Just finished another fun Saturday night. It had reached 1 a.m. Been a steady shift so far; usual run of medical stuff and minor trauma. Got a call to run on an unconscious female in one of our more ‘smarter’ towns; though it has more than it’s fair share of pubs and wine bars. Patient had collapsed outside a restaurant in the high street, possibly as a result of alcohol. It’s about a 10 mile run from my base.
“No back-up available at present. All ambulances busy on other calls”
“Great. Here we go. Usual Saturday night ‘piss-heads’ turning out of the pubs.”
The local response car was already tied up on another pub brawl in the town. He phoned me while I was en-route to see if I fancied suturing a face wound. He had a young gentleman who’d had a bottle in the face, now had a small gash to his cheek. I explained that I was already on another call and that our protocol doesn’t allow me to do faces and hands so he’d better ‘send him in’ and let the ‘max-fax’ boys (and girls) do their stuff. It was a shame really ’cause suturing jobs don’t come along that often.
“So that guy had had a fun night out then!”
I got to the high street in question. Usual crowds of late night revelers falling all over the street, some pretending to ‘be ill’ as I passed, others just waving away. Makes it very difficult sometimes to identify the ‘real’ patient. Anyway, no sign of my patient or the restaurant in question. I called up on the ‘bat phone’. Surprisingly someone answered. They would “get back to the caller for a better location”. I headed back up the high street to the accompaniment of jeers from all the revelers I’d passed on the way down. The bat phone rang.
“Caller doesn’t know where he is. Thinks he’s near the bus station.”
“Oh good, that’s only about a quarter of a mile away on the other side of town.”
Off I shoot down the high street again. Now twice is having a laugh but three times is really ‘taking the piss’. The revelers had a field day!
I finally found the crowd I was looking for. As I approached they all got up off the pavement, including the ‘unconscious’ patient who staggered over to the car. I could tell she was the one ‘in trouble’. Possibly it was the vomit matted in her hair and dripping off her face that gave it away; or it could have been the shit smeared all over her skirt and spattered down her legs.
“Lovely. Just the sort of girl you want to take home and meet Mum!”
They all tried climbing into the car.
“Whoa. Hold on here. I’m not taking anyone in the car. What’s the problem?”
“She’s dying man. Can’t you see, she dying!”
“No she’s not, she’s just had a bit too much to drink.”
“No she’s dying, you gotta take us to the hospital now!”
There followed a spate of highly charged questions but I managed to discover that, “no she hadn’t fallen over and hit her head”. “No she hadn’t taken any ‘recreational’ drugs”. “Yes she had had a bit too much to drink and now she’d shit herself so she must be dying”. The girl, herself, was quite ‘with it’. She could string a coherent sentence together. She could walk; a bit wobbly mind, but she could still walk. I explained that she didn’t really require an ambulance and that if they were concerned they could get a taxi.
“I just wanna go home.” the girl said.
“No babe, you need to see a doctor, you’re dying.”
“No I don’t. Just piss off, I wanna go home.”
“Why don’t you just take her home,” I helpfully suggested.
“Fuck you man, you’re fucking useless!!”
Then they all launched into a cavalcade of abuse about the state of the ambulance service and that ‘old chestnut’ of how I have to take them ” ‘coz our taxes pay your wages”.
I was reaching for the bat phone, thinking it might be time to request the help of the ‘old bill’ when, luckily, the girl decided she’d had enough and was going home with or without her ‘mates’. She staggered off up the road and her friends decided to follow her hurling off the occasional passing shot about my birthright and other obscenities.
“Three cheers for alcohol”
Meanwhile, a call had come in for an unconscious male at one of the local pubs nearby. An ambulance was already on its way. When I called up Control gave me the details and off I shot. I’m pleased to say that we all arrived at the same time. The crew weren’t in the happiest of moods though, they’d just done a ‘drowning’.
Seems a middle aged lady had supped a glass of wine too many. Decided to take a bath. Vomited. Choked and aspirated on the vomit and drowned in the bath. Hubby had found her not long after and a couple of ‘first responders’ were carrying out CPR when the crew turned up. They ran it as a working cardiac arrest. They had an output (sort of) at A&E but her pupils were fixed and dilated. Prognosis? Probably brain dead.
Another happy celebration then!
Meanwhile our man was lying on the pavement with a large gentleman of the proverbial ‘brick shit house’ variety kneeling on his arm.
“It’s bad mate. It’s a real bleeder. He’s sliced his arm punching a window.”
“Can we take a look?”
“You sure you want to, it’s a real spurter?”
“Think we better. Just to see what we’re dealing with”.
He removed the bandage he was pressing against the guy’s arm. We only had a short look, that’s all we needed. Enough to see a large hole at the elbow where he’d managed to severe his arm through the joint. Lots of blood, muscle, bone and general mess but it was the fountain of ‘claret’ spurting up that clinched it. We were dealing with something a little nasty here! An arterial bleed!
“Better get him on the back, hang some fluids and go.”
With the aid of all and sundry we unceremoniously dumped him on the trolley. One of my colleagues got ‘a line’ in, the other applied copious large dressings over the wound while I ran up a saline drip. We managed to get about 50 mls in him before he started ‘kicking off’. Arms thrashing everywhere, blood flying, obscenities raining down and then, before we could make the cannula secure, wham, out came the line.
“Shit! Damn! Bugger!”
“We’re never going to get another one in with him like this. Let’s just go!”
The large gentleman stuck his head in the door.
“Thought you guys better know, he’s had a right skin full. Loads of beer, double spirits and he’s snorted about a gram of coke.”
“Brilliant. Wonderful. This just gets better by the minute!”
So, with one colleague trying to staunch the blood flow and me vainly trying to keep one of the patient’s arms still long enough to try and get another line in, we roared off to hospital.
Full trauma team was waiting. All hands to the deck. Lines in. Fluids up. Then off to theatres to see what the surgeons could do to stop the fountain. He’s going to end up with the plastic surgeons eventually – if they can save his arm that is! No pulse at the wrist. No sensation to the hand and fingers. No movement. Sadly it’s his dominant hand too. First task is for the vascular surgeons to stitch up the artery and graft together a couple of veins so they can make a circuit and hopefully restore a blood supply to the arm. Plastics can sort out the nerves. They’ll take months to heal (if they ever do) and he’s a smoker too, so the odds are stacked against him right there. They’ll probably have to complete a skin graft to cover that hulking great hole.
And, to top it all, it’s his birthday today. That’s why he was out celebrating.
“Many happy returns mate!!”