Recently, after a bit of a break away, I had a couple of shifts working in A&E. I really enjoy working in that environment, not least for the interest factor. Some shifts in particular I find that I can entertain myself for hours trying to figure out the real story behind the euphemisms I’m regaled with. Predictably, there were an assortment of unfortunates who pitched up hoping to be fixed. In one day I dealt with;

• A man who said that he ‘accidentally licked the tip of the spatula – you know what I mean?’ while he was etching metal with acid and sustained burns, not to his tongue, but to the uvula – that’s the bit that dangles down at the back of your throat
• A man who said he was ‘dusting the picture rail’ while standing on a ladder that slipped from under him causing him to fracture his knee-cap (patella)
• The young lad who cut his hand on a broken glass while ‘washing up’
• Finally, a man who had ‘been walking the dog’ through a park (wearing long trousers) and arrived home to discover that an opportunistic tick had attached itself firmly right in his buttock crease

While I actually don’t know what some of these euphemisms may stand for, I don’t think that any of them came close to describing the reality.

I reflected on how the tick  may have really got-where-it-got while I cautiously removed it from the buttock, and just this once I’ll give him the benefit of the doubt…. but, the story about the man ‘dusting the picture rail’ – you don’t really expect me to believe that do you?!

After discovering his very kind review of my book in the Nursing Standard I felt duty bound to purchase and read Dr Nick Edward’s book in return.

I don’t normally read books of the medical genre because:

a) I live and breathe medical type issues for the day job and I usually prefer to read Italian fiction and in particular Italian crime fiction as a form of escapism.

b) I worry that these books will influence my ‘unique’ writing style.

c) I worry even more that they will make me realise how pale my efforts were in comparison and then I’ll be forced to seek out more Pinot Grigio than usual to drown my sorrows.

However, I really enjoyed the book and found his writing style very engaging. He comes across as a genuinely nice guy; not only the type of doctor that I would like to work alongside and perhaps be mentored by (if you’re reading this Dr Nick – please take note), but also the type of doctor who I would like myself or my family to be treated by should we ever require the service of an Emergency Department – although perhaps that important fact should have been said first…

Dr Nick Edwards is a non de plume and if I’m honest, I rather envy those who write under a pen name.  How wonderful to have that freedom of speech, confident in the knowledge that your true identity will remain secret, leaving you free to tackle with gay abandon some of the meatier issues without recourse – I’m far too much of a coward to be controversial while writing in my own name.

Jealousy put aside, I found it to be a well written, interesting, funny and easy to read collection of stories. All the elements one would expect to find in a book of this genre are played out. Tales of happiness and heartbreak, integrity and ignorance are peppered with insightful observations on the behaviours of the NHS, patients and other members of staff. Dr Edwards manages to illustrate perfectly how government policy has had its impact over the years – sadly not always for the benefit of the patient (in fact it was within those observations where I found most of the heart breaking and ignorant elements).

Dr Edwards and I may work within different professions, but I found his thoughts and experiences often echoed many of my own. As a paramedic, I was pleased to note that he referred very positively to the ambulance crews that he dealt with. Initially however, I was left wondering where in the country he worked, because it appeared that whenever a patient was brought in by an ambulance crew they never seemed to have had any paramedic interventions performed. For example, when cardiac arrest and trauma patients were brought in, it was Dr Edwards who tubed them, gave analgesia, Narcan and put in lines/IOs etc as paramedics stood impotently by. I should have thought that patients who were coming in by ambulance would have these bits already done – surely this couldn’t be happening in London? This started to bug me and so I asked Dr Edwards about my observation. In his reply he pointed out that a lot of the tales in his book were pulled from times gone by, since then the number of paramedics has risen and the amount of pre-hospital interventions gone up massively. From a personal point of view while I would have liked to see the full gamut of skills that paramedics use reflected in the book – obviously this should never be at the expense of historical accuracy!

In summary: A great read that will interest health care professionals and lay folk alike, highly recommended.

(Click here to see the book on Amazon.co.uk)

Carpet Deep Clean, by flossyflotsam, on Flickr

Working on the car recently, I was called to a large gated residence situated on a private road. A retired professional couple lived there; Mr Middleton, (not his real name) called because he was concerned that his wife, who’d been having antibiotics for a chest infection for a couple of weeks, seemed to be deteriorating rapidly.

I approached the huge wooden front door via the ‘scenic route’ crunching up the gravel drive that snaked around the flower beds (even though skipping through the flower beds would have considerably shortened the distance).

Mr Middleton greeted me and welcomed me in to a grand wood-panelled hallway with parquet flooring and antique furniture. He took me up the sweeping staircase, to a huge bedroom complete with en suite bathroom and a pristine white shagpile carpet.

As we climbed the stairs Mr Middleton explained that he was worried about his wife because although she could walk to the en-suite bathroom not two hours before, despite expressing an urgent desire to use the toilet, she now seemed unable to even get herself out of bed and was becoming very poorly.

As I entered the room I could immediately tell that she wasn’t well. She was breathing quite fast; she looked very flushed and was sweating profusely. I quickly took her observations and they were significantly abnormal, enough for me to decide that she needed prompt admission to hospital (CRB-65 Score = 4). Her pulse was racing and her blood pressure was rather on the low side; she also seemed quite confused. This, along with the fact that she had gone from being fully mobile to immobile in the space of 2 hours, concerned me a lot.  I explained this to the couple, telling them that I wanted an ambulance to take her in to the nearest hospital with an A&E department because she would probably need further tests, x-rays and intravenous antibiotics. The husband appeared to take on board what I was saying, but Mrs. Middleton seemed more concerned that I shouldn’t soil the carpet with my boots than about her deteriorating medical condition. I took a sneaky peek down and was glad to see that all though there were some small pieces of gravel wedged in the tread, my boots were clean and I hadn’t made any marks on the immaculate carpet – I reassured her about this but she continued to question me on it constantly. She then said,

“Anyway, I’m not going to the local hospital – I want to go private”

“Private hospitals don’t accept emergency patients” I tried to explain, “There is no A&E department and so no provision for this type of situation”

“Well you can go away then, my husband can take me there in the car. I’m not going in a NHS ambulance, I want a private one” she unsuccessfully attempted to get herself up out of bed as she spat the words out at me.

“And I don’t want to go in to a bloody NHS hospital”

“Let’s be sensible here, you can’t get to the car because you can’t walk – that’s why I am worried about you, if you try to stand you will fall because you are unwell and very weak, you may injure yourself” I reasoned.

She wasn’t having any of it and continued to try to get out of bed. I asked the husband to help me persuade her to travel in an ambulance to A&E but he seemed reluctant to go against his wife’s wishes. In fact he even started to try to help her get out of bed! I pleaded with them both not to continue with this but it was all to no avail. Predictably, perhaps, she then fell and was incontinent of urine as she lay on the floor. At this point I insisted on calling an ambulance to back me up; things were getting out of hand. I told them both that I could understand that they may not be happy about my action, but I believed it was the safest, if not only viable option and finally they reluctantly agreed.

The ambulance arrived promptly and as the husband brought the crew in to the bedroom, I cringed as I noticed that one of my colleagues was treading in some squashed garden matter on the underside of his boots, unwittingly leaving a trail of evidence wherever he walked (he’d obviously unwisely decided against taking the ‘scenic route’)  I’m sure Mr Middleton noticed too – but neither of us were brave enough to say anything – things were bad enough as they were and this could have pushed poor Mrs Middleton over the edge! As it was, Mrs Middleton was taken to hospital muttering and complaining all the way, none the wiser about the fate of her carpet. Perhaps Mr Middleton had it cleaned before she returned from hospital, because to my knowledge, no letter of complaint has arrived – as yet…

'Domestic Violence' by Like_The_Grand_Canyon on Flickr

This chap came in to an Urgent Care Centre where I was working with a young lady and a toddler in a buggy who looked about two years old. After our polite introductions he said to me;

“I’d like you to document all my injuries; I’ve been a victim of police brutality and I’m covered in bruises” He started to pull his sweater off to show me his war wounds as he spoke.

“Oh dear, let’s start at the beginning, when did this happen?” I asked. “Tell me all about it….” He proceeded to fill me in and said something like this….

“It happened five days ago. I don’t drink often, but when I do – well you know…. well I can go a bit mad. This night me and my bird both had a few cans and we was well p***ed up. I can’t hardly remember it to be honest. Anyway, me and her started fighting. I called the police ‘cos it was getting right out of hand. When they arrived though, I wouldn’t let them in to the flat and they had to kick the front door in. If you knew me, you’d know I wouldn’t hurt anyone; I’m more of a danger to myself than anyone else if I’m honest. But, when the police got in, I had this bread knife in my hand, I only waved it at them, I wasn’t gonna use it to hurt anyone. Well, they just all piled on top of me – half a dozen of them. They pushed me face down to the floor and held on to my arms and legs, they banged my arm to make me drop the knife. Look at the state of me – I’m covered in f***ing bruises. But what I don’t understand is that I am right handed, and it’s my left arm that is really bad – look at it it’s black and blue, and look where the handcuffs were – they was put on too tight” 

“Where was the child during this? He must have been very frightened” I asked.

“No, he was alright, he was in his bedroom, he’s used to anyway it we’re always rowing” they both chorused laughing.

“It’s her I normally get the bruises off!” he pointed mock accusingly at ‘his bird’ who raised an eyebrow as she turned her head away smiling.

“Like I said I can’t even bloody remember it ‘cos I was that drunk”

After enquiring about his normal state of health, medications and allergies, I conducted a full examination and logged all his injuries as requested.

We talked about how, as an epileptic, he shouldn’t have been drinking alcohol with his medication. He said he realised this and that’s why he rarely drank (only a couple of times a week in fact), but he admitted that when he did drink, things could get ‘ugly’ and they’d often end up arguing. Sometimes their arguing spiralled in to more dangerous territory and slaps and punches were exchanged between them.

At the end of the consultation I could bear it no longer – I asked him how much responsibility he was willing to accept for what had happened to him. He didn’t seem to know what I meant. So, I suggested to him that if he was aware that things got ‘ugly’ when he got very drunk (his word not mine) he may wish to seek help for his harmful drinking, perhaps they both should I added. I pointed out that this would be for the good of their child as well as themselves. I then said;

 “As a paramedic and with friends and colleagues in the police service I am used to being called to situations such as this. We have the right to go to work and not be threatened or stabbed with drunks with knives and should be able to do what is necessary to keep ourselves safe. We have families that we love and wish to return home to at the end of our working day. If you hadn’t got yourself in to that state, called the police to your flat and then waved a bread knife at them, we wouldn’t even be sitting here having this conversation would we?”

They both seemed genuinely surprised that I saw the situation in this way.

“Well I don’t even remember it like I said but when you put it like that I suppose it’s fair enough” he shrugged. I surprised them again when I told them that I also now had no choice but to refer the child to Social Services.  They had told me clearly that the little lad was regularly exposed to Domestic Violence (DV) in his own home between the very people who should be keeping him safe from harm. How awful for him to have to be around to hear or even see his parents yelling, throwing insults and punches at each other. How could they look after him when they were regularly too drunk to realise how damaging their behaviour was for all involved.

There is a strong correlation between DV and child neglect and abuse and factors such as problem drinking increase the likelihood and risks to the child. Once a health professional becomes aware of the presence of DV they have a responsibility to make a referral to Social Services for any children less than 18 years of age in the household. If the danger is believed to be significant or imminent then obviously the police should also be alerted promptly.

If you are worried that a child is being neglected or abused or witnessing Domestic Violence please refer to this helpful advice from the NSPCC or call the police.

Image by pinguino on Flickr

After years of being in the role of care provider, suddenly a couple of weeks ago, late at night, an unbearable pain in my tummy meant my husband had to pop me to our local A&E department, the hospital where I trained as nurse and have worked intermittently in various guises since. Now I was the recipient of care and that takes some getting used to.

Abdominal surgery rapidly ensued and I remained in hospital for a little over a week, nursing what shall hereafter be referred to  as my ‘Italian Job’ -  the large laparotomy wound that bisects my tummy north to south, skirting tightly around my belly button. The ’job’ is Italian because a delightful young dottore from Napoli was my surgeon. For any of you who know me, you can imagine how much it tickled me that it was an Italian who was to be my saviour. Not that I would have welcomed a tickle, because it hurt to laugh or cough or do anything come to think of it. Even the simple act of blowing my nose became a very gentle past-time that barely made the tissue flutter.

They say laughter is the best medicine, and while I’m sure that many drug companies would dispute this it certainly helped me deal with my hospital hiatus (just so long as I held my tummy to stop the jiggling hurting it). Let me tell you about a couple of times that I felt lucky not to have burst my stitches…..

One particular evening I entertained guests at my bedside (as you do). They sat enraptured, while I regaled them with all of the gory updates on my bowels. A delightful and rather deaf elderly lady who occupied the bed next to mine said nothing at the time but hardly took her eyes from us.  The next morning she approached me, and raising an eyebrow she leaned in close, and shouted at the top of her voice:

“I HAVE NOTICED THAT YOU’VE BEEN HAVING RATHER A LOT OF YOUNG MALE VISITORS SINCE YOU’VE BEEN IN HERE.”

“Yes, I have, yesterday it was my son and my nephew who came to see me” I replied quickly – and quietly, before she could cast any aspersions on my character.

“MMMM, YES, I THOUGHT THAT IT COULD BE SOMETHING LIKE THAT OR ELSE I WONDERED IF YOU WERE HEADING UP SOME KIND OF POLITICAL PARTY” She then shuffled off. Having obviously given it a good deal of thought overnight, this was the only plausible explanation she could come up with!

As a patient, the modern dilemma of mobile phone etiquette is an interesting one. The signs clearly say they should be switched off when in hospital. But to the modern girl-about-town like me, they are a lifeline to the outside world. I compromised by putting it on silent and tapping out discrete texts as the need arose, stepping outside the clinical areas to make any calls; I think I got away with it.

The lady in the next bed had a mobile phone – but not a clue what to do with it, she couldn’t even make a simple call and when it rung she would just look at it flummoxed. This meant that in order to assist her, at the first ring I would have to begin to rock myself into a sitting then standing position and shuffle to her bedside before it stopped. Once I had helped her answer it, she would proceed to shout at the poor caller as if they were on the other side of a football pitch until their ears bled.

The next day, my noisy neighbour was replaced by a very young lady and she brought her own bad phone habits. This popular young lady was in possession of more than one phone and the recipient of many, many, many text messages, BBMs and albeit less commonly, phone calls – each with their own unique (loud) musical ring tone.

So, this particular afternoon the gynaecological doctor has come to examine the young lady.  I’m flicking through a copy of Italia magazine (naturally!) trying to distract myself as the doctor discreetly explains in hushed tones on the other side of paper thin curtains, that he just need  ‘to pop the speculum inside to have a little look at the cervix’ and then says  ‘yes, sorry it is a bit uncomfortable, but shouldn’t take long’. Then the sudden jolting shock as we are aurally assaulted by the sound of chart hit LMFAO ‘Sexy and I know it’ blasting out of her mobile phone – quickly followed by a long drooling “Alriiight” as she only goes and bloody well answers it! At this point I have to admit I stopped reading, I was keen not to miss what would happen next (and anyway I had to put the magazine down as I needed both hands to stop my belly jiggling).

“Would you like me to leave or should I carry on?” Asked the doctor, mindful of his patient’s right to privacy.

“S’alright carry on” She replied, then continued with her phone conversation while doctor did the necessary! Dom Joly could have had a field day with that one!

As a patient/nurse/paramedic you know it’s time to go home when you start taking bed-pans to the other patients and so they kicked me out and now I’m all fixed and back home with my family. I can’t praise the staff at my local hospital enough for the care they gave me. Everyone I came into contact with was a credit to themselves and their profession. My final words – Long live the NHS, our national treasure!

Image by JackBetty on Flickr

I saw a lovely patient this week, he was a very shy young man who didn’t speak much English but sadly he had just been mugged. There were three of them and only one of him – so violence really wasn’t necessary, but still they punched him in the face a number of times as they ripped his mobile phone from his hand.

Some women were standing at a bus stop nearby and witnessed everything. Immediately one called the police. Additionally, the other woman had the incredible presence of mind to capture the attack on her mobile phones. It was a brave thing to do, had the men seen this they most certainly would have wanted to get the phone containing the evidence from them and I doubt they would have had any qualms about using force to achieve this.

The police arrived very quickly, but the men had already fled the scene. However, the women handed over the footage on the mobile phone and very shortly afterwards the group were spotted and arrested for the crime.

Even though the victim would soon have his mobile phone back, he was in a lot of pain because he had sustained a broken jaw bone and needed to go to a hospital with Facial Maxillary facilities for surgery. But I would like to say well done to those Good Samaritans who can feel very proud of themselves. Without their selfless quick thinking the cowards may have very well got away with it.

I don’t know if I believe in karma but it certainly seemed to come in to play with my patient last week. Although he was seen fairly promptly and spoken to politely, he was an impatient and somewhat objectionable man from the moment we made contact.

As he told me the story of how he obtained his injury, I could just picture the scene! He barely concealed his anger as he recounted the story in great detail, of being ‘cut up’ by a young driver of a tatty Fiesta as he was driving along a local road. He told me that he eventually managed to manoeuvre his car in front of the lad who was forced to come to a halt (and who from his description, sounded terrified).

Our chap then pulled the lad from his car and started telling him what he thought of his driving ability as he jabbed him in the chest repeatedly. And that’s when it happened…

As he jabbed away with his finger at the poor young lad’s chest – the force of the impact caused it to dislocate! This obviously brought a swift end to the situation, it probably also brought a tear to the eye and a few choice expletives. No doubt it also caused a sign of relief from the young driver too – who took the opportunity to make a dash for it!

With no one remaining to take his frustrations out on, Mr Angry then drove himself to the emergency department, still rather cross, to get the finger sorted out.

Even after I had got his finger pointing in the right direction he remained rather grumpy, and left the department muttering under his breath; he didn’t even say ‘Thank you’!  – There’s just no pleasing some people!

Image from madehow.com

My first patient a couple of weeks ago was worried because following a routine visit to the dentist’s surgery she had come away with rather more than she bargained for.

The dentist was working on one of her molars and during the procedure the drill bit came loose and was swallowed before the dental assistant could suck it up.  Dental drill bits are commonly formed from tungsten carbide particles and are usually less than 3 cm long. Luckily she swallowed rather than inhaled the bit as things could have been a lot more serious giving rise to some serious breathing difficulties. We reassured her that nature would take her course and that there were unlikely to be any adverse incidents as the bit passed through her digestive tract. We advised her to seek medical attention if she had any new or worrying symptoms. The dentist had given her instructions too; he had asked her to look out for the bit so that she could retrieve it and return it to the surgery – apparently they are quite expensive! Say arhhh!

Image by acme on Flickr

I think that you can often predict the type of cases that we may see during the winter if you just consider a few influencing factors. It’s not very complicated really; let me give you some classic examples to illustrate my point:

The weekend mornings during the playing season – guarantees an influx of rugby and football players with their deformed limbs, making a muddy mess of ambulances and emergency departments alike.

A sudden cold snap – means we’ll see lots of fractured bones as folk slip on the ice usually while wearing at least ten layers of clothes that then have to be cut off if we are to access the affected body part without causing more pain.

Temporary ice rinks are also to blame for a lot of fractured wrists and other bones as people old enough to know better try to recreate that winning Torvill and Dean moment. Over the years I’ve seen quite a few who failed and scored only a miserable nil point for their efforts.

The last working day before the Christmas break –  ‘Mad Friday’ – will always bring in lots of drunken city workers and party goers in various stages of inebriation.

Working over the Christmas season also brings its own unique challenges. One shift I worked over the holiday period typifies this.

Firstly there was the lady, who after drinking a considerable amount of Baileys attempted to reattach a Christmas decoration that had come loose from the ceiling. She clambered on a dining chair and whoops – need I go on?

Then there was the chap who had an unfortunate incident involving a Ferrero Roche. He was happily munching away on his Christmas chocolate treat when he noticed his mouth filling with blood. Four hours later and it was still bleeding so he came to the emergency department. We stopped the bleeding eventually and found a tiny little cut on his tongue that had been causing all the trouble.

One poor grandfather had gifted a scooter to his grand-daughter and was eager to demonstrate his skills. Rather predictably perhaps he took a bit of a tumble. The poor man had landed on his face causing a black eye, lot of facial bruising and some really nasty, deep grazes.

And finally the lady who fell off a chair and hurt her back after putting all her energy in to pulling a cracker during the family Christmas dinner – she never saw the joke!

I know that this is coming a bit late to some, but if you’re still looking for a gift for the Paramedic in your life, here’s a few ideas:

Streamlight stylus pen torch – £25 – Amazon.co.uk

With a metal casing, this torch eschews quality. Batteries last for ages  and because it’s metal its of a sturdy construction. I’ve been using one for years and think they’re great.

Laser engraved Littman stethoscope – £50 – Medisave.co.uk

Medisave offer FREE engraving on the bell of littman stethoscopes. Really adds a personal quality and should hopefully prevent theft!

Nonin Go2 pulse oximeter – £78 – Amazon.co.uk

I know some people like to own and carry their own pulse oximeter, me included. The Nonin Go2 uses the same technology found in the onyx, but at a reduced price. It’s aimed at the consumer market, hence the slightly larger size and brighter colours on the casing. I’ve been using one for over a year and it’s very reliable.

Blood Bath Shower Gel – £7 – Amazon.co.uk

Excusing the name, i’ve got a penchance for IV bags and blood bags being used for regular things. Couldn’t get hold of this last year (constantly sold out) but has a wider distribution now.

Dr Cool Bag – £7 – Amazon.co.uk

Staying on the IV bag theme, you can get these IV bag shaped cooling gel and also hand warmers.

Giant microbes – now availabe as tree ornaments! – £20 – Amazon.co.uk

These plush versions of disease causing bacteria and viruses are now available as decorations for your Christmas tree, if you so wish!

A Plethora of books worthy of a read

Also be sure to check out my previous post: Medical related items to buy.