Sunday, 31 January 2010

A horse called ASBO

This is ASBO; that's his stable name because he doesn't behave himself.

Day shift: One calls; one assisted only; one treated on scene; one by car.

Stats: 1 Fall; 1 Distended stomach; 1 Head injury; 1 Impaled tongue.

A very slow start to the day and my first call of the morning was a non-convey for a 95 year-old woman who fell in the street and was helped up and back to her home by two mounted police officers. One of their horses (ASBO) was walked along by a PCSO so that the female police officer could take care of the sprightly old lady as they waited for us.

An ambulance was sent as well and we arrived at the same time, only to be told by the old lady that she didn’t need us. She was right – she had no injuries and was fine to go about her normal day after a stumble that most 75 year-olds would have had trouble with. At her age, it was rare and heart-warming to see that she could still take care of herself. She practically ran to the lift to get back to her flat when her obs were completed!

I took the photo of one of the police horses, known by the stable name of ASBO because he can be less than well behaved, as we chatted outside afterwards.

Later on I was sent to a block of flats for a 21-month-old boy with ‘fever’ and a distended stomach. The block’s only lift wasn’t working and I didn’t discover that until I’d waited long enough for it. Then I had to gain entry to the stairwell, which was security locked, and walk five floors (but ten flights as each floor had two sets of steps up to it) to the relevant flat, where mum and dad were waiting with the child.

He had a recent history of pneumonia with sepsis and his little tummy did indeed look huge but it wasn’t rigid and he’d moved his bowels earlier. He was off his food but nevertheless lively (hyperactive in fact), so I took him and his mum (and the pushchair) to hospital. It took a long time for them to get organised. Never mind, it’s not as though I have emergencies to get to later anyway.

I made the mistake of taking my break at a bookshop and going into the medical section. I always, always come out poorer for doing that. Never again, I say, like a practised drunken schoolgirl.

Luckily I was saved by a call in which I was asked to go and transport a patient currently being attended to by one of my MRU brothers. The lady had sustained a head injury as the result of a mystery incident. She couldn’t remember how she got it but she was found face down in the street and nobody seems to have witnessed her falling or being hit. This was a very busy junction and there were lots of people around, so it was all a bit strange.

The hospital was literally across the road and she had no neck pain, seemed to be fully conscious and aware and able to stand and walk, so I drove her the short distance to A&E while she vomited into a clinical waste bag in the back seat. This was possibly a sign of something more significant than a minor cut to her head and I took no more than 1 minute about getting her in through the doors.

She continued to vomit on and off and began to remember stuff – like she had been running. She could have fallen hard, knocked herself out and lost the immediate memory of the incident as a result. It was strange that this hadn’t been witnessed in such a busy area though. Luckily, a first aider and someone else who happened by helped her until the biker arrived.

An interesting little intervention after coffee when I was asked to go and help a 95 year-old lady (yes another one) whose dentures had got ‘stuck in her tongue’. It turned out she was eating dinner when the dentures became loose and the jagged wire frame that they are mounted on impaled her tongue, going through from the base to the top. When I examined it I thought it was going to be too tricky and painful to remove – I wondered if she’d bleed too much or she’d scream in agony as I attempted to take it out while she fought to breathe properly.

I told her to breathe through her nose (that helps lessen the gag reflex) and I got my fingers around the obstruction but it slipped and slithered so much that I thought I’d never get it. The wire was quite well embedded and her tongue had actually wrapped itself around the thing like it well-loved metal.

After a few attempts and a near-decision to take her to hospital and have someone else inflict the pain, I had one last go at it and this time, remembering that I was dealing with a muscle that was older and wiser than any of mine, I pushed the tongue over the wire until it was free. Initially she winced in pain but when it came out, she was very, very relieved. I had saved yet another life on the cheap and it felt good.

‘£600’ she ‘drew’ on her table using her finger while she recovered the power of speech via her newly liberated tongue. Then she said it angrily – ‘six hundred pounds I paid for them!’ I know one dentist who isn’t going to be given a long shrift for his handiwork and I’d love to be a fly on his wall when she confronts him. Ninety-five or not, once she had her voice, she was a force to be reckoned with.

Be safe.

Saturday, 30 January 2010

Falls, faints and cardiac arrest

Day shift: Five calls; one left on scene; one assisted-only; one by car; two by ambulance.

Stats: 1 Chest pain; 1 Cardiac arrest; 1 Faint; 1 Fractured arm; 1 Eye injury.

Frosty and cold today, with a light dusting of snow. There, that’s the weather done for you.

I’ve been off ill for a few days (I don’t normally do ill) and I was away on a break coincidentally – I went to Centreparcs to write this novel of mine, or at least flesh it out a bit more. I have given myself a deadline – April this year – to complete it and I am finding it hard work to be honest. Now, I know you may think of Centreparcs as a typical corny Brit breakaway but I love the relative peace and quiet, cabin life and the fact that the only traffic you’ll encounter are bicycles with tinkling bells. And that rarest of sounds; something I grew up with but no longer hear as often – children laughing and playing in the background, even at night. It’s as near a Utopia for safe living as you can get in these modern times. Except for the mad ducks, occasional baby deer and rampant squirrels that demand feeding every day at your door!

Back to the real world and my first call is for a 21 year-old French man who is standing on the street with his friend. He is complaining of dizziness and ‘heart pain’ after sniffing Mephedrone, which is a plant food. I’d never heard of it before, so I was sure he was saying Methadone and I drew my conclusions on that basis but his friend, the spokesman, persisted until I got the point. Then he handed me three or four little bags of white powder, there and then on the street while Londoners were getting themselves to work or to the early opening shops. I must have looked like I was buying cocaine from him, so I handed him and his little sweetie bags over to the arriving crew before I got arrested on suspicion of handling a Class A drug with intent to criticise. I should point out that the powder looked like cocaine and that Mephedrone is actually legal in the UK at the moment. I was being sarcastic.

A senior colleague joined me on the car for a few hours so that we could chew the fat about stuff and he attracted a cardiac arrest as soon as we stopped for coffee. The 53 year-old man had collapsed at some point earlier and had been found by his friend, on the toilet floor and not breathing. His girlfriend had seen him, alive and apparently well, just an hour before, so this was a shock to them.

We arrived just ahead of a crew and found the man’s friend compressing his chest in the hallway, where he’d been moved to make things easier. We took over and a motorcycle medic joined us a few minutes later.

Our aggressive resus made no difference to his condition; he’d been asystolic when we arrived and he remained that way, despite drugs and effort. His BM was low at 2.6 and his temperature, which I took on the basis of the way he looked, was reading ‘LO’. The man had been in this state for a while. I’d noticed the discolouration of his skin around the neck and shoulders and thought he may have been gone for an hour or so. So, after a lot of hard work I called it, with the agreement of the team. We weren’t going to be able to bring him back.

I did the paperwork as everyone tidied up and the police arrived for a handover. There was no suspicion here and I learned that the man had a familial history of sudden cardiac death; his father had died that way at a youngish age. It wasn’t until the sister and his nieces arrived that I found out that he’d been complaining of chest pains and DIB recently but had ignored it. He was a drinker and smoker but didn’t do drugs.

I led his sister into the room after warning her about the tube and cannulae, which have to remain in place. She howled and cried over him. ‘Wake up, come back’, she repeated. It was sad to watch but I have somehow become used to the tears of others.

After all the paperwork had been done and a debrief carried out for the sake of a trainee who’d been on the last job – her first ever resuscitation – we were off to a 29 year-old woman who’d fainted and was recovering in a bar. Her husband and family was on scene and she seemed embarrassed by the circus that we brought around her but she needed to be checked thoroughly before we were willing to let her continue her day. She had a restaurant booking and was anxious to get there on time, so after full obs and an ECG that was normal, I drove her and her mother (in-law?) to the venue and she made the scheduled booking time... kind of.

I’d suggested that she was possibly a bit ‘dizzy’ as a person and her husband confirmed that she was, in a nice way of course. She recovered fully by the time she was dropped off and I returned to give her the PRF copy after I’d filled it in. We had been called to a false alarm cardiac arrest in the south but were cancelled on the way, so I managed to get her signature for a non-convey as she was sitting down to eat. That’s how rude I can be.

She must have been happy with the service because she posed for a photograph with us just so she could prove she had been in an ambulance. She’ll be reading this so... try not to faint again on your next visit and reserve another place at the dinner table next time :-)

At Piccadilly Circus a 67 year-old Irish lady and her family waited for us after she’d fallen badly and broken her arm. She’d tripped over raised pavement slabs and sustained a bump to the head too but it was her fracture that concerned me most. Her arm was badly deformed and she needed morphine to control the pain as I immobilised it in a sling for her. I sat in the back of the car with her as my colleague drove us to hospital, where she was taken into Resus for what I’d already warned her would be a bit of 'manipulation' to straighten it. Poor woman.

Another faller, this time a 35 year-old lady, sustained a deep cut above her eye, a broken cheek bone and what looked like Hyphema of her eye. The eyeball itself was also definitely damaged, so much so that when an ambulance arrived I let the crew take her because she’d need to go on blue lights for that injury alone. She was, as you’d expect, very upset and scared about what she’d done to her face, simply as the result of running for a bus in high heeled boots. So, two things to remember here - don't run in high heels and look where you're going if you do.

Be safe.

Saturday, 23 January 2010

Wet Footed StuFru

Night shift: Seven calls; one left on scene; two by car; four by ambulance.

Stats: 1 Cold homeless person; 2 eTOH; 1 EP fit; 1 Tachycardic; 1 AF.

I have plastic bags over my socks inside my boots. Once again, after only a year or so of wear and tear, my work boots are cracked on the sole and are leaking water and whatever else I step in into my socks. I endured the damp, squidgy feeling last night for the entire shift but today, as I inspected my footwear and realised both boots were soaking inside and that I was about to put my nice new, freshly-showered and warmly dried besocked feet into them, I took the radical decision to cover both using the small freezer food bags that we keep at home.

So, first job with dry feet was a false alarm for an angina attack on board an incoming train. The crew was with me and we stood by on the wrong platform until we were moved and then informed that the BTP had decided to have the train stopped at an earlier station. There was no ambulance deployed there, however, so more advice, for the train to be allowed to continue, was given.

We changed location and I got myself and my bag a lift on the little noisy kart (it would have been quicker to walk but it was fun and convenient) but it was all in vain because a crew were despatched to the nearer station and all we got was a ghost train.

Then a 37 year-old man claimed he had a fractured shoulder and demanded to be taken to hospital. A posteriorly photogenic police officer (this is a private joke so don’t worry) was on scene at the time and he informed me that the man was homeless and showing no obvious signs of distress. This was a typical cold homeless person wanting off the streets and I have sympathy for them but his ‘injury’, which was never diagnosed, was two years old and so I felt kind of abused. If he’d told me the truth and levelled with me about getting a free warm, dry place to put his cold feet, then I’d have more respect for him but he preferred to lie.

I drove him to hospital anyway and he valiantly carried most of his fairly heavy bags, despite his painful shoulder. He’d be carrying them back out the exit door of A&E in a few hours I imagine.

Outside a University campus building, lying in the gutter is a 19 year-old girl with thick, smelly vomit in her hair (the shampoo of the new generation). She’s been found by a bunch of students and a security man and they put her into the recovery position and call an ambulance because she’s ‘possibly drunk’. Correct diagnosis but I'd like to expand on it with my extended medical knowledge. She is very drunk. So much so that after telling me she’d just had ‘three drinks’ that night, she commences vomiting again until her face is covered in the stuff and her warbling voice tells me that she is feeling guilty but unrepentant at the same time. They used to say 'never again' but now they just say 'I'm really sorry' or 'I'm disgusting'.

She gets scraped off the road and into an ambulance where fluids help her falling BP to recover, although her dignity never will.

South of the river and a 25 year-old doctor is fitting in a wine bar where a piano-playing jazz singer bellows out a tune as she shakes on the floor for almost five minutes. I struggle to communicate with her as she recovers and the manager finally puts a stop to the cacophony ( sorry, I'm not a great jazz fan), just in time for me to hear that she’s recently been diagnosed after a short history of ‘absences’ and a full-blown seizure weeks ago. The crew persuade her to go to hospital because her BP is high and she has yet to completely get over it. Trying to convince a doctor to go to hospital is almost like trying to prise a live whelk out of its shell.

The Saturday night morons began their onslaught just before 2am when a call came in for a 30 year-old man who was ‘unconscious’ and vomiting outside a gay club. The police were on scene and they made it clear before I got started that the man had been ‘playing dead’ all night. He was flopped dramatically on his back with a large crowd of cat-calling transsexuals around him. They were clearly enjoying the sport and you don't see that very often. Not unless you are a fan of The Rocky Horror Picture Show.

I woke him up with the necessary pain and made him sit upright before establishing certain facts. I discovered that – 1. He was Lithuanian and 2. He was drunk. He was left on scene with no promise of an ambulance.

It is not unusual for young men to have fast heart rates every now and then when Adrenaline rushes through their bodies for no reason whatsoever but when you have high blood pressure and have been through a vivid sex dream, the risks associated with a tachycardia are greater, so I took the Russian patient to hospital in the car after ensuring that his ECG was normalish for his current heart rate (180bpm dropping to 111 after a few careful exercises in reducing it) and that he had no pertinent chest pain.

Interestingly, he seemed keen to stress that he had managed to complete his sexual antics before waking up with what he thought was his first heart attack. I'm not entirely sure which tale he was trying to impress me with.

I don’t get to meet many true ladies in my job (foul mouthed drunken women don’t count) so it was refreshing to be sent to the aid of an Urgent Care crew who needed help in deciding whether or not to leave their patient at home after she’d fallen out of bed. The patient, a titled Lady, had COPD and, at 89 years-old, wasn’t doing very well in the breathing department. Her ECG also showed AF and it was necessary to take her into hospital on the basis of a lack of information from her live-in carer and the confused state of the patient herself. Whether she coped normally with her rasping, heavy breathing and erratically irregular heart beat wasn’t clear and I wasn’t about to take the risk.

Be safe.

Friday, 22 January 2010

Unexpected dramas on a routine night

Night shift: Nine calls; two treated on scene; three by car; one false alarm and three by ambulance.

Stats: 1 Head injury; 1 Hypoglycaemic; 3 eTOH; 1 Not hypothermic child; 2 Assaulted (same call); 1 Panic attack disguised as DIB; 1 DOAB (assaulted)

The first call took me to a block of luxury apartments and the man on the door just stood there without indicating to me at all. This was originally a Red1 because the patient was unconscious and nobody knew if he was breathing but it was downgraded slightly when someone eventually informed us that he was conscious again but was bleeding badly. For that reason, as I passed the location looking for a ‘building site’, I would have expected a bit of urgency from the member of staff waiting for me.

A woman appeared as I went in and the ambulance crew pulled up – she was visibly upset and led me up to one of the upper floors, where in darkness and on extremely slippery flooring (some kind of oil or wax had been used to treat it), I found an agitated man in a suit. He’d bled badly onto the floor and had severe facial injuries, including what looked like a fractured orbit and maxilla but his behaviour intimated other, potentially life threatening injuries – he may have been bleeding into his skull. He thrashed about and tore the collar off as we tried to keep him still. There was no way he was going to let us immobilise him and the fight would cause him more injury, so we decided to get him out of there as soon as possible and by whatever means was safe for him. We were working in what amounted to a pitch black ice rink.

I’d asked for a Delta Alpha (BASICS doctor) to attend in case he needed to be calmed down for transport to the nearest neuro hospital and he arrived as we tried to settle the patient down in the ambulance.

Meanwhile, the poor woman who’d come to me and told me what had happened explained in more detail what had taken place up in that black hole of a room. The man was an estate agent and she was the potential client, ready to fork out thousands a month for this place but when he discovered the lights weren’t working as he showed her around, he told her to stay put then went forward and tripped up on a step, falling very hard onto his face, according to the woman. He’d lost consciousness and she was left wondering what the hell had happened. You couldn’t see your hand in front of your face without a torch, so she much have been petrified as the man began to make ‘bad’ breathing noises.

A member of staff arrived but told her to stay there while he went to make the call for an ambulance – she couldn’t do anything and no first aid kit was brought to her. The man lay on the floor regaining consciousness but bleeding all over the wood from multiple wounds to his face. She stood by him and didn’t know how to help. Then she was forceed to come and get me because the useless doorman was, well...useless.

When the man went to hospital, I took the lady in the car so that she could be with him. She wanted to know that he would be okay and she kindly called his sister so that she could join him in Resus. I felt very sorry for her because she’d gone through a lot of drama and seen a lot of blood for someone who just wanted to look at a pricey piece of property. I doubt she’ll rent it now.

Then as pizza was ordered and began to get cold, Sod showed up and stuck his oar in, so off I went to a private hospital where the prices are so high they don’t even tag the dead, for a 63 year-old woman having a hypo. The qualified nursing staff on scene didn't seem to know what to do for this and I found the lady sitting on a chair next to her bed-bound post-op husband. She was confused and I was told her BM was ‘one point something’ but when I checked it was actually 3.5 and the health care professionals there could easily have just fed her a couple of biscuits to solve the problem. And that’s all I did; she got orange juice and biscuits and within ten minutes she was right as rain.

After another set of checks and a round of toast (for her, not me - I had cold pizza waiting in the car), I left her to it and everyone was happy, including the hospital nurses of course. Nobody died on their watch.

Friday night kicked in post-pizza and the next call for a 38 year-old male ‘fitting’ was going to be a non-starter and I knew it. The location gave the game away because it’s where our local Russian and Polish community alcoholics gather and fall down. A crew was on scene and they signalled the waste of resources I had become, so I popped my head in to make sure he was what I imagined he’d be (he was) and then I left.

No sooner had I made my way north when a call from the south had me turn tail for a 25 year-old male who’d been found drunk and with a head injury by a police officer. He’d been attempting to urinate and in his stuporous state had fallen onto the wall, splitting his eyebrow open. By the time I arrived, he had a nice clean dressing on his head, courtesy of the copper but he pulled it off contemptuously as I explained that he’d need to go to hospital. He spoke very little English and expected me to dial his partner’s number so that he/she/it could come and collect him but I declined on the basis that I wasn’t that kind of public servant and I didn’t fancy becoming embroiled in an even more complex language barrier conversation while the rain dropped on my head. I already had a soaking sock, courtesy of a split in the sole of one of my boots and water had seeped through and possibly blood from the earlier head injury, so I wasn’t comfortable standing in a puddle any longer than I needed to.

Eventually, the cop and I managed to get him into the car and I took him to A&E. He tore his dressing off for the second time and I left it alone. He refused to have any obs done on him and was stubborn about everything except following me to where he needed to be.

One 5ml spoon of calpol and one 5ml spoon of children’s Neurofen won’t cause a massive core temperature drop to hypothermia. A woman whose 5 year-old child was recovering from a chest infection took her axillar temperature using an oral thermometer and got various wild readings. She got 38c and thought her daughter was going to develop a fever, so she gave her the meds, then she took another temperature and got 34.5c, which is unlikely. Fearing she’d given her kid an overdose into hypothermia, she called an ambulance but luckily common sense prevailed and I went there to check it out before all the alarm bells went off.

Sure enough, the little girl was fine. She had a normal temperature and was showing no signs whatsoever of dying until she’d reached a ripe old age. I gave mum some advice about temperature taking and that was that.

A 22 year-old drunken girl was left in an alley by her workmates, who then called her boyfriend to inform him that she was ‘in no fit state to get home’ and when he found he she was sitting in a pool of her own vomit, alone and very vulnerable in the small hours behind the bins in an alleyway. He will, no doubt, have words about this reckless abandonment with her so-called friends.

She’d been drinking steadily and had the usual ‘I haven’t had many’ excuse which didn’t impress me at all. Her boyfriend thought she may have been drugged because she was quite wired (but apparently she always acted like she was on drugs), so I asked her if I could check her pupils, ‘look up for me’, I said and she squinted as if in pain and said ‘if I look at you I’ll throw up’. That hurt deeply. No, really, it did.

Anyway, I took her and her boyfriend to A&E where she told me she would have a hysterectomy if I got her a puppy. I couldn’t make the connection until the conversation I had with her earlier flashed back; the one where I had asked if she was currently on her period and she said ‘yes’. So, I told her that she was likely to feel the effect of alcohol much more acutely as a result. I guess she’d rather be able to have a good drink and survive with a little dog than have kids and stay sober.

I left her with her head in a sick bowl and her boyfriend sitting beside her. No puppies were harmed in the writing of this post.

One of those double-ups next when I am asked to go to a man with an eye injury and arrive to find the police on scene with two men who’ve been assaulted by a little gang of thugs. The 19 and 20 year-old Lithuanians were out enjoying themselves when they were set upon with fists and bottles. One of them had an eye injury caused by an aggressive elbow and the other had an incision to his chin and a head injury caused by a bottle which broke on impact. They were stable enough to go in the car and a police officer accompanied them.

I left the next place smelling of cigarettes because the patient had just finished a ciggie at home prior to my arrival on the basis that she was having emergency 999-style difficulty in breathing (DIB). Her grand-daughter indicated to me (by use of the world known hand gesture) that she had been drinking tonight and I walked in to a room full of smoke and booze, where her adult daughter and a 4 year-old girl, who was the great-grand-daughter and, thankfully, did not smoke at present, (although I’m sure her lungs would tell a different tale if they were asked, such was the indifference shown to her health in this household), were present.

I had to ask each of the grown-ups in the room to put their cigarettes out because I was using oxygen. I know this is a contentious issue and that smokers believe they have the right to continue puffing away in their own homes but I could barely stand the atmosphere in there and I couldn’t fathom why the patient was sitting wheezing at me when she knew her next cigarette was only a few minutes away. It was 4am and this was no way to show a small child how to live.

The patient had a long and chequered medical history but tonight she was just panicking and putting on a show for her family after having had a disagreement with them. I tried her on Salbutamol because she needed a little but she reacted as if it was burning her lungs. This was despite the fact that she had inhalers around her and a redundant compressor nebuliser sitting on a table. She was a fool to herself and I knew I’d get nowhere with her. She refused an ambulance and she refused to leave the fags alone for a few hours. So I left and the family went straight back to smoking and bickering about whatever they felt like as the small girl watched.

Tonight’s drunk on a bus was unusual because I had to call an ambulance for him. He was lying on the back seat, as they always are – drunk of course but also sporting a heavily battered and bloodied face. He’d clearly been set upon and the driver told me that he’d boarded the bus looking like that earlier on.

He was reluctant to let me help him and threw his arms around a little, so I thought it best lto eave him alone and get some backup. A few minutes later and two police officers were helping him off the bus – he didn’t do anything for me or the crew when they arrived but he recognised the cops and complied.

He told us that he’d been attacked by four men in south London but he hadn’t been robbed (all his belongings were on him). His fist was swollen and cut as if he’d been giving as good as he got and he had a tell-tale pattern mark across the back of his ear, left either by a sliding boot or a belt buckle. My money's on belt buckle.

The cops could do little with him because he wasn’t making much sense and, although a head injury can be masked by alcohol, I think we were looking at the effects of the latter rather than the former.

Be safe.

Tuesday, 19 January 2010

Fracture dancing

Nearly time to go home...

Day shift: Five calls; one assisted-only; two by car and the rest by ambulance.

Stats: 1 Dizzy pregnant person; 1 ?Flu; 1 Chest pain; 1 Diarrhoea not vomiting blood; 1 Sore throat.

I’m going to be interviewed for the programme ‘Bizarre ER’ tomorrow. They want anecdotes to put on the show and I’ll be describing one or two of the strangest call-related stories from either the book or the blog. It's to be aired in April, so I'll keep you posted.

Back in the land of the unwell, a pregnant 37 year-old woman with low blood pressure, recurrent epistaxis and dizziness (probably as a result of her BP), called an ambulance from her place of work. This is a common and almost daily thing for us; there are dizzy, fainting pregnant people all over the place at the moment.

I could have taken her to hospital in the car but an ambulance showed up, so I was spared the journey.

Meningitis is usually diagnosed on the basis of a few key elements; photophobia, non-blanching rash, vomiting, neck pain and headache for example, so it is hard to believe that a GP diagnosed the possibility of a potentially life-threatening condition over the phone on the basis of the Flu-like symptoms that my next patient, a 27 year-old female who lived, quite literally, yards from the hospital had, and told her to make a 999 call for an emergency ambulance. Nobody wants to get these things wrong but surely a more accurate assessment is needed before alarm bells are rung and patients are left wondering if they are heading towards death’s door. For my part I saw only Flu and I may have been wrong to be so hasty about my conclusion but here’s what I saw: sore throat, sore head, aching legs, back ache and neck ache. No vomiting, no rash, no photophobia and no problem when she pushed her chin to her chest (Brunzinski's sign). Oh, and she’d also recently been in contact with people who suffered Flu.

It took one minute to drive her and her partner to hospital using the one-way system around the building. It would have taken them 20 seconds to walk.

Off to court next and a man collapsed complaining of chest pain and lower abdo pain during his trial. This happens a lot. He had no cardiac history but was a kidney stone sufferer, so that explained the abdo pain at least.

I found him sprawled dramatically on the floor with first aiders all around him. He was on oxygen and getting lots of attention and worried looks. I asked him to sit up and relax because he was panicking and I think that’s what was giving him chest tightness. His behaviour was strange and suspect but I went down the line of caution and treated him for cardiac chest pain, even though I felt it wasn’t the case. He got GTN and aspirin. ‘Have you ever had GTN before?’ I asked, showing him the little bottle of red liquid. ‘No, never’, he replied. Then as I prepared to give him a spray I said ‘Open your mouth and lift...’ Before I’d got to the words ‘your tongue’, he’d done it. Usually people have to be shown what to do; a mere description isn’t enough but I hadn’t even finished the sentence, so I knew he’d gone over this routine before.

Then he flopped onto his back and stayed there until physically lifted back upright by the security man. He was playing a game.

The crew eventually got to me (the place is so large that I got lost initially and the crew got lost too) and we carted him off to the ambulance for what turned out to be a very normal ECG and BP check. None of his obs said danger. He had tried to break into a wailing sob while strapped to the chair but didn’t quite make it to the correct octave for convincing sympathy votes to flood in and cruel as I sound, this man was wasting everyone’s time just to get away from court. People do it in immigration offices, police cells and anywhere else where running from your responsibilities is the done thing.

The first aiders here can give oxygen, which is a prescription drug but they have been told not to give aspirin, which is an over-the-counter drug. Apparently their Health & Safety Manager deems aspirin to be a risk and oxygen not. This is ironic in light of recent research indicating that supplementary oxygen given during an MI could lead to further damage but that the risk reduction of secondary clotting gained after taking an aspirin, regardless of the time it takes to work, far outweighs the risk of a stomach ulcer bleed. Some people just bang their heads for the sake of it.

Soon enough, after a coffee and a chin-wag with my MRU and CRU brothers, I was off to see a 34 year-old woman who thought she’d vomited blood after taking laxatives to relieve what she thought was constipation. She purged herself so violently that she went into mild shock as she sat on the loo, causing her to vomit. The vomitus was bright red and she could taste metal in her throat. When I examined her in the first aid room of her workplace, I could find no evidence that she’d thrown up frank blood. There was no red staining in the mouth, on the tongue, lips or teeth and she hadn’t washed her mouth out, so I suggested this: she’d become constipated as a result of the antibiotics (metronidazole), mistakenly taken laxatives and purged unnecessarily causing her body to react by making her sick and the metallic taste was the residue of her antibiotics - the 'blood' was probably the partially digested red salmon she’d eaten earlier.

She was happy with this explanation and calmed down considerably, so I felt I’d done a good job, even if it wasn’t saving a life. I left her at work to relax and recover while she read a copy of my paperwork.

Immediately after this I was sent to a Red2 sore throat south of the river. A motorcycle colleague was on scene and the 25 year-old patient sat waiting at her college for me to taxi her to a very busy A&E for something she could have seen her GP next month about. Ridiculous.

Over the years I have watched hundreds of tourists and visitors taking photographs of the main attraction on Trafalgar Square; Nelson’s Column. Only tonight, whilst watching a few people standing on the steps above the fountains, framing that epitomising picture in their digital screens, did I realise that unless they stood halfway down Whitehall, they’d be photographing the same image – the back of the statue. There’s little point in taking a picture of the back of a human form, real or sculptured, unless the backside is particularly attractive or there is merit in the form from that angle. It amuses me to think that millions of photo’s of the back of Nelson’s body, lit up by spotlights from the nearby rooftops, have been taken and shown to semi-interested friends and relatives around the world. I know Lord Nelson is orientated to look out to sea (or the river Thames at best) but maybe a rotating podium would help to make the image more identifiable when photographed from the only logical place that people tend to go.

And a late(ish) job to end the shift. A Green call for a dancing man who performed a leap of some kind (he was proud of having achieved it and called his partner to let him/her/it know) and landed hard on to his third toe, probably breaking it as a result. So, instead of packing ice onto it, elevating it and hopping home where he could pop into A&E and have it looked at, he had someone dial 999 for an ambulance. As you do.

I dragged my sorry tail up to the studio, which I know very well from many previous jobs of this nature and collected him for hospital. When we arrived the place was packed and he was sent to sit and wait.

Be safe.

Monday, 18 January 2010

Stroke day

Apparently this is how my name is written in Arabic.

Day shift: Five calls; one not required; one by car and three by ambulance.

Stats: 1 Haunted fire; 1 Near faint; 1 ?TIA; 1 ?CVA; 1 High BP.

I decided to do a bit of people-watching this morning as I sat idling on Trafalgar Square. At 8am, as commuters passed me by on their way to whatever they do for a living, I noticed that they all had a similar expression on their faces – neutral. I know they’d hardly be bouncing around with grins on their faces without reason and if they did, it would look mad but it made me think of the predicament of the human condition. Most of the time we look unhappy. There are probably a few cultures where the general population wake up and are smiley, happy people from the start but it isn’t here; it’s not us Brits.

Then I thought about myself and how I look from a patient’s perspective. It’s difficult to paint a smile on when don’t feel like it but every now and then my patients just light me up. Something they say or do – the fact that they smiled first... something triggers it and I feel better for it. What I try to do but find so difficult, is approach a routine call with a pre-set happy demeanour. I wonder how many of my patients would begin to feel better if I did that or are we so abused and down-trodden as a profession that it isn’t worth the effort?

Nobody smiled at me until a PCSO passed by; she beamed in at me as she walked on her patrol. A single smile acknowledging one uniform with another.

Smoke coming from a disused part of Holborn Underground Station – a haunted part I’m told by the member of staff leading me and the crew down to the platform – triggered a fire alarm and the Fire Brigade went in with breathing apparatus to locate the source. We stood on the platform as train after train crawled past and onward without stopping, unhappy commuters staring out balnkly at us. The station was closed and the acrid stench reaching our nostrils confirmed that something was indeed on fire behind the area inside the tunnel.

We were stood down eventually by a Duty Officer – nobody was dead or dying and the fire was being tackled by the Fire Brigade. HART was on scene now anyway and we became surplus.

The Underground has a reputation for being haunted and some very interesting stories have been told about things that happen, especially at night, inside the miles of meandering darkness. A self-ignited fire in a disused part (where an old station line used to run) will probably figure among those tales now. Maybe one or two of my readers work or have worked in these places – I’d like to hear any tales you have. We all would I’m sure.

A pregnant lady felt a little faint with blurred vision at work and called an ambulance, so I was sent, as is my remit, to assess and convey if necessary. AT 24 weeks into her pregnancy, she was bound to start feeling the physical effects and I reassured her about the experience, which she was recovering from when I arrived on scene but she still wanted to go to hospital and I obliged by driving her in the car and walking her to the ante-natal assessment unit.

After a quick cup of tea I was off to an hotel for a 47 year-old man who was experiencing right-sided numbness. He had no medical history of significance but had been panicking recently after attending a ‘life coaching’ seminar in which his entire human fabric was unravelled so that it could be re-built. This alone will cause psychological problems in people with lots to unravel, I would imagine (I attended one of these things in the ‘80s – two very expensive days of soul demolition and not a lot of benefit afterwards).

However, the numbness didn’t go away after ten minutes of chatting to him. His FAST check was negative and he could move and feel the affected side. His BP was normal, as were his other vitals, so I still think he was in the midst of a psychological crisis with physical manifestations. Or I could be wrong and he has had a TIA. A crew arrived to take him to hospital in case the latter spat out the former.

Another call in which the diagnosis could be flawed was to a 34 year-old pharmacist who suddenly complained of a swollen face and neck, which she attributed to a possible allergic reaction because she had a history of shellfish allergy. She hadn’t actually eaten anything with fish in it and it did indeed look and sound like a mild allergic reaction – itchy, puffy skin, nausea and that feeling of constriction in the throat. Her breathing was a little fast but she had plenty of oxygen getting in and could talk in full sentences. She felt ‘strange’ but was able to walk towards the ambulance, which turned up just before I was able to complete my obs.

The one element that I still hadn’t checked was her blood pressure. When it was taken in the ambulance it was very high – the high 160’s over the high 120’s. The reading was repeated just in case but it was correct. She had been suffering from blood pressure problems, according to her doctor, she informed us but she had been given nothing for it. Now she was sitting there with a significant indicator for stroke. Her neck pain (and now she had a headache that was getting worse) may have pointed to SAH, so she was ‘blued’ in immediately.

This call would have been taken in the car on the basis of a mild allergic reaction but her blood pressure changed the picture entirely and it was fortunate that an ambulance had been despatched anyway rather than wait for me to ask for one. Sometimes the odds we play are evens for one thing or the other.

A 40 year-old man working for the Government felt dizzy as he walked out of his workplace. He had no history of significance but was being seen by his doctor for high cholesterol, so when the crew arrived and we got him into the ambulance, we took his blood pressure, which was consistently high. He felt nauseous and looked stressed as he called his wife on his mobile to let her know he was going to hospital. He didn’t seem like the complaining type and so the way he felt was to be considered serious enough for him to worry about it and have an ambulance called. He may well be on his way to his first stroke.

Be safe.

Friday, 15 January 2010

Is that all you've done all day?

Day shift: Two calls: Two by car.

Stats: 1 ?O/D; 1 Epistaxis.

I’ve been going through one of those periods in life where an aspect of communication seems to be going wrong at every turn. Perspective is a funny thing and every one of us has a singular sensitivity to the way information is received – that means ALL information; spoken, written, visual... this is why I don’t particularly like texting when a complex situation needs to be resolved and it’s also why I tend to over-explain things when I am trying to get a point across. No amount of text, with or without so-called 'emoticons', can relay the real emotions that are being felt with the words - so anger, denial, impartiality and so on are often confused, misunderstood or simply not picked up at all in the sentence.

What is seen can also be misunderstood because all of the facts aren’t known, so something is perceived without true perception – this is a major cause of conflict with people and I have been at the sharp end of it recently without the means to defend myself because it’s impossible to agree a middle point with individuals who, for reasons known only to themselves, have a rigid set of rules over who they decide is right and who is wrong. It’s a form of prejudice and we can all suffer from it unless we open our minds and accept that we all can be victims of it. I’m just throwing this out there for debate. It's not a rant. :-)

Another slow day and a false start cancellation for a young woman with neck pain. This was followed a few hours later by a call to a 25 year-old man who’d wandered into a hostel and behaved ‘strangely’ after taking one (by his own admission) Risperidone tablet which he claimed he’d been prescribed by a GP, although he couldn’t tell me which GP and there was no packaging with the pills. He was very reluctant to even let me see the tablets and I was suspicious about the possibility that they didn’t actually belong to him but he insisted all he wanted to do was sleep and that he’d only taken one but the staff members I spoke to were worried that he’d taken a lot more than that. Obviously, if he is schitzophrenic, all of this is to be expected but his physical demeanor changed and this made it all a bit more complex. Had he taken something else? Had he taken lots of those pills?

His pulse was very irregular and his BP was on the low side, so the crew (who’d arrived on scene just before me) took him to the ambulance for an ECG. On the way he decided to have a smoke but I told him to wait. He argued a little but eventually gave in. He was a very cagey individual and I didn’t trust him instinctively. His ECG had minor anomalies that could be explained by his youth and stature but his BP was dipping and we had to elevate his feet to stabilise it. Strangely, his pulse became regular again and his ECG showed no slip in rhythm at all. If I was the only one who’d checked his pulse I would put that down to my dumb fingers but I had asked my colleague to check it too and she confirmed that it was very irregular – three beats then a long pause before the next one and so one. The change in his position may have rectified something or the single drag on the cigarette he’d just had might have some bearing (possibly not tobacco in it), I’m not really sure. Answers on a post card if you care.

He went into Resus just in case he’d swallowed a load of those tablets and not come clean but he was stable as a fish in water as we gave the handover to the doctor. Better safe than sorry I say.

Later on and I was back into the same hospital as overdose guy with a 22 year-old girl with learning difficulties who’d had a ten minute nosebleed and headache. Her support worker came along with her because she was in a basic skills class at a college when the epistaxis struck. She’d had a recent ear infection and it’s not unknown for nosebleeds to be associated with this – same tube structures and all.

In a packed A&E she was sent to the front to sit it out and I noticed my overdose man sitting on a chair with no life-threatening signs and no desire to sleep. I still don’t know what I was looking at with his whole pulse and BP thing but I believe I acted appropriately for the possibility of overdose. I’ll remember his face for future calls though.

The shift ended as it had begun, with a cancellation and I was happy about that. These slim-picking days are very long and tiring, strangely enough, so my run south for a last-minute possible minor cut to face, called in and subsequently cancelled by the police, was a relief.

Be safe.

Thursday, 14 January 2010

Emergency chin

Icebergs in the water on Trafalgar Square.

Day shift: Three calls: Two by car and one by ambulance.

Stats: 1 ?TIA; 1 Deep cut; 1 Assault.

Back on the car to watch the rain melt any remaining snow as the weather became a little less cold, giving us a respite from the fall-fracture and associated calls that have plagued the service over the past week.

It was a long time before I received my first call of the shift – it was lunch time in fact. I went to check on a 66 year-old man who’d developed left-sided numbness in his arm and leg. He had no medical history of any significance and he was able to walk, talk and complain about the number of times he had to repeat the story of his current problem. I apologised for being the one asking him for the fourth time and explained that I didn’t know it, so needed to hear it for myself. I thought about the earful the poor doctor was about to get for being the fifth person in line.

He lived with a disabled woman he called his 'friend' in a cluttered flat with the largest portable commode I’ve ever seen. She, to be fair, was a wide lady and the device was required because she was unable to move much – still the size of it had me staring for a few seconds. At times I was tempted to place bits and pieces on it, like my BP cuff and BM kit but remembered what it was used for and resisted to the point where I would be looking around the room for a tidy space that didn’t receive human waste on a daily basis. I settled for the floor.

The man rode quietly in the back of the car and was deposited in a cubicle to await irritating person number five, who would no doubt find something minor wrong with him – or he had suffered a TIA and would recover fully.

Later in the afternoon, after I’d been watching the ice melt on the Trafalgar Square fountains, a call came in for a 35 year-old man in a police cell who had a cut to his chin but was ‘bleeding seriously’. Now, I wasn’t sure how to take this one and I let my imagination run wild in supposition (maybe he’d impaled himself on something nasty) as I drove to the police station. Once in the Custody Suite (the police hotel), the nurse explained that the man, who was being guarded by five large cops as he sat in his cell, had been bleeding for four hours because he simply refused to have anyone dress it. He’d been to hospital and a doctor had stopped the bleeding for a short time but as soon as he was being returned to his cell he tore off the dressing and the cut bled even more aggressively. When I finally got to meet the patient I was shocked to see just how much he’d bled from what turned out to be a 4cm laceration under his chin. Drip, drip, drip it went onto his white clothing (worn as his religion demanded), soaking through and making it heavy. It was covered in large clots which had been created by the sheer accumulation of blood. His head, face, hands and feet were crimson. Nothing had escaped the staining – the cell door was smeared with it and the toilet bowl contained a pool of it. It was like walking into an abattoir.

I managed to make the man see sense after his initial resistance to go anywhere but home. ‘This is nothing’, he said unconvincingly. Only when I got him to really look at the amount of blood he’d lost (and don’t forget he’d been bleeding elsewhere for hours before this) did his face register the possibility that he might need urgent hospital attention. I haven’t yet seen someone die of shock as a result of bleeding from their chin and it would be another hour at least before he’d lost enough to make hypovolaemia an issue but he had seemed adamant about leaving it to leak all over the place. Now, at last, I’d gotten through to him and he was pressing a large dressing onto the wound – the pad soaked through in minutes and had to be replaced several times before the ambulance crew arrived to take him, escorted by four police officers, to A&E for stitches.

I watched as the five foot nothing man was taken out of the cell and into the ambulance and I noticed that he was more responsive to the male crew member than the female attendant – this may have been cultural because he’d also been a pain with the female nurse at the station. Of course, male or female, he didn’t like any of the cops.

I’d had a quiet day and was due to go home early anyway because I’d had no break (ironically) but the most irritating thing happened just as my last hour of work elapsed – I got an awkward, time-consuming call – Sod and his law.

A 30ish-year old man had been found wandering into the main road by police and when questioned had not responded – he seemed confused and edgy and had bruising to his face, cuts to his ear and an obviously fractured hand. A cycle responder colleague was already on scene and had requested me to have a look and take him to hospital – if they could catch him again, that is. By the time I showed up he’d legged it and the police were tracking him down, so I stood at a busy junction and chatted with my colleague about the patient.

Nothing was known about him except that he had been injured, possibly assaulted and that he was homeless. After ten minutes, he was brought back to us with three police officers (two plain clothed). He was a six foot plus dark-skinned man with a vacant stare. I asked him over and over again if he wanted to go to hospital and examined his hugely puffed up hand. He didn’t respond to me and he had a passive interest in his injury, so I asked the officers to get him into the car for the trip to A&E.

At first he was compliant but then he wanted out of the car and refused to go to hospital. I asked him a few pertinent questions to establish capacity but he either couldn’t or didn’t want to answer, so I had only two options – let him go and he might wander into the road and be killed or fall down dead because his head injury was severe... or ask the officers to section him under the Mental Health Act to enable me to take him against his will but for his own protection. Now this decision is always tricky and I waited until I’d driven him and the officers to hospital before I asked for the Act to be invoked. Until then he was convinced to stay in the car by the police with the capacity argument in our favour.

When we got to A&E he tried to walk away and repeatedly refused to go into the department. I asked a nurse to come out and see if she could sweet-talk him inside but that didn’t work too well and there was no choice but to use Section 136 to enforce his protection. So, the cops gently but firmly walked the man into A&E and the first available cubicle. Only then did the facts of his situation start to come out as the officers received new information over their radios. Allegedly the man had attempted to steal someone’s mobile phone and had gotten himself beaten up for his trouble. His reluctance to accept medical help was probably down to his guilt rather than a lack of ability to understand the consequences of his refusals and the time and energy that had been wasted trying to persuade him to get treatment for his injuries could have been spent on me and the cops driving to our respective homes, so I was a little annoyed with him.

Be safe.

Wednesday, 13 January 2010

Snow joke

Twinkle, twinkle.

Day shift: Three calls: One assisted-only; two by ambulance.

Stats: 1 Nosebleed; 1 Back pain; 1 ? Flu.

An ambulance shift for me today and the reason we only managed to get three calls covered was that I had an afternoon meeting to attend and that consumed the rest of my day. Oh, and sick Londoners were fewer and further between today as the snow floated onto their pavements yet again.

Epistaxis, or nosebleed, is usually of no consequence and there is no need for concern when it occurs, especially in young people and children (for whom the most likely reason is nose-picking) but when it occurs in the elderly or in anyone where the bleeding is significant, there may be an underlying problem. Posterior expistaxis can be serious and the 39 year-old woman we attended to at work had a familial history of brain haemorrhage; her young sister (in her twenties) died of one and now she was in the ladies toilets with colleagues, nursing a nosebleed that had gone on for more than 30 minutes and which had produced tissue upon tissue of crimson distress. She had lost no more than 100mls of blood but she was clearly worried about what was happening.

We took her to A&E – her vital signs were normal, although her blood pressure could have been a little lower for her age and the bleeding had stopped by the time she reached the hospital. As I said, most nosebleeds are inconsequential and do not require an ambulance but some can’t be ignored.

An 88 year-old man with back pain called us and we climbed five floors, past offices in a narrow building to reach his flat, which was one of five on the roof of the premises. The long-ago fire station had residences at the top and commercial units from then on down so it was very unusual. It also meant that come 5 or 6 o’clock and at weekends, the residents were completely isolated at the top of the building. Our patient was one of them. His flat was tiny, a little untidy and cold. His front room looked like a depot of some kind rather than a living space and although we had climbed a lot of stairs to reach him, he told us he used a lift to get out and about when he could. We used that lift when we left with him – it was a large goods lift, full of junk and bits of rubbish strewn around the floor. To get to it we had to make our way down a flight of stone steps and when we exited we had to snake along a darkened corridor to a fire exit leading into the street. This is how the old man got in and out of his home. We also learned from a worker on the premises that the patient’s own toilet had long since become unusable and that he had to use a facility two floors down from his little hovel.

He had severe back pain and hadn’t been able to get out for weeks to collect his prescription medicines, so his blood pressure (for which he had meds) was high and his general health was not good. This frail old man had finally lost his independence and by his own admission needed support. I spoke to a very kind ‘neighbour’ from one of the companies inside the building and he offered to run daily errands for the man and to ask everyone else to keep an eye out for him. We also completed a vulnerable adult form in the hope that he will get much needed care in the future – he simply can’t continue to live like that.

Our last job took us to a fashion clothing outlet with more security than Buckingham Palace. The place was staffed by well-dressed young people and the goods on sale were spread around as if they needed their own space to breathe. Designer handbags, jeans and shoes were presented without price tickets for the most obvious of reasons and it smelled as if the rich frequented the place more often than the not-so. The 21 year-old member of staff who’d almost fainted and had reportedly suffered chest pain had been panicking because she felt unwell. All our checks were normal and after a long chat and deliberation, she was left to the care of her colleagues and advised to go home and rest. She probably had ‘Flu and that meant a day or so off work. The possibility of those handbag and clutch prices making her sick existed too.

On the way out I suggested that my hi-vis jacket could be ‘souped up’ with designer flair and sold off as something kitsch but current. I got sympathetic looks and nods but no takers.

Be safe.

Friday, 8 January 2010

Bloody weather

I've been unable to get into work because I am virtually trapped at home by local untreated roads, so nothing new to report. I hope my colleagues have been safe and well out there though because we aren't as well off as the Red Cross and don't have 4x4's trucking around for our patients, so the tyre condoms will be on when things get tough...

Oh, thank you to the people who have pressed the 'donate' button and given a little to support this blog. One of you even paid for my next coffee and pannini! If you have no objections I will use the money to buy Harry and Scruffs stuff since their images have kept you all amused over the years (or months, in the case of little H).

I'll be back next week.


Friday, 1 January 2010

The start of it

Night shift: Five calls: One assisted-only; one false alarm; one by car and a two by ambulance.

Stats: 1 DOAB; 1 EP Fit; 1 Depressed actress (running call); 1 RTC; 1 Abdo pain

A female DOAB to start the busiest night of the year (6000+ calls) and a few minutes into my arrival on scene, she was off the bus but it took a few more minutes to get her to move on. This Scottish sleeper wanted to assert her right to kip wherever she liked.

The call number was heading into the mid-6000’s, mainly as a result of the spill-over from New Year’s Eve, when I was sent with a crew to an epileptic 11 year-old who was fitting. On arrival he was resting on the sofa with his foster carer on scene. He’d had a seizure but had recovered, so I left the crew with him because I simply added to the little crowd in the front room. As I stepped out into the freezing night, I was greeted by the sight of someone lying sprawled on the road in front of the ambulance and two women looking over her.

‘She’s cut her wrists very badly and she is suicidal’ said spokeswoman number one, who lived on the street and had witnessed this person ‘collapse’ conveniently two feet from the emergency vehicle. I looked at her wrists but the scars were old and she was a habitual self-harmer from the look of it, so I thanked the concerned MOPs, who had called another ambulance and the police for good measure, and attempted to get sense from the very drunken, unwilling-to-cooperate female on the ground. She slurred at me several times but I was unable to translate. Luckily the police knew her and when they turned up, they got down to the business of making her see sense.

The other crew arrived and I left it to them. Meanwhile, upstairs in the epileptic boy’s house, the first crew were completely unaware that a dramatic attention-seeking act had played out for their benefit.

It started to snow just after midnight and the first RTC casualty was an 84 year-old man who lost control of his car and crashed nearside into a lamp post, damaging the car on that side, bursting the tyre and deploying the airbags. I found him unscathed and sitting in the back of a police car – the patrol had been passing and were bemused to see him standing by the vehicle looking confused. It took less than a minute to establish that he remembered the entire collision (he’d seen a shadow on the road and swerved to avoid it) and that he was diabetic. A BM test revealed a low blood sugar level; not critical, just low enough to cause concentration problems, so I suggested he went to hospital for a proper check and to ensure that he’d come to no hidden physical harm as a result of what he describe as a '20 mph' impact.

This man told me of his wartime life and it cheered me to know that he was still independent and willing to take life’s knocks without blaming everyone else. ‘I’m an old soldier – I’ll survive’ he told me as he tried to convince me he could just go home. The police took care of his car and I drove him to A&E, where he tied his gown on around his neck instead of across the back of his shoulders – he looked as if he had a thin bow tie on. ‘I’m feeling better every minute’ he said as he trotted around his cubicle waiting impatiently for medical attention. I could tell he had other plans – his dinner date at the casino for example.

A late early-hours call for a French man with abdominal pain was a wasted journey because he was fit enough to walk over with his friends and be given directions to the nearest drink of water. He’d been drinking and thought something may have been put in it by someone else - but they all say that.

Be safe.