Wednesday, 26 May 2010

Professional junkie

Night shift: Seven calls; one assisted-only; five by car; one by ambulance.

Stats: 1 panic attack;1 head injury;2 eTOH;.1 dizzy person; 1 eTOH with head injury; 1 dislocation.

A 20 year-old student had been hyperventilating for an hour or so when I arrived – not that I was late; her friends wanted to control the problem themselves and she didn’t want to go to hospital. The young lady has a fear of crowded places, so coming into London and getting involved with the public transport system was probably not a good idea.

As she puffed frantically, with her friends around her and an oxygen mask going nowhere on her face, it became clear that she wasn’t going to calm down for me – or anyone else, so I took her to the car and prepared the paperwork for the inevitable trip to A&E. She collapsed to the ground from the back seat and so I knew the time had come to stop messing about and take her with one of her friends, leaving the others to go home to Kent on their own.

I started the journey and realised I didn’t have my paperwork with me. The reason for that became clear a few seconds into the trip when my folder slid down from the roof, where I’d left it, onto my windscreen. Luckily, it slid nonchalantly, so I think I got away with it. Unfortunately, however, my cover was blown when one of the patient’s friends ran up to me and handed in the PRF I’d just completed. It had blown into the street when I took off. I don’t think any of that helped my patient’s breathing.

Then I was sent to a possible assault with a head injury, promptly cancelled for a higher priority (allergic reaction) and then cancelled again to be re-instated on my assault call. The 30 year-old man had allegedly been chased down by door staff at a pub – he fell down stairs and bashed the back of his head. Police were on scene and the patient was nursing a painful noggin when I got there. He was complaining bitterly about the ‘murderous’ doorman but I had to take his head injury seriously because he said his skull was tender to touch where he already had scars from a RTC-related head injury he’d sustained years before. That time he needed emergency hospital treatment, so I opted to take him in the car with two police officers flanking him. He’d been arrested and was cuffed.

On the way, a call came in for a RTC in which a pedestrian had been struck by a car right on the route I was going to travel. Control asked me to stop and render aid and the two cops had to sit in the back of the car while I did so (the man who’d been hit was drunk and had been clipped by a taxi. He was conscious and breathing). When a motorcycle paramedic arrived to take over, I continued my journey but now my patient was getting drowsy, so I sped up and got there quickly.

He was taken into a Resus bed for observation, police at his side. In the midst of it, a woman with lots of tattoos threw herself to the floor of her own cubicle, tearing the curtains from the hooks, and proceeded to have the worst ever acted fit in history. She was so bad at it, the police around her paid no attention and the nurses stood and told her off as she wriggled like a worm. It was going to be a crazy night.

Two words that come up very often on a Wednesday night are ‘drunk’ and ‘student’. Even the country’s most intelligent minds haven’t yet worked out the limits they have for alcohol... or they simply don’t care.

A 24 year-old Chinese girl collapsed on an underground train and I found her lying on the platform with staff members, an off-duty police officer and an off-duty nurse tending to her. A friend was sitting on the bench but she was very drunk and I preferred to talk to the nurse and cop initially.

The girl had downed a bottle of wine (her and her mate had drunk two between them) and now she was vomiting on the platform as passengers got out and walked around her, staring and gawping in mock interest. I got very little response from voice but she moved when a painful stimulus was given, so she wasn’t too far gone.

A crew arrived within ten minutes and we bundled her up to the ambulance for a trip to hospital that had her friend crying and wailing and would no doubt cause the young unconscious lady some degree of shame when she woke up.

A 27 year-old man suddenly felt dizzy and light-headed whilst going home on the underground, so he got out of the train and asked staff to call him an ambulance. I was sent and I took him in the car to hospital. He had no medical history but this had happened to him before and his GP had diagnosed stress and that may well be the case but a constant feeling of light-headedness and faint could also be significant, so an ECG would be a good idea.

The more intelligent members of society also seem to be more likely to become obnoxious when drunk. I see it as a sign of repression; they may always be of that nature but they manage to hide it well enough until alcohol disinhibits them.

A 35 year-old woman fell down and banged her head on the pavement, so her friend called an ambulance and I arrived to a drunken patient who was a little annoyed that I was trying to help her. She had a lump on her head and her bemused friend had to keep her restrained when she began to get a little rattled about her predicament.

I took them in the car to a crowded and noisy A&E department, where the fire alarm rang out incessantly, a very small baby vomited through its mouth and nose and a cubicle containing a supine, star-legged man having his hands held by two large and unshaven transsexuals made the whole thing surreal. They must have thought they’d been taken to a bad dream.

She mouthed off at the nurse for no reason (something about ‘do you know who I am’) and had to be told to show some respect. I left her in the nightmare called A&E.

I went onto the FRED system after midnight and calls bombarded me as expected. They were cancelled one by one but I am still expected to start running on them – I’d be starting and stopping at a ridiculous rate if I did, so I waited for one call to settle and went on it.

I was soon in a dark little alleyway, on my own with a man who appeared to be folded over on his front in a doorway. He was outside a pub and he looked to be either asleep or dead. Luckily, when I shook him hard enough, I found that he was alive and for the first time in a while I was being very cautious about him in case he turned on me because I had nowhere to escape to in this little street.

Then a young woman appeared from inside the pub – she had called the ambulance because she couldn’t wake him and didn’t want to touch him. He could have been a drug addict who’d overdosed and I can understand her reluctance. The guy soon sparked up, however. He told me he lived locally and was just drunk but that he could walk home. Fair enough, I thought. He got a free bottle of water from the friendly pub girl and staggered off into the night.

Soon after that call I was asked to assist an off-duty paramedic who’d dislocated his shoulder ‘whilst dancing’ the info stated. I found him on a bar stool in a pub that was closing for the night and he told me he’d dislocated his shoulder posteriorly. He also asked for an analgesic we no longer carry and an anti-emetic we never used and this had me thinking.

His shoulder was out of place and I gave him entonox and a small amount of morphine (and metoclopramide; the anti-emetic we do carry) but he vomited violently all over the floor, my bags and my uniform. My boots and trousers were peppered with sick splashes that I knew wouldn’t come off easily. It was almost as if this guy knew what was going to happen if he received morphine – he’d even specified the cannula size and site for the IV injection – it was all a bit strange, so I stopped all analgesia and took him in the car (once he’d stopped throwing up) to A&E.

Once inside, the nurse recognised him. He’d told me he frequently dislocated his shoulder and the reason he’d given for tonight’s mishap was that someone had bumped into him as he left the toilet. Someone, somewhere had said he was dancing, didn’t they? The nurse in the hospital (which he’d asked to go to) said he’d been in four times this week.

I asked him about carrying patients and bags, etc at work but he didn’t give an answer. Then a crew took me aside and explained that they knew this young man. He wasn’t a paramedic at all and he frequently worked this number to get morphine. After all these years I felt like a prize chump.

Be safe.


Cat said...

Have you seen this story?

The first of many, perhaps?

Anonymous said...

Hi there

just wondering: that "pseudo-paramedic" with the dislocated shoulder: first of all you said his shoulder actually was dislocated, so he might be one of those people who can do that deliberately and without too much pain (we had a girl in class who could do that with her kneecap without feeling any pain and she used it - not to obtain narcotics lol but to make us all go "yuuuuuk" and "aweeeeee" ;-)

Then: he is obviously a drug-seeker but why does he tell everyone he is a paramedic? What for?

And most of all: WHY does he fake a painful dislocation to obtain morphine, yet asks for drugs you don't carry (which he should know if he was a medic), PLUS: WHY would he want morphine if it quite obviously makes him throw up and feel sick???
Don't get that :-(

Anne (from Surrey)

PS: very interesting and entertaining blog btw, love it

Xf said...


I've no idea. He's not a medic; that's why I was wary when he was getting his drugs wrong but I don't know why he does this.

Joe said...

Maybe just looking for that initial hit, and is willing to put with a bit of puking to get it, or perhaps he's just a weird sort seeking attention?
Altogether more amusingly, he might have a weird fetish for being cannulated by a hairy bloke?

Anyway, stay safe Stu, and keep up the good work.

Achelois said...

mega long post so a complicated evening.

To blogger who described fellow student who could dislocate at will to freak out classmates. I used to be able to do this without pain turned out I had a rare connective tissue disorder known as ehlers danlos I didn't know this then and it would seem I caused myself significant harm in showing my party tricks off only to be known later in life when said rare connective tissue disorder showed itself! Daughter inherited it and I dissuaded her from showing off her party tricks!

I have a relative hence my annonyimity here as they are adopted and Chinese who has a gene common in many of Chinese origin who is intolorent to alchohol. Missing the gene which metabolises it? ethananol? am afraid I am no medic so sufficient medical detail hazy. Suffice to say that after only one drink he gets what is called an alchoholic flush indicating the missing gene and acts as though he has had about a whole bottle of wine. Turns out many Chinese people have this condition if one could call it that and it renders the poor sufferor very incapacitated. Not saying this is the case here but could be why she fell apart completely after a whole bottle and also the reason why she needed to go to casualty as apparently the feeling is awful as the sufferor has no idea why what it seemed not too much alchohol (bearing in mind our propensity for it) rendered her completely and devastatingly incapable. This is true and worth medics in the UK reading up on it as it may make it easier to be kinder to seemingly very drunk Chinese who don't actually feel as though they have drunk too much when they are just trying to keep up with their peers. Strange but so true.

The rest of the night sounds really stressful. I hate it when people feign seizures having two close relations with 'proper' epilepsy I was really intolerant of it until a clinical psychologist friend explained that sometimes people who do this have unresolved and very real issues sometimes based in a history of childhood sexual abuse. Since then I have been more understanding. Obviously not saying this is the case here but it did help me to not judge anyone with a pseudo seizure and my understanding is that ignoring them is not entirely helpful.

Anyone who feigns stuff for whatever reason may not actually have a weird 'amusing' fetish but may actually have very real emotional problems. Physical illness sometimes I think is easier to deal with than undiagnosed attention seeking behaviour which may have its roots in a very real mental health problem.

I may be naieve or accused of being too understanding but I think there are many people in casuality who feign physical illness because they are unable to access appropriate mental health services, it must be difficult to do so when emotionally unwell perhaps?

I really do admire your patience when you continue to give of yourself professionally over and over again when sometimes you must just want to say &*^% *&^ !!

Sam said...

I got done by a morphine seeking patient the other week.

She was a very convincing lady, supposedly with horrendous abdominal pain, which had been on going with investigations. I was suspicious but she put her pain at 10/10 so thought I'd get a bigger roasting for not giving morphine to someone with genuine 10/10 then for giving it to someone hamming it up.

We arrived at A&E and she had been a problem patient in there that very day. She has had scans and test gallore and has been told there is nothing wrong. She lists such a random and extensive list of problems and symptoms its a very odd.

I got back to station adn found out another paramedic had been fooled by her the night before!