Tuesday, 15 December 2009

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.


Anonymous said...

Sometimes I read your blog and wonder stuff. Today its this. I wish on the occassion we called an ambulance for my mother in law in her seventies that we had the benefit of medical training. I wish when I was taken to A & E by concerned relatives that my severe musculo-skeletal pain was just that - nothing much, only EDS. I wish relative with a severe episode of costochondritis had medical training and hadn't thought they were having a heart attack and therefore wasted professional's like yours time. Hindsight and knowledge are fantastic.

But mostly I wish you didn't spend your entire shift most days having your time wasted by people and then were late home.

I have a relative in their eighties who enjoys gardening and another a little younger in a home who is pretty happy. Both lead full lives and are content apart from the aches and pains that their age would predict. Neither would appreciate being shot. Old age isn't necessarily rubbish. Both look forward to each new day and conversationally are two of the most interesting people. But I guess they shoot horses don't they?

I wonder how many people end up in a Police Cell who have epilepsy, mental health problems or physical debilitation as described when had a little common sense prevailed perhaps a lift to the hospital would have saved everybody's time including yours.

The more i read of your blog the more I sense a very real sense of frustration which I wish you didn't have to encounter. It makes me wonder as well if the eight minute appointments given these days at gp's are somewhat responsible. Had the piggy flu man had been given a cup of tea further to his jab and a little time in the surgery to chat about possible side effects then possibly your expensive time would not be wasted. But my guess is my feelings on all of this are naive and ill informed.

Hope tomorrow's shift is better and you are not late home.

Xf said...


The shooting comment is for my own personal use... I was reflecting on how some people in old age get on with life and others deteriorate. Personally, I'd rather not continue if others had to spend all their time looking after me becuause I cant do it myself.

As for my professional time. It's not just me; it's all of the NHS and yes, you are right, people should learn a little about their health and welfare so that they can deal with minor problems themselves but I'd rather be late home day day of the week as the result of helping one of your elderly relatives because they have a genuine medical problem that for those who simply don't care to consider other, more suitable pathways for care than an ambulance.

Anonymous said...

Have a wonderful first christmas with that cute little fella.

Thank you for the job you do and for the blogging that spreads the reality.

joan said...

Hi xf
wishing you all a happy xmas and new year to u your family, crew and readers.
Happy 1st xmas Harry xx