Left Behind

"34 year old male, ? Collapsed behind closed doors"

This job gives you a lot of strength in many ways. I suppose it's fair to say it's good for character building.  Over the years I have found myself in various situations, where when I look back, I think 'how did I hold it together?' I often feel that the job has desensitised me to a lot of things. It has to. Everyone has their own coping mechanism and ways to deal with different situations. The much vaunted 'gallows humour' is something that all emergency services use. Perhaps after seeing the same thing over and over again, it just doesn't matter any more. There are some jobs however, that don't come along every other day or even every other month. These are the jobs you remember. Everyone remembers their first cardiac arrest, their first dead body, their first baby delivered etc and today was no different. As far as a day goes, it didn't feel right. I was just on edge, no idea why. When the call came down I knew it would be a serious job. We get  'collapsed behind closed doors' ever week but this just felt different. We headed round to the address to find two women standing at the front door. 

We grabbed our stuff and headed over. It was the patients partner and mother. They hadn't been able to get through to him all morning, afternoon or evening. It was now 10pm. His car was outside the house and they could hear his phone ringing inside. The police had been requested but we had no ETA so we decided to try and get in ourselves. The door had been locked from inside so forced entry was our only option. My crew mate stepped up and gave the door a kick but she just bounced back off the door. I then had a go. After three kicks, the door swung open with a deafening bang as the brass door knob crashed into an iron radiator. The sound billowed through the hallway. The goal was to get in and we had achieved that but now a feeling I'll never forget engulfed me. I had a pitted knot in my stomach and was very apprehensive about going in any further. The hall was pitch black and the house felt cold and motionless. I shouted as I gingerly walked forward. All I heard back was silence. The light came on and lit up the downstairs. My crew mate entered the only closed door but the room was empty. Upstairs it was then.

I looked up and braced myself. I don't like exploring dark, empty houses at the best of times but today I was really nervous. It was a split staircase, and as I went up the first few steps I could feel my heart pounding. I pressed the light switch on the wall beside me and a single bulb illuminated the stair well. As I turned halfway up, I saw my crew mate and the two woman starring up at me with a look of expectation. I continued up, the stairs creaking with each movement, and as I got to the penultimate step my breath was taken away. I had looked to the right down the dark landing and six feet from me, poorly lit was a silhouette. It was the silhouette of our patient. I was the silhouette of him hanging, motionless from the loft hatch. I still see it like I do a photo. A moment locked in time that will stay with you, haunt you perhaps, forever. We cut him down, the tragic and gut-wrenching pain that his loved ones were experiencing was palpable. It's not a nice sight for someone who is used to seeing some pretty horrible sights. For someone who isn't, I can't to imagine what that feels like. We laid a blanket over his body and went downstairs to where his family had gone. 

For us we could immerse ourselves in protocols. The guy had been dead for hours so we called the police to confirm an unexpected death, we filled out our paperwork and our Recognition Of Life Extinct form for the coroner. It all seems very scientific but it's a way to remove yourself from what the natural human reaction is to do. Cry. Seeing a relative cry in mourning is enough to put the lump in my throat and make me well up. They are horrific situations and no amount of training would make a difference. What do you say? What can you say? There is no way to powder coat what had happened. The evidence was there for them to see. It wasn't just knowing their partner or their son was dead, it was knowing how desperate he felt before his death to do what he did. Those feelings are what will haunt them just as much as seeing him hanging there. Every suicide effects many more people than the ones you see. There are always the ones who are left behind. The ones who feel that pain every day. The ones who still have to live their lives. Alone. That is the tragedy of suicide. 

He had a 3 year old son. He will never know him, but will know how he died

He had a 1 year daughter. She will never know him, but will know how he died.

He had a sister. She will always hurt because her little brother didn't come to her for help.

He had a brother. He will always feel that he should have done something more.

He had a mum. She will always feel that she failed. 

He had a dad. He will always feel like he failed.

He had a partner. She will always blame herself and raise their children alone.

He had many friends. They will all ask themselves why they didn't notice. 

He had depression. He couldn't confront it, or if he did, he couldn't turn the corner

NB: My final bullet points were inspired and partly taken from @chocolatewig blog post Life After Suicide with her permission. Felt it highlights the tragedy well.

There it is

"22 year old female, shortness of breath, ? Pulmonary Embolism, in GP surgery"

I will tell you now that the time this call came in was 17:47 on a Friday evening. We were sat at hospital, I was scribbling paperwork while my crew mate was cleaning the back of the ambulance. It is a routine we go through about 9 or 10 times a day. Hand patient over, book patient in whilst driver makes tea, do paperwork wile driver cleans ambulance, drink tea quickly, go  and do another job. It occurs like a broken record! Having gone through the routine, we came up available for the next one. Within seconds we got it. We headed off through the busy rush hour traffic and within 8 minutes were on scene. The job was now a success regardless of what happened to the patient! We walked in to the surgery at 17:55. A cursory glance at the sign on the front door showed the opening hours:

Mon-Thur: 8am - 7pm

Friday: 8am - 6pm

Saturday: CLOSED

Sunday: CLOSED

Call me a cynic but I do not see these times a coincidence! Then again, a pulmonary embolism (PE) is a serious, life threatening condition, hence the Category A response time and an immediate ambulance. I mean...the GP wouldn't lie to get an ambulance quickly would she?! Surely she wouldn't do that just because the surgery is about to close?! I tried to keep my mind open and treat as I found. For those not in the know a PE is a small blood clot that travels through the bloodstream and gets stuck in the pulmonary artery, which carries blood from the heart to the lungs. There are various risk factors that cause it, such as a recent operation or injury, long journeys such as plane travel and overweight smokers over 40 to name but a few. Seeing as the GP had called us for a PE, I assumed the patient would have at least some of the risk factors associated with the condition.

Sat in the GP's consultation room was our patient, stood next to her was a frustrated looking GP. I have had a variety of handovers from GPs. Some are very detailed, some are vague, some give me the letter, some give the patient the letter to give to me, it doesn't really matter. What made today amusing was the amount of bizarre and irrelevant information she gave me.

"This 22 year old lady has a 45 minute history of shortness of breath, there is no spinal tenderness, her reflexes are fine and she is able to weight bare, she has no calf swelling and both calves are 38cm in circumference. I have referred her to the medics to rule out a PE. Could you give her some oxygen please"

While she was talking, I was looking at the patient and wasn't at all convinced.

"What is her oxygen saturation?"

"I don't know"

"OK, I'll check before with give her the oxygen..........it's fine, her oxygen levels are at 100%, have you listened to her chest?"

"No not yet"

"Why do you think it is a PE?"

"She has shortness of breath and chest tightness"

"Any risk factors? Recent travel, operations, smoker, pregnant etc?"

"No, none"

"You do know she is having a panic attack?!"

I turned back to the patient and tried talking to her. She was unable to string a sentence together due to her hyperventilation. I started coaching her breathing while asking her to nod to any questions I asked her. I manged to ascertain that she had some chest tightness, dizziness, pins and needles in her hands and legs, palpitations and was nauseous. It was a classic panic attack, as text book as they come. I turned to my crew mate:

"Can you grab the 'lifepack', we'll do an ECG in here"

At this point the GP interrupted.....

"Can't you do that on the ambulance, we are closing now?"

And THERE it is! That is why we were here. That is why she said it was a PE and not a panic attack. On a Friday evening, she knew all too well that she would have to wait a while for an ambulance if she said 'panic attack'. She wanted to go home! This was not lost on me for one second and in a rare stance of defiance, I dug my heels in. If the GP wanted to play games, so would I. No GP in their right mind could actually think this was a PE. There were no real symptoms or any risk factors whatsoever. She simply didn't want to waste her time, talking a panic attack down and waiting for the symptoms to resolve. Call the stretcher monkeys, we'll deal with it!

"As you think it is a PE and she has chest pain, I think it best we do an ECG before moving her, don't you?"

"Well maybe it is just a panic attack"

"Well if it is just a panic attack, shall we NOT take her to the medics and leave her in your care?"

.........."Probably best to rule out a PE, OK, do your ECG here"

I laughed inside! We did the ECG, I took my time and eventually took her (now fully recovered) to the ambulance. She didn't need or want to go to hospital so signed my paperwork and went on her merry way. What a complete waste of time! What a complete abuse of the system. PE my arse!

Trying My Patients

As I said last month, I felt that Diagnosis: LOB was getting a little stale. Not so much in the posts but in the name and what it stood for. Like everything, things change and what I set out to do certainly changed. My initial plan was to share the funny jobs and see what happens! I wanted to talk about the Load Of Bollocks that we sometime have to go to but over the months I found that there was much more I was talking about. Thoughts, feeling, opinions all came flooding out into my writing and the title of my blog didn't reflect how I was now writing. 

I came up with loads of ideas for a new name and whittled it down to 3. As my readers are the people who have kept me writing I decided to let you decide. Typically, the 2 names I couldn't decide between got the exact same number of votes so I was back to square one! So here were are! On the toss of a coin my blog is now called Trying My Patients. If you don't like it, well.....tough. My blood pressure has raised quite sufficiently to warrant not changing it again for at least a year!! 

The website itself looks different and will be evolving as the days goes by so bare with me. Any ideas for the artwork / photo will be greatly appreciated! Thank again for your continued support! 

Ella x

The Temperature

Temperatures. We all have them, we all deal with them, kids especially. Until the age of 5 children cannot control their core temperature as well as adults so are prone to high temperatures when fighting any major or minor infections. To that end, we give Calpol and do so because it contains Paracetamol. Paracetamol is an 'anti-pyretic' and will bring the temperature down. If the temperature isn't controlled there is a risk of a febrile convulsion which can be scary to see for a new parent. Generally, it is common sense though. Before I started this job and had any medical training I was a parent. I didn't have a clue what I was doing but I knew when my son was ill and knew that when he had a temperature I was to keep him cool and give Calpol &/or Nurofen. Apparently, I was one of the lucky ones though! Lucky because I was given this closely guarded secret and extremely useful knowledge.

"2 year old male, fever"

Wednesday lunch time. We had done the usual mix of slips, trips, falls and chest pains when this job came down. My first thought was 'So?!' That was the only information we had to go on which was reflected in its low priority category. We arrived at the tower block and rung on the bell. The piercing buzz of the locking mechanism echoed down the corridor towards the 'not so welcoming' looking lift. We risked it anyway as 16 floors was not about to be walked! The smell of urine and graffiti on the wall told us all we needed to know really. We arrived at the flat, the door was open, so we wondered in. Sitting in the living room were both parents and the child. Our patient was lying on the sofa, dummy in mouth, looking around inquisitively whilst wrapped in about 20 layers of clothes and various blankets!

"What's the problem today?"

"He's gotta tempricher"

"OK, how long for?"

"I reckon bout an hour ago or summit"

"And have you given any Calpol?"

"Nah"

"Have you got any?"

"Nah"

I got out our Calpol whilst shaking my head a tad. He did have a temperature but not that high. I removed most of the clothing whilst reminding them that dressing a hot baby as an eskimo will not lower the temperature! 

"Has he been unwell at all? Any cough or cold symptoms?"

"Nah"

"Any vomiting or diarrhoea or pain you are aware of?"

"Nah"

"So what made you worried enough to call an ambulance?"

"He's gotta tempricher"

SO WHAT?! She didn't get where I was trying to go with this conversation. I tried my best to explain that kids get temperatures and that doesn't mean they necessarily need an ambulance. The kid was happy as anything! Perhaps if the temperature lasted a number of days and he wasn't well and didn't respond to treatment, then perhaps a GP would be a good idea, but a 1 hour history?! Hmmmm. Sadly my words of wisdom were lost on her! Hospital it was!

2 hours later.........

"4 year old female, fever and shaking"

It was clearly going to be one of those days. We'd spend half the shift picking people up off the floor and now the latter was being spent taking temperatures and administering Calpol! In stark contract to the first job we were now driving towards a very affluent road. We pulled up outside this grand detached house with a huge double garage as separate outhouse. Parked outside the garage was a Porsche 4 x 4 and a branch new Range Rover. I couldn't help a sarcastic 'Oh...so they do have cars' comment as I ventured up the path to the huge front door. As I learnt towards the doorbell, the door opened. A very well spoken woman in her 30's opened the door. As we walked towards one of the living roomS I couldn't help but think that given a house like this I'd do a better job! Sitting in a high chair was the kid. He had a flushed face and looked tired and grumpy. I'm not surprised. He had a whopping temperature! 40.9 to be precise! I'd be grumpy if I was that hot!

"What's the history? What's been going on?"

"Well, it started about 3 or 4 days ago. He's generally been under the weather and not himself but I thought it would pass but it hasn't"

"So what has changed today?"

"He had a convulsion about an hour ago and has since been really groggy, I'm getting a bit worried now"

"And have you spoken to his GP at all?"

"Oh no, I didn't think of that!" she said with a jovial tone. Haha.....

"What time did he last have Calpol?"

"He hasn't, we don't do Calpol, we don't agree with it"

"Well it's what is going to bring his temperature down. That's what the hospital will most likely want to give"

"Well as parents we decided not to use unnecessary drugs"

I skipped on. I was never going to win. I wasn't educated. She was. I have no money. She was rich. She was talking down to me. I wanted to be done with this job. We took her and her kid to hospital & I left the department grinning, as the nurse schooled her on the benefits of temperature control, whilst sad next to our previous patient! I wear smug very well indeed!

Seriously though, when did the concept of giving kids Calpol get forgotten. These are by no means isolated jobs. Most kids we see with temperatures have not had Calpol. That is probably partly because the ones who have had Calpol don't need an ambulance. See, there is a clue! Temperatures need treating, they don't need ambulances. Kids with temperates also still fit into their own car seats......just a thought! A temperature on its own is also not a medical emergency. It is simply the bodies way of fighting off an infection. Let it do it's thing! Also, please please please don't wrap them up in every piece of fabric you can find. I really did think that people knew this when I started the job. It's just common sense. As for wanting to go to hospital, 4-6 hours sat on a metal chair in a waiting room will probably make things worse for all involved. Giving your child Calpol when they are unwell is basic parenting and personally, refusing to give it 'on principle' is negligent. If the kid grows up and decides he or she doesn't want to take it then fine, but to risk a child's health and comfort because of a warped principle is wrong. 


I'm not saying don't call an ambulance, I'm simply saying do the basic things to reduce a temperature first. If they are unwell and showing signs of serious illness, have a rash or go floppy the do not hesitate but a one hour history of a moderate temperature is not an emergency. That is all!




For tips on treating a fever see the NHS Choices website. 

NO! NO! NO!

"27 year old male, severe pain in finger"

Like I've said before, who am I to judge the pain that someone is experiencing. Pain is of course subjective (apparently) isn't it? Regardless of how bad the pain is, the fact still remained that someone with pain in their finger does not need an ambulance. They need a lift or a taxi. Then again, who am I to decide who does & doesn't need an ambulance? Calls are triaged; calls are filtered and given a category. That category decides what kind of response the call gets. Category A calls are for cardiac arrests, chest pains, difficulty in breathing and seizures etc and get an 8 minutes response. Category B calls are for abdominal pain, vomiting, falls, moderate bleeding, and a variety of other calls and get a 19 minute response. Everything else that is minor is a Category C and will get an ambulance as and when one is available. These calls are normally filtered again through Clinical Telephone Advise where more details are taken with the view to discharging some patients back into their own care and making their own way somewhere to get treatment. Unfortunately, in a system controlled by algorithms and a computer, some buzz words pop up which automatically upgrade a call to be worthy of an ambulance. The most common of these is 'not alert'; it automatically upgrades a call to a Category A and thus gets the FRU and an ambulance relatively quickly.

We had been at work for the best part of 45 seconds when the job came down. Surely a hurty finger didn't need an ambulance?! Apparently it did! Off we went at a leisurely pace, desperately hoping to get cancelled for a higher priority, or better still, 'call downgraded'; nope! Instead the call got upgraded to a category A:

"27 year old male, severe pain in finger, patient thinks it may be a splinter, patient is not alert"

A splinter?! Really?! Who is making these decisions? Who is authorising the use of a £750-a-call ambulance for a splinter? Why isn't he being told to get a taxi/ walk/ get a lift, or use some frickin' tweezers?! Seriously? The problem is, no one has decided this. They have answered the questions in a certain way which means they will get an ambulance. They know what buzz words to use, and if they want one, as things stand, they will get one. It's also not my job to ask these questions. It's my job to treat these people so that is what we did. 


A few minutes later we arrived at the house. We walked into the living room and my eyes were drawn immediately to the TV. It was at least 70" across and took up most of the wall. For those who have read The Rules of EMS, you may remember rule 80; 'The size of a patient's TV is inversely proportional to that patients social worth.' Oh, how true this was. The place was a pit. Most of the family were there and the cynic inside me said that at 14:30 on a Wednesday afternoon the fact no one was at work meant none of them did. I was right. 

"What's the problem today sir?"

"My finger is killing me innit"

"What have you done to it?"

"I don't know, I can't touch anythin' with it, I think it's a splinter"

"A splinter?"

"Yeah, I thought I got one earlier and pulled it out but maybe it snapped inside"

At this point his mother / sister / aunt chipped into the conversation.

"Can you tell him I'm right and he can get blood poisoning?"

"I very much doubt he'll get blood poisoning but let me have a look"

And have a look I did. He held out his grubby index finger, nail bitten back to the cuticle, nicotine stain on the skin and I inspected. There was a slight mark where a splinter may have been or still was, the skin was slightly redder than the rest, but that was it. It was indeed a splinter. The first time I had been called to one.

"Yep, it's most likely a splinter" I said with a slightly disgruntled tone.

"What do you reckon I should do?"

"Nothing?! It's a splinter, if you are worried you could go to the walk-in-centre or go and see your GP"

"So I don't need to go to hospital?"

"No, not for that"

"Safe"

Safe?! You've called an ambulance for a splinter and now you're saying safe to me?! What is wrong with people?! When did calling an ambulance for a splinter become the thing to do? I was always taught that ambulances were for emergencies. All advertising I have ever seen says the same, and all schools that I know of explain what an emergency is. Every time an ambulance is dispatched to a job like this the bar is lowered as to what it's acceptable to call an ambulance for. We are not far off sending a truck and a car to hand someone the tissues, cook dinner and wipe their arses. Something has to give. The fear of litigation has to stop and they simply have to say NO! NO, you don't need an ambulance. NO, you cannot have an ambulance. NO, you will not get an ambulance. NO! NO! NO!