After all the excitement of Saturday, last night turned out to be (extremely) quiet. Probably just as well really as I hadn't got a lot of sleep during the day and was, by any stretch of the imagination, not at my best. In fact I became quite 'tetchy' with the second patient of the night. Classed as an 'A' category: difficulty in breathing, I surfed my way round in the pouring rain. Sadly, unlike Nee Naw's world, we still give these sorts of calls top, life threatening priority.
The patient was a young gentleman whose throat was swollen. First thought diagnosis?? anaphylactic reaction or something similar. Yet the patient looked fairly comfortable and didn't seem to be in any great distress.
"How long have you been like this?"
"Since the day before yesterday"
"Ah!, immediate reaction then!. Only 36 hours. Obviously life threatening!"
"So, just so I can be clear, has anything changed in the last 10 to 15 minutes that worried you enough to call an ambulance?" trying to be as diplomatic as possible but already deciding this was an LOB job.
"No, not really. My Mum came round and she was a bit concerned."
"That'd explain the extra car in the drive then."
I turned to the lady sitting on the other side of the room. "What are your concerns then and how did you think I might be able to help?"
"I thought it might be life threatening, his throat swelling up an all that. You know, he might stop breathing at any moment."
Deep breath. Count to ten.
She'd heard about anaphylaxis and that it could be a killer. I explained that if it was going to be life threatening it would have happened in the initial few minutes. The gentleman was clearly still able to breathe very comfortably after 36 hours and, if she was still concerned, they could make their own way to A&E. I spun a little yarn about the nearest ambulance being 20 odd miles away (it wasn't) and seeing how the local A&E was only ten minutes drive "would they mind very much?"
Now I know I could have been more diplomatic and a touch more sympathetic but sometimes it just gets to me that relatives get themselves in a right 'two and eight' over something fairly mundane. The gentleman was a touch unwell I'll grant you. Yet his tongue wasn't swollen, no redness at the back of the throat, no abscesses that I could see (thinking quinsy here, Dr Crippen). He felt a touch warm (don't carry thermometers – NHS cutbacks and all that). He could walk. He could talk (a little huskily) and he could breath (very easily). And all this for the last 36 hours with no change. Meanwhile there were two cars parked out on the drive and three drivers in the house (I'm assuming the patient's partner could drive here). Now maybe I'm missing the bleedin' obvious but how does all that warrant a front line emergency response screaming through the driving rain on a Sunday evening?
Perhaps Mum saw the light, perhaps my 'offhand' manner was the key (I can feel a complaint coming on). Anyway they agreed to 'brave the elements' and make their own way. Another triumph for common sense.
My final job of the night was an ECP out of hours call. Sometimes the out of hours world seems a little quirky. I was asked to visit an elderly lady with possible urine retention. "
"What does the 'doc' think I'm going to be able to do about that?" I responded to the dispatcher. "We don't catheterise women."
I know some of my colleagues work miracles but I'm just a humble ambulance man trying to get through the shift. The dispatcher agreed, "let me have a word with the OOH desk and call you back."
"Doc says the woman seems a bit confused so he's not sure whether she has been to the toilet or not. Would you mind going over to see?" Welcome to the wonderful world of an ECP. All that additional training so I can go and ask a patient the same questions that the Doc's already been through on the phone – bit of a change from last night's action.
As it happened I'm glad I went. Lovely family. Husband and son were a real laugh. The lady had a raging UTI (urinary tract infection) and I carry medication for that. So all in all it was a worthwhile visit and saved her being carted off to hospital for possible urine retention that she didn't have. She remained at home, a happy bunny, and I left her watching the golf on TV – bless her.