Saturday, 14 March 2009

Pillow vomit

This confused pepper made me think about personalities and how often they are split, even in the so-called right-minded.

Night shift: Ten calls; one treated on scene, two assisted-only, one declined, one false alarm and the others by ambulance.

Stats: 1 eTOH fall with facial injuries; 1 Stoned drug addict; 2 eTOH; 2 DIB; 2 DOAB; 1 Hypoglycaemic; 1 Asleep!

The long trip out to deal with a drunken person who’d fallen on his face turned out to be a NPC for me because the crew, predictably, go to him as I pulled up.

One of the seediest hostels in my area, and one that the police don’t relish going to either, produced a call for me and I found myself talking to a thin young drug addict who was lying on his filthy bed out of his skull. There was a lot of shouting going on around me and the staff looked useless for control if I needed it. The call had been initiated by a member of staff who was convinced that the man was dying but, with a syringe by his side and the paraphernalia of drug use strewn around the room, it was clear he need no medical attention…yet.

The shrillest sound I heard came from another skinny drug addict – his wife, so she claimed. She leered in at him with almost no teeth and spat profanities at him; she almost convulsed with hatred, this woman. ‘F**k off you’, she shouted at me from about two feet, ‘he’s my ‘usband!’ I had only asked her to back off so that I could check the man’s condition. ‘Just doing my job, ma’am, just doing my job’, I didn’t say.

During the process of listening to the spaced-out man (who denied taking anything and said he was just tired) decline my help, the rat-woman from hell spoke over my shoulder and through my hair. ‘If you’re gonna die, before you go, tell me why you f***ed that fat slag’, she spat eloquently. I felt there was a domestic brewing, so I looked for help towards the door, where a staff member stood, but all I saw was neutrality and disinterest.

The aggression grew and her volume overtook the background clatter that resides in these places. Then she was joined by a Scottish druggie; he decided that a fight was in order and I decided I’d had enough. I packed my stuff, gave the skinny man on the bed as much advice as he would listen to and bid farewell to all in that delightful hovel. I was pestered out the door by the Scottish loud-mouth who had an opinion or two to share with me. I think he detected my lack of concern for his troubles at this point, so he stood at the doorway and completed his attitude novel on his own.

The ambulance was pulling up but I told the crew not to bother and explained how hostile things were inside. They sensibly agreed (they knew the place too) and moved off. I asked Control to inform anyone else who might be called to the place later to consider police backup.

I was cancelled on a call for a drunken female who’d fallen outside a pub – ‘no longer required’ my MDT said but I made the mistake of rolling past the place on my way back to the station and was immediately hailed, like a cab, by frantic people who’d gathered around a lump on the ground. A man came running up to the car and said ‘how can we get her into your car mate?’

‘You don’t’, I said (and I’m not your mate).

The woman was emotional; she obviously had other things going on (booze amplifies depression), so I persuaded her to go home with her friends in a taxi, so long as she promised not to throw up all over the driver. One of her friends told me she that was a nurse – big mistake really because she was the one who’d made the call and demanded an ambulance for someone who was quite obviously in no clinical need of hospital care. All she needed was a new life.

They were all grateful that I had pulled off this miraculous recovery (I got the drunken woman to stand up) and one of the men (equally drunk) asked me where the nearest charity was. ‘Eh?’ I said. Then he tried to slip me a fiver, you know, like you do with a waiter. I don’t take money from patients or their drunken friends, so I refused and suggested he walk down the road to HQ and make a donation to the ambulance fund or HEMS or something. A fiver buys quite a few Mars Bars and they would see me through this night but I wasn’t losing my job for it. The gesture was empty anyway; if he hadn’t been so drunk I would have taken the compliment and still refused but he was just trying to be patronising.

A 71 year-old gentleman I know well had an asthma attack and was quickly nebulised before being taken by the crew to hospital. I’d spent a few minutes in his flat looking at his shrink-wrapped TV remote controls with curiosity. He told me he did it to avoid getting infections from germs off his hands (and his wife’s hands). I wanted to tell him he’d get them from the plastic instead but I thought it would be cruel and petty, given his current state.

Here’s what bothers me and everyone else on the frontline – A call for a 100 year-old lady with DIB (so you can believe that it is genuine) was cancelled for a higher priority call as I made my way. I thought it must be a cardiac arrest to take me away from an old, frail, DIB lady. It was a Red2 for a drunk on a bus! It was given as ‘unconscious’ but they always are, so the poor old lady’s Red3 DIB had to wait. If she died because of the delay, there would be nothing done about it.

When I got on scene the police were there and they told me that he’d got up and walked off the bus. It’s truly disgusting and we need to sort it out. Almost every ‘unconscious’ person on a bus, especially if they are young, is asleep, I promise you.

Luckily the next patient, an 82 year-old woman with ‘general malaise’, according to her GP who I met on the way in (he was leaving), got my attention, and that of the crew without a cancellation. She was very poorly, weak and looked on her last legs. She was dehydrated and had a low BP. She lay on the sofa, trying to speak but without the energy to summon many words. I left the crew to take her away to hospital.

‘F**k off!’ was my welcome as I tried to wake the next DOAB I encountered. This one, East European and belligerent, wasn’t happy to see me and wouldn’t move for me until I threatened him with the police. I usually have to make the call to Control before they shift and, predictably, he reacted. Off he went, lit fag in hand, into the darkness.

A night club for a drunken, vomiting young girl next. I arrived and a private cab merchant asked me if I could park my car somewhere else because he couldn’t get the cabs to his customers. ‘No’, I said, leaving him with his mouth open in the background. I don't have conversations with people when I'm on a call.

The drunken 18 year-old was lying in the basement of the place with a first aider on scene and a couple of security guys hanging about. She had taken in a litre of vodka, so I’m told, although I found it hard to believe. My obs were done and the Booze Bus crew arrived to take her away. She was wheeled out on the chair for everyone in the queue to see. I hope she isn’t local because she’ll never live it down. The jeers and cackles that rang out around her will echo in her intoxicated little head for years to come.

A call in the small hours took me to an unmarked tower block in an estate undergoing renovation. The thoughtless Council neglected to put temporary signage up identifying each of the identical towers in the area, so my instruction to go to a specific one left me standing in the middle of them all, looking up and hoping for the best.

The call was for a 42 year-old man who was ‘not alert, possibly drunk’, outside his own home. I waited and waited for someone to tell me where I was going. I called Control but all I got was ‘look for a yellow building’. Even in the dim light of the morning, there was no way I could identify the colour yellow on any of these drab, horrible buildings.

Then a shrill voice sounded out over the quiet air. It drifted down to me but I had no idea in which direction I needed to look. I knew up was a good start but I didn’t know which block the voice was coming from. After a few moments of searching in the dim light, I finally saw a frantic arm waving from about the sixth floor of one of the towers. I shouted out that I had seen the signal and walked toward the building.

Inside, on the threshold of his own flat was a very drunk Glaswegian man. I knew he was from Glasgow because he spoke with a slurred accent that I recognised and he wore a Rangers T-shirt. His wife (well, I thought it was) and 15 year-old daughter were there and I was told that he was diabetic, so I did a BM was low (2.2). The man was conscious but not fully – he reeked of alcohol as if the stuff had been doused on his skin; I could probably have set him alight with a single match if I’d had that cruel intention within me.

I got him to eat a tube of Glucogel, then I asked his ‘wife’ to get a chocolate biscuit or something – she produced a Mars Bar and I was instantly hungry. If he didn’t eat it, I would.

I half-forced the Mars bar into his mouth, through his gritted teeth and he began to chew, like a cow with grass. He kept pawing me and saying stupid things. Little giggles would escape him every now and then but I knew his hypoglycaemia wasn’t doing that, his alcoholism was.

‘Is this normal for him?’ I asked the trodden-looking Filipino woman who was standing at the door watching my every move – her daughter had gone back to bed.

‘Yes...every week now’, she said in the high-pitched, almost shouting voice that is indigenous with Filipinos. There was no smile and no background emotion when she said it. She was living this misery and had no power over it. Whether this was a better lot than the one she'd left behind in her mother country, I don't know. Her face didn't tell me. All it said was servitude and sadness. The poor woman had suffered a stroke too, a year earlier. she had no use of her right side and her arm lay limp at her side.

The man on the floor began to stir but he remained stubbornly drunk in his behaviour, even though his sugar level was rising. Using Glucagon would have been useless, incidentally, as alcohol negates its efficacy.

I managed to get him to stand up and walk into his front room. I continued to ply him with sugary drinks and that Mars Bar, which he slowly sucked away at like a child. When his BM reached 4.0, I decided I’d had enough. I’d been with him almost an hour and he was starting to get lary, wanting to be my friend and to know all about me (he’d recognised where I was from). So, I went to get my PRF so that I could leave him with a copy. He didn’t want (or need) to go to hospital, so I spent a nice quiet ten minutes in the car doing paperwork.

When I was ready to go back up I headed out and was met at the main door by his daughter. ‘He’s fallen and cut his head now’, she said in a voice that, if it had owned a face, would have looked pissed off with it all. I think I sighed out loud and I'm sure she heard me.

I went up to find him in the toilet with blood all over his face and a little pool of it on the toilet seat and cistern. He’d fallen forward while peeing. I dressed his wound, which was thankfully minor, and advised him to go to bed. I presented the form to his ‘wife’ for signing and that’s when she announced that she was ‘no wife...just friend’. She backed away from the PRF as if it was possessed; the word ‘wife’, which I had ticked, seemed to terrify her.

I persuaded her to sign when I changed her title to ‘other’ and bit my lip to restrain myself from asking why they had a teenage daughter if they were just friends. Someone else’s voice in my head told me it was none of my business – I think it was an immigration officer.

Anyway, I bid farewell to the drunken Glasgow man and noticed something familiar hanging on a rail as I turned to go. It was a high visibility jacket, much like mine. It bore the word AMBULANCE on the back.

‘No way’, I thought.

But it was true. He worked for a private patient transport service (PTS). This man handled frail old people on a daily basis. On a weekend he couldn’t even handle his drink or his own blood glucose levels and he cared nothing about the state his family was in. I had no respect for him at all. To cap it all, on my way out of the door he shouted ‘Rangers or Celtic?’ which, in Glasgow terms, is another way of asking my religion ‘Protestant or Catholic?’ I shouted back ‘Rangers’ and got the inevitable hooray for being a good boy. If I’d been Catholic and returned a ‘Celtic’ to him, he would probably have chased me out the door and had a shower afterwards to rid himself of contact with me. Thankfully, this breed of ignorant men is dying out and modern Glaswegians are aware of the possibility that not everyone shares the same viewpoint.

My last call was Red2 because it had been passed back from Clinical Telephone Advice (CTA) on the basis that the caller insisted on an ambulance. His reason was that the ‘patient couldn’t be woken’. Fine, I thought, I’ll have a look. I went there knowing that this would be stupidity.

Inside the flat two Chinese men were looking anxiously at another man who was lying on his side in bed. He had vomited and one of the worried man pointed at it and said ‘look, on his pillow’.

I walked up to the sleeping man, pulled him onto his front (I had seen him shrug his friend’s hand off him as I walked in) and he opened his eyes. ‘Wake up and stop play acting. Your friends have had to call an ambulance for you’, I said. He looked instantly ashamed and apologised. He was wide awake now, stinking of booze and covered in his own puke. His pillow had a large pool of vomit on it and, by turning him over, I had inadvertantly (possibly) placed him on top of it.

My guess is that he was due to get up for work and after a heavy night of irresponsible drinking had decided he didn’t want to. His panicky friends could think of no other way to get him out of bed but to dial 999. Remember, I don’t get annoyed because I have to do this job, I get annoyed because I know that as long as I am tied up with chores like this, I can’t be available for real emergencies, like 100 year-old DIB's, which actually happen. I want to have a book of tickets that I can write, fining people who treat us like this.

‘Right, your friend is now awake. Please pay this fine to the ambulance service within seven days. It will be £50 if you pay within that time and £100 if you are late. Bye now and have a lovely day.’

Be safe.


PK said...

I totally agree with bringing in fines, it may be the only way to get people to use their brains a bit more before deciding to call an ambulance!! Its so frustrating going to a call that you know as soon as it comes in that it will be a waste of time and just another (most likely drunk) person abusing the system.
Still you can bet that the one call like that which we decide not to run to like any other will actually be something more serious and then it will come back and hit us in the face. There's no winning really!!

TonyF said...

Fines may well be a good idea. I suggest you take them to 'hospital' first, the one with the nice 'nurses' in blue uniforms, and use one of their 'wards' until sober/paid up.

I er, took the liberty to miss-quote you.." I asked Control to inform anyone else who might be called to the place later to order a Harrier strike as backup."

kingmagic said...

We would need bigger vehicles to carry the boxes of tickets required to hand out on most of our jobs!

medicblog999 said...

The one thing that I constantly find myself asking when reading your blog, is
"why are you at that type of patient?"
Let me explain further.
In the North East Ambulance Service,when working on a rapid response car, our control cannot knowingly send us to any cases which involve alcohol, drug use, violence, potentially volatile situations are known trouble areas and addresses.
Obviously sometimes we get caught out as control can only act on what they are told, but essentially we are used only for medical/trauma which are deemed safe for a single responder to attend.

Xf said...


Perhaps the way to win is to accept that sometimes things go wrong and it's not necessarily our fault. If we didn't go to any DOABs, for example, they'd all wake up eventually and go home BUT there will possibly be that one who drops dead...well, it happens.

Xf said...


That's a good question and the answer is litigation. Down here in the south the right-minded shake in their boots when it comes to risk.

A young person who is not rousable and has had a lot to drink? You and I both know what's wrong with him but the 'he might choke on his own vomit' brigade make the rules here.

We don't get sent to obviously dangerous calls but alcohol, drugs and sometimes potentially volatile situations aren't covered and we go. Its then down to common sense.

Your ambulance service obviously thinks of YOU first - not to slight mine of course but there is clearly a sensible policy in place up there.