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First Impressions

Posted Sep 21 2009 12:00am
The call? 25 years old. Male. Chest Pain.
Go on, fellow medics. Admit it. Doesn't fill you with the joys of spring, does it? Didn't do much for my need for an adrenaline rush either. It's the sort of call that immediately throws up images of drunk and incapables. Or Man Flu. Or a bad takeaway dinner. Or something equally as life-threatening.
We weren't met by the frantic windmill that's the traditional signal either for a very poorly patient or for mass unnecessary panic. Good.
We weren't met by the patient lying in the middle of the street. Very good.
We were met by an open door, a filthy house, and a mixed aroma of alcohol and vomit. Bad.
However, so far, so predictable.
The front door opened straight to a flight of stairs, so nowhere to go but up. As we're climbing the stairs there's a call of "We're up here!". I roll my eyes and wonder to myself where else there is to go. Somewhere sunny, warm, and far removed from self-indulgent, self-harming drunks would be nice.
I'm a bit of a one for first impressions. I make instant, snap judgements on people as soon as I meet them. I try very hard at work not to make these sorts of decisions just by reading the call on the screen, but at times it's a little difficult. And I admit, this time I'd already made my mind up, and it wasn't particularly complimentary. Normally it takes a very long time to convince me of the error of my first impression. In fact, it almost never happens. I'm just too stubborn. Tom, for his part, was going to do everything to prove me wrong.
As soon as I'd set foot in the room, I could see that I was wrong. Tom was indeed about 25. And in pain. Not chest pain, but pain nonetheless. And he looked ill. Very ill. His pulse was well over 100 and climbing. His blood pressure was in his boots. His temperature sky high. His abdomen was very tender and he'd been vomiting, or at least trying to, for days. His partner told us his story.
The cause? A rotten tooth. Antibiotics for an abscess had failed to work. Painkillers had failed to do their duty. The doctor had told him to wait until he felt a little better and then go to the dentist, a thought that would have filled me with dread. And probably make me turn to drink, too.
The thing is, he wasn't feeling any better. He was feeling worse. He was short of breath. He could hardly talk. He couldn't eat. But he could drink. So in an attempt to numb the pain, he drank. And drank. And vomited. And drank. And vomited. And drank. Tom had been drinking constantly for nearly a week, and now his body was finally giving up.
It could be his liver, his kidneys, his pancreas, his bowels. Anything or everything in that region. They could be inflamed, they could be ruptured, they could be failing. Whatever it was, it was possibly killing him. When I put the priority call into the hospital, I didn't really know what to tell them. Not having a mobile CT scanner made it a little difficult. I think that I said something along the lines of "acutely unwell" and just reeled off a set of observations. Hopefully they would give the staff a clue. Once there, they continued our treatment of oxygen and fluids, gave him some IV antibiotics and rapidly handed him over to the surgeons.
The last I heard, Tom was still teaching me a lesson about first impressions. From his bed in the Intensive Care Unit.
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