Day shift: Nine calls; Two assisted-only, seven by ambulance.
Stats: 2 Chest pain; 1 EP fit; 1 Melaena; 3 eTOH; 1 Migraine; 1 Asthma
Carol singers of various kinds (some amateur and bad at it and some professional and good at it) are gathering beneath the half-decent Christmas tree in Trafalgar Square to belt out some old favourites every day. The public have been joining in and it’s all very festive and cheery. I watched one group of carollers as the tree gently swayed in the wind above them as they went through their repertoire. It reminded me of the year (a few years ago now) when the grateful Norwegians donated the skinniest tree of all time and it almost toppled over in the first decent breeze to rise up. If it had fallen as many as two people could have been hurt, such was the emaciated nature of the thing. It was a scrawny emblem of thanks in a size zero dress when it was decorated.
Thankfully this year the carol singers can all fear the consequences of this one if it dares to fall. I say this with my usual sarcasm and humour and no emphasis is placed on the wish that it should ever happen of course. Nor is it the direct fault of the lovely Norwegians that a few of their number can't pick a decent tree from millions available.
A paraplegic man who never usually complains of pain was lying in his bed suffering chest pains and his wife decided enough was enough. His father had died at a fairly early age of a sudden heart attack, so he was in danger too. They were a nice couple and his wife even offered me a cup of tea as I carried out my obs and he clenched his chest as the pain hit again. It would have been profoundly unprofessional to take her up on the offer, so I politely declined. Maybe another time.
His ECG was anomalous; bradycardic (at 47bpm) and his p waves were inverted, so his pain was likely to have a cardiac origin.
A 40 year-old man had a fit in the street as he worked with his colleagues unloading a van. He was still post ictal when I arrived and his mates were propping him up, so I took him out of the drizzle and into the car until an ambulance arrived.
The next call, to a 98 year-old lady left little to the olfactory imagination. I walked into the flat with the crew not far behind me and found her in bed looking very unwell. She had melaena and the bed sheet and mattress were never going to get clean again. A large pool of the black, tarry excrement had formed underneath her.
She was also very cold – my thermometer simply read ‘LO’ when I tried to get a number. She had clearly been getting cold over a period of time and, as well as her obvious problem, this was contributing to her poor level of consciousness.
As I left the crew to get on with moving her I reflected on the inappropriate attire of her Japanese carer – she was a nice enough person but the way she had chosen to dress for this particular job mystified me. She had her regulation nursey-type top on of course but she also sported knee-length black boots and the world’s shortest skirt. Maybe she had a party to go to afterwards.
I didn’t make much of an appearance at my chest pain call; the traffic and inexact location of the call put paid to that. The crew was already on scene and I had wasted my time.
Try not to fall too deeply asleep on public transport – you’ll wake up to find me, my colleagues and a few police officers around you. This was the experience of the ‘unconscious’ male I attended on a train. Everyone else had disembarked at the station but he was left slumbering in his seat. The rail staff did their best (so they told me) to wake him up but, convinced that he was beyond their help, we were called.
The poor young man had just been released from prison and was making his way to London to meet friends and get on with his life. Now, fully awake and looking very intimated by the people around him, especially the cops, he was doing his best to plead innocence as he explained that he’d had a few to drink and that he’d simply gone to sleep. No crime in that but his ID had to be checked and his onward journey delayed. The crew and I left the police to take care of him.
We’d hardly had time to complete the paperwork on that when a police officer asked us to look at a 35 year-old man who’d been taken to the police office after people had seen him behaving strangely on the platform. I’m not sure what they meant but when I popped in to see him he seemed out of it. I asked him about drink and drugs and he admitted both – his pupils were pin-point but that can mean something or nothing. In combination with bizarre behaviour and a noticeable reticence to answer honest questions, it usually means something.
In the ambulance he denied taking any drugs and his GCS instantly improved; funny that.
The migraine belonged to a 19 year-old shoe-shop assistant who was a regular sufferer but who’d forgotten her usual meds today. She was photophobic, nauseous and in no mood for work. On the way out of the shop she opened her personal bag for one of the other staff members to see – this was to show that she wasn’t stealing goods from the place. She still had the capacity for honesty even though her head was making life miserable for her.
An alcoholic with palpitations and who was ‘not alert’ got a Red2 and we were scrambled to her aid like the heroes we are. The crew was on scene so I didn’t even meet her but I’m sure her palpitations were nothing to do with illness and her ‘not alert’ status had been awarded to her because she simply didn’t know how to answer simple questions. If a patient with a genuine problem dies because of one of these calls nobody will care – except of course those of us who do care.
My last call was for a very overweight young woman who had an asthma attack at a train station. She was sitting in the medical room when I arrived and, although she was breathing quickly, she didn’t seem to be having too much trouble. Her sats were good and I heard no wheeze. Her inhaler had run out, so calling an ambulance was a sound idea but she seemed agitated; preoccupied and a little unsure. She spoke to me when I was on my own but she clammed up completely when the crew arrived and the female paramedic asked her questions. Her asthma didn’t seem to be the problem – something else was going on but I didn’t stick around to find out what. I went home.