Day shift: Four calls: Four by car; one by ambulance.
Stats: 2 Abdo pain; 1 ?EP fit; 1 Faint; 1 Cardiac arrest;
A drizzly morning start to the beginning of the end of the year, so to speak and I am asked to go to a million-star hotel to attend a 33 year-old female with abdominal pain. She is an employee and she is just about to start work on her ironing and other associated tasks when she is struck by acute pain, she claims.
I take abdominal pain seriously when it is deserved but I have to say, without running the risk of sounding like a completely uncaring person that this is the second time I have had to take a complete sham of an act into hospital. Abdo pain is one of the easiest complaints to feign – especially when you want a day off work and you are a low-paid employee. As soon as I saw her I could tell the pain wasn’t genuine and the fact that, once again, I am told the problem has existed, completely undiagnosed or treated, for years made me even more suspicious. There are, of course, ailments without aetiology but sooner or later something is done about them, even if it to throw analgesics at them in the hope that they will go away but I know when something just isn’t there – and there was nothing here.
In the car she was fine (until she called her mum – then she cried and wailed). At hospital she was fine, until a nurse approached her after my handover – then she threw herself from the chair, rolled on the floor and screamed in ‘agony’. It was embarrassing to watch and the noise she made brought people out of Resus and other areas to see what the hell was going on. The nurses stood over her and waited for the act to end before taking her to the furthest cubicle away from them. When I took her paperwork in I peeked round the curtain to check she was decently dressed before entering the cubicle. She was quiet and alert. Then I showed myself and dropped the paperwork off – only then did she begin to hobble and moan again.
I’m sorry if you see me as uncaring or unprofessional but I really despise weakness like this. There are plenty of genuinely ill people around and they try to take care of themselves most of the time. When they need medical help, they retain a modicum of dignity and their plight is very real to us.
At a medical walk-in centre a 30 year-old Chef presented himself to the nurse practitioner after suffering a number of what he described as ‘blackouts’. He has a history of epilepsy from his early teens but these events were new and different, as his epilepsy had been well controlled by drugs over the years. But epilepsy can change form over time and its possible that he was entering into a new phase with his condition. It’s also possible that a life-change, such as moving home or the stress of a job, has affected him – he may even need to have his drug reviewed. Whatever it is, he complained of having several more ‘vague phases’ during the trip in the car to A&E.
After a short interval in which nothing happened I was called to an 18 year-old female who’d fainted at a train station. She was 19 weeks pregnant with her second child and had passed out momentarily in the loo. Her hip was hurting as a result of the fall and an exacerbation of a condition known as SPD, which she developed during her first pregnancy and probably had again, if her description of how the hip and pelvis felt were anything to go by. She remained cheery and conscious during the trip to A&E in the car but her large Christmas bag, containing a heavy toy for her relative’s child, burst open and had to receive treatment from me in hospital, involving mainly tape and staples. It was a difficult and emotional job but... someone had to do it.
An 18 year-old female with period pain decided to have an ambulance called on her behalf when she could not cope with the cramping. She and her friends had police officers tending to them, even though a couple of painkillers would have been more effective. She’d taken paracetamol a few minutes before my arrival and had endured the pain all day, so she really hadn’t thought it through properly. Still, I took her to the busy A&E department, where she and her mate sat on a chair waiting. She was smiling and feeling better by the time I delivered her.
There had been a number of cardiac arrest calls during the day and I was tied up with the above jobs instead of running to the ones that were near enough for me to have helped (if they hadn’t turned out to be purple), so it wasn’t surprising that one came my way and I was asked to assist a crew on scene. The 78 year-old man had collapsed in the rainy street and his wife stood by as the team on scene resuscitated him. He was shocked quite a few times and his ECG rhythm changed from VF to a slow PEA and then on to VT. We eventually managed to get him breathing, although he had been trying himself from the start and, with the help of a passing anaesthetist and a medical student, we managed to keep him going until his rhythm changed and stabilised long enough for a pulse to be felt. That happened in the ambulance as we were getting ready to leave.
He arrived at hospital breathing weakly and with a half-decent pulse and BP, so it’s now down to God and fate as to whether he survives in the long term but I think he has a fighting chance.
* I was able to check on this man a few days later and was told that he is still alive in Intensive Care. The medical student deserves thanks for her sterling work on the compressions - they would certainly have contributed to saving this man's life.
Be safe.
Wednesday, 30 December 2009
Sunday, 27 December 2009
Na,na,na,na,na,na,na,na Bedman!
Day shift: Four calls: Two by car; two by ambulance.
Stats: 2 Falls; 1 ? Fracture/dislocation; 1 ? TIA.
After a few hours of nothing, an 80 year-old Australian lady tripped on a raised pavement slab and fell on her face, cutting her head just above the eye. She also had a numb face on the same side and some mild shoulder pain, probably caused by her attempt to stop the fall. Her family was with her and I took her and her son in the car, while the others followed on by taxi. Easy and sensible.
Shoppers, far too busy with bargains, delayed me from getting to an 18-month old girl who’d fallen onto her face in a large store. There was nobody to meet me and a MOP had to tell me where I was going; thankfully there was no serious injury to deal with. The little girl was wailing in distress – she had a cut and swollen lip and a bruised nose and cheek. There were a few loose teeth too, so I took her and mum (who is a GP) to children’s A&E for treatment and reassurance.
I had a quiet word with the manager of the store on the way out with the patient ( I had just cleared the lift of able-bodied people who were unwilling to give me the space at first) when he asked what was going on. I suggested that he speak to his staff about communication and receiving emergency service personnel.
Later in the day a 48 year-old French woman fell awkwardly whilst shopping with her family. I found her in the changing room, lying on the floor in agony after (probably) fracturing her clavicle at the extremity where it meets the upper arm bone (humerus). It also looked dislocated so I understood why she was reticent to have it moved in any way.
There was a translator on scene (a member of staff), which was fortunate because my limited French and her limited English were getting us nowhere. She told me she worked as a nurse and so this made things easier in terms of treatment (entonox) and description of the injury.
I had almost set off to hospital with her in the car and prepared to return for the rest of her family when the ambulance showed up, even though I wasn’t hopeful of getting one. It was a blessing because it meant we could take the patient and her three family members to hospital together. So, I travelled behind the ambulance with two family members, neither of which could speak English. I had to entertain myself by people-watching as I trundled along Tottenham Court Road. That’s when I saw a man dressed as a bed, with a full mattress over him, walking along the street advertising a bedding store. He was preceded by a shivering, fed-up looking woman who was dressed in an old-fashioned night gown and hat and carrying a candle. I couldn’t think of a useful French phrase for this, so I let my guests work it out themselves as they followed the line of my gaze with their mouths open.
The injured woman and her family were due to travel home a few hours later but I told her that this was very unlikely.
Confusion after a headache can mean a TIA has occurred and so the visiting friends of an 87 year-old man decided to call 999 when he lost the ability to speak properly and became vague. When I arrived he’d started to improve but he knew himself that something wasn’t right. The crew was on scene soon after me so I didn’t get too far into the history and obs on this one but he would have been taken to hospital for sure.
I have to say I’m finding it more and more difficult to make judgment calls about individuals with possible neurological problems when I am subjected to walking human beds in the middle of the afternoon.
Be safe.
Stats: 2 Falls; 1 ? Fracture/dislocation; 1 ? TIA.
After a few hours of nothing, an 80 year-old Australian lady tripped on a raised pavement slab and fell on her face, cutting her head just above the eye. She also had a numb face on the same side and some mild shoulder pain, probably caused by her attempt to stop the fall. Her family was with her and I took her and her son in the car, while the others followed on by taxi. Easy and sensible.
Shoppers, far too busy with bargains, delayed me from getting to an 18-month old girl who’d fallen onto her face in a large store. There was nobody to meet me and a MOP had to tell me where I was going; thankfully there was no serious injury to deal with. The little girl was wailing in distress – she had a cut and swollen lip and a bruised nose and cheek. There were a few loose teeth too, so I took her and mum (who is a GP) to children’s A&E for treatment and reassurance.
I had a quiet word with the manager of the store on the way out with the patient ( I had just cleared the lift of able-bodied people who were unwilling to give me the space at first) when he asked what was going on. I suggested that he speak to his staff about communication and receiving emergency service personnel.
Later in the day a 48 year-old French woman fell awkwardly whilst shopping with her family. I found her in the changing room, lying on the floor in agony after (probably) fracturing her clavicle at the extremity where it meets the upper arm bone (humerus). It also looked dislocated so I understood why she was reticent to have it moved in any way.
There was a translator on scene (a member of staff), which was fortunate because my limited French and her limited English were getting us nowhere. She told me she worked as a nurse and so this made things easier in terms of treatment (entonox) and description of the injury.
I had almost set off to hospital with her in the car and prepared to return for the rest of her family when the ambulance showed up, even though I wasn’t hopeful of getting one. It was a blessing because it meant we could take the patient and her three family members to hospital together. So, I travelled behind the ambulance with two family members, neither of which could speak English. I had to entertain myself by people-watching as I trundled along Tottenham Court Road. That’s when I saw a man dressed as a bed, with a full mattress over him, walking along the street advertising a bedding store. He was preceded by a shivering, fed-up looking woman who was dressed in an old-fashioned night gown and hat and carrying a candle. I couldn’t think of a useful French phrase for this, so I let my guests work it out themselves as they followed the line of my gaze with their mouths open.
The injured woman and her family were due to travel home a few hours later but I told her that this was very unlikely.
Confusion after a headache can mean a TIA has occurred and so the visiting friends of an 87 year-old man decided to call 999 when he lost the ability to speak properly and became vague. When I arrived he’d started to improve but he knew himself that something wasn’t right. The crew was on scene soon after me so I didn’t get too far into the history and obs on this one but he would have been taken to hospital for sure.
I have to say I’m finding it more and more difficult to make judgment calls about individuals with possible neurological problems when I am subjected to walking human beds in the middle of the afternoon.
Be safe.
Saturday, 26 December 2009
Goodwill to all men (unlikely)
Shoppers prepare for the Boxing Day Sales.
Day shift: Eight calls: three assisted-only; one false alarm; one by car and three by ambulance.
Stats: 2 Abdo pain; 1 Fitting; 1 Unwell adult; 1 Broken nose; 2 falls.
Another year and the Boxing Day sales are on. Oxford Street, and in particular, Selfridges, was hosting the biggest crowds in London for the day, or at least until they’d spent themselves into debt. Fortunately the Starbucks across the road was serving coffee and Panninis in a smooth and efficient manner, even if they weren’t having a sale – something that would have eased the pain of their horrific prices - £8 for a latte and a hot piece of bread!
The fairly sedate start was quickly run over by a call to the north for a chest pain that was an abdo pain in disguise. The 45 year-old Somalian man had a very strange ECG but his tall, thin figure and genetic predisposition called for anomalies that were normal for him. He also had a missing lung – the result of an earlier fight with pneumonia.
A cardiac arrest call came in as I left that job to the crew and I ran on it in good faith, knowing that it was probably nothing of the sort. A biker was on his way and as I approached he called in an all too familiar report, ‘not as given’. I stood myself down before the excitement overwhelmed me. I had the madness of sales fever to deal with later on anyway.
A call that went from red to green in quick succession turned out to be for a 50 year-old street dwelling alcoholic who had fitted in a doorway. I was only a minute from the location, so stayed put when the call changed priority and watched as he had another seizure in front of me. He was unresponsive but conscious and I’m sure that his habit had a lot to do with this event, although his friend told me he’d never seen him have a fit before. The man has been on the streets for eleven years and now his time was coming – the seizures, loss of bladder control, inability to breathe properly without oxygen and the fairly new hospital tag around his wrist were all testament to that.
To the south next for a 74 year-old Bangladeshi lady with a nosebleed that stopped before I got there. She was lying on the sofa and had been shaking with stress before I arrived. Her family was around her and they explained that she was a worrier and that, although healthy as a horse, she made herself ill by thinking she was ill. I spent a good 30 minutes with them and enjoyed chatting and learning about them, as a family and their culture. I convinced their mum to settle down and stay at home with her family and won the day – PRF signed obviously. Oh, and a crew showed up after I’d asked for them to be cancelled, so our comms were working top notch as usual.
Acute severe abdominal pain next and a 41 year-old woman with a 20 year history of unsolved agony called us, so I went to give her morphine because it works ‘instantly’ she said, in between long screams and moans. She was doubled up on her sofa, trying to vomit into a small bowl that may or may not be used later on for cooking and such. Her BP was consistently high and so the crew ‘blued’ her in. She was very adamant that she wanted to be taken to a particular hospital and I wasn’t too happy that she wouldn’t let us take her to the nearest but the issue was logged and she went where she wanted to go.
They knew her there and she has a little history of going in by ambulance, staying for a while until they give her pain relief and then leaving without a diagnosis. So, the facts of the matter are yet to become the light of her problem – nobody knows what is wrong with her. Her dangerous hypertension and obvious pain made it impossible for us to be passive about it, so she will present again and again I should think, with the same problem and never get to the bottom of it.
Outside a theatre, as the crowds swelled the streets, a 50 year-old woman tripped and fell onto the pavement as she and her boyfriend (it seems strange to use that title at that age, doesn't it?) were about to go inside to see the show. The manager told me that she didn’t really need an ambulance and I accepted that but her boyfriend came out and I thought better of leaving the scene too hastily when he explained that she probably needed ‘butterflies’ in her lip.
She appeared with him a few minutes later and it was obvious that she’d busted her nose. It was leaning over to the right and this, I was told with confidence, was not how it had been created. Her lip had a little puncture in it but she went in the car for the nose. I made a point of telling everyone who would listen that she’d been in a fight. It brought a cheery smile to those waiting outside Resus, which may or may not have been appropriate.
A Red1 that became a Red2 became a farce when I arrived in the crowds of Oxford Street for a 28 year-old woman who’d fallen. A gangsta type offered his medical opinion ‘she’s diabetic’ when I asked the woman what had happened. He was nothing to do with her; his little gang stood around just being nosey and I’m sorry to say (and this is not a slight on young people) that I worried that my car may not be locked. There’s helpful and there’s dodgy.
Anyway, the woman had absolutely nothing wrong with her except an emotional problem that nobody would be able to solve except her husband. She flopped around and I did my obs. She was in normal health and they agreed to take her to their nearest hospital after I cancelled the ambulance and informed them that I would drive her to a four or five hour wait at one of ours. The ambulance I had cancelled, as per the whole point of having me there, arrived anyway, so the crew were informed of the decision and they left empty-trolleyed.
And just as the day ended for me I was asked to assist an Urgent Care crew who wanted to leave an elderly person at home after helping him back up after a fall. He had no injuries but his BM was high, so I went there to double check him and carry out a thorough examination, including an ECG.
There were the usual anomalies but they were expected for a 93 year-old. He declined hospital before I’d even started to check him and his wife added her own refusal on his behalf. He had wet himself and his urine smelled familiarly off, so I suspect he had a UTI and I advised his wife to contact their GP as soon as possible to have it treated. Apart from that he was fine, so I left him in the care of his wife and the crew, who completed their paperwork on scene.
During the day, as per last year and the year before, a gang of youths went on the rampage and a fight broke out in Oxford Street. Someone was stabbed apparently and this is now normal on sales day up there. The atmosphere is seldom friendly and people become selfish and aggressive, driven by their overwhelming desire to cash in on the best bling at the cheapest prices, regardless of the health and welfare of others. Welcome to the new society.
Be safe.
Day shift: Eight calls: three assisted-only; one false alarm; one by car and three by ambulance.
Stats: 2 Abdo pain; 1 Fitting; 1 Unwell adult; 1 Broken nose; 2 falls.
Another year and the Boxing Day sales are on. Oxford Street, and in particular, Selfridges, was hosting the biggest crowds in London for the day, or at least until they’d spent themselves into debt. Fortunately the Starbucks across the road was serving coffee and Panninis in a smooth and efficient manner, even if they weren’t having a sale – something that would have eased the pain of their horrific prices - £8 for a latte and a hot piece of bread!
The fairly sedate start was quickly run over by a call to the north for a chest pain that was an abdo pain in disguise. The 45 year-old Somalian man had a very strange ECG but his tall, thin figure and genetic predisposition called for anomalies that were normal for him. He also had a missing lung – the result of an earlier fight with pneumonia.
A cardiac arrest call came in as I left that job to the crew and I ran on it in good faith, knowing that it was probably nothing of the sort. A biker was on his way and as I approached he called in an all too familiar report, ‘not as given’. I stood myself down before the excitement overwhelmed me. I had the madness of sales fever to deal with later on anyway.
A call that went from red to green in quick succession turned out to be for a 50 year-old street dwelling alcoholic who had fitted in a doorway. I was only a minute from the location, so stayed put when the call changed priority and watched as he had another seizure in front of me. He was unresponsive but conscious and I’m sure that his habit had a lot to do with this event, although his friend told me he’d never seen him have a fit before. The man has been on the streets for eleven years and now his time was coming – the seizures, loss of bladder control, inability to breathe properly without oxygen and the fairly new hospital tag around his wrist were all testament to that.
To the south next for a 74 year-old Bangladeshi lady with a nosebleed that stopped before I got there. She was lying on the sofa and had been shaking with stress before I arrived. Her family was around her and they explained that she was a worrier and that, although healthy as a horse, she made herself ill by thinking she was ill. I spent a good 30 minutes with them and enjoyed chatting and learning about them, as a family and their culture. I convinced their mum to settle down and stay at home with her family and won the day – PRF signed obviously. Oh, and a crew showed up after I’d asked for them to be cancelled, so our comms were working top notch as usual.
Acute severe abdominal pain next and a 41 year-old woman with a 20 year history of unsolved agony called us, so I went to give her morphine because it works ‘instantly’ she said, in between long screams and moans. She was doubled up on her sofa, trying to vomit into a small bowl that may or may not be used later on for cooking and such. Her BP was consistently high and so the crew ‘blued’ her in. She was very adamant that she wanted to be taken to a particular hospital and I wasn’t too happy that she wouldn’t let us take her to the nearest but the issue was logged and she went where she wanted to go.
They knew her there and she has a little history of going in by ambulance, staying for a while until they give her pain relief and then leaving without a diagnosis. So, the facts of the matter are yet to become the light of her problem – nobody knows what is wrong with her. Her dangerous hypertension and obvious pain made it impossible for us to be passive about it, so she will present again and again I should think, with the same problem and never get to the bottom of it.
Outside a theatre, as the crowds swelled the streets, a 50 year-old woman tripped and fell onto the pavement as she and her boyfriend (it seems strange to use that title at that age, doesn't it?) were about to go inside to see the show. The manager told me that she didn’t really need an ambulance and I accepted that but her boyfriend came out and I thought better of leaving the scene too hastily when he explained that she probably needed ‘butterflies’ in her lip.
She appeared with him a few minutes later and it was obvious that she’d busted her nose. It was leaning over to the right and this, I was told with confidence, was not how it had been created. Her lip had a little puncture in it but she went in the car for the nose. I made a point of telling everyone who would listen that she’d been in a fight. It brought a cheery smile to those waiting outside Resus, which may or may not have been appropriate.
A Red1 that became a Red2 became a farce when I arrived in the crowds of Oxford Street for a 28 year-old woman who’d fallen. A gangsta type offered his medical opinion ‘she’s diabetic’ when I asked the woman what had happened. He was nothing to do with her; his little gang stood around just being nosey and I’m sorry to say (and this is not a slight on young people) that I worried that my car may not be locked. There’s helpful and there’s dodgy.
Anyway, the woman had absolutely nothing wrong with her except an emotional problem that nobody would be able to solve except her husband. She flopped around and I did my obs. She was in normal health and they agreed to take her to their nearest hospital after I cancelled the ambulance and informed them that I would drive her to a four or five hour wait at one of ours. The ambulance I had cancelled, as per the whole point of having me there, arrived anyway, so the crew were informed of the decision and they left empty-trolleyed.
And just as the day ended for me I was asked to assist an Urgent Care crew who wanted to leave an elderly person at home after helping him back up after a fall. He had no injuries but his BM was high, so I went there to double check him and carry out a thorough examination, including an ECG.
There were the usual anomalies but they were expected for a 93 year-old. He declined hospital before I’d even started to check him and his wife added her own refusal on his behalf. He had wet himself and his urine smelled familiarly off, so I suspect he had a UTI and I advised his wife to contact their GP as soon as possible to have it treated. Apart from that he was fine, so I left him in the care of his wife and the crew, who completed their paperwork on scene.
During the day, as per last year and the year before, a gang of youths went on the rampage and a fight broke out in Oxford Street. Someone was stabbed apparently and this is now normal on sales day up there. The atmosphere is seldom friendly and people become selfish and aggressive, driven by their overwhelming desire to cash in on the best bling at the cheapest prices, regardless of the health and welfare of others. Welcome to the new society.
Be safe.
Friday, 25 December 2009
Merry Christmas!
A merry Christmas to you all. Thank you for reading the blog and sticking with me through thick and thin. Harry and Scruffs also thank you for your thoughts and messages throughout the year.
Xf
Xf
Sunday, 20 December 2009
Headaches
Night shift: Five calls: One assisted-only; one by car and three by ambulance.
Stats: 1 CVA; 1eTOH; 1 DIB; 1 Allergic reaction; 1 Eye injury post assault
Move away from the Chardonnay! Yes, it’s definitely that time of year – where the meaning of Christmas (Christian soul or not) is blurred out of focus by commercialism and selfishness, drunkenness and stupidity. Oh and lovely presents. My wife says I’m the Scrooge of Christmas but I think my cynicism is realistic because it allows me to see the real spirit of the Festive season when and where it appears. I still love snow, Jingle Bells and mulled wine. Honest. I don’t agree that lying in a gutter, vomiting your stomach empty and swearing at your friends is a good way to celebrate this pagan thing. Sorry, I know I'm reeeeellly boring!
As the tide of human waste turns on the bars and clubs in the West End, a 52 year-old lady lies in her dry bath, unresponsive for three hours until her son discovered her, naked and limp. She’d had a stroke and her right side was useless. She couldn’t speak but I suspect she understood something of what was going on.
I was asked to assist a crew and FRU already on scene and we planned a way of getting her out but it involved man-handling her onto the chair and slowly carrying her weight down steep narrow stairs. But we succeeded without a hitch or a back injury and got her into the ambulance, where she remained unresponsive except to pain and loud voice (and only then to open her eyes momentarily). I tried to get a line in but failed miserably and decided she didn’t really need the extra hassle, so I left her alone and accompanied the crew as she was ‘blued’ in to Resus.
This lady’s consistently high BP indicated a haemorrhagic stroke cerebellar or brain stem) rather than an embolic CVA – her pupils were almost pinpoint and non-responsive, her breathing was stertorous and she had complained of a headache earlier in the night. She needed emergency medical attention rapidly if she was to survive.
It must be Christmas because my next call sent me to a place where the Polish drunks seem to breed, for a 53 year-old man ‘collapsed, possibly drunk’ outside a shopping centre. He was sleeping on the ground and yes, he was drunk... and Polish. A random woman was on scene with the security guy from the shopping centre and she seemed very concerned about his health and welfare until I revealed his secret – he was just drunk. She suddenly became more concerned about whether he had a work permit or was legal and started to interrogate him about it. I stopped her, asked her to leave (politely of course) and stood him up for his journey out of the immediate area. And I say it must be Christmas because this Polish man decided to thank me with a big unwelcome hug and a sloppy, all in my ear, kiss, which, being Glaswegian, I didn’t really appreciate. So, I left him in the care of the security man because my job wasn’t to usher drunks off the premises- nor was it to accept alcoholic kisses from blokes.
Pizza was interrupted by a call that had originally been given to Urgent Care but went Category A because the patient had DIB, so my cold dinner sat in the car while I went inside the world’s smallest flat with the crew to put the patient on oxygen for his low sats, which improved immediately. He had a recent history of recurrent chest infection plus many other medical problems from the past, so he went to hospital (in his own wheelchair), oh and in the ambulance of course. I eventually got back to my pizza but it had to be reheated in the microwave and so it didn't taste the same.
A 28 year-old woman with hugely puffy eyes sat in a train station waiting for me to take her to A&E for the second time since she began to react to eyebrow tinting dye a few days earlier and was given IV piriton and oral steroids to solve the problem. It didn’t and now she had watery, sticky closed eyes and large swollen lids to contend with. Even from a distance it looked painful and frustrating – she couldn’t see much at all and opening them was painful for her.
Normally I would take a call like this in the car but she had suitcases with her and I didn’t have the space to accommodate them, so I asked for an Urgent Care crew to come and collect her.
A stint of standby on Leicester Square was broken by an assault not far from me in Piccadilly Circus. A 26 year-old Australian man was set upon by four men when he tried to break up a fight in which the gang had turned on someone. For his trouble, he got punched and kicked to the ground, leaving him with a deep cut above his eye. Otherwise he was fine but I took him to hospital in the car and the police followed on. While on scene he saw one of his assailants walking close by and identified him to me and the cops. The cheeky thug had brazenly walked into the crime scene he’d helped to create just so that he could look at his handiwork. He even smiled. Happy Christmas!
Be safe.
Stats: 1 CVA; 1eTOH; 1 DIB; 1 Allergic reaction; 1 Eye injury post assault
Move away from the Chardonnay! Yes, it’s definitely that time of year – where the meaning of Christmas (Christian soul or not) is blurred out of focus by commercialism and selfishness, drunkenness and stupidity. Oh and lovely presents. My wife says I’m the Scrooge of Christmas but I think my cynicism is realistic because it allows me to see the real spirit of the Festive season when and where it appears. I still love snow, Jingle Bells and mulled wine. Honest. I don’t agree that lying in a gutter, vomiting your stomach empty and swearing at your friends is a good way to celebrate this pagan thing. Sorry, I know I'm reeeeellly boring!
As the tide of human waste turns on the bars and clubs in the West End, a 52 year-old lady lies in her dry bath, unresponsive for three hours until her son discovered her, naked and limp. She’d had a stroke and her right side was useless. She couldn’t speak but I suspect she understood something of what was going on.
I was asked to assist a crew and FRU already on scene and we planned a way of getting her out but it involved man-handling her onto the chair and slowly carrying her weight down steep narrow stairs. But we succeeded without a hitch or a back injury and got her into the ambulance, where she remained unresponsive except to pain and loud voice (and only then to open her eyes momentarily). I tried to get a line in but failed miserably and decided she didn’t really need the extra hassle, so I left her alone and accompanied the crew as she was ‘blued’ in to Resus.
This lady’s consistently high BP indicated a haemorrhagic stroke cerebellar or brain stem) rather than an embolic CVA – her pupils were almost pinpoint and non-responsive, her breathing was stertorous and she had complained of a headache earlier in the night. She needed emergency medical attention rapidly if she was to survive.
It must be Christmas because my next call sent me to a place where the Polish drunks seem to breed, for a 53 year-old man ‘collapsed, possibly drunk’ outside a shopping centre. He was sleeping on the ground and yes, he was drunk... and Polish. A random woman was on scene with the security guy from the shopping centre and she seemed very concerned about his health and welfare until I revealed his secret – he was just drunk. She suddenly became more concerned about whether he had a work permit or was legal and started to interrogate him about it. I stopped her, asked her to leave (politely of course) and stood him up for his journey out of the immediate area. And I say it must be Christmas because this Polish man decided to thank me with a big unwelcome hug and a sloppy, all in my ear, kiss, which, being Glaswegian, I didn’t really appreciate. So, I left him in the care of the security man because my job wasn’t to usher drunks off the premises- nor was it to accept alcoholic kisses from blokes.
Pizza was interrupted by a call that had originally been given to Urgent Care but went Category A because the patient had DIB, so my cold dinner sat in the car while I went inside the world’s smallest flat with the crew to put the patient on oxygen for his low sats, which improved immediately. He had a recent history of recurrent chest infection plus many other medical problems from the past, so he went to hospital (in his own wheelchair), oh and in the ambulance of course. I eventually got back to my pizza but it had to be reheated in the microwave and so it didn't taste the same.
A 28 year-old woman with hugely puffy eyes sat in a train station waiting for me to take her to A&E for the second time since she began to react to eyebrow tinting dye a few days earlier and was given IV piriton and oral steroids to solve the problem. It didn’t and now she had watery, sticky closed eyes and large swollen lids to contend with. Even from a distance it looked painful and frustrating – she couldn’t see much at all and opening them was painful for her.
Normally I would take a call like this in the car but she had suitcases with her and I didn’t have the space to accommodate them, so I asked for an Urgent Care crew to come and collect her.
A stint of standby on Leicester Square was broken by an assault not far from me in Piccadilly Circus. A 26 year-old Australian man was set upon by four men when he tried to break up a fight in which the gang had turned on someone. For his trouble, he got punched and kicked to the ground, leaving him with a deep cut above his eye. Otherwise he was fine but I took him to hospital in the car and the police followed on. While on scene he saw one of his assailants walking close by and identified him to me and the cops. The cheeky thug had brazenly walked into the crime scene he’d helped to create just so that he could look at his handiwork. He even smiled. Happy Christmas!
Be safe.
Saturday, 19 December 2009
Sober and lonely
Night shift: Four calls: One assisted-only; one false alarm and two by ambulance.
Stats: 1 High BP; 1 fall; 2 eTOH
It’s shameful the way we ignore and neglect our old folk and I have said this again and again over the years. Nothing will change because there isn’t the will to do anything. Social Services in this country fall way below the standard expected of our long-time tax-paying, war-fighting elderly and it’s very frustrating.
The first call of the night, when there are no ambulances available due to the demands of London’s drunken revellers, was for a 91 year-old woman who had pressed her Careline alarm. I arrived to find no access because, even when I pressed all the buzzers for the block of flats, nobody would let me in – everyone in the building seemed to be out. I was concerned that the lady was trapped behind locked doors because she didn’t answer me initially either. Control arranged for the police as I waited outside in the minus zero temperatures but luckily someone came out and I let myself in and took the lift to her flat.
She didn’t answer the bell or my voice when I shouted through the letterbox but I could hear the extremely loud voice of the Careline person speaking to her over the phone system, so she was inside and alive at least but what was stopping her from opening the front door? After a lot of repeated commands from the phone voice for her to let me in, she eventually scooted into view behind the frosted glass of her front door, using a Zimmer frame to get to me.
I got her back into the front room and she seemed fine but it became obvious almost immediately that she had a major problem with her hearing. She wore an aid but the battery was flat and she had no spare, so I spent almost an hour in her house writing messages on a pad to communicate and trying to get transport for her because she was very vulnerable and could not stay there on her own.
She had no TV and no radio – nothing to listen to in fact. Her bedroom was a mess and I don’t think she used her bed at all. She had no food in her fridge and the place was generally untidy, with her less than 5 foot frame in the middle of it. She was a tiny, lovely lady who was abandoned by society. Her 'care' records stated that she didn’t take her medicines (her BP was high as a result) and she was frequently visited by police, fire and ambulance personnel because she pressed her button for help, couldn’t hear it when it was there and had to have her door broken in each time. Her flat was littered with hand-written notes from various people who’d found it impossible to get her to hear them.
Social Services had been told about her but nothing was done. Her own sister-in-law apparently didn’t care (according to a friend who phoned when I was there) and she had no immediate family left. This poor, smiling deaf woman was very alone and very vulnerable. I would have adopted her as my granny if I could.
The crew arrived after a long wait and she was taken to hospital after I’d made sure that Social Services were alerted, yet again, to her plight. I don’t expect miracles.
A few false alarms later and I was stuck with a 25 year-old man who’d fallen down metal steps at work and hurt his leg. It didn’t look badly damaged but he was in some pain, so I gave him entonox, which instantly helped. In fact, he became wildly drunk on the gas and I wondered why it was having such an effect on him. It wasn’t until I considered the weather outside and the fact that the cylinder had been sitting in the back of the car that I remembered something important about entonox – the gases (nitrous oxide and oxygen) separate at minus four degrees, leaving nitrous oxide at the top. No wonder he was off his head. I quickly mixed the gases back together by rotating the cylinder an few times. It won’t have done him any harm i the short period he was breathing it.
I waited for more than 30 minutes until I got a SJA crew and they splinted him and took him to hospital. He was still grinning like a Cheshire cat when I left him in the back of their ambulance.
It started snowing, as predicted for the night but somewhere along the way the temperature lifted and the fluffy white stuff became sleet. So, obviously I was sent to a 25 year-old drunken female. She was in a doorway with her friends and the first words to greet me were ‘she doesn’t really need you’. The doormen of the local club had called us, so after checking that the drunken woman was just that and no more (she was fit enough to go home by taxi), I asked the door staff if they could please try not to call us tonight if the person they were concerned about was just inebriated but could still walk. We were far too busy for this and sometimes they just call to clear human debris from their club’s vicinity. We are already London’s great human garbage removal service, so it’s time to give us a break for people like my last two patients, I thought.
Drunken women all over the place as usual. Why can’t they get the point and control their drinking? This one, a 25 year-old found ‘collapsed’ in the toilet of a club at chucking out time, was lolling about on the settee when I got there. She was drunk enough to be a nuisance but sober enough to know she was. I got her to the car after her fifth appeal for me to give her ‘just one more minute’- which is a standard line given to us by drunks who want to go to sleep and not be harassed by yellow jackets.
I offered her the chance to go to hospital to sober up but she asked me to take her home, miles away in north London instead. I told her I wasn’t a taxi and she opened her door and stormed off, only to return a few minutes later, climb back into the car and say ‘please take me home’. In fact she pleaded over and over to be taken home but the best I could do for her was to drive her to Kings Cross station and drop her off – at least she was a few miles closer to home and she would be less vulnerable, hopefully.
I went into Leicester Square on the hunt for good coffee and warm apple pie (which I found and consumed) and I had an epiphany as I sat in the car watching a young man vomiting his alcohol into a wheelie bin (a least he held the lid open as he threw up inside it). Wouldn’t it be cool if we could fine every drunk, say £50, once they’d sobered up in hospital, if an ambulance had to be called for them? The money could then be given directly to the elderly of society – the ones who are lonely and vulnerable, like my first patient tonight. I don’t think there’s a drunk in the country who’d object too strongly to that. If I had the time and support, I would campaign for it. Instead, the reality is that they get me, ambulances and ‘Booze buses’ laid on especially for them... for free. And old people get nothing but broken doors and hand-written messages.
Be safe.
Stats: 1 High BP; 1 fall; 2 eTOH
It’s shameful the way we ignore and neglect our old folk and I have said this again and again over the years. Nothing will change because there isn’t the will to do anything. Social Services in this country fall way below the standard expected of our long-time tax-paying, war-fighting elderly and it’s very frustrating.
The first call of the night, when there are no ambulances available due to the demands of London’s drunken revellers, was for a 91 year-old woman who had pressed her Careline alarm. I arrived to find no access because, even when I pressed all the buzzers for the block of flats, nobody would let me in – everyone in the building seemed to be out. I was concerned that the lady was trapped behind locked doors because she didn’t answer me initially either. Control arranged for the police as I waited outside in the minus zero temperatures but luckily someone came out and I let myself in and took the lift to her flat.
She didn’t answer the bell or my voice when I shouted through the letterbox but I could hear the extremely loud voice of the Careline person speaking to her over the phone system, so she was inside and alive at least but what was stopping her from opening the front door? After a lot of repeated commands from the phone voice for her to let me in, she eventually scooted into view behind the frosted glass of her front door, using a Zimmer frame to get to me.
I got her back into the front room and she seemed fine but it became obvious almost immediately that she had a major problem with her hearing. She wore an aid but the battery was flat and she had no spare, so I spent almost an hour in her house writing messages on a pad to communicate and trying to get transport for her because she was very vulnerable and could not stay there on her own.
She had no TV and no radio – nothing to listen to in fact. Her bedroom was a mess and I don’t think she used her bed at all. She had no food in her fridge and the place was generally untidy, with her less than 5 foot frame in the middle of it. She was a tiny, lovely lady who was abandoned by society. Her 'care' records stated that she didn’t take her medicines (her BP was high as a result) and she was frequently visited by police, fire and ambulance personnel because she pressed her button for help, couldn’t hear it when it was there and had to have her door broken in each time. Her flat was littered with hand-written notes from various people who’d found it impossible to get her to hear them.
Social Services had been told about her but nothing was done. Her own sister-in-law apparently didn’t care (according to a friend who phoned when I was there) and she had no immediate family left. This poor, smiling deaf woman was very alone and very vulnerable. I would have adopted her as my granny if I could.
The crew arrived after a long wait and she was taken to hospital after I’d made sure that Social Services were alerted, yet again, to her plight. I don’t expect miracles.
A few false alarms later and I was stuck with a 25 year-old man who’d fallen down metal steps at work and hurt his leg. It didn’t look badly damaged but he was in some pain, so I gave him entonox, which instantly helped. In fact, he became wildly drunk on the gas and I wondered why it was having such an effect on him. It wasn’t until I considered the weather outside and the fact that the cylinder had been sitting in the back of the car that I remembered something important about entonox – the gases (nitrous oxide and oxygen) separate at minus four degrees, leaving nitrous oxide at the top. No wonder he was off his head. I quickly mixed the gases back together by rotating the cylinder an few times. It won’t have done him any harm i the short period he was breathing it.
I waited for more than 30 minutes until I got a SJA crew and they splinted him and took him to hospital. He was still grinning like a Cheshire cat when I left him in the back of their ambulance.
It started snowing, as predicted for the night but somewhere along the way the temperature lifted and the fluffy white stuff became sleet. So, obviously I was sent to a 25 year-old drunken female. She was in a doorway with her friends and the first words to greet me were ‘she doesn’t really need you’. The doormen of the local club had called us, so after checking that the drunken woman was just that and no more (she was fit enough to go home by taxi), I asked the door staff if they could please try not to call us tonight if the person they were concerned about was just inebriated but could still walk. We were far too busy for this and sometimes they just call to clear human debris from their club’s vicinity. We are already London’s great human garbage removal service, so it’s time to give us a break for people like my last two patients, I thought.
Drunken women all over the place as usual. Why can’t they get the point and control their drinking? This one, a 25 year-old found ‘collapsed’ in the toilet of a club at chucking out time, was lolling about on the settee when I got there. She was drunk enough to be a nuisance but sober enough to know she was. I got her to the car after her fifth appeal for me to give her ‘just one more minute’- which is a standard line given to us by drunks who want to go to sleep and not be harassed by yellow jackets.
I offered her the chance to go to hospital to sober up but she asked me to take her home, miles away in north London instead. I told her I wasn’t a taxi and she opened her door and stormed off, only to return a few minutes later, climb back into the car and say ‘please take me home’. In fact she pleaded over and over to be taken home but the best I could do for her was to drive her to Kings Cross station and drop her off – at least she was a few miles closer to home and she would be less vulnerable, hopefully.
I went into Leicester Square on the hunt for good coffee and warm apple pie (which I found and consumed) and I had an epiphany as I sat in the car watching a young man vomiting his alcohol into a wheelie bin (a least he held the lid open as he threw up inside it). Wouldn’t it be cool if we could fine every drunk, say £50, once they’d sobered up in hospital, if an ambulance had to be called for them? The money could then be given directly to the elderly of society – the ones who are lonely and vulnerable, like my first patient tonight. I don’t think there’s a drunk in the country who’d object too strongly to that. If I had the time and support, I would campaign for it. Instead, the reality is that they get me, ambulances and ‘Booze buses’ laid on especially for them... for free. And old people get nothing but broken doors and hand-written messages.
Be safe.
Tuesday, 15 December 2009
A Urea moment
Day shift: Four calls: One by police van; one by car and two by ambulance.
Stats: 1 DIB; 1 ? Renal problems; 1 ? Flu jab reaction; 1 Chest pain.
Most of the 26 year-old males I go to claiming difficulty in breathing are not and are probably stressed, hyperventilating or just plain over-reacting but the young man I visited at the medical room of his college seemed to have a genuine problem. He had been suffering shortness of breath with a localised chest pain for a few days and the events leading to his condition today seemed to have stemmed from a recent chest infection he’d suffered. On the face of it, he looked like he was hyperventilating... and he was but it wasn’t an emotional response, it was a physiological one. As soon as I touched his hand I could feel that his body was distressed – he was sweaty profusely through the palms.
He was a tall, thin young man who exercised and went to the gym regularly. He had clear breath sounds when I listened but they were somewhat diminished on one side, quite low down and that led me to a possible diagnosis for his condition – spontaneous simple pneumothorax. It’s quite common in young men and isn’t necessary life-threatening but he’d need to go to hospital and get an xray done to confirm it. He may also have had a new infection but I doubted that.
The longest call of the day (it took two hours to get done) was at a police station, where a 60 year-old man was being held in custody for assaulting two police officers the day before. The Forensic Medical Examiner (FME) had requested an ambulance and instructed the police that the man must go to hospital because of his highly agitated state but when I arrived and was handed the doctor’s letter, it said nothing about the man’s health or why he needed to go. On the basis of a doctor’s demand alone, I had to ascertain whether the man in the cell had capacity and could therefore refuse to go (which is what he’d been doing apparently).
I was introduced to him through the cell door hatch because the cops deemed him too dangerous for me to get near. He shook my hand and then sprayed me with his saliva as he shouted answers to my questions. I caught some of his drool in my mouth and I silently hoped he didn’t have anything contagious except a cheery outlook on life. He refused to go to hospital and I was happy to oblige until he told me he had regular dialysis, three times a week; Tuesday, Wednesday and Saturday. I checked my brain quickly and realised that today was Tuesday...so he had to go and get his treatment. Not only that but I wasn’t sure, given his temperament at the moment, if he’d had it on Saturday. This could lead to significant complications, including the behaviour I was witnessing – he was violent, aggressive and almost psychotic.
The logistical problem I faced now was how to get him to his dialysis unit and whether they would accept him like he was (I doubted it and thought he’d have to be sedated). An ambulance was out of the question and I got the cops to agree to take him in their van, with me as company for him in case something went awry. I had to listen to him rant, swear and repeatedly refer to me and the cops as ‘Babylon’ all the way to the hospital. Then he had to be dragged from the van (just as he had been introduced into it), cuffed and struggling into a wheelchair and all the way through the very public (shocked faces and gasps of disbelief) areas to the lifts. Four police officers accompanied me, including two in territorial suits, less the body armour and helmets, so it looked like we were bringing a dangerous murderer in for treatment. He continually screamed and shouted at us, threatening to kill us and demanding to be let go. I felt we were being cruel to him but we had no choice.
The nursing staff, who knew him, told me that they’d never seen him behave like this and that it was entirely out of character for him. So, something was going wrong with him, mentally or physically... or both.
82 year-old men are normally retired, living the rest of their lives in quiet calm, gardening or in a home (shoot me before that happens to me) waiting to die but my next patient was still behind a desk at work. He’d had his piggy-flu jab in the morning and then felt worse for wear later on. It’s possible he was having a mild reaction to the anti-viral or he may have other health issues. He was pale and lethargic with abdominal cramps and nausea – his vital signs were normal but his ECG showed a Right Bundle Branch Block (RBBB) but he already knew about that and he told me he’d had it for years,
I took him to hospital in the car and, although he didn’t felt any better during the trip, he didn’t feel any worse either.
Just as I was about to go home early, after having covered the east area for a few hours as a favour to the sector, I was turned back to go and deal with a 43 year-old French man with chest pain that had bothered him for the past 24 hours. He was walking out of his workplace with a suitcase when I arrived, making his emergency call and the subsequent response look like an ironic bit of silliness.
He was normally fit and well and travelled by air regularly but none of his flights were long-haul. His chest pain sounded more musculo-skeletal than cardiac but it was best to get him into an ambulance and taken to hospital rather than risk it. So, I waited with him for another fifteen minutes and completed every check I could get away with in such a public place. The ambulance arrived and the crew took him to his next destination.
I got home a little later than planned but that’s par for this little course I play on, so I’ll get over it and I’m sure that my colleagues on ‘the desk’ will make up for it next time.
Be safe.
Stats: 1 DIB; 1 ? Renal problems; 1 ? Flu jab reaction; 1 Chest pain.
Most of the 26 year-old males I go to claiming difficulty in breathing are not and are probably stressed, hyperventilating or just plain over-reacting but the young man I visited at the medical room of his college seemed to have a genuine problem. He had been suffering shortness of breath with a localised chest pain for a few days and the events leading to his condition today seemed to have stemmed from a recent chest infection he’d suffered. On the face of it, he looked like he was hyperventilating... and he was but it wasn’t an emotional response, it was a physiological one. As soon as I touched his hand I could feel that his body was distressed – he was sweaty profusely through the palms.
He was a tall, thin young man who exercised and went to the gym regularly. He had clear breath sounds when I listened but they were somewhat diminished on one side, quite low down and that led me to a possible diagnosis for his condition – spontaneous simple pneumothorax. It’s quite common in young men and isn’t necessary life-threatening but he’d need to go to hospital and get an xray done to confirm it. He may also have had a new infection but I doubted that.
The longest call of the day (it took two hours to get done) was at a police station, where a 60 year-old man was being held in custody for assaulting two police officers the day before. The Forensic Medical Examiner (FME) had requested an ambulance and instructed the police that the man must go to hospital because of his highly agitated state but when I arrived and was handed the doctor’s letter, it said nothing about the man’s health or why he needed to go. On the basis of a doctor’s demand alone, I had to ascertain whether the man in the cell had capacity and could therefore refuse to go (which is what he’d been doing apparently).
I was introduced to him through the cell door hatch because the cops deemed him too dangerous for me to get near. He shook my hand and then sprayed me with his saliva as he shouted answers to my questions. I caught some of his drool in my mouth and I silently hoped he didn’t have anything contagious except a cheery outlook on life. He refused to go to hospital and I was happy to oblige until he told me he had regular dialysis, three times a week; Tuesday, Wednesday and Saturday. I checked my brain quickly and realised that today was Tuesday...so he had to go and get his treatment. Not only that but I wasn’t sure, given his temperament at the moment, if he’d had it on Saturday. This could lead to significant complications, including the behaviour I was witnessing – he was violent, aggressive and almost psychotic.
The logistical problem I faced now was how to get him to his dialysis unit and whether they would accept him like he was (I doubted it and thought he’d have to be sedated). An ambulance was out of the question and I got the cops to agree to take him in their van, with me as company for him in case something went awry. I had to listen to him rant, swear and repeatedly refer to me and the cops as ‘Babylon’ all the way to the hospital. Then he had to be dragged from the van (just as he had been introduced into it), cuffed and struggling into a wheelchair and all the way through the very public (shocked faces and gasps of disbelief) areas to the lifts. Four police officers accompanied me, including two in territorial suits, less the body armour and helmets, so it looked like we were bringing a dangerous murderer in for treatment. He continually screamed and shouted at us, threatening to kill us and demanding to be let go. I felt we were being cruel to him but we had no choice.
The nursing staff, who knew him, told me that they’d never seen him behave like this and that it was entirely out of character for him. So, something was going wrong with him, mentally or physically... or both.
82 year-old men are normally retired, living the rest of their lives in quiet calm, gardening or in a home (shoot me before that happens to me) waiting to die but my next patient was still behind a desk at work. He’d had his piggy-flu jab in the morning and then felt worse for wear later on. It’s possible he was having a mild reaction to the anti-viral or he may have other health issues. He was pale and lethargic with abdominal cramps and nausea – his vital signs were normal but his ECG showed a Right Bundle Branch Block (RBBB) but he already knew about that and he told me he’d had it for years,
I took him to hospital in the car and, although he didn’t felt any better during the trip, he didn’t feel any worse either.
Just as I was about to go home early, after having covered the east area for a few hours as a favour to the sector, I was turned back to go and deal with a 43 year-old French man with chest pain that had bothered him for the past 24 hours. He was walking out of his workplace with a suitcase when I arrived, making his emergency call and the subsequent response look like an ironic bit of silliness.
He was normally fit and well and travelled by air regularly but none of his flights were long-haul. His chest pain sounded more musculo-skeletal than cardiac but it was best to get him into an ambulance and taken to hospital rather than risk it. So, I waited with him for another fifteen minutes and completed every check I could get away with in such a public place. The ambulance arrived and the crew took him to his next destination.
I got home a little later than planned but that’s par for this little course I play on, so I’ll get over it and I’m sure that my colleagues on ‘the desk’ will make up for it next time.
Be safe.
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