Friday, 1 August 2008

Teen trouble

Day shift: Five calls; one assisted-only, four by ambulance.

Stats: 1 TIA; 1 HepB; 2 Faint; 1 Frequent flyer with odd excuses

Transient Ischaemic Attacks (TIAs) are calling cards for stroke – they are ‘little strokes’ if you wish, caused by a sudden decrease in blood-oxygen supply to a small part of the brain. Multiple TIAs are fairly common in people prior to the big one.

My first patient of the day was a 53 year-old man who woke up in his hotel room bed, unable to move his right side properly. He had lost power and some feeling in the limbs and had speech problems caused by a cranial nerve dysfunction. He noticed his speech was slurring when he made the emergency call.

We carry out a FAST test on suspected neurological patients and this basically involves checking for power, sensation and co-ordination. This man’s test was positive for ‘arm drift’ and ‘crooked smile’. He knew himself that things weren’t right. He was a stoical German type and kept repeating solemnly ‘this isn’t good’. I put him into a more positive frame of mind by reminding him that he could recover fully from his predicament.

Drug addicts are more prone to Hepatitis B than most of the population because they are in a higher risk category for exposure. My next patient, a 41 year-old ex-heroin addict (he’d been using since he was 16 years old) rolled about in agony on a chair at the hostel he lived in. He clutched his abdomen (this call was given as ‘chest pain’ incidentally) and moaned about the pain he was in. He was a very skinny and very sweaty individual with a history of HepB and a recent inoculation of the C variety. He didn’t look very well and it was obvious that his illness was giving him problems. He’d dined on a concoction of Methodone, Valium and Cocaine the night before, so he left a little room for differential diagnosis.

His BM was low, so a liver-related problem was more likely and off he went to hospital, although he dithered and stopped a few times along the way to drink something, grab ciggies and chat to mates about how miserable he was – funny, they all seem to do that.

Pain causes some individuals to faint and I guess that until I have experienced truly agonising pain, I won’t know for sure if I am one of those people but I doubt it. I tend to stomp around smashing things instead – it doesn’t relieve the pain but I get my own back on inanimate objects that have always annoyed me. The last time I did that was when I had a nasty tooth abcess.

So it was with my usual smiley, happy-to-see-you face that I greeted the 32 year-old female who’d fainted because she had back pain. Another German person determined to play it down. She was fully recovered by the time I arrived and, after the crew gave her a quick on-the-spot check, she was left at work to continue her day. She asked for my phone number. I smiled but didn't give her it - I'd be in trouble if I did :-)

My second faint of the day was a 40 year-old man who collapsed inside the toilets of his workplace. He lay there feeling ill as I tried to get to the root of his problem. He was pale and shaky but he seemed to be recovering well enough. He had no medical history of significance and had fainted once before, so he knew the score. He told me he was dealing with a lot of stress at work (who isn’t these days?) and that he hadn’t been able to cope very well with it – evident from his current situation.

He was taken to hospital and actually started to look even more ill as he was trundled through his workplace by the crew.

I spent a short time in Wells Street, W1 after that doing my paperwork and I noticed a little pub called Ben Crouch’s Tavern sporting a sign claiming that it had a ‘spooky atmosphere’. I’d like to visit it one night when I’m off duty but if any of you guys get a chance before me, send me a report. Also, let me know what the prices are like.

Just as my day looked routine, I got a call to attend a 15 year-old boy who’d ‘passed out’ several times in the street. I got on scene and he was waving at me from a call box, looking well enough to walk. I couldn’t understand a thing he told me and there was nobody else with him. He didn’t know his age or his date of birth and was vague about where he lived. This concerned me and I was relieved when the crew arrived because I didn’t want to be on my own with this kid. His behaviour was strange and he made no eye contact whatsoever. I don’t trust anyone who doesn’t make eye contact.

While the crew chatted to him (gaining no new ground) I called for the police to attend because I suspected something wasn’t right with this boy but the cops were busy dealing with a firearms incident and couldn’t get there ‘til much later. Great.

I didn’t want the crew going off on their own with him because that would mean the attendant would be alone in the back of the vehicle with him and God knows what he’d come out with (the boy, not the attendant). I agreed to travel in the back as well, so there were two of us. He’d already said something spurious about a man talking to him and suggesting things to him and that made me nervous about his state of mind.

I managed to get his mother’s contact number, one of only two that he stored in his mobile ‘phone (who has only two numbers in their phone?). Ironically, the other number was his.

I called and called but there was no reply. Then, as we were preparing to set off after twenty minutes of getting nowhere with the boy, his mum called me back but she was evasive and gave very little information. She asked which hospital he would be going to and that was pretty much that, despite my enquiry as to his mental health or if he had learning or behavioural difficulties.

We got him to hospital whilst he repeatedly reminded us that he wasn’t mad, not that any of us had even suggested it and I found out through a colleague who just happened to call me that he was a known frequent flyer from her sector and that this was exactly his M.O. – he loves the lights and sirens apparently and calls the police and ambulance services out to appease his desire. Someone’s mum needs to have a really long chat with someone I think.

We left him in a cubicle, after having to catch him several times as he wandered off at random in the hospital. The nurses could take care of him now and I hoped never to see him again. I hoped he’d return to his usual stamping ground…we’ve got enough of our own down this way, thanks very much.

Be safe.


Donna said...

Wait... there's a vax for Hep C? Since when?

Lesley said...

Thanks for the card for TIA. My husband has had a couple, but our GP wasn't time, I'll call for you!

Anonymous said...

Think it's a chain - looks exactly the same as Pit and Pendulum in NOttingham. It is ok but usually full of tourists (and that is Nottingham so you can imagine what the one in London will be like. The do 7 deadly sins cocktails which are nice and beer bout 3pounds a pint.

Anonymous said...

with a history of HepB and a recent vaccination for the C variety.

I thought there was NO vaccination for Hepatitis C?

If there is that's one I need to get sharpish! :P

studentnurse said...

Think you might have your B&C mixed up - there's currently no vaccine for HepC, but there is one for HepB.

I wonder if your pt was being actively treated for HepC - some of the symptoms are similar to those my pts on inteferon have experienced. That would explain the HepB vaccine - getting the two infections together is not very pleasant.

Xf said...

Donna and Anon

Oops! I was being sarcastic and the word I should have used was inoculation! He'd got himself both strains through bad needle hygiene and generally unclean behaviour.

I shall amend the phrase to avoid further confusion...or distress.


Xf said...



Sewmouse said...

I am pleasantly surprised to hear that one of your first actions before all else was to deal with pain management. Every. Single. Time. I have ever been in an ER here (A&E there, I suppose), I've been told that they cannot do anything for the pain until test results are in.

Anonymous said...

Above poster got the prices about right - think its the same chain as O'Neills as they do similar pub food. But its well worth a visit or two for the great dccor, hammer horror flicks playing behind the bar and creaking door sounds or manic laughter as you enter the gents...

Gillian said...

Probably not relevant to your evasive 15yr old but people with autism or asperger's syndrome can find eye contact very distressing.
Just a comment - not a criticism!
Gillian - mother of 14yr old 'aspie'!

Spookydel said...

Re Ben Crouches : yes, it's a chain, nice enough pub and the prices are reasonable, but it's not the spookiest of atmospheres! Bit like a cleaned and polished version of the Intrepid Fox that used to be on Wardour Street...

Worth a visit tho for the flix showing behind the bar and the cocktails in test tubes!

miss emma said...

I agree with Gillian's comment above.
In September I'm starting as a mentor at my school with the Special Educational Needs children and we have been told that those who are Autistic don't often make eye contact. It might also explain the fact that he wanted to get his 'fix' of the sirens and lights as Autistic children may often obsess with something like that.

Whilst working at HEMS (I'm still loving it but sadly I finish in a week) I discovered that the boyfriend of someone I work with reads your blog too! Small world!

Xf said...

gillian and miss emma

Yes, I agree too but his mum was quite adamant about him having nothing wrong with him except learning difficulties. My point was that I don't trust people who dont make eye was a general comment, not specific to the patient, although it told me he was making stuff up.

Xf said...


You're welcome. I can tell you that we in the ambulance service take all neurological insults seriously.

Xf said...

all those about the pub (via comment AND email)

Thanks, I probably got them quite a few new customers!

There's a pub in Edinburgh called Frankenstein's and from what you have all said, it sounds like a similar I correct?

Esther said...

Where you got to I am getting withdrawal symptons!

Anonymous said...

the BC is like the marlborough head off Oxford Street. i like it. the food prices are perhaps a bit much for what is essentially pubbe grubbe but the cocktails and shots are pretty neat.

p.s. i know this is a bit late in the day, but i've been away for three weeks and catching up :)