Saturday, 4 October 2008

Dead in the shed

Day shift: Five calls; one taken by car; one dead at scene; three by ambulance.

Stats: 1 Faint; 1 ?EP fit; 1 eTOH fit; 1 ?Cardiac problems; 1 ?Suspicious death.

It’s getting darker and colder – winter is approaching and within a few months that means the season of goodwill and joy to all men (and women) will be upon us. Oh, wait, I mean the season of drunken debauchery and copious public vomiting. Yeah, that sounds more like it. I'd like to think the new TV campaign 'why end your night like this?' will have an impact and reduce the number of stupid people but I doubt it, especially after being called the 'booze taxi' by a passing Hen group in Leicester Square, one of whom went on to say 'I'll be seeing you later'.

Until then, I am working my way through the shifts with the usual routine alongside my brave and noble comrades.

A 31 year-old Norwegian man fainted twice at an underground station and he was recovering well when I got to him, although I advised him to go to hospital, or at least have an ECG done. He seemed keen to get on with his day and his colleagues stood around outside the station’s medical room waiting for word that he was okay to continue with them. BUT, two faints in a short period where no previous medical history exists can be ominous and so the crew took him to the ambulance and I left them to persuade him not to work today but to get his health checked.

Lying on the floor of her office was a 24 year-old American woman who’d had a fit, although nobody had actually witnessed it. She’d been found collapsed and confused and the assumption had been made. It turns out she has fitted once before but it had never been diagnosed, or at least she wasn’t sure if it was or not. She did have medicine for it but she couldn’t recall what it was or precisely why she took it. She was definitely confused.

It took more than 30 minutes before she made sense again and the same amount of time waiting for an ambulance before I decided that, clinically, she was fit enough to travel in the car.

My next fitting patient was lying on the rain-soaked pavement of a busy street and I took a short handover from an umbrella-bearing man who’d stopped to help him when he’d seen him suddenly fall down and have a seizure. I asked the man with the umbrella his name and thanked him for his help, while I covered my patient in a blanket and did my best to keep him (and myself) warm and dry. People rushed by with vaguely interested faces on them and I had neutral emotions about London for a time. If it hadn’t been for the umbrella man (and one other who’d left when I got on scene) this poor fitting person may well have been left to it on his own.

Umbrella man took his leave as soon as I was into my obs and once again I thanked him for his kindness. Then I spent fifteen minutes or so on my own crouching over the semi-conscious patient as he began to slowly recover on oxygen. Legs and feet passed within inches of us but they were all in a hurry to get somewhere. The people at the top of them were only marginally curious and the more hardened commuters defied their instincts and ignored the obstruction altogether.

Once the patient was able to speak, I asked his name and he gave me the same name that umbrella man had given – how unusual, I thought. The ambulance noisily pushed its way through the rush hour traffic and arrived just in time for my interest in the name coincidence to evaporate. A bed was brought over and the patient was loaded on board.

He was an alcoholic, we learned and he hadn’t been drinking for a while, so his fit was probably the result of withdrawal. At least he was out of the cold, rainy was I.

Another person who fainted twice in a short period of time was a 71 year-old Indian lady, whose daughter was very concerned about why this was happening. I would have reached them both quicker if the staff at the shop (I wish I could name it) had bothered to meet me and guide me to them but they were all too busy selling stuff to customers and I entered completely unnoticed by some and ignored by others. I had to approach one of the counters and ask where the patient was. I got a shrug of the shoulders and a blank, disinterested look. Only then did the woman’s daughter come up to me herself and show me where her mother sat.

The lady had fallen ‘like a stone’ according to her daughter. Once after walking around and again when she got off the bus. She had hurt her knees as a result but I was more concerned with why she was passing out.

A stoical woman, she showed little interest in going to hospital and I had to persuade her, with the help of the crew, after her ECG had been done. It looked like she may have a heart block, a cardiac condition that would result in faints. She took our advice and I left the scene knowing that if I was wrong at least she’d be properly checked out.

A Red1 for an ‘unconscious’ man, ‘not moving’ became a cardiac arrest with ‘caller declined to start CPR’ and I was on my way to a possible suspicious death. We are not officially allowed to state that something is suspicious but we can determine whether a death merits investigation or not.

The man had been found by his neighbour. He was on his knees and bent forward in the corner of a little brick shed in his garden. He had been preparing to paint it but not a drop of the stuff in the tin was touched. The ambulance crew had arrived on scene with me and as we approached from behind, we could tell he was dead.

He had a head injury and there was a good sized pool of blood on the floor where his head was resting. We had to move him in order to establish that he was beyond help, so we pulled his body over on to its back and during this process we saw enough evidence to support an evaluation of death - Post Mortem staining all over his trunk and head. Asystole was established over two minutes and I recorded a time, pronouncing him life extinct.

The police were called, as is normal under such circumstances but closer inspection of the head injury gave me cause for concern. I can’t describe the wounds in detail but I will say that I wasn’t sure if they were consistent with a fall post cardiac arrest. The police agreed and CID was brought in to investigate. It would be up to them and the Coroner to decide whether he’d died naturally or not.

Be safe.


Tabitha said...

Do you ever follow up and look for the coroner's reports in these cases? And do you get any sort of trauma counselling for all the upsetting stuff you see?

Anonymous said...

I find your constant assumptions about the general public somewhat confusing.

You comment that they pass by with little interest in the patient in one paragraph when in another paragraph you comment that you have to clear a tube carriage to keep the staring to a minimum.

You complain when there are people trying to assist you and also complain when no-one seems to care about the injured person. It's a little contradictory.

And in any event, what do you suppose the public should do in such a case?

Have you considered that they simply don't feel they can, should or know how to get involved?

Xf said...


My 'assumptions', as you call them, are simply observations. They change to suit the environment and the call I'm dealing with. That's the point of the diary. I share my emotions and thoughts, right or wrong, with readers of this blog. There's no debate required :-)

Xf said...


No, I'll get called up if there's anything the Coroner needs from me. Otherwise, I have no time to find out stuff unfortunately.

We do get counselling if we ask for it but most of us are so used to seeing these things that we don't use it.

AnalogueAndy said...

Re the fitting man in the rain (and the public's attitude). A story for you.. I was just old enought to remember, my dad says "about 5". We were walking hand in hand, heads down in the heavy rain, passing a busy church when we came across a man laying half in the gutter, half on the pavement. It was the evening, people were coming out of the Church and ignoring the man, I remember one even literally stepping over him.

We stopped, dad (a policeman at the time) bent down, I remember watching the water running down the gutter and pouring into the mans clothes. Without creating too much fuss dad sent someone for an ambulance which must have arrived quite quickly.

We talked later about the man, dad obviously said he would be fine, but apparently I was worried he had died.

Next day dad took me to the hospital to see him.

Dad later told me that he and a colleague popped into the Church and suggested to the priest that he's next sermon might include some lesson about 'turning the other cheek'!

That man, dad's actions, (and the attitude of the 'good Christian' Church goers!) helped shaped my views for the rest of my life.

Thank you, Umbrella Man and the rest of us who'll never 'walk on by'

Keep up the good work :-)