Saturday, 1 August 2009

Seagulls at dawn

Night shift: Seven calls; all by ambulance.

Stats: 1 Fractured foot; 2 Faint; 3 eTOH; 1 Normal labour.

I was waved down by a manic Norwegian windmill as I poodled along Piccadilly, so I stopped and the man tried to push a large hopping woman into the back of the car. I wasn’t having that, so I asked him to desist (well, that wasn’t quite the word I used) and questioned him about his actions.

He’d called an ambulance for his wife (the hopping woman) after a heavy shop sign had tumbled onto her foot, making it swell like a whale’s penis (not that I’ve seen one). I called it in as a ‘running call’ so that I didn’t get caught with a Red1, drunken emergency in the middle of this tourist crisis and an ambulance snaked its way around the traffic to reach us.

The woman’s foot had been given some treatment using a bag of frozen prawns and I knew I couldn’t help what I was going to ask next (and neither, I daresay, can you).

‘Are they Norwegian prawns?’

‘Yes, of course’, replied the man as his family giggled in the background.

The man’s son had run down to the local shop to buy them and had slapped the pack on her injured extremity to keep the swelling under control – a wise and educated move; one which very few of my Brit (or pseudo-Brit) patients would have bothered to try before dialling 999 in a panic.

‘They cost a lot!’ the man’s son went on to say. Yeah, in Norway they are cheaper because they are caught on the doorstep. Bring them over here and they go up in price – it’s therefore less expensive to break your foot in Norway, right?

Anyway, she hopped into the ambulance (which she didn’t need to be honest; they’d waited long enough for a cab to A&E) and I got on with my night.

My next patient sat on her sofa holding on to a jug of what looked like pastry mix but which was in fact her own vomit. The 53 year-old lady had passed out earlier, so her daughter called an ambulance. She didn’t look well at all – very pale and sweaty with obvious SOB. Her sats and BP were a bit rubbish (in fact her sats were so low that I didn’t believe my probe; it becomes inaccurate when the battery is going).

She’d been vomiting for a while and, because she was diabetic, I thought the answer might lie there but it didn’t – her BM was normal. She’d also suffered a recent ongoing headache and this made me wonder about other possibilities, including a subarachnoid.

Her husband is disabled due to recent strokes, so she was very reticent about leaving him to go to hospital but her condition merited the trip and I was concerned that she may deteriorate – I’ve seen it too many times before.

When the crew arrived, we got her down to the ambulance and confirmed that her sats were indeed low, so she got more oxygen. As we were loading her, a woman from another block of flats asked if someone could help her with her disabled son, who had cut himself, so one of my colleagues went up to see him as we continued our care of the lady in the back. When she’d finished (dressing applied and advice to go to A&E given) we took the patient to hospital.

It was just about then when I received a text telling me that the young woman whose throat had been cut the night before had died in Resus. I couldn’t believe it and felt utterly numb. I cope very well with people who are dead or dying and there’s inevitability about it but I find it hard to reason out the loss of a life when it had been delivered alive to definitive care. She was only 22 and it had been an accident, I thought, over and over again.

When we got to hospital with the patient and after the handover had been carried out, I asked one of the nurses who’d been on duty when I brought the cut-throat girl in – he told me that she’d gone up to Intensive Care and that she was ‘doing well’. I’d been caught out, yet again, by the mis-communication brought about by rumour after a serious job. It’s common enough; other crews talk about it and then it becomes a matter of different stories from different people – especially when the outcome is discussed. I was relieved and so, I guess, are you!

Some of the poshest restaurants in town are also the hardest to find. They have little signs and well hidden road numbers, if they have them at all. I guess they think they have some kind of exclusivity if they appear to be discreet but for us it’s a nightmare, so the call to a 60 year-old man who’d collapsed in one of these places meant I was three minutes late getting there – the name plate was so small you’d need binoculars to eat there.

Inside the restaurant, the toilets were even more pretentious; small egg-shaped capsules in which males and females could secrete themselves and their bodily waste while looking chic and modern about it. I know this because the patient was sitting on a stool in the middle of these things as pretty people went about their ablutions – not the best environment for a sick man.

He’d been feeling unwell and had collapsed a little earlier. He didn’t want to go to hospital and I was tempted to oblige and leave him to it after his obs looked normal and he said he felt better but he had a history of kidney stones and he still didn’t look well, so when the ambulance arrived I sat with him as his BP was measured again and again – it dropped considerably several times, so he was taken in urgently – something wasn’t right.

I was told that my ‘attitude’ wasn’t good enough when a young Asian student, a friend of the patient I’d been called to, who was drunk and had fallen, cutting his face in the process, took exception to the way I said ‘So, he fell because he’s drunk and he cut his face just as you would if you fell normally and you felt the need to call an ambulance?’ To me it was a straight-forward question.

The man on the ground had a tiny cut to his cheek and he could stand and stagger if made to (proven when he was taken to the ambulance). This had been given a Red1 category because someone had said he wasn’t breathing. Someone (I dare not suggest who) had simply panicked. We are the result of knee-jerk reactions to alcohol-induced confusion.

All of the men around me were students; medical students I may add and their combined intelligence should have counted for something but this young man ranted about what I’d said as if it were the world’s biggest incriminating statement. In a way it was; it incriminated their lack of common sense and he didn’t like that one bit.

Meanwhile, his drunken friend refused to get into the ambulance and wasn’t interested in help anyway, so the crew had to spend a good deal of time coaxing him to behave.

A long and hard job later on involving a large 30 year-old man who’d collapsed in the basement of an hotel in the cheap end of town. He’d vomited all over his face and the floor; you could smell it from the top of the steps – it was the thick stuff, like porridge and it was playing havoc with his airway, so I scooped it out of there first.

His mates, who had no idea how he managed to get down there from the third floor, swore to me that he’d only had 4 pints. I reckoned that, given his large frame, this guy could tolerate much more than that before he got into such a mess. He was barely conscious. There must be another reason for him to be so wasted. He may have taken drugs but that was denied vehemently by his mates or he could have fallen and banged his head on those steps. If he had a head injury, it was internal because there was no visible sign of it.

The crew arrived and we spent the best part of thirty minutes trying to figure out how to move him safely. He was aggressive and combatant when we tried to life him and his position in the corner meant that we were crouching just to get a hold of him. He was sixteen stones of dead weight and our backs weren’t happy.

I put a line up in the hope that the fluid would wake him up a bit but it didn’t and we were left with no choice but to wrap him in a blanket, so that his arms and legs couldn’t flail, then drag him to the chair and carry him up three or four of the most awkward sets of steps you can imagine. This hotel was in a bad state of disrepair and the convoluting corridors and stairwells made emergency rescue almost impossible. I dread to think what would happen if there was a fire in there or if someone had a cardiac arrest in that bloody basement.

We took the man to Resus because I was unsure of his problem. I hoped they’d find a good reason for their time, such as a head injury that could be fixed or something... anything that would deserve a bed in that department but, I found out later on, he was just very, very drunk. It turns out his mates had lied repeatedly – he’d been downing shots all night and was poisoned out of his skull. In fact, when he woke up he demanded compensation for his shirt, which had to be cut from him. The nurse asked him if he was prepared to compensate for the vomit-stained uniforms of the paramedics that had helped him. He declined and went home with a tucked tail.

I’d rather ‘blue’ a call in and get it wrong than put someone’s life at risk by not doing so. In that respect I feel vindicated.

Next up, a Maternataxi job for a 21 year-old whose contractions were 5 minutes apart but whose waters had not yet broken. She could have gone in a cab but I’m guessing they didn’t have a car and 999 was their preferred option because pregnancy is such a problem these days and is rarely normal, right? I remember well the midwife who once said to a patient I’d taken in by ambulance ‘You’ve had none months to save up for a taxi’.

I’d watched a young black man (gangsta-type) with a metal-tipped brolly causing trouble in Leicester Square in the early hours. I remember thinking that he didn’t have that umbrella for rain as he wielded it around dangerously while his little gang looked on, suitably impressed. Then I met him later on when he called 999 for one of his friends who was now slumped on the street, drunk, with fag-ash on his chest. As I turned the car around to get to him, the brolly-wielding man shouted abuse at me, thinking that I was leaving them there. He probably thought that as they were all young black men, I’d decided not to bother... this in itself is a form of racism. I have no qualms whatsoever about the colour of someone’s skin. I don’t care to be honest.

His mate was in no need of my help and pushed me away at every attempt to start my obs. He got a cigarette out and puffed away quite happily and his crew watched as I became redundant. You see, we are simply pawns of the NHS and we do as we are told to do.

One obese white girl in the gang stuttered verbal rubbish at me as she chomped (ironically I think) on a bowl of salad. Then she looked up suddenly and shouted, as if some magical thing had happened, ‘Oh look. A seagull!’

Be safe.


Anonymous said...

Will taxis carry women in labour? If my income depended on the trim in my car not being covered in amniotic fluid I'm not convinced I would...

Elisabeth said...
This comment has been removed by the author.
MarkUK said...

Some staff round here have been designating the timewasters a Total Waste of Ambulance Time, or TWAT for short.

Is this common parlance throughout the country, or is it from "Call me Dave's" recent faux pas?

Tom said...

Having read the complete post, and not the fraction I read yesterday, I am so pleased your 'glassing' patient survived. The initial feelings of numbness and denial in such circumstances I know well.

I went to Sheffield university. A medical student friend said that the very first thing they were taught was first aid. How those clowns felt justified in turning out a blue light buggy defies common sense. Surely a gentle stagger back to digs via A&E was appropriate.

Stuart. Your observations cause me to laugh out loud, and gnash my teeth in equal measure but I thank you for my education.

Unknown_Knives said...

Stuart, I know quite well the feeling of being told a pacient has died... sadly I get alot of calls on the highway... and many fatal. Though, I must admit, I did feel a certain relief when you mentioned that it was all a rumour.

I was wondering if you could, by any chance, post a brief "dictionary" of the abbreviations you use. You see, I am an EMT in Mexico City, so I really have no idea what you mean when you say SOB, or PS, or most of your abbreviations.

Thank you.

Xf said...


Look up the TPD Glossary that Ive created...its on the left side bar. Tells you all you need to know.

Dan said...

Why don't you have the tools to get a BAC estimate from a patient? It would seem that "fell, hit head, now dizzy, BAC 0.03" would be a much higher priority than "fell, hit head, dizzy, BAC 0.16".

Xf said...


Good idea but what if the BAC is high and they also have a hidden head injury? The problem with categorisation is inherent in that conundrum, so we are stuck with solving every problem with one tool - intuition.