Wednesday, 4 March 2009

Dangerous Pro's

Night shift: Nine calls; one treated on scene; the rest by ambulance.

Stats: 1 ? Miscarriage; 1 RTC with hand injury; 1 Haematuria; 1 D&V; 2 Chest Pain; 2 Fall with head injury; 1 Stabbing.

I want you to know I have a life outside of work – I just don’t see that much of it right now…taxman to pay, things to achieve, etc. I was a professional musician and songwriter when I was younger and that kept me in comfort for over a decade before I stumbled into pre-hospital care on the back of my objective of becoming a doctor (a childhood yearning).

When I don’t post for a while there are several reasons – I’m off and ‘resting’, I’m ill (which is unlikely), I haven’t got anything useful to say…or I am just too tired to catch up. So, if you are a new reader, forgive the blank spots in the diary but as I write an average of a quarter of a million words a year, just on this blog, I suspect that, in combination with the other stuff I write, if I don’t rest I will end up with damaged fingers!

I don’t like emergency obstetric calls – I’m uncomfortable with the prospect of having to deal with the emotion and possibilities for complicated situations involving a new life and a current one – if you’ve read the book you’ll know why. So as I made my way to a pregnant 38 year-old, halfway through term at 20 weeks who was bleeding PV and with a ‘head out’ reported, I got a sinking feeling about it.

I got on scene first but the address was not where I’d landed and the crew arrived at the same incorrect place as I searched for the right building. I had to head back out onto a main road before I finally located it and the crew were a few minutes behind.

I pressed the buzzer just as a man appeared at the entrance of the block. A woman’s voice beckoned me in and the man asked me what was wrong. I asked him who he was and he told me that he was the woman’s husband. This was tricky.

‘Is it the baby?’ he asked.

‘I’m not sure yet’, I said. This was true and I had nothing else for him but his face changed, his eyes dropped and he slumped back against the wall after kicking it. I think he knew what I suspected. I felt awful for him.

When I got into the flat the woman was sitting on a chair crying. She told me she had bled and had abdominal pain. I asked her the usual questions required in these situations and I had to carry out a visual examination, which is always a bit uncomfortable for both parties I think. There was a female crew member on the ambulance but she had yet to appear, so I had to do this myself.

There was no blood and no head. I didn’t doubt her story but without evidence of a problem there was no need for anyone to panic, so I calmed her down after telling her what I’d found. The husband remained unsettled; he paced up and down a lot.

The crew came in just as I completed my baseline stuff and I explained what was happening. The woman was taken to the ambulance but the husband didn’t go with her – he stayed at home with his other children while another relative accompanied her. I found that strange.

I have a special sympathy for women who lose their babies in pregnancy, regardless of how common it is, but I still haven’t formulated a meaningful conversation that I can have with them to make it all better – probably because there isn’t one....and it wouldn't.

South of the river and a 25 year-old moped rider has been knocked off his bike by a car driven by a beautiful tall black woman. It was a simple accident and nobody was badly hurt – the man just had a bruised, probably sprained, wrist and hand. He wanted to get off because his office was flooding and he was on his way to deal with it when the incident took place at a busy junction. The tall woman stayed with him as the police took details and as I bandaged his hand and did the paperwork so that he could present himself at A&E whenever possible after his plumbing task, he and she hit it off! They swapped mobile numbers (and not just because of the accident) and chatted about what they did and where they were going…it was nice to listen to – they genuinely liked each other, I could tell. She even gave him a kiss on the cheek as she left the scene. I waited for mine but it didn’t come…

A 66 year-old with blood in her urine (Haematuria), argued with her daughters about how much she smoked when I asked one of my usual questions during obs.(her sats were low). The fact that they all smoked a lot didn’t seem to make any difference to the younger ones, who berated her for doing it. They were a family of very large, tattooed, smoking, drinking people who idled outside their house in the cool evening air with cans of lager and fags in hand. I was ushered in through their midst and told about the problem the woman currently had and despite my description of them, which is honest and accurate, they were the ‘salt-of-the-earth’ type that I had grown up with in Scotland. My personal politics define this group as separate from the other one that I detest so much – the lazy, clueless and thankless members of society who contribute nothing but take everything. Challenge me on it if you want but at least this family worked for a living – whatever they spent their time and money doing was their business.

I left the crew with a pregnant 44 year-old who’d become ill with diarrhoea and vomiting (D&V) after eating a fish kebab earlier in the day. They were advising her to go home, drink fluids and let her body do its job. The alternative was a long, long wait in A&E.

NPC for a chest pain next.

The call description for my next job was '35 year-old male, fallen 25ft down escalator'. I was sent a long way for this, only to find HEMS on scene. Why they needed me was a mystery.

Inside the tube station a drunken man sat chatting to the HEMS team – all five of them – and nothing was being done. I assumed that this meant there was nothing required of me, or anyone but I popped my head in and asked. They thought I was one of the ambulance crew but I disappointed them when I told them I was solo. There was no ambulance to send, so I suspect I had been despatched to do just what I suggested as we all waited there twiddling our thumbs. ‘I’ll take him to hospital in the car’.

A weight seemed to be lifted. The man had a minor head injury and had been knocked out, so this wasn’t usually done but if the HEMS doctor was happy and the guy was stable, then it would be better than waiting around on a very busy night for someone to get to him. It was clinical decision.

In the car he kept apologising (drunk people do that a lot). ‘I’m a twat’, he said over and over again until I got the point. ‘My wife is going to kill me’, he added.

I smiled back at him and tried to keep him calm. He wasn’t happy to go to hospital because he was deeply embarrassed and his 25 foot tumble had been nothing of the sort – he had fallen down on the ‘up’ escalator when he lost his balance. He had the usual three-tooth groove etched in his scalp to prove it. There was nothing significant about his injury – if there was he wouldn’t be sitting in the back of my car.

He prodded the dressing I’d put around his head and said ‘please don’t tell me I’ve got brain damage’. He’s a City broker, so I understand why he felt the need to get wasted tonight but I’m surprised at his lack of intelligence, even when drunk – that’s the sort of desperately stupid phrase one of our local alcoholics would come out with.

Chest pain in a 65 year-old man with a cardiac history, who lay in his bed with a pulse of 50 is to be taken seriously, so this pleasant man and his anxious wife were taken to hospital as soon as the ECG confirmed a problem existed.

The second fall of the night proved to be one that HEMS should have been sent on. The 46 year-old man had dropped about 10 feet onto his head in the basement of a night club in the West End and was now unconscious. His condition didn’t improve during the 30 minutes I spent with him, with just an off-duty fireman and the staff of the establishment to help me. He only stirred when he’d been given enough oxygen to awaken his brain but that didn’t mean he was out of the woods. He had a large bump on his head and because he’d been drinking there was no way of knowing just how bad he was.

By the time I got an ambulance on scene, he was ready to go – all my work was done and he was conscious but groggy. We had to collar and board him for the move, which meant lifting him almost vertically up spiral stairs. We got plenty of help from the staff – especially the world’s tallest East European doorman (a guy I wouldn’t argue with sober or not) and they helped us achieve our mission of getting him out and into the ambulance without dropping him.

A taxi driver was stabbed in the arm with a broken bottle as he attempted to break up a fight between two women in Soho. This is not advisable, so he was very lucky because one of the women got stabbed in the head by all accounts, although she and her attacker had left the scene before the police arrived. Now I was being asked to look out for a couple of prostitutes, one of whom was injured. Needless to say, I never found them…nor did I scoot around the area looking for them.

Be safe.


Hugh said...

have a few months with BETS at the Royal London - that should give you lots of neonatal experience

Ian said...

I spent my previous life as a musician and composer too!! It's good to know I'm not the only 'artsy' one out there. The medics I hang around with have little to no appriciation for fine culture, which makes me sad,

---> J.