Friday, 22 February 2008

Actor's union

Now there's something you don't see every day!

Five emergency calls – one assisted-only and four required an ambulance.

A cold, crisp morning but the sky promised me a pleasant, sunny afternoon ahead. Nothing lifts my spirits more than working in Central London when the sun is shining and the air is warm. Its half term for some schools, so there are tourists and families mixed together and they are all going to cross Trafalgar Square at some point…they all do eventually. That means a buzzing atmosphere and free entertainment from the local dancers and musicians and that’s good when I’m on stand-by.

Until then, I find myself on the top floor of a house, in the small and untidy bedroom of a 41 year-old man who lives with his mother. He has been short of breath since getting up this morning. I look at him and I see that he’s not kidding. He’s not hyperventilating out of panic and he’s not suffering from asthma, even though he is an asthmatic. Something else is going on.

His breathing rate is in the high 30’s per minute and his pulse is continually fast and weak. In fact, I can’t find a radial pulse at all at first. I can’t get a blood pressure reading either, so I put him on oxygen and wait for the crew to show up. The O2 helps him and his breathing slows down but he remains tachycardic and scared.

He tells me he’s been to his GP for tests but nothing has been diagnosed. His asthma is well controlled and he took his inhaler when this started, just in case. But I detect no wheeze and there is no tightness in his chest. He’s breathing like a man with heart failure. It’s clear he isn’t carrying enough oxygen in his blood and the reason for this hasn’t been discovered yet.

The crew arrive and we take him to the ambulance for further checks. On the way, he needs to pee, so he goes to the loo without oxygen. A few minutes later he comes back and he’s completely out of breath. He’s behaving like an unfit 80 year-old. He’s not overweight and he doesn’t have a cardiac history. He’s younger than me but he can’t put one foot in front of the other without feeling weak and dizzy.

In the ambulance his blood pressure is taken and it’s low. His heart rate is still fast and remains that way all the way to hospital. He has a history of PE; he had one a few years ago but he is feeling no pain. To me, that makes little difference as pain is not necessarily a definitive signature for PE. I think he’s having another one to be honest.

I left him in the Resus department with a doctor and nurse trying to figure out what his problem might be. Somebody needs to test him for lung and cardiac function. His ECG wasn’t normal. He is deteriorating.

Trafalgar Square next and an hour of stand-by in the warming sunshine. It’s like spring and I want to wander around but I’m called to a job well out of my area for an unconscious ‘? Cardiac arrest’ which has been relayed by the police.

I raced to the scene but was intercepted before I got there by a police vehicle. The patient I was heading towards was just drunk and they had managed to move him on but they had another call, this time to a drunken female who had fallen and they asked if I would attend with them. Being the happy to oblige soul that I am, I drove round to the address with them and let my Control know what I was doing. This confuses the paperwork, you know.

On the street, below a set of steps leading to an estate block, lay a middle-aged lady. She was in the throes of insulting the police officers around her and they invited me to calm her down. Yeah, right.

‘Hello, what’s your name?’ I asked with my professional LAS voice.

I got one of those long hard but ever-so-slightly out of focus looks that drunk people, especially women, give. Sometimes it’s accompanied by ‘who the hell are you?’ or ‘F**k off’, or some other excuse for an answer. This time I got a long, silent and almost psychiatric gaze. Every second or so, her eyes would lose track of me and her head would nod forward involuntarily, only to be snapped back to regain the territory she had fought so hard for (my attention).

‘Why are you lying on the ground?’ I enquired.

Staring silence. Then a quick reference to the police officers. It took twenty minutes to convince her to talk to me and when she did, she wouldn’t stop. I got her life story (recent history) and a request to let her go away with the handsome police officer that she had taken a shine to.

‘I fancy him’, she said, pointing a gnarled finger in his general direction. The officer was probably 24 years-old. She was at least 50.

She was a long way from home and was trying to visit her dying father, or so she told us. Her emotional state would best be described as unstable and her physical condition (drunk) merited a trip to hospital for her own safety. She had already tumbled down the steps and she could barely get up herself, never mind walk anywhere. So, even if it came to citing the Mental Health Act, she was going. She overheard this discussion and let us know how she felt, in a very loud voice.

‘Okay, I’m going to hospital because I’m mental now!’

Nobody disagreed.

The crew arrived after my second request via the police (they had forgotten he first one) and she was duly packed off to a better place. I then made my way back to familiar territory.

A 35 year-old faker had us looking like fools when he collapsed inside a Home Office building where permits for entry to the UK are scrutinised. Two security men were pinning him to the floor because he had been thrashing around so violently and they were reluctant to let him loose. I arrived with the ambulance crew and a cycle responder joined us (I had passed him on the road as he pedalled to the scene at full throttle). We all looked at him lying there and we all knew he wasn’t having a fit, epileptic or otherwise.

He also pretended to speak no English and everything was translated for us by a member of staff in the building. As soon as we got him into the ambulance, he settled down but still insisted on trembling and shaking, making life difficult for the crew.

‘You can stop now because nobody is here except us’, I said. I was gambling on being right with this patient.

He nodded and stopped.

‘So, you can understand and speak English, can’t you?’ I said.

‘Yes’, he answered.

Shameful. The whole act was a distraction designed to get him out of there and into hospital where no awkward questions would be asked. I could feel another few pence of my hard-earned tax money being ripped from my pocket by him.

On my way back I drove up Whitehall and glanced over at the mounted guards as they suffered the tourist crowds and happy snappers all around them. A taxi stopped directly in front of the gate of Horseguards to let a passenger out but one of the guards moved his horse forward and out of his sentry box to tell the driver to move along. It was the first time I had seen one of these soldiers do something that was distinctly non-touristy. No offence to them, of course. I mean it reminded me that they had a function and that they did more important things. They obviously guard those gates but I think the tourists should be kept further away from them...people get far too close to those soldiers and their mounts.

I got back onto Traffy Square and was approached by a homeless man. He shoved a photograph through the open car window. I took it from him.

‘Have you seen this dog, mate?’ he asked.

I looked at the picture. A small, mongrel dog (Alsation cross) stared back at me.

‘Sorry, no I haven’t seen him. Why?’

‘I’ve lost him. He’s been gone since Valentine ’s Day’. He’s called Shiney.

He was almost tearful and I felt genuinely sorry for him, especially knowing how much these people value their dogs. They offer companionship and protection, two things you really need when you are homeless and living on the bottom rung.

I promised I would look for Shiney wherever possible and that I would tell my colleagues to keep an eye out but I couldn’t imagine what I was going to do when I found him. I couldn’t take him into the car and the police wouldn’t be interested, so I took a contact number from him.

He shuffled off and I realised that even with the best intentions and a telephone number, I wouldn’t be much good to him because I couldn’t hold on to the animal if I spotted it and I wasn’t able to hang around with it if I did. I think he’s lost his dog for good. Someone probably stole it.

Please don’t walk up to me with a stupid smile and ask me for a hug because you ‘feel sad and unwell’. I’ll say no. Especially if you are a tall, skinny student who is creating attention for himself so his friends can have a laugh. Go away, I’m working.

Drops in blood pressure in the elderly can be sinister or completely innocent, depending on predisposing histories and the rate of recovery of the affected person. An 80 year-old who collapsed at a posh restaurant during a meal with her friends rapidly recovered and was doing well when I arrived. She didn’t seem worried and her blood pressure was rising again after the rest. She had no significant medical history or current problems to speak of and she adamantly refused to go to hospital.

The crew took her to the ambulance and she was given a quick check-up. I finished my paperwork in the car and gave refuge to one of the lady’s friends as she waited for the results of the ECG. It took fifteen minutes to declare her well (in terms of the tests we can carry out) and she decided that she still wasn’t going to hospital. Instead, her friend (the one in my car), would take her home, so she was given advice and off she went.

It’s been one of those days. The last call, for a 47 year-old man with chest pain, took me to an underground station, where a crew had arrived just ahead of me. This job was going to make me late getting home and it wasn’t helpful to see how the man mimed his pain and referred to it only when asked. He was homeless and play-acting. All the way to street level, up two escalators and two flights of stairs, any of which could have caused my colleagues injury had they misjudged them, he didn’t complain at all – he sat and allowed himself to be carried by men who were in the same condition as he was – fit and well.

Be safe.


Claire said...

Hello Xf. I am a long-time reader of your blog and recently (albeit, belatedly) read your book from start to finish in one sitting, no less. I simply wanted to say thank you for opening a window on your working life (and of course, those of your patients). As a first year student nurse I have also (rightly or wrongly!) found your writing to be both an education and humbling insight into the lives you touch.

I wish your book (and latest 'publicity drive') every success and hope to be fortunate enough to catch a radio interview very soon.


Seamus said...

What was the abnormal ECG reading in the 41 y/o in respiratory distress?

BTW I got your book a week ago (it took 3 weeks to ship to Florida) and everyone in my family is hooked! Keep up the good work!

Anonymous said...

It's not the paperwork we care about but we do like to know who's with what patient, tends to reduce duplication of effort :)