The Complete Blood, Sweat and Tea

Drunk and Disorderly

We got called to a pub (which is always promising), to a 24-year-old female who was having ‘difficulty breathing’. When we turned up at the pub, we were met by a man who, after letting us know he was a ‘first aider’, told us that she was fitting and that she had stopped breathing, but that mouth to mouth resuscitation had ‘brought her back’.

Entering the pub we found the woman thrashing around on the floor. She wasn’t having a fit, it was more like a temper tantrum. Throwing himself on top of her was her husband, who was reluctant to let us approach her. People in the pub told us that they had both been drinking heavily.

We near enough had to force the man off of his wife just so we could examine her properly, and it soon became apparent that she was just very, very drunk. Out of the corner of my eye I saw sudden movement and ducked quickly as the husband threw his wife’s shoe at a man standing behind me. We decided that loading her onto the ambulance would be the best thing to do. The husband demanded to be let in, but we told him that we needed room to properly examine his wife. He banged on our windows twice, but then left, apparently running up the road – possibly as a result of him throwing a pint glass at another of the pub’s customers. (This was very unwise of him, because half of Newham police force were 200 yards up the road dealing with an armed incident.)

By this time a second crew had turned up, as someone had called 999 and told our Control that the woman had stopped breathing. We stood them down, although, on reflection, they could have been of help keeping the woman on the trolley because she was still throwing herself around, refusing to lie still, and generally making life difficult. We managed to get a blood sugar, pulse and blood pressure (all of which were normal) but she refused to stay on the trolley and wouldn’t sit on a chair – so we let her lie on the floor.

At times like these, I think I’d give my eye-teeth to be able to put people like her in a 4-point restraint, but it’s something we are not allowed do.

Later, while I was driving to hospital, she made an attempt to leap out the back of the ambulance, and it was only the rugby skills of my crewmate that prevented her escaping under the wheels of a following car. The rugby tackle was all the more impressive given that my crewmate is 5-foot-nothing tall.

We finally managed to get the patient to hospital, where she threw her vomit bowl (with vomit) over the floor and tried to hit a nurse. Luckily I was standing behind her and grabbed her before she could damage any of the staff, or even a patient.

To cut a long story short, the nurses let her phone her sister to come and pick her up, and then kicked her out the department.

Two things about this job that bring a smile to my face: (1) one of her shoes is still lying in the gutter, where we picked her up from, and (2) her husband got out of prison today and, given his attitude and behaviour, he’ll soon be back inside.

So, it’s not just weekend nights we get the violent drunks, it’s every damn night …

We are not taught how to restrain patients who might be violent but sometimes it is essential – for example, in the event of someone having a serious head injury and becoming violent. So, we have to make it up as we go along and hope that it turns out alright.

Favourite Job

The other night I had my favourite type of job, the type of job that meant I wasn’t upset to be late leaving work.

People who are diabetic sometimes have very low blood sugar; this makes them confused, agitated and sleepy, and this can lead to unconsciousness and even death. Their blood sugar can become low for any number of reasons. Most often they have done more exercise than normal and not eaten enough to raise their blood sugar.

The treatment for this condition is to either give them sugar or an injection that ‘frees up’ some sugar that is stored in their liver.

Our patient last night normally controls her diabetes very well; so much so that her family had never seen her with a dangerously low blood sugar (the medical term for this is hypoglycaemia). They called us because she was acting confused and was unable to speak properly or stand upright. We arrived, and found out she was a diabetic; checking her blood sugar we got a reading of 1.6 mmols (the normal range for a diabetic is around 4.5–12.0 mmols) – this is very low and explained why she was losing consciousness.

The family were understandably upset, as they had never seen this before. They saw her slipping into a coma in front of our eyes, so we explained what was going on as I prepared the injection that would raise her blood sugar. I gave the injection (this injection is called glucagon) and waited for it to take effect, all the time reassuring the relatives.

Within 10 minutes she was up and talking, we then gave her some sugar jelly which raises the blood sugar some more. Soon she had made a full recovery, with her blood sugar reading 5.6 mmols. We gave her some carbohydrates (for ‘slow-burn’ energy) and left her in the care of her exceptionally happy family.

The reason why this is such an enjoyable type of job is that we are actually saving a life (for a change) with the treatment that we can give, and that the recovery is normally rapid, and always impressive. From unconsciousness to 100% fitness in the space of about 15 minutes really impresses onlookers … and it does our ego good to be praised every so often.

Notting Hill – Stabby, Stabby

Yesterday was the last day of the Notting Hill Carnival. The police are calling this year’s carnival a success, with little reported crime, but I would tend to disagree: it’s just that the crimes all happened to people as they travelled home.

Our second call of the night started worryingly when Control told us that a male had been stabbed in Stratford shopping centre, and that he could still hear shouting in the background of the call. The stab vest went on and we made our way down there, meeting up with a lot of police officers trying to control a rather large crowd of post-carnival spectators.

We found a 15-year-old male lying on the floor, with a policeman holding some paper tissues over an upper abdominal stab wound. There was no external bleeding, and the patient was alert, calm and talking. He also had a small wound to his right leg, which again was not bleeding significantly. I ran through a primary survey (a very quick examination of the patient to rule out anything that is going to kill him in the next 5 minutes) and then concentrated on making sure his chest and lungs were not damaged. On clearing them I turned my concentration to the belly wound.

We don’t like stab wounds: they can do a lot of damage leaving only a tiny entry wound. One stab wound can easily kill you, whether it is in the leg, the arm, the chest or the belly. After my examination I decided that, although he needed exploratory surgery, he wasn’t critically ill. There was a bit of ‘something’ poking out of the wound, I had no idea what it was (I initially thought it was part of the policeman’s dressing) so I soaked one of our dressings in saline and applied it to the wound. We then got a phone call from what I took to be the HEMS road team (a doctor and paramedic) letting us know that they would be on scene in 12 minutes and that the patient should go to the Royal London Hospital. The problem with this is that the Royal London is some way further away than Newham, and that I knew that if the HEMS crew got on scene they would want to ‘stay and play’ securing IV (intravenous) lines, considering intubation and running a full examination on the roadside. In my opinion, having assessed the patient, his best option would be to go immediately to the nearest hospital and let the surgeons there deal with him.

So, we loaded the patient onto the ambulance and made a run to Newham hospital which took us less than 5 minutes.

The result of which was the patient got to theatre, was ‘packed’ as he had a lacerated liver and gall bladder and is now in ITU for recovery.

I wonder if the HEMS crew will moan. I suspect they won’t because around the corner was another young lad who had been stabbed in what later turned out to be a connected series of battles between two schools. The HEMS crew played around on scene with that patient before taking him to the Royal London Hospital (who really love their trauma jobs). There were then reports throughout the night of other crews picking up more teenagers injured during the fight. The patients were spread fairly evenly between the two hospitals, so no one department became overloaded.

A couple of things struck me as amusing, the first was that when we were about to leave for hospital the patient’s girlfriend and cousin were fighting amongst themselves over who loved him more and should go to hospital with him. The patient’s brother was also there and was fighting with police to get to the patient. He then vanished, and my prior experience would suggest that he was planning revenge and a counterattack.

While going to hospital, the patient’s girlfriend was talking about the other lad who had been stabbed (apparently his name is ‘Biggy G’) and how it seemed that the fight had been planned at the carnival.

As always when I got to the hospital it seemed that the doctors weren’t interested in my handover … on which I will post/moan more later.

As we were going to hospital another crew, this time in North London, were putting in a priority call to their local hospital. They had two young men (aged 19 and 20) who had been stabbed, luckily in a non-serious manner.

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.

Sad Stories That Stay With You

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?

Update on Last Posting

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.

Tricky Extraction