Sunday, 23 March 2008

Losing babies

Eight calls and one running call – two conveyed by me, one no trace/hoax, one false alarm, one assisted-only and three required an ambulance.

I’ve posted about miscarriage many times and my first call, to a hotel in south London, reminded me of the emotional impact such a devastating event has on a couple. The 33 year-old was distraught because this wasn’t her first failed pregnancy. This time it had gone further than before but it looked like all was lost again. She had lower abdominal pain (cramping), heavy PV bleed with clots and a history to back it up. Her husband could do nothing more than hold her as she sobbed in the back of my car. I decided to take them to hospital myself; they had walked out to me and I could see in her distress that the last thing she needed was more fuss than she already had.

A call to a night club and restaurant in the West End for a 42 year-old female who was having an allergic reaction to oysters turned out to be a faint by all accounts. My colleague was on scene just ahead of me but I managed to get the gist of the story and there were certainly no tell-tale signs of allergy. That didn’t stop her arrogant friend from telling the paramedic that he was wrong and that she was definitely reacting to the oysters she had eaten. Her tone was very patronising and it’s something I can’t abide because I don’t see us as merely servants to the whim of the public.

‘Are you medically qualified to make that diagnosis madam?’ I asked politely.

‘Well, no’, she replied.

‘Then can I suggest you let my colleague carry on with his checks and reach a conclusion based on them?’

I too must have sounded arrogant but I didn’t mean to; I could see this lady bullying her opinion onto the PRF and that wasn’t right.

A 30 year-old male fitting outside a pub carries the high probability of my finding a drunk on the ground but this time it was an emotional young man with mental health problems. He was reluctant to have the crew help him in any way and was a little aggressive with me to start but the shocker for me was finding out that the very drunken guy who kept butting in to ‘help’ was the manager of the pub I was outside. He may have been off duty but he was still a bad advertisement for the place as he was more sozzled than his customers. Are you allowed to be that drunk in charge of a pub? Surely you still have a duty of care whilst on the premises? If you are a publican, let me know, I’m curious and too lazy to look up the licensing act.

The patient had left his coat and bag somewhere and I went to look for it while the crew settled him down but it was nowhere to be seen.

‘Don’t worry’, slurred the super-sloshed manager, ‘if we find them we’ll take care of them for him.’

Admirable but not what was right.

‘No, can you find out if anyone on your staff has seen these items?’, I asked.

He wobbled a bit and I decided to do the job myself. I went into the bar and asked if the man’s belongings were in there. Immediately, the barman pointed to the floor and there they were. They soon joined their rightful owner before he became upset again.

A drunken Australian was found collapsed outside on the pavement by a bus driver and I arrived to find him being guarded by the aforementioned good citizen. I thanked him and got on with the job of waking my charge up. He had vomited a few times and was clearly too drunk for his own good. I always find Aussies honest and generally good-natured about their inebriation. It’s almost a hobby to some of them, although they would never dare use the term ‘alcoholic’.

‘Can’t you just leave me here to sleep it off, mate?’ he asked after I told him he would be going to hospital. He was almost ashamed of that and preferred to lay there in the middle of a public place until the morning. By that time, of course, he may have choked on his own vomit or died of hypothermia, so strictly speaking, much as I admired his courage and respected his Antipodean way of thinking, my duty was to see that neither happened. He was going to hospital.

As usual with all my patients from the land of the big red hill, he was a thoroughly likeable bloke.

Then I got to drive around Euston with an ambulance and the police in tow trying to find an invisible man who’d allegedly been beaten up and left for dead in the street. Nobody saw him and the caller couldn’t be contacted again. Funny that.

A lonely 53 year-old woman who just happens to live very near to our main ambulance station had me fixing her home nebuliser, just so she could have company for twenty minutes. She had called claiming an asthma attack but that simply wasn’t the case; she was smoking a fag when I got to her flat. All she wanted to do was chat for a bit.

I fixed her machine and she proclaimed herself feeling much better, thanks. She hugged me and kissed my cheek, which was entirely unexpected (I’m not much for hugging strangers) and I left her home with a sense that, although I now had the smell of a thousand fags on my uniform, I had done some good.

The early hours brought me a running call for a man with DIB. He came up to the car and told me that he wasn’t feeling well and had problems breathing. His sats were very low – around 80% and that isn’t good but he looked fine otherwise. I told him to get into the car and that I would take him to hospital myself. On the way I came across another FRU and saw my friend and colleague dealing with a man who had been hit by a bus. He had a badly fractured leg and I called Control to advise them that, although I had a patient on board, I was needed here too. I got a chaperone to take care of my new friend in the back (who was entirely stable) and helped with the RTC I had come across. Periodically, I asked one of the armed cops who were on scene with us (they are all around the West End, you just can't see them) to pop his round and check that my patient was okay. I forgot to factor in the tension an armed man would create without announcement.

As soon as an ambulance was on scene and the injured man was taken on board, I got back to my patient and continued with the journey to hospital.

His sats were still reading very low in A&E and the nurse thought it was a mystery too but he hailed from a high altitude country and I wondered if that had any bearing on his apparently compromised oxygen uptake. Again, I have no time to look into this, so any suggestions from you would be welcomed…just make them sensible :-)

My last job sent me to a very dodgy part of south London for two drug addicts who were apparently unconscious in a flat after overdosing. I didn’t like the sound of this at all and the crew were thankfully with me when I arrived on scene. I asked if the police were available, just in case but I was told that they were busy with a shooting murder from earlier, so we had no back up but each other.

It turned out some foolish young man had called us because his girlfriend had taken cocaine with him earlier and he was worried about her behaviour(!) She was in bed and wasn’t happy at all to have three men in uniform walk in. A lot of fuss for nothing. We left them to it. He would inhabit a doghouse for a while after that.

Be safe.

14 comments:

SP said...

Sounds like a much more routine shift tonight with no real emergencies.

I hope you are recovering somewhat from your last shift and you're encounter with what is left of human morality.

Thank you again for doing a job I would neither be capable nor brave enough to do and thank you for being a thouroughly decent human being.

Fiz said...

That miscarriage story grabs me by the throat and makes me cry. I've had two ( I also had two healthy children, thank God)and only have to read your words to know how I felt then and how your patient must have been feeling. I do hope she can get get and stay pregnant again, otherwise the grief never fully leaves you. I also have a question for you, which comes from my mum's local paper - a lady took her 2 year old toddler with DIB to our local hospital last Friday night. She had to wait for the child to be seen after all the fightening drunken maniacs in A and E were seen to first. The same thing happened when she had a severe cut that was gouting blood everywhere. She asks if she should get drunk too to get any attention the next she or her family need A and E.

Jamie said...

Hi Stuart, just finished reading your book a few months ago, absolutely brilliant. More inclined to join the police myself, but my EMT/paramedic wannabe friends will definitely be getting referenced here! Thanks for the great insight into a fairly unsung profession.

Heather said...

It was kind of you to take the miscarrying lady to hospital. So often when this is happening a well-meaning doctor tells us to take some paracetemol, go home and try again, we're young.

While this is often exactly what should happen, it's almost always the last thing you want to hear when you're losing yet another baby.

I'm sure you gave some comfort, and under the circumstances that's the best you can do.

Xf said...

sp

Thank you (and everyone else) for the kind words.

Xf said...

fiz

This is shocking. We take all our children directly to the children's A&E, which is usually a separate unit - that way they don't have to mix with the adults in waiting.

Has your local hospital not got a children's A&E? If not, it's nothing short of scandalous that any child should wait in line behind drunken fools.

Xf said...

jamie

Thanks for that. I hope your friends will learn something from it. Good luck with your career choice.

Xf said...

heather

I've dealt with dozens of miscarriages but I always remember to leave patronising remarks at the door because I have no idea what these women are feeling and I know nothing I say or do will compensate for their loss.

Fiz said...

Xf, the better of our two hospitals has, which is where my daughter went when she had suspected appendicitis, but we took her, on a GP's advice. If we had to have an ambulance, they would take us to another , which does not have a children's A and E. I had to take my eldest there when she damaged a foot tendon. We waited all day and were seen last, apart from an older woman who had done the same thing. Likewise, my youngest knocked all her top teeth loose at four and we were in the town where this horrible place is and we waited two hours while she bled everywhere and didn't do a thing - no tissues, water cottonwool, nothing. I finally took a calculated risk and became assertive, and asked that that at least get her some tissues and was any body competant around? It got results - she was seen, x-rayed, saw an extremly nice doctor who gave me advice, and we departed. I wonder just how long we'd have just sat there if not. It was 10.30 on a Saturday morning and they were underwhelmingly busy. Take care of yourself, Xf.

JackB said...

Good blog as ever, I've been reading this, and your brilliant book, for a fair while now but rarely have anything worth saying.
But I have lived in a pub for my whole life and seen plenty of ambulances as a result.
As to the question of the manager, any one with a liscence can be the premises supervisor, if there was no one else and the manager could be held as incapable then he stands to lose his. If you decided to complain against him then it will be filed ready for his next review.
Sorry for taking so much space.

J-P said...

On the note of the low oxygen uptake and the patient coming from a place of high altitude; what happens is that the person creates more red blood cells to be able to compensate for the lower partial pressure of oxygen in the air. At sea level the partial pressure of oxygen in the air is 20kPa, and red blood cells make up to 40-50% of the blood, but at 6500 metres the partial pressure of oxygen in the air is about 10kPa, and red blood cells make up 50-70% of the blood.
JP

KT said...

J-P is right - if anything one would expect the increase in atmospheric pressure to assist oxygen saturation, so to have an altitude adjusted individual at low altitude with O2 Sat of 80% is a worry indeed... Don't suppose you've had a chance to follow this one up?

Xf said...

jackb

Thanks for that info. Take as much space as you like :-)

Xf said...

j-p and kt

Yes, I understand this increased red cell production and therefore maximised haemoglobin capacity but, as kt rightly says, his low sats were mysterious as I expected to see a high number.

Unfortunately, in the great scheme of things, us paramedics are rarely told anything about our patients after leaving them at hospital, so I haven't been able to track this one and other events have overtaken it.