Proper jobs come round once in a blue moon. But when they do, its a bit like the buses – they all come at once.
After the initial pleasantries it was clear to us that we’d have to hold him down to give treatment. There’s nothing satisfying about doing this but sometimes it just has to be done. And, after one Glucagon injection(IM), several sandwiches and a sweet cup of tea later we were able to leave the patient at home fully back to normal and with our closing words of “just doing my job man”.
After changing vehicles at the fitters it was onto our next job – a patient with a BM measuring “High” on the monitor (this means its through the roof and at a minimum of 30mmol/L). The patient looked unwell, very obviously dehydrated, poor mobility and kept drifting off to sleep. We gathered them onto the ambulance where I was told to get I/V access to give fluids!
Right. Access. I/V access. Ok. Um . . . right, I needed a cannula. What else? Erm . . . er . . .
Whilst I struggled remembering what basic bits and pieces I needed to gather together, I smiled at the patient and reassured them that we were going to look after them. I made sure not a single one of my frayed nerves showed externally and took my time as best I could, under the circumstances. I was about to insert the cannula when my Mentor touched my arm and whispered to me, “take a deep breath and let it out slowly”. She must have noticed the tiniest beads of sweat starting to form on my brow – or probably that I was gibbering like a pathetic child and frothing at the mouth. Either way, it helped and the cannula went into the tiny vein first time.
I secretly “high-fived” myself – but not before letting the patient bleed onto the ambulance floor as I failed to place pressure on the vein to put the cap on the end of the cannula . . . but these “little” faults can be excused.
After about 200ml of fluids the patient had perked up lots and even managed a smile. And we felt that we’d managed to do something good and worthwhile when we handed them over to the hospital staff.
The next two jobs were “blued” into the hospitals. The first was a poor woman with suspected haematemesis (vomiting blood) and melaena (gastrointestinal hemorrhage coming out as black tarry poo – not good). Again, she looked very sick. This was pretty much a “scoop and run”. Because of excessive hyperventilation we found it hard to obtain an accurate blood pressure but later the hospital told us it was 63/33!
The last job was a suspected . Upon arrival it was clear the patient was reduced as they were confused and struggling with articulation. The more the patient tried to speak the more incoherent they were and it appeared that this was distressing the patient as they knew something wasn’t right. It was also clear from the history that only an hour before, this person had been up and moving and talking normally.
We attempted a FAST test but the patient was frightened and combative. Therefore, it was a “load and go” situation again. The carers on scene contacted the patient’s family as we started moving her to the ambulance and we got ready head off sharpish – as this was now time critical for the patient. Cannulation and an ECG were also ruled out as the patient withdrew from all efforts to do so.
It took us twenty five minutes of aggressive (but safe! Honest!) driving for us to travel the 7 miles to the Royal London Hospital. And after rushing the patient into resuss we handed over to the Stroke Doctors.
As I sat in the ambulance afterwards, sipping a cup of tea, my Mentor approached and informed me that the doctors had decided they would not be the patient as she was over the cut off age of 80. Apparently it is not considered to be in the government’s best interests to treat patients over this age. Not viable I guess.
The patient was 81.
This means there will be no treatment for her other than palliative like care. It did nothing less than boil our blood and break our hearts. And as this was our off job it left a bitter taste in our mouths.
Weekend off now and back on Tuesday. I will now attempt to keep these posts regular.