Wednesday, 28 November 2007

MAD

Seven calls – one refused (then agreed) to go, one detained under the Mental Health Act, one false alarm and four taken by ambulance.

I think, personally, if I got clipped by a bus and survived to tell the tale – I mean I was walking, talking and full of beans – and I found myself on the corner of the hospital grounds, I’d probably walk into A&E rather than call an ambulance and wait until it arrived. But that’s me.

My first call of the shift was for a 44 year-old man who had been knocked, ever so slowly, off his motorcycle by a bus as it turned a corner. He landed hard on his right shoulder and had a little discomfort there. I was on scene within four minutes and the ambulance was a minute behind me. The system was working...

I arrived to find the man standing on the corner of the hospital with a small group of witnesses and concerned citizens. The bus driver was there too and there was an expectant glance in my direction as I pulled up.

I got three questions in (what happened? Are you hurt? Is anybody else hurt?) before the crew turned up to take over. They did their cursory check (he had no neck pain and hadn’t been unconscious) and the attendant walked him round to the A&E department. It was much faster than sitting him in the ambulance and travelling all the way around the one-way system.

Then off to see a 29 year-old female who was ‘collapsed outside a cafe’. A call like this rings a bell. Usually, someone ‘collapsed’ outside a public place in the middle of the morning is (a) drunk, (b) drugged up or (c) gone before I arrive. This girl was from the (b) category. She was slumped in a chair outside an Italian man’s coffee shop in trendy Covent Garden. It was around 11am and there was a lot of passing trade...passing by. She was obviously putting his customers off and something had to be done about it – dial 999 and ask for an ambulance.

I woke her up from the stupor she was in and she warmed to me immediately. Her name was 'Trish'.

‘F**k off!’, she requested.

‘You can’t sleep here. Sorry but you have to go somewhere less public or we’ll be called out again for you.’

‘Leave me alone, I ain’t doin nuffin wrong’, she said, eyes half open (or shut).

She had taken heroin and was sleeping it off before she travelled the area looking for her next score. That’s the lifestyle she wanted. She wasn’t 29 either, she was probably only 20. Her habit made her look older.

I spent twenty minutes persuading her to move and eventually she agreed to go if she got a free cup of coffee. Strangely, the Italian proprietor was only too happy to oblige. I thought about fishing for one myself (it wasn’t offered) but then I didn’t want to spend any more time with my new druggy friend.

I left after cancelling the ambulance and made my way back to the station. As soon as I parked up I got called back to the same location for a ‘female, collapsed in street’. This time she was described as a 16 year-old - somebody needs to go and get their eyesight checked. The MRU was preparing to go too and I told him that I thought this was probably the same girl from earlier. I went with him to check it out and sure enough, it was my friend ‘Trish’ from a mere thirty minutes ago. She was starting her career as a frequent flyer.

She was asleep – standing up in the middle of the pavement. People were consciously avoiding her as they walked by; some of them were crossing the road to consciously avoid her. The ones who weren’t consciously avoiding her were bumping into her because they thought she was moving. She wasn’t. She was London’s first live pavement statue – ‘the sleeping drug addict in rags’.

I felt sorry for her because she was so young but I had tried to reason with her about the way she was living and all I got was abuse and a hard-lived stare from her red, watery eyes. I’ve had that stare hundreds of times and it means nothing is going to change. Drugs control people.

The ambulance crew arrived and I managed to persuade ‘Trish’ to go aboard the good ship LAS for some free ‘treatment’ and a bed until she had snapped out of it. The police showed up too because her pavement antics had generated a lot of calls from the panic-stricken people of that area. As I sat in the car doing my second lot of paperwork for her, the LFB turned up and four or five fire-fighters fell out of the truck. I was beginning to think this was turning into a comedy of errors but realised that they were on a separate call. They filed past me, directly to the wrong address (I knew that because someone was calling to them from a completely different building). I smiled and sympathised because that happens a LOT to us.

A 41 year-old female with ‘difficulty swallowing’ was my next patient. She was in her office and suddenly felt as if she was on a ship; her balance and co-ordination went. She couldn’t swallow properly and a headache developed. She thought she was hypo (although she isn’t a diabetic) and went to get a sandwich but during the trip to and from the shop people were helping her as she flopped and wobbled along the pavement. She told me she felt and probably looked drunk.

The crew arrived to take her to hospital and I wondered if there was something neurological going on.

I was on lights and sirens to my next call - a 34 year-old man who was half-naked in a tube station – when the car in front of me pulled in to let me pass. Unfortunately he pulled in at 30mph and the driver of a parked vehicle opened his door at the precise moment in which he carried out the manoeuvre. I watched as the first car ripped the wing mirror clean off the second car, almost injuring the driver as he tried to step from his vehicle. I passed them by, saw that the stationary driver wasn’t hurt and carried on to my destination. Every now and then minor bumps and shunts take place in front of us as a direct consequence of our need to get through traffic. This is one of the reasons I don’t like FRED and his cancelling habits. If an accident is going to happen, I’d much prefer it if I was completing a call and not half way to one before being stood down.

Anyway, I got to the tube station and the police were surrounding a drug addict who had stripped off for the benefit of the public. There were children around, so it wasn’t wholesome family entertainment. He was completely off his head and sang at the top of his lungs before threatening the cops if they tried to arrest him. 'You'll never take me alive coppers' doesn't sound the same when you are a skinny, half-naked Cockney drug addict with amatuer tattoos on your arms.

The crew arrived and we stood back and considered the options. He was far too unbalanced to stay in the public domain but he had no clinical problems – he was just mad. I suggested we take him to hospital and use the Mental Health Act to ensure that he went. In other words, he was going whether he liked it or not. So, Section 136 was invoked and he was duly restrained for the trip to hospital – I should point out that he was only restrained because he became aggressive and threatened violence; otherwise there is usually no need to cuff someone for the purpose of this Act.

I travelled with the police and the singing nutter and watched him being led/dragged (he wasn’t willing) to a small, private room with a television. Well, one-way television – CCTV.

The false alarm was another of those ridiculously inaccurate calls for ill babies that we sometimes get. A one month-old baby was in cardiac arrest, so the ambulance, the MRU and me flew to the address, stormed in expecting the worst and were confronted by shocked parents and a hot baby. Babies with temperatures are not in cardiac arrest. Please parents...check your baby's breathing...check its reaction to you screaming 'Oh my God, my baby's dead!' If the baby moves at all, it is probably NOT dead.

My last job was to a 24 year-old female with a history of epilepsy and a recent problem with medicines not doing their job. She had fitted for 20 minutes, according to witnesses and by the time I arrived she was recovering, although still a little post ictal. She was confused and kept trying to get up (this is the usual pattern of behaviour in the end phase of epilepsy) and it took a lot of persuasion to keep her still until the ambulance arrived and the crew took her to hospital.

Thus, another shift completed and, although the day didn’t involve any drama, it was busy and kept me sane - even if others weren't.

Be safe.

7 comments:

Anonymous said...

What do you think happened to that madman afterwards?
Living in London I am certain there are far too many mad/mental and dangerous people on the streets.

Also, what happens if someone threatens to kill himself (e.g. jump off somewhere or cut himself).
What if he refuses to come to hospital? Can you restrain him as well/section him?
What if someone takes an overdose but refuses to go?

stuart said...

Do you not find it a bit annoying sometimes that you don't get to find out what happened to the patients you treat?

Perhaps you deal with so many it would just take so long to follow up with them...

New to your diary - love the first person perspective on treating patients :)

Anonymous said...

Aren't you supposed to stop if there is an accident resulting from a blue light run even if it doesn't involve your vehicle directly, or is that only if someone is inured?

Stonehead said...

If I can lopsidely cycle three-quarters of mile to my son's school with a fractured clavicle, ankle strain, multiple bruises and abrasions thanks to a hit-run driver, then your pedestrian could have made his own way into the hospital.

This sort of time wasting really annoys me - and I'm not in the healthcare or emergency professions myself.

Oh, and I went to the school as it was closer than the local village hospital and the teachers would have been wondering where I was at collection time. I went to A&E after frightening all the clucky mums... :-D

Xf said...

anon

The madman was probably released back into society soon after (within 72 hours).

The Mental Health Act provides the police with limited powers under section 36 to remove a person to a 'place of safety', such as a hospital, if they are in a public place and appear to need care and control.

So, in all the examples given, a person can be 'sectioned' temporarily. If they are in their own home, it is harder for the police to do, although a senior officer can make the decision. Or a doctor.

Xf said...

stuart

I gave up trying to find out what happened to my patients a while ago, I'm afraid. I will only chase after the seriously ill or injured ones but generally we are far too busy to back-track and our patient turnover is such that it becomes impossible to find the time.

Xf said...

anon

I will only stop if someone has been injured. If I am on a high priority call and a minor accident occurs then there is no need for me to stop if both parties involved are uninjured and can swap details. In this instance, the driver who clipped the parked car carried on driving but I slowed down enough to tell him he had hit a car and to stop, which he did.