Wednesday, 18 June 2008

Junkie bait

Nine calls; one assisted-only, one refused and seven by ambulance.

A crew was already dealing with a 73 year-old man with angina who’d forgotten his medication and was having chest pains in the street, so I wasn’t required, thus my shift started.

Another ‘chest pain’, this time a man was found wandering the streets of south London in hospital pyjamas. He’d absconded from a secure hospital (so not very secure then) when he decided the doctors were ‘no good’ and had walked for miles to get to where a passer-by had discovered him. He had no chest pain but was clearly confused and rambling. I had spoken to him for five minutes until a crew arrived and only then did I see that he still had IV’s in situ in both arms. He’d obviously unplugged himself and left in a hurry.

Despite a bolus of IV fluids, my next patient, a 79 year old female whose blood pressure was very low after a faint, did not improve. She was at home and her friend of over 40 years was convinced she was going to die. She was ‘blued’ in to hospital with no improvement in her condition; if anything it seemed to deteriorate – clearly something was very wrong. Even in Resus the doctor couldn’t figure it out. When I went back to the hospital later on I was told that she still hadn’t improved and that she was unlikely to survive.

A Red1 ‘life status questionable’ turned out, as usual, to be nothing more than a sleeping 26 year-old man who’d made the mistake of kipping down in the middle of the Strand where nervous MOP’s were bound to agree that he was probably dead. The police were on scene as we discussed the possibility of him not sleeping there but he was fed up being disturbed wherever he lay his head and requested that the police lock him up for the night. They refused. I gave him a blanket to keep him warm and sent him round the corner to an alley where he was less likely to be designated a corpse.

We were a bit short of ambulances tonight and my next call, to a two car RTC in the middle of a very busy and dangerous junction, where the traffic lights had failed, had me trying to control a Korean man whose car had been smashed in a collision with another, as he paced around, shouted down his mobile and generally irritated the police.

The other driver was standing on the pavement, sensibly enough but the little loud man insisted on staying in the middle of the road as attempts were made to ascertain who he was, what was wrong with him and whether he needed help. I was on scene for a long time and still had no ambulance back-up, despite many requests through Control. At one point a vehicle was diverted en-route for a higher priority call, which is fair enough – probably needed for a Red1 ‘life status questionable’ on the Strand.

Meanwhile, the Korean man’s wife drove into the confusion…I mean right into the middle of the crash scene. She attempted a messy three-point turn in the area as fire-fighters cleaned up the fuel spillage and made the wrecked vehicles safe. Traffic was chaotic and dangerous around us and the world’s tallest armed police officer tried to maintain some control of it all until the regular cops showed up. The wife’s antics were causing bemusement to say the least. I think she thought it was a car park. Mr Korea was shouting down his moblile 'phone at her, presumably giving directions, yet she was only a few feet away from him, albiet in a car. She could lip-read him for Pete's sake.

After almost an hour on scene, a crew from a completely different NHS ambulance service stopped to help out and I managed to hand over both patients (the Korean man had chest pain after hitting his steering wheel on impact; the other driver had airbag-related injuries) to the crew. I imagined the stories they’d tell their colleagues back at the seaside when they ended their shift.

I had to trek a long way to get to a 45 year-old man who was allegedly fitting by the river bank. I’d been given the wrong location, as had the crew, so it took a wee while to get to our patient. He wasn’t fitting, or at least not when I got to him but he was incredibly confused about where he was and kept insisting that he was somewhere up north – and by that I don’t mean Camden. He was taken by the crew and I noticed that he had multiple scars on his arms – a tell-tale sign of self-harm and possible mental health issues.

A 21 year-old female who was ‘vomiting blood’ at home in her little third floor flat didn’t seem to be unwell at all to me and insisted that she’d see her GP in the morning, rather than wait for an ambulance. Even my offer of a lift to hospital in the car was refused. I’m sure she hadn’t vomited blood because her mouth bore no sign of the stuff, which tends to stick and discolour. ‘I washed my mouth out afterwards’, she told me. That was plausible but she must have had a little mouth scrubber with her to make that tongue so clean.

Chest pain and swollen, painful legs associated with long-haul flights can be significant, regardless of age and state of health, so my 25 year-old patient was taken to hospital with her boyfriend after she’d developed it soon after a trip over here from New Zealand. Sluggish circulation encourages clotting which can lead to an embolism and then cardiac, pulmonary or neurological problems. Nobody said she had any of this going on but all the signs were there and it was well worth checking out before she collapsed in a heap on the floor of her hotel.

Speaking of collapsed, my last patient of the night staggered around in the street, clutching his abdomen after calling an ambulance because he had crumpled to the ground and been unconscious for a short time, although how he remembered that is questionable. He described his pain as eleven out of ten, which we all know is as possible as giving something ‘110%’ but I understood this to mean very painful, so I offered him entonox, which wasn’t enough and then morphine, which he seemed glad to have. Too glad, in fact.

I have to administer pain relief if appropriate and so I gave him a little bit to take the edge off his agony but I looked at his arms and the track marks I saw were ringing alarm bells. He insisted that the puncture sites and trails were the result of many, many recent visits to hospitals for his unknown abdominal problem but I wasn’t convinced and he got no more class A drugs from me. He was either an addict or had been unfortunate enough to encounter every medical student in London.

At hospital even the nurses were suspicious and asked me what I thought. I told them I thought the guy was probably a junkie and this was as cheap a way as possible to get a fix (free on the NHS from gullible paramedics and doctors). I also mentioned that there really was no option for me because not giving pain relief when it is required is indefensible in my profession.

I left them to deal with him and mentally photographed his face so that he wouldn’t catch me out again, hopefully. It wasn’t the first time and it won’t be the last; I’m a soft touch apparently. Others less kind would say mug.

Be safe.


miss emma said...

why some people think you will believe these stories about their "previous hospital trips" is beyond me!

I had a rather interesting experience today! I donated blood for the first time but the first needle was broken which meant that the blood went in the needle and back out the needle... onto my arm and the floor! I hadnt felt a thing and the guy said it was a beautiful vein! shame that my right arm wasnt the same because that really hurt! but i will be back again and it did make me laugh coz it was really comical the way that the blood was pouring down my arm!:D

stay safe stuart! x

Sam Tyler said...

I think I know the tallest armed cop in the world you talk of...Would you say he was about 7ft?

Xf said...


Yep! 7ft easily...

Sue said...

Not that I'm defending your morphine seeking abdo pain man, but you really can have pain that is off the scale (the 1-10 scale). Try waking up in recovery post rectum removal with a malfunctioning epidural - now that was 11 out of 10 on the pain scale...!!

I'm covered in bruises - not track marks - on both arms. Four attempts by an anaesthetist to get a line in on Tuesday, and 2 attempts by radiology for the CT scan on Thurs... You really wouldn't want to have to cannulate me in an emergency!!

Xf said...


yes, I understand pain that's off the scale but it's easy to recognise those who have a low threshold and select high numbers (often 11 plus out of ten) and those who really are in you seemed to be :-(