Thursday, 24 July 2008

Monday is the new Friday

Night shift: Nine calls; three assisted-only and six by ambulance.

Stats: 1 DIB; 4 ETOH; 1 Alcoholic fit; 1 Hyperventilation; 1 GI bleed; 1 Abdo pain.

We’ve been taking an average of 4,000 calls a day over the weekend and tonight (a Monday night) has been crazy. Don’t people have work to go to in the morning?

A 75 year-old man with DIB, cardiac problems, liver failure and cancer deserves my attention first off and I arrive to find him surrounded by worried family members as he lies on his bed wheezing. I put him on a nebuliser, which gives some relief, and carry out my obs until a crew arrives and takes him away. More family members show up and spill out onto the street as he is taken to hospital. I think they're expecting the worst.

Into Soho next for a 55 year-old ‘unconscious’ man who couldn’t be seen at first because people were sitting at tables drinking and chatting around him as he lay slumped on the pavement. Typically, nobody seems to notice him and the ambulance crew are about to call it a no-trace when I spot him, legs first.

He is an old queen and he is instantly annoyed by our presence as we wake him from his drunken slumber. ‘Go away!’ he barks before we can get a kind word in. We spend ten minutes getting him on his feet to move until he plants himself back down in someone’s doorway. A couple are trying to get into their flat but he’s obstructing them, so we move him again and this costs the NHS another three minutes. He wanders into a bar and is ejected very quickly. Then he finally shuffles off with his eye liner and painted nails; the only evidence that he was a coordinated person at one point.

A couple of colleagues were on a night out and I chatted to them as I did the paperwork for that patient. I left the scene wishing I was just another jolly MOP myself…a long night was ahead of me.

My next patient was a 35 year-old alcoholic who’d had a fit outside a gym and had been taken inside by the kind staff as he waited for the ambulance to arrive. He was face down on a massage bed in his own private world when I walked in to see him. He didn’t stir – I think he was asleep. He stank of booze and his clothes were filthy; he was giving the place a bad name – at least the regular clients were sweating for healthy reasons.

I got him to turn over and sit up and began my obs after establishing his name and what had happened. His clarity and demeanour made me doubt he’d had any kind of fit at all and this is a common enough game played by homeless alcoholics who just want a bed for the night, so what the hell. I asked him for his finger so that I could put my sats probe on it (the device slips on a finger and measures blood oxygen saturation levels (sats), normally they are above 94% in most people). He sneezed into his hand and offered me said germ-ridden mitten by reflex. I declined the offer and asked for a clean(ish) one. Since he had only one more to put forward for testing, I got that instead and a grin. I got no apology and I gave no blessing. Such is the straight-forward nature of this job sometimes.

It took me so long to get access to the road in which my next patient lived that she had recovered from her panic attack and was sitting on the sofa as if nothing had happened. Her friend had called the ambulance when she started to hyperventilate; she thought there might be a connection between the breathing problem and her mate’s bulimia.

The 25 year-old’s heart rate and blood pressure were low but this was normal for her and she was as thin as a rake (how did we get to that? Isn’t a shovel or a brush just as thin when looked at the right way? Oh wait, brushes are reserved for daftness, aren’t they?). She had recently fallen out with her boyfriend and this had triggered an emotional state in which her breathing rate had rocketed but she was absolutely fine now and I left her at home with her friend and a ‘get out of jail’ form. The ambulance had arrived with me earlier but I’d told the crew what was going on and that they weren’t needed.

Gastrointestinal (GI) bleeds can be life-threatening emergencies and the 74 year-old woman with abdominal pain, a low BP and who looked like death warmed up (pale, cold, clammy) was in real trouble. She had been reported as ‘not alert’ by her family and at times she wasn’t, otherwise she seemed to communicate quite effectively, insisting that she was in good shape, even though her body argued with her.

A patient I can only describe as a nutter on drink stormed off and walked into traffic, almost getting himself injured when I tried to get him to wake up from his ‘unconscious’ state on the pavement. The French 24 year-old and his gathering of equally French friends (who were all able to handle their alcohol sensibly I should say in their defence) had been out all day drinking but he collapsed on the way home and now no bus or taxi on Earth (or in London) would touch him. I know this because when he became aggressive and started physically pushing me and others around I called the police in. He was cuffed and told to behave, then one of the cops flagged down a taxi and I asked the driver if he’d be so kind as to convey the man and his buddies to the East (miles away). Despite the prospect of a fat fare, the cabbie declined, citing imminent vomiting and bad behaviour in the back seat as reasons for refusing. I had to agree with his perspective and thanked him anyway.

Earlier, the crew had turned up and I’d asked them to ignore this young drunken fiend because a) he was hostile and b) another collapsed person had been found down the street. They went to investigate what may have been a more serious running call while I waited for the police to arrive.

It turned out that the second collapse was a 15 year-old boy who was locked out of his friend’s flat – he’d been sleeping outside after attempting to wake his host up but it was impossible because the flat was on the first floor and there was no way in or up. And the host was obviously a) deaf or b) dead to the world in sleep, which is the same as deaf but with your eyes closed.

Meanwhile, my annoyingly obnoxious patient was un-cuffed and taken to the ambulance. He had become very, very pale, so he was going to hospital, like it or not. The 15 year-old was taken away to a safe place by the police and all ended well – I don’t think the Frenchman projectile vomited on the crew but I wouldn’t guarantee that.

A 50 year-old man with Liver problems and abdominal pain was given as ‘chest pain’ but I’m used to that now so I didn’t make a fuss – the crew was on scene soon after me, so I didn’t get beyond the basics.

Then a 40 year-old man who was ‘unconscious’ on a bus assaulted me as I tried to wake him up and get him off the vehicle. He didn’t like being prodded and pinched, so he swung at me and forced his way into my space – luckily I’m the world champion pinner-downer of such individuals (I’ve had a lot of practice) and he got no further than that with his aggression.

I waited with the driver for fifteen minutes and gave the drunken man plenty of opportunities to leave the bus but he refused and the police arrived to drag him off physically. He was less inclined to violent behaviour when they were on scene strangely enough but he remained lippy.

‘How old are you?’ asked one of the cops.

‘Ten’, the drunken man replied without a hint of humour. See? Alcohol does age you!

I wasn’t required for my last job – an unconscious 25 year-old man in the City – the crew was on scene and he was fully conscious.

Be safe.


Sewmouse said...

"dead to the world in sleep, which is the same as deaf but with your eyes closed."

Thanks, I needed that giggle this morning!

joan said...

Hi xf what does ETOH stand for i could not see it in glossary, and another busy day at the office for you!

Xf said...


You're welcome :-)

Xf said...


It means drunk. I think I better just write that in from now on. It is in the glossary, you just have to type it in the search box...

Anonymous said...

too depressingly true.

Great blog btw.