Tuesday, 22 July 2008

Cycling drunk

For all you Scruffy fans - here he is with that famous penile cactus I showed you earlier in the year. The plant is growing well, as you can see and no longer resembles the meat and two veg that made some of you gasp (by email). Scruffs is not impressed, however.

Night shift: Seven emergency calls; one assisted-only; six by ambulance.

Stats: 1 drug overdose; 1 emotional; 1 high BP; 3 ETOH; 1 sickle cell crisis.

GHB and cocaine might make for a happy party at your house when a new friend has been invited to join you for the night but it can result in an ambulance being called for an unconscious stranger. As was the case with my first call. The two young gay men had brought a man they barely knew home with them and together they’d taken a cocktail of drugs, most of which was snorted and ingested by their guest. He now lay on the bed, completely unresponsive and with a less than competent airway.

The crew arrived as I remedied the airway problem and we got some Narcan into him before moving him. This had an effect and he became a little more active, although not fully conscious until he reached the ambulance, where he quickly relapsed to such an extent that he had to be ‘bagged’ in order to keep him breathing.

His hosts knew nothing about him, apart from his first name. This is the second patient I’ve had in the past few months in such circumstances. It’s a dangerous game to play and one day the guest is going to end up dead.

The 31 year-old was ‘blued’ in and the anaesthetist continued what we’d started. He wasn’t in good shape when I left.

An emotional 20 year-old woman lay crying on the floor when I arrived after receiving the call that she’d ‘fainted’. The crew was on scene with me and I left them to it. I compared her with my last patient and couldn’t decide who was more deserving of an ambulance – both were tax payers, one caused his own problem and the other couldn’t control her emotions and thought 999 was the answer. If we had one ambulance available and a 93 year-old with DIB came up and it was up to me, I know who'd get it first.

Those hallway timer switches that you get in shared flat buildings are very annoying when you are trying to get obs on the stairs. I had been called out to a 41 year-old woman with chest pain, a headache and high BP. She’d walked out to meet me and I’d asked her to return and sit down. Now I was struggling to see her as the light kept going out every thirty seconds. I ran between her and the push-button on the wall like a comedy paramedic. I must eat more carrots.

Falling asleep is natural (mostly and except if you never wake up). Falling asleep when you are drunk is expected, so when I got a call for a 43 year-old man who ‘keeps falling alseep’ at a hostel for known alcoholics, I wasn’t too wildly concerned. Neither was he because he was wide awake and disputing the need for an ambulance when the crew and I arrived to assess him. Inside his dirty, smoky, dark little flat there were a number of other, similarly drunk, people – the skinny people of wasted lives. All of them ganged up on the man to tell him to go to hospital for his sleepiness – none of them seemed to realise that alcohol might be the culprit (I ruled out the possibility of him having worked hard all day).

None of the lights were on and nobody bothered to use any of the switches for us, so we were standing in the dark and the hallway became a void of black space as we took the man to the ambulance. I’d had enough of the game however and switched on one of the lights – I had no idea why we were being so shy about it. Now we could see and the man stood at the top of the stairs, arguing with his mates. He looked much better with the lights off.

I went ahead to the car and watched as the crew brought the man and his friends out of the hostel. They loaded him on board and I thought that was that but as I drove down the road five minutes later, I saw two police cars arriving and a message appeared on my screen asking if the crew was still in the back of the ambulance or on the premises. I u-turned and headed back to the vehicle. I got a quick nod from one of the crew to say that everything was ok but I learned later on that one of the guy’s friends had kicked off and become aggressive and threatening towards them as they ‘treated’ the patient. More often than not we are put at risk for people with no medical emergency whatsoever; this was a good example. If the crew hadn't arrived with me I would have been up there with that psycho on my own in the dark until they did. I may or may not have been able to contain him myself - who knows. I really do get the feeling that time is running out for me.

For some reason I’m going through a period where I’m having difficulty getting a cannula into sickle cell patients. Their veins tend to be challenging at the best of times but I’ve had a run of fails and multiple attempts recently. So when I got to the 23 year-old sickle cell crisis patient and attempted to put a line in for morphine (entonox was working but only marginally), I had no luck and I’m wary of wasting a crew’s time by delaying the trip to hospital just so that I can prove a point, so I gave up after one attempt rather than try again. It meant my patient wasn’t getting the pain relief he should have received but it also meant I acknowledged the possibility of delaying hospital treatment. I’m sure it’s just a phase I’m going through – I don’t have any trouble with other patients, honest.

Then a Red1 ‘life status questionable’ where the caller was too scared to approach the patient, who was lying in the street motionless. As I drove towards it I knew I’d be wasting my time (or rather, a genuine patient’s time). He was on his back and reluctant to respond to me or the crew (they arrived with me) and we spent ten minutes trying to persuade him that we knew he was alive and well…and drunk. The MOP who’d called it in stood around with a can of Stella in his hands, nursing a long dead cigarette. I wondered why he couldn’t recognise a fellow drunk.

In the end, we hauled him onto a trolley bed and wheeled him into the back of the ambulance where a miracle took place. He sat bolt upright, stood up and walked off without saying a word. Not even a thanks. I have a theory - maybe the ambulance has a specific 'aura' for waking up faking drunks, or maybe they suddenly realise that once inside the vehicle, we have control...enough control to slip them down to the morgue to sleep it off.

He tried to rest himself in a doorway and I warned him to keep moving or the police would be called. This guy was going to generate calls all night if he didn’t behave. He shuffled off in a huff, leaving me and the crew with smiles on our faces.

At the end of a long night shift I am asked to find a cyclist who’s come off his bike and has sustained a head injury. The address is vague and when I turn up with the ambulance, we can’t see him. It takes a few calls to clarify the location and we find him fifteen minutes later, sitting on a wall with an off-duty fire-fighter (he identified himself) looking after him. The cyclist is very, very drunk. His bicycle has no pedals, just stumps of metal to rest his feet on and he has a heavy bag on him. I can’t imagine how he stayed on the bike for more than a few seconds but he must have cycled as far as here without coming off and his luck ran out on a dark residential street. Luckily, it’s 5.30am and there’s no traffic about.

The man has no recollection of what happened – the gash in his head has been bleeding heavily and nobody knows how long he’s been on the ground before he was found by the passing fireman. He looks like a student to me and if his bike is anything to go by, he’s a poor student.

We get him into the ambulance and the crew carry out their examination – they collar and board him because we simply don’t know how hard he fell and at what speed. We don’t even know if he’s been hit by another vehicle and been left lying there for hours. His body temperature is low but alcohol will do that.

The fireman offers to take the man’s bike to his house nearby and gives me his details to pass on to the patient. This is a kind act and I hope the man thanks him properly when he recovers and returns to collect it. I wouldn’t be at all surprised if he didn’t bother though – the bike is a wreck, much like he is.

Be safe.


Fiz said...

Xf, I do keep reading you, but I am not commenting because I would sound too much like "Disgusted of Herts". I reckon only three of your calls were necessary last night:- Stats: 1 drug overdose; 1 emotional; 1 high BP; 3 ETOH; 1 sickle cell crisis. I would think the first, third and last were the only ones you should have been called out for. The first one was self-inflicted, and as for the etohs, someone give the service a break - I am fed up for you with all the "own goals" that members of the "Great(?) British Public" keep scoring and leaving you to sort out.

Xf said...


Your selections are correct and your assessment of our service and the way it is run ragged is also correct but unless the GBP are educated the abuse will never stop.

You should also be fed up as a tax payer because you and I are funding this stupidity.

Anonymous said...

Long time reader, first time commentor, very good blog.

Please please, tell me what ETOH stands for as I've been racking my brains for weeks and can not come with anything reasonable explaination.

Anonymous said...

What fiz said.

Scruffs is quite the handsome fellow, though.

Xf said...


ETOH means drunk! Please use TPD Glossary - there's a link for it on the side bar - if you get stuck with my terminology (although I have been trying to cut it down)

Louise said...

Its good to see scruffs is well although he doesn't look too amused in the photo!! The cactus seems to have changed shape to resemble a three-fingered alien arm which looks like it's growing out of the pot! (Well thats what I thought anyway!!)
I agree with what's already been said about the unnecessary calls. People really do need to be educated on how to use 999 and the term 'emergency' properly!
That said, i'm still enjoying the blog, keep up the good work stuart!

Anonymous said...

Awww Scruffs has turned into such a handsome grown up boy. Huge cuddles from me.

(Sorry stuart but the cuddles are for Scruffs.)

Helen Mack and Flora

Sue said...

"I really do get the feeling that time is running out for me."

I do hope not! I'll give you a Miraculous Medal, that will keep you safe. Not that I'm Catholic but three years living there rubs off on a girl. Seriously though, look after yourself out there. The West End has turned into a not very nice place. Gone are the days when I felt happy walking around on my own at night, sober or drunk.

As for unnecessary 999 calls, I think if you had a whole post just listing some of them people just wouldn't believe it. Until you see it for real that is - an 11 yr old with earache (5 mins in A&E); a mid 20s male with "bleeding penis" after sex = girl friend on her period!; back ache 6 months after an RTA, now looking to increase insurance claim; new years eve and "I was lonely and thought I'd come here for some craic"...

Oh I do miss A&E somedays.

Anonymous said...

You forgot to explain 'ETOH' in your glossary.

Anonymous said...

And 'DIB'.

Xf said...

anon...there are LOTS of terms in there. Just type in ETOH or DIB or whatever you want in the 'Search Blog' box and it will appear.