Friday, 24 October 2008

Dying alone

Day shift: Five calls; all went by ambulance.

Stats: 1 Asthma; 2 Faint - 1?cardiac; 1 Cardiac arrest; 1 EP fit.

A 71 year-old asthmatic with COPD began to have breathing problems four days ago and went to his GP. The doctor told him to go away and call an ambulance (allegedly). I arrived four days on, when he’d decided to give 999 a try, to find him in trouble. The lovely little Indian man held my hand as I walked him back into his flat (top floor, last flat) and sat him down. His breathing wasn’t good and his sats were low. He seemed to warm to the female member of the crew and didn’t need much persuading to go with her to the ambulance. Even at his age and with his present condition, he was able to flirt with the opposite sex. I hope I see that day myself at 71.

If you have a pacemaker fitted and you keep passing out, you might need to have the device checked. The 88 year-old man lying on his toilet floor had fainted suddenly while chatting to his wife (I have no idea why he was in the toilet with her). He tried to faint again when we tried to move him to the chair, so I think his pacemaker is due for a service. Either that or he has developed another problem. He never looked less pale even when he claimed to have recovered a little, so off he went as soon as we could keep him stable enough for the short trip to the ambulance.

A Red1 in Oxford Street and I arrive just behind the MRU. I run in with the equipment I think we’ll need and I find the staff surrounding the bottom of the escalators – a human screen alongside a medical screen. Behind it an 82 year-old man lay on the floor with a head injury after falling down suddenly. He was in cardiac arrest. My colleague had started attaching the defib and a couple of volunteers; first aiders from the store, an off-duty doctor and a young A & E Support person named Katherine (Kat) from Oxford were carrying out resus under instruction. I slotted myself into the role I knew I’d have and began assisting my colleague. Two crews arrived to help and I asked everyone except the ECA to leave and create a view-blocking screen for us. We worked furiously on the man and one shock was delivered early on – this shock was about to be given as people stood on the metal escalators – a warning had to be shouted for them to get off in case they caught a jolt from it. That button should never be pushed until you are absolutely sure of the risk to others. The five second delay was worth the safety of bystanders.

Kat was wearing marigold gloves and I reasoned that she’d been given these by staff because nothing else was available when she asked for them. It was very strange to see someone compressing a patient’s chest wearing those brightly coloured and overly large mittens. It would have been funny if it wasn’t…if you know what I mean. She worked tirelessly alongside us and defintiely contributed to the outcome.

An output was eventually detected and the patient was taken to hospital, where he survived and was taken to Intensive Care. Unfortunately I learned later in the week that he died three days after we’d ‘saved’ him. Usually the saving part is important so that family members can say goodbye in the small window of time provided by medicine but I also learned that the poor man had no family to say that to him.

Sometimes people need to be taken to hospital because they have issues, rather than physical complaints. A 24 year-old who ‘passed out’ but seemed to be faking it all while her friends and concerned lecturers hung around, bore self-harm scars on her upper arm and wrists, so conclusions, whether right or wrong, were drawn about her sudden, inexplicable collapse prior to an exam.

My epileptic patient was moved by passers-by who’d witnessed him have a fit. He was soaking wet from the rain that had fallen recently and they felt it necessary to take him into a dry building for his own safety as he recovered. I thanked them as they left – it was entirely reasonable and human of them I think. The 30 year-old patient had a cut to his lip and was still post ictal but he was getting better; less vague and irritable. By the time the crew arrived, he had been told what had happened and willingly went to the ambulance for further checks.

Be safe.

1 comment:

Kat said...

Hiya Stuart!
Just had a read of your latest post. Loving the part about the marigolds... to explain a little i never actually asked for them they were thrown at me by a member of staff and i felt obliged to wear them as they'd gone to the trouble of getting them for me. I also felt equally silly wearing them but hey never mind :). Hope your shifts are going ok. 'Be safe :P'
Kat x