The Complete Blood, Sweat and Tea

Cut forward 40 minutes’ worth of trying to sedate the patient with increasing amounts of medication. For the medically trained out there, the patient needed 10 mg haloperidol and 17 mg of midazolam. At one point the doctor was thinking about knocking the patient completely out and intubating him. Luckily the patient was sedated enough for us to get him out of the conference centre and into out ambulance, where we ‘blued’ him into Newham hospital just in time for him to wake up (the sedation lasting only around 15 minutes) where the doctors there did paralyse and intubate him.

We have few ideas why the patient was so violent and so deeply confused – it’s something that will be investigated in hospital. We were considering epilepsy, head trauma (from when his head hit the floor), meningitis (so antibiotics were given on scene) or some form of brain insult. I’m asking my crewmate to find out what happened to the patient.

The reason why I am off sick? Well after holding the patient down for an hour and 10 minutes, I managed to sprain my thumb. Since I can’t be considered safe to carry a patient downstairs, I’m taking today off (plus 2 days of leave) so that my thumb can heal and I can get back to saving lives picking up drunks again on Monday. Oh, and it’s my birthday tomorrow – 33 is such a young age don’t you think?

I did manage to see the patient again … see the next entry.

Patient Gets Better!!!

I went to visit our patient from the last post. This morning I’d put my hand in my pocket and found that I had £2.66 of his money that had spilled out of his pocket during our struggle and I’d put it in my fleece for safe keeping – given the saga of the job, I’d forgotten to hand it in when we reached the hospital. I thought it would be best if I returned it to him, so I had a chat with the lovely receptionists at the hospital, and they told me what ward he was on.

I went to the ward to find him sitting there, seemingly none the worse for wear. He did have a bit of a black eye (not my fault … honest), and when I spoke to him he told me that the doctors suspected that he had fainted, and when he had hit his head had suffered a form of concussion. His CT scan and blood tests were all normal, although I suspect that they will be running EEGs (electroencephalograms) and other more detailed tests a little later. He told me that he was feeling pretty much normal and I suspect that they are keeping him in hospital to continue to run their tests.

He was very pleased to see me, and we had a little chat. I offered him his money but he refused and suggested that I get myself a pint with it.

It’s the first time I’ve actively gone to look for a patient after bringing them into hospital – and it is a weird experience going into a ward to see a patient whom I last saw trying to fight me. Yet another new thing I’ve done because of writing this blog.

Safety Net

I’ve mentioned before how the ambulance service and the A&E department are often seen as a ‘safety net’ by other health-care providers. Both yesterday and today we had perfect examples of this.

Yesterday we were called by a 70-year-old man with a urinary catheter which had blocked. This is a fairly simple thing to solve as it just needs a flush of water up the catheter to clear the blockage. It’s a 5-minute job that we, as ambulance crews, aren’t allowed to do. However it is the sort of job that district nurses are supposed to do.

So why hadn’t a district nurse been to see the patient so that she could flush the catheter and prevent the patient from having to attend A&E? Why was the patient, who had phoned up the nurse himself, and told her exactly what he needed doing, forced to call an ambulance?

Because the nurse didn’t have any water to actually flush the catheter. It’s a bit like if I turned up to someone having an asthma attack, and didn’t have any oxygen to give them.

So the district nurse told the patient to dial 999 for an ambulance. We arrived and found him with a bladder so full it was causing him severe pain. We took him into Newham hospital, who, within minutes, had cleared his catheter, and eased his pain. They gave him a ‘takeaway’ bottle of water so that the district nurse wouldn’t have an excuse the next time she needed to visit him.

Today, we were called to a patient who needed his anti-Parkinson’s disease medication. He had a carer, who was supposed to visit him once a day to clean and arrange his medication. But for the last 2 days, because the ‘carer’ couldn’t get in touch with the patient’s GP, she’d just left him without his medication. We turned up, not knowing what we could do to help. The flat in which the patient was living is brand new, and yet was already very untidy. The patient told me that he was lucky if the carer spent longer than 5 minutes with him (the carer is contracted to work with him for an hour a day).

This poor man was left, alone and shaking, with a carer who seemed to think that if she ignored this ‘problem’ it would soon go away. So, we did the only thing that we could: we took him to hospital, so that they could sort out his medication for him. Meanwhile I filled in an ‘LA260’ which is a ‘vulnerable adults’ form and allows the LAS to bring situations of abuse, and potential abuse, to the attention of the local social services. They now have the name of the care agency, and this problem can be solved before it repeats itself in a month’s time.

Hopefully, someone will get a bollocking, and our patient will get a carer who actually cares for him.

It often feels that we, and the local A&E departments, are left to do the jobs that other people should be doing, but because we are there, these other agencies don’t seem to care about doing a competent job. I’m aware that there are probably loads of health visitors/social workers/district nurse/CPNs and GPs who do actually give a damn about their patients – it’s just that we never seem to meet them.

I never did get any feedback from the LA260 that I filled in – normally you get a little note sent to you explaining what has been done to resolve the situation.

A Hidden Pregnancy

Our ‘interesting’ call of last night was a Matern-a-taxi. What, I hear you ask could be interesting about taking a pregnant woman 1.2 miles into the local maternity department?

Well, apart from the patient, no-one else knew that she was pregnant – she had been hiding the pregnancy from everyone. She hadn’t seen a doctor; neither had she booked into a maternity department. Her family suspected nothing. It’s not as if she were a ‘large’ woman, who could perhaps hide the tell-tale bump under the pretence of fat. She was actually rather slender, which leads me to ask how she could hide her rather obvious pregnancy from everyone.

When my crewmate spoke to her (I was driving), she told him that she had hoped that the pregnancy would ‘go away’.

We tried to prewarn the maternity department that we were coming (because she was quite close to actually delivering the baby), but they hung up the phone twice on our Control. The problem is that the entrance to the maternity department is locked at night, and we need someone to come down and open it for us. So … we were left standing around outside the department waiting for the midwives to phone for a porter to traipse the length of the hospital to come and open the door for us (as opposed to one of the midwives walking down the stairs and opening the door).

By the time we got in the patient was starting to bleed, and we were getting more irate at the apparent ignorance of the midwives.

So, tonight we are going to put in a ‘clinical incident report’ to highlight the danger that standing outside the maternity department for 10 minutes while they arrange a porter puts the patient in.

One of the people on complex has had to deliver a baby in the back of their ambulance while they were waiting for the doors to be opened, so something needs to be done.

Upsetting

Three of our jobs today had the potential to be upsetting, and while they were all sad, only one seriously upset me, and did so in a way I consider rather out of character for myself.

The first job of the day was to an 86-year-old female in a nursing home with a ‘blocked nose’: we raced around there because … well … it was a Category ‘A’ call and those are the top-priority ‘get there in 8 minutes to please the government target’ calls.

Just as we pulled up outside Control let us know that the patient was upgraded to a ‘Suspended’ (no pulse, no breathing), and sure enough we ran into the home to be greeting by a FRU who was doing CPR. I jumped down and did a round of chest compressions, which cracked her ribs (a recognised side-effect of effective CPR), and then noticed that on the cardiac monitoring machine her heart rhythm had changed. She had a pulse! … People don’t normally get a pulse back from cardiac arrests of her particular type. We rushed her to the hospital, where a full cardiac arrest team was assembled. Her pulse was lost, and then returned. Unfortunately, her prognosis was poor, but she stayed alive long enough for her daughter to reach the hospital. She died with her daughter there, which is a small victory, but one that we are getting more used to.

The second potentially upsetting job was to a 1-year-old boy who had pulled some boiling milk on top of him. We turned up to find about 20 police officers on scene, and the HEMS helicopter circling above. The same FRU responder was there and the child had around 10% partial thickness burns to parts of the neck and chest. While nasty, this wasn’t immediately life-threatening, but the HEMS doctor who turned up decided that it would be best to take the patient to the Paediatric Burns Unit at Chelsea and Westminster Hospital by helicopter. As the helicopter could get the child there in under 20 minutes it seemed like the right plan of action. My job during this call was to (1) hold onto the other two toddlers in the house, (2) mix up some paracetamol for the child, and (3) drive child and doctor to the helicopter, which was around 300 yards away. The job was interesting because she was the type of parent who thought it was a good idea to wedge a settee into the hallway to stop her children from falling down the stairs …

The final job was a lot simpler – we were called to an 18-to 22-year-old female who was ‘unresponsive’ in a bus. The bus had reached the end of its route and the driver couldn’t wake up the patient. (Possibly interesting aside – bus drivers cannot touch any of their customers to wake them up.) We turned up and soon managed to wake up the very sleepy girl. She remained drowsy but agreed to let us take her to the place where she lived, but after talking to her a bit, we soon realised that she was homeless. This, coupled with the way she would fall asleep as soon as we stopped talking to her, made us think that it would not be safe to leave her on the street. We decided instead that we would take her to hospital. When we reached the hospital she refused to go in, and instead pulled out a ‘crack’ pipe and started to light up. We told her that she couldn’t do that … So she jumped up, pushed my crewmate and ran off. As there was nothing physically wrong with her we couldn’t chase after her; instead we returned to our station to fill in the necessary paperwork.

So why was it that this last job was the most upsetting, not only for myself but also for my crewmate? Well it wasn’t because she was pretty (she wasn’t, and she had a remarkably nasal voice), and it wasn’t because she was ill, neither was it because my crewmate got shoved.

With our first job, the woman was at the end of her life, and until she died, had enjoyed fairly good health. She didn’t die a painful, protracted death, and she died with her daughter next to her. With the scalded child, he would forget the pain, and will receive excellent care from the hospital he went to, he would return home to his loving (if ever so slightly dense) mother. With this girl, it was as if she were lost; at some point in her life her potential future had unravelled. Instead of getting an education, holding down a job, finding someone special and living a long and happy life, she is homeless, a drug addict, and her future is probably painful and short. What is so depressing is that no-one was able to turn around this descent, and this is perhaps why I despair at society – that so many people are prevented from reaching their full potential. I understand that she has made her own choices, but how much power did she have to make those choices? I wanted to help her, but there was no way I could do this.

And it’s that which annoyed and upset me.

I keep getting upset and annoyed at the same things – the waste of a life is a terrible thing to see. That, and the knowledge that I am helpless to do anything to change it. I imagine that this is why I dislike alcoholics so much.

Therapy?

We got sent to a job of a 6-month-old baby not breathing. While this often means that baby has a cold, it could also be one of the worst jobs you can get. We sped to the address and entered a house where the whole family was distraught. It was an Indian household, so there were a lot of people there, and most of them were crying. Once more, I heard the type of crying that can only mean that something awful has happened – entering the living room I instantly saw a baby lying dead on the settee, father crouched over it crying and the mother standing and wailing, shouting out that her baby was dead.

There is only one thing that you can do in a situation like this, which is to scoop up the baby and run to hospital as quickly as possible. I reached down and picked up the baby; I was shocked to find that it was as stiff as a board and very purple, indicating that it had been dead for some time. It looked more like a doll than anything that had once been alive. We could have recognised the child as dead on the scene, but taking the child to hospital would mean that the parents would see that everything that could be done was being done and, more importantly, they would be in a hospital with all the support that the hospital could provide.

I ran out to the ambulance with mother in tow, and told my crewmate to get us to hospital as quickly as possible. The father and grandmother followed behind us in another ambulance who had heard this call go out and had turned up to see if there was anything that they could do to help. On the way to hospital I did the CPR that I knew was ultimately pointless and spoke to the mother. She had last seen the child alive at 3 a.m., and he had been fine then. It looked like it may have been a case of sudden infant death syndrome, and I did all that I could to prepare the mother for the worst.

We pulled up at hospital and handed the baby into the care of the hospital. I spoke a little more with the mother and grandmother, but there is nothing that you can say to people who have had such a tragedy. Our station officer met us at the hospital and asked us if we were alright, then he booked us off the road so that we could go back to station and have a cup of tea and ‘decompress’. If we needed more support I think it would have been there, but I just wanted to get away from the hospital.

I’m not often affected by jobs, and this isn’t the first dead baby that I’ve had to deal with, but it is the first dead baby I’ve had since joining the ambulance service and it is very different from dealing with them in hospital. Going into someone’s house to take away a dead child is very different from having the child and parents turn up at hospital, which is your safe territory.

At the hospital all the other crews were asking if I was alright and, to be honest, I wasn’t really alright – I was upset that while I was doing CPR on the baby its legs were seesawing into the air, and it looked too much like a doll. There was a point after the job where I thought I was going to start crying, but a moment outside the Resus’ room and I was back to functioning as I normally do. I’m not weak, and when in the midst of something I can deal with anything – it was only after the doctors and nurses at the hospital had taken over that I started to feel anything.

We returned to station, where the therapy of talking about anal surgery with another crew, and a cup of tea, soon had me feeling better. It used to be that you would return to work straight after a job like this, but then I think they realised that if we got our normal inappropriate call (bellyache for 2 weeks sort of thing) we might say something to the patient that we might later regret.

Well, an hour on station later and I feel fully prepared to deal with that sort of thing again – but I think that I’ll be haunted by the image of that child lying dead on my trolley.

I had loads of people commenting on this post, loads of support, which was very much appreciated. The title is a reference to the fact that I have found my blog to be ‘therapy’ for some of the things that I’ve seen and done in the ambulance service … and it’s cheaper than hitting the bottle.

Dog Teams

I’ve often mentioned that the ambulance service and the police tend to get on rather well together; this is at least in part due to us both being called to the same jobs, and probably because we share the same view of the ‘Great British Public’.