Sorry! I've been using up leave days and concentrating on other projects, so I have more than a few postings backed up and waiting to be written. I'll get back in gear by Friday :-)
Xf
Tuesday, 9 September 2008
Friday, 29 August 2008
Insult to injury
Day shift: Six calls; one false alarm; one taken by car; one arrested on scene and three by ambulance.
Stats: 1 Allergic reaction; 1 Fall ? fracture; 1 Headache.
Assault calls are always tricky because you rely on the information given and the assurance that police are on scene before you arrive, so that you don’t go straight into a conflict. Many colleagues have been hurt, some seriously by misadventure when it comes to calls like these. No amount of counselling is going to make up for the fact that you got damaged doing your duty. So, when a call came in for an assault with multiple victims and ‘screams heard’, I was hoping to arrive with backup on my tail, if not in front of me.
The police were on scene and there were excited looking youngsters hanging out of the window of the building, which is a youth rehabilitation centre. I was very cautious when I entered because I’d yet to be told what was going on and the staff told me that someone was still loose in the building – that someone, I assumed, was the assailant. This turned out to be fantasy; the police had the assailant in custody and the victim (just the one) was in a separate office.
An argument had blown up between the huge man and his petite manager. She was tasked with issuing him with a final warning and he reacted very badly – shouting, slamming his fist on the table and allegedly threatening her, thus the screams (his or hers, nobody knows). No-one was actually physically harmed and it all seemed under control now. I’d asked Control to keep the crew away from where I was until I knew what was happening and I found them sitting in the reception area as if they had an appointment.
Allergic reactions can cause angiodema, which in turn can be life threatening if the airway occludes. My next patient was a 61 year-old man whose tongue had swollen suddenly as he sat on his train into London. He presented himself at a local walk-in centre when he arrived at his station and I was called to assess him. He was given adrenaline and piriton but it hadn’t changed anything and when I arrived his tongue still looked very, very fat, although he could still breathe normally. He tended to talk like a man who’d just come from the dentists after extensive root canal work, so I let him off with minimal questions.
The ambulance was delayed so I made an executive decision and took him to hospital myself on the hurry-up. He was stable but I had no idea how long that would last. I didn’t think I could afford the luxury of a potential ten or twenty minute wait.
When I got him to A&E we discovered that, although he had no allergies and hadn’t eaten anything to cause this, he’d recently changed his prescription antibiotics. That would be the answer then I guess.
A motorcyclist was thrown from his bike when a car collided with him at around 25mph. The car shunted into the back of him because the driver was distracted and looking elsewhere at the time. The knock caused the biker to veer off towards the pavement as he tried to control his machine but it clipped the kerb and he was ejected into a post before landing ten feet from it. I arrived to find a MRU colleague on scene and attending to him. Someone had taken his crash helmet off, despite the protestations of other MOPs and then proceeded to move him into the recovery position, even though he was conscious and alert. This is not to be done as it simply increases the risk to the patient. Leave it to us unless there is a clear risk to life if it isn’t done.
The 45 year-old was in pain; his ribs had smashed off the post and he had a foot injury which we discovered when he was taken into the ambulance and stripped down for checks. A deep cut on his sole indicated that he’d landed on it so heavily that his skin had burst and the energy had probably broken the bones too. His foot was white and bruising could be seen on the top of it. His boots were perfectly intact, so our suspicion of severe impact trauma was on track. This energy can radiate through the bones and damage structures further away, such as the femur, pelvis or even base of skull, so great care was taken with him and he was blued in to hospital.
An 86 year-old lady fell badly at her community centre lunch and sustained a head injury and sprained ankle. The poor woman was lying on the floor in great pain as her peer group looked on in sympathy. I moved the old ladies out of the hall, denying most of them their meals for a while but I’m sure they didn’t mind – patient privacy and dignity are always of greater concern to me than the comfort of others on scene.
She was given entonox and her leg was placed in a splint when the crew arrived. She was wheeled out onto the ambulance and taken to hospital, probably after the paramedic gave her stronger analgesia.
You know I’m not one for foolishness and I think dragging myself and my equipment through a crowded shop in Oxford Street for a perfectly healthy 23 year-old man with a headache is just plain stupid. He had no medical history, no acute trauma and he could easily have taken himself off to his GP…or had a couple of paracetamol. Instead he insisted that I half carry him to the exit while the crew accompanied us to the waiting ambulance. He amplified his drama by pushing down on my shoulder and practically limping as I supported him across the acreage of shop floor. Silly man.
The newest frequent flyer (well, new to me), called us again for a head injury, post assault, that he simply didn’t have. I knew it was him before I arrived on scene – the age, the location and the nature of the call hinted at it and when I arrived I found him inside a phone-box, on the phone to our 999 call-taker. I knocked on the window of the box and asked him to come out. When he recognised me he dropped the phone and I picked it up to explain what was happening and to cancel the ambulance. Risky as this may seem to some of you, I could see immediately that he had no injuries and his face confirmed that fact. He wants off the street but try as we do, he resists all efforts to help him, so I gave him his options, none of which included going to hospital (on the last call to him he changed his mind because the hospital didn’t suit him).
The police arrived on the ‘assault’ call and they too recognised him; he’d been arrested the day before and they pondered over a solution, including re-arrest for hoax calls to the emergency services. At first he sat quietly in the back of my car but then he became abusive with me and opened the door to leave. The officers stood in front of him as he got out and he swore at the WPC and punched her in the stomach – that was enough and he was immediately arrested for assaulting a police officer – ironic really.
Okay, he may have psychiatric problems and he is homeless but I have tried to help him and many of my colleagues are just plain fed up being abused by him when they try to help too, so the only place for him until he is catered for appropriately is a police station cell. We are stretched to the limit because of individuals like this and they are costing you money and threatening to drain resources that could be allocated to your mother when she has chest pain. That’s how I see it and, although I have a duty of care, I also have to exercise it in the wider sense. I’m also a responsible, tax-paying grown-up. I may as well give him a fiver every time he calls us; it would be cheaper in the long run.
As I drove around Piccadilly Circus I overheard a comment made towards me by a man crossing the road. ‘God bless the NHS, it hasn’t got long’, he quipped. What he said rings true and it’s no wonder when we continually pander to the minority of people who over-stretch the service simply because they can.
Be safe.
Stats: 1 Allergic reaction; 1 Fall ? fracture; 1 Headache.
Assault calls are always tricky because you rely on the information given and the assurance that police are on scene before you arrive, so that you don’t go straight into a conflict. Many colleagues have been hurt, some seriously by misadventure when it comes to calls like these. No amount of counselling is going to make up for the fact that you got damaged doing your duty. So, when a call came in for an assault with multiple victims and ‘screams heard’, I was hoping to arrive with backup on my tail, if not in front of me.
The police were on scene and there were excited looking youngsters hanging out of the window of the building, which is a youth rehabilitation centre. I was very cautious when I entered because I’d yet to be told what was going on and the staff told me that someone was still loose in the building – that someone, I assumed, was the assailant. This turned out to be fantasy; the police had the assailant in custody and the victim (just the one) was in a separate office.
An argument had blown up between the huge man and his petite manager. She was tasked with issuing him with a final warning and he reacted very badly – shouting, slamming his fist on the table and allegedly threatening her, thus the screams (his or hers, nobody knows). No-one was actually physically harmed and it all seemed under control now. I’d asked Control to keep the crew away from where I was until I knew what was happening and I found them sitting in the reception area as if they had an appointment.
Allergic reactions can cause angiodema, which in turn can be life threatening if the airway occludes. My next patient was a 61 year-old man whose tongue had swollen suddenly as he sat on his train into London. He presented himself at a local walk-in centre when he arrived at his station and I was called to assess him. He was given adrenaline and piriton but it hadn’t changed anything and when I arrived his tongue still looked very, very fat, although he could still breathe normally. He tended to talk like a man who’d just come from the dentists after extensive root canal work, so I let him off with minimal questions.
The ambulance was delayed so I made an executive decision and took him to hospital myself on the hurry-up. He was stable but I had no idea how long that would last. I didn’t think I could afford the luxury of a potential ten or twenty minute wait.
When I got him to A&E we discovered that, although he had no allergies and hadn’t eaten anything to cause this, he’d recently changed his prescription antibiotics. That would be the answer then I guess.
A motorcyclist was thrown from his bike when a car collided with him at around 25mph. The car shunted into the back of him because the driver was distracted and looking elsewhere at the time. The knock caused the biker to veer off towards the pavement as he tried to control his machine but it clipped the kerb and he was ejected into a post before landing ten feet from it. I arrived to find a MRU colleague on scene and attending to him. Someone had taken his crash helmet off, despite the protestations of other MOPs and then proceeded to move him into the recovery position, even though he was conscious and alert. This is not to be done as it simply increases the risk to the patient. Leave it to us unless there is a clear risk to life if it isn’t done.
The 45 year-old was in pain; his ribs had smashed off the post and he had a foot injury which we discovered when he was taken into the ambulance and stripped down for checks. A deep cut on his sole indicated that he’d landed on it so heavily that his skin had burst and the energy had probably broken the bones too. His foot was white and bruising could be seen on the top of it. His boots were perfectly intact, so our suspicion of severe impact trauma was on track. This energy can radiate through the bones and damage structures further away, such as the femur, pelvis or even base of skull, so great care was taken with him and he was blued in to hospital.
An 86 year-old lady fell badly at her community centre lunch and sustained a head injury and sprained ankle. The poor woman was lying on the floor in great pain as her peer group looked on in sympathy. I moved the old ladies out of the hall, denying most of them their meals for a while but I’m sure they didn’t mind – patient privacy and dignity are always of greater concern to me than the comfort of others on scene.
She was given entonox and her leg was placed in a splint when the crew arrived. She was wheeled out onto the ambulance and taken to hospital, probably after the paramedic gave her stronger analgesia.
You know I’m not one for foolishness and I think dragging myself and my equipment through a crowded shop in Oxford Street for a perfectly healthy 23 year-old man with a headache is just plain stupid. He had no medical history, no acute trauma and he could easily have taken himself off to his GP…or had a couple of paracetamol. Instead he insisted that I half carry him to the exit while the crew accompanied us to the waiting ambulance. He amplified his drama by pushing down on my shoulder and practically limping as I supported him across the acreage of shop floor. Silly man.
The newest frequent flyer (well, new to me), called us again for a head injury, post assault, that he simply didn’t have. I knew it was him before I arrived on scene – the age, the location and the nature of the call hinted at it and when I arrived I found him inside a phone-box, on the phone to our 999 call-taker. I knocked on the window of the box and asked him to come out. When he recognised me he dropped the phone and I picked it up to explain what was happening and to cancel the ambulance. Risky as this may seem to some of you, I could see immediately that he had no injuries and his face confirmed that fact. He wants off the street but try as we do, he resists all efforts to help him, so I gave him his options, none of which included going to hospital (on the last call to him he changed his mind because the hospital didn’t suit him).
The police arrived on the ‘assault’ call and they too recognised him; he’d been arrested the day before and they pondered over a solution, including re-arrest for hoax calls to the emergency services. At first he sat quietly in the back of my car but then he became abusive with me and opened the door to leave. The officers stood in front of him as he got out and he swore at the WPC and punched her in the stomach – that was enough and he was immediately arrested for assaulting a police officer – ironic really.
Okay, he may have psychiatric problems and he is homeless but I have tried to help him and many of my colleagues are just plain fed up being abused by him when they try to help too, so the only place for him until he is catered for appropriately is a police station cell. We are stretched to the limit because of individuals like this and they are costing you money and threatening to drain resources that could be allocated to your mother when she has chest pain. That’s how I see it and, although I have a duty of care, I also have to exercise it in the wider sense. I’m also a responsible, tax-paying grown-up. I may as well give him a fiver every time he calls us; it would be cheaper in the long run.
As I drove around Piccadilly Circus I overheard a comment made towards me by a man crossing the road. ‘God bless the NHS, it hasn’t got long’, he quipped. What he said rings true and it’s no wonder when we continually pander to the minority of people who over-stretch the service simply because they can.
Be safe.
Monday, 25 August 2008
When pavements attack
Day shift: Two calls; both by ambulance.
Stats: 1 burn injury caused by an explosion; 1 Mental health transfer.
Well, there were more than two calls on this shift but I was on an ambulance and I wasn’t attending today, so I cherry-picked the calls worth writing about.
The explosion on Oxford Street wasn’t a dramatic terrorist attack but it could have been and when the call first came in we were certainly gearing up for the worst because this is how 7/7 unfolded. At first the location was vague and an underground station was named; a MOP had heard a loud explosion coming from the underground, according to the early report but we were diverted into Oxford Street itself and nowhere near the station. A few police cars had parked up and a small crowd had gathered around an area where an alley was congested with Fire-fighters and one engine. A woman stood with her family on the corner and we were told she was the only injured party, so we went over to find out what was going on.
A piece of the pavement (see pic) had suddenly blown up, fragments of it showering passers-by. The cause of the explosion was a mystery, although gas or electricity seemed to be the culprit. Molten tar hit the woman as she passed with her son and husband – it burned her shoulder and stuck in her hair. She was shaken and, apart from the burns, physically sound. Her family didn’t get hurt and nobody else around caught the debris from the blast. The bang had been heard all the way down the street, so it’s possible someone mistook it for an explosion on the underground but this didn’t stop the LFB from showing up in force to check the station anyway.
The area was cordoned off and we took the family to hospital. It was a small, insignificant event but it made us aware of how quickly things can go from normal to dangerous in this city.
It took over an hour to wait for, collect and transport a perfectly physically well man with psychiatric problems, who’d volunteered to go for assessment, to a Mental Health Unit in south London. No blue lights, plenty of traffic and a waste of emergency resources in my opinion. We are struggling to meet demand at times and yet we still have to do transfer jobs that could be managed by a private taxi firm. It’s small wonder we fight for our targets sometimes.
Stats: 1 burn injury caused by an explosion; 1 Mental health transfer.
Well, there were more than two calls on this shift but I was on an ambulance and I wasn’t attending today, so I cherry-picked the calls worth writing about.
The explosion on Oxford Street wasn’t a dramatic terrorist attack but it could have been and when the call first came in we were certainly gearing up for the worst because this is how 7/7 unfolded. At first the location was vague and an underground station was named; a MOP had heard a loud explosion coming from the underground, according to the early report but we were diverted into Oxford Street itself and nowhere near the station. A few police cars had parked up and a small crowd had gathered around an area where an alley was congested with Fire-fighters and one engine. A woman stood with her family on the corner and we were told she was the only injured party, so we went over to find out what was going on.
A piece of the pavement (see pic) had suddenly blown up, fragments of it showering passers-by. The cause of the explosion was a mystery, although gas or electricity seemed to be the culprit. Molten tar hit the woman as she passed with her son and husband – it burned her shoulder and stuck in her hair. She was shaken and, apart from the burns, physically sound. Her family didn’t get hurt and nobody else around caught the debris from the blast. The bang had been heard all the way down the street, so it’s possible someone mistook it for an explosion on the underground but this didn’t stop the LFB from showing up in force to check the station anyway.
The area was cordoned off and we took the family to hospital. It was a small, insignificant event but it made us aware of how quickly things can go from normal to dangerous in this city.
It took over an hour to wait for, collect and transport a perfectly physically well man with psychiatric problems, who’d volunteered to go for assessment, to a Mental Health Unit in south London. No blue lights, plenty of traffic and a waste of emergency resources in my opinion. We are struggling to meet demand at times and yet we still have to do transfer jobs that could be managed by a private taxi firm. It’s small wonder we fight for our targets sometimes.
Be safe.
Players
I spent ten days near the town of Bakewell at the beginning of August being the medic for a kids' summer camp. While on a visit to the town, I saw this sign in a small newsagent's shop.Night shift: Seven calls; one declined; one assisted-only and five by ambulance.
Stats: 1 Abdo pain; 1 Chest pain; 1 Allergic reaction; 1 DIB; 1 Unconscious ETOH; 1 Assault with minor injuries.
Abdominal pain and fainting are kindred spirits and my first call, to a 67 year-old with those afflictions had an infection. She was passing loose stools and feeling unwell. Her past history of CVA had little to do with her current problem.
Up north, a cyclist is asked for help by a man clutching his chest. The cyclist dismounts and the man collapses in the street. I arrive on scene thinking I might have to start CPR because a mini-crowd has gathered and it all looks too dramatic but the man is conscious. The cyclist tells me all he knows but the patient doesn’t speak to me, even though I know he can because my cyclist friend has confirmed this. The man with the chest pain lies there, looking at me and wincing every now and then. He’s pale and clammy and I still think he’s going to arrest in front of me but there’s something under the skin of it all that tells me he’s not as sick as he makes out.
When the crew arrive and we get him onto the vehicle, he becomes Mr. Chatty from Chattyland, Chattyville. What’s that all about? He’s an Irishman on a visit and he’s an alcoholic. He says he hasn’t been drinking though. How many alcoholics tell us they haven’t touched the stuff? Seems like a paradox to me. He’s friendly now and I set off to find more excitement in my world as the crew prepare him for hospital.
The neighbour of a 45 year-old woman who was suffering an acute allergic reaction to chocolate was shocked to find her standing, wheezing and puffed up, at her door. I arrived within five minutes of the call and she was sitting on a sofa looking much better than the description given. She was recovering and had her Epipen handy, although she hadn’t used it. Self-resolving anaphylaxis is unstable because it can kick in again at any time, so she was taken to hospital with adrenaline on stand-by.
If you thought Ipods were only for the young, you are sadly mistaken. I’ve got one for a start…but my 77 year-old cricket-expert patient with lung cancer and acute DIB also owned one. The lovely man looked sad as he was taken away from his home, where he lives alone among his almanacs and whisky. His classical and jazz favourites are stored on a couple of Gigs of hard drive and he made sure it came with him. He is a true gentleman of his generation and he’s now getting too ill to cope with his stiff upper lip.
The cops waited for me over the apparently lifeless body of a Polish alcoholic and I pulled up to see his equally alcoholic friend gesticulating his concern as his mate passed the time on the pavement.
No matter what I did, the man wouldn’t wake up, although he did respond. Every now and then, with deep pain, he’d lift his head…that was it. I could tell that he was an expert at playing possum and incredibly, he’d become completely accustomed to our pinches, rubs, shouts and needles. It’s a lifestyle, I suppose.
The crew fared no better and once I’d hooked him up for fluids, he was carted off to the sanctuary for alcoholism that is St. Thomas’ hospital. It’s shameful that such a famous institution has been downgraded by society’s lowest rung.
On the way off the ambulance, as his trolley bed was moved across the ramp, he took the time to wake up momentarily, life his head and spit onto the floor. He knew where he was, he knew who we were and he knew what he was doing. It’s not even clever.
A 31 year-old female was allegedly assaulted in a club in Soho and I was asked to attend because she had grazes and broken nails! The ambulance crew arrived, rushed out and one of them said ‘we heard there were broken nails involved, so we got here as fast as we could’. Hey, it’s a chuckle in amongst the pain, isn’t it? Anyway, the woman didn’t want an ambulance; the police had called us as a matter of routine.
I met the new frequent flyer with psychiatric problems again tonight. He calls us with spurious reasons for needing an ambulance, this time it was ‘fainting’. He came out of the callbox when I pulled up and sat, in his usual place, in the back of the car. I called the Street Rescue people about getting him off the street because now I recognised his real problem and I genuinely want to help him. I also want to stop him calling ambulances because this was the fourth time he’d dialled 999 today I learned.
The crew weren't happy to see him because they had taken him to hospital earlier and now wished they were doing something useful. I could see their point but we had to do something with him. I offered him the chance to go to another hospital but he wasn’t interested and suddenly changed his mind about it all. I gave him a blanket and sent him to a doorway so that he could sleep safely. I would see him again all too soon.
Be safe.
Sunday, 24 August 2008
New kid on the block
Night shift: Seven calls; one treated on scene, the rest by ambulance.
Stats: 1 ETOH; 1 Psychiatric problems; 2 Chest pain; 1 Abdo pain; 1 Drug overdose with head injury; 1 Asthma.
Early into the shift I am requested for an 18 year-old girl who has collapsed at a busy bar near Leicester Square. Her friend is convinced that her drink has been spiked because (and I’ve never heard this before) ‘she’s never been like this’.
Despite being told over and over again that she’s only had a couple of drinks (never heard that one either), she looks like a girl with plenty of booze on board. She’s unconscious and has vomited at the feet of customers who are trying to get on with the business of enjoying their night out, even though there are two paramedics (myself and the CRU) among them spoiling their fun.
After a few minutes the girl seems to be recovering a bit; she tells me she’s been drinking all day – then she slumps back to sleep and that’s the last time I hear from her while I’m attending. I put a line in and fluids go up to support her diminishing BP. Fluids are also very good at flushing alcohol through the system, so she should wake up soon.
The crew arrive and take her away. I’ve had to control the emotions of her screeching friend a couple of times with stern words and I regret being a little harsh with her at times but it’s hard to concentrate when you have crowds around you, a drunkenly unconscious patient and a banshee in the same periphery.
As I tidy up the debris from my labours and gather bits and piecesd from a table I’d used, I apologise to the two ladies who have been sitting at it and who, all the while, have patiently got on with their drinks a mere two feet from the disturbance. They smile, thank me back and ask for my phone number. Of course, I’m not shy and don’t mind the attention at all. ‘It’s 999’, I say.
My first encounter with another regular next. He’s been in the area for months but I have never come across him, until now and for the next few shifts. The 29 year-old man is small, quietly-spoken and vulnerable. He’s living rough and has psychiatric problems. He has called an ambulance for ‘chest pain’ and I believe him when he says he’s ill. He is in a callbox which is literally a hundred metres from the hospital. The clues were there but I chose to ignore them because I felt sorry for him and I believed (and still do) that he needs help.
His lip is cut and he offers no reason for this. He sits in my car until the ambulance arrives and I can see no reason not trust him, so he’s taken to hospital. Only after this am I told by another crew that he is a frequent flyer. I thought I knew them all.
A big 40 year-old Irishman with chest pain kept apologising as we helped him. He’d suffered for a week and thought it would go away but it’s now much worse and he has had to give in and call 999. He’s an alcoholic by his own admission but he’s not been drinking, he tells us. GTN helps him a little but the crew are taking him in because we don’t take chances with chest pain and this is genuine.
Many of our ‘chest pain’ calls are nothing of the sort. As I explained before, a lot of people cannot differentiate between chest and abdomen, so my next call didn’t surprise me. I walked into the shop, where late night workers were re-stocking shelves, to find a 26 year-old man laying flat on a table. He had abdominal pain, which he scored 10/10 and he was so uncomfortable that he couldn’t keep still. This is one of the signs of true pain.
I didn’t know how long I would wait for an ambulance and fifteen minutes had gone during my obs and questions, so I offered him pain relief and opted for morphine, rather than entonox because the former is much more effective and long-lasting than the latter. I was drawing it up when the crew got on scene and gave him a small amount to get him to hospital.
Another genuine chest pain and a yappy dog at the address of a 50 year-old woman who’d held out for 4 hours before her husband decided enough was enough and dialled 999. She looked unwell and the crew, who arrived behind me, took her swiftly away…I wasn’t going to slow this down by playing on scene. The dog was relentless and his bark rang in my head a few minutes after I left. They don’t need a smoke alarm at that house.
GHB again and a 20 year-old Spanish man stood in the doorway of a club, supported by the doormen on duty. It’s raining now and I’m getting soaked as translations fly between me, the patient and the intermediate on the door. He’s okay but kind of out of touch after taking the drug, so when the ambulance arrives I leave them to deal with him.
Last call; a 24 year-old bodybuilder suffering an asthma attack at home. He’d been woken up by chest tightness and he was wheezing a little but not at death’s door. I sound him out, give him a neb, wait while he recovers and take my leave with the crew when he confirms that he is much better and would rather stay at home. I remind him on the way out that he needs to put some muscle on because he’s looking weedy. You can have a laugh with blokes who look like the Hulk because they aren’t easily offended and you get one chance to duck if they are.
Be safe.
Stats: 1 ETOH; 1 Psychiatric problems; 2 Chest pain; 1 Abdo pain; 1 Drug overdose with head injury; 1 Asthma.
Early into the shift I am requested for an 18 year-old girl who has collapsed at a busy bar near Leicester Square. Her friend is convinced that her drink has been spiked because (and I’ve never heard this before) ‘she’s never been like this’.
Despite being told over and over again that she’s only had a couple of drinks (never heard that one either), she looks like a girl with plenty of booze on board. She’s unconscious and has vomited at the feet of customers who are trying to get on with the business of enjoying their night out, even though there are two paramedics (myself and the CRU) among them spoiling their fun.
After a few minutes the girl seems to be recovering a bit; she tells me she’s been drinking all day – then she slumps back to sleep and that’s the last time I hear from her while I’m attending. I put a line in and fluids go up to support her diminishing BP. Fluids are also very good at flushing alcohol through the system, so she should wake up soon.
The crew arrive and take her away. I’ve had to control the emotions of her screeching friend a couple of times with stern words and I regret being a little harsh with her at times but it’s hard to concentrate when you have crowds around you, a drunkenly unconscious patient and a banshee in the same periphery.
As I tidy up the debris from my labours and gather bits and piecesd from a table I’d used, I apologise to the two ladies who have been sitting at it and who, all the while, have patiently got on with their drinks a mere two feet from the disturbance. They smile, thank me back and ask for my phone number. Of course, I’m not shy and don’t mind the attention at all. ‘It’s 999’, I say.
My first encounter with another regular next. He’s been in the area for months but I have never come across him, until now and for the next few shifts. The 29 year-old man is small, quietly-spoken and vulnerable. He’s living rough and has psychiatric problems. He has called an ambulance for ‘chest pain’ and I believe him when he says he’s ill. He is in a callbox which is literally a hundred metres from the hospital. The clues were there but I chose to ignore them because I felt sorry for him and I believed (and still do) that he needs help.
His lip is cut and he offers no reason for this. He sits in my car until the ambulance arrives and I can see no reason not trust him, so he’s taken to hospital. Only after this am I told by another crew that he is a frequent flyer. I thought I knew them all.
A big 40 year-old Irishman with chest pain kept apologising as we helped him. He’d suffered for a week and thought it would go away but it’s now much worse and he has had to give in and call 999. He’s an alcoholic by his own admission but he’s not been drinking, he tells us. GTN helps him a little but the crew are taking him in because we don’t take chances with chest pain and this is genuine.
Many of our ‘chest pain’ calls are nothing of the sort. As I explained before, a lot of people cannot differentiate between chest and abdomen, so my next call didn’t surprise me. I walked into the shop, where late night workers were re-stocking shelves, to find a 26 year-old man laying flat on a table. He had abdominal pain, which he scored 10/10 and he was so uncomfortable that he couldn’t keep still. This is one of the signs of true pain.
I didn’t know how long I would wait for an ambulance and fifteen minutes had gone during my obs and questions, so I offered him pain relief and opted for morphine, rather than entonox because the former is much more effective and long-lasting than the latter. I was drawing it up when the crew got on scene and gave him a small amount to get him to hospital.
Another genuine chest pain and a yappy dog at the address of a 50 year-old woman who’d held out for 4 hours before her husband decided enough was enough and dialled 999. She looked unwell and the crew, who arrived behind me, took her swiftly away…I wasn’t going to slow this down by playing on scene. The dog was relentless and his bark rang in my head a few minutes after I left. They don’t need a smoke alarm at that house.
GHB again and a 20 year-old Spanish man stood in the doorway of a club, supported by the doormen on duty. It’s raining now and I’m getting soaked as translations fly between me, the patient and the intermediate on the door. He’s okay but kind of out of touch after taking the drug, so when the ambulance arrives I leave them to deal with him.
Last call; a 24 year-old bodybuilder suffering an asthma attack at home. He’d been woken up by chest tightness and he was wheezing a little but not at death’s door. I sound him out, give him a neb, wait while he recovers and take my leave with the crew when he confirms that he is much better and would rather stay at home. I remind him on the way out that he needs to put some muscle on because he’s looking weedy. You can have a laugh with blokes who look like the Hulk because they aren’t easily offended and you get one chance to duck if they are.
Be safe.
Saturday, 23 August 2008
Bring on the nights
Night shift: Eight calls; all by ambulance.
Stats: 1 Unwell adult; 1 BP problems; 2 ETOH; 1 Drug overdose; 1 Abdo pain; 1 Asthma
The night starts with a 55 year-old lady with little wrong with her. She’s lying in bed, family gathered around, hyperventilating, not communicating and occasionally thrashing around for effect. We see this a lot and there’s nothing we can do to help because hospital is not the answer. All her obs are normal; she just hasn’t taken her usual meds and is now feeling under the weather. She’s been fasting all day and hunger can throw up anomalous symptoms. I leave her with the crew.
In Theatreland a 40 year-old man is stuck in a standing position near the end of an aisle after watching a show with his wife. He suffers from arthritis and his leg has simply given up the will to work, so he can’t move without pain. His doctor took him off his diuretic and now he’s trying to cope with swollen joints. His hugely inflated wrists hint at the discomfort he’s in. His blood pressure is high and he is a little breathless. It’s an awkward, heavy job to move him into a chair and off to the ambulance but with three of us on scene the task is completed with minimal embarrassment to him. He’s resolute and wants to help himself as much as possible, so it’s hands-off when he requests it…until he needs it.
A silly 25 year-old female socialite collapsed behind a toilet cubicle door at a pub and now she’s stuck fast with her head lodged against the door, so it’s impossible to gain entry to assess her and she won’t wake up when I call to her. An off-duty and slightly drunk doctor is assisting and gave me a hand-over of sorts when I got on scene but she’s overly dramatic and insists the patient has stopped breathing. ‘She was snoring and then she stopped’, she tells me. 'I can intubate', she states. So can I, I thought to myself.
After a fruitless five minutes of trying to get into the cubicle I request the LFB because the door will have to come off, especially if what the doctor presumes is correct, although I doubt it. Upstairs the bar is packed and I know that moving her from here to the outside world is going to be a problem, so I’m hoping the ambulance won’t be too long.
As we wait for her to regain consciousness or for the Fire Brigade to turn up, the police arrive and they begin to plan the best way of getting through the door but all efforts to push it open are stymied by the presence of her head and the risk to her neck if we force it too violently. Useless tools are brought down for us but the door is solid (good quality toilet doors – very unusual).
The crew show up and the smallest of us manages to get an arm through to prod the woman hard enough to get her to wake up. She had started snoring again but it had nothing to do with her airway and much to do with how she sounds when asleep. She moans and wakes up enough for us to make it clear that she is causing havoc. She moves on demand and we get in, bring her to her feet and march her out of there before she has a chance to relapse. She hasn’t taken drugs; she’s just too drunk to stay awake. She isn’t apologetic and she isn’t thankful, she’s a perfectly inebriated Sloane girl with no regard whatsoever for the concern and trouble she has caused.
When she is taken to the ambulance a ‘friend’ of hers approaches the car and asks me if she’s alright. ‘Yes, she’s just drunk’ I tell her. Then I ponder what kind of person allows her friend to go AWOL for so long without bothering to investigate, especially when twenty minutes has elapsed and ambulance, police and fire service personnel start arriving on blue lights and sirens. I’d want to sit down and have a long chat with a friend like that.
Another unconscious GHB victim lies in the street in Soho and only a club manager and her security man are helping him. He’s a 25 year-old and by the time I arrive he’s waking up. The crew arrive soon after me and he’s walked to the ambulance and out of the crowded bliss he slumbered in.
An aggressive, drunken Lithuanian man, known to us in the area, lay flat out on the pavement near the train station. A concerned citizen called the ambulance and I show up and recognise him. The crew arrive and together we persuade him to get up but he’s not happy and wants to demonstrate how much he loathes us all, so he unzips his trousers and urinates in front of us. He pees and pees and pees – the flow goes on until a little river of urine is flash-flooding its way towards my car. His bladder must be the size of a camel's hump.
He finishes after an age then brings his filthy hands up to his face for a quick rub of his mouth and chin. I’m encouraged by the thought that the only person he’s contaminating is himself but he staggers towards the car and I feel the need to green up and leave the crew to it as they await the police.
I thought the next call was a no-trace because I couldn’t find the 23 year-old man with abdo pain at the location given, so I toured around until I was windmilled by him. He’s on anti-depressants but hasn’t been taking them. He’s also had a large amount of alcohol and I’m guessing it’s a substitute. He could have walked to hospital and it would have taken him all of ten minutes but he felt the need to exercise his God-given right to dial 999 and utilise the service that tax payers fund on his behalf. He gets his wish and an ambulance comes to collect him.
Before I leave the scene a passing motorist asks me for a vomit bag for his drunk girlfriend who is about to throw up in the back of his car. She’s holding a pathetic little paper cup under her chin in the vain hope that the deluge to come will be securely caught and stored in it – she has obviously never studied physics…or common sense.
A homeless 67 year-old man walked into a police station in the early hours complaining of chest pain. He’d taken his own GTN but with no relief and as I carry out my obs, I find myself more convinced of his need for a bed rather than medical care but I am no position to judge this on the face of it and wouldn’t dream of re-considering his request to go to hospital. Even if all he needs is a warm place to lay his head, I can see no harm in helping him get that.
My last job for a 51 year-old asthmatic whose inhaler doesn’t seem to be helping him required no more than basic obs from me because the crew was on scene before I’d started any treatment for him. This brought me nearer home and my trip back to the station was uneventful.
Be safe.
Stats: 1 Unwell adult; 1 BP problems; 2 ETOH; 1 Drug overdose; 1 Abdo pain; 1 Asthma
The night starts with a 55 year-old lady with little wrong with her. She’s lying in bed, family gathered around, hyperventilating, not communicating and occasionally thrashing around for effect. We see this a lot and there’s nothing we can do to help because hospital is not the answer. All her obs are normal; she just hasn’t taken her usual meds and is now feeling under the weather. She’s been fasting all day and hunger can throw up anomalous symptoms. I leave her with the crew.
In Theatreland a 40 year-old man is stuck in a standing position near the end of an aisle after watching a show with his wife. He suffers from arthritis and his leg has simply given up the will to work, so he can’t move without pain. His doctor took him off his diuretic and now he’s trying to cope with swollen joints. His hugely inflated wrists hint at the discomfort he’s in. His blood pressure is high and he is a little breathless. It’s an awkward, heavy job to move him into a chair and off to the ambulance but with three of us on scene the task is completed with minimal embarrassment to him. He’s resolute and wants to help himself as much as possible, so it’s hands-off when he requests it…until he needs it.
A silly 25 year-old female socialite collapsed behind a toilet cubicle door at a pub and now she’s stuck fast with her head lodged against the door, so it’s impossible to gain entry to assess her and she won’t wake up when I call to her. An off-duty and slightly drunk doctor is assisting and gave me a hand-over of sorts when I got on scene but she’s overly dramatic and insists the patient has stopped breathing. ‘She was snoring and then she stopped’, she tells me. 'I can intubate', she states. So can I, I thought to myself.
After a fruitless five minutes of trying to get into the cubicle I request the LFB because the door will have to come off, especially if what the doctor presumes is correct, although I doubt it. Upstairs the bar is packed and I know that moving her from here to the outside world is going to be a problem, so I’m hoping the ambulance won’t be too long.
As we wait for her to regain consciousness or for the Fire Brigade to turn up, the police arrive and they begin to plan the best way of getting through the door but all efforts to push it open are stymied by the presence of her head and the risk to her neck if we force it too violently. Useless tools are brought down for us but the door is solid (good quality toilet doors – very unusual).
The crew show up and the smallest of us manages to get an arm through to prod the woman hard enough to get her to wake up. She had started snoring again but it had nothing to do with her airway and much to do with how she sounds when asleep. She moans and wakes up enough for us to make it clear that she is causing havoc. She moves on demand and we get in, bring her to her feet and march her out of there before she has a chance to relapse. She hasn’t taken drugs; she’s just too drunk to stay awake. She isn’t apologetic and she isn’t thankful, she’s a perfectly inebriated Sloane girl with no regard whatsoever for the concern and trouble she has caused.
When she is taken to the ambulance a ‘friend’ of hers approaches the car and asks me if she’s alright. ‘Yes, she’s just drunk’ I tell her. Then I ponder what kind of person allows her friend to go AWOL for so long without bothering to investigate, especially when twenty minutes has elapsed and ambulance, police and fire service personnel start arriving on blue lights and sirens. I’d want to sit down and have a long chat with a friend like that.
Another unconscious GHB victim lies in the street in Soho and only a club manager and her security man are helping him. He’s a 25 year-old and by the time I arrive he’s waking up. The crew arrive soon after me and he’s walked to the ambulance and out of the crowded bliss he slumbered in.
An aggressive, drunken Lithuanian man, known to us in the area, lay flat out on the pavement near the train station. A concerned citizen called the ambulance and I show up and recognise him. The crew arrive and together we persuade him to get up but he’s not happy and wants to demonstrate how much he loathes us all, so he unzips his trousers and urinates in front of us. He pees and pees and pees – the flow goes on until a little river of urine is flash-flooding its way towards my car. His bladder must be the size of a camel's hump.
He finishes after an age then brings his filthy hands up to his face for a quick rub of his mouth and chin. I’m encouraged by the thought that the only person he’s contaminating is himself but he staggers towards the car and I feel the need to green up and leave the crew to it as they await the police.
I thought the next call was a no-trace because I couldn’t find the 23 year-old man with abdo pain at the location given, so I toured around until I was windmilled by him. He’s on anti-depressants but hasn’t been taking them. He’s also had a large amount of alcohol and I’m guessing it’s a substitute. He could have walked to hospital and it would have taken him all of ten minutes but he felt the need to exercise his God-given right to dial 999 and utilise the service that tax payers fund on his behalf. He gets his wish and an ambulance comes to collect him.
Before I leave the scene a passing motorist asks me for a vomit bag for his drunk girlfriend who is about to throw up in the back of his car. She’s holding a pathetic little paper cup under her chin in the vain hope that the deluge to come will be securely caught and stored in it – she has obviously never studied physics…or common sense.
A homeless 67 year-old man walked into a police station in the early hours complaining of chest pain. He’d taken his own GTN but with no relief and as I carry out my obs, I find myself more convinced of his need for a bed rather than medical care but I am no position to judge this on the face of it and wouldn’t dream of re-considering his request to go to hospital. Even if all he needs is a warm place to lay his head, I can see no harm in helping him get that.
My last job for a 51 year-old asthmatic whose inhaler doesn’t seem to be helping him required no more than basic obs from me because the crew was on scene before I’d started any treatment for him. This brought me nearer home and my trip back to the station was uneventful.
Be safe.
Friday, 22 August 2008
Figments
Night shift: Ten calls; two refused, two no-trace and the rest by ambulance.
Stats: 1 ?CVA; 2 Head injuries; 1 ? Tetanus; 1 Anaphylaxis; 2 ETOH.
My first call of the evening, to a 72 year-old female ‘? CVA’ was to a familiar address. It was the patient who’d slipped under the bed a few days before. Now she was in real trouble. She wasn’t smiling – she was crying. Her face has changed and she couldn’t communicate vocally at all. I felt terribly sorry for her but I knew that with cancer of the brain, fitting and other neurological problems, including stroke, were bound to occur. It didn’t stop me feeling her pain though.
A girl walks into a Chinese restaurant in Chinatown, orders, eats and then attempts to leave without paying. When she is confronted by the small Chinese manageress, she refuses to pay and says ‘you can’t do anything about it because you can’t touch me’. Then she tries to leave. She is again obstructed by the feisty little owner and the customer attacks her, smashing her in the face and breaking her cheap wooden jewellery on it as a punch is landed on her head. A male colleague attempts to intervene and protect his boss but he too becomes a victim and gets a punch in the eye for his troubles. The girl then storms out but is caught and arrested by police, who are always nearer than you think in this part of town.
I sat with the lady as she nursed her head. She hadn’t been knocked out and her injuries were minor really but she was badly shaken and broke down in tears a few times as I carried out my obs and asked her questions. At first she didn’t want to go to hospital but then she relented (the crew persuaded her it was best).
Bad people who know their rights should be stripped of them when they abuse them to such an extent. I couldn’t imagine stealing food like that and then using my human rights to get away with it. The right not to be detained physically should never be used like a cloak of invisibility but there are always people out there who will defend such a person…until they harm them or their families.
A funny story from the annals of stag history next. I arrived on scene for a 33 year-old male with a head injury and the police officers on scene were grinning at me. ‘You’re going to love this one’ the lead cop said to me as I pulled up.
On the pavement, wearing a field dressing applied by the police medic, was a sheepish-looking man. He was on his stag night and had, for reasons only known to himself, smashed a champagne glass, full-force, into his own head ‘for a laugh’. It turns out the joke was on him because nobody could believe he’d done it and his head was now gashed and blood was pouring from the wound. He was, in his defence, very, very drunk.
‘I’ve been really stupid’, he told me. His mates took photographs of him as he sat with a new bandage on his head after I’d taken a look at the wound. He was a very likeable bloke and he had a sense of humour about the whole thing but I wondered what his wife-to-be was going to think of his new permanent scar and the life-size photo’s that were going to be shown at his wedding during the Best Man’s speech.
It’s been the year for multiple drunken females in single calls for me. Two drunken women were falling all over the place as I drove by after the last call. I pulled up and asked if they needed help and a MOP who’d tried to assist told me that they’d given him abuse. I decided I’d leave them and they pretty much ignored me anyway. The taller of the two dragged her sleepy friend off across the Euston Road and I watched until they were off my radar and out of my realm of responsibility.
A 24 year-old complaining of feeling ‘unwell’ with a ‘tight chest’ seemed very genuine to me when I examined him as he lay on his sofa. He had a temperature of 38.0c and his BP was low. He’d been abroad recently and had also been treated in the not-too-distant past for a cut finger that had become infected. His tetanus status was unclear because he couldn’t remember if he’d had a booster in the past ten years. The one aspect of his presentation that struck me as unusual was that his fingers were stiff and bent; tetany it’s called. This, his high temperature and the chest tightness and discomfort he was feeling made me think of one thing – Tetanus infection.
An anaphylactic 17 year-old male stood on Oxford Street waiting for me as his face and throat swelled after eating something he was obviously averse to. He hadn’t brought his Epipen with him and so he got on-the-spot treatment before being taken to hospital, where his IV care continued. If you are anaphylactic, carry your Epipen at all times.
Another of our famous frequent flyers has re-appeared on the scene after a stint of absence – I think they work in shifts. This one is notorious for calling us three or four times a day and he lugs cases around with him as if he’s on holiday. There’s never anything wrong with him and hospitals in the area simply chuck him out after a while. Sometimes he’ll call an ambulance the minute he’s been ejected, only to be returned to the A&E department that didn’t want him. Sometimes he demands to go to a different hospital. Most crews know him but some do not and every now and then he fools them into doing his bidding. Normally I wouldn’t care but he, like so many of the others, is going to contribute to the death of a genuine patient as he ties up crews all day long.
This time he was on a bus and had to be lifted out of his seat before going to the ambulance. He won’t move unless he is sure you are going to take him to hospital – that’s his M.O. He can also be aggressive and violent when he feels like it or he doesn’t get what he wants. I often wonder why his rights are more important than ours.
I was flagged down to assist a diabetic who was ‘unconscious’ but I could see that he wasn’t. He and his friends were boisterously crowding on the pavement as they tried to drunkenly manage each other. His brother insisted that he was ok but the Polish man who’d drawn my attention to him wasn’t satisfied and shouted at me for doing nothing to help. I told him I couldn’t because he’d refused and his brother was going to take him home but Mr. Angry was most insistent. So much so that he started an argument with the small crowd of drunks. A punch-up looked inevitable, so I stood myself in between them to calm them down. I shouldn’t really do this but I’m from Glasgow and it’s in my nature. The fight was avoided and I continued on my way.
Two no-traces for the end of my night. The first for an unconscious man lying in the street outside a McDonald’s was invisible. He’d probably walked off. My presence prompted the security man at the McD’s to ask for advice about whether he should go to hospital by ambulance or not after being assaulted. I looked at the large-framed man and I looked at the smallest cut in the world and I couldn’t believe he was serious.
The second no-trace was for a 21 year-old unconscious drunken male. He didn’t exist either. I wish all unconscious drunken people were figments of my imagination.
Be safe.
Stats: 1 ?CVA; 2 Head injuries; 1 ? Tetanus; 1 Anaphylaxis; 2 ETOH.
My first call of the evening, to a 72 year-old female ‘? CVA’ was to a familiar address. It was the patient who’d slipped under the bed a few days before. Now she was in real trouble. She wasn’t smiling – she was crying. Her face has changed and she couldn’t communicate vocally at all. I felt terribly sorry for her but I knew that with cancer of the brain, fitting and other neurological problems, including stroke, were bound to occur. It didn’t stop me feeling her pain though.
A girl walks into a Chinese restaurant in Chinatown, orders, eats and then attempts to leave without paying. When she is confronted by the small Chinese manageress, she refuses to pay and says ‘you can’t do anything about it because you can’t touch me’. Then she tries to leave. She is again obstructed by the feisty little owner and the customer attacks her, smashing her in the face and breaking her cheap wooden jewellery on it as a punch is landed on her head. A male colleague attempts to intervene and protect his boss but he too becomes a victim and gets a punch in the eye for his troubles. The girl then storms out but is caught and arrested by police, who are always nearer than you think in this part of town.
I sat with the lady as she nursed her head. She hadn’t been knocked out and her injuries were minor really but she was badly shaken and broke down in tears a few times as I carried out my obs and asked her questions. At first she didn’t want to go to hospital but then she relented (the crew persuaded her it was best).
Bad people who know their rights should be stripped of them when they abuse them to such an extent. I couldn’t imagine stealing food like that and then using my human rights to get away with it. The right not to be detained physically should never be used like a cloak of invisibility but there are always people out there who will defend such a person…until they harm them or their families.
A funny story from the annals of stag history next. I arrived on scene for a 33 year-old male with a head injury and the police officers on scene were grinning at me. ‘You’re going to love this one’ the lead cop said to me as I pulled up.
On the pavement, wearing a field dressing applied by the police medic, was a sheepish-looking man. He was on his stag night and had, for reasons only known to himself, smashed a champagne glass, full-force, into his own head ‘for a laugh’. It turns out the joke was on him because nobody could believe he’d done it and his head was now gashed and blood was pouring from the wound. He was, in his defence, very, very drunk.
‘I’ve been really stupid’, he told me. His mates took photographs of him as he sat with a new bandage on his head after I’d taken a look at the wound. He was a very likeable bloke and he had a sense of humour about the whole thing but I wondered what his wife-to-be was going to think of his new permanent scar and the life-size photo’s that were going to be shown at his wedding during the Best Man’s speech.
It’s been the year for multiple drunken females in single calls for me. Two drunken women were falling all over the place as I drove by after the last call. I pulled up and asked if they needed help and a MOP who’d tried to assist told me that they’d given him abuse. I decided I’d leave them and they pretty much ignored me anyway. The taller of the two dragged her sleepy friend off across the Euston Road and I watched until they were off my radar and out of my realm of responsibility.
A 24 year-old complaining of feeling ‘unwell’ with a ‘tight chest’ seemed very genuine to me when I examined him as he lay on his sofa. He had a temperature of 38.0c and his BP was low. He’d been abroad recently and had also been treated in the not-too-distant past for a cut finger that had become infected. His tetanus status was unclear because he couldn’t remember if he’d had a booster in the past ten years. The one aspect of his presentation that struck me as unusual was that his fingers were stiff and bent; tetany it’s called. This, his high temperature and the chest tightness and discomfort he was feeling made me think of one thing – Tetanus infection.
An anaphylactic 17 year-old male stood on Oxford Street waiting for me as his face and throat swelled after eating something he was obviously averse to. He hadn’t brought his Epipen with him and so he got on-the-spot treatment before being taken to hospital, where his IV care continued. If you are anaphylactic, carry your Epipen at all times.
Another of our famous frequent flyers has re-appeared on the scene after a stint of absence – I think they work in shifts. This one is notorious for calling us three or four times a day and he lugs cases around with him as if he’s on holiday. There’s never anything wrong with him and hospitals in the area simply chuck him out after a while. Sometimes he’ll call an ambulance the minute he’s been ejected, only to be returned to the A&E department that didn’t want him. Sometimes he demands to go to a different hospital. Most crews know him but some do not and every now and then he fools them into doing his bidding. Normally I wouldn’t care but he, like so many of the others, is going to contribute to the death of a genuine patient as he ties up crews all day long.
This time he was on a bus and had to be lifted out of his seat before going to the ambulance. He won’t move unless he is sure you are going to take him to hospital – that’s his M.O. He can also be aggressive and violent when he feels like it or he doesn’t get what he wants. I often wonder why his rights are more important than ours.
I was flagged down to assist a diabetic who was ‘unconscious’ but I could see that he wasn’t. He and his friends were boisterously crowding on the pavement as they tried to drunkenly manage each other. His brother insisted that he was ok but the Polish man who’d drawn my attention to him wasn’t satisfied and shouted at me for doing nothing to help. I told him I couldn’t because he’d refused and his brother was going to take him home but Mr. Angry was most insistent. So much so that he started an argument with the small crowd of drunks. A punch-up looked inevitable, so I stood myself in between them to calm them down. I shouldn’t really do this but I’m from Glasgow and it’s in my nature. The fight was avoided and I continued on my way.
Two no-traces for the end of my night. The first for an unconscious man lying in the street outside a McDonald’s was invisible. He’d probably walked off. My presence prompted the security man at the McD’s to ask for advice about whether he should go to hospital by ambulance or not after being assaulted. I looked at the large-framed man and I looked at the smallest cut in the world and I couldn’t believe he was serious.
The second no-trace was for a 21 year-old unconscious drunken male. He didn’t exist either. I wish all unconscious drunken people were figments of my imagination.
Be safe.
Subscribe to:
Posts (Atom)
Posts
