It Happens To The Best Of Us

"23 year old female, ? drink spiked, vomiting"

It was ridiculous-o-clock in the morning and most of the night's revellers were either a) tucked up in bed b) tucked up in a hospital bed or c) lying in a pile of vomit in a park waiting patiently for a good samaritan to call 999. As far as night shifts go, it had been particularly torrid. Alcohol and drugs had been the stars of the show, with the police and the ambulance service run ragged all night long! Some of my highlights of the proceedings included being spat at and threatened by a crack head, having someones dog 'set on me' (the dog couldn't be arsed) and watching a great episode of domino vomiting (one goes, they all go) outside a club. Oh, spending an hour trying to convince a man in only Thundercat boxer shorts, that lying in the road with his hands in his pants wasn't conducive to good public relations and future job prospects was also one for the out-takes reel. 

It was about 04:30, I was resembling a wild banshee and looking rather dishevelled! My hair really was a thing to marvel at! Being sent to a vomiting drunk person with delusions of drink spiking hardly filled me with warmth, I must say. I was wildly confident that the only thing her drink had been spiked with was alcohol. We headed on up to the 'top floor' flat as instructed. We were met half way up my a drunk, scantily clad girl who was walking like a new-born giraffe. Funny it was, graceful it wasn't. We followed her, and the noise of crying / wrenching into a bedroom. 

There, lying sprawled on the bed, wearing a t-shirt a thong was our patient. Her head was hanging over the edge of the bed and she was indeed vomiting. Her makeup had run somewhat and her hair was....well, matted in vomit. She looked a treat! She was also crying. Stood in the corner of the room as a sheepish looking boyfriend, who wasn't drunk and seemed rather annoyed by the whole situation. 

"Hello my dear, good night was it?!"

"Oh my god, I'm so sorry, I can't stop being sick!" she slurred at me.

Between her and her friend they went on to explain that she hadn't drunk any more than she normally would and drunk the same amount as her friends. They just didn't understand why she was so drunk! Must be a spiked drink eh?! Not the lack of food all day and tiredness combined with any number of other things. Oh, and all the Jaegerbombs. And wine. And other spirits. Definitely, without doubt, a spiked drink! Hmmmmm!

Her boyfriend just rolled his eyes! He looked particularly unimpressed by the whole situation. I made a few jokes about the situation and he chuckled. It was then I noticed his shirt. It was white, with flaps on the shoulders for epaulettes and a velcro patch on the chest. 

"Is that a police shirt?!"

"Yep! I'm a cop, I'm on early turn, start at 7am, then get a call from this muppet!"

"Sleep's overrated anyway buddy!"

The patient started wailing / crying again! She was apologising profusely and stating how ill and drunk she was!

"What do you do for a living?!"

A sorry pout and half grin appeared on her face.

"I'm also in the police! I'm so embarrassed!"

I just laughed, and laughed hard! She started laughing, and her boyfriend was now seeing the funny side of it! 

"And what do you do?!" I said to the friend.

"And what do you do OFFICER!" she said bursting out in laughter!

As far as I was concerned, all her sins were forgiven! Sure, it's favouritism and yes, I have bitched and moaned about drunk people calling ambulances because they are drunk and YES, they should have known better. But, the thin blue line is spread so thin and they do such a great job day in, day out that getting smashed on a Friday night was probably just what the doctor ordered. We spend half an hour talking work, sharing war stories and we left her to wallow in self pity for the entire day before she started night shifts! 

Getting drunk and paralytic happens to the best of us at times, even the police. When not in uniform we are all just normal people making the same stupid mistakes as everyone else! I won't hold it against her when our paths cross professionally. I will however, mock her unreservedly!

Don't forget, nominations are now open for the MAD Blog Awards 2014. Please go and nominate me by clicking HERE. Just add my URL www.tryingmypatients.co.uk to the categories I'm eligible for! (Best Writer & Most Entertaining) Thank you! 

MORE Opinions Required

Ok people, I require your help AGAIN! Thanks for all the comments in Opinions Required. Same question, except this time I have changed 1 number and added one word.

I did a job a few weeks back that I want to write about. First though, I want some different opinions from you lot! 

"94 year old male, chest pain, suicidal, verbally aggressive, police requested"

That was the information that I had. I chose not to wait for police because he was 94! I was feeling particularly bolshy on this particular day!

The patients brother met us outside the flat and gave us a run down on his past medical history. The highlights included, paranoid schizophrenia, delusions, hallucinations, psychotic outbursts and OCD. Today he is extremely agitated. We entered the property and cancelled the police. 

I swung open the bedroom door. The patient was standing in the middle of the room holding a zimmer-frame. He stared at me. He slowly starts walking  towards me.

"Get out of my fucking flat or I'll throw you out of the fucking window, I mean it. Fuck off."

He says this whilst raising his fists.

*          *          *          *          *

So! What I want to know is, what would you do? What should I have done? What are your thoughts on the situation I find myself in? I welcome the views of everyone! Ambulance staff, police, mental health working, nurses or anyone who wants to share what they'd do! Please comment!! 

Thanks, Ella x

Opinions Required

Ok people, I require your help! I did a job a few weeks back that I want to write about. First though, I want some options from you lot! 

"44 year old male, chest pain, suicidal, verbally aggressive, police requested"

That was the information that I had. I chose not to wait for police because I was feeling particularly bolshy on this particular day!

The patients brother met us outside the flat and gave us a run down on his past medical history. The highlights included paranoid schizophrenia, delusions, hallucinations, psychotic outbursts and OCD. Today he is extremely agitated. Despite all of the above, we enter the property without the police. 

I swung open the bedroom door. The patient was standing in the middle of the room. He stares at me. He slowly starts walking towards me.

"Get out of my fucking flat or I'll throw you out of the fucking window, I mean it. Fuck off."

He says this whilst raising his fists.

*          *          *          *          *

So! What I want to know is, what would you do? What should I have done? What are your thoughts on the situation I find myself in? I welcome the views of everyone! Ambulance staff, police, mental health working, nurses or anyone who wants to share what they'd do! Please comment!! 

Thanks, Ella x

Tea And Toast

"89 year old male, collapse, irregular breathing, not responding"

I remember my first ever shift on an ambulance. I remember everything about it, every job, every patient, the two people I was with, where I was working, how I was feeling etc etc. There was a job that day which was given as 'COPD patient, difficulty breathing, not responding'. My mentor turned to me and said 'this guy could be very unwell, he may die on us'. I didn't understand how he could possibly know that! He told me it was just a feeling he sometimes got. Sure enough the patient was unwell. Very unwell indeed! On route to hospital he went into cardiac arrest and despite our best efforts he died. I remember feeling quite amazed that my mentor had predicted it from the minimal information we had. Well, years later, and I get those feelings, and today I had one! 

I told the student with me to grab everything we would to take to a cardiac arrest. She looked at me like I was drunk, but I was insistent! We headed into the care home and were told the patient was on the second floor. My student pressed the button for the lift, I didn't wait and with surprising vigour, I bounded up the stairs. My student didn't follow, and waited for the lift with one of the carers. I was quickly located to the room and sure enough, lying on the floor was our patient, well and truly in cardiac arrest. I started CPR, got the oxygen on him and attached the defibrillator. The student was no where to be seen. It turns out they had to wait ages for the lift, then went to the wrong floor and then couldn't find the room. I later explained that no matter what floor the patient is on, as a first responder, if you suspect the patient could be very unwell, never take the lift! 

As resus attempts go, this was quite long and drawn out. Once everyone had arrived, there were 5 of us in total sharing the workload. By sharing, I mean the two students were doing the lions share of the CPR, I was doing nothing but running the resus (perk of arriving first) and the other two were administering the drugs etc. We got his heart started at least 10 times but it was never sustained for longer than a minute or so. Each time it started beating it was slow and weak. We tried external pacing to no effect and it quickly became clear he was just reacting to the adrenaline we were pushing into him via the vein in his neck. After 90 minutes we stopped. We'd exhausted all of our options for the guy and after seeking advise from some grown ups we ended CPR, removed the oxygen and called a time of death. 

It was quite sad. He hadn't been unwell, and only just moved into the home so wasn't known well by the staff. It was just his time. As is protocol, we requested police for the unexpected death and started our reams and reams of paperwork whilst the students started clearing up! A carer appeared in the doorway.

"Would anyone like some tea?" she said.

We all unanimously nodded away! How very British! There is nothing a good brew can't fix!

"How about toast? Would anyone like toast?"

Again, we all kind of looked at each other and started nodding away! 

"Yes please, thank you!"

She disappeared off and we continued with the writing. Five minutes later she and another carer appeared with two large trays and set them down on the dressing table. There was pots of tea and coffee, sugars, milk, a selection of biscuits and about slices of toast with a pot of butter! Amazing! One of the students took up the role of 'chief butterer' and the other begun taking orders and pouring drinks. It was much needed and very appreciated. We sat around talking about the job, looking at the patients photos of himself and his family and talking about the life he had had whilst drinking tea and eating warm buttered toast. 

The door then opened and two police officers entered the room. Take a freeze frame of what they saw:

5 members of the ambulance service, one sitting in an arm chair, one sitting on a bed, two sitting cross legged on the floor and one leaning against a chest of drawers, all with a cup and saucer of tea in one hand, toast in the other and a dead 89 year old man lying in the middle of them.

This sums up our job and a picture paints 1000 words. Some may think it's not appropriate, some may think it's extremely weird. To me, the last 5 people this man had contact with, who tried for 90 minutes to save his life, were sitting around toasting (excuse the pun) his life with tea. I like to think that he would have looked down and enjoyed his very British send off. 

R.I.P

Don't forget, nominations are now open for the MAD Blog Awards 2014. Please go and nominate me by clicking HERE. Thank you! 

Reservoir Dogs

Having hosted a great guest blog by Binder Smiff from Not-On-My-Shift.org a few weeks ago, he kindly gave me the opportunity to share my ramblings over on his blog! He wanted humour and buffoonery as a vague theme, and seeing as being a buffoon is a speciality of mine, it wasn't to hard to find something relevant! Anyway, this was my guest post! Enjoy!

"84 year old male, chest pain"

It was student season. For 4-5 weeks the university students were chucked out from the comfort of their lecture rooms to the unforgiving shift patterns of their respective mentors. It is during this time they home their skills and learn how to take a patient history, diagnose conditions and talk to people. Of course, always under the watchful eyes of one of us! I remember being chucked into the deep end all those years ago. staring blankly at an expectant patient and not having a clue what to say, there were so many awkward silences! It's just part of the learning process. 

We headed off to this particular non-descript chest pain and one route discussed what relevant questions should be asked. Chest pains are a very common call to go to and as such, it is one of the first things that students get well accomplished at doing. However, as today proved, it is often far too easy to get overly focused on one thing, and not looking at the big picture! 

The door to the care home was eventually opened and we headed in! It always amazes just how long it takes them, despite having called 999 and presumably expecting an ambulance to arrive! We followed the carer upstairs and were presented with our patient, who was lying on the floor! To me, it was painfully obvious why we were called. To me, the injury was obvious, as was the fact they had said chest pain just to ensure a quick ambulance. To the student, it was a chest pain lying on the floor and so the history taking began! 

To their credit it was an excellent example of history taking for a patient with chest pain. Unfortunately, they were concentrating so hard on trying to establish the history via the dementia patient's carer and his confused responses that they neglected to focus on what I felt was glaringly obvious. Not wanting to rain on the parade I allowed it to continue for a few moments. I turned to the carer and quietly asked her to get me a few things that I would be needing! (All will be revealed)

"So, from the top, tell me what we have?"

"Frank had an unwitnessed fall, unknown loss of consciousness and now has some discomfort in his chest, not radiating anywhere, says it feels heavy."

"Anything else?"

"Should I do an ECG?"

"Yes, that's probably a good idea. However, perhaps address the fact that his EAR isn't attached to his head first."

The student glanced with horror towards the patients head, and clearly for the first time, realised that lying next to his head in a small pool of blood was his ear. Completely severed. The look I was given was of distraught fear. On cue the carer arrived with 2 sandwich bags, 1 empty and 1 full of ice that I'd asked for.

"Can you pass me the ear please?" I said with a smile on my face. 

I thought it was about to be an ear covered in vomit! Apprehensively the ear was picked up and handed to me. 

So, there I was, standing in a care home, a student kneeling in front of me almost in tears, a patient lying on the floor grinning like the cheshire cat having a whale of a time and I was holding his ear in my hand. I couldn't help but think I was just a cut-throat razor away from Reservoir Dogs! It was most surreal. I popped the ear onto a sterile non stick dressing and put it in a sandwich bag. I then put that in the bag of ice.

"OK, from the top, what's the plan now?!"

"A dressing?"

"Excellent!"

Our patient, who was in no discomfort, was promptly wrapped in a bandage and thoroughly checked for more injuries. I couldn't help but ask the student to check for any more missing body parts to which they just glared at me. The ambulance arrived, an excellent handover was given and we left for a debrief in the car! 

The student felt awful. Part of me felt cruel for allowing it to go on as it did. The other part thoroughly enjoyed it! We have all been there when we were new and naive. It's easy to miss the blindingly obvious when our minds are telling us to look for something else. The first thing that went through my head as I entered the room was "WHY THE F**K IS HIS EAR ON THE FLOOR AND WHY DIDN'T THEY MENTION IT?!". Clearly, the first thing on the students mind as we walked through the door was "Chest pain, chest pain. chest pain!". 

It served as a valuable reminder that looking AT the patient is always a good place to start. Things are rarely as we expect to find them and despite being taught to expect the unexpected, the student fully expected to find a man with chest pain, not a modern day Vincent Van Gogh. I have no doubt, missing body parts will never be overlooked again!