Chest pain

Six calls – two refused, four by ambulance.

Forty kilograms is a lot of weight to drop onto your chest and my first call was to a 57 year-old, in good health and with years of experience ‘pumping iron’ who did just that. He’d been working out, as usual, in his local gym when the Swiss ball (an inflated rubber ball used for various exercises) he was balancing on whilst lifting two ‘dumb-bell’ weights suddenly burst underneath him. He collapsed immediately and one of the bells fell onto his sternum, knocking the air out of him.

I found him lying on his side on the gym floor while all around people were getting on with their exercise routines. He had been attended to by staff members, who had covered him with towels as make-shift blankets. He was in great pain, mainly in his back and chest and any slight movement caused him to cry out.

He was a large man and the musculature of his chest may well have saved his life because a crushing weight like that can cause damage to the heart and lungs. Of course, his lung function was my first main concern and I listened carefully for the sound of air entering them, especially on his left side, where most of the pain seemed to be.

I had to wait a while for the ambulance crew because they had been sent to the wrong location, thanks to some confusion among the staff about where they were. I spent twenty minutes monitoring him but I couldn’t (daren’t) move him without other professional hands because his spine was a major consideration too.

As long as he remained conscious and breathing adequately, I could manage him without disrupting his precarious state. My first attempt at getting a cannula in so that I could administer pain relief failed because he was at such an awkward angle that access to a decent vein was difficult; I’d tried a small vein in his hand but it collapsed as soon as the needle entered it – this happens every now and then. He would have to make do with entonox (gas and air) until he was on his back.

When the crew arrived, they had already been updated about the situation and brought in everything needed to collar and board him. He’d have to be lifted out of the fire exit and there was no ramp, just three or four narrow steps but with three of us now on scene, it was achievable.

I gave him morphine before we got going and the gas helped to ease the pain while we moved him from his side to his back. Entonox has a wonderful side-effect and by the time he was moved into the ambulance, he was grinning like a Cheshire cat, even though his pain hadn’t diminished much. His breathing remained stable and air entry to his lungs seemed normal but I suspected he’d broken a couple of ribs. It could have been a lot worse.

You all know my views on some ‘care’ homes (not all, some) and I’ve posted many horror stories from them. I have many more but I can’t publish them because they are just too ridiculous to be believable and some carers will get angry because they are in denial. Like I said, not all care homes for the elderly are poor but the system we have in place, where a lot of individuals who couldn’t care less are paid to look after our most vulnerable members of society, is becoming dangerous.

My next call was to a 74 year-old who was complaining of chest pain. He’d been suffering all night and when I examined him, it was clear he had a well established chest infection – every cough rattled loudly. He wasn’t well at all and there were three care assistants in his flat doing nothing useful. They talked among themselves, moved stuff around and generally stayed away from the man they were paid to care for. He sat in his chair while I carried out my obs and put him on oxygen and none of them came over to show an interest. Even when I asked the simplest questions, like ‘Has he seen a doctor?’ I received blank looks and head shakes.

He’d been chain-smoking during his illness and this was, of course, not helping him at all. When the crew arrived to take him away, he picked up the two most essential things he would need for his trip – his cigarettes and his lighter.

Sometimes MOPs and windmills forget what they are looking for when they’re tasked to wait for an ambulance and guide us in. I walked past a young girl as she stood in the doorway of what I suspected was the location of my 20 year-old asthma attack patient. I made eye contact but it wasn’t acknowledged, so I assumed she wasn’t my guide. I continued to walk among the thronging crowd of tourists by the Thames, looking for an ill female somewhere out there.

I found nothing and called Control to request a better location but the ambulance had arrived and I could see the crew coming down the steps leading to the walkway I was on. They walked towards me and then cut right. The girl I had thought might be my windmill was my windmill. She had seen me walk past, in a bright yellow jacket and bags of equipment but, for some reason, hadn’t connected me with an ambulance. Maybe her brain was programmed to see two people as a crew but I wondered why she thought I was there at all.

The asthmatic girl was hyperventilating badly; she was jumping up and down on the chair. There’s hyperventilation and there’s I wanna be hyperventilating. I left her to the crew.

I only had to assist the crew when I got to the next call for a 25 year-old ‘not alert’ at an underground station. They had beaten me to it and were dealing with her when I arrived. I’d spent ten minutes looking for them outside the station because this was the location that was given by the caller. The crew had been wandering about too, by all accounts, and had only discovered she was inside the station, on a platform, by chance.

A 35 year-old alcoholic who was said to be ‘unconscious’ in the street, wasn’t. At first he wouldn’t talk to me, but then I asked the most important question, ‘do you want to go to hospital?’ Of course he did but he made his answer a demand and that annoyed me.

‘I want to go but you have to take me to Charing Cross’, he said.

Charing Cross hospital is miles out of my area and there was no way me or the crew were going to be treated like taxis for the benefit of someone who cared nothing about what we were and why we were there. In any case, unless we specifically have to go to a named treatment centre, he would have to go to the nearest. I told him this.

‘Well, if you don’t take me to Charing Cross, you can basically piss off’, he replied.

Another nice customer and another reminder that this country is going to the dogs.

I asked the crew not to bother when they arrived, I’d cancelled them anyway so they parked up and did their paperwork. A CRU colleague had joined me earlier and neither of us could persuade the man to comply…or be nice. He had to be moved on because he’d generate further calls from this area, so I requested police to deal with him and by chance a lone police officer in a van passed by. I flagged him down and asked for his assistance.

The drunk had crossed the road to harass a group of people standing there and the officer went over to tell the man to move on. He argued a bit and the officer, with endless patience said that he didn’t have time to argue with him because his van was blocking the road.

‘You’ll have to move it’, said the officer, referring to the fact that he wanted him to go away from the area.

‘But I can’t drive’, said the drunken fool.

Another drunk, this time with a sense of humour and no aggression, was found slumped in the street with a ‘leg injury’ that didn’t exist. Some French tourists had seen him in passing and decided that he must be in trouble, so they called an ambulance. Don’t they have drunken vagrants in France?

An ambulance, MRU and yours truly were sent to this; it was way over the top and the man sat on the ground, happily sticking his tongue out at us. At one point, he picked up a harmonica and blew into it, producing what he must have thought was a tuneful aria but what, in fact, sounded like a cat being castrated without anaesthetic (as I’d imagine that to sound, I hasten to add).

He didn’t go to hospital because he didn’t need to and he refused any assistance offered. We left him to his ‘melody’ and hoped no other tourist would walk past him should he decide that music was not enough to keep himself awake. That would suddenly be translated as ‘unconscious’ or ‘dead’.

Be safe.