The Complete Blood, Sweat and Tea
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A night full of people getting stabbed. Just a coincidence that it is the last night of Notting Hill? The media said that the carnival passed without serious incident. Either they were not looking very closely, or they decided not to report the violence around the capital.
Some jobs will just make you sad, and it’s those that you’ll find yourself carrying around with you for a time. It isn’t always the death and horror that affects you, and you can be surprised by the things that haunt you.
We got a call to a block of flats, it was given as a 69-year-old female who was unresponsive and who had a history of schizophrenia. Her condition could be caused by any number of things, so you carry all the equipment up the flats as you never know what you are going to encounter.
We were met by the woman’s husband who led us through to the bedroom where our patient lay. She was on the bed and was not talking to anyone; with one hand she was ‘fidgeting’ and plucking at her clothes. This was normal for her, and could be due to the antipsychotics she uses to treat her schizophrenia. Looking at her prescription sheet we found out that she was also a diet-controlled diabetic, but her blood sugar test showed a normal amount of sugar in the blood. The patient was unable to talk, and looked very scared. Was this episode related to her schizophrenia?
Our physical exam, however, showed a complete loss of function and muscle tone down the right side of her body; this led us to think that she had had a CVA, or stroke, and that this had affected her speech and muscle function. We rapidly removed her to hospital, and, to be honest, the job itself went like clockwork.
The thing that stays with you though, is her husband telling you that they have been married for 50 years, and for the last 20 of them he has stuck by her while she was suffering first from manic depression and then schizophrenia. To have stayed by her side while she was under the shadow of these illnesses shows true love. Every so often, during the transport to hospital, her husband had to wipe a tear from his eye; he was sitting holding his wife’s hand, trying to provide some comfort to her and ease the scared expression on her face.
If she survives the stroke she will probably be permanently disabled and will require quite intensive care for the rest of her life.
I think her husband will continue to stand by her.
In unrelated news … I was so tired driving home this morning that I took the wrong turning to go home and went down the wrong street. Aren’t you glad I’m looking after the health and well-being of people?
Lots of people want to know what happened to the lady in my previous post, so tonight I spoke to the nurse who was looking after her.
The patient continued to be unable to talk, although (perhaps sadly) she could understand everything that was happening to her, and around her. She was also unable to use the entire right side of her body. It seems that the stroke was caused by an infarct (or clot) in her brain and not the more life-threatening cerebral bleed. She went to one of the better wards in the hospital after spending some time in the Resus’ room, during which her husband constantly stayed by her bedside. The nurses looking after the pair of them felt a lot of sympathy towards them, and I think they all fell a little in love with the husband.
I mention that the nurses looked after the pair of them, because that is what good nurses do, they look after everyone affected by the illness.
Sometime later today or tomorrow she will have a CT scan of her brain to determine the extent of any infarct, and then she will start the long road to a hopeful recovery.
I used to work in a medical ward, and we would have a lot of stroke patients. Unfortunately, there is no magical medical treatment for a stroke once it has taken place; instead, it is a long gruelling slog through physiotherapy, speech therapy and occupational therapy. It can take months to recover some function, and many do not recover at all: they remain chair-or bed-bound and are discharged into a nursing/care home until they succumb to an infection that kills them.
Unfortunately, given the type and strength of the stroke this lady has had I would not hold much hope for a recovery. Miracles do sometimes happen, and I suspect that this entire woman’s family will be praying for such a miracle.
I think I’ve mentioned on more than one occasion how, when working in a hospital, the patients are often nicely ‘packaged’ ready for examination, this can often hide the trauma that the ambulance crew has gone through in getting the patient into hospital in such a condition.
My crewmate and I got called to a ‘collapse’, and we made good time getting there to be met by relatives of a 72-year-old female who had vomited altered blood (probably from a stomach ulcer) and had collapsed to the ground hyperventilating. The woman was around 20 stone in weight (280 pounds to the Americans in the audience). She was in a bungalow, so we had no stairs to get in our way, and the relatives were willing to be helpful. The patient was lying on the floor and had just finished an episode of hyperventilation (a panic attack).
Should have been a nice easy removal, even with the weight of the patient and reduced ability to walk. We had our carry-chair and after struggling a little to get the patient on it, we didn’t expect any trouble.
Heh …
It turned out that the patient was an agoraphobic and hadn’t left her house in 20 years …
Sweating profusely, the patient fought us the entire way out of the house; she grabbed at anything tied down, at door-frames and at the handrail she had installed in her house. Trying to get a sweaty 20-stone patient out of a house is tough enough without them fighting you the whole way.
We had explained that she needed to go to hospital, and she had logically agreed, but this didn’t stop her panicking when we started to move her. When we finally managed to get her into the open air her panic rose to a dangerous level.
She was shaking, her eyes rolled back into her skull, sweat was pouring off of her and her thrashing about in the carry-chair got worse (if such a thing was possible). Both my crewmate and myself thought that she was going to have a heart attack; in fact, she had all the classic symptoms of a massive myocardial infarction (posh medical term for a heart attack). Then she started a strange screaming/moaning call that sounded completely unearthly. I could just see the next day’s newspaper headline, ‘Ambulance Crew Scare Patient To Death!’
All I could think about was to try and calm her down, so I tried using some hypnosis techniques that I just happen to know, which helped a little, but by then she was in such an agitated state that horse tranquillisers probably wouldn’t have affected her.
We managed to get her into the ambulance, where we shut the doors very quickly and made as smooth a transport to hospital as possible. During the transport my crewmate and the patient’s family worked constantly to calm the patient down, but they were only having a fairly limited success; every so often I would hear her moan in that alien fashion and my crewmate babbling at her to calm down.
When we got to the hospital, we nearly threw her off the ambulance into the A&E department; actually, she was so slicked with sweat we could have slid her off the trolley. She calmed down a bit once she was in hospital, which only made our exhausted faces seem over-dramatic to the nursing staff.
You never know what you are going to get in this job, but nine times out of ten it isn’t the illness that surprises you, but the circumstances around the job.
I can’t drive past that address without thinking about the trouble we had with that call.
We got called as a ‘second crew’ to an address. Sometimes, when a situation is beyond the capability of one crew to deal with, they will request another crew; normally this is because they have two patients, or the one patient that they have is too heavy for one crew to lift on their own.
We got the job as ‘female giving apple to 7-day-old baby’, which had us wondering …
As we turned up we saw the other ambulance and a police car. On entering the flat we saw two policemen standing in the corner, with a 5-foot 2-inch tall female paramedic sitting on a young woman (Patient Number 1); her crewmate was dealing with a male who had a nasty bite on his arm (Patient Number 2). The police were talking between themselves deciding what to do, as we got a quick briefing from the crew who was sitting on the woman.
It turned out that the woman (who had a previous mental illness episode), had given birth by Caesarean section 7 days earlier, and today had tried to feed the baby apple pie; she had then ‘freaked’ (note the professional medical terminology), shouting that the man wasn’t her husband, and had attacked him. The ambulance crew had been called and, as they arrived, the woman had sunk her teeth into her husband’s arm. The crew had fought the woman to – ahem – disengage her teeth, and this is why they were sitting on her. The police had been called, but were reluctant to do anything (I got the impression that they were a rather crap pair of coppers) and the second crew (us) had been called to deal with the husband (with new teeth-mark wound) and baby.
This woman was (brace yourself for more medical terms) ‘completely bonkers’, she had the rolling eyes, the delusional thoughts and the inability to communicate that separates the mildly strange from those who need immediate medication. It was actually quite sad to see this family come apart at the seams; the husband was shell-shocked, the wife was completely detached from reality and the police weren’t being very helpful (which is unusual).
We got the husband and baby out of the house and into the back of our ambulance, and then returned to see the police (finally) manhandling the woman out of the house and into the back of the first ambulance. She was securely strapped down (although we don’t have restraints, so she could have easily gotten free if she so desired); we had to lend the first crew a belt-strap as the one on their trolley was broken. The first crew then forewarned the hospital about what they were bringing in (violent schizophrenic female) and we all set off for the hospital.
We got there first and advised the nurse in charge that this was a ‘real’ warning and that security guards would be needed, along with the private ‘psychiatric’ room. It took her 20 minutes to arrange both, while the ambulance took less than 5 minutes to get to the hospital. So, while the secure room and security was being arranged this very disturbed woman was lying on the ambulance trolley … Not a good situation, and it made the job a lot harder than it should have been.
The husband was completely stunned; he had no idea how to look after a baby and quite simply couldn’t cope. Social services were informed, and the child was admitted to the paediatric ward for a while, until the husband could be taught how to look after a baby. The woman was sent to the local psychiatric unit for assessment and treatment; hopefully, this is a temporary condition brought on by childbirth (puerperal psychosis). The husband had his wound treated, and was sent home.
Oh, and the baby is a hermaphrodite.
There are jobs that you can recount around a dinner table (or at the pub) when people ask you what your job is like. This is one of those jobs, although for some reason people seem to prefer hearing about me being injured by little old ladies.
The London Ambulance Service doesn’t just deal with emergency calls to people’s houses, we also do hospital transfers – patients who go from hospital to hospital because the original hospital hasn’t the expertise to deal with that person’s medical problems. An example of this would be the transfer I recently did from Newham to the Royal London because Newham’s CT scanner was broken, and the patient needed an emergency scan.
One of the regular places that we find ourselves transferring people to is St Joseph’s Hospice, or as we call it Holy Joe’s. Sometimes we will be picking up patients from one of the nearby hospitals, sometimes from the patient’s own home. Its one of those jobs most of us don’t mind doing. The patients are, by definition of needing hospice treatment, actually sick, and we are not so hard-hearted that we would begrudge an ambulance to someone who is ill. Then there is Holy Joe’s itself …
Holy Joe’s is a religious place, it used to be run by nuns, but now they are a bit few and far between. To be honest, I saw my first nun there yesterday, and she was picking her nose … But, you walk into the place and it just seems nice, it is clean, the staff are all friendly, the patients all seem happy and there is a really good social atmosphere there. I don’t know if it is because of its ties to the religious orders (I hate all religions, but the best nursing homes always seem to have nuns running the place), but the hospice just seems to exude calm.
My crewmate and I had just transferred a terminally ill patient into Holy Joe’s and were having a cup of tea in their tea bar (hot drinks are free to the LAS – another reason to love Holy Joe’s). Sitting in this clean, comfortable area, we were watching the patients chat with relatives, staff and other patients, giving the place a real friendly atmosphere quite unlike anywhere in the NHS. It is very rare to see a doctor sitting down with a patient, chatting about nothing in particular and having a cup of tea with them. We both agreed that this has got to be one of the better places to see out the end of your days, and that it is a real shame that there are not more places like this.
It is a shame that in this increasingly ‘technical/evidence-based/audit/professional development/governmental targets’ style of health service, we seem to have forgotten that sometimes we simply, and honestly, need to care.
I went back there for the first time in 18 months. It’s even better now. I’m thinking that the NHS should poach the board of directors and point them at some of our local hospitals.
I got assaulted yesterday, which made me smile …
We got called to ‘Male collapsed outside park’, which immediately set my ‘drunk-o-detector’ bleeping. This is the sort of call that is nine times out of ten a drunk who has decided to have a sleep in a public place as opposed to going home. In a case like this we tend to wake them up, and get them to move on before another ‘good Samaritan’ calls us out again.
We woke him up, so he stood up and started moaning that we had woken him up. Both my crewmate and myself were actually being quite nice towards him – mainly because it was towards the end of our shift and being nasty to people takes energy that we just didn’t have. Then he decided to take a swing at my crewmate, then he decided to have a swing at me … the next thing that I knew I had him in an armlock up against the side of the ambulance. My mate called on the radio for urgent police assistance, and the radio controller asked if we were both alright, to which my crewmate replied ‘I’m alright, but my crewmate is restraining him’.
The police were quick to turn up, and I had just enough time to tell them that he was drunk and had taken a swing at us before he was under arrest and carted off to the local police station. It was then I realised that in the struggle I’d managed to hit myself in the chest, right where I’ve got a broken rib. It was a bit painful. It had already gotten a whack from a heavy trolley yesterday, so I’m wondering if it will ever manage to heal.
I can tell you what went through my mind as I was pinning him to the ambulance: the first thing was ‘Oops, I hope I haven’t over-reacted’, the next thought (about 5 seconds later) was, ‘By the time I return to station and fill in the “incident form” my shift will be over … Result!’ I’d imagined that, going by the speed that the police arrested him, they were close to the end of their shift as well.
I’m just waiting for a Team Leader to read the incident form and call me into the office to ask if I need counselling …
A police friend of mine emailed me a couple of months later telling me that he had been in court providing evidence and the case before his was of a drunk assaulting an ambulance person. After a further description I could tell him that it was me who’d been assaulted. The drunk was found guilty, but had no penalty to pay as he was homeless. It would only have bothered me if he had actually connected with his punch.
One of the jobs that we find ourselves going on (perhaps once or twice a day) is that of vaginal bleeding, in a woman who is around 8 weeks pregnant. This invariably turns out to be a miscarriage. Unfortunately, it is normal for the body to ‘reject’ a foetus that has no chance of developing into a full-term baby. I would suppose that this stops a woman from carrying to term an infant that would not survive outside the womb.
While dealing with such patients (some of whom have been trying to get pregnant for some time), I always try to be sympathetic, and explain that what is happening is not anyone’s ‘fault’, and that it is a normal happening.
Because of the number of people we have with this problem, and the rate at which hospitals deal with them (when working in A&E we would have about 12–18 cases of this every day), we have all become a little blasé about it. We feel some sympathy, but deep down in our hearts, we know that there is nothing we can do, and that it is a good thing that this is happening now, rather than in 6 months’ time. Nonetheless, we are worn down by the sheer numbers, and at the end of the day, perhaps we stop caring that these women are losing babies.
I have no intention of getting into the whole abortion argument, I’ve seen them done, don’t like them and would rather have the whole thing stay out of my world view.
I first thought that it was just me, and that as a male I was not best placed to pass comment. However, after having a chat with some female colleagues, it seems that they feel the same way I do, that it is natural, and that it is not worth worrying about. But it worries me a little that I seem to have come to care so little for the dead babies.
There were two interesting jobs today, I’ll tell you about one now and let you wait until tomorrow for the other one.
We got called to the very common ‘Male Drunk – Police on scene’. I’ll not moan about how often we get called to this type of job, you’ve heard it all before …
We arrived on scene and were met by a policeman who first apologised before leading us to a man who was approximately 30 years old. The man was obviously drunk, and my crewmate told me that he smelt heavily of alcohol; along his arms were the scars of a ‘cutter’ – something else we are seeing more and more of these days. The policeman told us that the patient was refusing to give his name or medical details, only that he was called ‘John’.
We approached ‘John’ and he agreed to come to hospital with us. I got him into the back of the ambulance and he refused to let me touch him, so I couldn’t do my usual battery of tests. In fact, he didn’t want to talk to me at all, and sat in the back of the ambulance not talking; at one point he threatened to leave the ambulance but I managed to persuade him otherwise. (Don’t ask me why, I normally let drunks go as soon as they say they don’t want to go to hospital.)
All went as normal until we rounded the corner to the hospital, where he got off of the chair and laid on the trolley-bed. One hundred yards later and we pulled up to the hospital and I told him to get up, then I told him louder, then I did a sternal rub to wake him up – and there was no response! I then slipped an oropharyngeal airway into his mouth, this would wake anyone up, but not a flicker … he was deeply unconscious. This meant he was due for the Resus’ room.
We rolled him (rather quickly) into the Resus’ room and were met by a rather angry nurse – she wanted to know why we hadn’t pre-alerted the hospital. I explained that he had just lost consciousness outside the department. She then asked me why he didn’t have oxygen on him. Again, I repeated that he had collapsed when we were outside the hospital. We got him onto one of their Resus’ trolleys while the doctors in the department ran into the room.
For the third time I explained what had happened, and that I had no vital sign observations; this time they paid attention, and accepted what had happened.
To be honest I don’t blame them, the A&E department rarely has any surprises – the hospital is normally forewarned about any ‘nasty job’ we are bringing them, and to suddenly have a seriously sick patient turn up without any warning is always a bit of a jolt.
Now the patient was unconscious the nurses were able to do those vital observations that I was unable to do – and they were all normal. His pulse, blood pressure and blood oxygen levels were all better than mine, his blood sugar was also well within normal limits. There was no obvious reason why he was in such a deep state of unconsciousness.
He was quickly intubated, and we left the department. I’ve spent some time wondering if I missed anything – if there was anything I would have done differently – but to be honest I don’t think there was. Even if I had managed to get a full set of vital sign observations, they would have all been normal and there was nothing that indicated his condition changing so quickly. I can’t ‘assault’ a patient who has refused a procedure (such as observation taking), and all I could do was exactly what I did do – watch him while we took him to hospital.
The current idea is that he had taken an overdose of some sort along with the alcohol, and that it had started to work. Because the patient hadn’t spoken to me, I had no way of knowing if he had taken an overdose.
I never did find out what had happened with the patient – it’s one of the poor things about this job, that you can’t always follow them up.
We were asked go to the local police station to help with arresting someone. The arrestee (is that a real word?) was an 80 (or more)-year-old male who was accused of recently committing a crime that I would suggest required some amount of physical strength. We were to follow along because the person had heart and breathing problems – so much so that he had bottled oxygen in his house.