Kerb judgment

Nine emergencies; one deceased, one assisted only, one conveyed and six taken by ambulance.

I spent the first part of my shift talking to a dead man. He was sitting in a chair in his front room, a half-opened nebuliser in his hands and cans of beer strewn around the floor – one of which was waiting to be opened. It never will be – not by him anyway.

The 68 year-old had been found by a caring neighbour who regularly visits to give him his breakfast. He had let himself in to find his charge sitting upright, as if watching the garden through his patio doors. He was asthmatic and had emphysema. He had a home oxygen system and a portable, mains-powered nebuliser compressor. I’m telling you this because a tragedy seems to have occurred in the early hours. His power had gone off because his meter needed credit. Nobody is sure when it happened but the sequence of events looked to me thus: Breathlessness and a tightening chest. He reaches for his nebuliser, switches on his portaneb, prepares to load his nebuliser with salbutamol...then the power fails. Everything stops and he dies – out of breath.

Now that may all seem melodramatic but I can’t figure out many other likely scenarios from the evidence, I suppose he could have died before the power went off and was just too late to help himself. Whatever happened, he went very quickly, peacefully and in the middle of trying to save his own life.

He has no living relatives and few friends but he was an avid collector of models (cars mainly); he had hundreds of them around him. He probably liked his own company.

As I sat there, I went through what might have happened with him (I always chat to the dead when it is appropriate - you never know) and the police arrived to take over. Then an inconvenient and rather embarrassing thing happened – my service mobile phone rang. That in itself is no big deal but I hadn’t realised (and how could I?) that the ring tone had been reset by someone to one of those feature sounds. I sat there, police in attendance and the man’s friend just outside the door, with the sound of a rooster calling in the room. I wasn’t amused (although I'm certain some of you are smiling right now) and I don’t think I even looked up as I reached for the phone and took the call.

I left the scene after I had completed the necessary Recognition of Life Extinct (ROLE) form. I then returned to my base station to replenish some kit and to change that stupid rooster sound to a normal ringing tone.

Soon, I was on the road again and I wandered into my usual area, just in time to be called to a fast-food restaurant to attend to an unconscious male. The call description stated that staff thought he might be drunk or on drugs and I was willing to bet on one, the other or both.

Sure enough I arrived to an empty welcome and had to walk around the place looking for my patient. No member of staff even tried to help me out - they were all too busy selling burgers. I went downstairs and there he was (at least I made an educated guess that it was him), sitting at one of the tables, leaning drunkenly to the right. He was a young man and he looked scarred and beaten by life, so I was being very careful with my approach.

He was conscious and not very interested in being helped. He didn’t want an ambulance; he just wanted to be left alone. This is where we find ourselves in a no-man’s land, professionally speaking. It’s really not our job to turf people out of public places and yet the Manager, who turned up eventually to watch, expected me to do just that. The crew turned up and I felt a bit better about my odds but I was still unwilling to do anything other than treat the man if he needed it. He didn’t – he made that clear.

The crew walked out with him after a few minutes though. I talked him into at least leaving the premises (at least I think I did, or he may have been persuaded by common sense) and my two colleagues walked with him until he was in the street again. The idea was that he would get checked over and a decision about a trip to hospital could be made if necessary. He changed his mind, however and I watched him refuse all treatment and stagger off, almost re-entering the premises he had just left.

I think I handled him the right way because when he stood up to go, he verbally threatened the Manager, who had been the only person to talk down to him. I thought he was going to throw a punch at him and it shook the man a little; he looked frightened. It wasn’t a pleasant exchange at all. Earlier he had bragged about how much he fought and that he had been banned from Croydon. I tried to look impressed ‘cos I’ve no idea how to get banned from an entire town.

A long trip south followed for a 26 year-old who was vomiting and ‘can’t wake up’. My mind automatically assumed alcohol-related for this one but I was wrong. The young guy actually looked ill. He hadn’t been drinking or taking drugs but he lay in his bed, barely able to open his eyes, shivering and suffering from abdominal pains. I hadn’t got started on obs when the crew arrived, so I let them get on with it – the man needed to go to hospital. A doctor needed to look at him, so the less delay the better.

My next call brought me back to my own area and to an unconscious 25 year-old. He was found by an off-duty police officer, curled up in a corner at a busy tube station. I had to keep pinching his shoulder for a long time to get him to respond. I could smell the alcohol from him, so I had a reasonable suspicion that he was sleeping it off. Eventually, he came to and looked around in a daze. He was American and he thought he was in Chicago. He was genuinely shocked to be in London. He didn’t know where he was, where he stayed, what he had been doing last night or what day it was today.

I noticed a bruise on his forehead and it looked like he had been hit but I also noticed a wad of £50 notes hanging from his pocket, along with his wallet. I pointed these things out to the police officer. I don’t think he was mugged, I think he got so drunk that he fell over and hit his head. He was now concussed and, quite frankly, lucky to be in possession of his cash and wallet at all. He must have lain there all night and nobody took a blind bit of notice. Sometimes Londoners are a saving grace.

There was nothing else wrong with this man; he recovered from his ‘unconscious’ state and I found no abnormalities with his vital signs. His BM was good and he had no other injuries. I was literally a spit from the hospital (if you are a great spitter and can lob saliva half a mile), so I cancelled the ambulance and took him myself in the car. When we got to hospital, he was just as confused as ever.

“I can’t believe I’m in England, man. This is England, right?”

No rest today (they tried to send me on my break twice but I got called) and so the next job came in immediately after I ‘greened’ up. This one was for a 60 year-old man who was feeling weak and suffering abdo pains at a swimming pool. The staff members who met me were worried that he may be having a heart attack – I know this because I could see it on their faces but also because they had their defibrillator up and ready to go. Nothing like being prepared.

He sat in their first aid room, clearly in some pain. He had been swimming and felt the sharp pain start but had ignored it, assuming it was cramp. He carried on swimming until he could go no further and the pain stopped him. He admitted that he had probably overdone it.

His obs were good and the pain was in a very specific place, so it’s possible he had torn a muscle or suffered a hernia. I don’t think he was having a cardiac problem but it can never be ruled out (until it is ruled out, of course), so he was going to be moved by chair and have an ECG done. The crew arrived and did just that. They gave me a copy of the ECG and, apart from the expected anomalies given his age (he was actually 70 odd but didn’t look it), there was nothing remarkable on the strip. The crew took him to hospital and gave him something for the pain.

For some reason my kerb-hugging parking, which is usually good, was rubbish today. I thought it was the way the mirrors were set, so I adjusted them but time and time again I parked up, got out, did my job and returned to find that I had left about a mile of space between the wheels and the kerb – okay, not a mile but a fair bit. It was starting to get embarrassing by the end of the shift. I've been driving (and parking) for over twenty five years - what's this all about?

I returned to Trafalgar Square to meet my buddy for the next few hours – the journalist from Radio 4. I was a bit nervous about how it would all go but she turned out to be friendly and easy to talk to. We have to be very careful what we say to the media when we are on-duty; it’s a different matter when you are expressing a personal opinion (say, in a blog) but I have to watch for press minefields when I am working. I could get sacked if I don’t.

During the few hours of my interview, I received two calls and she came along for the ride (with LAS permission, of course). My first call was for a 28 year-old pregnant lady who felt dizzy in a coffee shop. A crew was on scene just ahead of me and so I wasn’t required. The next call was to another coffee shop (the same chain ironically) at a different location. This time it was for a man with DIB and asthma. Two Cycle Response Unit colleagues were arriving when I pulled up, so they joined me as I assessed the patient.

The man had chest pain, not DIB and was extremely anxious. His partner was with him and he confirmed that he was prone to stress. My worst jokes came out for him and he appreciated them (I think). A patient with chest pain needs tons of reassurance, not a dead-pan face and a sober attitude. Not that I clown around, of course, that’s way too far down the line. Most of my colleagues have a great sense of humour around ill patients (where appropriate) and I have seen it work wonders.

It was raining heavily when the ambulance crew arrived to take the man to hospital. His pain had eased and I am sure he had nothing but stress to blame for it but the doctors will confirm that.

My Radio 4 adventure ended after that call and I went back to work alone after chatting with my CRU colleagues and grabbing a quick (and free) cappuccino during paperwork time.

I got a few cancelled calls after that, including one which sent me to SE1 from W1 just to be cancelled on arrival. It was getting dangerous driving in the torrential rain, especially when no other driver seemed to see me coming and I had to use brakes and steering in slick conditions to avoid them. My top speed in the rain is probably 40 mph...on the straight.

A 26 year-old female with severe abdo pain and a history of cysts was my next patient. She had been waiting with her husband at a bus stop for a while before I arrived – not because I took my time but because there were no ambulances available due to the high call volume. She could barely stand up and wasn’t willing to move much. Her face told me she was in genuine pain and I hoped an ambulance would come soon.

There was a drunken man sitting on the same bench with her. His head was down and he was drooling a stream of saliva (or something nastier) down to the ground. He wasn’t moving much and he had his trusty cans of lager at his side, should he feel the need for a break. Ironically, another drunken man sidled up to him, looked at me, then back at him, back at me, rolled his eyes to heaven and showed me a face full of disgust. Mr. Bean couldn’t have created the comedy that I was watching now. I might write another book entitled ‘Drunks are funny’.

When an ambulance did arrive, some ten minutes later, the crew told me that they were on a different call. They had already stopped though and this was getting awkward. The woman’s husband would not be pleased if this ambulance went away again, so I asked what they were going to and they told me it was a probable ETOH, lying in a doorway. The crew agreed to help the lady and I called Control to see if we could swap the jobs. They obliged after I explained the need to treat this patient for her pain and the awkward situation we now found ourselves in.

I gave her morphine for her pain and went with the crew to hospital. It took ten minutes to treat and convey her. She had waited almost an hour.

My last call of the shift (and I was glad it was over) was for a 41 year-old homeless alcoholic who had been found semi-conscious and coughing up blood. He was lying on the steps of a church that gives refuge to the local alcoholics and drug addicts. The Parish takes responsibility for feeding them, clothing them to some extent and giving them a place to lie down.

I knew this man. He had been a patient of mine last year and he was drunk and abusive. Now he was too ill to care. He was still drunk and he was lying in his own filth. There was an eye-stinging smell of urine about him and I had to hold my breath several times to deal with it but he wasn’t well and his body needed to go to hospital, even if his soul was meant for somewhere else.

His friends were deeply concerned about him and I think they are used to being ignored and vilified because one of them said:

“We are good people but we are alcoholics”

It stopped me in my tracks. I could hear her in my head saying ‘we get treated like crap all day, so please don’t do it now’. I had no intention of treating them any less than anyone else.

As I left they thanked me and the crew, who had taken the sick man to the ambulance. The woman shouted out that she didn’t know what else to do and that she was sorry she called us but...

“I didn’t want to wake him up dead”

Be safe.