a bench watching the entire spectacle, raised her hand. The ambulance attendant asked her if she had called us. Yes she had. It didn’t take much experience to determine the lack of crisis here. She was a homeless Romanian woman (and there will be many more soon). She just wanted a bed for the night and knew how to play the system. I think there is a special school somewhere in which the great British system is explained in detail. All the tricks of the trade are taught in this school but it is strictly out of bounds for tax payers. Sorry.

I was across the bridge and less than a mile from freedom (going home) when I was turned around by the wicked FRED and sent to an assault in the opposite direction. I sped off, arrived and was flagged down by an Italian windmill. His friends had been gathered in the street (the tourists come out very early to catch their buses and trains home) when a drunk stranger happened by and punched one of them in the head for no reason. The young man’s head was bleeding a little and there was a gash in the back of it, so the ambulance crew took him off to hospital.

It’s nice to know that, whatever time of day it is, you can rely on someone to represent this great capital city of ours. Welcome to London chaps.

Be safe.