Saturday, 5 September 2009

Bacardiac Arrest

Some people are sober when they behave drunk.

Night shift: Seven calls; all by ambulance.

Stats: 1 Vomiting; 1 Allergic reaction; 1 Drug o/d; 1 eTOH; 1 High temperature; 1 Chest pain.

I’ve decided that most of our Red calls should be dubbed ‘Bacardiac Arrest’, since they are alcohol related anyway.

A single night shift among the leave dates I have booked (you may have noticed the sparse postings of late) and I am running to a 68 year-old woman who is ‘unconscious’. When I almost get on top of the call, I radio Control and ask them if I am still required because it went green as I travelled towards it and I’d decided to keep going until they cancelled me, which is the usual practice. I’m told that I’m no longer required but no reason is given and I don’t ask for one. I turn my tail and head for the West End, where I will haunt the drunks for the night.

Thirty minutes later and the same call, to the same restaurant for the same patient, rings onto my screen. This time it’s red and I get myself on scene as fast as I can because bitter experience has taught me that when these calls are wrongly categorised, patients can suffer and this lady had been unwell since my initial activation.

I arrive and walk into the place to find her vomiting on the clean, posh sofa of a clean, posh restaurant. Her family is with her and they are none too pleased about the delay in getting help to her. She has been in this state for almost an hour, I’m told. An ambulance was called but somewhere along the line, someone had called it off… I suspect the staff at the restaurant had something to do with it; communication gone wrong.

The poor woman was in a real mess; very pale and sweaty, shaking and throwing up. The vomit was acrid and soaked into the light cloth of the restaurant lounge sofa, staining it, probably forever.

She had no history of illness and she and her family suspected that something she ate had triggered this although the onset of food poisoning in such a short time was unlikely unless she'd eaten shellfish. Whatever it was, she should never have been left like this for so long and as soon as the ambulance arrived, she was taken away and out of public view. I went back into the restaurant to help clean up the mess that had been left behind, mindful that customers were trotting in and out of the place, passing the devastated sofa; it wasn’t the best advertisement for eating there and the smell was so powerful, it could be detected outside as you read the menu.

In the narrow road that we’d blocked off with our blue-light flashing vehicles, a couple of drivers had dismounted and walked up to me in a demonstration of anger, as if just by being close enough to show me how annoyed they were, I would disappear and the road would become passable again. I did what I could to move out of the way but the ambulance remained in the middle of the road like a fat dog at rest and there was no way it was going to move until the patient was checked and made comfortable. Whilst I understood the irritation this must cause to drivers with places to go in a hurry, weekend night-time double-parking is to blame. The design of London’s streets is to blame… The Great Fire of London (1666) is to blame. The LAS and the NHS is not to blame. For that reason, would you kindly stop threatening us when we park, without an option, awkwardly in the street for an emergency call and will you also stop yelling at us, swearing and gesticulating your annoyance when our sirens insult your delicate ears?

If you are anaphylactic, you will experience severe, possibly life-threatening signs and symptoms, ranging from swelling of the face and throat to DIB and shock. If you are allergic to things but have no more than a tickly throat and can speak and walk around without any problem… and you are approximately a mile from hospital and metres from the nearest taxi, dialing 999 is a little far-fetched.

I saw my 26 year-old ‘lump in throat and DIB’ patient chatting on the phone and leaning against a wall as I pulled up on scene. She didn’t identify herself and I only know it was her because, after walking around in plain sight for a minute or two, calling in a possible no-trace and chatting to the ambulance crew that arrived after me, she wandered over and let us know she was the one who’d called.

Our walking, talking, normally-breathing patient seemed to have no difficulties whatsoever, except for the disease of panicking and reaching for the three 9’s as if there was a limitless supply of ambulances. She hadn’t identified herself to me because some people simply don’t see the car as an ambulance; it confuses them when I arrive.

No patient contact on the next call. A 28 year-old woman had fallen and a crew was on scene. So, I slinked back onto Trafalgar Square, where I had a long and enlightening conversation with a police officer about made up porn names. We came up with Paddy Spurger, Buster Chamberlain, Stuart Scamp and Mopsie Hucklebridge for the real people we knew. They know who they are!

Then a 30 year-old drug addict overdid it with Heroin at his hostel. He was staggering out with the crew when I arrived and I gave him some Narcan to wake him up a little. It worked well and he remained passive but by the time he got to hospital he’d collapsed again and needed more Naloxone to keep him breathing. Silly man.

This call was followed by a 24 year-old female who’d collapsed, vomiting in the toilet of a club. She too had taken something she shouldn’t have and when she pulled the IV line out, after I’d worked hard to get it in there, it looked as if her vein was spewing blood around like it was an artery – always a worrying thing. In fact, blood had gone up into the tubing and was now pouring back out of it under the influence of the fluid pressure when she dislodged the thing. It made the patient’s brother frown a bit and the floor of the loo was now awash with watery pink stuff.

A 30 year-old Arabic man with a Hickman line fitted lay in his bed with a temperature of 38.8c because the entry site of the line was infected. He was very unwell and, in addition to having cancer, this current acute situation was a kick in the teeth I would imagine. His family was around and they showed great concern for him as he lay there not wanting to move.

In stark contrast the last call was for a 26 year-old man with nothing wrong with him except the inability to grow up and behave. He lay in bed not suffering from cancer, with normal vital signs and generally good health, crying about having ‘chest pain’ that was clearly the result of hyperventilation. His entire family, mostly female, gathered around him as if he was dying. They actually looked like they were rehearsing the mourning bit of their lives. I let the crew deal with him because I had just been to see a man who probably wouldn’t make his 31st birthday and was suffering to the end and I had very little professional medical sympathy for this one as a result. Sorry.

So, to cheer me up, I was entertained in the early hours of the morning by ‘Darth Vader’ as he strutted his stuff and threw his light saber around on the 4th Plinth on Trafalgar Square. I tried to imagine how this grown man’s normal daily life went, what his routine was and whether he still lived with his mum.

Be safe.


CrazyNewt said...

Ah, it seems every city has a "Darth Vader".

In Victoria, we have a guy that dresses up like Darth Vader, and plays the fiddle for money. He'll dance around while he plays, takes photos with tourists, and all that.

I always wondered how a guy could wear a full black suit, and a helmet, while standing out in the sun when it's 30+ degrees out.

MarkUK said...

A call today. A woman "collapsed outside No. 15 - history of CVA".

Arrived at No. 15 to find the pavement and grass verge devoid of patients.

I knocked on the door of No. 15 but didn't get an immediate answer. Then a lady came out of No.13 and toldd me that "she's been taken home - No.23".

Making my way to No.23, I found the lady's husband just ending a call to control cancelling the ambulance. I called the desk and told them the situation but the truck was only a minute away and they decided to let them arrive.

The lady had fallen (not collapsed) when she caught her toe on the grass of the verge. She was a bit unsteady from the stroke she'd had 10 years ago! Total injury - one grazed big toe. The lady at No.13 had been a bit over-zealous.

Still the patient got her toe cleaned by a PTL whilst the tech and I looked on.

Fee said...

You wondered whether Darth Vader still lives with his mum? I'll bet money he does!

We have a bit of an amateur "Darth" at my work, over 40, lives with his parents, never had a girl (or boy) friend, and he gets a bit upset when I ask him why he dresses up as the Green Cross Code man. Younger readers probably have no idea what I'm on about!