Friday, 23 May 2008

The price of flowers

This is the memorial to the young man who was stabbed to death near Trafalgar Square a while ago. I remember thinking how young he was when I was at the scene of this crime. I also wondered what the cost would be for the family.

Eight calls (including a running call) – one no trace and seven by ambulance.

Theatres are often close, hot places where hundreds, or perhaps thousands of people are packed in like sardines for hours at a time, with one or two breaks, if they’re lucky, between acts. This is a recipe for sudden syncope and so it is not uncommon to go racing off to one of these public buildings to help a ‘collapsed’ or ‘unconscious’ person.

Tonight I went to a couple of theatres; a 60 year-old woman collapsed as she climbed the stairs to go inside the auditorium of the first theatre I visited. It was warm in the bar and she’d got hotter and hotter, so much so that when I touched her head, she felt unusually warm. She’d never fainted before in her life and had no medical conditions but it was wise to get her checked out properly in the ambulance, where an irregular heart beat was found on the ECG, prompting us to conclude that she needed to go to hospital. She never got to see the play, unfortunately.

On this occasion, the St. John Ambulance were on duty but for some reason were not told of this lady’s collapse, so when I arrived, not only did they bemusedly watch me go past with the security guy, the poor lady upstairs had nobody attending to her as she lay flat on the floor with her dignity diminishing.

My second trip to the theatre was for a 38 year-old (although he looked older) man who’d fainted inside the auditorium during the interval. Derren Brown’s show is playing here at the moment and I walked past all of his labelled trunks and storage boxes wondering if he was about to spring out at me.

The man sat in a chair outside the fire exit being nursed by his wife and a member of staff. Generally speaking, theatre staff take very good care of their ill customers and I have always received co-operation and help from them. The same applied here and I was given a detailed handover by the manager. The call had come in as ‘?heart attack’ but the man had no medical history of significance and, from what he told me, he’d simply passed out because of the heat.

The crew arrived and he was taken off to the waiting ambulance – and then hospital – for further checks. As he was wheeled out I told him that it wasn’t happening and that he had been hypnotised by Derren Brown into believing it all. Well, it raised a smile.

Presumption can lead to mistakes in this job and I am no less a victim of it than anyone else, so I must be more careful in future. I was called to an 18 year-old male with chest pain at a large store in Regent Street. My experience of such calls is that I will probably come across a shoplifter who’d been caught, or an individual who simply wants to get away from the place. I’d been given no other details and because we now start rolling to calls before the call-taker has completed the conversation, it’s possible to arrive on scene without all the facts – another minute-saving idea that has not been properly thought out.

I went into the store with everything I’d need for a call but I didn’t take my bag. When I got to the patient, I found out he was a member of staff. He was in the basement and he was suffering a Sickle Cell crisis. That meant I needed to have entonox with me. It’s not something we carry to every call automatically. I had morphine but that would require an IV line and I wasn’t expecting to have the luxury of time to insert one before the crew arrived.

I put him on high flow oxygen and that helped. His pain score, luckily, wasn’t too high and the pain itself was localised to his chest area. He would need pain relief and possibly fluids and without entonox to hand I was at a disadvantage. He’d already had diamorphine earlier at the hospital but it had worn off.

The crew arrived within ten minutes and he was taken to the ambulance, sucking on entonox because they had received all of the information about the patient, unlike me. While he sat there and we exchanged paperwork and callsigns, he became less responsive and when the paramedic asked him to speak he said ‘Are we there yet?’ in a drunken, slurred voice. He had been hitting the entonox far too fast and hard; he was an entonox junkie and that explained why he insisted on the gas rather than an injection of more powerful stuff.

No traces are frustrating because they tie up resources and waste money. My call to a 33 year-old male with chest pain took me to the Strand, where I searched for him to no avail. The crew arrived and they too looked around. The call had been made from a public phone box, so it had obviously been a hoax...or he had changed his mind and wandered off. Luckily for my next patient, this no trace had brought me and the crew to her locality.

I went into the McDonald’s (I know but I was starving) to get something to eat and I had ordered and received it when the manager came up to me and said ‘when you’ve finished can you have a look at this lady here, she’s not breathing too well?’

I couldn’t very well take my meal away, eat it and then go and help the lady and she was sitting forward in her seat, breathing with obvious difficulty, so I went straight to her and asked her what was wrong. She told me she had a history of Pulmonary Embolism and high BP and now she had DIB and chest pain. I checked her oxygen saturation level – it was low.

‘I’m just going to get some oxygen from the car, you wait here’, I told her.

‘Oh, please finish your meal first’, she said.

As I left, I wondered how the headline would read in tomorrow’s paper if I’d taken up her invitation as she continued to deteriorate.

‘Paramedic munches meal as patient dies in front of him’, it would scream.

I’m never going to be so hungry that I’d ignore the needs of an obviously ill person; I’ve even stopped eating to give a plaster out. We are all good guys and girls really.

I went to the car as she sat inside and grabbed my oxygen and other bits I’d need. I called it in to Control and requested an ambulance. Then I returned to find her gone. I looked around but couldn’t see her anywhere. The manager came over and told me she’d gone to the toilet, so I waited outside the door for her like a stalker. She took an awful long time and I considered the possibility of having to unlock the door to get to her.

After ten minutes, she appeared, looking much paler than I’d seen her earlier. The ambulance arrived and the crew, who’d been on the no-trace up the road, took over. By the time she was settled in, she began coughing up blood, so she was quickly taken to hospital.

I went back and got a fresh meal but still had to pay for it.

It’s rare to meet anyone who has experienced cardiac arrest and survived to talk about it. My next patient, a 62 year-old man with chest pain, told me he’d suffered a heart attack and arrested at home just a few months back – he said the pain he experienced now was similar to the pressure he felt on his chest as a result of the compressions that had been carried out on him. He’d been shocked back to the land of the living then and a stent had been placed in his heart to prevent another heart attack but here he was, sitting on his bed, going down the same road. He’d been ignoring this pain for a few days.

He was taken to hospital but wasn’t too keen on the idea. He wanted us to tell him he was okay. He was frightened and I completely understood why.

A 21 year-old girl sat outside a club with her mates and wailed as she tried to breathe properly. Her hyperventilation disguised any sign that her breathing may not be 100%, and this was important because she told me that she had a heart problem and was taking Warfarin. She had a history of blood clots but I wasn’t told what the heart condition was. I took her seriously and, even though she was a little drunk and very emotional (not helped at all by her clawing, pawing friends who wouldn’t keep away from her as I tried to talk), I had to get to the bottom of her problem in case she collapsed on me.

I had her settled and calm in ten minutes and the ambulance rolled up the street to take her away. Her friends took another ten minutes to calm themselves – alcohol induces hysteria in otherwise well-controlled people.

A call to a 27 year-old male ‘collapsed, bleeding ? where’ took me to Trafalgar Square and to a gang of people in a doorway. Three tourists had called an ambulance and they left shortly after I arrived but I was still among five or six drunken men who were non-English speaking in the majority and who didn’t mind getting in my way unless I physically pushed them away from me.

All of the men, including the patient, who was flat on his back completely drunk, were Romanian. When I asked what they did for a living (the patient’s hands were very rough, so I figured they were builders), the only English speaking representative of the group proudly said, ‘we work in black market’.

The man had vomited but that wasn’t going to be the end of his show. As soon as the ambulance crew arrived and took him into their vehicle, he projectile-vomited all over the paramedic’s uniform, repeating his performance over and over again until the floor was awash with the stuff. I popped my head around the door at the precise moment he did it again; I could feel little splashes of it hitting the doors and around my hands. It smelled awful and I wondered what he’d been drinking all night. Whatever it was, it didn’t cost him much and it came by the litre.

Be safe.


Anonymous said...

I can't believe McDonalds' made you pay for another meal.
You should put a warning on here about reading this while eating. I almost felt like projectile vomiting. lol

Sue said...

You are so right about people fainting at the theatre - and throwing up (why go out when you feel sick I'll never know!). I worked Front of House at Les Mis for three years and it happened so often. Not helped in the summer by the fact that the theatre had no air con, and temperatures would regularly reach 86f!! As for the St John, they used to be there so infrequently that you forgot they were there.

My first week a guy collapsed before the show and they had to put a "is there a Dr in the house" call out, and one day an American tourist collapsed with a cardiac arrest and died - the firemen from across the road came over to help but there was nothing to be done.

You know I still look at every FRU that I see and wonder if it's you!

Steve said...

Simply cannot believe that after the manager interrupted your break and asked for your help he didn't offer to replace your food once you were finished free of charge.

Anonymous said...

Just out of interest: what exactly do you mean by "he was an entanox junkie"
Do you mean he was faking everything to get the gas/doing that on a regular basis?
And if so why would he be so keen on it rather than much stronger morphine???
I had that stuff for two hours while in labour (gosh what a pain) and I didn't particularly liked it to be honest, it makes you feel woozy and dries your mouth out, yet it is not enough to take away all the pain from a real birth - not my cup of tea at all, what do you think?
Do you get those people often??