Monday, 10 March 2008

Chocolate

Eleven 999 calls; one refused, two assisted-only, one conveyed by me and the others went by ambulance.

There were no ambulances available for the first hour of my shift, so when I received a call to a 40 year-old alcoholic-epileptic man who was fitting at home, I went there knowing that I was going to be stuck dealing with it on my own. At the time, I thought I’d be left with the patient for only a few minutes; ten at most but this was going to be a slow start to the day.

The patient was in bed when I arrived on scene – his partner told me he was a renounced alcoholic who had fallen off the wagon again, after two years of being dry. Now, as a direct consequence of his binge, he had suffered a seizure and was completely confused. On top of that, he was an epileptic with a habit of fitting more than once.

When twenty minutes passed and all my obs were completed, I called Control for an update on an ETA for the ambulance. I do this often and I probably annoy them with my frequent calls but it’s not comfortable to be sitting around waiting with an ill patient, not knowing how long backup is going to take. I remember working out in East London a few years ago and I heard a FRU pilot continually calling for help because he had a desperately ill asthmatic with him and he had no ambulance. This was during one of our very busy periods (about this time of year). An hour later, my crew mate and I were assigned the job and we arrived to find a very upset medic who had done everything he possibly could to stabilise an elderly man who was now quite obviously dying. This was before I decided to go on the FRU myself and I have never forgotten the look on the medic’s face or the tense atmosphere that was created by the delay.

Having said that, remember this; delays like that are often caused by a workload imposed upon us by MOPs with minor ailments or nothing wrong with them at all.

Anyway, I was told that nothing was available as yet, so I prepared an IV line and drew up some Diazepam in case my patient, who was still quite out of it, decided to fit again. I then waited with his very upset girlfriend for another thirty minutes until the crew arrived. By this time the man in the bed was a little more alert and hadn’t threatened me with a second seizure. He was alert enough to refuse to go to hospital, which was very annoying after all the fuss.

I left the crew to work it out with him and I learned later that he did go but only after a lot of persuasion. Obstinate behaviour is part of the illness of alcoholism; it’s wrapped up with a refusal to believe help is needed and denial of the reality of the situation.

A 75 year-old lady with a history of neurological problems answered my questions about how the oxygen was helping by counting to ten. Her husband had been asking her to do this as a way of proving to me that she wasn’t quite right. She had become confused and had a headache. She was currently awaiting scans and I suspected she may have had a bleed. The oxygen helped her to count properly and that was a positive sign.

My next call was a long way out of my area. An 86 year-old female was ‘in a coma’.

She wasn’t. She was dying on her sofa. Her husband was with her and he didn’t seem to realise the severity of her situation. The crew were with me and together we lifted her limp, stained body out to the ambulance. She was barely breathing.

A tourist suffered sudden chest pains as he carried his heavy cases around town. By the time he got to McDonald’s to have lunch with his wife, the pain had become too much to bear. When I examined him, he complained of pain when he breathed in. He wasn’t particularly tall or slim but he had diminished breath sounds on the painful side and he had a slow pulse, which was normal for him. In fact, he had the pulse of an athlete, yet he was 49 years-old and didn’t exercise, although he had been very active when he was younger.

Some people retain a fit and healthy pulse even into old age, usually as a result of years of conditioning during youth. This factor, coupled with his lifting effort when carrying the heavy cases, may have contributed to a spontaneous pneumothorax.

The man also had a history of Bronchiectasis, which may or may not have been a feature in his current condition. His ECG was normal and his sats, which had dropped, improved on oxygen. He was taken to hospital by the crew, who had arrived a few seconds after me.

A call to a 25 year-old female ‘? Fitting’ was being dealt with by a crew when I arrived. She seemed to be alert and I was obviously not required.

Every day, a number of calls will come in with a description that will cause the generation of a RED1 for ‘life status questionable’. Very rarely do these calls result in a person being resuscitated. In fact, most of them are sleeping drunks, so I wasn’t at all surprised to find my 45 year-old LSQ man sitting against the wall outside a fruit shop, in full view of MOPs at a bus stop, one of whom had dialled 999 in a fit of panic because she couldn’t wake him up and she was concerned he might be dead. The strong, stagnant smell of alcohol didn’t make her suspicious of another possibility, which I found quite naive.

I went to my ‘dead’ patient and found him to be very alert for a corpse.

‘Do you need an ambulance?’ I asked.

‘Yes, I think I do. That woman said I should go to hospital’, he slurred.

‘Why?’

‘I’ve got a cough and keep bringing up yellow stuff. My ribs hurt every time I cough.’

‘Have you seen a doctor about it?’

‘Yeah, he gave me antibiotics and pain killers a week ago’.

‘Did you take them?’

‘No, ‘cos I’m an alcoholic and I’ve been drinking’. He rested his case.

After mulling over the stupidity of what I was hearing, I considered the time that I was wasting while some poor sod elsewhere was having a heart attack.

‘If you go to hospital they’ll do nothing more than your doctor has already done and the fact that you haven’t bothered to take your tablets means you aren’t getting better. You should take your meds and quit drinking’.

This annoyed him and, not one to be lectured by a mere nobody like me, he announced his decision to let me off the hook.

‘Go on then. Go and save someone else.’ Then he dismissed me with a wave of his hand. Charming.

I called it in and left him in his alcoholic slump. The woman who had made the emergency call had taken the bus and left. She was gone, along with her concern for him.

A stupid, selfish driver had parked his vehicle in such a way that I was obstructed on my way to the next emergency call...by a fire engine. It had attempted to get through the small gap left in the road because of the wide, corner-parking of Mr or Mrs Don’t Care but got stuck and had to reverse all the way back, forcing me back too. It caused a delay of about three minutes on my run, which could have been critical if the patient was in serious trouble. Luckily, he wasn’t.

A 25 year-old man was being pinned against the outside wall of a store in Regent Street when I finally arrived. I had been called to this one because the security guys suspected he had taken drugs. Almost immediately, he became aggressive with me and tried to paw at me. I pushed his arm away from my face and he didn’t like it at all.

‘You lot are winding me up’ he said. Then he pushed his way past us and walked off down the street, staggering every now and again. In his current state, he was capable of causing trouble, so I asked for the police to be sent. I waited and a crew turned up, despite my request to cancel them. I waited some more and then got bored, so I went over to the little police office in Piccadilly and gave them a description of the now long-gone drugged up man.

Ex-nurses tend to know when they are not well. They don’t pretend or exaggerate their condition. My next call, to a Chinese restaurant in Chinatown, for a 68 year-old retired nurse who had fainted, demonstrated this.

She was quite pale as she sat outside the restaurant with her husband and a member of staff. ‘I don’t feel well at all’, she told me. I believed her and so did the cycle responder who was with her for a few minutes before I arrived. It didn’t take long for the crew to show up and she was taken to hospital. She may have eaten something that didn’t agree with her, or she may have suffered a minor cardiac event.

I raced off to a call in the north and found a motorcycle medic attending the patient. The 25 year-old man was lying on the ground complaining of a racing heart. A passer-by had called an ambulance at his request. When asked if he had taken anything, he repeatedly replied that he had eaten chocolate before this happened to him. This caused a bit of confusion until it dawned on us that he was referring to drugs.

Chocolate is a street term used for opium but apparently a new combination has taken on the title; magic mushrooms in chocolate. The mushrooms are either mixed with chocolate or that is the name given to the paste’s colour – I’m not sure to be honest and I’m still trying to find something about it on the Web.

This was the first time any of my colleagues had heard the term and it wouldn’t be my last, as you’ll see from my next few posts.

He was taken to hospital but I’m sure his symptoms are simply the expected effects of what he has ingested.

I didn’t even get into the building on my next call, which was for a 23 year-old male with a fever which developed after an insect bite. The crew were ahead of me and three’s a crowd when it comes to simple job like that.

My last call took me four miles north and I was lost when I got there. The patient, a 24 year-old girl, was suffering a mild allergic reaction and her lips and hands were red and swollen as a result. Fortunately, her breathing wasn’t affected, although she had the typical sore, slightly swollen throat that goes with the territory.

It was the other end of the day and again there were no ambulances available, so I decided to convey her myself. She was stable and had walked herself out to meet me, so it was a logical decision. I have a feeling I’ll be making a few more convey decisions over the coming weeks as the great God Orcon needs to be satisfied.

Be safe.

10 comments:

KT said...

As an Australian it gives me a little chuckle to hear the rest of the world often saying how insect bites are 'simple jobs' - I think we have just about the most toxic little critters on the planet here, most of which love hiding in your shoes...

Tabitha said...

"When asked if he had taken anything, he repeatedly replied that he had eaten chocolate before this happened to him."

I was about to shout 'CAFFEINE INTOLERANCE' at my monitor then, until you mentioned the drugs bit. Normal chocolate makes me giddy enough as it is; mixing it with any sort of funghi sounds vile.

Anonymous said...

If our ambulance services are at full capacity most of the time now, what would it be like if we had toxic critters here...

God, think about the paramedics! :P

kt, is it just NZ or are most of Australian ambulances run by St John Ambulance? I saw some trailers on youtube and found that fact.

Rocky Mountain Medic said...

Thanks for the nice read. I enjoyed it.

Anonymous said...

I don't know KT, we only have Funnel Webs, Redbacks, Hopper ants that can cause anaphylaxis, Blue Ringed Octopus, Great swathes of the coast that are unsafe to swim in due to the Crocs and Box Jelly Fish and 9 of the 10 most venomous snakes in the world 8-).

I love a sunburnt country!!!

Adelaidian

Anonymous said...

St John only run WA and NT services thank goodness. We got rid of them in SA 15 years ago and are much better for it.

Anonymous said...

St John only run WA and NT services thank goodness. We got rid of them in SA 15 years ago and are much better for it.

Anonymous said...

Mushroom Chocolate is just a mixture of dried psilocybe mushrooms and melted chocolate repressed into bars. This is done because the taste of magic mushrooms is generally considered unpleasant. It's readily available in Holland and presumably most of the stuff in the UK is home-made.

A user would be more likely to refer to the 'shrooms than the chocolate though, I'd imagine ;-)

KT said...

Anon is right about the StJ bit - the actual workers are great but the admin make the whole system difficult to work in...

That's been my experience at least, others are welcome to disagree!

Xf said...

anon

Thanks for the info on chocolate shrooms. This is what caused the confusion at first - the patient referred to it as chocolate and a few shifts later (soon to be posted), I came across another call in which it was referred to simply as 'chocolate'. I guess the Brits are giving it their own term.