Friday, 9 March 2012

The shopping trip

The second night shift with the Welsh one....

A call to an 82 year-old female who is reported to have a fractured ‘P12’ (soon to be reasoned out as a misheard T12, unless there are new vertebrae I’m unaware of), starts us off. We arrive to find the lady in a lot of pain and a crew on scene. Our task is simply to assist with the transfer of the patient from her sofa to the ambulance down a few flights of stairs.

The poor old lady is unable to move or be moved without a good deal of discomfort and her anxious family stand around us, no doubt wondering how we are going to get her out of there. She’s been given 5mg of morphine but it’s nowhere near enough. The paramedic on scene is balancing the analgesic dose with the lady’s vital signs, but she gets another 5mg because pain is the greatest enemy of sustainable vitals, and the removal, or at least easing, of it can make everything much better; respiration rate, pulse rate, blood pressure.
Once she’s settled, we decide to transfer her onto a scoop stretcher by sliding it underneath her and pulling her gently onto it. Then we place her on the floor, wrap her up to secure her, and lift her all the way down to the ground floor and onto the trolley bed, which has been parked outside the uselessly small lift.

As soon as the lady was inside the ambulance, Naomi and I set off on the next call. The idea for these two shifts, is to clear as many of the waiting and minor calls as quickly as possible by running on them and either transporting the patient ourselves or deciding on an alternative pathway. Additionally, the options for most of the calls we receive are pretty straight-forward. We can leave the patient at home, treated and safe, or we can leave them at home awaiting a GP visit. Our aim is to hit and run, as it were, to reduce the number of calls that are clogging up the system and slowing down an ambulance for those who really need it.

A 49 year-old woman with chest pain in a train station next. She was a known asthmatic and she had a slight wheeze, but you can never tell with chest pain and so it was prudent to have a look at her ECG before making decisions in the direction of a cardiac origin. A crew turned up within minutes of our arrival and so they took this patient for further investigation.

Then a call to a 23 month-old child who’d ingested incense somehow was cancelled, so I did a quick U-turn. The call was reinstated and I did another U-turn.... then it was cancelled again. My U-turns are getting very good.

An aggressive 56 year-old male, with a special liking for harassing female crews, called for an ambulance but we were sent to suss it out because he rarely needs to go to hospital. When we arrived, I knocked on the back door of his house and he shouted for us to go in. I was a bit wary because the little room he stayed in was gloomy and unlit.

He was lying in bed; his island in a sea of debris and rubbish strewn all over the floor and around him. He told me he had high blood sugar and needed a nurse to come and give him insulin. Naomi checked his BM and it was normal – so he didn’t need anything.

He accepted that all his obs were normal and he asked if we could go and buy him some bottled water and a pay-as-you-go card for his mobile phone. He asked politely but routinely. He had clearly done this many times before.

I spotted about a dozen bottles of liquid on the floor and I drew his attention to them.

“What about this water? Why don’t you drink this?” I asked.

“That’s piss”, he answered.

He wasn’t insulting the water per se, he meant what he said. He urinated into bottles and just left them in the middle of his floor. A simple and efficient system I thought.

Naomi did his shopping (the local shop was only about 50 metres away) and returned to report that the shop keeper knew who she was buying the water for. This, indeed, was a regular habit of his.

I accepted the shopping trip this once but when he asked me if I could pop over to the GP surgery, which was in the same location as the shop, to check when the nurse could visit, I told him he’d reached his limit as far as goody-tokens were concerned. We bid our farewells and left before he asked us to spring clean his flat for him.

In an office more centrally located than the last call, a 28 year-old female had a faint, a fit or a panic attack – nobody seemed to know which. The evidence pointed in the direction of a panic attack because she admitted to having them and seemed poised for another if she didn’t get out of her environment quickly. Her colleagues were concerned and this was creating tension, especially when they spoke of her being unconscious and having seizures, none of which she could recall.

So, an ambulance crew took her off to hospital and by the time she’d reached the steps going in to the vehicle, she seemed much better. She’ll have tests done but I doubt they’ll find much wrong with her.

A drunken 70 year-old staggered into a bar, sat down, wet himself and then proceeded to annoy the customers, according to the manager when we met him. This call was literally around the corner from the last one and so we were on scene very quickly. But even our rapid response couldn’t beat the speed at which the tall manager had removed the drunk from his premises.

He was sitting on a chair outside the front door as people came and went and the street began to get busy with nightlife. He was a typical amusing drunk. That is to say, he was harmless but more than a wee bit annoying and clawing. He wouldn’t tell us where he lived or where he was heading. Neither would he admit to drinking much. We’d considered and abandoned a stroke possibility because he reeked of alcohol and his demeanour was of one who’d practised this art of boozy-clowning over the years.

Naomi went to get something she needed and I was left for a few minutes with the man. He pawed at me, grinned at me and then warned me that he was going to wet himself. Then he fulfilled his promise and a stream of urine trickled out from his trouser leg and onto the pavement. The local smoking women standing outside the bar were not impressed.

Luckily the ambulance arrived and I was able, with Naomi’s help, to get the man to his feet and away from the area before his dignity went the way of the meandering liquid he’d deposited. When I informed the manager of the bar that there was a pool of urine just outside the entrance, he was not pleased with me at all. “Stuart, I can’t believe you let him do that”, he chastised.

So, two lessons here: number one; paramedics cannot prevent nature from taking its course when it comes to drunks peeing. Number two; be careful who you give your name to.

The next call initially looked like it would need the assistance of the Fire Service. We arrived to find a 45 year-old man semi-conscious, with his arm trapped in between a railing and a wall, near the top of a flight of steps. It looked tightly stuck. Passers-by had noticed the man behaving strangely and had reported him being unconscious at times. Now he was semi-conscious, semi-standing and possibly risking the loss of a limb.
We carefully bore his weight and attempted to free him by sliding his body up towards the top end of the steps. It looked possible but was very tricky because his arm was being squeezed even tighter at times. Suddenly, however, the man woke up. He reeled around and seemed momentarily confused. He fought against us as we tried to keep him still, then he yanked his arm out of the space. If he’d done that before we’d taken his weight, he’d have ripped it off at the elbow.

Then things became very strange indeed. He didn’t want to go to hospital. He didn’t want to be examined and he denied being drunk. He did admit to smoking a little weed though, but he was very embarrassed. I can’t tell you what he did for a living for obvious reasons, but it’s not the sort of thing you do very long in your life after being caught under the influence of drugs.

An ambulance arrived and I explained the situation. The crew insisted on taking the man inside the vehicle for a chat about what to do next. He couldn’t go directly back into the hotel where he was staying (the hotel that the stairs and railing belonged to) because he’d almost certainly start to behave erratically and things would go bad for him. The idea was to persuade him to go to hospital and ‘dry out’ before going back. A fair proposition I think, don’t you?

A bit of a selfish one next. An encounter with an HiV positive patient who walked out to the car and demanded to be taken to a specific hospital because he’d been banned by the nearest one for ‘aggressive behaviour’. He then demonstrated this by getting angry when I told him we’d be taking him to the nearest. He stormed off but came back and relented.

I looked at the miles between one hospital and the other, and decided to give him a break. I’d take him to the next nearest and hope that would appease him.

He had bleeding open sores on his head and had been picking at them. He put blood on his hands and purposefully wiped them all over the back seat and head rest. I had warned him on several occasions to consider where his blood was going but he didn’t seem to care at all. I could have sat there and dressed each and every separate wound he had but it would have been pointless because he was determined to mess with them.

Eventually, he behaved and allowed me to take him where he needed to go, without further fuss.

Later on, after coffee and a bit of a break, we went to see a 63 year-old man with back pain. His front door was open and after announcing our arrival with a knock and a shout, we entered his flat. It was in darkness, so we tread carefully.

The patient shuffled out from his bedroom to greet us. He was naked except for his underpants, which were worn and freshly soiled. He was clearly not being taken care of and his first complaint was that his door was unlocked. Apparently his carers had been earlier but they’d left his door unsecured – allegedly anyway.
“That door is always locked when they leave”, he told us.

He had chronic back pain and was prone to falls. All he needed was his medication, which had not been given to him by his visiting carers, again allegedly.

I checked his blister pack, called his care team and then, after clarifying that he had been visited but nothing had been done, gave him his Tramadol. I made sure the care team knew that this man had been left exposed, in more ways than one, and that his meds had not been given, as prescribed.

He didn’t want, or need, to go to hospital but he was genuinely upset that he’d been neglected like that. I sympathised with him, as did the red-haired Welsh one. We’ve both seen this time and time again in our business. It’s sickening.

Finally, we get a call to a man who is inside a pink taxi. He’s either drunk or under the influence of drugs. Police are on scene and they want us to check him out because they’ve found a large number of tablets and paraphernalia on him when he was searched.

We arrive to see the pink cab driving away with a furious looking female cabbie behind the wheel. The man is being spoken to by the cops and his tablets – some prescribed, some illicit, are on the roof of the police car.
“He made the cab drive around for a while and he jumped in and out of several clubs, pretending he had business in them”, explained one of the cops. “But he was getting drugs or messing about. We found a crack pipe on him.”

They didn’t find any evidence of hard drugs on him, however. Most of the stuff they asked me to identify was his own or somebody else’s, but nevertheless harmless.

The man himself was unusual. I mean, he didn’t come across as a typical drug addict. Instead, he looked like a lost lamb; somebody with no purpose and the need to find one. He may have had (and I suspect he did) mental health issues.

He had no need of hospital and the police weren’t going to arrest him, so he was told to walk home. He pleaded for a lift but the cop’s order was quite clear.

“You aren’t wasting our time or the LAS’s time tonight. You are going to walk home.”

He only lived around the corner anyway, so it was no big deal.

This man had spent a few hours in that cab apparently. He had the driver take him from place to place in a circle until he’d run up a £100 fare, which he didn’t pay. I’m truly surprised that any cab driver would have allowed that to happen. I would have thought he’d be asked for at least some of it when he stopped for the first time and got out!

Be safe


Pienk Hasie said...

I love reading your blog. I'm an ALS paramedic in South Africa. (Yip, working with a bullet proof) Trying to stay human with all the violence. Interesting how a lot of your patients are similiar to mine and some conditions worlds apart!
All the best and stay safe!

Isla said...

It's great to see your back and posting about patients again.

Lawrence said...

Great to hear your posts again Stuart. Keep 'em coming!

Yrina said...

Gosh, how you survive day-to-day.
I would have certainly lost my patience with some of them! It is people like you who keep Britian going and look how you get treated, all the respect has gone for the NHS.

Anonymous said...

As a paramedic in Cheshire, it seems the problems we face in the ambulance service are endemic throughout the country.
I have long believed that it is also a social problem that we are facing - in that when an address comes up, we can say with a degree of accuracy if the "job" will be genuine or not.
Most working people are used to supporting themselves materialistically and emotionally and will call an ambulance as a last resort.
The cant work wont work section of our society are used to demanding and getting, have no idea of the concept of responsibility for their own actions,(and social responsibility,) and are selfish in that "I know my rights and I pay your wages".
People need to take responsibility for their own actions,(I tell my sons that whatever they say or do, there is always a consequence - be it good or bad).
The ambulance service does a brilliant job - it must be one of the most rewarding professions in the job market but we are only human.Self inflicted obesity, binge drinkers who pass out and vomit over us,matern-a-taxi,callers who cant be arsed to call a GP and GPs who cant be arsed to do the job they are incredibly well paid to do will annoy us.

John said...

I just wanted to say I am really enjoying your blog. I am training to be a paramedic in September and find what you say fascinating and love the way you write - it's awesome!


Anonymous said...

I find that very hurtfull john in December I had to call out the paramedics as i was in a lot of pain all of a suden I called my doc 1st but was in so much pain i could not wait 2 hours to see him and i was so apoigetic for calling 999 I may not work at the mo but I have respect for the 999 crew ok and not all of us are like that so please do not judge us all as the same because we are not

Alex said...

WOW, what an interesting account of what it's REALLY like being a paramedic. It's quite honestly one of the most unflinching accounts I've ever read--at least online.

It goes to show that good paramedics don't just need a good heart or sympathy, but also patience.

And clearly, patience really IS a virtue!

With all the pain and violence that paramedics are forced to encounter, it's just really nice to read a blog post about the day in the life of a medic that isn't dripping with pure cynicism or even anger when it comes to his patients.