Monday, 24 December 2007

On the edge

Five emergencies – all of them taken to hospital by ambulance. No timewasters today!

It all starts with another dark morning and I set off for breakfast in the hope that I remain unharrassed until I have at least eaten something. Usually it takes a handful of special ‘pixie dust’ and magic beans to ensure that someone doesn’t have an ‘emergency’ until the daylight properly arrives. Usually.

I drove up the foggy road out of Waterloo and the south, where there is much more likely to be a 999 call made for a sore throat or a runny nose. I made my usual way through Whitehall and past Trafalgar Square. The Christmas tree looked eerily strange in the blanket of mist around it. Pretty but eerie; like Santa was going to jump out of one of the high branches with a machete in his hand.

I U-turned for The Strand and went into McD’s for breakfast (I know, it’s bad for you and all that but I burn it all off during my shift and I don’t usually eat anything else – much – until mid-afternoon).

And it’s Christmas.

So I went in, got myself something unhealthy and paid the lady (no discounts for us). The place was busy, even at that ungodly hour of the morning, with still-drunk and sobering-up party people. A young girl behind me started to shout at a couple of lads she was with.

‘And as for you two, you can sling it. Just f**k off, both of ya!’ she yelled.

She clearly had no sense of dignity or decorum. She was a nice looking girl but her mouth gave her character away and I’m assuming that every capable guy within a few metres of her gave her as wide a berth as possible, given that she limited her vocabulary to a very few expletives and explosive comments (mainly detailing every man’s lack of...well, everything).

She left with a few more rounded phrases and her pointy fingered anger went out the door. She was tall, attractive and foul mouthed. A real catch. Obviously somebody had said or done something to her. Or she was mad.

I left a few moments after she had disappeared from sight, her two male friends hurrying after her, and almost bumped into her outside. A man I recognised from the street came out too and spoke to her.

‘I apologise. What I said was out of order, so I’m saying I’m sorry, Ok?’

She wasn’t convinced and I didn’t have a clue what he might have said. I got into the car and out of their business. But my breakfast was getting cool and I was starving. Still I had to watch this melodrama unfold because I knew it would. The guy’s apology was crap and insincere and she was mouthing off even more. Not only that but she was doing something that I have witnessed time and time again when a female is drunk and out of control in a situation like this – she was egging the two lads on to ‘do something about it’. Ah, the old inequality of sexuality; that old chestnut.

She was stoking the fire – I sat and watched her doing it. Every move was aggressive, every word designed to inflame the situation even more. Now there were two street people involved – I know them both and they are nutters. The two lads with her were sussing out the sport and posturing for a fight – testosterone was leaking onto the pavement. It nearly put me off my food.

She banged on my window (of course she did – I have a uniform on and blue lights on the car). I wound it down and looked at her drunken eyes.

‘Oi. You gotta sort this out. I work for the NHS too and I work bloody hard. I don’t need this aggro!’

I had no idea what she was on about. Maybe she was a mad nurse. I think she expected me to get in the middle of her little debate and argue in her favour because she was a ‘colleague’. Yeah right.

Predictably, after she left me alone (I didn’t say a word to her) it all kicked off. Her two friends decided they could take the street men and punches were thrown. Insults were traded and kicks flew until everyone was back inside the McD’s, where the fight continued. I couldn’t really be bothered with this but I decided to stick around for possible casualties. I’d only get called back anyway. Meanwhile I eyed my breakfast with a heavy heart.

It settled down after three minutes and the security guy inside had caught hold of one of the instigators. Nobody seemed hurt enough for an ambulance, so I left and ate my hard-earned food on the Square.

Soon after eating I was called to a 41 year-old male with ‘DIB’. She was on the 21st floor of a building I loathe going into. It’s wrapped in so much scaffolding net that it looks like a grotesque giant Christmas present.

The crew showed up behind me so we went in together. I had no choice really – I couldn’t get out of the place until the ambulance reversed away first.

Inside we found a panicky man with the flu (possibly). He had a high temperature and was generally unwell. So was I in fact. I came to work with a viral cough and I looked a bit rough to be honest – great for patient morale I think. At least I covered my mouth whenever I coughed.

An hour or so later I was off to a 65 year-old with breathing problems. Again the crew arrived with me and we all piled into her flat. She had genuine DIB, it was obvious to see and she had been suffering for two days before her husband called us. Her ankles were badly swollen and she had a history of two heart attacks in the past few years. Both MI’s had been silent (pain free) and now she was like this with no chest pain. It was definitely worth an ECG.

Her ECG indicated a few anomalies, including ST elevation, which could mean she was having another heart attack but I wasn't sure. What I was sure about, however, was that her heart wasn’t pumping efficiently anymore (thus the swollen ankles). We got her to hospital quickly.

I got my break after that and a few hours later received a call for a 40 year-old ‘collapsed and coughing’. I radioed in to double check that I was needed. The job was over 2.5 miles away and, according to the descriptor, the patient had a bad cough. Wouldn’t I be better off dealing with a more local emergency? Nope, they said. There were no other vehicles and the man had ‘collapsed’, they reminded me.

On the way I was updated with ‘now ? fitting’ and I thought that was ominous. I had seen heart attacks begin with coughing fits, progressing to what looked like a seizure (when in fact the patient is in a desperate spasm to breathe and stay conscious). I thought this might be one of those unusual calls that actually turn out to be a genuine emergency.

When I got on scene there was nobody in obvious distress. No-one came to get me and there were no windmills at all. I was in the right place and there were lots of people walking around. I did a slow area search in the car, turned around and called my Control for advice. They told me they would check the location again. Meanwhile, the ambulance shows up and the crew park behind me.

‘There’s nobody here’, I tell them after greeting them.

I set off with one of the crew to do an on-foot area search, just in case. I walked up a little hill and my colleague walked down it. I saw nothing and nobody drew my attention to anything. I walked to the middle of the hill and was just about to go back and give up when I saw a man lying flat on his back at the top of the street, right outside a shop and in the way of everyone who was passing by. Unless he had an invisibility cloak on and nobody could see him, not a single person cared to let me know he was there.

I went to him and tried to get a response. Nothing. He was breathing but it was very noisy and he had vomited – it was now on my trousers, so I couldn’t mistake it. I looked up for my colleague but he was out of sight and I had no way of communicating with him, so I set about getting the basics. I opened his airway, cleared his mouth of gunk, checked his breathing again and felt for a pulse. All good. But he still didn’t respond.

He smelled of alcohol (I thought) and he was less floppy than a truly unconscious person would be and that made me try something when my colleague finally arrived – I had caught sight of him after a minute or so and waved at him to come and help me. He grabbed his paramedic bag and legged it up the hill; his crew mate wasn’t far behind.

I decided to insert an OP airway and see what happened. The general rule here is that if the patient doesn’t gag and tolerates it, he needs it. I put it in after giving the man a loud verbal warning that it was coming. He didn’t tolerate it at all. He gagged, retched and spat it out on the pavement. Then he unleashed a sudden torrent of violence and verbal abuse, some of which I can’t repeat here – even with letters asterisked out!

He grabbed my chest, pinching some of the skin quite hard and he held on, swearing at me and threatening me.

‘If you do that again I’ll hit you’, he spat.

I had no choice. I sat on him, pinning his body to the ground before he got any weight behind his threat. He was strong and he wasn’t kidding. I managed to get him to let go of my skin and held his arms down by the wrists. His legs were still free, so he used them to kick me around the legs and back until my colleague fell on them for me.

All of this was totally unexpected. He was a middle-aged Asian man. He wasn’t the ‘usual’ type for this kind of violence. Surely there was something else going on here?

We managed to get a BM and found that it was quite high. His hyperglycaemia may have been the reason for his outrageous behaviour. It didn’t make him less of a threat but at least we could rule out (possibly) alcohol or drugs. The smell I had noticed may well have been Ketone, not alcohol.

Ironically, while all this was going on in the middle of a busy street, people became nosily interested. They hadn’t bothered when he was unconscious on his back, possibly in cardiac arrest but now there was entertainment, they came over to stop and watch.

The police were called and they arrived in time to help us keep him on the ground – he was still kicking and thrashing but every now and again he slumped into the almost unconscious state that I found him in. Our vehicles were out of reach and needed to be moved so I left my colleague with them and went to bring my car up to the other end of the street. The ambulance was going to follow me there but we discovered another problem. The ambulance wouldn’t start. I called Control and requested another vehicle and let them know how feisty our patient was.

By the time I had driven back around and brought my colleague's crew mate with me, there was another crew, a Station Officer and a Team Leader on scene. The patient was still being ‘managed’ by the police but he was quieter. He was loaded into the ambulance during one of his lulls and an ECG revealed other possible problems, so he was taken to hospital quickly.

I learned later that he was being monitored but was still hurling abuse at the medical staff at the hospital.

At almost going home time I went to treat a man who had a ‘racing heart and feels paranoid’. I got to the smart apartment and was led in by his emotional wife. He was behaving erratically and looked nervous and agitated to me. Apparently he had suddenly declined to this state over a period of 24 hours because of a high level deal that he was in the middle of with his job at a bank. He said it was worth a hundred million pounds. This is why he was behaving like this. To me it looked like he was having a nervous breakdown. He was at the very edge of sanity and he was ready to fall.

‘How much would it cost to have someone killed?’ he enquired when the crew arrived and we tried to get him into the ambulance. He had pulled on two odd socks during a diatribe in his bedroom which we were all privy too.

The question brought a stunned silence from us and a wail of despair from his obviously suffering wife and we walked him to the vehicle and tucked him in for the trip. He wanted me to come with him.

‘You can come. I trust you’, he said.

As warm and tingly as that compliment felt, I respectfully declined and assured him that the crew were my friends and could also be trusted. He had a new and unsettling glint in his eyes now. He was borderline schizophrenic I think.

As the evening wore on and the fog returned with a vengeance, I was called to a 24 year-old male having an epileptic fit at his workplace in Oxford Street. I arrived to find him in a post ictal state, confused and very sweaty. He had obviously been seizing violently but he seemed to be recovering. He went to hospital nevertheless.

And just to spoil my chances of getting home on time, I copped a job that took me into overtime, whether I wanted it or not. A 40 year-old lady was having a heart attack at a large shop in the West End. All hands to the bridge then.

But of course she wasn’t having a heart attack. She had lost her bag.

The Cycle Response Unit arrived with me and we dashed to her aid, defib at hand, only to find her sitting in the stairwell, surrounded by staff, crying her eyes out. She was a French lady and my poor attempts at getting information caused confusion. I got her name and she got mine. The rest I left with a translator.

I felt sorry for her, she had lost her money, passport...the lot but she wasn’t medically ill. She didn’t have any injury and we weren’t the police. I still don’t know why the staff thought she was having a heart attack. In some cultures there is a lot of wailing and pointing to the chest whenever a crisis, however small it may be to you and I, occurs. In their defence, I guess they were pro-active and if she had been having a heart attack, she may have survived it because we were on scene within five minutes of the call.

I left her to my cycling buddy after I had exhausted all my humanity.

I’ve got Christmas day off, for the first time in four years and I am looking forward to it! Merry Christmas to you ALL and thanks for reading the blog. I’ll be back in a few days.

Be safe.


elm said...

Merry Christmas to Scruffs!

miss emma said...

Merry Christmas and enjoy your day off! I have spent my first days of my xmas hols reading your blog. Ive been sucked into it! Im on july atm and i think it is brilliant!
i want to be a paramedic and came across this while i was doing some research. i will be ordering the book with my xmas money as well.
thanks for a great read!

Alison said...

Merry Christmas!

Anonymous said...

merry xmas, enjoy your day off. i really enjoy reading your blog, and check every day for new postings.
i will deffinatley be buying your book. thank you

Sue said...

Merry Christmas, and enjoy the respite from the masses! I worked one christmas, amazing the ammount of people who go to A&E on Christmas day with problems they've had for weeks, I know the tv is rubbish but really!!

Anonymous said...

Merry Christmas! Enjoy your day. Hope to find your book in my parcels when I finish work, I did write to Santa!
Take Care. Gill

Anonymous said...

Merry xmas xf got your book yesterday, i work in care home so on late shift buffet tea with sherry then prize bingo!! all the very best to you and your colleagues
lv joan

petrolhead said...

I got your book for Christmas, and I have to say it's excellent so far! My dad said it's really hard to get hold of though, Amazon don't have any and nor do any of the major bookshops.

Anonymous said...

Great Blog.
From a fellow Paramedic in Tasmania, Australia.

Anonymous said...

Love the blog and already finished the book. Hope you write another one soon, great read and very informative.

Sam Tyler said...

A belated merry christmas Xf. I worked christmas day night and had a good chat with the LAS, seems you were all on minimum strength too. Nightmare!

P.S I finished the book in two days, cracking read.

Chris said...

On important matters - I think you are entitled to NHS discount at McDonalds - I know that some of them do it - I've been in a few places they even give it to us Johnners!

jkiev1 said...

I'm just doing so back reading of your old posts so don't mind me, but If you ever feel like moving to Australia, wear your uniform all the time and you'll get 50% off all McDonalds, just as good as the cops and fire brigades.

Not that it should be an incentive to go to mcdonalds more often though there is this one paramedic that gets 10 coffees almost everyone morning :P (and it's 50% off) :P