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Dying in the rain

Posted Dec 30 2009 10:36am
Day shift: Four calls: Four by car; one by ambulance.

Stats: 2 Abdo pain; 1 ?EP fit; 1 Faint; 1 Cardiac arrest;

A drizzly morning start to the beginning of the end of the year, so to speak and I am asked to go to a million-star hotel to attend a 33 year-old female with abdominal pain. She is an employee and she is just about to start work on her ironing and other associated tasks when she is struck by acute pain, she claims.

I take abdominal pain seriously when it is deserved but I have to say, without running the risk of sounding like a completely uncaring person that this is the second time I have had to take a complete sham of an act into hospital. Abdo pain is one of the easiest complaints to feign – especially when you want a day off work and you are a low-paid employee. As soon as I saw her I could tell the pain wasn’t genuine and the fact that, once again, I am told the problem has existed, completely undiagnosed or treated, for years made me even more suspicious. There are, of course, ailments without aetiology but sooner or later something is done about them, even if it to throw analgesics at them in the hope that they will go away but I know when something just isn’t there – and there was nothing here.

In the car she was fine (until she called her mum – then she cried and wailed). At hospital she was fine, until a nurse approached her after my handover – then she threw herself from the chair, rolled on the floor and screamed in ‘agony’. It was embarrassing to watch and the noise she made brought people out of Resus and other areas to see what the hell was going on. The nurses stood over her and waited for the act to end before taking her to the furthest cubicle away from them. When I took her paperwork in I peeked round the curtain to check she was decently dressed before entering the cubicle. She was quiet and alert. Then I showed myself and dropped the paperwork off – only then did she begin to hobble and moan again.

I’m sorry if you see me as uncaring or unprofessional but I really despise weakness like this. There are plenty of genuinely ill people around and they try to take care of themselves most of the time. When they need medical help, they retain a modicum of dignity and their plight is very real to us.

At a medical walk-in centre a 30 year-old Chef presented himself to the nurse practitioner after suffering a number of what he described as ‘blackouts’. He has a history of epilepsy from his early teens but these events were new and different, as his epilepsy had been well controlled by drugs over the years. But epilepsy can change form over time and its possible that he was entering into a new phase with his condition. It’s also possible that a life-change, such as moving home or the stress of a job, has affected him – he may even need to have his drug reviewed. Whatever it is, he complained of having several more ‘vague phases’ during the trip in the car to A&E.

After a short interval in which nothing happened I was called to an 18 year-old female who’d fainted at a train station. She was 19 weeks pregnant with her second child and had passed out momentarily in the loo. Her hip was hurting as a result of the fall and an exacerbation of a condition known as SPD, which she developed during her first pregnancy and probably had again, if her description of how the hip and pelvis felt were anything to go by. She remained cheery and conscious during the trip to A&E in the car but her large Christmas bag, containing a heavy toy for her relative’s child, burst open and had to receive treatment from me in hospital, involving mainly tape and staples. It was a difficult and emotional job but... someone had to do it.

An 18 year-old female with period pain decided to have an ambulance called on her behalf when she could not cope with the cramping. She and her friends had police officers tending to them, even though a couple of painkillers would have been more effective. She’d taken paracetamol a few minutes before my arrival and had endured the pain all day, so she really hadn’t thought it through properly. Still, I took her to the busy A&E department, where she and her mate sat on a chair waiting. She was smiling and feeling better by the time I delivered her.

There had been a number of cardiac arrest calls during the day and I was tied up with the above jobs instead of running to the ones that were near enough for me to have helped (if they hadn’t turned out to be purple), so it wasn’t surprising that one came my way and I was asked to assist a crew on scene. The 78 year-old man had collapsed in the rainy street and his wife stood by as the team on scene resuscitated him. He was shocked quite a few times and his ECG rhythm changed from VF to a slow PEA and then on to VT. We eventually managed to get him breathing, although he had been trying himself from the start and, with the help of a passing anaesthetist and a medical student, we managed to keep him going until his rhythm changed and stabilised long enough for a pulse to be felt. That happened in the ambulance as we were getting ready to leave.

He arrived at hospital breathing weakly and with a half-decent pulse and BP, so it’s now down to God and fate as to whether he survives in the long term but I think he has a fighting chance.

* I was able to check on this man a few days later and was told that he is still alive in Intensive Care. The medical student deserves thanks for her sterling work on the compressions - they would certainly have contributed to saving this man's life.

Be safe.
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