Wednesday, 12 August 2009

Terminations


This is a bronze statue of James II. It's over 300 years old and was made by Grinling Gibbons. It stands outside the National Gallery on Trafalgar Square. In his right hand he is holding a traditional (not so bronze and not so old) empty lager can. Its all about culture in the UK.


Day shift: Six calls; four by car, one gone before arrival and one by ambulance.

Stats: 1 Head injury; 1 D&V; 1 Miscarriage; 1 SOB; 1 Tachycardic.


With my regular Student Paramedic (SP) on board, I set off for another exciting episode on the FRU and conveyed our first patient, a 36 year-old lawyer-type, who’d tripped on the kerb and hit her head on a lamp-post on the way to the ground. She had a nasty little cut to her forehead and a mild concussion. She cried in the car as we prepared to take her to A&E and I waited for a few minutes before driving off, so that my hand could reassure her hand that everything was okay. It seemed to work and she settled down.


Our next patient wasn’t so keen to have reassurance, however. We’d been called to a train station for a 25 year-old female who’d felt faint but, as it was only a Green call (which is fair enough) and nobody had been rushed to her aid for twenty minutes, she decided not to bother waiting. She would have fully recovered by then anyway.

I nearly lost my SP in the station; I’d asked her to go inside and try to locate the patient but, as our patient had long since left the scene and the railway staff seemed none the wiser, she was on an empty mission and I was elsewhere in the car. If I went back to where I dropped her off, I might miss her as she came out of another exit. If I stayed where I was, she may never appear again. It was one of those conundrums that you slide into without thinking and where there had been no fore-plan. Luckily, she came out of the correct exit and I was in position to pick her up and give her the good news about our fruitless journey.


Then back to the same train station as soon we were safely out of harm’s reach (yeah, right) for a 19 year-old woman with diarrhoea and vomiting (D&V). She’d had this problem on and off for months and that is enough to be concerned about but her sister had recently been diagnosed with bowel cancer. This young lady was, understandably, stressed and this can be enough to produce the D&V she suffered from but I can also understand her deep concern at the coincidental signs of serious illness. My money is on stress, however, as her problems began when her sister was first diagnosed.

We took her to A&E in the car and kept her smiling as much as possible all the way. We discussed IBS and other fun stuff to keep her head out of the mire of worry and in the here and now, for her own health. Best she thought of annoying but fairly innocuous problems than life-threatening ones, right?


Another heart-string pulling job came along soon after that one. A 40 year-old woman was sitting on a wall with a neighbour and a taxi driver by her side. She was pregnant with her first child and now there was more than a little bleeding going on down there. The taxi driver had been put on standby to take her to hospital if I didn’t show up. The call was given a low priority and I won’t even bother going into this interminable problem with this type of emergency. I’ve said enough in the book about how I feel when women lose babies and are given nothing but a shrug of the shoulders for their pain. Period pains, faints and dizziness are often of no real consequence; miscarriages are permanent psychological scars.

Her blood was trailing down the little wall and onto the soil beneath her. She was being strong and realistic about it and I just wanted to hug her. How many chances was she going to get at her age?

She stood up and walked gingerly to the car – she didn’t want the fuss of an ambulance and didn’t need it anyway. She needed TLC and some grown up appreciation for her current predicament. As she made her way, little spots of grey-tinged blood spattered the pavement. The neighbour watched and the taxi driver watched – both had sad faces and an understanding of the consequences of this departure.

I left this lovely lady in her cubicle in A&E after discussing the other possibilities with her, although we both knew I was talking to her about slim chances. ‘I’m ready to accept the loss’ she told me. ‘I’ve already told my husband that it’s probably gone’. I could imagine a grown man crying somewhere.


A regular caller with imaginary (probably, since it is his MO) shortness of breath (SOB) and a pain in his side, called 999 and had us attend to him at yet another railway station. He was as fake as an eleven-quid note but we still gave him the attention he required ‘cos that’s what we are all about, yes? As soon as we got him into the cubicle bed in A&E, he fell asleep, with no problem at all in the breathing department. I watched him as the SP gave her handover; his breathing pattern only changed when he knew he was being watched. Anyone can do that, mate.


Our last call was to a 65 year-old man with a history of rapid heart rate and who was now suffering a tachycardia that made him feel dizzy. Despite trying the usual things – valsalva and carotid sinus massage, his heart beat continued to run in the high 100’s. He had no chest pain but he did tell me he had Polymyalgia and Arteritis although he did say polymyalgic arteritis but he may have meant this separately or polyarteritis and if so, this was probably the contributing factor if the disease was adversely affecting his aortic artery.

We took him into the ambulance when the crew arrived and an ECG showed a narrow complex tachycardia, so he’d need to go to hospital quickly and get his heart muscle brought under control – either by drugs or, if things got worse, cardioversion, before his condition deteriorated and he went into VF. His blood pressure was dropping and continued to do so when he got to Resus. He’ll survive and his condition will have to be closely monitored for a while, I expect.

Today had been clinically interesting and emotionally challenging without being too busy or dramatic. It’s funny how certain jobs can affect your mood when you least expect it.

Be safe.

5 comments:

Fiz said...

I'm so sad for the woman that (probably) miscarried. It's happened to me twice, and I wouldn't want it to happen to anyone else. I hope she and her husband can be strong for each other. I cried nonstop for weeks and was on the verge of walking out on my husband because he didn't seem to care. He said he did care, but he just showed it differently. Sometimes I think hormones can really screw women up. My second daughter to be came along a few months later, and I hope that this will happen to this woman.

Chapati said...

Miscarriage must be so hard to deal with, particularly when you can't do anything for the woman involved.

Fee said...

At least that poor woman knew you gave a damn. I hope she has a happier ending in the future.

Tom said...

I can only describe that as a 'bastard' of a shift.

I remember attending a doctor who was patiently dealing with a threatened miscarriage with great skill and care. Alas this lady lost her child, but the doc was really very good.

In your patients case, I suspect that you and I went through the 'I better get home as the wife is due..' In reality, I thought that a miscarriage was akin to a loss of a child, and mourned with the family.

Yes Fee, we all give a damn, but with the pressures on the service, an institution of which I was a very proud member, is being wrought assunder with PC, and un-reachable goals.

Anonymous said...

Thank you for understanding that, Miscarriage is devastating - i have been trying for a baby for 4 years and have thankfully only suffered one MC, very early on but still i can relate to this woman. So many people say awful things like at least it happened now and not later, you're so young you have all the time in the world (im 24 now) - thanks but you're not helping! anyway, thank you for getting it. its good to know that someone else understands.

Ellie