Lack of Festive Spirit

28 December, 2006

Christmas – My Arse!

Well that’s another Christmas over and done with and a pretty dismal one it was too. I’ve worked Christmas every year since I became an ambulance man. It’s no big deal; there’s only me and the cat and he’s not big on Christmas dinner; unless it’s a double helping of Wiskas ‘Oh so fishy’ sardines (and none of that Felix ‘roasted’ range shite, thank you very much). Generally I like working Christmas; there’s usually an atmosphere of festive cheer, the punters are often ‘nicer’ than usual and there’s always lots of nibbles and things around the ambulance station and in A&E. If I’m really lucky I might get a Christmas kiss from my favourite nurses.

This year though there seemed to be a distinct lack of seasonal goodwill. The run up to Christmas was the usual round of ‘granny dumping’. For those not familiar with this concept, this is an arcane ritual seen prior to most bank holidays in the UK whereby relatives decide that granny/granddad, who’s had a chronic illness for the last umpteen weeks/months, has suddenly taken a ‘turn for the worst’ and needs to be in hospital. What this really means is that they can’t be arsed with the inconvenience of looking after their elderly relatives while they snuffle into their Christmas turkey and overdose on cheap mulled wine. At the same time the hospitals are attempting to send patients home ‘for the holdiays’ to make way for a possible rush. It’s really just a game of NHS musical beds. After the holidays all the new admissions get sent home as they don’t really need to be blocking beds and all the ‘early’ discharges get sent back in as they’re really not able to cope at home (even with the help of grumpy relatives).

Christmas and Boxing Day were filled with gripes of belly ache and assorted odd ailments. Don’t these morons ever realise that ‘over doing it’ is likely to lead to a spot of indigestion/trapped wind/belly ache. It’s amazing how those paracetamol tablets that have coped with their hangovers for the previous 363 days of the year stop being effective and we get calls for “something stronger”. – Bugger off and get a life.

Of all the people I met during my run of nights only 1 family had the courtesy to wish me a Merry Christmas; and what a lovely family they were too. A young foster couple who had agreed to ‘take on’ three young African children only days before. The children spoke absolutely no English but the lady spoke a number of languages and one of them just happened to be the one these children spoke. If I had been asked about the chances of anyone in Scroatsville speaking this language I’d have fallen over laughing. The fact that the lady who did is also a foster parent makes it all the more remarkable. And she was so, so lovely. She is one of those people who just exude love, understanding and comfort; with a mischievous glint in her eye and a smile to lighten up the darkest of rooms. She was wonderful. The couple knew next to nothing about the children. It appears they’d been ‘dumped’ in the UK by child traffickers and they needed homing over Christmas until Social Services could sort out something more permanent.

After a lot of translation, questioning, some prodding and poking on my part and a few tests, nothing conclusive was found. We dismissed all the obvious causes and all agreed, at least I hope the child did, that she would remain ‘at home’ and try some of the paracetamol they had available. If things got worse the lady was happy to run her up to A&E. The couple wished me a Merry Christmas and even offered some of their Christmas dinner. They really were a joy to be with over an otherwise pretty morose Christmas.

Now we can look forward to the joys of all the pissheads on New Year’s Eve.

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Primal Scream

27 December, 2006

The only thing we have to fear is fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.

Franklin D. Roosevelt, First Inaugural Address, Mar. 4, 1933
32nd president of US (1882 – 1945)

All of a sudden a fracas erupted. Police officers in their black uniforms emerged, seemlingly from nowhere, and wrestled the young man to the ground. One got swiped round the head, the side of his face covered in blood; not his though, it transpired, but that of the subdued man; he’d slit his wrist and much of the blood had ended up down the officer’s face. One of my colleagues set to securing a dressing around the offending wrist, possibly the only part of the man’s body not pinned to the floor by a sea of black stab vests.

This was A&E in the early hours of Boxing Day morning. The place was heaving. All cubicles full; bodies draped over trolleys in the corridor; bored relatives littered about on chairs. The tinsel and decorations made a rather incongruous background while a radio played quietly to itself from one of the cubicles full of untouched Christmas cheer.

I had no idea what had happened. It must have been something extraordinary; numerous police officers, a sergeant, an inspector and even a police photographer. When I returned to the department a couple of hours later things were a little calmer. The young man was now in a side room which had been stripped of all necessities with just a plastic mattress on the floor. Two police officers sat outside, trying to while away the time and looking like they wished they were anywhere but here. The department was still as busy as ever but there was an air of resigned waiting; to see a doctor; for blood tests; for admittance; for a taxi home – waiting – for something.

Aaaaaaaarrrrrrrrrgggggggghhhhhhh!!!!!!!!!!!!

A primal scream like nothing I’d ever heard before. It came from the cubicle where the young man had been lying, apparently asleep, only moments before. Instead, he was now at the cubicle door; fists clenched; biceps and shoulders bulging with muscular rage; neck veins distended; teeth barred; and screaming – primal, atavistic, full of aggression and terror – but it was his eyes that held my attention. One can only imagine what horrors he saw before him. This was a man in fear; the terror of a primate backed into a corner who knows that he must kill or be killed. His eyes flashed aggression; a last ditched attempt to terrify whatever horror bore down on him; and a terror that he would be torn apart if he didn’t fight back; of knowing that these may be his final moments. And that scream – something to terrorise an opponent and of someone terrified almost to death.

Without pause the two officers launched themselves at him. In the blink of an eye they tackled him back onto the mattress while he continued to battle with whatever nightmare stalked his mind. It was all over in a matter of seconds. As the dust settled an older gentleman slinked out of the room. He looked ashen, dazed, puzzled, confused, bewildered. No one paid him any attention. I couldn’t be sure but I wondered whether this was the young man’s father; helpless to comfort the son he loved.

I finished my business in the department and trotted round to see what ‘the latest’ was. Surprisingly the young chap was now standing up having a calm conversation with the officers, no hint of his earlier aggression. Nearby a doctor, who I took to be a psychiatrist, was arguing his corner as to why the guy shouldn’t be admitted to the psychiatric unit. The A&E charge nurse and the doctors seemed exasperated – where else was he supposed to go?

The young man was gone when I returned later. I never learned what it was all about but I only hope he’s getting the help he needs. I wonder what ‘set him off’ – wouldn’t be anything to do with the new moon would it?

 

Picture by Jaksa Vuckovic.


Merry Christmas

25 December, 2006

Trying to be a bit festive this year.

Merry Christmas everyone.

I hope you all have a wonderful time and over-indulge: but not too much.

If you do happen to “overdo it” please don’t call an ambulance; like the lady last night who had me travel 15 miles for an ‘A’ category chest pain only to discover that she’d got well and truly stuck into Mum’s Sunday roast and now had trapped wind: 4 explosive burps and a few farts later and all was well. – another life threatening AMPDS success.

P.S. For anyone on the front line, like me, who’s working over the next couple of days (I’m on nights – again) don’t forget that under Agenda for Chance we’re now on flat money for working bank holidays. Meanwhile, that under 12 tech, who’s managed to scrounge an overtime shift, will be on double-bubble and will no doubt be earning far more than us. – Merry Christmas commissar Hewitt.


Nequissimum Et Periurum Caput

22 December, 2006

One of our new ECPs – a pompous, arrogant buffoon

The following was related to me by one of my EMT colleagues recently.

Cast of characters:
ECP: a former senior manager who’s been shunted sideways so many times that he should have got the hint by now, but has failed to do the honourable thing. Recently qualified as an ECP he’s been back on the road about 2 months but has probably spent most of that time hiding in an office pretending to be someone important.

EMT: My colleague, a very capable EMT of 2 years standing.

Manager: A current senior manager with the service who’s A&E qualification is as an EMT.

The Scene: A small(ish) room, within which lies a large, elderly male; unconscious and sprawled awkwardly across the floor.

The EMT arrived first on the RRV (rapid response vehicle) closely backed up by the ECP and the manager. Having identified that the patient was in cardiac arrest it became imperative that they move him into a position that would enable them to commence CPR. The ECP was positioned at the patient’s head with the EMT at his hips. The EMT moved the patient’s arm ready for the ECP to assist with lifting the patient. As he lifted the arm it was apparent that the patient was lying in a large pool of his own faeces and urine and his upper body was drenched.

ECP: “I’m not lifting him in that state. I’m an ECP now, this is a tech’s job. You come here and lift him.”
EMT: “Give over (I think the original was f**k off). You’re there so get on and lift.”
ECP: “You can’t talk to me like that, I’m an ECP.”
EMT: “Well I just have so get on and lift.”
ECP: (turning to the manager) “You’re only a tech, you come here and lift him.”
Man: “Just get on with lifting and stop moaning.”

Sadly, this is the sort of arrogant nonsense that staff are experiencing from ECPs all over the county. One station in particular has a whole host of these ‘superstars‘ who are superior to the rest of us. You know the ones: they wear their underpants on the outside of their trousers and have a big ‘S’ on their shirts.

++++++++++

Nequissimum et periurum caput: roughly translates as ‘Utter dregs and dross of a man’ according to “How to Insult, Abuse & Insinuate in Classical Latin” by Michelle Lovric & Nikiforos Doxiadis Mardas.


‘A’ (cat) Sore Throat

21 December, 2006

Open wide.

Another ‘A’ category call for ‘extreme difficulty breathing’.

The small lounge I was directed to was full of people. Grandad had pride of place at the end of the settee nearest the fire, with various grown up children and assorted in-laws scattered around. All of them looked well. No one appeared to be having the remotest difficulty in breathing.

“Hello, who’ve I come to see then?”
“It’s me.” replied grandad.
“What seems to be the problem?”
“He’s not breathing properly,” pipped up one of the female adults.
“He’s only just come out of hospital,” said another.
I knelt down by granddad. “Can you tell me what happened?”
“I had one of those allergic reaction things last week.”
“He had to go to hospital,” butted in someone.
“I had tubes and stuff in my arm.”
“And he was in for 4 days, and came out this morning.” Miss interruption again.
“So what is the problem today?”
“It hurts when I breathe.”
“In what way does it hurt?”
“My throat’s sore.”
“Are you having any problems actually breathing in and out?”
“No, it just hurts my throat.”
OK, so this chap has been hospitalised following an episode of anaphylaxis, I wonder…
“When you were in hospital did they keep you on ITU, the intensive care unit?”
“Yes”
“And did they put a tube down your throat to help you breathe?”
“Yes, that’s right.”
“And did they not tell you that you were likely to have a sore throat for a while?”
“Can’t remember.”
“Well best thing for you young man is some ice-cream to help ease that throat.”

A nice easy job. Everyone happy. Lots of thanks and some apologies from the lady that dialed 999.

Well done to AMPDS for another success in identifying a sore throat as ‘extreme difficulty in breathing’.


Ottawa Rules – OK!

13 December, 2006

For a larger view click here.

My chest feels like I’ve contract some kind of insidious respiratory disease. I blame it on Kevin, or to be more precise on his friend, the one that rents the flat where Kevin was staying. We’ve all been there; a studio type flat; kitchen filthy with piles of week old washing-up all over the counters and muck everywhere. The main room had a shabby mattress in the corner, grey in colour and probably spawning mushrooms. There were the leftovers from the last few nights’ takeaways littered across the coffee table, the sofa and the floor. Every ashtray was full to overflowing and there were copious fag ends and ash ground into what remained of the carpet. It was, as we say, a place where you wipe your feet on the way out. Of course there was the obligatory large screen TV and wires littered over the floor attached to the PlayStation, XBox or whatever else they had to play the hundreds of DVD and games piled around the walls.

I found it almost impossible to talk to Kevin. It wasn’t just the five flights of stairs I’d just climbed but the air was thick with stale cigarette and wacky-backy smoke mixed in with a rancid miasma of chip fat and oily takeaways. It made me gag and my chest still feels full of noxious substances.

Kevin was complaining that he’d hurt his ankle, having tripped up a step the previous evening after a drunken night out. Now he reckoned he couldn’t move it or walk on it and that it “hurts like hell.”

“How did you manage to climb all the stairs?”
“We carried him up.” grunted one of the two rather large gorillas skulking around the room.
“Do you feel like carrying him back down again?” I quipped. A suitable grin in place.
The sarcasm was lost on these two; both a sandwich or two short of a full picnic. By the look of them I decided not to trust my luck with any other fancy ideas.

I got Kevin to pop both legs up on the sofa so I could have a better look; not easy as the only light was a dim old bulb in the centre of the ceiling. All the windows where blocked up with ancient sheets and blankets stapled/nailed/blu-tacked up at the windows. I struggled to avoid vomiting and examined his legs: Look, Move, Feel. No swelling / deformity / bruising / redness or anything else of note. I asked him to move his foot – no chance. Every attempt was greeted with groans and cries. I gave his ankle a rather cursory prod. He practically hit the ceiling when I palpated his lateral malleolus. Was he just being a complete wuss or was this genuine?

On the ECP course you get taught about ‘Ottawa rules’ for knees and ankles. Without boring everyone with the history behind this, suffice to say that, for ankles at least, if any of the following are positive then the patient should be referred for an X-ray.

X-rays are only required if there is any pain in the malleolar or midfoot area, and any one of the following:

* Bone tenderness along the distal 6cm of the posterior edge of the tibia or tip of the medial malleolus
* Bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of the lateral malleolus
* Bone tenderness at the base of the fifth metatarsal (for foot injuries).
* Bone tenderness at the navicular bone (for foot injuries).

* An inability to bear weight both immediately and in the emergency department for four steps.

Barely able to stomach the choking atmosphere I headed for the front door and ordered an ambulance. Kevin had come up ‘Ottawa positive’ as far as I was concerned and he could go in. I wasn’t prepared to go back inside for a more comprehensive examination, they could do that down at A&E. I still wasn’t totally convinced that Kevin had fractured his ankle so I apologised to the crew when they turned up as this could have turned out to be a complete waste of time. To keep them sweet I carried one end of the chair on the way down.

Later in the afternoon I had occasion to pitch up at A&E with another patient so, afterwards, I wandered around to minors to see what had become of Kevin.
“We sent him home.”
“So there was nothing wrong with his ankle then?”
“Oh yes, he’d broken his ankle all right but he was being a real cry-baby until his mother turned up to collect him.”

So I guess those guidelines do work then. Ottawa Rules – OK!


Angry Dunce

12 December, 2006

Magwitch arrives for the day shift

I may have got out of the wrong side of the bed this morning, or perhaps it was just the result of a busy party weekend. Either way every job today seemed to be a “load of crap”. How do I define a crap job? Well, anything I’m not in the mood for probably sums it up. Today, most of the calls seemed to be for “patient unwell”. Now what the heck is that supposed to mean? Can’t the patient be a little more specific? Got a headache, chest pain, trouble breathing, foot fallen off, stake through the heart? I had a rather alcoholic weekend and by yesterday I was feeling, erm… ah… unwell. Last week I had a couple of days with a dodgy tummy and felt – unwell. And when I have a migraine a feel, just a touch, unwell. I know I’m “under the weather” and deal with it accordingly. What I don’t do is dial 999 for an emergency ambulance.

It was in this frame of mind that I drove round to see Mrs Sourberry; she was feeling unwell. She looked fine; well perfused, sparkling eyes, clear tongue. She just seemed to be feigning illness for a bit of attention.
“Can you explain what unwell means to you?”
“Aaahhh, I just feel rotten,”
she panted.
“Can you be a bit more specific? Have you got a
[insert anything you can think of] ?”
“No.”

Mrs Sourberry’s been like this for a week now. She’s seen her GP, saying it was her chronic back pain “playing up again” -he gave her some diclofenac to help out. Three days ago she pitched up at A&E because she felt ‘unwell’; back pain still much in evidence and some vomiting to boot. They ran tests and excluded a triple-A and pancreatitis, amongst other things, apparently. They took bloods but found nothing of note. They sent her home with instructions to carry on with the diclofenac and her existing analgesia.

“Is your back pain better today”
“Yes it’s a bit better”.
“Are you still vomiting?”
“All the time”
pipped up Mr Sourberry junior – though in all the time I was at the house she didn’t so much as retch.
“And she can’t walk.” he continued.
We covered the usual scenarios of getting to the toilet, climbing the stairs etc. Yes, as expected, she can walk but just feels weak.
“Could it be the tablets?
‘It’s possible but I don’t know.”
“Could it be a reaction to the back pain?’
“Might be but I don’t know.”
“Could it be…
[a hundred and one other ideas he had come up with]” All of which I had to honestly reply that “I don’t know.”
“Not very helpful are you!”
My initial inclination at this point was to shake him very warmly by the throat or see what a mess his head would make if it came into collision with a brick wall. I was, of course, as professional as usual, and explained that “I am only a paramedic and not a doctor and that I’m unable to answer any of the questions posed”.
He apologised.

ECP 1 – Annoying relative 0

After chatting to the patient’s GP and the med reg at the assessment unit, I arranged for her to go in. Maybe it was just my mood but I’m sure the GP gave the impression that this was one of his ‘awkward’ patients.

Back on station my colleagues said I seemed a touch aggressive today. OK, so I gave the weatherman on the TV a piece of my mind and told him to “piss off with your cold weather and more rain.” Later, the channel ran a trailer for a programe about a woman who knows she’s fat, had just been told she was clinically obese, but “that was ok because its a lifestyle choice and makes me feel sexy”. Wrong! You’re a fat bitch who’s going to suffer from hypertension, cardiac problems, diabetes and all sorts of other life threatening diseases and, in a few years, some ambulance staff are going to have to break their backs humping your bloated carcass down the stairs while your fat, lethargic children look on while munching a large bag of crisps.
Ok, ok, I know, I’m fattist.

I bumped into the crew that conveyed Mrs Sourberry later in the shift. They did the handover to the MAU sister based on the notes I’d written in my clinical report. Now, I make a point of running through the notes I make with the patient, to see if there are any errors or omissions. I did this with Mrs Sourberry and she was in agreement with my history. At the hosptial, while my colleague was handing over, she apparently kept saying “no that’s not it. It’s not like that at all.”

Arrgghh. Bitch!
Yes doctor, I’ll double my medication immediately and wear my straight jacket tomorrow.”

Picture from Monkeys with Hats