Complacency

Complacency A feeling of contentment or self-satisfaction, especially when coupled with an unawareness of danger, trouble, or controversy.

I was stood in the resuss bay helping a senior consultant gain I/V access to our patient via the jugular vein (central line).  Well, I say “helping” . . . I was merely stood to one side holding an ultra sound probe in one hand and a tube of lube in another waiting for instructions to pass them to the Consultant.  But I considered this form of “help” to be a team effort and deep down I was just dead excited to be involved, albeit on a menial level.

Our patient was sick.  Big sick.  He’d just been roughly diagnosed with Necrotising Fasciitis, or ‘nec fec’ as the Consultant liked to call it.  After my crew mate and I had worked out what that actually was on our smart phones, we had a little review.  We started retracing our steps and recognising the different points that clearly showed us the tell tale signs of why our patient was so ill . . . and perhaps why we should have taking him a bit more seriously than we did.

The job came down as abdo pain.  Now, we go to a lot of abdo pains every day.  And I hate to say it but it tends to be a bit too easy to become complacent in your outlook on the patients at times.  We don’t want to be and we certainly don’t intend to – but it just sort of happens . . . especially when 99% of the abdo pains you go to end up being so benign and . . . what’s the word I’m looking for . . . pathetic.

Our patient looked . . . pathetic.  Not in a harsh way – it was just his actions appeared too over zealous and too over dramatic to warrant anything being serious.  Even his family weren’t impressed.  As far as they were concerned (and as far as what we could ascertain), it was just another recurrence of his chronic bowel problem.  And, after lots of shrugging of shoulders from the family we were left with solely that as our history.

He was laid prone on the bed and said he couldn’t move.  When we did try and help him, his screams and wails were almost child like.  Trying to get him onto our chair resulted in what appeared to be a throw-yourself-to-the-floor response complete with hissy fit and flailing arms.  Something you might expect from a five year old who doesn’t want to go out to dinner with their parents.

As a result, our patience was wearing thin.  Our eyes had started to roll and sighing was beginning to occur.  It was a bit like when you see a parent in a supermarket who’s glazed expression barely hides through gritted teeth their years of patient suffering as they try to hold still their child who is throwing a screaming tantrum.

But then there was the first warning bell that something wasn’t right.  As we examined him we laid eyes on a scar that ran down the centre of his lower abdomen.  On its own, this was nothing special – but surrounding it and over much of his belly was inflamation that was red and very hot to touch.  Not good.

The second warning sign could of been (if we knew more about the condition) his behaviour.  Patient.co.uk mention one of the symptoms of Necrotising Fasciitis as; ‘Severe, constant pain, out of proportion to the physical signs . . . a notable feature’.  Our patien’ts actions were certainly worthy of this description.

And as we went on, other warning signs became more obvious;

  • Indescriminate vomiting
  • Tachycardia
  • Slightly pyrexic
  • Generalised oedema . . . (in that when I attempted to gain I/V access – and failed – the torniquette left a complete indent in his arm, as if the strap was still there, but invisible.)
  • BM of “LOW” . . . (LOW?  My crew mate Marvin* and I looked at each other.  We’d seen “HIGH” on the BM machine but never “LOW”. We did it again . . . “LOW” once more.  That definately wasn’t good – especially as our patient AND his family had said he wasn’t diabetic.)

But of course, by now, we knew something wasn’t right and had kicked up a gear or two.  The blue call was made and we set of to the nearest A&E.  Whilst Marvin sped through the streets of London I tried to do what I could for our man.  Half way there our patient began showing further signs of deteriation and started losing consciousness.  I didn’t in any way hide my concern in this sudden change of circumstances and my response was slow, deliberate and almost matter of fact.

“Oh dear . . . ”

My crew mate clearly recognised the tone in my voice.

“Would you like me to put my foot down a bit more?”  he asked politely.

“Yes please Marvin.  That’d be nice.”   I hoped the raise in pitch didn’t reveal the anxiety spreading over me.  So, whilst I fumbled in the prevention of my bowel movements . . . and of course, dealt with the patient, Marvin managed to get us to Hospital in super sonic speeds.

After handing over, the lead Consultant chose to go for a central line as “all his veins had collapsed” . . . this of course made me feel heaps better after my abysmal failure at I/V access earlier.  I asked the Consultant why his blood sugars were so low (the blood gases had come back saying they were 0.3) and he ventured that it was possibly to do with “overwhelming sceptic shock and that his organs were possibly giving up”.  And without looking up from his work he concluded nonchalantly;

” . . . and that he’s possibly dying”

I didn’t know what to say to that.  So, I did what I thought was the next best thing – and whatever any other blithering idiot would do in my place – I patted the patient’s hand and mumbled the words, “I’m sorry” . . . before leaving.

I didn’t say sorry because I thought he was going to die.  In fact, later on, the Consultant seemed more positive in his prognosis.  I said sorry because I’d fallen foul of that one word I’d hoped I never would fall foul of . . . complacency.  We’d seen this man’s presentation and they resembled any other presentation of tummy ache from someone who was wanting attention.  And like a fish to bait, we’d fallen for it.  Hook, line and sinker.  I said sorry because as early as seeing his stomach, I knew complacency had bitten us on the bum.

Don’t get me wrong, our treatment wouldn’t have changed for this man.  And we did everything we could – and as fast as we could at that.  And by all accounts there may have been a positive outcome for him.  Who knows.  But it can still leave a bitter taste in your mouth when you know you could have been a tad more compassionate or understanding.

I reckon its good to have these subtle moments of clarity.  Or the “bite-you-on-the-bum” instances as they’re sometimes called.  For me at least, it allows a certain amount of reflection.  And it allows me to ‘re-direct’ myself somewhat, back on to the path of the reason why I joined this job in the first place.

After finishing at hospital we decided to head back to station and give the ambulance a clean . . . a thorough clean!  I mean NOTHING was left untouched.  And after that – we put all our clothes into clinical waste bags for incineration.  And after that, had a thoroughly good shower . . . and after that, we then went home.

It was an odd shift with an interesting off-job.  One I’d certainly like to try and chase up some time.  And for now, I’ll keep complacency at bay . . . well, for now at least.

Binder

*Marvin is not his real name – of course.  But Marvin is my new crew mate . . . for the time being anyway.

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