Tuesday, 4 March 2008

Clever drunk

Six emergency calls – one assisted-only, the rest required an ambulance.

My last night shift and I’m called out almost immediately to a 1 year-old girl with ‘? Meningitis’. This is always a worrying statement as it could very well be for real. Along with the usual information – widespread rash, etc., there was a line which read ‘headache’. As I sped along to the address I couldn’t help but wonder at the level of communication someone obviously has with this baby.

When I got to the posh address in a leafy part of London, I found a nanny taking charge of most of the stress. The mother, a well-to-do lady, seemed concerned but somehow detached. I examined the child and found that the rash blanched when a clear glass tumbler was pressed into it. This was a good sign; non-blanching rashes are ominous and one of the definitive signs of septicaemia. It took a few attempts to get the right kind of glass from the nanny. She brought a champagne (what else) glass first, then one which had come straight from the dishwasher and was still hot, then a whisky tumbler, which had to do. Neither of them knew about this simple test.

The child displayed no stiffness and was otherwise in good health. There was a moderately high temperature, so I had to assume that the fairly widespread erythemic rash she had developed was the result of a viral infection or a reaction to something. I found out that the nanny had recently changed the brand of washing powder used for the child’s clothing. That may well have been the culprit but she was going to hospital to be checked anyway.

‘Do I need to be there?’ the mother asked.

This took me by surprise and I think she saw the doubt in my eyes.

‘Well, yes, probably because I don’t think the doctors will accept the nanny’s authority to go ahead with any procedure they may need permission to carry out’, I replied, knowing that there wouldn’t be any ‘procedures’ but it was the only answer I could come up with at short notice.

I was hardly likely to say ‘Of course not, your baby can come with the nanny, who might only have been in your employ for a week, and we will take all the responsibility for her.’

‘I have a meeting I simply must attend’, she went on.

Really? A meeting? It must have been very important because I still don’t know why it even came close to over-riding her duty to be with her sick child. Then again, I’m not her and it’s her life, so I mustn’t be the judge of anything, right?

In the end, the crew were happy to have just the nanny along with the baby. Mum agreed to catch up later on. I was still gobsmacked.

A fairly serious RTC next in which the 48 year-old motorcyclist came off worst against the car that hit him. He was unconscious for a short time but had regained consciousness when the crew arrived. I was there a few minutes later. The paramedic was already trying to assess his injuries but he screamed in pain and educated us to what the main problems were his body.

‘I’ve broken my arm, my leg hurts and I have pain in my chest’, he told us, helpfully.

He wasn’t kidding. His arm was badly distorted at the shoulder (I know because he drew my attention to the fact that I was kneeling against it), both bones of his lower right leg were broken and he may have had a punctured lung. Getting him to hospital would be a priority; the fancy stuff could wait.

In the ambulance he slipped in and out of consciousness and this gave us even more impetus to get moving. I stayed with the crew to help the paramedic in the back while we were travelling to the nearest A&E. I tried to get a line in for IV access and he pointed out that he had ‘funny veins’. He was right, they bent around at strange angles and my attempt to cannulate him failed when the catheter stopped halfway in – the vein veered away at 45 degrees. It was a three minute journey to hospital so a second attempt was pointless.

He got to Resus and was conscious again, although his pain was still there – lots of entonox had helped but it doesn’t last long – he could have had morphine if I had been cleverer with my cannula. He’ll survive his injuries but he may not walk the same again.

Another nasty estate with no vehicular access next and a 43 year-old female who said she had chest pain but complained of mainly back pain when I got there. She pointed to the muscles of her back and there was no other clinical sign or symptom to back up a cardiac origin. Muscular it is then...probably. Of course, she went to hospital because there’s always that one case of back pain that turns out to be an aneurysm.

A 98 year-old man with severe DIB and a rattling sound every time he breathed needed to get to hospital quickly. He was extremely frail and unsteady and had a cardiac history. I gave him Frusemide and GTN for that rattle and by the time he arrived in hospital, he had improved markedly...but that wouldn’t last long. At his age and in those circumstances, he would need very special care, if he survived at all.

Some drunks are a surprise to me. The 35 year-old man that I helped a crew attend to in the street didn’t fit the bill at all – he was educated (he told us he had a masters degree), well dressed and was carrying a laptop and various documents in a bag, yet he was found lying on his back in the pouring rain on the street at small-hour o’clock in the morning. He hadn’t been celebrating because he seemed depressed but he had filled his skin with enough alcohol to render himself stupid for a month. He couldn’t be left where he was, despite his protestations that he was ‘alright’ and he couldn’t be taken home by us because he lived miles away. There was only one course of action to follow.

He had adamantly refused to go to hospital and we had checked him over thoroughly and found him to be...drunk. He had the means to get a taxi but no taxi driver was going to stop for him and sectioning him would have been a bridge too far, so I got out of the ambulance, hailed the first free cab I saw and chatted to the driver about our situation.

The guy was staying at a nice hotel and he had the money to pay, so it was agreed that, as a courtesy to the LAS, the cabbie would take him off our hands. It was a matter of common sense and mutual trust. The alternative didn’t really exist. The crew were happy with the plan and so was I...oh and so was the drunkard. The only person who seemed a little unsure was the taxi driver, especially when the man crashed onto the floor of the cab after missing the seat as he tried to sit down. The smile we got from it was worth the effort and the rain.

Before he set off, he shook our hands and when he got to me he said ‘let’s go for a drink’. I think he meant there and then and I don’t know why I seem to make instant friends (or enemies) but I politely declined.

My last job of the night was for a 67 year-old male who had DIB and a swollen ankle. Despite getting on scene ahead of the ambulance, which had travelled out from my station with me, the difficulty I have finding exact addresses, being on my own and having to strain to see badly designed signs on boring faced housing blocks as well as drive safely, meant the crew hopped into the flat ahead of me. Embarrassing, but a fact of my working life.

I left them to it once I had popped my head round to see if I could help. They didn’t need me, so I did something I always enjoy doing when I finish a trail of nights. I went home and slept. And Scruffs the cat kept trying to wake me up because he has no sense of my reality at all sometimes. Bless him.

* The young man who got stabbed in Trafalgar Square died unfortunately. All for nothing.

Be safe.


Mayonnaise said...

Sorry to hear about the fellow from Trafalgar Square.


Tabitha said...

Oh no, that's sad. Poor guy. What a night you've had. Thank you for doing what you do.

gjmoomin said...

So sad at the waste of a young life. Thank God there are guys like you around to help the victims of this sick world.
Take care. Gill