'The patient had suffered a sudden huge and unrecoverable bleed into the brain. She would never wake up'
Extracts from 'More Blood, More Sweat and Another Cup of Tea'
Tuesday 16 June 2009
On Saturday one of the first jobs was to go to someone whose name my crewmate recognised.
"He's a nice old boy," he told me. "When his wife was alive she'd call us every time he coughed. He's deaf and blind. He used to be a British champion boxer. He's a big fella so I hope we don't have to carry him downstairs. We don't see him much now; he hasn't called us out in ages."
The patient was sitting alone in his flat, scattered around him were books that he could no longer read. In the corner was a television that probably hadn't been turned on in years. He was just a frail man sitting quietly in his chair marking time. On the table next to his chair were the remains of some 'meals on wheels'. I could see that he had once been a 'solid' man, like the old men still living in our area who used to work on the docks – tall and thick with muscle. He wasn't that man any more. He was frail, shaking, and seemed nervous of everything, not something that you'd expect from an ex-boxer.
It was hard getting his history as I needed to lean close to his ear and shout. At one point he let out a hacking cough just as I was up close to him so we took him to hospital with a possible chest infection.
Our last job of the day was back to the same address – he’d been discharged from hospital and just wanted someone to 'check his pulse'.
We didn’t mind.
For the past five nights the majority of my patients have been sick with one or more of the following:
So there must be at least one highly infectious disease epidemic in the area. While you or I might want to curl up in bed with some Lemsip and paracetamol, it would seem that a large number of Newham's population would rather sit for hours in an A&E waiting room.
Which leads me to the point. Ambulance crews spend a lot of time around these infectious patients, who have often never been taught the good manners of putting their hand over their mouth when they cough.
So is it any wonder that I've got painful eyes, a streaming nose, a constant mild headache and a feeling that I'm suffering from a mild hangover.
Ambulance crews mustn't have more than three periods of sick leave in an 18-month period.
So I'm having to drag my potentially infectious body into work – where maybe I can infect some more people...
So in conclusion:
Send me nurses – pretty female ones with plenty of drugs.
You've got to laugh when an 'old salt' police sergeant tells you that he'd like to meet the person who assaulted my patient...
...And shake their hand...
...And you agree with him even though you've only known the patient for 20 seconds.
After two days of struggling with people, it was nice to go back to the simple jobs that are a joy to do. It's also good to see a sense of community.
In this case it was a little old lady who had tripped over a wobbly pavement in one of our local markets. She was surrounded by people of all backgrounds. There was a black market warden who had put cones over the offending paving stones. A Bangladeshi man was chatting to her and two Greek-looking men met me at the ambulance and led me to the patient. A Sikh stall keeper also pointed me in her direction.
The patient herself was one of the dying breed of 'traditional' English east Londoner. Normally an extremely healthy 80-year-old, she had a graze to her nose that refused to stop oozing blood. A real pleasure to talk to, we chatted about how the east of London has changed in her lifetime and how she still enjoyed living here.
"I’m an ethnic minority now," she told me, "but there are still a lot of people around who'll help you out."
And she was right – as an ambulance person I tend only to see the worst of people. I go to the assaults and the arguments. I hear about the murders and the abuse, the neglect and the trouble. Just as this woman was, for me, an unusual patient in that she was a healthy 80 year-old, so it was that I saw the unusual event of people helping someone in distress.
It was one of those jobs that leaves you with a smile on your face for the rest of the day.
Lying to Patients
Here is the thing - I'm a pretty poor liar. I don't get much practice, I don't like doing it and as part of my personality flaws I love sharing things that I know with anyone who'll listen. Unfortunately, in this business you need to try to keep some things to yourself.
I was called to a place of work where a 55-year-old woman was complaining of constant headaches. When I arrived on the scene a work colleague was comforting her as she had obviously just been crying.
I got a verbal history from the patient – the headache had been coming and going for two weeks and normal painkillers weren't touching the pain. There was no other history of ill health, she hadn't been to the doctor for years and she had no allergies. She told me that on that morning she had woken up with the headache and also a feeling of "not being connected to the world." Once more, her painkillers hadn't even touched the pain.
A quick 'n' dirty neurological examination didn’t reveal anything particularly scary and her observations were all normal apart from a moderately raised blood pressure. I discounted the blood pressure as her being scared and sitting in the back of an ambulance looking at my ugly face.
So we had a drive over to the hospital.
All through the trip I could see that her main fear was that she had grown a brain tumour. The words were never mentioned but her fear was of such intensity and direction that I knew that this is what she was thinking. I would have loved to lie to her. I would have given a lot to be able to put my arm around her and tell her that there was no chance of the headaches being caused by a brain tumour.
But I couldn't.
I had to sit there and explain about all my "negative findings." I could tell her that her pulse was fine, that she hadn't had a stroke, that her blood sugar was better than mine and that her short neurological exam didn't show anything unusual.
But I couldn’t tell her what she wanted to hear.
We reached the hospital, and while I handed over to the nurse one side of her face started to become numb...
A little later, while returning to the hospital with another patient, I saw our woman in the resuscitation room. She was sitting up and talking to her work colleague who had accompanied her in the ambulance. I wondered why she was in there but was too busy to ask the resuscitation nurse.
Towards the end of my shift I saw our patient walking back from the toilet (with colleague still in tow). I asked her what the doctors had found.
"They are keeping me in," she told me and my heart sank, "apparently I have a really high blood pressure, and that's what's been causing it."
"Oh superb!" I said. "They can cure that!"
You could see that she was a lot more relaxed, and that her main concern was that she was now going to be in hospital while the doctors treated her blood pressure.
Hardly a concern at all.
The thing that I didn't tell her was that her blood pressure had been so high, our machine for recording it hadn’t been able to measure it correctly. Which is a little troubling.
An Upsetting Job
She was 31 years old and I was kneeling next to her forcing air into her lungs because she had stopped breathing.
I was sent the call as a '31-year-old suspended' and to be honest I didn't think that it was going to be as given. 'Suspended' means no signs of life, and that tends not to happen to young people. I was working solo on the FRU at the time, and I sped to the address, reaching the place at the same time as the ambulance. It was an ambulance with two trainees working it. While one of the trainees and I went to the patient the other one and their supervisor turned the vehicle around so that they could leave the scene quickly if needed.
I rang the bell to the block of flats. Whoever answered the entryphone seemed to be a bit disorientated, but we soon got in.
"Probably a psychiatric patient," I said to the trainee as we stood in the lift.
"I hope so," replied the trainee, "I’ve not done a suspended before."
"Don't worry about it," I said. "Just remember that you need to try to keep calm. I'm there to run it until your supervisor gets there."
The doors to the lift opened and we made our way to the flat. I walked in through the door and all hopes of the call not being a suspended were dashed.
The patient, a deep shade of blue, was lying flat on the floor. Over her was a man I took to be her partner; he had one ear on the phone, listening to instruction from one of our call takers. Tears were running down his face as with his free hand he pushed on the woman’s chest in an effort at CPR.
On the sofa was the daughter of the patient - she was around five or six years old. She was also crying. I realised that it was this little child who had opened the flat door for us.
The trainee and I fell into our roles - I managed the patient's airway and breathing while the trainee connected the defibrillator. The patient had had a pulse but had suddenly stopped breathing. There was nothing in the patient's history to suggest what had caused this sudden stopping of breathing. The mother had overcome a serious illness a few years earlier, but that wouldn't account for what was happening today.
The job itself went pretty well; while the patient didn’t start breathing again on her own, we did manage to 'pink her up' a lot. The transport to hospital went well and we handed the patient over to the hospital staff with a real hope that she would make a recovery.
I went back to the hospital a while later.
The patient had suffered a sudden huge and unrecoverable bleed into the brain. She would never wake up.
For some reason this really upset me. I don't normally get upset at people dying, but for some reason this one really did.
I don't know if it was because she had left a small child behind - a small child who saw her mother die in front of her. I don't know if it was because the mother overcame a serious illness six years ago for the sake of her child. I didn't know what would happen to the child as the mother's current partner wasn't the biological father.
I suspect that it was because, for once, I thought that in giving the patient the best chance possible, she might have survived. I'm guessing that I was disappointed that the patient died despite doing our best work.
Whatever the reason, I was at my most upset over a dead patient since I’d attended the death of a 13-year-old a year ago.
If there is a slight upside to the story it's that because we kept her organs protected by breathing for her, those same organs were used to give a new lease of life for a number of other very sick patients. I only hope that this fact gave some comfort to her family.
Yes, I'm a registered organ donor.
Category A call
Take off your shoe.
Now remove your sock/stocking.
Get a ballpoint pen (red for added authenticity).
Lightly touch the nib of the pen against the sole of your foot.
You are now looking at the same wound that I went to last night. As a Category A call.
The patient was a 25-year-old woman who had stood on a sliver of glass. The pain was apparently so bad that not only couldn't she walk, but the pain was travelling up her leg and into her chest.
Chest pain = Category A call = blue light response, get there in eight minutes or someone might die.
I had to wheel her out of her expensive riverside flat apartment.
Her husband told us that he would follow behind us in his car.
The only sound you could hear while she was being wheeled out was Reynolds grinding his teeth.
After she was safely dropped off at hospital I indulged in a little 'primal scream' therapy.
From 'More Blood, More Sweat and Another Cup of Tea' By Tom Reynolds, Harper Collins, £12.99
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