Wednesday, 25 November 2009

The kindness of strangers

A lucky escape.

Day shift: Five calls; three by car; two by ambulance.

Stats: 1 ? #Leg; 1 Arm injury; 1 ? Spleen; 1 eTOH; 1 French person

On my own again for a few shifts.

I drove at 1mph trying to reach a RTC that had taken place a mile up the road I was travelling on. That’s the trouble with some of these road accidents; they can cause such a tailback of traffic, especially in rush hour, that even the emergency services have trouble getting to them.

An ambulance was fighting its way through the same mess that I was but we both arrived at the same time at the scene of a lorry vs lorry vs car RTC. The first lorry had ploughed into the back of the second at 30mph. The second lorry was stationary when hit and was shunted off his brakes into a small car carrying a mother and her two young kids. Luckily nobody was badly hurt and all we had to concern ourselves with was the passenger of truck number two because he’d bashed his head on the dashboard and, more significantly, the driver of truck number one, who was trapped by his left leg because the entire front section of his vehicle had come into the driver’s cab, pinning him.

It took a long time for the LFB to pull away the dash and steering wheel so that the driver could be freed – they had to work very carefully, as always, so that they didn’t inadvertently injure the patient. Meanwhile another two ambulances were requested to take away the head injury and the kids (just to be sure). I considered HEMS because the lorry driver’s injured leg had been squashed against his seat for some time now – going on an hour – and I was concerned about crush syndrome. But the leg didn't look too badly pinned and once he was freed, another, more thorough, physical examination ruled out any immediate threat.

I gave him morphine for his pain and we immobilised him for good measure. He’d been very lucky and if he’d had a passenger, he’d have been trapped next to a corpse.

Next, a 68 year-old lady from New York was hit by a speeding motorcyclist as she stepped from the pavement. Police were on scene and she was sitting in a shoe shop insisting that she was okay. She was a feisty 'New Yoiker' type and didn’t look her age at all – it was given as 50 by the system and I believed it.

She wanted to get on with her day and visit the theatre and my advice to go to hospital for a proper examination of her arm, which was swollen and bruised after the hit, was met with mild resistance. Due to fly home the next day, she clearly didn’t want her day to be spoiled by a mere broken arm (if she had one), so I agreed to take her to the local minor injuries centre for assessment. She was happy to do this and invited me to join her at the theatre later on (she’d also offered to take the female police officer who’d been dealing with her back to New York – for her son). I declined her generous offer on the basis that I was too bury with my shift, otherwise I might have been tempted.

This was a pleasant lady with friends in high places (judging by the names she quoted when phoning around) and she was sensible enough to know that her injury may or may not be significant enough for hospital but that she’d take responsibility for herself.

She was deemed fit to carry on (the nurse and I came to an agreement) and so I drove her to the street she’d had her accident in, where she could get to the theatre on time and without fuss. She got the best treatment the NHS could offer and I got a peck on the cheek as a thank you.

Ironically and coincidentally I had been asked by my last patient if accidents like hers occurred regularly on that particular street. I confirmed that they did and, as if the point needed to be made, another call came in for yet another collision at the same spot. This time a pedestrian had been hit by a cyclist who’d run the red light. His handlebar had hit the 30 year-old woman at 20mph, punching into her left lower abdomen, exactly where her Spleen lies and this is what concerned me.

She was sitting on the pavement as police officers interviewed the cyclist and I was given a short handover by an A&E nurse who happened to be passing at the time of the incident. The patient had no significant pain, other than in her abdomen and there was some tenderness on palpation of the area, so I decided I would not be conveying this one in the car and asked for an ambulance. The Spleen is an organ that can be damaged without much in the way of visible changes in vital signs and so I wanted to play it safe with her.

I witnesses a demonstration of the frustration that real patients feel when they take themselves to hospital but don’t get seen because it’s too busy and priority appears to be given to those less worthy.

I had been called to a collapsed 40 year-old man and I found the police around a human lump with a blanket over him and a bottle of wine at his feet. He was drunk and had already been assessed as being so by a crew earlier on in the day. I knew that he was playing the winter game because it was cold today and he was dishevelled and shivering, so I asked him if he needed to go to hospital and got the expected response – an enthusiastic nod of the head. I agreed to take him in the car if an officer accompanied him because he had a record of hitting the police, so I would be fair game with my back to him as I drove, should he decide to kick off.

We arrived to a packed A&E and I apologised for what I’d brought in because it was clear they had bigger fish to fry but as a vulnerable drunken man who’d go on playing his game until a dozen ambulances had been called for him, I was left with little choice.

I sat him down on the seats in A&E and two women who had been waiting there (one of them had been crying), stood up and walked off. To be fair, he did stink of urine and I wouldn’t want to be unwell and in his proximity either. Then one of the women collapsed in pain and I had to steady her until other medical staff helped out. She had a serious headache and had been sitting waiting for attention for hours after having come by taxi and booked herself in. Now I understood the look of disgust she had given me as she stood up to walk away from my offensive friend. As far as she was concerned, a drunk would get higher priority than her. After all, he had arrived by ambulance. For all we knew that poor woman was suffering a serious condition (subarachnoids can present as severe headaches initially).

Meanwhile, out in reception, an impatient patient stormed out of the waiting area to complain about how long she’d been made to wait, only for her name to be called while she was away. She had to sit down again and wait for even longer. This annoyed her, so she got up and stormed off once again to complain. I walked into reception to hear her name being called again and the staff’s amazed reaction that she had missed her second chance at being seen. She might go on all day like that.

Calls can often be a little strange and my next (and last) call of the shift sent me east for a 26 man who had abdominal pain and a headache. He had collapsed in the street but two young ladies found him and taken him to their 5th floor flat in a nearby tower block. This strange action was carried out in the name of humanity and kindness I can assure you because when I got there, three young men and two young women were standing over a doubled-up Frenchman in their kitchen. He was like a sick stray cat, except, as I pointed out for their benefit, he wasn’t and they didn’t know what he might have been up to. He spoke very little English and my French is just about good enough to get by in an emergency, so they didn’t even know what his background was.

I found, through fumbled broken Francais, that he had broken up with his family in France and had run away to London, where he’d spent two days on the streets, penniless. His abdo pain and headache may have been real enough but I think his underlying problem was being lonely in a strange city.

I took him to hospital in the car because he was another vulnerable case as far as I was concerned but I had to keep checking him in the mirror – he was behaving oddly and I had that ‘I’m not sure why but I’m not comfortable’ feeling with him. I imagined him reaching over with a huge knife or attempting to strangle me with my own seatbelt but this mild paranoia probably had more to do with my instinct and natural wariness of people who behave oddly than any actual threat, otherwise I would never have conveyed him, right?

A&E was packed and I had to wait a long time before I got to book him in. All the while, he sat in a seat, looking pain-free and watching everything and everyone around him as if he was expecting something. Maybe I’d behave the same way in a strange, foreign environment if I was alone and desperate.

Be safe.

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