Reg springs a leak

We were way out of our usual area and it was late. I had never even heard of this particular suburb before, let alone been there. There were no available ambulances on that side of town, so my partner and I had been sent Signal 1 all the way across the city, flying along the wet freeway to try to get to a place neither of us had heard of. The job was given as a “Possibly dangerous haemorrhage”. I had the street directory on my knees and was calling out directions to try and find our way in to the big new estate with lots of dead-end streets. At one point we found our way blocked by a house. The map clearly said the street kept going, but the house in front of us was irrefutable evidence that it didn’t. Cursing, my partner hauled on the steering wheel and turned us around.

The house numbers were unreadable as usual so we took a small guess and pulled up out front of the only house in the street with a light on. Bingo! Our call-takers usually ask people to put an outside light on, lower the drawbridge and chain up the hounds. We like this because it usually means we don’t get eaten. However we do still occasionally turn up at houses with no lights on, large dogs running everywhere and padlocked 6 foot gates to try and get past.

Nanna met us at the front door - let’s call her Doris. She was wearing a dressing gown and looked like a normal old lady, except for the fact she was covered in blood. It was caked all down the side of her face and over her shoulder and front. She was wiping at it with a towel but much of it was already dried. She asked us to come inside and told us we were actually there to see her husband. We stepped into the hallway to be greeted by a scene out of a splatter movie. There was evidence of blood everywhere, Sprayed in arcs up the walls and all over the carpet. As we passed the bedroom Doris paused and told us that her husband Reg had been lying in bed next to her when she had woken because her face was wet. I looked in the bedroom and it was a real mess. Above the head of the bed the walls were sprayed with more arcs of blood which had dripped downwards. The sheets and pillows were dark red.

We were shown to the bathroom where Reg was seated on a stool in his pyjamas holding a washcloth to his head. “Hello” he said cheerfully “I’ve sprung a leak”. Carefully stepping into the bathroom to dodge the blood drops on the floor, I asked him what had happened. The sink and mirror next to reg were also covered in blood where he’d clearly been trying to get a look at where the blood was coming from – this resulted in an unusual bathroom makeover. Reg said he’d had cryosurgery that morning to remove a handful of skin cancers from the top of his head that morning. Cryosurgery uses (I think) something like dry ice to remove the spots and usually leaves a scab behind for a while. Reg told me he’d tried to stop the bleeding but it just kept going. Immediately I figured Reg was probably taking Warfarin which reduces the blood’s clotting ability.

Reg had obviously knocked one of these scabs off and somehow disturbed an artery. The scalp is highly vascular and tends to bleed a lot at the best of times, but Reg was clearly going for the record. I gingerly pulled the washcloth back from his head to get a look at the wound – a jet of blood sailed over my shoulder and I quickly pressed the cloth back hard. “Well I wont do that again in a hurry” I joked – very glad I was wearing my safety glasses. My partner prepared a dressing and bandage while I checked out Reg’s vital signs. His blood pressure was a little low and he had lost a fair bit of blood volume. We wrapped his head up like a mummy, got some IV access and loaded him into the ambulance. Doris was going to come along but changed her mind – I think she was aware of how much cleaning up she was facing. I hope there were some relatives to come over and help. We took the blood-soaked Reg in his striped pyjamas off to hospital to get his leak fixed.

I kept wondering what would have happened if Doris didn’t wake him up.

Fresh Air

Here is a job from early this morning: My partner was driving and I was in the “jockey seat” which meant I was going to be assessing and attending to the patient when we got inside. As we were going to a child who was short of breath, we discussed the normal values for a child of this age on the way (repiratory rate, heart rate, weight etc.). Its only a rough guide and every child is different, but at that time of the morning it also helps to keep you awake.

The grass in the front yard was knee high and there were two cars in the drive, one of which had no engine and some cardboard for a back window. I could see my partner’s breath on the cold air as we waited for the door to be answered. In this area, the fences are all chainmesh and the houses are old Government Issue, made from cement sheeting and originally built for the 1956 Olympic Games. Many are now pretty sorry looking examples of public housing.

The guy who answered the door was talking on a mobile phone and waved us into the lounge room before walking out into another room to continue his conversation. It was hot inside and the cigarette smoke was thick making it seriously hard to breathe after the chill of the air outside.

The girl was maybe 5 years old and we’d been sent to assess her for an exacerbation of her asthma. She was sitting on the couch with her mother and another smaller child. She was coughing and sniffling and looking miserable. I asked her if I could have a listen to her breathing and she nodded. She flinched when I put it on her back and I realised how cold the stethoscope must have seemed after being chilled outside. I inwardly kicked myself. Sorry sweetie that must have been freezing. She was moving good amounts of air and did not seem to be putting a huge effort into her breathing, but she did have a clear wheeze when she breathed out. She was running a temperature and looked quite pale. Every few moments she let out a hacking cough that belonged in an old person’s body.

Her mother appeared to be nodding off to sleep while I assessed the little girl and woke with a start when I repeated my question a little louder; Have you given her anything for her asthma? She had apparently been given “heaps” of puffs on her Ventolin but was not getting any better. She had been coughing on and off ‘for weeks’ and tonight she would not stop. My partner made a comment about how smoky it was in the house and that was certainly not helping the girl get better. She sat up, looked at my partner and said defensively; “we never smoke in the house”. I looked at the full ashtrays on the coffee table, the bong (pipe) on top of the TV and the cigarette packets on every surface and made a poor attempt to hide my disapproval. I asked had she seen a doctor about the cough – and she hadn’t, so I said well she really needs to be seen by a doctor.

She probably had a chest infection and an exacerbation of her ‘asthma’ from the environment she was in. It was not going to get any better where she was. I treated the girl with some Oxygen, Ventolin and warm blankets as we went to hospital.

I took the nurse aside at the Children’s Hospital and explained about the smoke – she told me she could smell it on us all when we walked in. I sniffed my jacket, she was right. Rancid. She promised they would try and educate the parents about smoking in the house. I doubt it will make any difference. Yeah maybe the girl could have waited to see a doctor in the morning and she was inevitably going to be back in that environment in a few hours. But we left knowing we had given her and her little brother a few hours of smoke free air.

Two Fingers

I have been a little lax with my updates. I will try to be more regular - note to self "Eat more fibre".

Last night was finger night. I'd hardly call 2 similar jobs a run of work, however when you don't attend a certain kind of work for ages and then suddenly you are off to two in a row - it does seem a little odd.

First was to a chap at a house that was being renovated. I think they were working back late on it and it looked like all the cousins and brothers were gathered to help. The place was well lit with those double builders lamps on stands and it was looking good with polished floors and fresh paint going on all the walls. Nice. The trail of blood led down the hallway to the bathroom where we found 70ish year old "Joe" who had sliced himself a beauty while cutting a piece of ceramic bathroom tile.

Joe was on wafarin to "thin his blood" and as a result he was not clotting very well. Still actively bleeding despite a handkerchief and a filthy tshirt wrapped around the wound. Joe had a deep slice running the length of his index finger and curving into his palm. It was going to need more than a few stiches to repair. We cleaned and rewrapped his finger using a big pad and bandage then wrapped him up like a boxing glove to try and stop the bleeding. Joe was asked to try and keep his hand elevated above his head, but he was so busy waving his hand and telling all the relatives how to paint, how to tile, where to put the rubbish etc, that I was contemplating tying his hand to the roof of the ambulance. Anyway despite his protests, we dragged him off to hospital where the hand specialists would need to have a look at him to decide how to put him back together.

Next we went to "Frank" the mechanic although he pronounced it "Frunk". I'm still not entirely sure how Frunk crushed his finger, as he had driven himself his doctors clinic going past 2 hospitals on the way. It seemed he had been working on a car when something (a chunk of engine maybe) had dropped on the back of his hand, which crushed and sliced the middle two fingers on his right hand. Frunk could close his hand into a fist with a great deal of pain, but was unable to then straighten his fingers again. This meant likely tendon damage in itself but when I inspected the wound with a torch I could see right through to the bones and damaged internal structures.

Frunk was in for a long night at hospital while the surgeons attempted to reattach his tendons and get his hand back into some kind of working order. I could see he knew he's messed up and this was going to impact on his work for a long time - if not permanently. It was of course up to his hand surgoen to tell him the prognosis. I gave him some pain relief, took the indecypherable letter from the GP and we walked out to the ambulance. On the way I tried to get more of a story as to what happened, but Frunk just talked round in circles. Sometimes you just never find out.

Ooops.

A few days ago a crew was notified by the police that it was safe to enter a scene:
http://tinyurl.com/24oqnj

It turns out that decision was perhaps a little "premature" and now there are quite a few people on both sides of the fence having a look at what happened. This kind of thing has happened many times before with varying degrees of seriousness. These scenes are often chaotic, always difficult and I'm sure it's easy for human error to occur in the heat of the moment. I'm glad this time none of the people (police and ambos) who responded to this scene got injured while trying to help this patient, but I also hope this issue gets sorted out.

Escaped!

After all this talk of prison last week I thought I tell you of a recent jailbreak. We found 87 year old Enid sitting outside the bakery in Glenroy. She’d somehow come to the attention of the staff who’d called an ambulance because they thought she must have been unwell. Enid was immaculately dressed, with her hair perfectly done, an ornate brooch, a pressed blouse and a simple handbag in her lap. My partner was astute (awake) enough to notice our Enid was wearing only one earring – women are definitely more attuned to that stuff - I have to look down and check that I’m wearing pants some days after nightshift, let alone notice what nanna is wearing. Anyway, despite being slightly miffed I hadn’t spotted it, I had to concede it was a good pickup. The missing earring said right away that something wasn’t right. And someone as well dressed as Enid was not leaving the house til everything was just right.

Enid clearly had some dementia. She would answer our questions to the best of her ability but then when she didn’t know the answer, would ignore us, lean forward and look down the street like she was expecting a bus to come along, or perhaps somebody she knew. If you smiled at her, she would return the most genuine smile and say “Hello dear” like she’d just met you all over again. She was beautiful old nanna and my partner and I were both ready to take her home. Sadly our service frowns upon you keeping patients as pets, so we set about trying to find where Enid was from. A few phone calls later and I spoke to the nursing home a few streets away – It turns out yes, as a matter-of-fact they do normally have a resident called Enid, but today they couldn’t seem to find her. Would they like her back? Why yes they would!

We made one last call to our Duty Manager to notify our intention to return Enid and her earring to the nursing home and then we loaded her up, checked her out and drove round the corner to the home. I rang the buzzer and chuckled as I said “are you missing an Enid?” into the intercom. I let the staff know about her missing earring and they promised to look for it. Apparently that morning Enid had got all dressed up as she always does and “headed off to church”. Usually she is apprehended at the door before she gets far, but today she’d somehow made it past 2 key coded security doors, out of the grounds and down to the local shops. Not a bad escape for an 87 year old in broad daylight. We waved goodbye and then headed off to our next job.

Do not pass 'Go'

Well I finally got sent to jail. I knew they'd eventually catch up with me one of these days. Actually, I got sent to jail (or Gaol if you prefer) 3 times in two days!

First it was to Juvee (juvenile) jail, the children's 'prison' for a chest pain. I could tell the medical staff there thought the young man was "putting it on". I thought so too. But everyone was erring on the side of caution so we took him to hospital along with a carload of minders who would have to sit with him until the doctors decided he was clear to head on back.

Next day it was off to one of the city Police Stations for a prisoner who was having a seizure. This guy was doing a pretty good job of it too - except he was opening his eyes every now and then and looking around to see who was watching. I have found a lot of people in police custody think that if they get taken away in an ambulance, whatever charges the police have laid are suddenly going to disappear. It rarely works. People invent all sorts of medical complaints and an ambulance has to come down and check them out. Often we all know its crap - the prisoner knows its crap, the prisoner knows that we know its crap and the hospital staff give us 'the look' because they know its crap too. Everyone is busy covering their butt.

Last thing before we knocked off for the day, it was off to the Remand Centre in the city. This inner city prison is the full deal and security is tight. Our patient was 'generally unwell' and although he was simply complaining of stomach pain and nausea, he was a bit agitated and twitchy. He kept yelling out to someone who was obviously held somewhere near enough that he figured he could be heard yelling his obscenities through the walls. The staff kept telling him to pull his head in and answer our questions. There was clearly a lot more going on than we were party to. After checking him out, we saw that he wasn't dying and the medical staff had him well under control.

We got out of prison for good behaviour and felt very grateful to be going home.

Anniversary

Oh dear - I'm hopeless. I have just realised I have missed my blog's anniversary. Along with a few other things in my life, it has fallen victim to the post nightshift haze. Here was I thinking I'd only blog this stuff for a couple of months. Then I said to myself I'll keep going til Christmas, now more than a year has gone past and I'm still tapping away, albeit somewhat sporadically!

Thanks to everyone who has been visiting, reading and posting, it has been great hearing from you. And of course lets not forget those who are occasionally spamming the comments section, your generous offers of cheap software, viagra and share market tips really make my day :)

Anyway I don't have any candles, but there is one beer in my fridge - it seems only fitting to drink it now.

Grief

We all know different cultures handle grief and loss differently. For some grief is a very quiet, private and solemn affair. Some wail, pull at their hair and make a lot of noise. Still others might dance and sing. Each person goes through a grief process, dictated by their own feelings or culture. And yes much has been written on that grief process. In my work as a paramedic I have seen grief handled in many different ways, sometimes surprising ways and sometimes wholly expected.

The other night I was asked by a family to transport a woman whose main complaint was grief. She had suddenly lost a relative in a conflict overseas and after much open and vocal grieving had now ‘shut down’. She was not talking to anybody, was lying on the couch, refusing to open her eyes, refusing eat or drink and was worrying her large family who had gathered around her. I struggled a bit on the night as to what was the best course of action for this woman, she wasn’t physically unwell and although you could argue she had experienced some kind of emotional breakdown, she was actually grieving, and grief is something that I don’t think western medicine handles very well.

Her family were adamant that she needed to go to hospital and be seen by a doctor, she appeared to be wishing we would all go away (yeah I know that’s me projecting onto her) and in the end even after we suggested that a locum doctor (home visit) might be more appropriate for her – meaning she would still be seen but could remain at home rather than waiting at hospital – the family insisted that we take her. I’m still not convinced it was the right thing to do.

Has anyone else been to something like this?