Monday, 18 January 2010

Stroke day

Apparently this is how my name is written in Arabic.

Day shift: Five calls; one not required; one by car and three by ambulance.

Stats: 1 Haunted fire; 1 Near faint; 1 ?TIA; 1 ?CVA; 1 High BP.

I decided to do a bit of people-watching this morning as I sat idling on Trafalgar Square. At 8am, as commuters passed me by on their way to whatever they do for a living, I noticed that they all had a similar expression on their faces – neutral. I know they’d hardly be bouncing around with grins on their faces without reason and if they did, it would look mad but it made me think of the predicament of the human condition. Most of the time we look unhappy. There are probably a few cultures where the general population wake up and are smiley, happy people from the start but it isn’t here; it’s not us Brits.

Then I thought about myself and how I look from a patient’s perspective. It’s difficult to paint a smile on when don’t feel like it but every now and then my patients just light me up. Something they say or do – the fact that they smiled first... something triggers it and I feel better for it. What I try to do but find so difficult, is approach a routine call with a pre-set happy demeanour. I wonder how many of my patients would begin to feel better if I did that or are we so abused and down-trodden as a profession that it isn’t worth the effort?

Nobody smiled at me until a PCSO passed by; she beamed in at me as she walked on her patrol. A single smile acknowledging one uniform with another.

Smoke coming from a disused part of Holborn Underground Station – a haunted part I’m told by the member of staff leading me and the crew down to the platform – triggered a fire alarm and the Fire Brigade went in with breathing apparatus to locate the source. We stood on the platform as train after train crawled past and onward without stopping, unhappy commuters staring out balnkly at us. The station was closed and the acrid stench reaching our nostrils confirmed that something was indeed on fire behind the area inside the tunnel.

We were stood down eventually by a Duty Officer – nobody was dead or dying and the fire was being tackled by the Fire Brigade. HART was on scene now anyway and we became surplus.

The Underground has a reputation for being haunted and some very interesting stories have been told about things that happen, especially at night, inside the miles of meandering darkness. A self-ignited fire in a disused part (where an old station line used to run) will probably figure among those tales now. Maybe one or two of my readers work or have worked in these places – I’d like to hear any tales you have. We all would I’m sure.

A pregnant lady felt a little faint with blurred vision at work and called an ambulance, so I was sent, as is my remit, to assess and convey if necessary. AT 24 weeks into her pregnancy, she was bound to start feeling the physical effects and I reassured her about the experience, which she was recovering from when I arrived on scene but she still wanted to go to hospital and I obliged by driving her in the car and walking her to the ante-natal assessment unit.

After a quick cup of tea I was off to an hotel for a 47 year-old man who was experiencing right-sided numbness. He had no medical history of significance but had been panicking recently after attending a ‘life coaching’ seminar in which his entire human fabric was unravelled so that it could be re-built. This alone will cause psychological problems in people with lots to unravel, I would imagine (I attended one of these things in the ‘80s – two very expensive days of soul demolition and not a lot of benefit afterwards).

However, the numbness didn’t go away after ten minutes of chatting to him. His FAST check was negative and he could move and feel the affected side. His BP was normal, as were his other vitals, so I still think he was in the midst of a psychological crisis with physical manifestations. Or I could be wrong and he has had a TIA. A crew arrived to take him to hospital in case the latter spat out the former.

Another call in which the diagnosis could be flawed was to a 34 year-old pharmacist who suddenly complained of a swollen face and neck, which she attributed to a possible allergic reaction because she had a history of shellfish allergy. She hadn’t actually eaten anything with fish in it and it did indeed look and sound like a mild allergic reaction – itchy, puffy skin, nausea and that feeling of constriction in the throat. Her breathing was a little fast but she had plenty of oxygen getting in and could talk in full sentences. She felt ‘strange’ but was able to walk towards the ambulance, which turned up just before I was able to complete my obs.

The one element that I still hadn’t checked was her blood pressure. When it was taken in the ambulance it was very high – the high 160’s over the high 120’s. The reading was repeated just in case but it was correct. She had been suffering from blood pressure problems, according to her doctor, she informed us but she had been given nothing for it. Now she was sitting there with a significant indicator for stroke. Her neck pain (and now she had a headache that was getting worse) may have pointed to SAH, so she was ‘blued’ in immediately.

This call would have been taken in the car on the basis of a mild allergic reaction but her blood pressure changed the picture entirely and it was fortunate that an ambulance had been despatched anyway rather than wait for me to ask for one. Sometimes the odds we play are evens for one thing or the other.

A 40 year-old man working for the Government felt dizzy as he walked out of his workplace. He had no history of significance but was being seen by his doctor for high cholesterol, so when the crew arrived and we got him into the ambulance, we took his blood pressure, which was consistently high. He felt nauseous and looked stressed as he called his wife on his mobile to let her know he was going to hospital. He didn’t seem like the complaining type and so the way he felt was to be considered serious enough for him to worry about it and have an ambulance called. He may well be on his way to his first stroke.

Be safe.


Rocco said...

I still have to read the post, but I fear that isn't your name in arabic. Though the letter with two diacritics is indeed a "t", the one with three diacritics over it is a "th" (same sound as the english "th" in "think").

Xf said...


You are probably right and bless her, the girl who wrote it out for me was just starting to learn the language....she thought it made the phonetic 'StU'


Rocco said...

I see... this gives some sense to the second vertical line from the right, which wouldn't have any meaning without a diacritic. She probably mixed "s" and "sh" and forgot to connect their base (common) simbol to the "t" correctly. It happens quite commonly, when you just began.

But she should go on studying, arabic is a beatiful language indeed, although quite difficult. :-)

Anonymous said...

I worked on the underground at night replacing the advertisements on the walls opposite the platforms, one night as I looked down the platform into the darkened tunnel I saw what looked like 2 red lights about 10cm's apart, I assumed it was some kind of LED light thingy, until I made some noise with the ladders the two lights starred straight at me and raised into the air about 10feet, then turned and disappeared. I am sure it wasn't a ghost but it gave me the eebe gee bee’s

Xf said...


Was it a very tall rat do you think? :-)

Anonymous said...

Hi mate,

I've only commented once before but was hoping you could folow up on your 34 YOF - ?CVA. I'd be interested to see what her diagnosis was given her diastolic BP with those odd symptoms (when compared to a textbook CVA)

Xf said...


I will try and get an update on her for you but her symptoms, although not textbook, were indicative of hypertension and there may have been no more than that going on.