Thursday, 20 August 2009

Amputation

Night shift: Five calls; one assisted-only, one by car and three by ambulance.

Stats: 2 Chest pain (one who was drunk); 1 Sprained ankles; 1 one-under; 1 eTOH.


Every now and then a nightshift will produce a single call that haunts you. This call will be significant for reasons you can’t put your finger on and will be surrounded on either side by mundane or routine stuff that you must still get through regardless. I have been careful not to go into too much detail with the call I am referring to but be aware that you may still not want to read it.


So, a chest pain call for a 48 year-old man who ‘refused to give the exact location’ meant I was heading for a troublemaker. I spent a while outside the tube station where the call had originated, practically accusing a Big Issue seller who was sitting on the pavement of making the call. ‘I wouldn’t do something like that’, he said. There was nobody else around who fitted the bill but I had to believe him – he had a believable face.

The crew arrived and we all had a good look around the area for this 'emergency' but still couldn’t find him. Until, that is, he hobbled across the road with anger on his face, crutches in one hand and a can of Special Brew in the other. As soon as I saw him darting towards us I knew he was our customer. He was livid that we hadn’t drawn up to where he was sitting, invisible and intoxicated. We are chariots of servitude for the self-abusing minority. We are there at the beck and call of those who pay no taxes and do no favours for society and right at that moment, as he almost collided with me and spilled his beer on my uniform, I felt lower than him just for turning up.

I took his beer can and poured the contents out into the gutter. He didn’t like that and objected with beery-breath and spittle as I walked him to the ambulance. ‘I’ve got chest pain’, he said. He may have had but his sprint, albeit on crutches, said he was in better health than any genuine heart attack victim I'd ever met.


Over on the busier side of town, a 52 year-old man sat outside a hostel waiting for me to arrive and examine his ankles. He’d sprained one of them three weeks earlier but had done nothing about it and had continued to walk about despite the huge swelling and the pain. He was homeless, thus had no choice but to keep on the move but his other ankle had been compensating for this and it too was now quite swollen. With both ankles effectively out of commission he was crippled and almost unable to stand at all. Luckily, he had some movement left in him and I was able to get him to the car for the trip to A&E. His feet smelled like rotten cabbage and when we got to hospital he dragged that aroma through the entire area to reception, where he was deposited in a chair to wait with everyone else. One of the nurses came shooting by with a can of air freshener and a dirty look for me.


Then later on this bizarre ‘one-under’ call came in. A one-under is a call in which someone has fallen under a train; usually there is nothing to do as the patient tends to be pretty dead but this one described the patient 'arguing' while under the train. He had fallen under while the train was moving, so I expected him to be dead, dying or seriously injured… certainly not talking to anyone. I assumed he must be a drunk who’d fallen in the gap between the train and the platform (it happens) but that he hadn’t actually been hurt by the train itself.

I rushed to the scene, half expecting to be cancelled but I wasn’t, and a crew and officer were already there and unpacking equipment. Someone was taking it seriously obviously. I had also been asked to report for HEMS and this indicated that more detail had been given than I had received so far.

We ran down to the platform and found that it hadn’t yet been cleared of passengers. There were quite a lot of people milling around, staring and trying to get a better look at the human railway sleeper lying below the stationary train. Railway personnel were on hand and someone was reaching down into the gap and holding a man’s hand. I looked into the narrow space and saw a very drunk man lying on his back with one of his arms reaching back over his head as if he was holding on to the train. At first it looked as if he had no injury and could simply be plucked out but when I asked for a closer look at where his arm was going we could see that the wheel of the train was on top of it, crushing it into a pulp on the rail – he was bleeding but not significantly. The man was completely unaware of his predicament.

I got down into the gap with my colleague and a couple of firefighters, who’d arrived on scene in force. We had been given assurances that the power was off but I never trust those promises and going down there was always going to be a risk. Personally, I don’t mind being under trains and have done this a number of times but the thought of a live rail making life nasty and short for me and my colleagues plays on the mind.

The man was so drunk that he continued to misunderstand where he was and why we were there. Even when I cannulated him and started fluids, he couldn’t figure out what was going on. Yet something about him stirred and his face would show it every now and again; his body knew he was in serious trouble even if his brain didn’t and every now and then his expression would change and he’d sober up for a few seconds.

‘Where am I?’ he asked me.

‘You’re under a train and we need to get you out’, I told him.

‘I need to speak to my wife’, he said with a sad, sombre expression.

I felt for him, I really did. He still didn’t know about his mangled hand. We had a plan to free him but he’d probably lose that hand one way or the other. An emergency doctor was now on scene but she pretty much left proceedings to us. I cut the circulation in his arm off with a tourniquet so that he didn’t bleed badly when the train was lifted off his hand. Then the firefighters set to work, cranking the train up slowly using a powerful manual Jack. It seemed to take ages because the wheel was only being elevated centimeters at a time.

The platform had been cleared of the general public but was now pretty full of uniformed people. All the while the train was being lifted, there was a calm quiet and it made things a little more unnerving for me. I was holding his arm and watching the hand literally peel off the wheel as it began to rise from the rail.

Just before we began the lift, he did something else that made me realize that he knew, beneath all that alcohol, he was in danger. He asked to hold my hand. ‘I don’t know why I want to but I just do’, he said. It was poignant and painful to watch a grown man struggle with this traumatic reality under tons of stinking train. He was still too drunk to feel any pain or know any better but his life was about to change forever.

I continued to watch his destroyed hand as it unglued from the metal of the train wheel; it was like watching a fake rubber hand being pulled out. When there was enough of a gap for the hand to finally be released, I gave his arm a gentle pull and hoped that I wouldn’t see his limb torn apart by the stress. Instead, his completely degloved hand came away and fell towards me, blood oozing from the crushed bones and sinews. The damage was severe and started at his wrist, with extensive avulsion all the way to his broken and missing fingers.

I guided his arm into a box splint which had been prepared with thick dressings and I listened as he screamed in pain – the first pain he had acknowledged since the accident had occurred. There was no pain relief for him at the moment; he’d have to wait until we’d freed him from under the train and the doctor could deal with him.

Once his arm had been released, we had no option but to sit him upright and haul him out of the gap like we would do with any drunken faller. His covered limb had to be carefully handled because the least movement made him cry out in agony. There was no time to waste with him either, so as soon as he was given pain relief, he was taken to the ambulance.

Outside in the ticket hall, the passengers who had witnessed the incident were waiting. Some of them had shocked looks on their faces, some were talking excitedly into their phones and most of them, I was told later, believed that we had just cut the man’s hand off to save his life.

We rushed him to hospital and he was taken into Resus where a trauma team took over. I still don’t know how he came to fall under a moving train and I don’t know how he got on. He will have survived of course but his hand was completely destroyed and so his career would more than likely be over. For some reason, the fact that his hand had been taken from him like that, hit me quite hard. If he had been killed under that train my reaction would have been very different and probably equal to any other I’ve had when dealing with traumatic death, but I still can’t forget this one and I think about it often.


After all that work and a debrief with the officer, who was a true gentleman, I was sent to wake up a DOAB. As usual, he was reported as ‘unconscious’ and, as usual, he wasn’t. It took no more than ten seconds to prove that.


My shift ended with a 46 year-old woman who had ‘breathing difficulties’ She was an asthma sufferer and her main complaint was left arm pain which had been going on for a few hours. She was in a hotel room with her husband and two kids (who were sleeping in a separate area) and she’d been trying to sleep when the pain and breathlessness took hold of her. A crew arrived as I was completing my obs and I left them to it. I was still processing what I had dealt with earlier, so I felt unnecessary at that point.

Some shifts test you and some leave you feeling emotionally drained. Tonight, I had been challenged by an unexpected call and was making my way home with only the memory of what had gone before running through my head. I was reflecting on it and that’s healthy. I wasn’t depressed or upset by it but I was shocked in the way that you are when you see someone in desperate trouble and you discover that it is your brother.

Be safe.

16 comments:

The Crazy Newt said...

Yikes, that's rough. I think the hardest part would be going right back to work after something like this.

Anonymous said...

This is the first post of yours that made me teary :-( God bless him.

Anon
A Southwest Cop

Anonymous said...

Thank you.

I have one question though. Why could he not be given pain relief in situ?

Kieran said...

Still reading the diary regularly Xf. This is one of the most shocking posts yet, just this morning i was talking to one of my friends about how I'd deal with a call, were they involved in it.

My thoughts and best wishes,

Kieran.

Xf said...

Anonymous

He was drunk and this is a contraindication for the use of either entonox or morphine, so the doctor had to be there before it was given.

JB102 said...

Horrible, it's amazing though how despite being trolleyed his body was still acknowledging that something was so wrong despite his conscious state not being able to recognise it. I guess the real recovery will start when he leaves hospital.

Anonymous said...

Thank you for all you do.

Anonymous said...

Stu,
It's easy to forget that paramedics only see mangled people for the first hour or so of their pain. When we consider that this injury will involve months of rehab and they will never be the same it is certainly sobering. Its funny how we refer to our patients by illness or injury not name when talking with our peers. Its a sign of your humanity that you still remember that under the clinical challenge is a real person with a life, family, responsibilities and aspirations.

Regpara

Anonymous said...

Stu,
It's easy to forget that paramedics only see mangled people for the first hour or so of their pain. When we consider that this injury will involve months of rehab and they will never be the same it is certainly sobering. Its funny how we refer to our patients by illness or injury not name when talking with our peers. Its a sign of your humanity that you still remember that under the clinical challenge is a real person with a life, family, responsibilities and aspirations.

Regpara

Henners said...

Just by reading this post, I feel some sort of attachment to this guy; poor chap. I think it just goes to show how one single (silly) event in your day can change your whole life forever in the most dramatic way.

Alcohol had a contributing factor to the cause of his injury - he may have been stumbling along the platform and just fell and that makes it sad in a way. What if he hadn't been drunk? Would he be in a different position today? I think so.

Another well written post Stuart.

Clare said...

Thank you for going out and dealing with these things for all of us.

Becca said...

Poor lad - not nice at all.

No particular reason for it to end his career, though - after some rehab and recuperation and sorting out a decent prosthetic he should have a reasonably well functioning limb and while the nature of his duties may or may not need reviewing he should be able to continue to contribute, assuming that he wants to.

Lots of amputees return to work these days - even foot/leg amputees in various uniformed services, including the armed forces.

Thinking good thoughts to him - he has some hard weeks and months ahead.

Xf said...

TO ALL

I have amended this post because, regardless of my good intentions and the fact that the mention of the patient's profession was only supposed to highlight why the emotion was stronger, I have to take heed of its potential for identifying this person. I would not want to be seen as someone who disregards the privacy of others, despite the fact that I would not have been the original source of his identification and that his his work colleagues would defintiely have known regardless.

But this argument can always be contested by those closer to him than I and for this reason, I have edited certain details that were originally posted.

Sometimes commenters make pertinent points that I cannot ignore and if they are made in a non-personal and logical manner, I am much more likely to pay attention to them.

One commenter added his/her voice to that of a close friend of mine, stating that I may have contravened in terms of confidentiality and so this has now been put right.

Lesley said...

Yes, see what you mean about the editing... such a sad tale.... Hope the guy manages to keep his career and that he has a really supportive family. And I feel so much for you, too, in this tragic situation...

Rach said...

Thank you.

Just, thank you.

To put it in perspective, I lost my Dad to a speeding car. He was clouted by a maserati travelling at motorway speed, and he was killed (mercifully) intantly.

I felt something click for me on the day of the inquest- the paramedic who found him - or rather found his shoe and realised it was still attached to a person - was there, and described how he was found.

It felt comforting to look into the eyes of the person who found him and treated him with dignity and compassion and say "thank you" and shake his hand.

I want to say thank you to you in advance, in case you are the person one day who finds me, or another of my loved ones in such a situation.

Library Girl said...

Thank you. Thank you for giving me this opportunity to peer into your world. Thank you for being.