*Oh well in for a penny in for a pound. No holds barred since I've decided to continue! I will go with the post I was planning before The Times crapped on blogger's.*
We pull into the small village between The Concrete Jungle and Jacketsville blue lights flaring and sirens wailing.
The job on the screen states a GP has requested an emergency response for a toddler with severe asthma.
As we pull into the street where the surgery sits, squat between a small food shop and a hairdressers, I see a lady stood in the doorway holding a small child. A man also stands by them and then lifts his hand to wave at us.
I jump out of the attendant seat and move to the back of the vehicle.
"Hello. Are you expecting us?" I manage a light cheeriness that disguises the thoughts bubbling up in my head. I hope its not what I think.
One look at the child tells me otherwise.
I get the mum and the patient on board, Dad informs us he'll meet us there, I settled them in a comfortable position. It might not have been the safest for travel but our very ill patient would not let go of her mum so it was the only option.
I hear a story of a child with asthma getting progressively worse over the last 24 hours.
I hear a history of hospitalisation for severe bronchiolitis 3 months previous to this.
I hear of a mother who requested an emergency appointment early this morning and was told she had to wait 3 hours to see a locum.
I hear a story of a GP hearing this history and calling an ambulance.
The GP then wrote a letter and sent the mother and child to stand outside and wait for us.
As I'm hearing all this I assess the young girl
She is white as a sheet, breathing at well over 45 breaths per minute, using every single muscle her little body can recruit to keep her chest moving, she is tired and doesn't fight when I place a mask over her face to give her the vital medicine she needs. Her chest pushes and rattles with wheezes every time she tries to force air out of her narrowed airways. At the top of her lungs is the tell tale sound of asthma. The bottom of the lungs is so faint I'm not even sure I can hear air being moved. Although I count her heart rate from the sounds, its working just as hard as her lungs.
"What happened with the bad episode 3 months ago?" "We came in and before the Doctor asked anything she put her on a nebuliser as soon she saw she was bad. Then she called an ambulance then asked us questions" "Was it the same doctor today?" "No" "And the surgery have a nebuliser?" "Yes"
A deep breath and I swallow down the urge to march back into the surgery and demand a word with the GP.
The one, very big, thing stopping me is the fact that my patient is very, very sick.
She is rapidly heading toward giving up on the very important job of breathing.
I call into The Holy Hospital. Its not a paediatric unit but its the closest hospital.
On the way I constantly monitor the young girl, writing various observations on my hand. I'm too engrossed in this task to think about picking up the computer to write the report. That can wait until my full attention isn't needed else where.
I explain to the mother why we're moving into hospital on blue lights and that there will be a team waiting for us at the hospital.
Her respiration's are not improving but her colour is, the pallor is moving into an unwell shade of pale.
"If she ever gets this bad again just dial 999. If she's unwell and you can't get to your doctor for a few hours and you know this can happen then please just call us". Mum nods as this taken on board.
We pull into the hospital and the doors are opened by the ever ready porters we see everyday going about their business. I ask Mum to carry the patient in while I follow with the oxygen and the information for the doctors.
Its the nice Irish consultant with an A&E registrar in tow that meet us.
He listens to my handover, asking for a second to sound the child's chest before letting me resume the history of this episode and others.
I go through the motions of reciting what I have done, Oxygen, Salbutamol, Atrovent, counting, watching, asking, caring.
I leave the resus room with the patient beginning to look better. Better colour, better respirations.
I leave the room knowing I did everything within my remit for the child. But I can't feel good about the job, I can't feel good about the fact that I did all I could.
Because I know others didn't. When they should have.