Том Рейнолдс – The Complete Blood, Sweat and Tea (страница 14)
I decided that we should ‘run for it’: if we got a pulse back it would be a purely temporary measure until his high blood sugar could be corrected. It was a very difficult removal – my back was spasming as we carried him down the 5 narrow, dark, winding flights of stairs and ran him across the 100 yards of pavement to our ambulance. Throwing him and his fiancée in the back of the ambulance we started the long run back to the nearest hospital. For 10 minutes I did CPR in the back of the ambulance while my crewmate tried his best to get through the exceptionally busy traffic – stopping and starting, swerving across the road, over pavements; he drove to the limit.
Throughout transport the only rhythm we had was ‘asystole’, which is when the heart isn’t beating at all. With our First Responder ‘bagging’ him and myself doing CPR we were doing all we could to support his life. During the transport the fiancée told us that he had had a previous arrest when he had stopped taking his insulin, but that he had, obviously, recovered.
Rolling up to the hospital we were met by the ‘Arrest Team’ – senior doctors from across the hospital. They descended on the patient, trying to get IV access, a secure airway and running diagnostic checks. It seemed, however, that the team leader didn’t want to listen to our handover. I was later told that he was concerned about getting the audit times right. The first thing he said was ‘the patient is biting on the airway’ suggesting that the patient wasn’t actually in cardiac arrest – because he hadn’t listened to my handover he didn’t know about the cramping episode earlier. The hospital staff did their own ‘pulse check’ and were confused about feeling a pulse (in a stressful situation doctors often feel their own pulse rather than the patient’s). It was only after some time that I could actually give the team leader a complete handover that he paid attention to.
The team worked on him for over an hour. His blood tests showed that his potassium was a sky-high 7.5; this was probably the main cause of his arrest. It transpired that the patient had renal failure and the high potassium and high blood sugar probably meant that the normal biochemical reactions in the body were being interfered with, leading to his fitting and cardiac arrest.
One hour later the patient was declared dead.
His fiancée was distraught; the patient’s parents had to travel 170 miles to the hospital and so it was necessary to tell them what had happened over the telephone – I can only imagine the drive down to London. The fiancée was convincing herself that it was her fault, that it was the argument that killed him, or that she should have recognised his symptoms of a high blood sugar before they became fatal. Both I and the nursing staff tried to console her, to tell her that it wasn’t her fault – but would the parents blame her?
I was thinking, would he have survived if we had remained on scene longer? Was making a run for it the right decision, given that I knew we had to carry him down the stairs? Would he now be alive if he had lived in a house rather than a flat? Did he die because he was an ‘angry young diabetic’ who didn’t want to comply with this treatment? He did have a history of taking an insulin overdose 2 weeks before.
It was a bad job, travel time was longer than it should have been, the flat was awkward to reach, it was difficult to remove the patient and the return journey to hospital was too long. It could have gone so much better. Although the patient might still have died it would have made us feel better. The job has left my crewmate and me a little depressed. Two deaths in as many days, one a ‘victory’, the other a real loss. I have today off so I’m going to relax and prepare for the joys of a night shift tomorrow.
One question for my medical readers: in the same situation would you ‘Stay and Play’, or would you ‘Load and Go’?
I got a couple of replies to the question above when I originally posted it online. The best was a mnemonic that I have taken to heart: L.A.T.E.R (Load And Treat En-Route). I don’t want to fool around on scene with a sick person who needs to be in hospital.
I’m feeling a bit fragile at the moment – these nights are really taking it out of me for some reason. I think the main thing that is getting me down is that I should be getting my HIV test result on Friday; as predicted, I haven’t been worrying for the past 3 months (is it really that long ago?) but with the result due, it is sitting at the back of my mind nagging away. I’m confident that I’ll test negative – even so I have the framework for two blog posts, one Negative, and one Positive.
Either way, I think I’ll be having a drink or two after I get the result.
At the moment there is some confusion about how I actually get the result. The receptionist at the clinic didn’t know if their telephone text messaging trial was still being used – I suspect that on Friday I’ll hang around the ambulance station after the end of my last night shift and then walk down to the clinic and get them to give me the result at 9 o’clock. It would be cruel to make me wait until after the weekend …
… So it’ll probably happen, or they will have lost the sample or something similarly evil …
Tonight, the only job to really stick in my mind was a ‘purple plus’ (someone who has died and is beyond our help because of the amount of time they have been dead). It was an 85-year-old female who died, leaving behind her husband of nearly 70 years holding her hand. A very sad job, he was putting on a brave face, but I think later today it’ll sink in. Hopefully, his son will be with him when it does.
So, dear readers, the next update to this blog (unless my leg drops off) will be after I get my HIV result; I’m not in a frame of mind to write anything legible at the moment (as I’m sure you have noticed). Hopefully, my next post will be Friday, but I’m a strong believer in the inherent evil of the Universe … so I’ll talk to you on Monday.
Yep, the title says it all: the HIV test is negative, the syphilis test is negative and hepatitis tests are negative.
Needless to say I am so far beyond ‘relieved’ as to be numb with it all.
I spent the last 20 hours awake, first at work, then in the ‘Clap Clinic’ waiting room; I now think I deserve a deep relaxed sleep.
Goodnight, I’ll write more when I wake up …
Posted at 11:13 a.m. local time.
Well … I’ve had some sleep so I can now post in a slightly more focused fashion.
First off, thanks again to everyone who has shown support, either through the comments box, or via personal emails – it’s all gratefully received. It looks like I’m going to have to find something else to die from now.
Tomorrow my brother and I shall be going for a nice relaxing drink, the first proper pub visit in over 3 months – there may well be a hangover involved.
I only had to wait 45 minutes at the ‘Clap Clinic’ for the test result – pretty hard to stay awake, but I think the emotional numbness that comes with exhaustion only helped me deal with the wait. The ‘consultation’ was over in less than 15 seconds: led into a room, asked to sit down and then told by a shaved-head counsellor that everything was fine. I didn’t have a massive flood of emotion (possibly owing to the aforementioned exhaustion), but afterwards I sat on a stone outside the hospital, rang my mum and brother, text messaged my old crewmate and breathed a sigh of relief. (Old crewmate told me that I had to go and repopulate Newham – something I don’t think I’ll be doing quite yet …)
I didn’t sleep well last night – I think a total of an hour and a half – so if I’m a bit incoherent I’d like to register that as excuse number one. No real reason for the lack of sleep, it’s a disadvantage of rotating shifts that every so often your body clock just throws up its hands in despair and goes to sulk behind the sofa, leaving you suffering insomnia and/or intense fatigue.
Last night was actually quite pleasant. The first job of the shift (at around 4 p.m.) was given as an 80-year-old male collapsed in the street. Making our way there we were beaten by not only the police and fast response car, but also by a Duty Officer who had taken an interest in the job. It turned out to be a drunken Russian, actually in his early fifties, who had decided to lie down and sleep it off in an alley. I suspect he was very surprised when he woke up to find himself surrounded by three police officers and four ambulance bods of various ranks. He was a pleasant enough fellow, who didn’t speak a word of English, so to be on the safe side we loaded him onto the ambulance and took him to sunny Newham hospital. When we got there (and remember that this is around 5 p.m.) the crew before us, and the crew who followed us, both had people who were worse for wear for drink. Luckily for both our patient and the hospital a Russian nurse was working, so he could translate that the patient had indeed just drunk too much and would very much like to be left alone so he could go home. I’m always impressed by people who can speak another language, two people talking what sounds like utter gibberish, yet making complete sense to each other never fails to entertain.