Diagnosis? N.F.I.

Walking into Walls


Walk this way sir.

I was passed an ECP call the other day to visit a 50 year old gentleman with pain behind his eyes and dizziness when standing. What on earth did they think I was going to do? I don’t carry any magic pills for that sort of thing. Besides, it was a weekday and just before lunch, so the GP surgery would be open and there was still time to book a home visit for that day. Bear in mind as well that this was originally a 999 call so we’d already gone through the useless ultra cautious triage provided by AMPDS which had churned out the result that this was neither a life-threatening call (the usual response) nor even an urgent one. In fact AMPDS had given this a ‘C’ rating and the call had been passed to the ‘C’ category desk – a relatively new set-up along the lines of NHS re-Direct – where all the crap inappropriate 999 calls we receive are sent. The paramedic on the desk had phoned the caller back and had had a good old question and answer session to try and determine what was wrong. This normally results in offering self-care advice or telling the patient to contact their GP. Today, however, they’d decided that I needed to go round. WTF?

When we used to have OOH calls as well as all the 999 stuff these ‘odd’ visits were quite common but at least the triaging doctor in the control room was usually good enough to speak to us lowly plebs and explain his or her reasoning. Invariably it was along the lines of “haven’t the foggiest what’s wrong with this patient but its the middle of the night so would you mind popping round, doing a quick assessment and then phoning back so we can sort it out together.” Teamwork, that’s what it was all about. I was the doctor’s eyes and ears on the ground and in return I would probably pick up a tip or two to file away for future calls. With the ‘C’ cat desk there’s none of that. They haven’t got a clue either and seem to be under some kind of misapprehension that ECPs are miracle workers.

Anyway, I eventually pitched up at the address about 2 1/2 hours after the patient first dialled 999. Oh, and why did they dial 999 in the first place? Because they’d already spoken to the GP, explained the symptoms and the GP had advised an ambulance response and a trip up to the hospital – of course Control and AMPDS know better!

“How can I help?”
“I’m having trouble walking.”
“In what way?”
“Well every time I try and go through a door I end up crashing into the wall.”
“Is it like your body/eye co-ordination has gone?”
“Yeah, that’s it.”
“And does it always affect the same side?”
“Yes, the right. I always seem to end up veering to the right.”
“Is there anything unusual about the right side of your body?”
“Its all numb. I can’t really feel it properly.”
“When did all this come on?
“Only since I woke up this morning. I was fine yesterday.”
“And have you got a headache?”
“Oh yes, right behind my eyes.”

Ok, now you don’t need to be Sherlock Holmes to surmise from this little exchange that something neurological is going on; possibly a CVA (stroke) or a TIA (mini stroke). Either way this guy needs to be seen at the hospital. I’m guessing that’s what the GP thought too. Yet the pile-of-shit wonderful piece of software that is AMPDS didn’t think so. Nor did the paramedic doing the telephone triage on the ‘C’ cat desk.

I figured we’d already let this patient down enough so I rang up to see if we had an ambulance available. Silly me, what was I thinking. Of course not. Nearest vehicle was about 30 miles away whilst the DGH is only over the road from the ambulance station and I was due to head back for my break after this. So, with the aid of the patient’s two sons, I guided him through the doors of the house and got him into my response car. I had him up to A&E in about 15 minutes.

I stopped by the department again towards the end of the shift to see how he was getting on.

He was up on the stroke unit.

Another AMPDS success!


Picture by Banksy