Night shift: Seven calls; two assisted-only, five by ambulance.
Stats: 1 DIB; 3 eTOH; 1 EP fit; 1 Chest injury; 1 Chest pain.
The last night of the tour and its busy and business as usual in Dodge. It kicked off with a 95 year-old lady with shortness of breath (SOB). She’s a CHF sufferer and at her age things are going to start deteriorating unfortunately. Her Californian-dwelling family were over to visit and they told me she is always ill when they see her and that she gets worse each time. The poor old lady’s ECG showed a possible heart block and so she was ‘blued in’. She will probably survive this with good care but is unlikely to see many more years… or months.
The 31 year-old who was ‘fitting’ wasn’t when we arrived. The crew was on scene and the alcoholic man was suffering from nothing but withdrawal symptoms; something he ought to expect, given his habit.
This call was followed by a similar patient who decided to go to sleep on the floor of a shop. Strangely, the owners weren’t happy to have him there, so we were tasked with his removal, although the police would have been more appropriate since all he was doing was trespassing and being a public nuisance.
The crew arrived as I pulled up at the store and we all piled in to find our ‘patient’ flat on the floor and unwilling to raise his head to acknowledge us when we spoke. One of the crew was a trainee and she was trying her best, with a gentle manner and quiet voice, to rouse this experienced drunk. I gave her a few minutes before grabbing the man’s collars and hauling him up into a sitting position. Once moved like this, they tend not to sleep any more and one of two things will occur; compliance and a satisfactory completion to the job, or aggression and possibly violence. Unfortunately, he chose the latter path and, like it or not, this risk is inherent in the removal of offending alcoholic trouble-makers. He was lying on that floor just to show that he could and that he would create problems for others if he did. He was right on both counts… until we arrived.
He swung his arms around and his clenched fists threatened us more than once, so I pinned his arms against his chest until he was less willing to wave menacingly. At one point poor Lottie had her arm pinched when the guy held onto her in a drunken faux-friendly way – she’s learning fast.
‘I’m a Marine’, the drunken man said as he staggered to his feet, ‘I’ve killed eight people’. I was very impressed by his statement and wanted to be his friend for the rest of my life. I have no doubt that other servicemen and women are proud to be connected with this kind of person, regardless of where he served and what he allegedly killed. I don’t think so, somehow. The majority of them manage to get their lives together without reaching such lows, even if the Government stiffs them after they’ve done their duty.
He became verbally abusive and a tall, skinny alcoholic buddy wandered into the shop to ‘have a word’ with him and sort him out. ‘These people are here to f***ing help you, stop being such a pratt!’, he told the aggressor, who had now decided to start trashing the shops hanging sweet display. It was a bloodbath, with jelly tots and wine gums flying all over the place and the threat of harder sweets getting involved. To help the man make his mind up and perhaps pacify him, the tall guy decided to grab him by the neck and ram his head into the sweet rack, so that his eyes were immediately in danger of being pierced by the holding spikes protruding from every level – including eye level. I felt this was probably not the best tactic and so asked the shop owner to call the police (I had to ask him twice because his brain seemed to stop working when he witnessed this display of madness - or he was upset at the death of so many innocent sweeties).
Meanwhile, people were still coming and going with their cigarettes, sweets (if they could pick them off the floor) and small grocery items. They had to veer around us as we stood with the noisy Marine. He threatened us and other people a few more times before settling into a quieter tirade of generalised abuse. The cops arrived, dragged him out and sat him on the ground outside, where he continued to be an arse for their benefit.
The crew left the scene and Lottie and I hung around, just in case. The skinny tall man was still being a pest in general and had to be shooed away more than once as the officers tried to get the drunken man to move on. They weren’t going to arrest him and now they had a problem – could I arrange for an ambulance to take him to hospital, they asked. Uh-oh! I’d just sent the one that was here away. Now I had to call another one and explain to the crew why they had to taxi this obnoxious man to A&E.
It took another twenty minutes of waiting before the crew showed up. They weren’t impressed and I apologised profusely, as if it was my fault and I’d thrown alcohol down this guy’s throat just for the hell of it. I couldn’t blame my colleagues; he was a complete waste of time and would probably be thrown out of the hospital two minutes after arriving. He couldn’t walk but he couldn’t be arrested – so A&E.
Off to Hyde Park later on, where a gig staff member had become so drunk, she’d fallen and bumped her head. A St. John Ambulance bod was on scene, as was Paul, the man in charge, who would soon become a friend of mine. The girl was just drunk – her head was fine and as soon as I spoke to her, she responded. She flashed a white Californian smile as I went through the process of checking her brain was working properly (so I accused her of killing Michael Jackson) and generally wound her up for fifteen minutes. Paul was chuckling away in the corner. I don’t think he realised that we, of the LAS, take great pride in our professional duty to produce sobriety through mirth.
The crew arrived before I could cancel them and they didn’t need to do anything because the girl decided she was fine, got up and went to join her equally drunken sister (who had virtually no sense of humour from what I could gather).
Speaking of lacking humour; a call to Trafalgar Square had us sitting on the steps as I tended to the hurting chest of a 21 year-old man who ran, full pelt, into one of the metal posts around the lions. He had intended to jump it but his brain had forgotten to tell his legs what to do, so his upper mid-body took the full force of the impact. The potential for a serious injury was there, given the mechanisms but as I chatted to him, I realised he’d survive – probably with bruises (chest and pride).
There were a few other teens around him, including one girl (south London gangsta-girl type), who had told me what he’d done. She asked if he was going to be okay when he was taken into the ambulance and I attempted banter with her about the possibility of having to do an operation there and then, where we’d take each lung out and examine them for injury. I put on my most sincere face and serious voice but she blanked me until she’d had enough and then put her hand up, looked me in the eye and said ‘you’re gas’.
Finally, a 53 year-old drug addict with a recent history of pneumonia, sat in the reception area of her hostel with chest pain, localised in her lower left side. I could hear crackles in there and she was very uncomfortable, repeatedly asking for pain relief. She got entonox, which helped a little but IV morphine was out of the question because her veins were non-existent. She was in a mess. Her BP and sats were low and physically, she just wasn’t stable.
She was blued in and it’s possible she had a recurrent pneumonia, although I couldn’t rule out a PE or other significant problem, associated directly with her lifestyle and habits no doubt. People make their own choices – the outcome of them is often very predictable and unavoidable.
This tour of nights ended Charlotte’s adventures into my world and hopefully inspired her to write a bit for her medical publication – it will probably be titled ‘Paramedics have a rubbish sense of humour’ or something like that. I was glad of her company and she kept me in check when I forgot I had female company (no swearing allowed). She may decide to venture out again to expand on her project, who knows? Between now and then, I will have a few more people on board with me because I will be supervising a number of students over the next few months. At least I won’t be alone on those long, busy nights. You know how lonely I get :-)