Tuesday, 11 November 2008

Right and wrong

Day shift: Nine calls; one no-trace; one left on scene; seven by ambulance.

Stats: 1 Malaena; 1 Hypoglycaemic fit; 1 Back pain; 1 Hyperventilation; 1 Mental Health Issues; 1 Haematemesis; 1 Overdose; 1 Cardiac Arrest.

Malaena, for those of you who are new to this blog, is something I find very unpleasant to work with, as do my colleagues. A 40 year-old man waited on a bench at a railway station as police stood over him because he had been ‘pooing blood for days’ as he eloquently put it. He’d been caught trying to steal wine from Marks and Spencer (good quality stuff) and the police were disinclined to take him to the police station, smelling as he was. I don’t blame them.

A MRU colleague was on scene for my next call to a 40 year-old man who collapsed and began fitting in the road. A passing moped rider stopped to help and I found him holding the patient’s head as he came out of it – my colleague was busily trying to establish his baseline obs.

The road was hazardous and just before I pulled up a large lorry turned into the street where the three men were situated, narrowly missing them. So I parked up to block a repeat performance by any other vehicle whose journey was more important than the safety of the patient, crew and helper.

The man became combative when the crew arrived and tried to persuade him to get onto the trolley bed. He was strong and fought us vigorously for almost ten minutes until he’d calmed down enough and recovered sufficiently to realise what was happening. His BM had read low when tested initially, so he needed a sugar boost. I had a small Snickers bar in the car, so I offered this to him and he greedily ate it up. His behaviour was very like a diabetic, except he wasn’t one. Neither was he epileptic, so his seizure was a mystery.

He had sustained a head injury on falling and when a work colleague was contacted, he confirmed that the patient had been in a traffic accident in the near past – he may have suffered a previous head injury and this was now manifesting in fits. He’d have to be thoroughly checked out.

His work colleague was kind enough to attend the scene and talk him into going onto the ambulance, which he’d been unwilling to do for the duration of his recovery. He was eventually walked, at his own request and preference, to the waiting vehicle. His friend travelled with him.

After a quick coffee and chat with my colleagues in the area, I was sent to a Red3, 78 year-old male, DIB, blue around the lips and known cancer patient. It was a good jog away in heavy traffic and I knew the housing estate very well. I arrived to find a man with back pain. No DIB, pink lips and his cancer was under control with treatment. This was a Green call for sure – his back pain was Sacral and non-acute; he’d been getting on with it for weeks and only in the past 24 hours had it become worse. He had no deficit and could easily walk.

The call had been graded Red because the on-call warden had given the description of a dying man to the call-taker in Control. If we’d been busier the cost of a FRU and ambulance would have been deducted from someone in real trouble at that time but there seems to be no way round this problem of panic-stricken descriptions that are sometimes given of perfectly well patients with fairly low-priority problems. It’s easier to judge when you get there I guess but common sense must surely play a part in answering leading questions.

On the Strand a 31 year-old man who’d called us because of blisters on his feet walked into a chemist and told them he had DIB, so another call was made and, of course, the upgrade meant he got an immediate response.

He was hyperventilating slightly and a bit aggressive to me at first. ‘What’s the problem?’ I asked, as I always do.

‘Well I’ve already spent a lot of time telling the ambulance service what’s wrong with me, so that’s a bit of a stupid question, isn’t it?’ was his retort. He clearly wasn’t in a good mood, so I asked him to calm down and explained that I don’t get all the details all the time.

He apologised and we got on okay from that point. Actually, I felt quite sorry for him as he explained that he was new on the streets in London and had travelled from Brighton (it’s a common street person's migratory route) after his family had rejected him (or vice versa) and his wife had left him. He was cold, hungry and thirsty. He wasn’t an alcoholic but in an ironic twist, his thirst was quenched earlier on by another rough sleeper who asked him if he was alright and then gave him two cans of lager because ‘he’d feel better’.

He seemed very distressed about his situation and his need seemed genuine, so as soon as he was taken aboard the ambulance, I arranged for him to be visited by the wonderful London Street Rescue people, who can arrange accommodation and food for him in the short term.

Then I spent a while watching a Big Issue vendor who stands on one leg with his arm outstretched, winks and flashes smiles at passing women, stands to attention for businessmen in suits and generally embraces his lifestyle with as much humility and good humour as possible. I’ve watched his antics before in sun, rain and snow and the guy just never seems to look unhappy with his lot. Unsurprisingly, he makes passers-by smile and he does well enough, from what I witnessed of his sales.

I’d like to take a photo of him and get his name so that I can give him some fame on this blog but I haven’t had the opportunity and I guess I’d better wait until I’m not in uniform. If you are interested in seeing him in action, I’ll do my best to capture him ‘at work’ for you. In the meantime, if you are on The Strand, at the Trafalgar Square end, outside Boots the chemist, then please buy one of his magazines. I saw a laughing couple take several photo’s of him, which he gladly posed for, then walk off, fags in hand, without tipping him a penny…that’s just not cricket, is it? Madonna would charge you at least a quid for the privilege!

Next up, a strange call to a University library for a 70 year-old man who was ‘foaming at the mouth’. Apparently, he’d behaved like this before and had to be chased down the street so that he could be helped, according to the library staff. He is a member and had just gone in to borrow a book when his behaviour changed. I now found him sitting on a chair, surrounded by worried people. He was shaking, clenching and had his eyes closed.

It took a few goes but I managed to get him to stop moving and calm down – sometimes you can see behind the drama, even if you can’t figure out why it’s happening.

When the crew arrived he was a bit less frantic and thus more manageable. He was taken to the ambulance, which had been blocked at the entrance by a plumber’s van (I had to drive around it and onto the kerb to get in).

There was no trace of the supposed headachy, dizzy, chest-pain suffering 32 year-old female who’d called form a phone box and even after checking in at the police station up the road to see if she’d walked in, I had no luck. The police even did a sweep of the area on foot for me. It’s unusual to get hoax calls from females.

I thought the next call had been made from inside a Medical Centre and so I was appalled when the patient, a 20 year-old withdrawing alcoholic, was standing outside waiting for me. He was vomiting blood (Haematemesis) according to the call description and so I thought it was unprofessional of the doctor to send him out to the street to wait. I was wrong, however. The patient had made the call himself from just outside the door.

He wasn’t vomiting blood. The stuff coming from his stomach was white and acrid.

I walked into a bookshop on Piccadilly and instantly recognised it. I hadn’t been in there for over twenty years and now all the memories of having been there came flooding back. I used to manage it when I first came to London. I could have led myself to where my patient sat, huddled in the toilets.

She’d walked in and collapsed and when I arrived the manager came out to meet me. ‘I didn’t know what to do and we have no trained staff here’, she said to me.

I followed her downstairs and found the 22 year-old woman shivering and cowering on the loo. She had told the staff nothing of her problem but had simply said ‘I feel horrible’. They had called an ambulance on the basis of her ‘DIB’, which didn’t exist.

I asked her three times what was wrong until she confessed that she’d taken an overdose of paracetamol. She hadn’t actually taken enough to cause Liver damage but she had attempted suicide and that was worrying enough. She was very distressed and I kept her calm and walked her out of the shop to the arriving ambulance.

The crew took over once I’d established her obs were ok and she was taken to hospital. Hopefully, her problems will be discussed and she’ll get the help she needs to prevent another attempt.

My last call of the shift came as I was winding down to go home. I was sent to an 89 year-old cancer patient who was ‘semi-conscious with shallow breathing’. This was ominous and I knew it could change at any time.

As I reached the street, the call became a Red1 and changed to cardiac arrest. I rushed in as the ambulance arrived at the end of the road. I was met at the door of the flat by the patient’s son; he was weeping and frantic. ‘He’s dead, isn’t he?’ he sobbed.

The man lay on his bed and I approached and checked his vitals – there were no signs of life. The son had been carrying out CPR under instruction and the man had stopped breathing only a few minutes ago, so I was left with a very difficult decision to make and one that I later agonised over for days afterwards. Do I continue the resuscitation attempt and thus try to save his father, even if it’s for a short time, or do I simply tell him there’s nothing more I can do? The son’s emotional state was confusing because it wasn’t clear which he’d prefer – did he want his father left in peace or did he want something done?

I decided that, as the crew were on scene and the attempt had been started, it would be better to try. So, we moved him to the floor and spent the next sixteen minutes working on him with no change in his condition whatsoever. I communicated with the son, who insisted on staying in the room throughout and made it clear to him that we would stop after a certain time unless he absolutely did not want us to continue.

I have no idea why I felt so bad about this job when it was finished. I think I felt guilt at the emotion I had put the son through by having him witness such a horribly traumatic event (CPR is a messy, noisy and emotionally painful business). I could have decided not to start because the man had a terminal illness, thus he could have been left in peace on the bed but I felt strongly that the son would have seen that as inaction on my part and I know that I would be bitter about such reticence if it was my loved one. I felt it was better to try and fail than not try at all.

I called it after sixteen minutes because I know the son had seen enough and there was no hope. We wrapped the man up and laid him back in the bed. Even though the son thanked me for trying, I felt I’d let him down horribly for continuing the attempt that he’d started and of all the cardiac arrests that I’ve called over the years, I felt more depressed about this one than any other – I knew it was illogical but I couldn’t help going home with a black cloud over my heart.

Be safe.


Pzycoman said...

You did the best you could, you tried to save his life. Theres nothing more you could have done. You cant save everyone.

Anonymous said...

You did all you could, especially since htere was no DNAR. The son obviously knew what was happening and the decision to continue was the right one for him.

I had a similar job to this, the patient was terminal and the family had called the priest as they knew he was gone. We continued while the last rights were given and the family made their appreciation of our efforts known.


Anonymous said...

Since the son had started CPR, I think it was right to continue the attempt - as I feel that shows that he wanted it made.

8char8 said...

No one can fault you for trying. You did your absolute best for a dying man. It will hopefully give the son some closure in the knowledge that despite everyones best efforts nothing could have been done to save his father. Most importantly you all tried and you gave that man a fighting chance and you eliminated all possibilities. If you hadn't tried it would always be in your mind that the outcome may have been different but now you know. Be proud. Much respect x

Little Miss Ileostomy said...

You did the right thing. If the son hadn't of wanted you to try he wouldn't have started CPR himself. At least he now knows that everything that could be done was done.

I know when my great aunt died and the ambulance came (the neighbour had called them) my mum asked them not to "hurt" her. She'd been dead a few hours so there was nothing they would have tried to do anyway.

Anonymous said...

If you hadn't continued it would have been the sons attempts which had failed.
You have taken that burden from him

Fiz said...

Stuart, you did everything you could for a fellow human in an already hopeless conditon. As for the lorry driver, what a hero! I've twice nearly been totalled in my last two car journeys because I was waiting behind other cars for a good reason when idiots have come out of nowhere and then I've had to find more space from very little, and for it to happen to ambulance staff is appalling. I love your Big Issue seller - I have one similar in Stevenage and he always calls me "Darling" and says he knows I will stop for him - but he's not a public show! The cheek of those other people. I'm so glad I don't live in London any more!

Anonymous said...

If you hadn't continued it would have been the sons attempts which had failed.
You have taken that burden from him.

- I couldn't agree more. You did everything you could in the situation. As for the Big Issue seller, I'd love to meet him.