Saturday, 2 February 2008

One life in, one life out

Eleven calls: two assisted-only; one born on scene; one dead on scene. All the others went by ambulance (including the mother and her new baby).

Childbirth scarred me after a bad experience a few years back when things got terribly complicated and I held the newborn as it died. Since then I have felt some apprehension about dealing with ‘Born Before Arrival’ (BBA) calls alone. However, I choose to work on the FRU and therefore I choose to work alone, so this is my lot and I am supposed to be a professional with absolute confidence in my training and skills. Ask any of my colleagues if such cold logic works on the way to a potentially problematic job and they will say what I say – it just doesn’t feel like that.

First thing in the morning and I haven’t even had a chance to sit in the car, never mind complete my checks. A call comes in for a 24 year-old ‘in labour, imminent delivery, head out’. Unless there are dire consequences, this baby is going to be on the floor at home when I get there but I still have to book a delay because I don’t yet know if my vehicle is equipped for the job. My concerned psyche is telling me to be glad of the few minutes I will get because there will be back-up on scene when I get there. My ‘get over it and get on with your job’ psyche is rushing me through the checks I need to make. I have a delivery pack and I have an emergency paediatric kit, so off I go. The address is less than a mile away.

I arrive at the same time as the ambulance, which is a bit of a relief, and together the crew and I head up to the flat in the block on one of those estates I have a genuine dislike for. There is no lift and the patient lives at the top of the building (of course). I am a little ahead of the crew because they are carrying more than me and when I get to the top a young black man greets me at the door. He has a look of quiet horror on his face.

‘Is everything okay?’ I ask.

‘Yes, I’m just in shock I think’, he replies and a kind of smile breaks across his face.

A smile breaks across mine too because he has just told me that I can relax and that his baby has been born alive and well. So I enter the flat and a young girl appears in the corridor. She is the sister of the patient. They both point to the bathroom and inside, sitting up on the floor, is a woman with a brand new baby...cord attached and not making a sound but moving in a healthy way.

The floor is smeared with amniotic fluid and blood; the room looks like a fight venue but mum and newbie are looking well. She is smiling and happy. This is her second child and she is making absolutely no fuss – it was refreshing to see a post-pregnant woman behaving herself and not treating the event as if it was an illness – there was no song and dance about this and she waited patiently while my colleague and I clamped and cut the limp, grey cord. The baby girl had been born on that floor a mere seven minutes earlier.

‘She nearly went down the toilet, ‘cos I was sitting on it when she came’, said the new mum with a grin.

I checked the baby’s airway (clear), colour (pink all over), breathing (yep), fingers and toes (no webs and nothing amiss) and movement (wriggly). She was cold though and I replaced the wet, bloody towel she had been covered in with one of our little neonate ‘hoodies’ – basically a towel with a hood.

Now the crew were concerned about the cord. Although we had cut it, there was a loop taking it into the vagina. This end stayed inside and would not come out, even with some firm tugging. We decided to leave it alone because we weren’t sure if it was still attached in any way to the womb. If there was an intact membrane it may bleed heavily as it ripped away from the tissue. This sort of ‘complication’ isn’t mentioned in the training manuals, so none of us were entirely sure of how to proceed. Neither did we want to move her just yet, so we called for a midwife and waited...and waited...and waited.

Meanwhile I carried out all the usual basic obs and found mum to be in perfect health. I called control when we started getting bored waiting for a reply from the midwife and asked what the delay was.

‘She’s in the shower and will be there as soon as she can’, I was told.

The crew decided, quite rightly and with the new mum’s consent, to take her to hospital rather than wait. She wrapped the placenta and the remnant of its cord in a kind of make-shift nappy and secured it underneath herself as best she could. Then she got dressed and managed her way, carefully and slowly, down the stairs with the crew. I followed with the equipment and the boyfriend, sister and baby all came down afterwards.

I was happy to leave that job. I felt a notch more confident because this would one of a run of deliveries that I had attended where everything had gone smoothly. I know it won’t last but now I have exorcised the demons fully, I am ready for the challenge again.

I found out later that the cord was loose. The midwife just yanked it out whilst asking the young woman to cough hard – out it flew. So next time I see it I will know what to do but I think we were right to hold off; we couldn’t make any presumptions on scene, things could have got ugly.

I got back to my station and managed a cuppa before receiving a call for a 54 year-old female ‘feeling faint’ outside Euston station. I arrived to find a bystander helping her. He extended his hand and introduced himself as I got out of the car. What a friendly bloke, I thought. I shook his hand and listened to his eye-witness account.

The lady had felt a little dizzy and had sat down hard in the street. She was fine now and recovering well. She didn’t want to go to hospital and was a little embarrassed by the fuss being made on her behalf. Someone had offered to help her when she first felt dizzy and the friendly man had stopped to attend to her when she fell.

‘My faith in humanity has been restored by what’s happened to me this morning’, she told me.

Indeed, regardless of how cynical I become during the drunken nights and weekends, I can testify that the people of this city can be quite incredibly helpful when they see someone in trouble. This is why we get so many calls to ‘unconscious’ people who are simply drunk or homeless or asleep in the street. It still annoys me because a little investigation is all it takes to establish the need, or otherwise, for emergency care but it does demonstrate some of the heart that still exists in London. Having said that, next week, no doubt, I will be upset with everyone again...

I gave the lady a lift to work and advised her to call us if she felt off again. She was very happy to oblige but I knew she would be fine.

Then a 50 year-old female who felt ‘dizzy’ called an ambulance and I was sent to her aid. The crew arrived at the same time, so I left them to it.

I got my rest break on station but it was interrupted half way through for a suspended call. A female had been found in apparent cardiac arrest on the floor of her bedroom in a hotel. Details were thin because the caller, the hotel manager, could not turn her over to ascertain breathing because she was too heavy. I grabbed an officer (who is also a close friend) and asked him to come along in case I needed an extra pair of hands and he jumped aboard.

When we arrived the crew were already on scene. In an upstairs room lay the face-down body of a large and obviously dead woman. The petite hotel manager couldn’t possibly have turned her over and even if she could, it wouldn’t have been a pleasant experience because, from the state of the place, this person had died violently and suddenly as the result of an abdominal varicose rupture. The bed linen, carpet and floor-strewn clothing told us all we needed to know about her corporeal condition.

With nothing to do, my colleague and I left the scene and the crew continued with their paperwork and waited for the police. Downstairs in reception, the little Asian manageress was behind her desk, dealing with clients as usual. She had a corpse in one of her bedrooms but business went on as usual. She was calm, smiley and getting on with it.

I had to follow my next patient around a pub bar for a few minutes while the crew arranged to get him onto a stretcher outside as it poured with cold rain. He was a 65 year-old man who had fitted in front of the other drinking punters after a sudden collapse. Now he was post ictal and behaving strangely, as they usually do. He was intent on picking his nose in slow motion, regardless of the oxygen mask that barred him from access to his nostrils and he walked around reaching vaguely for objects sitting on tables while I tried to gently persuade him one way or the next to protect him from falling over things in his path.

Luckily, he remained passive and the crew eventually got him into the ambulance, although he was trying his best to escape. If he isn’t epileptic (and nobody knew for sure), then he needs to re-consider his alcohol intake; fitting is common with alcoholics – it is a withdrawal consequence.

Sleeping on a bus will cause panic. You know that now if you’ve been reading regularly. My next call for a 20 year-old male ‘unconscious on bus’ was actually for an unpleasant, foul-mouthed female and she wasn’t unconscious. She was, as they usually all are, drunk and asleep. She had just come out of a local hostel and dumped herself on the bus to create an atmosphere of calm and dignity. The crew knew her well and they were already dealing with her when I got there, so I didn’t even bother to introduce myself to her – I’m sure I’ll get a chance to meet her in the future. I must try to avoid the area at all costs.

Now here’s a conundrum. I was sent a call to a hospital specialising in cardiac catheterisation and critical care; a hospital we rush known MI patients to because they will get the best immediate treatment, for a 26 year-old female with ‘chest pains’. Control called me before I had a chance to raise my eyebrows and apologised for the call but they didn’t understand it either. Why on Earth was a specialist cardiac hospital asking for an emergency ambulance to come and deal with a person with chest pain who was sitting in their reception. A person who had walked in off the street seeking help in the knowledge that she had gone to the right place?

The crew arrived at the same time as me and the paramedic walked into the hospital and straight back out with the patient, who was walking behind him, smiling. She had seen him coming, got off her chair (where she had been left sitting with apparent chest pain) and made her way to the ambulance. The paramedic looked bewildered and I must have looked the same but I didn’t have a mirror handy to check my expression.

I went into the reception area and asked the man behind the desk why he had called an ambulance.

‘We don’t have an emergency department in this hospital and its policy to call an ambulance for such cases’, he explained.

‘So, if the crew do an ECG out there and find that she is suffering an MI and they bring her straight back in she will be treated upstairs?’ I asked.


‘That’s crazy.’

‘I know but it’s our policy’

We have become slaves to stupidity I think. If the crew see an MI, they’ll return her immediately and if they don’t get a clear ECG but there is something wrong, such as a bundle branch block, they’ll take her to the nearest A&E. If a diagnosis of MI is made there, she will be bounced right back to this establishment for emergency treatment. Either way, a delay has been caused and, in acute circumstances, it’s possible that a life could be lost.

None of us believed the woman had cardiac problems but that was beside the point. What I was being told was that if a pale, sweaty-faced 62 year-old staggered in, clutching his chest, crying out in pain and vomiting on the floor, they’d call us, sit him down and get the domestic staff to clean up the carpet before it upset the paying customers. Someone please tell me it isn’t true.

Late afternoon brought me a routine call for a 28 year-old female having an asthma attack at her office. The crew was with me and they dealt with her, although I stuck around to see if I was needed. I wasn’t, she was over her asthma and was hyperventilating a little.

I wasn’t required for the next call either. The 25 year-old female had been fitting in a shop but the ambulance crew were on scene and dealing.

My response to several calls was delayed today, as it was for the ambulances leaving my home station, because of road works (for water mains) that suddenly appeared, without prior notice, and blocked off access to the road leading to our station. Traffic was thoughtfully diverted right past our door, so it was proving more and more difficult as the day wore on to get out in a hurry. Even on blue lights and sirens there was no advantage because the street is narrow and cars queuing along it had nowhere to go. We were becoming trapped.

I spoke to the contractors and let my Control know what was happening and after a few more hours, the diversion was changed and traffic eased around us but it was still difficult to get to and from the station because of the road closure. This is set to continue for another week I’m told. It’s the sort of thing that reminds me of how far down the line we are as an emergency service. I’m pretty sure the police or fire service would have been notified in plenty of time. It’s a shame.

My next call was for a 25 year-old female who had fainted but was now recovering. She had fallen over in a shop in Oxford Street. The crew were there a while before me (thanks to the road works I just moaned about) and I wasn’t required.

Another drunk on a bus – this time of the more common variety (and by that I mean male and Eastern European). He slept the deep sleep of a drunken sloth while the bus driver worried that he might be dead. I assured him that the smell of alcohol, his heavy, raspy breathing and the occasional grunt meant that he was very much alive.

‘What state was he in when he got on the bus?’ I asked.

‘I dunno. I don’t even remember him getting on’, he replied, amazed at his own failure.


So I prodded him, pinched him, shouted at him and did all the things I needed to do in order to get a response but I got nothing. I pinched his shoulder hard and he reacted by pushing my hand away and grumbling a profanity – I think it was anyway but it was in Polish, so I’m not sure. I got some obs, just in case and the crew appeared a few minutes later as I considered my next move.

The ambulance paramedic tried for a response and within ten seconds he got one. The man sat up, opened his drunken eyes, made a comment in Polish and walked off the bus with us. The cheek of it!

Unusually, he thanked us then asked for directions to Victoria station, no doubt his next port of call for an inebriated kip. A medical finger pointed south and he wandered away and disappeared like a ghost. Someone will drag him off another bus later on, I thought. It won’t be me because I'll be at home.

Be safe.


Anonymous said...

you'r a super hero!!!!!!!!!!!!!!!

Xf said...


You know what? I don't think I am but I'll pass this on to my colleagues, some of whom are REAL heroes.

Thanks anyway


Anonymous said...

I agree with Anon. You are a super hero! And you need to take credit once and a while! ;)