Tuesday, 13 November 2007

Death's door

Six emergency calls – one refused and five required our attention.

Again, a relatively quiet night; the cold weather is probably responsible for the lack of people willing to go out and hurt themselves. The air is beginning to get a little ‘nippy’, as we say in the Homeland and the first frost is developing in the mornings when I come home from work. Of course, that means winter is here and the giant commercial beast that is Christmas is just around the shopping corner.

It all starts with a 55 year-old man who has ‘collapsed’ outside a pub in the City. Now, I know you will think I am a cynic but when I see the words ‘collapsed’ and ‘outside pub’ in the same sentence I usually expect to arrive at the scene to find a drunken male/female/shemale slumped against a puke-covered brick wall, surrounded by clucking friends who firmly believe that he/she/it has been ‘spiked’ or has ‘never been like this after just the one drink before’. Such is the inevitability of our descent into predicting calls of this nature – it creates singularly critical individuals of us all eventually.

I was wrong, however, but luckily I am armed with caution when I make presumptions – too many calls in the past have been genuine and I am always wary of making too quick a judgment.

I arrived to find a man standing at the door of a little pub. He looked unwell and two of his friends were on hand to help him. He was very pale and sweaty. He had suddenly felt unwell and looked like he was going to collapse, one of his mates told me, so they walked him outside and called an ambulance, such was their concern.

‘I had food poisoning over the weekend’, he told me.

That put it into perspective. He had no chest pain and he had no medical problems apart from a little hypertension and type two diabetes. I checked him for changes with either his blood glucose or blood pressure and found nothing untoward. I guess his food poisoning problems weren’t quite over.

A crew arrived within a few minutes and he was taken on board the good ship LAS for further checks (including an ECG).

I went on my merry way and found myself heading back to my own area for a 48 year-old female ‘fall, hit head, DIB’. Unless a head injury is significant, DIB is rarely a factor worth considering in these calls and it is a real problem for us because that single term determines the category of the job. It becomes much more urgent if those letters are added. I expected to find someone with a bump to their head and absolutely no problem breathing whatsoever and that’s exactly what I got when I arrived on scene.

The lady had slipped at work and cracked her head on the concrete floor. She had a nasty bump, a sore wrist and a painful rib. The rib injury was causing her to breathe cautiously, due to the pain but it didn’t impede her breathing and wasn’t in any way life threatening. Nevertheless, even though an injury like that should go by taxi to the nearest A&E, she was taken by ambulance to hospital.

Now that the weather is becoming colder, we tend to experience an increase in calls from the homeless as they attempt to secure warm lodgings and perhaps food in one of the local A&E departments, so I wasn’t at all surprised when I was dragged off to E1 for a 64 year-old man who claimed he had suffered three fits and was about to have another. He had managed to explain his medical emergency himself, lucidly and calmly, from payphone. When I arrived a crew were on scene and he was in the back of the ambulance chatting to them about his woes. Sometimes it’s hard to elicit sympathy from a crew who can feel the wool being pulled and so he wasn’t receiving the warmest of receptions but I guess we all have to put ourselves in their place. What would you do if you had nowhere to go on a bitterly cold night? Dialling 999 is still free (until the commercial animals get a hold of it) and generally speaking, the ambulance service aren’t going to say no to you.

I went south of the river for a 55 year-old lady who had collapsed on a tube train. I think she had mental health issues because she behaved erratically and refused to speak with any clarity or explain herself properly. Witnesses told us she was slumped in her chair and wouldn’t rouse when a member of staff attempted to wake her. The train had passengers on board and I don’t think any of them appreciated this delay in their journey as the crew and I attempted to get sense out of her. Some of them left to find other means of getting home. I was also wary of the fact that the entire line would be slowed or stopped as a result of this woman’s behaviour.

In the end, with exhaustion setting in on both sides, she stood up, refused any help and walked off the train. She crossed the floor to the other platform and stood there, petulantly, waiting for another train (going in the opposite direction). We had no choice but to leave her to it and the staff apologised to us for wasting our time.

After a good few hours of nothing, I went with a crew from my station to a 24 year-old who had fallen and sustained a head injury outside a gay club in the West End. It was freezing and rain had just fallen, so it was wet and freezing.

The man had fallen onto the ground and split his head open above the eye. In itself, the injury was innocuous but as he was too drunk to realise what he had done, it was safer to take him to hospital than it was to let him go home, which is what he wanted to do. Luckily his boyfriend persuaded him to take the sensible option. At this time in the morning and under these weather conditions options like this don’t hang around. I think he fancied one of the crew too.

My last call delayed me getting home but I didn’t mind because this patient needed us. It also reinforced my annoyance with people who insist on using the term DIB when they have nothing of the sort because this patient really was in trouble. He was a 48 year-old lung cancer patient who had developed severe DIB during the early hours and it had got worse as time went by. His frantic wife called us out because she had run out of options.

When you walk into the room of a person who is at death’s door, you know it immediately. There are no ifs or buts, a time-critical patient is an obvious sight. This man was at that door. His breathing was desperate, his eyes were pleading and he was using every muscle in his body to gather the strength to pull air in. If I could round up every caller who allowed the term DIB to be associated with their petty problems I’d shove them into this room, tell them to look at my patient and say ‘THAT is DIB’.

As soon as the crew arrived we took him to the ambulance. His lungs were filling with fluid, so I tried every drug at my disposal to resolve his immediate problem. His sats were in the low 60’s when I first checked them and even now, in the back of the ambulance, with a 100% oxygen mask on, GTN and Frusemide in his system, he wasn’t improving above 85%. He was diaphoretic, weak and scared. Every time I leaned over him I could smell that acrid, sticky aroma that hangs around the terminally ill; the smell of death. You can’t detect it during a resus and you don’t pick it up with acute emergencies – it’s associated mainly with long-suffering tissues and the ongoing breakdown of living stuff. I wasn’t fooling myself. I wasn’t going to save this man’s life. I was going to buy him enough time to say goodbye to his wife. I knew that, my colleagues knew that and he knew that. All I could do was try to make him comfortable, which in itself is an insult to the actual reality of the situation.

We got him to hospital in a reasonably stable condition and I handed him over to the doctor in Resus. His wife sat in the ‘family waiting room’ for news but her face was etched with despair and a fixed gaze developed in her eyes. I told her not to worry and that he was being taken care of now and she acknowledged everything I said without hearing a single word of it.

Be safe.


Anonymous said...

Hey paramedic,
I've been addicited, and reading ur blog has become a habbit already. I've always learn something reading it and I hope those knowledge I gain, I will be able to put them into use when I become a paramedic one day. Haha.

Smell of death? I haven't came accross that smell before. Anyways,believe in miracles...believe that theres hope... believe that he'll live!

Tertiary student from S'pore

Anonymous said...

After months of addiction to several medical blogs, I've finally started to post comments (well, on the ones I can work out how to do it!!!!). I hope I can add to your knowledge too.
You got the scenario so right - but there was one little block. He was 48 and the smell was there - I know it too, it's awful, isn't it -but please don't say "Don't worry" to a (reasonably) young woman who knows just as well as you do that the time has come closer when she has to say goodbye to her choice of life partner. She wanted someone to give her a big hug - I assume in this day of PC-ness that's not on the menu for you to give - but when I was there, I might have registered and valued someone saying "I'm so sorry" with a squeeze of the hand. "Don't worry" was from the person who hadn't put their brain in gear as to what it all meant - he's not just getting on a train, you know.
And miracles - yes, they happen, I got mine. But, unfortunately, they come in short supply and eventually your share runs out. And actually the miracle she needed was to know he was comfortable and less scared and she would - one day - be OK.
I couldn't do your job - thank you for sharing it with us.

Xf said...


Sorry but I see few miracles in this job.

Xf said...


Thanks for your comment. I feel this is written from a personal perspective and I'm afraid what you suggest doesn't suit everyone. Telling the woman 'I'm sorry' is much worse than just saying 'don't worry' because I was referring to his suffering. 'Don't worry, he is in good hands' translates to 'he won't die in pain'. as far as I'm concerned.

'So sorry' would have been inappropriate because he wasn't yet dead and for all I know, still had some time...hours, days.

What we say to people isn't done with our brains 'out of gear' at all. We have had plenty of practice at what to say and when to say it but it is the doctor's responsibility to speak to relatives in depth, not ours.

John Boy said...

Sorry to be commenting on such an old post.

"Sorry but I see few miracles in this job."

Have spent the day reading all of 2007 (or all of 2007 up to here) and I think that is the saddest thing I have read out of it all. Maybe because it is just so true I guess.

I would say don't lose faith in miracles, but I think that might be a little trite. I just hope you always manage to keep your faith - be that in Scruffs or whatever. You do an awesome job and write and awesome blog.

Be safe,


Xf said...


Late or not, thank you for reading and commenting