Casualty Department

Ambulance stories (26)

~ beetleypete ~ 11 Comments

Non-urgent

The London Ambulance Service used to have three categories of calls, in descending order of importance. The first was Red calls, originally given out as ‘Call Red-Accident.’ This was the highest priority, requiring immediate attendance, the use of blue lights and two-tones, and denoting something potentially very serious. The next, still considered serious, but not an emergency, was designated ‘LA4’. This was named after the form that was completed as a report on the job, and the Service had a duty to arrange a response within one hour of receiving a request.  Conversely, these calls were usually more serious than most of the emergency calls, as the patients requiring an ambulance had frequently been diagnosed with a serious illness, by a GP, or hospital doctor. They did not require the use of lights or sirens, and often ‘queued up’, until the delays had well exceeded the allowed 60 minutes.

The last category of call was a ‘non-urgent’ call, known as a White call, to show how it was the opposite of a Red call, so not remotely serious. These calls were varied in nature, though consisted primarily of conveying patients to clinics, for routine tests, and taking them home afterwards. The patients given this service, were supposed to be unable to attend hospital by any other means, whether because of illness, or because they were immobile as a result of injury, or a chronic condition. In reality, many were as able to make their own way as we were, and had managed to convince someone at the hospital that they needed an ambulance to get them there. The others might be amputees, or be grossly obese (it’s not a new thing), or suffer with dementia, or illnesses that made it unsafe for them to be out alone. The non-urgent label also applied to the countless hospital transfers that were ordered every day. This is long before part-privatisation allowed hospital trusts to arrange their own transport, or actually run their own fleets of vehicles, as is common today. Thirty years ago, most Central London Hospitals operated on many sites, and would transfer patients around from one to the other, like pieces on a gaming board. Because of the huge demand on resources, the Ambulance Service ran a dedicated, completely different fleet of vehicles, together with crews at various levels of training and experience, just to do all these White calls. When you were new, or did not want to work on the emergency side, this was your initiation into the work of the LAS; driving coaches, minibuses, and partially-equipped vehicles, to move all these people from home, and back again, and from one hospital to another, day in, day out.

However, this service finished at around 6pm, and did not run at all at weekends. During these times, the non-urgent work transferred to the emergency vehicles, and fully-trained crews.

We did not want to do these calls. Most of us had joined up to do the ‘glamorous side’ of the job. Driving fast, on the wrong side of the road, blue lights flashing, sirens wailing. We had been upset to have to do this non-emergency work when we first qualified from training, and had simply endured it (in my case for almost a year), waiting for the chance to get a full-time position at a station that just did emergencies. So, having served our time, the last thing we wanted to do, was to go back to doing White calls, which were considered boring, unnecessary in the most part, and more than a little beneath us, to be truthful. Of course, we were wrong. With maturity and experience, you begin to realise that a lonely old lady, brought in at 11am for an X-ray on a suspected fractured hip, becomes a virtual prisoner of the system, just as deserving of an ambulance as anyone else. Wheeled around from department, to clinic, and back again; tea shoved in her hand, perhaps a thin, floppy sandwich if she is lucky. After spending a day in a busy A&E department, being mostly ignored, a doctor finally decides that she has no fracture, and that she can go home. She is clad only in a nightdress, has limited mobility, and no money. She will not be able to contact relatives, as they are usually only too happy to get her off their hands. The doctor orders an ambulance at about 7pm. He agrees that it is non-urgent, and is told that it is a busy Friday night, and that it may take many hours to arrive; that is of no concern to him, as he has moved on to the next emergency, with other problems to solve.

So, the evening drags on into the night. A kind nurse has given the old lady more tea, but then she needs a commode, as she cannot manage to walk to the toilet. The nurses, trying to deal with stabbings, heart attacks, and road accidents, cannot really give her any time. She sits alone, behind a closed curtain, listening to the noisy symphony of a busy night in casualty. By midnight, she has been in the hospital for 13 hours, had two cups of tea, one half of a tasteless sandwich, and her temper is beginning to fray. By now, the night staff are so busy, there is no chance of more tea, or anything else to eat. The old lady drifts off to sleep, as well as she can, with bright overhead lights, and the shouting of the injured and the drunks, together with the interminable bleeping of monitors. When things calm down a bit, at 5am, we are given the job, a non-urgent call, to take someone home. We have been out since 10pm without a break, dealt with all sorts of aggressive people, numerous serious jobs, and we are hoping to finish our shift by 7am. The last thing we want to do, is to take home some old lady, who is going to be moaning and grumpy, because she has been in the department all night.

We remonstrate with our Control, telling them that it could be left until the day shift. They tell us to do it, as they have held it for too long. I turn to my good relationship with the hospital staff. If she has been there all night, surely another couple of hours won’t matter? They agree to hang onto her until the day shift arrives at 7.30am; I inform Control that she is going home later that morning, and they release us from the call. The old lady has now been on the trolley for almost 19 hours, and there is still no definite prospect of her transport home. We drive away, considering that we have won a small victory. It did not occur to me at the time, but we all of us neglected that old woman, showed her no respect, and did not care for her properly. I still feel bad about it, almost half my life later

Ambulance stories (8)

~ beetleypete ~ 28 Comments

Experience not necessary

This is another example of how experience does not always guarantee good performance, and how the wisdom of age can be cast aside by events.

One evening, I was working with the oldest, and most experienced man on our Ambulance Station. I was almost 40 years old, and he was over 50. Between us, we had some 38 years of experience in the job. Towards the end of the shift, which had been very busy, we were called to a traffic accident. It was described as a ‘hit and run’, a pedestrian had been knocked down, and the car responsible had left the scene. We had some way to travel to this job, and on route, we were updated on the radio; the situation was believed serious, Police on scene had advised us.

On arrival, things did indeed look serious. A man in his 30’s was lying across the road, which had been partially closed by Traffic Police. On examination, it appeared that the man was semi-conscious, smelt strongly of alcohol, and had a visible wound to his head. His shirt was wet around the abdomen, despite dry conditions, so my colleague removed it, to better examine the male. We immediately saw that he had organs protruding from a wound there, and soon ascertained that it was his intestines that were clearly visible. We applied a very large dressing, dampened to protect the exposed tissue, and advised the nearby hospital that we would soon be arriving with a seriously injured man.

I drove off, blue lights flashing, sirens wailing. In the back, my colleague administered oxygen, and closely monitored the patient, during the short journey to the local Casualty Department. Arriving at the hospital, we rushed him in to the Casualty, where a special Trauma Team was waiting. They quickly removed his trousers, to reveal a dislodged colostomy bag. What we had believed to be a torn abdomen, was in fact a surgical stoma, where a piece of intestine is left exposed to attach to the colostomy bag. The man was well-known to the staff there, and  he later confessed that he had been drunk, and tripped over the kerb, hitting his head, and detaching the bag attached to the stoma. There had been no car, and no traffic accident, all of that had been presumption on the part of the Police, and bystanders who had happened across him. Had we not allowed ourselves to get caught up in the drama, no doubt we would have worked this out for ourselves.

We both felt pretty stupid, and it took us a long time to live that one down.

Ambulance stories (2)

~ beetleypete ~ 22 Comments

Jimi Hendrix pubes

For those of you who do not know, Jimi Hendrix was a once-famous rock guitarist, who reached his height of popularity in the 1960’s. More information, and pictures, can be found at; http://www.jimihendrix.com For the purposes of this post, his hair is the only thing of interest. It was quite wild, usually in an Afro style, with a headband habitually worn around it. The reasons for this explanation will become apparent later.

Not all the interesting things that happen to you in the Ambulance Service happen as a result of 999 calls. It is a popular misconception that ambulances operate from specific hospitals, and are run by those same hospitals. This is not the case. In London, the whole area is covered by the London Ambulance NHS Trust, and the vehicles and crews are based on Ambulance Stations, at various points around the Capital. This means that they can go to any and all hospitals, usually choosing the nearest one to the incident, for convenience. In recent years, this has changed a lot, with specialisation, but at the time I am writing about (early 1980’s) an ambulance could go to almost any hospital, and as a rule, chose the nearest one to their own base. Where I worked, in the area between Notting Hill and Paddington, we tried, as often as possible, to use the small Casualty Department just off Ladbroke Grove. Our frequent arrivals here meant that we knew the staff well, and we were conversant with the layout of all the wards and departments. It was more or less a second home to us, where we could get the occasional cup of tea, meet up with other ambulance crews from different areas, and generally feel like part of the furniture.

This accepted familiarity also meant that we would help out, when we could. At that time, there was no computerised admission procedure, so we would fill out the name and details of the arriving patient in a large ledger book, like something Uriah Heep would have used in Dickens’ ‘David Copperfield’. These details were transferred to a smaller card, for the nurses and doctors to add comments to. If the staff were all busy, and we were at the reception window, we would also enter the details of people walking in off the street, as well as those of the person we had brought in.

One particularly busy night duty, there had been a lot of serious incidents. Added to the usual parade of unconscious drug users, violent drunks, and patients awaiting admission to the ward, it had all made for a difficult night for the staff. By the time things had quietened down a bit, around 4am, we arrived with instructions to take home a frail old lady, who had been waiting almost all day to return home after treatment earlier. The staff were having a well-earned tea break, when we entered their rest room to let them know we had arrived. After a brief discussion about keys, whether or not she had eaten, and what clothes and possessions she had, we heard the bell ring at the desk in reception. I told the staff to finish their tea, and that I would go and see what it was. In the small waiting room at the front, I saw a tall man, about 30 years old. He was of mixed race, with frizzy hair, and wearing a raincoat. He spoke politely, though he was obviously agitated, and asked if he could see a doctor immediately. I advised him that I would take a note of his details, fill in his card, and pass it to the nurse for assessment, and I began to do so. When I reached the section requesting a diagnosis, I asked why he had come to casualty at this late hour, and why he needed to see a doctor so urgently. “It’s my pubes”, he said, “they won’t stop growing”. This was uttered without a trace of sarcasm, and with complete sincerity, his face remaining severe and grave throughout, his expression one of concern, with furrowed brow. I thought at first that he must be mentally ill. I asked why he had not done anything about this condition previously, or seen his GP, instead of bothering a busy Casualty Department in the early hours. He was close to tears, telling me that his family doctor was of no help, and he could not be taken seriously, as it was not painful, or life-threatening. However, he told me, it was affecting his life in many aspects, and making him distressed, as well as depressed. I went back and told the staff. They were too tired to argue, and asked me to book him in, then someone would get round to seeing him eventually, and probably refer him to a psychiatrist.

We left, to take our old lady home, and had a bit of a chuckle about the ‘man with the pubes’. A couple of hours later, we had another job nearby, and had to go back to that same hospital. As soon as I dropped off my patient, I was met by an excited nurse, who ushered me into the rest room, hardly able to contain her giggling and obvious delight in something. ” You have got to have a look at that guy’s pubes” she hissed. She continued by telling me that she had never seen anything like it, in all her years of nursing. As the story unfolded, it turned out that they had brought the chap into a cubicle, deciding to have a quick look, before writing him off as a nutter. When he got undressed, he revealed a thatch of pubes, the like of which had never been seen before, by any of the staff. It was so amazing, that they were ringing other wards, so that their colleagues could get a look at the phenomenon. This man had been examined by more staff than if he had been at a private clinic, he must have thought that he had finally gone to the right place to get his problem sorted. Little did he know, that he was the subject of morbid curiosity, in the same way as John Merrick would have been displayed in Victorian times.

I was not going to miss out, that was for sure! I was given a white coat to cover my uniform, and I borrowed a stethoscope from a nurse. I would have to trust to luck that he did not remember me from earlier, or just presumed that I was one of the staff. I entered the cubicle with a flourish, barking in a loud voice, “good morning, what seems to be the problem?” He lifted the sheet, and raised his gown, no other explanation necessary. Luckily he was wearing underpants, though they were of the Y-Front type, so could hardly contain the veritable forest of pubic hair that greeted my gaze. From above the belly-button, extending down both thighs, almost to his knees, covering his genitalia to the point of invisibility, stood a four inch tall mat of hair, as frizzy as that on his head, and where the underpants intervened, sprouting like dark cauliflower florets, under some pressure. ” I cut it, and it just grows back like this really quickly” he told me, and I heard tiredness and resignation in his voice. ” Can you do anything about it please?”  “I will have to see” , I replied. Of course, what I did do, was to stifle my near hysterical laughter, then pass on my coat to the next in line to have a look, with the added inspiration, ” his pubes are like Jimi Hendrix’s hair, his pants even make the headband effect, you’ve got to see this!”

Sometimes, you just have to look on the lighter side.

Ambulance stories (1)

~ beetleypete ~ 29 Comments

The un-snippable turd

Sometimes, ambulances are called by other agencies, and not by the person in need of help. Railway staff make frequent requests for ambulances, whether in underground stations, or on the main line system. When you consider how many people are travelling on both systems on any given day in Central London, it is understandable, to some degree.

So, when we received a call on the radio to go to Paddington Station, it was not particularly unusual. We had added information, that a female was in a collapsed state in the toilets, in great pain, and unable to move. On the way to the job, with siren blaring and blue lights flashing,  we were in the habit of considering what we might be going to encounter on arrival. Using the basic information and diagnostics supplied by the caller, we could presume a whole number of things. Young female, toilets, great pain, cannot move. This could be a back injury perhaps, or maybe a gynecological problem. The pain of appendicitis, or kidney stones, could be very severe, and might impair movement. We would have to establish if the female was pregnant, as that could open up a lot more possibilities. Fortunately, Paddington Station is only a few yards from St. Mary’s Hospital, one of the biggest and best in London, with a very good Emergency Department, (which I prefer to call ‘Casualty Department’) so we would not be travelling far from the scene of the crisis.

On entering the station, we were met by staff, who quickly showed us down to the female toilets. They had thoughtfully closed that particular facility, to allow us to work in peace, and to leave room for the equipment we carried down, in case we needed it. It was soon apparent we were in the right place. Loud screams could be heard coming from a cubicle, and a worried-looking female Railway staff member advised us to ‘hurry up’. It is not easy to work inside a toilet cubicle that is already occupied by a sitting female, as I am sure you can imagine. Squeezing through the small gap available, I made a full assessment of the scene facing me. A shouting, near-hysterical young woman, aged about 25, was sitting on the toilet, legs splayed, bracing on the sides of the adjacent stalls. She was not wearing anything below the waist, and was yelling in a strange mixture of French and English combined. I have enough French to get by, and I managed a rough translation of her dilemma. ‘Get it out, quick, I can’t get it out, you do it, it hurts.’ She confirmed the location of the problem by raising her left buttock, and signalling between her legs with an agitated hand motion. I wondered what it could be. Perhaps she was trying to deliver a baby, not uncommon in toilet areas. Could she have sat on something sharp, or even been attacked, and have a foreign object impaled in her person? I managed to calm her down, stopped her screaming, and finally got her to co-operate. I gently lifted her from the seat, her arms around my neck, and I peered behind her, which given the physical restrictions of the situation, was not an easy feat.

What I saw, was a dark, hard stool, protruding from her backside to a length of some four inches. Or was it? It could have been a Mars Bar, or a Picnic, a Double Decker, or similar turd-like confection. It occurred to me that she may have been inserting it into her anus for personal reasons (not as unusual as you might suppose) and it had stuck there, unable to go all the way in, or come back out. But no, it was just a turd. Further questioning established that she was at the end of a short break holiday to London, she had become constipated, and tried to relieve herself, before travelling back to France. The recalcitrant bum-muffin had a short look at the outside world, viewed its fate, and decided to stay where it was. No amount of flexing of her young French sphincter would budge the first effort; it was literally un-snippable.

I decided that manual evacuation would be the only option, and handed her a latex glove, with instructions given to her in French to grasp the offending object, and snap it free. She refused, stating that it was too painful to contemplate. There was nothing left but to don the glove myself, and attempt the tricky manoeuvre personally. With no assistance from the panicking Parisienne, I was forced to crouch on the toilet floor, place my chin on her thigh, and reach around the rear of the toilet seat. This placed my face dangerously close to her arched pelvis, as she struggled to gain height from the bowl. No sooner had I come into contact with her stool, with no more than a brush of my hand, as light as a butterfly’s wing, she resumed screaming, and crying out that the pain was unbearable. By now, my temper was fraying. Her worried friend was yelling at me to leave the girl alone, and the Railway staff were asking how long would it be before they could re-open the toilets. I had to concede victory to the turd, and take it, and the girl, to the hospital.

I was far from happy. Although I am sure that it must have caused some discomfort, to have called an emergency ambulance to this nonsense was unacceptable in my view, and I told the Railway staff exactly what I thought of their actions. We had to wrap the girl in a blanket, place her into our small carrying-chair, and get her upstairs to our vehicle. She yelled all the way, as if we were deliberately hurting her, gaining the sympathy of the dozens of people on the main station concourse. There was increased volume as we transferred her onto our trolley bed, for the one minute journey to the Casualty Department. I handed over to the head nurse, unable to hide my annoyance at what I considered a complete waste of all our time. Luckily for the patient, nurses are unusually sympathetic by nature, so she was cooed over, and put into a comfortable cubicle. As the nurse unwrapped the blanket, to examine the girl’s nether regions, we could see the outcome of being carried upstairs in our chair, then transferred to the trolley. What had once been a proud, firm digit of a stool, now resembled a quarter-pounder burger, squashed flat against the young woman’s bum cheek.

I later found out that she had been given a laxative, and had manged to pass the rest of her package. Makes you feel all warm inside, for a job well done…