Thursday, 17 April 2008

Terminal

Eight emergencies – two false alarms, one declined and five by ambulance.

Cancer is a horrible thing; my father died of lung cancer and the end stage is perhaps the most awful part of it – watching a decline that you can’t stop. My first patient, an 86 year-old lady with lung cancer was in severe respiratory distress when I arrived at her flat. He husband and son were present and both had a haunted, surrendered look about them. All they wished for was that she didn’t suffer in her last hours or days.

She was pulling in little air whilst battling to make every breath count, yet she insisted that she didn’t want to go to hospital. I nebulised her and it brought instant relief but I knew that it would be short lived and as soon as the mask was removed, she would get bad again.

I stayed with her for a while until a crew turned up and the family were still saying that they’d rather she was at home but as I sat in the car doing my paperwork, she was brought out in a hurry, vomiting and with the DIB I’d seen when I first saw her. She was helpless and without written instructions to the contrary, she had to go to hospital. I doubted she’d see the outside world again and it was a sad thing to witness.

My father died at home with all of us around him; we all got to say goodbye and I was too young to realise the impact of it all but this job reminds me again and again of the fragility of life and the uselessness of State care when it comes to this – I’d rather die at home than in a ward.


A call for a 45 year-old disabled man who was fitting took me to an underground station where none of the staff knew what was going on – they hadn’t called us. Then I saw a familiar face, a homeless man, hobbling about on a stick. I knew he was the patient. He’d called many times tonight, according to the crew who showed up a few minutes after me. He didn’t really want our help – he just wanted to tell us how ill he was all the time.

A MOP offered him a cigarette for some bizarre reason and he favoured that over any help I could offer him, so he was left to it on scene – he wasn’t interested any more. Another few hundred tax quid down the drain.


A 28 year-old unconscious drug overdose in a hostel next and I found myself chasing him around the building. He was a tall, skinny man who’d just taken heroin and cocaine (brown and white) and believed he lived there. He didn’t.

The police were called to help corral him and in the end he was allowed to go to his rightful place of abode; another hostel somewhere nearby. Again, he had no interest in being saved but he did shake my hand and thank me for turning up.


Then a strange call to a 61 year-old with chest pain. It was pouring with rain and as I pulled up outside his building, I could see him watching me from his window. I got buzzed in and he led me into his front room, where he shouted his problems at me. He was a big, tattooed Welshman and his left knuckled bore the word HATE, so I immediately felt secure. There were a couple of knives laid out on his window ledge, as well as a pair of toenail clippers – I had to assume he used all of them for his nasty feet but it didn’t make me feel any safer.

I asked him about his medicines and he stormed into the hallway, despite my requests for him to sit still (he allegedly had chest pain remember) and he told me to follow him into a back room. This, I wasn’t sure about at all but I kept a distance just in case. The room was his kitchen and he opened a drawer to reveal a carefully stocked drugs storage area for all his meds. There were lots of them – too many.

The crew arrived and continued the conversation that I had started about going to hospital. He had refused and an ECG was carried out in his front room instead. My colleague took off his fleece and laid it down, noticing, as I did, a red LAS blanket on a chair. He had kept it as a souvenir, I thought.

I left as the crew continued to persuade him to go to hospital but then my colleague, who’d been attending, came out and asked me if I’d taken his fleece by mistake. I told him I hadn’t then it dawned on me that maybe Mr. Angry Welshman was a collector.

My colleague went back up to check the flat for his fleece but could only look in certain areas because he couldn’t prove it was there at all, even though he had definitely taken it off in that room. The man hadn’t moved anywhere but the fleece had disappeared into thin air. There wasn’t much else we could do, apart from make accusations that couldn’t be upheld, so the crew had to go without it…and without the patient because he refused to go and as I left, I watched him place the red blanket over something on his chair…probably a green LAS fleece.


A call for an unknown male ‘collapsed outside tube station, blood seen’, took me to Theatreland and I found the middle-aged man on the ground making strange noises as he drifted in and out of consciousness. He had been drinking but not much, according to his lady friend and had complained of ‘feeling strange’ all night. The blood was coming from a head wound he’d received when he fell to the pavement.

Night workmen around the station had helped all they could before I got there and I spent almost half an hour with him, keeping him awake on oxygen, before an ambulance arrived. As soon as he was moved he began to vomit acidic red stuff – not blood, food and red wine I think, but it smelled very bad indeed and burned the inside of my nostrils.

He was taken to the ambulance and off to hospital, a little more aware by the time he’d been transferred to the vehicle. I thought he might have had a neurological event but I heard later that he’d simply had too much alcohol. Apparently he’d been drinking long before he met up with his friend.


I think I’ve said this before…never ever abandon your drunken friend in a public place, even if he’s a pain in the neck. An inebriated 25 year-old man was dumped in Covent Garden by his so-called mates and I was called to help him. He was vomiting and helpless. He’d clung around the legs of a club doorman asking for an ambulance until he’d conceded, so off he went to hospital. Thanks, guys.


I wasn’t required for a 45 year-old with chest pain at a police station; the crew were on scene with me and another pair of hands was unlikely to be needed because most of these calls are from scared prisoners who just don’t want to be there.


My last call of the night came in the early hours, after a lull of about three hours. He was a 62 year-old COPD patient with severe DIB and it was genuine enough for me to put him on a nebuliser immediately, even though the crew were on scene a few seconds after me. He recovered a little on this and by the time he was in the ambulance, he looked a lot healthier, if that can be said of someone with a chronic breathing condition.

Be safe.

9 comments:

Sarah P said...

My grandfather died 4 years ago due to cancer related illness. He died in hospital with his family around him which wasn't so bad. My aunt didn't make it in time and saw him a few minutes after passing. I don't think she will ever get that last picture out of her head. To make it worse she had to have an op a couple of months later and she was put on the same ward 2 beds up from where he died. It's only due to medical professionals like yourself she was able to go through with it. Death affects everyone differently but I have never been able to think of my grandfathers death without immediatly thinking of my aunt and what she went through.

I know this veers a lot from your blog but I thought you would be interested as a medical professional. I personally find it deeply disturbing and wrong on so many levels. God help the pro choice movement in America.

http://www.yaledailynews.com/articles/view/24513

Fiz said...

She's mad, Sarah. The pro-choice situation in the US has been on knife edge ever since Roe v. Wade went through in 1973.

Jason said...

Hi Xf,

With regards to the following statements:

"he opened a drawer to reveal a carefully stocked drugs storage area for all his meds. There were lots of them – too many"

"noticing, as I did, a red LAS blanket on a chair. He had kept it as a souvenir, I thought"

"then it dawned on me that maybe Mr. Angry Welshman was a collector."

"I watched him place the red blanket over something on his chair…probably a green LAS fleece"

Surely the above should have warranted Police attention - or even the threat of Police attention?

I'm sure with even just the threat of the Police he would have returned the fleece (I am assuming of course, that the Welshman did steal it, as seems likely from what you say) and likely the blanket.

Also, what you said about the drugs - "There were lots of them – too many" - does that imply you thought that at least some of them had been stolen / acquired by non legal means?

From your description of the gentleman it does sound very much like Police attenance should have been required!

Thanks for all you do - times may be hard and the people you deal with may not be thankful, but take it from me, there are lots of us out there (who hopefully will never have to call you or your colleagues) who are very grateful that you are there if ever you are needed!

all the best,

Jason

Jay

Xf said...

sarah p

Sorry for your loss and especially sorry that your aunt was put nearby when she was admitted. It was a bit thoughtless, unless the staff had no idea.

As for your link...this 'artist' has no moral standards and I have no idea what 'message' she's trying to put across. It's an affront to all those women who are desperate to get pregnant and to those who've lost their babies through miscarriage.

What next? Suicide for art?

Xf said...

Jason

To be honest, it didn't occur to us to go that far - he was obviously unbalanced and, without hard evidence, I doubt the police would have gone through all his stuff to find it. At the end of the day, it was up to my colleague to pursue this but he will have put in a report about it and left it up to his superiors.

I doubt our bosses would have been too pleased that a vehicle was off the road while we searched for a missing bit of uniform.

Anonymous said...

This "art piece" looks extremely fishy to me. Are you sure it's not a hoax, on the part of the student probably? I mean "herbal and legal abortifacients" - that are 100% reliable? And aren't known by every scared sexualy active 16 year old here? I think it's just a shock piece, faked to stir up controversy and debate. On which grounds it's been very successful.

Xf said...

anon

I agree it's probably a hoax but I suspect that it is a real 'artist' behind it and she is hoping to glean emotional reactions to make a point. Nevertheless I stand by what I said; it's immoral and an insult to women who've had miscarriages or who can't have kids.

Anonymous said...

What “written instructions” would the 86 year old lady have required to be allowed to die at home and not have had this horrible experience? Would that be a living will and/or the signing of the Patient Report Form?

I think it is awful that she had to go to hospital and have to die there when she wanted to die at home. I would rather die at home as well, and find the thought of being bundled out in a hurry into an ambulance to be taken to hospital to die monstrous!

What would a person have to do to avoid this?

Xf said...

anon

You'd have to speak to your GP and agree on the basis that nothing else could be done to enhance life or sustain it in hospital. We'd have to see the document and confirm it with the GP, otherwise we must take the patient to hospital.