Chronic

St. Paul's at sunrise.

Nine emergencies; one taken by police, one assist-only and taken home, one running call, one conveyed and the rest went by ambulance.

A miserable rainy day in London. When the sun did pop out the tourists filled the streets and public places, in some locations so much so that moving on foot was just as bad as driving on the roads.

After a quiet start I was sent to deal with a 47 year-old suffering chest pains in his hotel room. He was on a ‘plane when it started twelve hours before but he chose to ignore it. His wife looked fed up with his stubborn behaviour, citing the fact that he never goes to see a doctor about anything. His history of gastric problems gave rise to the possibility that he wasn’t in any danger – he had taken something for a stomach problem but there was no relief. However, his familial history of heart attack (his father had suffered an MI and died) meant that a cardiac problem could not (and should not) be ruled out.

I gave him GTN and aspirin and the GTN gave him a headache, which is to be expected. A little oxygen sorted that out for him and then he was packed off to hospital. Although his ECG was fairly normal, there were anomalies and I don’t trust anomalies (or any other sea creature :-))

My next trip out was to see a 61 year-old lady with emphysema who was experiencing SOB. There’s not much I can do for patients like this, apart from increase their oxygen and give them a bronchodilator (Salbutamol).

When I arrived she was struggling to breathe and looked as if she was on her last legs but 5mg of Salbutamol through a nebuliser and ten minutes later she was improving. She was even able to manage a smile and a full sentence after that. Of course, she went to hospital for further treatment and more definitive care but she will be back home tomorrow with the same problem. It will eventually kill her.

An Italian lady fell on the escalator at a tube station then felt dizzy and sick when she stood up again. Her family were with her and they were concerned because she suffered from vertigo and they didn’t know if she was having an attack or if she had a more serious problem because of the fall. I examined her and suggested that after the fall, she felt faint and nothing more. Her BP was a little low and she was steady enough on her feet, so her long-term condition probably wasn’t the culprit but it couldn’t be ruled out, so she was taken to hospital by ambulance, family in tow. This either added something to their day out or completely ruined it.

A short spell on station was followed by a call to a 69 year-old gentleman with asbestosis who had chest pain. He also had a recent chest infection, unrelated to his disease but such complications can indicate a progression and need to be monitored, so he needed to go to hospital for further investigation.

Then a strange call which took me to an underground station in the City for a '20 year-old male, fallen from bike, arm injuries'. I was fully expecting an outdoor job this time but when I pulled up on scene a member of staff was waiting at the entrance to take me inside.

‘I thought he fell off a bike’, I said

‘Yes, a couple of days ago’, the LU man replied, ‘he has terrible cuts to his arm. Very deep.’

He went on to tell me that they (the London Underground staff) thought they knew him from last year and that there was something strange about him. I felt they were cautioning me to be careful with him, as if he would be some kind of threat.

I went into the office where he was being ‘treated’ and found a man in his thirties sitting on a chair with large and very deep cuts to his arms. I recognised two things immediately about this man: he was a drug addict (his arms were covered in tell-tale punctures) and he was a self-harmer (the wounds were obviously self-inflicted – the depth and direction of them gave that away).

The wounds were old and purulent - both were badly infected. It was possible to smell rotten flesh if you got close enough, as I had to. He had cut himself and left the wounds to fester. To be honest, if you are going to kill yourself, make sure the wounds do the job quickly; don’t leave them to get infected and hope that death will come easily – it won’t.

I asked him when he had last taken drugs and he confirmed that he had taken heroin that morning. He also told me that his leg was painful as the result of a DVT he had been living with for days. I examined it and there was little doubt that he was telling the truth; his leg was badly swollen and very hot to touch. He needed treatment.

The man was very depressed and had given his ‘fallen off a bike’ story to the staff just to get an ambulance. He is probably well known to some of my colleagues but as this is out of my area for the most part, I didn’t recognise him and so he could take advantage of that I guess.

There were no ambulances available for this call and I had to decide what to do. I asked him if he was able to walk to the car and offered to take him to hospital myself. He agreed and I let Control know of my decision. I really didn’t want to be standing here for another 20 or 30 minutes with this man, I had nothing to offer him. His depression made me feel depressed. He reminded me of the devastation that drugs wreak – the hole is even deeper than the one in which alcoholics find themselves.

I took him to hospital and there was no pity for him there. I walked him to a seat where he would wait and wait until a doctor finally got round to him. I had dressed his awful wounds but his soul was lost and beyond repair unless he got a miracle. I left him sitting there with his head bowed and an empty stare in his eyes. He is 38 years old; he probably won’t see 40.

I sat on stand-by at Leicester Square for a while after that job. The police were also hanging around and a couple of Officers approached me and asked if I would examine a female drug addict who had been found on the floor of the ladies toilets. I sat her in the car and she was obviously out of it. Her obs were normal and she said she had just wanted to go to sleep. I told her not to sleep in public places and to go and find somewhere hidden so that people didn’t call ambulances all day long for her.

She wandered off to find somewhere and I got on with my shift.

Another chest pain call took me south for a 79 year-old with dementia. She was generally unwell and had recently been diagnosed with a chest infection. She referred to pain in her chest and it was pretty central, so nothing could be ruled out and the fact that her lungs sounded clear indicated that the antibiotics she had been given had probably done their job. She could have another infection though, possibly a UTI, so a trip to hospital was advisable.

Her son, who was present, wasn’t happy about this because she had allegedly been treated quite badly, in his opinion, the last time she went. My colleagues and I spent some time persuading him that it was the right thing to do. I suggested a full set of obs, including an ECG, at her bedside before finalising the decision. He seemed happy to have that done.

Her obs were normal, apart from her ECG, which wasn’t, so I used this and the chest pain she was complaining of to finally persuade him to let her go to hospital. One thing I have learned in this job about patient relatives is that the surest way to get a letter of complaint is to ignore their concerns.

I popped into a shop on the way back from this job. I needed chocolate and something to drink. On my way out an American asked the shop owner if he had any breast milk. He repeated his request and when told no left saying ‘nobody in this country has breast milk for sale’. It reminded me of the ‘bitty’ sketches in Little Britain.

I went back to my station and read the paper. I came across an article about an 80 year-old man who planned a fake wake for himself. He even had a coffin put in his front room and planned to lie in it while his ‘mourners’ enjoyed his posthumous hospitality. Unfortunately and with greatest irony, he died of a heart attack the evening before the occasion he had planned so painstakingly.

Then a red1 for a 'male lying in street, life status unknown'. This translates to 'drunk' most of the time. The category wouldn't be so high if people were brave enough to see if the person is breathing.

Sure enough, when I got to him, he was drunk and asleep on the pavement. He was also Russian and aggressive. I left him to the crew when they took over. The police were going to arrange his removal.

On my way back to base I was given my last job of the shift. A 78 year-old lady was having a panic attack and couldn’t move her muscles to get down stairs.

I went into a smart house in a smart neighbourhood and she was at the top of a winding staircase, clinging to a cabinet. Her friend was with her but couldn’t get her to come down stairs, no matter what she said or did. The clinging woman confessed to me that she was agoraphobic and that she simply couldn’t move once she approached the stairs. I cancelled the ambulance and calmed her down. I walked her to the top of the stairs and slowly, carefully and with conversation as a distraction, walked her to the bottom. It took five minutes.

Normally she comes and goes by taxi but she was too scared to travel that way to get home, so I offered to take her myself. I called it in as a ‘home by request’ and took her the mile or so back to where she lived. She was very grateful and almost fully recovered from her fright. I felt useful and it put a smile back on my face to be going home with.

However, I got back to my base station late and discovered that a very good friend and colleague, someone I’ve known for almost fifteen years, had suffered a stroke and was seriously ill in hospital. My thoughts are with him and his family.

Be safe.