Blood, Sweat & Tea, page 15
So, thanks to the folks up in Control around the country for dealing with the obvious hoax calls.
Masking Histories
Sometimes patients can be awkward buggers, all their signs and symptoms point to one illness, and it is only a bit later, with a bit more investigation that you find out what is actually wrong with them.
Today was a case in point, I got called to a 40-year-old male who had been suffering from chest pain for the past 2hours. I turned up and started my examination of him. He had fallen down the stairs the day before, his chest was painful when I pushed on it and he had no symptoms leading me to believe that the problem was anything to do with his heart. I immediately thought that the pain was muscular in nature, rather than a more serious cardiac problem.
The only thing was that his pulse felt 'funny', a strange little 'thrumming' sensation that was a little like a double heartbeat. I thought that if I hooked him up to my cardiac monitor I'd have a better idea what was going on. However, the leads on the monitor weren't working so I would have to wait until the ambulance turned up.
It was a little embarrassing because the patient and his wife were both doctors (probably working in research) Both were happy with their treatment and the ambulance soon turned up. The patient was connected to their monitor and we found out that he was in SVT (supraventricular tachycardia) which is a rhythm problem with the heart, causing it to beat too quickly.
The actual 'chest pain' was probably related to the fall, being either a bruise or a muscle strain, while the patient's real problem was hidden from a cursory examination. It is only because we have the capability to electrically examine the heart that the patient was sped into hospital rather than taken in normally.
I'm wondering if the fall somehow caused the arrhythmia, it's probably not outside the realms of possibility.
Knowing what the patients problem was also meant that the ambulance crew didn't look embarrassed after handing the patient over to the nurses at the hospital.
Tomorrow I have a special learning day - learning how to 'maintain personal safety', how to defuse aggressive situations and how to escape from grapples and the like...
I went to this patient about 9months later. He'd had a sudden cardiac arrest and, despite our best efforts, he died.
Carrots
As promised, the quality of this blog is about to nosedive, as I discuss some of the things I have personally witnessed up a patients rectum.
I've not seen a FBUA (foreign body up arse) while in the ambulance service - I think most people are so embarrassed that they tend to make their own way to hospital rather than risk being laughed at by two hairy armed ambulance people.
The one that sticks most in my mind was the first one I ever came across. I was working in A&E at the time, and I think I'd only been there a year or so, when I saw a load of doctors crouched around an abdominal X-ray.
'You can see it there', said one.
'Don't be daft, but you can see the bowel being pushed out of shape', another said dismissively.
'Of course you can't see it', said another, 'It's organic...'
Being a nosey nurse I asked what they were looking at, and was told that the patient had a carrot up their rectum. Looking closely at the x-ray I could see where the lower part of the bowel was stretched upward by a large amount. There was no sign of the alleged carrot, but then it wouldn't show up in a normal X-ray film anyway, it being as organic as the flesh that X-rays go through unimpeded.
The story I was told was that the patient was a 72-year-old male who had gotten his groceries and was taking a short-cut across the local park when he was 'caught short'. Desperate to open his bowels, he had dropped his trousers and crouched behind a tree to - cough - 'open his bowels'. However, two 15-year-old boys ran up behind him, grabbed a carrot from the bag and inserted it rectally.
The patient didn't want the police involved because he 'didn't want to be any trouble'.
Us professionally trained staff, were of course sympathetic to his plight, and obviously believed every word of his tale.
Who am I kidding... we didn't believe a word of it. The patient went to have the carrot surgically removed and all was well in the world.
Carrots are a popular thing for FBUA - it was a year or two later, when I had become much more cynical, that I came across another 'carrot insertion incident'. The patient was a young male who fully admitted having taken some 'Ecstasy', and had been fooling around with a carrot when it had become stuck.
The patient himself wasn't too bothered because, ever mindful of disease, he had put a condom on the carrot.
So, I think the government is giving our youths the wrong message when it tries to dissuade drug use. Instead of the dangers of overdose, heart attacks and reduced sexual function, they should just show a picture of someone putting a condom wrapped carrot up their arse while thinking it's a good idea.
It's not all carrots, as some people have already mentioned in the comments section, sometimes it can be things that are 'supposed' (sort of) to be used in such ways.
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I was working in Triage in A&E at the time, where my role was to do the initial patient assessment to see how urgently they needed to be seen. A young man and his girlfriend walked in, the male was in obvious distress and I soon found out why.
The pair had been indulging in 'sex games' and they had been using a vibrator. Unfortunately, for the male, his girlfriend had gotten a bit vigorous in inserting it into her boyfriend's rectum, and it had been sucked into his body.
What people need to realise is that there can often be 'suction effect', which means that things will just shoot up there and refuse to come out.
Well, being the kind of nurse I once was - I had to have a listen. So the stethoscope came out, and after being gently applied to his abdomen I could hear a loud buzzing noise. I wondered how long the batteries would last.
The patient, while worried about his health, was more concerned that his mum would find out that he was at the hospital, and would turn up demanding to know what had happened to her son. Not wanting to be the nurse who had to explain to an irate mother that her son had a vibrator stuck up his arse, I got him seen as quickly as possible.
We got an X-ray taken, you could see the circuitry really well, while the 'body' of the vibrator was a lot harder to see.
He was booked for surgery, and just before he was about to go the theatres his mum turned up.
He started off by trying to tell her that he had a generic abdominal pain, but she questioned why he needed to go to surgery for a belly-ache. So he sat her down in a private room, (provided by me, I may be cruel, but I'm not that cruel) and explained exactly what happened.
To be fair, his mum took it quite well, there was no shouting, ranting, arguing or even sniggering. Instead she was supportive, if a little bemused.
If it was me I think my mum would disown me...
The vibrator was removed under anaesthetic, and the patient made a full recovery.
I don't know what happened to the vibrator though...
I posted a couple other stories about FBUA. It was all I wrote about for a week. Lots of people liked the stories. As I have mentioned earlier these are the sorts of stories you tell down the pub and people will end up buying you drinks.
Doorknob
For the final post about FBUA (for I am on night-shifts from tonight), I'd like to relate the tale of the doorknob.
A 45-year-old male came into A&E with a doorknob inserted where the sun doesn't shine.
His story was less than original. Apparently he enjoyed vacuuming his house while naked. While doing this he had backed up against his living room door, only to have the doorknob disappear up his rectum. Unfortunately, the doorknob was loose, and when he tried to remove himself, the doorknob gave way and thus became trapped up his bum. Thankfully, he got dressed before making his way to hospital.
Cue surgery, and removal of said object, when asked if it caused much damage, the surgeon replied 'It rect'um'.
...Bad joke, I know, but that's surgeons for you - she probably spent the entire surgery thinking that one up.
I vaguely remember two other stories: one of a woman who came to our hospital with a bed-knob inserted anally. The other is of a person who shaved doll heads, swallows them and then gains sexual gratification from passing them in his stool. This may not be true (I read it on the Internet), but it wouldn't surprise me if it were.
Short-Term Memory Loss
I've just come back from a 'Matern-a-taxi', and it always amuses me when I turn up 5minutes after they have called for an ambulance. Then, when I knock on the door, they look out the window, take in the uniform, the ambulance parked outside, and the big bag of medical equipment and ask...
'Who is it?'
Liars
I'm kind of prosaic about our regular callers, they have chronic conditions (normally brought on by drinking), but they are normally easy to deal with and, if you keep friendly with them, they are seldom trouble.
...Until they start being incontinent on the back of your ambulance. But that is a subject for another day.
What I do dislike are the regulars who feel the need to lie to our call-takers.
Take regular patient number one: she calls for an ambulance, claiming that she has had a fit. When I turn up (I get mobilised for patients having fits a lot), she tells us that she hasn't had a fit, but her legs hurt, so can we take her to the hospital. Repeat this once or twice a day and you wonder why some of us won't be too upset when we eventually find her dead in the gutter.
Tonight I went to regular patient number two: he is an alcoholic, who tonight told our Control that he had been assaulted 20minutes earlier and had had a seizure as a result of this assault. I get sent the job, and speed 3miles to get to the patient, only to find him drunk; he hadn't been assaulted and there was no evidence that he had been fitting.
It isn't the actual going to the patient that bothers me, as I mentioned earlier, it's an easy job. What does annoy me is that I rush to these calls, putting myself and other road users at risk, only to find the patient not undergoing a life-threatening event. I get very cynical about these jobs.
I've tried telling them that if they call for an ambulance and say they have a painful leg, then they will still get an ambulance, but that they won't be putting other peoples lives at risk by having me drive on blue lights and sirens (at risk of hitting a pedestrian), or by taking an ambulance away from someone who urgently needs an ambulance at that time.
But still they insist on calling for an ambulance with phantom illnesses.
The woman that I mention as regular caller number one, has been found a place to live in a Nunnery. We haven't heard from her since.
Can't Touch Her
My shift ends at 6:30 in the morning, so I was very happy to be left alone from 11p.m.
Except that at 6:20 I get a job (I ask them if they are joking - they aren't). The job is a chest pain on a bus, in a bus garage.
It is also so far out my normal area that I have to study the map for some time before I can work out how to get there.
I turn up to find out that the 'patient' is an alcoholic who is asleep in one of the buses. She denies any chest pain, injury or illness and after some persuasion she leaves the bus under her own power and leaves the scene.
If I were being cynical, I would be thinking that the bus company, unable to actually touch her for fear of assault, has called for an ambulance purely so that someone else is responsible for getting her off the bus.
Previous experience would suggest that this is indeed the case.
Why would they say she had chest pain - perhaps they know that this gets the quickest response from us...
Oh well... it's all overtime.
HAI
One of the bugbears that each political party is addressing for the upcoming election is the concept of HAIs (hospital-acquired infections). So far, the politicians have been mainly concentrating on MRSA (methacillin-resistant Staphylococcus aureus), but this is not the only thing that you can catch in hospital.
I've just come from a job where a 95-year-old female, who had spent a week in hospital for a blood clot on the leg, was suffering from some difficulty in breathing.
The patient had been discharged from the local hospital yesterday, and during the night had developed laboured breathing, a cough and a feeling of tightness in the chest.
Upon examination it seemed that the pain was not related to any cardiac cause. The tightness was worse when she breathed in, she had a slight temperature and, coupled with the cough and no history of heart problems, it seemed like a simple chest infection.
The patient and her daughter were happy with this provisional diagnosis, but were glad that she would be going to hospital for some more tests.
...But then the daughter asked me where her mother could have caught her chest infection... and I really didn't want to say 'from the hospital'.
I imagine that the ward from which the patient had been discharged had one or more people with a chest infection. Having worked in a hospital I know that a lot of patients, and their visitors, don't cover their mouths when they cough, and it seems completely reasonable that this is where the patient caught this infection.
It is probably unrelated to nurse or doctor hygiene (as these sorts of infection are often airborne) but instead caused by something as simple as someone not covering their mouth when coughing. It might not have been another patient - hospital wards see a lot of visitors, including small children who are constantly exposed to, and incubating infections.
It seems to me that a lot of hospital infections could be cut if patient visitors didn't treat the ward like some form of hotel, tracking their infections in and out of the community, and generally acting as if the rules of hygiene don't apply to them. I'm a big fan of restricted visiting for the majority of cases - and is there really any reason for children to be dragged around a hospital at all hours of the day.
It used to drive me barmy when I was running a ward.
However, medical staff do indeed need to improve their hand washing.
Flat
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So there I was, pulling up to a job (male fitting in street), the ambulance was already there (having been dispatched from the same station as me, only 2minutes earlier).
Then I heard a loud bang, and thought the bottom had dropped off the car - the crew on scene and the police who were there all looked in my direction.
My front tyre had burst as I had ridden up the kerb a little too forcefully.
There I was, stuck by the side of the road waiting for the tyre fitter to come and change my tyre. I may well have a spare tyre in the back of the car, but if I fit it, and it later falls off, then I'm to blame.
I returned to station to find a new wallpaper on the station computer...
'Brand new tyre required for Vauxhall Astra FRU, All enquiries to J2 station c/o Tom Reynolds'.
I love my workmates...
Dentist
I often moan about GPs that leave their patients who are seriously ill alone in their waiting rooms, or outside in the street having a cigarette. But until today I'd never been to a dentist (which might explain the state of my teeth - ho-ho).
The patient was a 42-year-old female who was 'shaking' on the dentist chair. I arrived and the patient was still in the chair, and was being given oxygen and reassurance from the dentist.
The patient had a long history of these episodes, and the dentist gave me a complete handover, including the social history of the patient, and while I was assessing the patient was still spending time reassuring her. The patient was not suffering from anything serious, but she agreed to go to the hospital for a quick check-up.
I must admit I was really impressed by this dentist for actually caring for their patient. It is only as I sit writing this that I realise that I'm impressed at a health-care professional that is actually doing their job.
Isn't that sad...
Radiating Pain
Sometimes you are really glad the patient isn't facing you.
I went to an elderly male with 'chest pain'; the ambulance crew turned up at pretty much the same time, so I found myself standing behind the patient as they got a history from him.
'Where is the pain?', the ambulance attendant asked.
'Here', he replied pointing to the top of his chest.
'What does the pain feel like?'
'Kind of a burning pain'.
'Does the pain go anywhere else?'
'Well, it didn't go with me to my friends house...'
...Cue me trying (thankfully successfully) to stop from laughing out loud. Instead, I managed to restrain myself to just some silent sniggering.
For those that aren't aware, chest pain which is related to the heart often radiates to the jaw or arm.
Bless him, I love this job.
I've just spoken to the crew, and the pain was related to his heart.
Values
I was called to a 39-year-old male, possibly dead. As I entered the house I saw his relatives crying, and sitting on a kitchen chair was my patient. He looked dead and wasn't breathing.
I felt for a pulse, didn't feel one, so I hooked up the heart monitor and there was no electrical activity at all.
I turned around to his relatives and told them that there was nothing that I could do for him, and that an ambulance crew would turn up shortly to help them out.
It took 10minutes for the crew to turn up, and I didn't recognise them at all - they must have come from outside our area.
Suddenly, one of the crew said they had felt a pulse!
The patient was also breathing. Oxygen was given and he was rushed out to the ambulance. All that was running through my head was how I had 'starved' him of oxygen, and how much trouble I was going to be in.
