Cocktail

“18 year old female, chest pain, dizziness”

I’ve spoken before about young people and chest pain. Basically, I think common sense should prevail more often when it comes to sending an ambulance and a car to a teenager with chest pain. I once went to a 23 year old having a heart attack, it was the youngest the cardiologist had ever seen. On top of that, he had risk factors and presented like a heart attack; central crushing chest pain for more than 15 minutes, shortness of breath, cold, clammy ashen skin blah blah blah. If I had THAT information to go with this 18 year old I may, unlikely, but may suspect it was something more than a panic attack or anything equally as minor. My point is, based on what the caller had told the call taker this should not have wasted resources with two vehicles, especially as we were no more than 50 yards to the A & E entrance!

Regardless of what my opinion was, we pulled into the road at the same time as the FRU. En masse we headed down to the garden path to the front door. It was eventually opened but a guy styled on Kurt Cobain. You know the type, long hair, baggy trousers, skater shoes, a jailers chain hanging down to the ankles, black nail varnish, a beanie hat, scruffy bum fluff and a lip piercing to one side of the top lip. Oh....and can only grunt answers and is physically incapable of smiling! Anyway, as the door was opened and I’d looked up and down the smell of skunk, cigarettes and cheap cider hit me! Aaah THAT is what ‘teen spirit’ smells like! We followed ‘Kurt’ into the kitchen where our patient was sat on a stool. She was also having a teenage identity crisis! A cross between a goth and punk with a bit of hippy chucked in for good measure. One look at her and I knew she was stoned. Pupils like saucers and an inane look of amusement with a hint of confusion. 

“Hello there, what’s the problem today?”

She looked at me blankly for a moment, her head swayed slightly and after a few seconds to re-focus she mustered the energy and brain power to respond.

“Got chest pain”

“How long have you had that for?”

Again, the stoned routine of saying the question back in her head, concentrating hard, putting together a balanced, well conceived response and then saying it. The whole process takes about 10-12 seconds.

“All day”

“OK, now I can smell some pretty pungent drugs, how much have you had and have you taken anything else”

A look of sheer panic spread across her face and ‘Kurt’s’ for that matter. It was if they didn’t think we would be able to smell it because they had opened a window! 

“We are the ambulance service, not the police, you are adults, I don’t care what you’ve taken but I need to know because you have chest pain, you’re not in any trouble.”

“Well i’ve been on a 2 day bender, we went on a rave last night and didn’t get home till about 10am today.”

“So what have you taken?”

“I took some pills last night, and some cocaine, few spliffs here and there, and a bit of MDMA. Maybe some ketomine to.”

Brilliant! Well that would explain the chest pain! A drug cocktail, possibly with some horse tranquiliser in the mix!

“No probs, and have you been drinking to?”

“Yeah, on and off all day really, I only slept a bit.”

“And have you eaten?”

“Not really, I’ve only eaten a few bags of crisps in the last few days.”

Bingo! Well that will explain the dizziness! Sherlock Holmes would be proud as punch! Why she didn’t think that the best part of 48 not eating, not sleeping, drinking, smoking and taking all the drugs she could find wouldn’t cause her to feel ill is beyond me! Why the call taker wasn’t able to establish any of this I don’t know either! 

“Right, shall we pop you out to the ambulance so we can do an ECG etc then pop you up to hospital?”

“Do I have to?”

“No. You don’t. But, you called 999 for chest pain and diziness, you still have chest pain and dizziness so it’s a good idea to come with us.”

“Yeah but if you say it’s cause of the drugs i’ll be fine”

“But until we’ve done an ECG we won’t know what is going on with your heart.”

“I think i’ll leave it for now and if I feel worse i’ll call you back.”

“No, we are here now, we are next to the hospital, that would be a massive waste of an ambulance. Let’s get it sorted now.”

She shared a look with ‘Kurt’.

“Nah I think i’ll leave it.”

“So why did you call us?” 

“Cause I thought I was dying.”

“So let us check you over and take you to hopsital,”

“It’s OK, don’t worry about it, i’ll just get some sleep.”

AAAARRRRGGGGHHHHH!!!!! Seriously!!! Why call an ambulance?! There are very few things that wind me up more! It drives me absolutely bonkers! As kid, infact, even as an adult before I did this job, I would look at an ambulance and think that they were a) going to a life threatening emergency and b) be taking someone to hospital. I had no idea that people would actually call 999 and then did not go to hospital. There is a drive within our service at the moment to leave more people at home and apparently that is the future but personally, as much as I do that, surely the main problem is the amount of people calling 999 who clearly don’t need to be in hospital or don’t want to be?! That is why we NEED to leave people at home. That is why hospitals are at breaking point. JUST.....SAY.....NO!! I was barking up the wrong tree with this patient. No matter what I said, she was never going to go in. I got her to sign the back of my paperwork and ticked the box ‘declined aid against advice’ and stomped off.  

Despair

“4 year old female, vomiting, DIB”

I see a lot of different people in this job; a lot of people from different backgrounds, different ethnicities, different religions and different sexualities. People come in all shapes and sizes, all ages and each with their own unique medical histories. Some people have nothing wrong with them; some have very complex needs and care packages. Until we arrive at someone’s house and go in, we have no real idea of what to expect.  A 4 year old vomiting with DIB is nothing out of the ordinary and could mean anything from a minor stomach bug to a life threatening condition. The latter is unlikely but always possible. 

On route to a job it is not uncommon to get an update, namely because we are dispatched automatically by a computer as soon as an address or mobile phone co-ordinate is obtained. As more information is received we are updated. 

“UPDATE: Patient has special needs”

This could mean anything but made the job a little more interesting. We arrived at the front door, which was opened by a small child who pointed upstairs. Up we went, bags in hand. In the living  / bedroom was about 8 or 9 members of a family ranging in age. Lying on the bed, on her back was our patient. She was very small for her age, her legs were not properly formed and her face was slightly contorted and swollen. In the corner of the room was a very complex looking wheel chair with head and leg straps and a torso restraint. It was clear her needs were very complex so vomiting could be a serious issue in terms of aspiration.

“What’s the problem tonight?”

“She vomited”

“Anything else?”

“She’s not breathing normally”

“OK, so what medical conditions has she got?”

“She can’t walk or talk”

“OK, but what is specifically is wrong with her, what condition has caused this?”

“She was born like it”

“OK but what condition is it that she has?”

They just looked at me blankly and then the mother passed me a folder. Normally when a folder is passed by a relative, it is a care folder with medical history, medications and patient details. The folder we were given contained financial information relating to the kid, benefit allowances, bank statements and letters requesting more money. A bank statement dated 2 weeks previous showed a balance 4 x my monthly salary.  It also transpired that no one in the house worked for a living. 

“This has nothing about her medical history, what is wrong with her?”

“You tell me, you’re the paramedics.”

“Yes. I know that, but without knowing her history or what she is normally like at 2am it is hard to form an opinion of the cause to the vomiting. What condition does she have that causes her to be in a wheelchair?”

*Shrugs shoulders and kisses teeth*

While I was fighting an uphill battle trying to get any kind of history, my crewmate had been checking her over. She grabbed the oxygen and put on a full flow mask. Very low oxygen levels, a very high respiration rate and a very congested chest suggested she might have aspirated on her vomit. 

“Right, we are going to be going to hospital, can you grab a bag of stuff for her”

The mum passed me a bag.

“Can you carry that? We have our bags to carry”

“Oh, do I have to come with you?”

“YES! She’s your daughter!”

“But we’ll be sat there for ages, can’t someone just call us when she needs to come home?”

“NO! One of you has to come with her.”

A look of sheer annoyance spread across her face. Was I really hearing this?! Do people like this actually exist?! Why is this poor child allowed to live somewhere where she clearly isn’t being given the care she requires? I really do despair at what society has to offer. Lying on the bed in the ambulance was a little girl who has a very poor quality of life at the best of times. Couple that with parents full of apathy and who’s priority appears to be what money they can get as a bi-product of her condition and I was left feeling sick. Sick that there has been no intervention, sick that situations like this exist. I don’t know if this behaviour was a cultural thing but as far as I was concerned it wasn’t something that should be tolerated in any culture or society. I certainly wasn’t going to let it go un-noticed.

In a heavily antiquated system there is too much red tape to cross, things simply take too long to take effect. Protocols need to be in place to enforce the strictest of penalties when the care of a child fall short from what is expected. Not just for the extremes in children with complex medical needs but in children who display anti-social behaviour, truancy and crime. I personally think that parents have to be held accountable for their failings at all levels otherwise their culture and apathy towards parenting will be evident in the next generation. Maybe I am being harsh but I really do despair at what we as a country allow to happen. 

50 Shades

"27 year old male, abdo pain"

As far as shifts go, this one had been as dull as they come! You literally cannot please an ambulance crew. It is an impossibility! If we are busy, we moan about the work load and lack of breaks. If on the rare occasion it is quiet we moan about time going so slowly! That's just how it is! Anyway, today was slow. We were sat on standby watching the world rush by when eventually we got a call!

Hardly exciting! As a general rule, 27 year olds are not ill or needing an ambulance. 27 years are generally healthy, they may smoke, do drugs, drink and get colds but they are not ILL! Unless they have been shot, stabbed, hit by a car or fallen from a great height, realistically, 99% should be able to make their own way to hospital and will be none the worse for doing so. I was fully prepared to go through the motions of finding out about the pain, learning that no pain killers had been taken, offering pain killers and referring on to the GP rather than clog up A & E.

We pulled up outside the rather nice looking house and noticed someone at the upstairs window, who promptly disappeared. As we got out the vehicle a guy was standing in the doorway to the house. We trundled over to see him! He looked very awkward, almost embarrassed to see us.

"My friend is upstairs" he said pointing at the staircase.

Sheepishly, he followed behind us and pointed is towards the bedroom. 

Sitting on the bed looking very distressed was our patient. Some people just have a look which makes you think they actually have something wrong with them and he had this look. He was holding his arm across his chest.

"What's the problem today?"

"........." he looked at his friend who was now in the doorway who gestured with his eyes to talk.

"We can't help you unless we know what has happened."

"I can't move my arm."

"So what happened?"

"I fell off the bed". His face went bright red. 

"And how did you land?"

"With my hands out first."

I was about to ask how he managed to fall in such away but luckily everything suddenly clicked into place. One of the skills you pick up when dealing with patients on a day to day basis is to look around houses while talking to the patient. You can learn an awful lot about them, from dietary habits, drinking problems, medications, hobbies and in this case, sexuality and love life! It didn't take a genius to work out that if you take two embarrassed guys and cross it with the paraphernalia on the floor beside the bed, you had all the tell tell signs that this 'fall' had interrupted some serious fun loving! Maybe I wasn't supposed to see them hurriedly, yet badly hidden away, but the lube, toys, condoms and 'stuff' were easy to spot. 

"It's OK, what goes on tour, stays on tour as it were, it happens to the best of us!"

He gave me a half smile! I looked at his shoulder and sure enough it was dislocated. We gave him some entonox and put it in a sling. 

"Right, do you think you'd be able to walk down stairs to the ambulance?"

"........." he looked at his friend again. "Just tell them!" he said.

"Tell is what?!"

"...........there's something stuck in my.......,.."

AWKWARD!!!!! In my head there was a celebration going on! AT LAST! A foreign body! Whoop whoop! Don't judge me! Everyone always asks me if I have been to any with something stuck up their arse and I always begrudgingly say no! Now I have and I was pretty chuffed! My face however showed professional concern with no hint of a smile! Well.....kind of!

"What is stuck?"

He reached to the pillow and pulled out a candle. Well, half a candle! I imagine the candle snapped during the 'fall'! Maybe it was the force of the candle that caused the fall! Let's just say it was 'sturdy' candle! Or we could say it had plenty of body! Sod it, it was bloody massive and the thought of it made me wince an tad! Good effort boys!

"Maybe we'll get you a chair then?!"

He nodded! We chatted for a bit while the chair was being fetched and he started to see the funny side! He was just mortified! His friend (now known to be his fiance) didn't know where to look, equally as embarrassed! I was in my element! We got him to hospital swiftly, taking it smooth over the bumps and handed him over to the doctor. I requested to do the handover in private, out of earshot of the other patients who surprisingly CAN hear through a curtain!

We said our goodbyes and left! Needless to say, I was beaming and the second we got into the ambulance and closed the doors we cried with laughter! At least their love life is burning strong! Sorry, had to shove in a candle.........pun somewhere! ;-)

The Sixth Sense

"38 year old female, ? assaulted, ? pain after C-section"

I think it's fair to say that everyone who works on the front line of the ambulance or police service develop a sixth sense regarding the general public. You can tell when something isn't right, you can tell when someone is ill and the police can tell when someone is up to no good. It didn't however, take a well homed sixth sense to realise something was amiss with this job. It had come from the police and every bit of information we received had a question mark in front of it.

'UPDATE: ? Intruder in house, ? Partner on scene, sounds distressed'

'UPDATE: ? Baby on scene, ? sexual assault, police now on scene'

It all just seemed a bit odd! There was snippets of information but no real presenting complaint or firm idea of what we were walking into! Nothing new there! We pulled into the road and headed up to where the police car was double parked.

As we approached the front door, it swung open. One of the coppers was standing there and we shared the police / ambo look! The look that says 'Hi, how are you, glad your'e here, this is a load of rubbish, I wish I was at home, why do we do this job?' in one half smile, slight nod of the head and a aura of resignation! We walked down the hallway to the other copper in the living room. Again, we shared the look!

'Hi guys, this is Jayne. Jayne had a baby 2 weeks ago and today is scared that someone is going break into the house and try to get her pregnant again.'

With a rather smug, gloating look he backed out the room leaving me to do the questioning. Jayne was sat on a chair, rocking back and forth slightly, her strawberry blonde hair was tangled and messy and she had a very intense look in her eye. I introduced myself and my crew mate and asked how we could help. She responded in kind and introduced as to her 'partner' Eamonn, who was sat in the arm chair on the other side of the room. He seemed totally unmoved by the whole situation.

Jayne went on to explain how she had given birth to Layla 2 weeks previous, by cesarian section. Lying in a moses basket next to Eamonn was Layla. All of the commotion hadn't made her cry, she just laid there, eyes glued to the ceiling. Apparently, for the last day or so Jayne had become convinced that someone was trying to break into her house to impregnate her. She had a real look of fear in her eyes but constantly tried to reassure us that she 'wasn't mental'. It's always awkard to ask about mental health history but I had to. She denied any and said she only suffered with mild depression. On cue one of the coppers handed me a discharge summary from the local mental health unit. A quick flick through revealed that Jayne was a medicated paranoid schizophrenic who frequently suffered from manic episodes.

It was of little surprise but when questioned about it she vehemently denied it, telling us they were wrong. She said she had been bullied by the psychiatrist and they had a vendetta against her. She said the reason she was so upset today was because Eamonn was angry that other men were trying to break in and impregnate her. I told her that I was sure that he wasn't angry but she snapped back 'well he's not talking to me'. He had nothing to say to the accusation. The whole room felt the air of awkwardness at the silence that ensued. We didn't know what to do or how to act. Family disputes are often difficult to be stood in the middle and this was no different. Eamonn's apathy was overwhelming. He had no response to her accusation and just stared blankly towards us.

"Would you prefer it if Eamonn wasn't here? Or maybe come to the ambulance to talk in private"

"Yes, take him away she snapped."

With that, one of the coppers walked over and picked up Eamonn under his arm and walked out the room. As Eamonn's leg hit the door frame he let out a squeak. 

Oh......didn't I mention?!

Eamonn was a blow doll.........

With Eamonn gone, Jayne got up and walked over to Layla and begun stroking her face. I couldn't bring myself to play along with the charade of talking to the 'My Little Baby' doll and suggested we went to the ambulance. She refused and said she wasn't going anywhere as she needed to protect her house and her family. There is no training for this type of situation for us or the police. You just have to improvise, adapt and overcome. Jayne clearly needed help desperately but being in her own home our hands were tied in the short term. Section 136 was useless and Section 135 would take time so it was the old fashioned good cop / bad cop routine with me playing the role of good cop! She didn't have capacity as far as I was concerned but there were less restrictive options available to us. Her life wasn't in imminent danger so we didn't really have the option of removing her against her will. It would also cause her more distress and we didn't want that.

I explained that I wanted her to come voluntarily to get help and talk to someone. She said no. She said she wanted her baby back. With that she pulled up her top and revealed a wound. It was a healing wound from a cesarian section. Her notes hadn't revealed anything about a pregnancy or a baby. 

"Where is your baby Jayne?" I said with real concern!

"They took her?"

"Who took her?" The copper said.

"Social services."

With that she handed me her hospital notes from the maternity unit. Twelve days ago she did give birth to a baby girl called Layla. She had been having frequent psychotic episodes since her partner, Eamonn, had left her and the baby had been taken away due to Jayne's inability to care for her. Clearly though there was no one caring for Jayne! Something as traumatic as having your child taken away would leave anyone distressed but for a paranoid schizophrenic already suffering manic episodes was a recipe for disaster. She certainly wasn't in a position to be left alone at home! What were they thinking?! 

Luckily for us, the fear of being put in handcuffs and taken away meant after some convincing she was willing to go to the mental health unit voluntarily and seemed keen to get some help. She refused point blank to go to A & E saying she'd rather die, so we decided to present to the mental health unit uninvited and deal with the staff when we arrived! 

As was expected they kicked up a stink about her needing to go to A & E first. They also wanted to know why she wasn't under section! It is as if they have never read the mental health act! After much arguing they eventually accepted her. Being reminded by the police that their choice to discharge her are a two night stay was a) irresponsible and b) the cause of us being here, swung it our way. We left Jayne in their 'care' hoping desperately that she would get the help she needed.

This job had two sides to it. The funny and the sad. It's extremely hard to keep a straight face when introduced to a blow up doll and a 'My Little Baby'. What do you say to that?! We certainly had a good giggle about it afterwards and I have no doubt it would be the talk of the mess room at the police station! It certainly was in ours. Some situation you have to laugh at purely because it's how our much vaunted black humour works. It's how we all rationalise the stuff we deal with. We are also well aware of the upsetting side to this job. The woman who's husband has left her, who went through the trauma of giving birth and having her child taken away. Having that mother and baby bond destroyed. Then the pain of being shipped back to her house. The house she shared and had expected to raise a family. The house with the babies bedroom as the constant reminder of what had happened. Pure torture. That alone would be enough to tip the most stable of people of the edge. She had been abandoned by the system, left to fend for herself and unfortunately for her, she had only been able to find solace in a blow up doll. This job was a stark reminder of just how much work is needed to bring mental health care up to the high standard of the rest of the NHS. 

Presumption

I often talk about not judging a job based on the information given to us. Ideally we walk into every job with an open mind, without bias and taking what we see at face value. Sometimes however it is hard not to presume. A ’21 year old, unconscious’ on a saturday night in a trendy part of town I will presume is ’21 year old, completely wasted, must show self restraint, will probably vom’. There will be the very odd occasion that I am wrong, but normally it will be exactly that. A ’17 year old female, DIB, chest pain, pins and needles’ to me, will be ’17 year old female, panic attack after argument with boyfriend, will be crying’. Again, most of the time it will be exactly that, or at least a variation on that! Bearing that in mind, when this job appeared on my mind I suspected exactly the same as what you are all thinking.....

“39 year old female, chest pain, bailiff on scene, patient is being evicted”

I read it as:

“39 year old female, saying she has chest pain to delay being evicted”

OK, OK. Best keep an open mind!

We pulled up outside the high-rise block of flats, got in the lift with it’s urine perfume and headed on up to the 17th floor. The views were amazing, the clientele.....not so much! Inside the flat were 2 bailiffs and our patient. One of them was changing the lock, the other looking frustrated. 

“Hi guys, sorry to call you out, I know you probably have better things to do but we had no choice. We have to cover our backs!”

“No problem, what going on?”

“We are here to serve an eviction notice on behalf of the council. This lady is living here illegally, she was staying here with a friend apparently, that friend has since left the country and she has been living here rent free for 5 months, she doesn’t qualify for a 2 bedroom flat, or any flat for that matter and despite numerous notices she won’t leave. When we arrived she refused to leave, when we explained the police would be called if she didn’t vacate the premises she said she had chest pain. That’s where we are at. I’ve tried to explain that regardless of the pain, the locks have been changed and minute she leaves she won’t be getting back in but she insisted she wanted an ambulance.”

“Okey dokey, no worries, we’ll have a chat with her.”

Call me cynical, but this sounded exactly as I predicted. Similar to chest pains in police custody suits, people time and time again, abuse the system in a vain attempt to delay the inevitable. 

“Hello my dear, do you still have the chest pain?”

“Yes”

“You do know that we will have to take you to hospital don’t you?”

“Yes”

“And if we do so, when you are discharged in 4-6 hours time you won’t be able to get back into this flat to get all your stuff.”

“What do you mean?”

“The locks have been changed, you won’t be able to get back in.”

“But it’s my stuff, they can’t do that.”

“I think they can, you have a chance now to pack your stuff up and take it with you, but if we take you to hospital you won’t.”

“I want the police, they can’t do this.”

“OK, well I believe they are on their way, but we need to take you to the ambulance to check your heart out.”

“No, i’m not going anywhere.”

“I thought you had chest pain?”

“Fuck off”

Charming! Great use of an ambulance! It is hard not to judge calls when you repeatedly go to things like this. I don’t think there is anyone who works for the police or ambulance service who don’t make presumptions based on information given. I’m sure i’ll get some people who will lie until they are blue in the face saying that they don’t......but they do! It’s human nature.

As for the lady suffering acute avoidevictionitis we waited in the corridor outside chatting to the bailiff (who was actually a really nice guy) until the police arrived. They dragged her out kicking and screaming within a few minutes.

“You can’t do this, I ‘av rights, I have chest pain.”

DAMMIT!!!