Monday 31 March 2014

A Heavy Heart

"31 year old male, chest pain"

I really am bored with chest pain. Historically people ignored it, and as such, people having heart attacks didn't get treatment and subsequently died. Cue the huge, expensive campaign to raise awareness about chest pain. It was hugely successfully and cardiac care in this country is now one of the best in the world. However, the increased awareness about chest pain has inevitably led to chest pain being overused as a symptom. It seems that any pain, anywhere on the torso and for any length of time must be a heart attack, and as such, the amount of people who claim to have just pain when calling an ambulance is huge! Some use it to get a quick ambulance because they know we will come immediately. Some, just can't cope with any pain, anywhere and assume they are dying. 

I would say that as high as 9 out of 10 chest pains that we go to are not genuine chest pains, which is quite remarkable. We go to them every single shift in some form or another, and very rarely is it a heart attack. As a rule of thumb, I find that chest pain in the under 40's is not genuine chest pain. More often than not it is a panic attack, chest pain caused by prolonged coughing, a stitch or any other common day illness which most normal people treat at home. However, 999 seems to be the first port of call! Obviously, there are exceptions to the rule and we wouldn't want to put people off calling if they are having a heart attack, however, what I can assure you of, is sharp chest pain that is only there each time you cough, is not a heart attack.

It was middle of the day and my shift was ticking away nicely when I got sent a job. I shook my head about a 31 year old calling with chest pain and headed off. There is nothing that can be done about filtering these calls. It is very black and white. 'Do you have chest pain?' 'Yes'. They get an ambulance. Find a solution which removes risk and you'd save all ambulance services millions of pounds!

Waiting at the door with almost a proud grin was the patient. I grabbed my bags, trying my best to avoid eye contact for as long as possible, as I'd seen his beckoning eyebrows dancing round all over the shop! Keep them still man! I eventually got to the door and headed in.

"Right sir, what's the problem today?"

"I have pain in my heart."

"Point with one finger where the pain is"

*points to right side of chest*

"Your heart isn't there."

"You sure?"

"Pretty sure."

"Oh, how odd, is that my stomach then?"


Welcome to my world! Needless to say, he was left at home with advice and 2 Paracetomol! Another life saved!

Wednesday 26 March 2014

Utter MADness!

Well, about a month ago a asked you all to nominate me for the MAD Blog Awards 2014! I was a finalist last year which was humbling to say the least, but this year things haven't run as smoothly! For various reasons I haven't been able to blog with the regularity I was last year, so when nominations opened I was asked out of hope more than anything! Since I posted my plea to the masses I didn't think about it again until the finalists were revealed!

In a severe case of Deja Vu, in a carbon copy of last year, I was working a late shift when I got a text message from @BigFashionista saying 'You're a finalist!'. I couldn't believe it! It really was shock! I am a finalist in the Best Writer category and Blog of the Year! I'm still completely speechless about the whole thing, but very much looking forward to it! I met some amazing people last year and can't wait to see everyone again! 

Now, as much as this post is a HUGE thank you to everyone that nominated me, it is also a war cry of sorts! Now I am a finalist I need your votes! I'm up against some seriously stiff competition so PLEASE PLEASE PLEASE take 30 seconds out of your day to vote for me!

Voting can be done on the MAD Blog Awards 2014 website! Select 'Trying My Patients' from the Best Writer category and that's it! 

Thank you all again for your continued support! It really is appreciated! 

Ella x

Friday 21 March 2014

A Spot Of Bother

It was a rather quiet morning on the car! I'd taken the temporary lull in jobs as an opportunity for coffee with a fellow FRU! It's nice when you get some company on the car as it can me quite a lonely place at time. It's been described as prolonged periods of boredom, occasionally interrupted by moments of sheer terror. I think that is pretty accurate! 

"New Road @ Station Road"

Not two sips into my coffee, a job! A road name @ another road name, usually means an RTC. It could be someone just outside by more often than not it's an RTC. I had no other details yet so just started heading in the right direction. One of the problem with the FRU is when you're driving on blue lights it is very difficult to see any updates that appear on the screen. A buzzer goes of and the message appears in red when the call taker gets more information. The next update was the determinant, which is the main problem, i.e.; Breathing problems, Chest pain, Stroke, RTC etc.

"New Road @ Station Road, Stabbing / Shooting"

Really?! On a tuesday-bloody-morning! Come on! I upped my pace slightly, because despite my shock and horror at a stabbing or a shooting so early in the day, I bloody love stabbing and shootings! I'm not weird, most of us love a juicy trauma really! I started making mental plans of what I might see, what I might need etc. 

"New Road @ Station Road, 17 year old male, impaled on metal fence, report on arrival"

IMPALED?! How did he manage to get impaled?! What is he impaled on?! What is he impaled through?! No time to come up with a plan though, I was arriving on scene!

There was a small crowd beneath the patient, supporting him up in the air. All the heads turned to face me as I got out of the car. That look of expectation mixed with panic on all of their faces! 

*cue emergency face*

They were looking at me as the 'specialist in impaled human removal'. Sadly for them I was far from it! I'd never done an impaling so I was about as experienced as all of them! The patient was panicking atop of his spiked metal fence and to be fair, I would be to! The spikes were about 8-10 inches long and by the look of things he was impaled on two of them, through his inner-thigh. It was hard to tell because he was 8ft in the air! 

His panicking was getting worse. I wanted him to stay still, and wanted everyone to continue helping to support his weight. It really was a logistical nightmare! I radioed into control and requested Fire, Police and HEMS. Fire to chop the fence and bring some ladders, Police to block the road, and HEMS to.....well, just do what HEMS do best! Unfortunately, hearing me ask for the entire world and his wife, the patient panicked further and despite my shouting at him not to, in one big burst of energy he lifted / prized his body off the spikes and fell into our waiting arms.

"Red base, patient is no longer impaled, cancel fire, update HEMS, patient has an arterial bleed from his femoral artery."

There was blood everywhere. The good samaritans moved back, some freaking out at the blood, others just starring. I put all of my weight onto his groin where there blood was coming from. It took an incredible amount of pressure to stem the bleeding. The problem was I now had no hands! I barked order at people to get me things from my car, to press the talk button on my radio so I could get an ETA for my ambulance and to use my scissors to cut up his trouser legs. It was organised chaos! 

Within a couple of minutes the ambulance was with me which was a huge relief. I was getting cramps through my arms, they were literally shaking with the amount of pressure being used. A pressure dressing was prepared, as was an extensive wound dressing. In a fluid movement I swapped places with one of the crew and we got the dressing in place. The patient was white as ghost and sweating profusely. He was in hyopvolemic shock and needed surgery very quickly. 

I set about getting lines in his arms. Luckily for me and the patient he was athletic and had HUGE veins which just popped up nicely for me. As I was setting up the fluids the helicopter appeared above us. What a relief! The bed appeared next to use so whilst waiting for the HEMS team to be driven to us by the police (*cough* not just crime fighters!), we got him loaded onto the bed. Based on where they landed we would have to drive him to the chopper and we didn't want to waste any time. His blood pressure was in his boots, his pulse was racing and he was becoming increasingly groggy. To help stem the bleeding we gave him some Tranexamic Acid which aids clotting. 

With HEMS with us they took over. They started giving him units of blood as we all started loading him onto the ambulance. I felt quite satisfied that that was all they could really do. We'd managed to do everything else before they arrived and that is always a good feeling! Within a minute or so we were next to the chopper and transferring him. Having to keep huge amounts of pressure over his femoral artery made moving him slightly awkward but he was quickly on board and taking off. 

His friend had stayed with him until take off and was awfully worried. 

"How did he get impaled in the first place?!" I asked him.

"He dropped a £10 and it blew under the fence, he tried to run up and volt over, but it went wrong he got stuck on a spike."

"All that for £10?! Couldn't he have just gone through the gate down there?!"

"Oh year, didn't see that."

I had to laugh! Even his friend begun to smile, despite being covered in blood. I was covered to! I looked like Carrie! It was a sight to behold! My arms were literally red! It was time for a shower, uniform change, a re-stock, a fair bit of paperwork and my cold coffee! Just another tuesday!

Thursday 20 March 2014

Obesity, Lies, Burgers & Fries

"30 year old male, vomiting, abdo pain, NHS111"

Another shift, another young person referred by NHS111 and my guess, was another young person who has said the right words to ensure NHS111 send an ambulance. I'm convinced it's a generation thing! In general, you have less ambulances for the 45-65 than for the 25-45. Equally, that 25-45 group, generally have less wrong with them and 99% of the time would have been perfectly able to make their own way to hospital without the need for an ambulance. It also seems a generation that is a lot less equipped with dealing with illness and injury. The elderly don't call ambulances even when they are dying because they don't want to waste our time, whereas the younger ones call us if they cough once, sneeze once, have a headache for 5 minutes, vomit once, or have the shits! It's a generation of pathetic whiners who need to get a grip! AND STOP LYING! They ALL bloody lie! Today, was a case in point.....

30 year old males vomiting are not about to die. OK, one, once, probably vomited and then died but as a rule of thumb, they don't die. His partner was waiting at the door for us in her onsie. Some people don't lend themselves to onsies and this was a prime example but I wisely didn't comment. Or point and laugh. We were led upstairs to our waiting patient. 

We were greeted with a sorry, pained expression of pure suffering and angst. Unfortunately, the 1 hour history of vomiting did not warrant the sympathy he was after. I kept my questions and responses to his whimpering at a professional level without indulging in his drama. It really does infuriate me when people won't talk, use their words and attempt full sentences because they feel unwell! They are grown ups, but it is like trying to communicate with a 3 year old who is mid-tantrum!

The patient was a big guy, a very big guy, 25 stone plus. The irony of really fat people only being able to fit into sports wear was not lost me but he had no pride in anything about him. The flat was a tip, I could smell fried food, there were pizza boxes everywhere and a half drunk 2 litre bottle of coke next to him. Clearly, his extensive medical history had had no effect in kick starting a lifestyle change! I could have guessed he had diabetes, high blood pressure and high cholesterol before he offered up the information, I was hardly bold over with shock! 

My questions regarding his symptoms continued and led to food that could have caused this non-life threatening episode of vomiting. 

"What did you have for lunch today?"

"Just a salad."

Yes, I'm judgemental and when I fatter than I am, I started by eating more salads, but I have met a lot of patients and I can spot the ones trying to lose weight and the ones pretending to be trying. This guy was the latter. The who's who of takeaway boxes and fizzy drinks around the place told me everything I needed to know.

"Just a salad?"

"Yeah, well some crisps and that too."

"And that???"

"You know, yogurt, chocolate and stuff."

Before I could ask about the "and stuff" his girlfriend butted in!

"You bloody liar! What else did you have for lunch?"

"Nothing!" he exclaimed.

"OK, what did you have just before lunch?"

"What do you mean?"

"What do I mean? I mean what about those burgers and chips you were shovelling into your face sat in you car round the corner! I bloody saw you! And I bet there were apple pies too, I know you, don't forget that."

"Oh yeah, sorry."

I stepped in before it turned into a slanging match, or before he died of embarrassment! 

"So, lunch was a few burgers and chips, some apple pies, some crisps, chocolate, yogurt, and a salad?"

"Yeah, I suppose."

Some people are so unlucky to get diabetes! I could have had a health promotion field day with this guy but it was pointless. In 5-10 years he will be having limb amputations, be going blind, having heart attacks and strokes. Maybe then he will buck his ideas up. The one thing I advised him today, was not to lie! There is no need for it. We always know when someone is lying, save yourself the time and embarrassment by just answering all our questions truthfully! And eat less, a lot less! Oh, and don't call an ambulance because you're vomiting. And tidy your flat. And have a shave and a wash! Gahhh, I just wanted to kick him up the backside! 

It's so frustrating to watch someone so young just self destruct! I just don't know how these people can get help or even begin to help themselves. It's a sorry state of affairs when dietary advise is harder to come by than junk food! What has to happen for them to realise that this lifestyle is slowly killing them?! I would suggest it's too late for this generation. On the whole it is too fat, too lazy, expects everything for nothing and has a poor work ethic. The money is better invested in the next lot to come through, hopefully then, we will see the benefits in 20 years or so. Until then, I'll just grumble away!

Wednesday 19 March 2014

Fake Smiles

"3 year old female, fallen of swing, cut to head"

We all have things that get under our skin! Chalk on a blackboard & chewing foil etc etc! Everyone has something they hate. Personally, I hate wooden ice cream sticks! Can't touch them! They send shivers down my spine! At work however, as I have discussed many times before, the term 'Ambulance Drivers' really gets my back up, most notably in my post Ambulance Drivers from last year. Police Officers are called Police Officers, not Police Car Drivers, Fireman are called Fireman, not Fire Engine Drivers so we should be no different. It just winds me up! Anyway......

The first sunshine of the year was out, the temperature raised above 12 degrees so understandably, the entire country put on their shorts and rushed to the park. Apparently, our patient had fallen off the swing and cut her head. Because she wasn't 'fully alert' she needed an FRU and an Ambulance. The FRU was already there when we arrived. He headed in past the plethora of cars on the drive way and then followed the sounds of the crying and the panicking. By the way, it wasn't the crying of a child, it was the mother. Combine that, with the father panicking and flapping around and you are left with a very scared child!

"Oh look, more Ambulance Drivers."

*fake smile*

"Hello there."

"Say hello to the nice Ambulance Drivers." he said to his daughter.

*fake smile*

She glared up at us and pouted. She had the smallest of cuts on her forehead, it barely needed a plaster. However, plasters fix a multitude of problems in children, most notably, making the kids feel better!

"Be a good girl and let the nice Ambulance Driver put a plaster on your head."

*fake smile*

She sobbed a little as I put in on the small cut and stopped as I moved my hands away again. 

"There you go, all done!"

"Say thank you to the nice Ambulance Driver."

*fake smile*

"Thank you Ambulance Driver!"

*fake smile*

"You're welcome!"

I gave her a sticker for being so brave. Her face lit up with a smile! We did our paperwork, and as the family didn't want to go to a busy hospital, we left them at home with advice and a GP referral. 

"Say goodbye to the nice Ambulance Drivers!"

*fake smile*

"Bye bye Ambulance Drivers!"

*fake smile*

"Bye bye!"

As we walked down the garden path, my crew mate turned to me and said 'count to 10!'. I got in the truck and exploded in ranting tirade about the phrase Ambulance Drivers! I'll leave what was said to your imagination! 

Sunday 16 March 2014

Reality vs Reality

WARNING: This post contains graphic descriptions and scenarios that some people may find very extremely distressing.

So there I was after an awful day at work, sitting in a local pub, nursing a couple of drinks. It's a good way to unwind after a bad day, offloading to people that really know you. No bravado, no showmanship, just good company with people who care about you. Perfect! Unfortunately, even the nicest pubs attract idiots. And drunk idiots at that! The one tonight was harmless, but latched onto us as his new best friends. It didn't take long for him to find out I was a paramedic, and then that was it. Suddenly I was immersed in tales of the '24 hours in A & E', 'An hour to save your life', and '999:What's Your Emergency?'. Apparently he watched them all and therefor was an expert. He was under the impression that everyone we met, we saved and obviously had no comprehension about death and what death involves. It isn't anything like they show it on Holby City and they can't show the reality of it, even in the fly-on-the-wall documentaries. I didn't want to sit there and set him straight but for those not in the know, this is what I associate with cardiac arrests and death.....

"36 year old female, cardiac arrest, CPR in progress."

My heart sinks, just 36 years old. I really hoped it wasn't as given, but the more information I got, the more I knew I was about to walk into pre-hospital hell. I pulled up with a screech and grabbed everything I could carry. I was first on scene and had no idea how long I'd be on my own. I rushed up the garden path to see a kid, no older than my son, standing at the doorway. 

"Please help my mummy, she's not breathing."

I literally can't deal with that stuff, so I ignore it. Children add a huge amount of emotion to any situation and cardiac arrests, are not a place for emotion. I need to stay calm, get in my zone and focus. It sounds very 'self help' but I do get in a zone and we all do what we have to do to keep our head in the right place. I bounded up the stairs to find our patient lying on the floor, her husband desperately doing CPR under the instruction of a call handler counting out the compressions over the speaker phone. I asked him to carry on whilst I got set up.

There was vomit all over her face and her hair was matted in it. When my hands touched her face, I could feel the vomit on my fingers. I begun ventilating her. With every ventilation, blood squirted out of her nose. I begun to suction the airway. I could tell the husband was beginning to really struggle with what he was seeing, and I didn't want this to be how he remembers his wife. I also can't deal with his emotion either so I sent him off to find someone to take the 3 children who were in the house. Again, the fact they were in the house and the fact that he was crying was something I chose to ignore initially. It's my way of focusing and my way of staying calm. 

I took over CPR as he was leaving the room. A number of ribs cracked, the sound of which made the husband visibly cringe. I could feel my knees in the vomit and blood but it didn't matter. Neither did the blood spray up my forearms. Luckily for me, the second car arrived. I secured the airway with an i-gel and continued to suction the blood and vomit that just kept coming. The other FRU started trying to get IV access. The was no joy on the hands or arms, her veins were so shut down, it was futile. I then tried on the external jugular vein (EJV) on her neck but again, no joy. The only way we could now get access was to drill into her bone.

I continued to manage the airway whilst the drill was set up. Just as she was about to drill into her leg, a child appeared in the doorway. You can try as hard as you want to ignore certain situations but some you simply can't. The little girl was no older than 5. Her mummy was lying on the floor covered in vomit and blood, a tube coming out of her mouth, blood trickling down her arms from failed cannulas  and a paramedic kneeling on the floor holding a drill. We both paused for moment not knowing what to do. 

"Excuse me!" I called out. The husband appeared in the doorway. "Your daughter really won't want to see this."

She was quickly whisked away. The needle was drilled into the bone so at least we could now start giving drugs. Unfortunately, as one problem was solved, another appeared. Despite the constant suctioning, the airway was becoming increasingly unmanageable and full of blood. We decided to remove the airway that was in place and intubate. This was not without risk but on balance seemed the best thing to do. I took over chest commissions whilst my colleague get everything set up. Luckily the ambulance arrived, so with their student we now 5 people to work with. The student took over CPR, I started running drugs through, the other medic assisted with the intubation and the other went about do temperature, blood sugar etc and rotating the CPR duties. 

The longer the CPR went on the worse the chest was looking. After about half an hour the top layer of skin on the breast bone had been pulled away due to the friction of constant compressions. Her chest was covered in blood and stomach contents was seeping out of her peg feed site. She had also become doubly incontinent, which is common in cardiac arrests. 

We did everything we could and did so for over an hour, but to no avail. We called a time of death and all just sat around looking at each other, not really knowing what to say. We all had blood on our hands, arms and clothes. We all had blood, vomit, urine or a combination of the 3 on our trousers. Me and the other FRU had blood on our faces due to the original CPR and ventilations. I cleaned myself up the best I could so I could go and speak to the husband. 

I stood at the top of the stairs and was reluctant to go down. Breaking bad news is not something we are trained to do, even more so in people so young. I had to tell a young man that his wife, the mother of his three children, had died. I had to tell him that everything we had tried, had failed. I didn't know, standing at the top of the stairs if the children were down there. I didn't know if I was going to the person they associate with hearing their mummy is dead. I didn't want to be the person to do any of that, but it had to be done. I started making my way down, and the husband appeared at the bottom of the stairs. 

"Is she dead?"

"I'm so sorry sir, we tried everything we could but I'm afraid she has passed away, I'm so sorry."

With that, he dropped to his knees and wept. I just stood there, choking up myself. I didn't want to turn around and go back upstairs, but also didn't feel comfortable watching him. I put my arm on his shoulder and apologised again. A neighbour appeared in the doorway. It turned out that all the children were in her house. She knew what had happened and took over front me. I couldn't get up the stairs quick enough, it was just awful.

There is often very little dignity in death. This young mother laid dead on the floor between us. She was lying in her own urine, faeces, she was topless, she had friction burns on her chest, she had a needle drilled into her leg, a tube coming out of her month and clamped to her head, she was covered in her own vomit and blood and her grieving husband and children were a floor below her crying and not having a clue how to cope and deal with her sudden death. This is why these things are not on Holby City, this is why fly-on-the-wall documentaries stay outside of jobs like this and only tell you what has happened. It's because no one ever needs to see this stuff. We see it, and are part of it because we have to be. Any other eyes have no place being there, in person or through a TV.  Death is not a soap or entertaining and that is why it is sugar coated for everyone. It may be considered reality TV and but it is as far from reality as can be.

Perhaps if I hadn't just done this job three hours earlier, the man in the pubs enthusiasm for pre-hospital entertainment might not have irked me so much. 

Saturday 1 March 2014

It Happens To The Best Of Us

"23 year old female, ? drink spiked, vomiting"

It was ridiculous-o-clock in the morning and most of the night's revellers were either a) tucked up in bed b) tucked up in a hospital bed or c) lying in a pile of vomit in a park waiting patiently for a good samaritan to call 999. As far as night shifts go, it had been particularly torrid. Alcohol and drugs had been the stars of the show, with the police and the ambulance service run ragged all night long! Some of my highlights of the proceedings included being spat at and threatened by a crack head, having someones dog 'set on me' (the dog couldn't be arsed) and watching a great episode of domino vomiting (one goes, they all go) outside a club. Oh, spending an hour trying to convince a man in only Thundercat boxer shorts, that lying in the road with his hands in his pants wasn't conducive to good public relations and future job prospects was also one for the out-takes reel. 

It was about 04:30, I was resembling a wild banshee and looking rather dishevelled! My hair really was a thing to marvel at! Being sent to a vomiting drunk person with delusions of drink spiking hardly filled me with warmth, I must say. I was wildly confident that the only thing her drink had been spiked with was alcohol. We headed on up to the 'top floor' flat as instructed. We were met half way up my a drunk, scantily clad girl who was walking like a new-born giraffe. Funny it was, graceful it wasn't. We followed her, and the noise of crying / wrenching into a bedroom. 

There, lying sprawled on the bed, wearing a t-shirt a thong was our patient. Her head was hanging over the edge of the bed and she was indeed vomiting. Her makeup had run somewhat and her hair was....well, matted in vomit. She looked a treat! She was also crying. Stood in the corner of the room as a sheepish looking boyfriend, who wasn't drunk and seemed rather annoyed by the whole situation. 

"Hello my dear, good night was it?!"

"Oh my god, I'm so sorry, I can't stop being sick!" she slurred at me.

Between her and her friend they went on to explain that she hadn't drunk any more than she normally would and drunk the same amount as her friends. They just didn't understand why she was so drunk! Must be a spiked drink eh?! Not the lack of food all day and tiredness combined with any number of other things. Oh, and all the Jaegerbombs. And wine. And other spirits. Definitely, without doubt, a spiked drink! Hmmmmm!

Her boyfriend just rolled his eyes! He looked particularly unimpressed by the whole situation. I made a few jokes about the situation and he chuckled. It was then I noticed his shirt. It was white, with flaps on the shoulders for epaulettes and a velcro patch on the chest. 

"Is that a police shirt?!"

"Yep! I'm a cop, I'm on early turn, start at 7am, then get a call from this muppet!"

"Sleep's overrated anyway buddy!"

The patient started wailing / crying again! She was apologising profusely and stating how ill and drunk she was!

"What do you do for a living?!"

A sorry pout and half grin appeared on her face.

"I'm also in the police! I'm so embarrassed!"

I just laughed, and laughed hard! She started laughing, and her boyfriend was now seeing the funny side of it! 

"And what do you do?!" I said to the friend.

"And what do you do OFFICER!" she said bursting out in laughter!

As far as I was concerned, all her sins were forgiven! Sure, it's favouritism and yes, I have bitched and moaned about drunk people calling ambulances because they are drunk and YES, they should have known better. But, the thin blue line is spread so thin and they do such a great job day in, day out that getting smashed on a Friday night was probably just what the doctor ordered. We spend half an hour talking work, sharing war stories and we left her to wallow in self pity for the entire day before she started night shifts! 

Getting drunk and paralytic happens to the best of us at times, even the police. When not in uniform we are all just normal people making the same stupid mistakes as everyone else! I won't hold it against her when our paths cross professionally. I will however, mock her unreservedly!

Don't forget, nominations are now open for the MAD Blog Awards 2014. Please go and nominate me by clicking HERE. Just add my URL to the categories I'm eligible for! (Best Writer & Most Entertaining) Thank you!