Ran on a call to a mobile home site the other day. I think they're called trailer parks in the States. Never quite seen the attraction of these myself but I’m always amazed at how homely some people make these places; all mod cons and landscaped gardens. On the other hand some are an absolute mess.
As I pulled up I was met by a lady, who never did explain who or what she was, but told me that Harold was an alcoholic and was lying, unresponsive in bed. She also stated that he’d broken his hip last year but hadn’t gone to hospital. As I entered the front door she helpfully advised that “it’s a bit of mess in there”. And she wasn’t wrong. That wonderful aroma of cigarette smoke, alcohol, body odour and general dirtiness punctuated with urine, whooshed it’s way straight up my nostrils and made me gag. “ooh, lovely!”
Harold was indeed lying in bed, accompanied by a half finished bottle of vodka. A bed that had seen better days. The mattress was brown with no sheet; the duvet was brown; the pillows were brown; even the walls were brown. Not sure what colour they used to be but now, everything was brown – years of cigarette smoke brown! And it stank! Harold was staring at me but said nothing. I spoke to him. He said nothing. I tried a bit of the ‘responsive to pain?’ option. He said nothing. First thought diagnosis? He’s had a stroke. On went the oxygen whilst I checked out a few other vital signs.
There was also a lady in the home, sitting watch the TV and puffing away on a fag.
“Can you tell me anything about Harold”
“I don’t know no nuthin’“ She carried on watching the TV.
“Is he under the doctor for anything?”
“I don’t know”
“Does he take any regular medication?”
“I don’t know”
Aagghh! Do you know anything you old lush!? I gave up. Might as well talk to Harold. At least he was looking at me.
To my relief, the ‘totty bus’ rolled up. Fab!, my favourite girls. I explained what little I knew about Harold and we agreed that we’d get him on the bus and do a full examination there, as there was no room in the bedroom. Trying to get the carry chair into the room was a real challenge. A bit like that game where you have to move the squares about to end up with numbers in the right order. (There’s a freebie PC version here) It was open this door, move the chair in. Close the door, move into the bathroom. Close the bedroom door, back into the hall. Open the bedroom door – you get the picture. As we moved Harold off the bed his broken hip was obvious. His leg was hanging off at a very strange angle. Once on the back of the bus it was all hands to the deck. Blood pressure, heart trace, pulse, respirations and blood sugar. Wooaa, Hold on! Is this the problem? Blood sugar – LO. It was so low it wasn’t registering on our machine.
On to plan B then. Get his blood sugar up. At one time, the prefered treatment for low blood sugar was to administer a single, intramuscular, bolus dose of glucagon; (It increases plasma-glucose concentration by mobilising glycogen stored in the liver – BNF treatment of hypoglycaemia) Takes about a minute to administer. Trouble is it costs £20 a shot. So now we go through the labourious process of cannulation (putting a plastic tube into a vein in the arm) and administer a 10% glucose solution plus a 9% saline solution (the glucose can irritate the vein so the saline sort of washes it through). Costs a couple of quid. (Doing our bit to keep NHS costs down. Wat Tyler take note). It worked wonders. These sort of jobs are always great; watching a patient come back to full consciousness. In about 10 minutes Harold was happily ‘kicking off’ in the back.
“I’m not going to hospital. I’m not going to hospital”
“They’ll kill me. I’m not going there. I’ll never come back”
One of my colleagues managed to get him to calm down and slowly, ever so slowly, we began to get the story. Seems that Harold had 3 friends who, so he said, broke their hips and went to hospital never to come back. He was convinced that the same would happen to him. He was terrified of the hospital. That’s why he’d never had his broken hip ‘seen to’. Goodness knows how he was managing to get about. I’m sure there’s no way he could walk on it. In the end we convinced him to go down for a check-up. He obviously hadn’t had a decent meal in a long time and his hip really did need looking at, though I’m not sure what the orthopods will be able to do for him after so long.
Before they set off, Harold asked me to go back and get his jacket for him. Inside the home the woman was still staring at the TV. The fag had gone. Instead she was polishing off that bottle of vodka. “Gonna miss Harold then?”