A Urea moment

Day shift: Four calls: One by police van; one by car and two by ambulance.

Stats: 1 DIB; 1 ? Renal problems; 1 ? Flu jab reaction; 1 Chest pain.


Most of the 26 year-old males I go to claiming difficulty in breathing are not and are probably stressed, hyperventilating or just plain over-reacting but the young man I visited at the medical room of his college seemed to have a genuine problem. He had been suffering shortness of breath with a localised chest pain for a few days and the events leading to his condition today seemed to have stemmed from a recent chest infection he’d suffered. On the face of it, he looked like he was hyperventilating... and he was but it wasn’t an emotional response, it was a physiological one. As soon as I touched his hand I could feel that his body was distressed – he was sweaty profusely through the palms.

He was a tall, thin young man who exercised and went to the gym regularly. He had clear breath sounds when I listened but they were somewhat diminished on one side, quite low down and that led me to a possible diagnosis for his condition – spontaneous simple pneumothorax. It’s quite common in young men and isn’t necessary life-threatening but he’d need to go to hospital and get an xray done to confirm it. He may also have had a new infection but I doubted that.


The longest call of the day (it took two hours to get done) was at a police station, where a 60 year-old man was being held in custody for assaulting two police officers the day before. The Forensic Medical Examiner (FME) had requested an ambulance and instructed the police that the man must go to hospital because of his highly agitated state but when I arrived and was handed the doctor’s letter, it said nothing about the man’s health or why he needed to go. On the basis of a doctor’s demand alone, I had to ascertain whether the man in the cell had capacity and could therefore refuse to go (which is what he’d been doing apparently).

I was introduced to him through the cell door hatch because the cops deemed him too dangerous for me to get near. He shook my hand and then sprayed me with his saliva as he shouted answers to my questions. I caught some of his drool in my mouth and I silently hoped he didn’t have anything contagious except a cheery outlook on life. He refused to go to hospital and I was happy to oblige until he told me he had regular dialysis, three times a week; Tuesday, Wednesday and Saturday. I checked my brain quickly and realised that today was Tuesday...so he had to go and get his treatment. Not only that but I wasn’t sure, given his temperament at the moment, if he’d had it on Saturday. This could lead to significant complications, including the behaviour I was witnessing – he was violent, aggressive and almost psychotic.

The logistical problem I faced now was how to get him to his dialysis unit and whether they would accept him like he was (I doubted it and thought he’d have to be sedated). An ambulance was out of the question and I got the cops to agree to take him in their van, with me as company for him in case something went awry. I had to listen to him rant, swear and repeatedly refer to me and the cops as ‘Babylon’ all the way to the hospital. Then he had to be dragged from the van (just as he had been introduced into it), cuffed and struggling into a wheelchair and all the way through the very public (shocked faces and gasps of disbelief) areas to the lifts. Four police officers accompanied me, including two in territorial suits, less the body armour and helmets, so it looked like we were bringing a dangerous murderer in for treatment. He continually screamed and shouted at us, threatening to kill us and demanding to be let go. I felt we were being cruel to him but we had no choice.

The nursing staff, who knew him, told me that they’d never seen him behave like this and that it was entirely out of character for him. So, something was going wrong with him, mentally or physically... or both.


82 year-old men are normally retired, living the rest of their lives in quiet calm, gardening or in a home (shoot me before that happens to me) waiting to die but my next patient was still behind a desk at work. He’d had his piggy-flu jab in the morning and then felt worse for wear later on. It’s possible he was having a mild reaction to the anti-viral or he may have other health issues. He was pale and lethargic with abdominal cramps and nausea – his vital signs were normal but his ECG showed a Right Bundle Branch Block (RBBB) but he already knew about that and he told me he’d had it for years,

I took him to hospital in the car and, although he didn’t felt any better during the trip, he didn’t feel any worse either.


Just as I was about to go home early, after having covered the east area for a few hours as a favour to the sector, I was turned back to go and deal with a 43 year-old French man with chest pain that had bothered him for the past 24 hours. He was walking out of his workplace with a suitcase when I arrived, making his emergency call and the subsequent response look like an ironic bit of silliness.

He was normally fit and well and travelled by air regularly but none of his flights were long-haul. His chest pain sounded more musculo-skeletal than cardiac but it was best to get him into an ambulance and taken to hospital rather than risk it. So, I waited with him for another fifteen minutes and completed every check I could get away with in such a public place. The ambulance arrived and the crew took him to his next destination.


I got home a little later than planned but that’s par for this little course I play on, so I’ll get over it and I’m sure that my colleagues on ‘the desk’ will make up for it next time.

Be safe.