We enter the small bedroom and the patient is perched on the edge of the bed.
"Hi, I'm Louise, whats your name?" "Steve*" "Hi Steve, whats been happening today?" "Well I was out walking the dog about half an hour ago and I got a really bad pain in my chest. I came back and thought it would go away. But then I was sick and I can't seem to stop sweating. It's pretty much gone now but still there a wee bit"
We hook Steve up to get reading of his oxygen saturation, pulse, blood pressure and ECG. He doesn't appear to be having any trouble breathing and his SAT's look good but we give him some oxygen anyway.
I try to get some history from Steve* about his health and this current episode. It becomes apparent he had a similar episode a week before but it went away after a few minutes so he decided not to bother his doctor with it (Are men allergic to the doctors????!).
The pain he got today felt like someone had suddenly sat on his chest, it had eased off almost instantly but was still hanging around and moving into his jaw and left arm as a "Kinda tingling feeling"
His basic ECG looks spot on but I'm not happy, too many of these symptoms are ringing alarm bells. He has no history of any cardiac conditions but he's over 50 and carrying a wee bit too much weight so anything is possible.
"Right, have you ever been told you shouldn't take Aspirin? Any stomach ulcers? Are you on Warferin or any blood thinners? No? Ok, well here's an Aspirin.................tastes great, chew that for me."
We un-hook our equipment and I send SoItIs* downstairs with everything but the oxygen to grab a chair.
"Right, I have a feeling your going to try and argue with me on this one, so I'll make it clear now I don't do being argued with" A mutual nod and laugh between us as this is made clear in the nicest possible way.
"My colleague has gone to get a chair we will get you out of here, you don't need to do anything" A hand goes up and he shakes his head like he's going to disagree "No, remember what I said about arguing! We have protocols we have to follow and one of those is that we do not allow you to walk out of here. At the moment I can't categorically say it is your heart causing this but that is how we are going to treat it until I have anything to make me think otherwise" "You can't carry me down those stairs! I'm too heavy" "Trust me, I'm a lot stronger than I look! And our chair is designed so I don't technically have to lift you at all. So don't be worrying about me."
A nod shows me he is going to submit, maybe with a few tuts and sighs but he will go along with the girl in the green suit half his age and stronger than she looks
We get him into the ambulance I give him a GTN after checking he can take it without any problems. We do a 12 lead ECG, which again, doesn't show any signs of a heart attack or angina but I still don't like the collection of symptoms that are presenting.
"Am I going to get out of here in a few hours? I really don't want to be stuck in" "Not up to me I'm afraid. As I've said we don't know exactly what is going on and with chest pain like this we will always go with the side of caution. So you may be kept in for tests, I can't predict what the doctor will do I'm afraid"
I get the submitting nod again. He doesn't look happy about the situation but he understands we and the hospital are a necessary evil.
I don't see the point in bull. If I think someone is ill I tell them and their family in the most tactful and appropriate way I can. I try to never commit myself to diagnosis, that isn't our job. We treat what we see in the best and most appropriate way.