Saturday, 23 August 2008

Bring on the nights

Night shift: Eight calls; all by ambulance.

Stats: 1 Unwell adult; 1 BP problems; 2 ETOH; 1 Drug overdose; 1 Abdo pain; 1 Asthma

The night starts with a 55 year-old lady with little wrong with her. She’s lying in bed, family gathered around, hyperventilating, not communicating and occasionally thrashing around for effect. We see this a lot and there’s nothing we can do to help because hospital is not the answer. All her obs are normal; she just hasn’t taken her usual meds and is now feeling under the weather. She’s been fasting all day and hunger can throw up anomalous symptoms. I leave her with the crew.

In Theatreland a 40 year-old man is stuck in a standing position near the end of an aisle after watching a show with his wife. He suffers from arthritis and his leg has simply given up the will to work, so he can’t move without pain. His doctor took him off his diuretic and now he’s trying to cope with swollen joints. His hugely inflated wrists hint at the discomfort he’s in. His blood pressure is high and he is a little breathless. It’s an awkward, heavy job to move him into a chair and off to the ambulance but with three of us on scene the task is completed with minimal embarrassment to him. He’s resolute and wants to help himself as much as possible, so it’s hands-off when he requests it…until he needs it.

A silly 25 year-old female socialite collapsed behind a toilet cubicle door at a pub and now she’s stuck fast with her head lodged against the door, so it’s impossible to gain entry to assess her and she won’t wake up when I call to her. An off-duty and slightly drunk doctor is assisting and gave me a hand-over of sorts when I got on scene but she’s overly dramatic and insists the patient has stopped breathing. ‘She was snoring and then she stopped’, she tells me. 'I can intubate', she states. So can I, I thought to myself.

After a fruitless five minutes of trying to get into the cubicle I request the LFB because the door will have to come off, especially if what the doctor presumes is correct, although I doubt it. Upstairs the bar is packed and I know that moving her from here to the outside world is going to be a problem, so I’m hoping the ambulance won’t be too long.

As we wait for her to regain consciousness or for the Fire Brigade to turn up, the police arrive and they begin to plan the best way of getting through the door but all efforts to push it open are stymied by the presence of her head and the risk to her neck if we force it too violently. Useless tools are brought down for us but the door is solid (good quality toilet doors – very unusual).

The crew show up and the smallest of us manages to get an arm through to prod the woman hard enough to get her to wake up. She had started snoring again but it had nothing to do with her airway and much to do with how she sounds when asleep. She moans and wakes up enough for us to make it clear that she is causing havoc. She moves on demand and we get in, bring her to her feet and march her out of there before she has a chance to relapse. She hasn’t taken drugs; she’s just too drunk to stay awake. She isn’t apologetic and she isn’t thankful, she’s a perfectly inebriated Sloane girl with no regard whatsoever for the concern and trouble she has caused.

When she is taken to the ambulance a ‘friend’ of hers approaches the car and asks me if she’s alright. ‘Yes, she’s just drunk’ I tell her. Then I ponder what kind of person allows her friend to go AWOL for so long without bothering to investigate, especially when twenty minutes has elapsed and ambulance, police and fire service personnel start arriving on blue lights and sirens. I’d want to sit down and have a long chat with a friend like that.

Another unconscious GHB victim lies in the street in Soho and only a club manager and her security man are helping him. He’s a 25 year-old and by the time I arrive he’s waking up. The crew arrive soon after me and he’s walked to the ambulance and out of the crowded bliss he slumbered in.

An aggressive, drunken Lithuanian man, known to us in the area, lay flat out on the pavement near the train station. A concerned citizen called the ambulance and I show up and recognise him. The crew arrive and together we persuade him to get up but he’s not happy and wants to demonstrate how much he loathes us all, so he unzips his trousers and urinates in front of us. He pees and pees and pees – the flow goes on until a little river of urine is flash-flooding its way towards my car. His bladder must be the size of a camel's hump.

He finishes after an age then brings his filthy hands up to his face for a quick rub of his mouth and chin. I’m encouraged by the thought that the only person he’s contaminating is himself but he staggers towards the car and I feel the need to green up and leave the crew to it as they await the police.

I thought the next call was a no-trace because I couldn’t find the 23 year-old man with abdo pain at the location given, so I toured around until I was windmilled by him. He’s on anti-depressants but hasn’t been taking them. He’s also had a large amount of alcohol and I’m guessing it’s a substitute. He could have walked to hospital and it would have taken him all of ten minutes but he felt the need to exercise his God-given right to dial 999 and utilise the service that tax payers fund on his behalf. He gets his wish and an ambulance comes to collect him.

Before I leave the scene a passing motorist asks me for a vomit bag for his drunk girlfriend who is about to throw up in the back of his car. She’s holding a pathetic little paper cup under her chin in the vain hope that the deluge to come will be securely caught and stored in it – she has obviously never studied physics…or common sense.

A homeless 67 year-old man walked into a police station in the early hours complaining of chest pain. He’d taken his own GTN but with no relief and as I carry out my obs, I find myself more convinced of his need for a bed rather than medical care but I am no position to judge this on the face of it and wouldn’t dream of re-considering his request to go to hospital. Even if all he needs is a warm place to lay his head, I can see no harm in helping him get that.

My last job for a 51 year-old asthmatic whose inhaler doesn’t seem to be helping him required no more than basic obs from me because the crew was on scene before I’d started any treatment for him. This brought me nearer home and my trip back to the station was uneventful.

Be safe.

1 comment:

Steve Irwin said...

'I can intubate', she states. So can I, I thought to myself'

I'm in stiches at that one. I'm not so sure I'd keep my cool if some drunk were patronising me about my sober job