Thursday, 3 December 2009

Down the drain

Night shift: Eight calls: One by car; Two Assisted-only; One treated on scene; Four by ambulance.

Stats: 5 eTOH; 3 Falls; 1 Chest pain; 1 Dislocation

I’m furious already and I’ve just started the shift. It’s Thursday night and that means we get very busy until the weekend finishes but we also have the added bonus of Christmas coming up and, notwithstanding the normality of pseudo-religious connotations for peace and goodwill (cos I guess it exists somewhere), we have the usual regular ‘players’ coming out of the slime.

I was asked to pick up a MRU colleague so that he could be returned to his bike and I got stuck in very heavy traffic on The Strand. I wasn’t going anywhere and when a call came in for a 50 year-old female who had DIB I tried to get going on it. This was an Amber call and I found that odd because DIB should be a category A, although I’m sure there are criteria which reduce it’s importance somehow. An update told me that she was now unconscious and that was very ominous, so I tried even harder to cut through the traffic; but even using the other side of the road, which I normally do, was out of the question as it too was packed solid and not moving.

I was then updated by radio and told that the patient had suspended (gone into cardiac arrest), so I began working seriously hard to get through it all. I climbed onto the meridian pavement and drove along it until a lamp post stopped me going any further, so I was forced back into the dead-stop traffic. There was no way I was going to make this call in time to save anyone. Hopefully an ambulance was there or on its way but it didn’t sound likely to me.

Then I saw a motorcycle colleague attending to a ‘collapsed’ man in the street – I’d heard this call go out to him earlier and he was standing over the man with a PCSO, so I stopped, rolled down my window and asked him if he was dealing with anything important. I knew from the look of it that he wasn’t, so I suggested a swap – he could run on the suspended patient and get there much faster than me. And that’s what we did; he got going and I stayed put, trying to keep an angry drunken Lithuanian man out of my face as he rolled around in pretend agony demanding an ambulance.

When the crew arrived, he was taken to hospital and that, I’m told, was his second trip in today. Now I don’t care how you judge me for this because I, like many others, am simply fed up with people coming into the country for the sole purpose of abusing our generosity and kindness. The cost of this man’s stupidity and selfishness may go beyond our taxes – he may inadvertently be responsible for someone’s death, it’s as simple as that. I wouldn’t want my mother to be left dying on the front room floor whilst ambulance crews, and particularly fast response units are tied up with rubbish like that. He drinks himself into his illnesses and yet he gets a Red category call and thus priority. Some poor woman can’t breathe, is given an Amber, so we can get there in 19 minutes if we want, and then promptly stops breathing, raising the category but all too late. When are we going to implement human intelligence into these calls and make sound clinical decisions based on training and experience? The chances of getting it wrong cannot possibly be greater that the mistakes made by the machines. If a call comes in for a 'collapsed' person and there is even a hint that alcohol is involved, we should consider the balance of what else is going on, so one collapsed drunk with a motorcycle responder on scene and one woman having difficulty in breathing and nobody available - re-assign the priority, like the cops do.

Rant over.

They send me south next because there was nobody available for a 57 year-old drug addict who was experiencing chest and abdominal pain – this was a Red call of course; you only have to mention your chest in any call and it’s virtually guaranteed that the machines will scream in panic and issue a category A. He had muscular pain and I guess it was all part and parcel of his decades of self-abuse. His cousin let me in to the flat and I thought he was the patient’s doctor – he looked so respectable; bespecled and smartly dressed. It threw me for a second.

The unwell man, a long-time morphine addict, was lying on a filthy sofa in a typically filthy abode. No drug addict keeps a clean house – it’s simply not a priority. His pyjamas were smeared with historical faeces and he looked like he hadn’t eaten for months. His methadone wasn’t helping apparently and he wanted me to give him...guess what; morphine. So I said no.

What he did need, however, was glucose because his BM was low, fluids because he was very dehydrated and metoclopramide to stop him vomiting his recent red wine dinner up.

He was in very poor health and, judging by the look of him, he didn’t have long to go. The pain in his side was a secondary problem compared to his general health and I could see why doctors simply gave up on addicts who’d come this far. A doctor had visited him earlier, obviously seen him in this sorry state and said she couldn’t do anything for him. Now the crew and I were here, we had no choice but to deal with it and I really wanted to try and make him comfortable but his future is bleak and others are dying and in pain, through no fault of their own, so I can’t reconcile this at all. I just treat and go.

‘Morphine’s good for me’ he said after my third refusal to give him the drug. I wanted to say, ‘Yeah, I can see that’, but I didn't.

As the night progressed I was sent to deal with a 50 year-old man who’d drunkenly fallen down steps on one of those party boats on the Thames. To be fair to him, he was no more than cheerily drunk – not irresponsibly wasted, so I guess his tumble was just one of those mishaps that occur when judgment is impaired. He had a history of brain tumour and his caring friends were concerned that there was a connection but I highly doubted it as he seemed fine apart from a nasty 2cm incision on his forehead. The skin was split deeply enough for a trip to A&E and a couple of stitches but he was resistant to the idea and it took all of my persuasive powers to convince him to go in the car. He’ll feel better about the decision in the morning I expect.

A patient for the booze bus next – he’d fallen as a result of having a proper skin full and the 'bus' was in front of me near the scene, so I asked if they could do the honours. His head was cut above the eye but he was okay otherwise so off he went to drunken heaven with the drunk-bus heroes.

After a quick coffee at Bar Italia in Frith Street, where all of the emergency services (armed and unarmed) go, I sped off to Charing Cross Road to help with a drunken 20 year-old female but she was beyond it. She was abusive and annoying, as was her potty-mouthed brother but they meant no harm; alcohol was speaking on their behalf. You might know what I mean - they swear, then istantly apologise to you for doing it, attempting to hug you as if you are their best friend. A crew just happened to be on scene with another drunken female, who’d fallen asleep in the underground platform. She was much more pleasant and continually smiled, although she wouldn’t give us any information about herself – off she went to hospital and the other one was left to the police.

A 30 year-old alcoholic woman fell through a half-open drain (see above) and sustained a nasty wound to her leg which bled through her jeans but which she adamantly refused to let me see or treat. She also chipped out her two front teeth on impact with the road and even when the police officer explained to her that she needed to go to hospital, as I had advised, so that she could be treated and then have evidence for a possible claim against the council, she refused. I was surprised to say the least but maybe I was misjudging the poor woman.

Her can of lager was of more importance than the prospect of compensation, possibly to the tune of a few thousand pounds. Anyone else would have been jumping at the chance to get some money for an accident like that. So, in this age of ‘where’s there’s blame, there’s a claim’, it was quite an exceptional thing to witness.

She wandered off after I had attempted, time and time again, to get her to come with me to hospital. She had sharks teeth and a decent wound under her jeans (which I had to dress over the clothing just so she could get on a bus home) but she didn’t want to know. All she did was cry and cry... oh and then go back to pick up the can of lager she’d left on the pavement. I think she was pregnant too but I didn’t ask.

This is the time of year when we frequently encounter normally decent people who have imbibed so heavily (‘cos it’s Christmas time) that they become rude animals with no respect for themselves or anyone else. The 30 year-old lady I was asked to help was asleep on a petrol station forecourt – oblivious to the comings and goings of traffic around her. The station attendant called us and rightly so as she was extremely vulnerable. Her handbag was lying next to her with her mobile phone and purse sitting on top of it. She could have lost it all in a second if someone had been nasty enough to consider robbing her.

She was obnoxious to begin with and refused to let me help her, so the police arrived and we spent the best part of 30 minutes trying to get her to go home. The first black cab the officer flagged down refused to take her as far as her address so I suggested a private taxi which had just pulled up into the station. I’m not sure of sending people like her in these cars but if black cabs are going to refuse to go distances then this is probably why they are being overtaken by private hire firms – sorry but if you won’t pick people up in the rain, take them ‘over the river’ or you have a preference for clientele, then the public, who have a choice, will go elsewhere.

She managed to stand herself up and flirt with the police officers and myself until we could get her to draw cash out for the fare – then I escorted her to the taxi and off she went but before she left, she sobered up enough to say this ‘you shouldn’t be wasting your time on a w**ker like me, I’m shameful’. Well, at least she could see what was going on from my perspective, although I didn’t think she was a w**nker. In fact, I didn’t think women referred to themselves like that at all (call me old fashioned).

Some calls are interesting for tame and mundane reasons. I was asked to attend a Greek man at a hotel that had ‘locked’ his knee when trying to stand up. I gave him entonox and straightened his leg whilst manipulating the patella gently so that it slid nicely back into its natural place. The click was audible across the hotel lobby I think and I felt it go in. The pain he felt initially was overtaken with relief and he was soon able to stand up and walk around on it – the more he did, the better it would be for him anyway. I advised him to consider hospital in case it slipped out again but he declined.

This sort of thing is outside my remit as a paramedic I guess but I’ve had a lot of training and experience with dislocations of this nature and sometimes just a little bit of movement is all it takes, so long as you know your anatomy well enough. I got a nice warm satisfied feeling out of doing that and it only took ten seconds, so no ambulance, no A&E and no hassle for anyone. I mean, all I'd done was straighten his leg for Pete's sake.

Further into the night, as 4am approached, I went to yet another drunken female but this one claimed DIB, or at least the person who dialled 999 did. She refused to go to hospital and rightly so because she was just drunk. The 25 year-old admitted that she was bipolar and this became evident from her erratic and changeable behaviour but then alcohol has the same effect; every drunk is bipolar to me.

After a lot of debating back and forth with her friends, who she loved and hated in equal measure during their conversations, I agreed to take her (with her mates) back to their hotel so that she could sleep it off. It was either that or get the police to prise her from my car because once she was in the back, she wouldn’t budge – even for a taxi that had been called for them all. It was a non-eventful journey and she will forget about the help I gave her and that’s okay because we are all used to such disaffection for our roles in society, especially when we are against a tidal wave of alcoholic indifference.

During the shift, I went into Resus and asked about the cardiac arrest lady from earlier. I was told that she died.

Be safe.


Anonymous said...

I don't normally comment on this blog but I just wanted to say how powerful and moving I found this post.

Anonymous said...

Soul destroying sometimes ain't it! Bring on nhs pathways, hopefully we can filter out more of the crap. Unlike ampds it realises that not everyone is dying when they ring 999.

How u getting on with airwave in London? Find it weird not knowing what everyone else is up to?

Achelois said...

I agree with the above annonymous comment. I understand the frustration with the drug addict but also wondered to myself what it is about our society that means there is no empathy for those with what undoubtedly is an illness near the end of their life. Perhaps his percieved 'weakness' was brought about as a result of childhood abuse too intolerable to bear or even if you are correct and his demise is entirely self inflicted. Its a sad and sorry story that he & others around him apart from the friend, care so little about the loss of a human life that he is discarded like rubbish as unworthy of the provision of at least a safe, clean environment in which to pass away. I am sure many analogies could be drawn with junkies & alchoholics but I don't see either of these categories as less worthy of attention regardless of where they come from. Had either of these people also been obese would they have been even less worthy I wonder? Their predicaments shout louder to me than the rest in a way - lonliness, depression, desperation & more. I am sure the young lady with mental health problems just wanted an enjoyable night out.

Its the one's who are fine who willingly drink to oblivion who have the choice not to, not plagued by addiction who I have no time for.

I have Ehlers Danlos so dislocation is a common day occurence for me. I thankfully have learnt to re-locate without bothering the emergency services.

I don't know how you do your job frankly and I understand all of your frustrations, I worry though that the final impact of constant exposure to the less fortunate in society forced to seek help in desparate cirumstances become the victim of an unintentional assumption regarding their sad life circumstances which evokes the fury you describe so eloquently.

Drug addicts & alcoholics are human beings and long ago they were children with a future ahead of which I have no doubt no one ever envisaged the sad sorry state you have the misfortune to encounter on a daily basis. I just wish this wasn't the case for you as I am sure in part your frustration is that you know so well - nothing you do or say will help them long term. Perhaps & I so hope this is the case is that your frustration is with society itself & the system within the confines of which you have no choice but to work within.

JB102 said...

Normally I'd check the MPDS coding for you and I'd confirm how a DIB can code amber. I can't do that any more so working from memory I believe it will go amber if the patient can complete whole sentences and has no other associated symptoms, based on the callers information of course. Odd that she should then go onto arrest as a result but you should never trust the caller.
As for a red drunk you really shouldn't get any unless the patient insists they are completely unconscious, otherwise you can chalk them up as O/D and the highest they get is amber 1.

Xf said...


My title tells you how I feel and I thank you for writing what you did but, as I have higlighted before, nothing I say or feel is a personal attack on a person, except those who willingly and deliberately waste resources and perhaps cost more deserving people their lives. It's just not right.

This drug addict had no terrible childhood; he got into his habit as a matter of choice when he went abroad. I always know the background of my patients before I comment. Nevertheless, it was his doctor who left him in the grime of his life, not me or my colleagues. I recognised immediately his need for help and he got it without bias.

We all have a tough life story you know and we don't all run to drugs or alcohol to hide. I'm sorry but much as I understand your point of view, I dont accept that they do not have a choice, like everyone else. Only a very few are forced into this life.

And most drug addicts and alcohlics live in filth - even if someone came round every day to clean up, they would continue to allow their environment to become unkempt and unclean. When you want to go to the toilet, you get up and go. They can do the same but they do not. This is what I see, almost without exception.

Xf said...


Yes,we need to change things.

Airwave is not great as far as Im concerned. The human touch has gone and it just doesn't work like it states on the tin, does it?

Achelois said...

Just to say without I hope harping on - I honestly wasn't getting at you personally, perhaps I didn't get across what I meant to say well enough. I tried to go on to say, that its unfortunately people like you that are left to clear up others mess and that this must make you incredibly frustrated somedays. In the same circumstances I don't honestly think I would have the dedication to check everyone's details so thorougly working in such pressurised circumstances. I'll be off before I unwittingly offend anymore. Take care.

Anonymous said...

im a reular reader and in the job in West sector, hearing about that suspended made my blood boil, i very rarely end up in central, but when i do,im glad that we've got bikes and CRU's because even 2 miles can take ten mintues on lights and the drivers/pedestrians are reckless, I couldnt work there on a daily basis, dont know how you do it mate

Xf said...

Anonymous (West Sector)

Too right mate. I'm a glutton for punishment I guess.

We all get hacked off when we hear these calls. We spend years training to do something about them and we get stuffed by the pencil-pushing processors.

Xf said...


Oh, you didn't offend. Chat to some of my regular readers and they'll let you know that you can say whatever you like as long as it isn't personal or offensive. Your point of view is every bit as valid as mine. I'm really not that sensitive :-)

Anonymous said...

The problem of the drunk Lithuanian is a pan-European problem. I don't know if this also happens in Britain but I do know that in the last couple of months a few Lithuanian lorry drivers have caused fatal accidents on German motorways (with more than one death plus the less awful problem of motorways being closed for hours) and one of them had just picked up his mate who had been stopped by the police the previous week and his licence taken off him on the spot. There was another one today. The blood alcohol levels are often three times the legal limit. There are nice ones - I've met several, but I wish the others would stay at home.

Tom said...

This is a bit off the main topic of todays blog, but is just a question out of interest. I'm an intensive care paramedic in Australia and was wondering; do you transport all cardiac arrest cases (excluding obvious deaths)? Our protocol is not to transport unless we gain retainable ROSC.

Xf said...


No, not always. If there has been a decent effort made and no change then we can call it and leave the patient but age and circumstances must be taken into account.