It's relatively early in the evening, still much nearer the start of my shift than the end of it. I've just seen two patients in a row with exactly the same, quite rare, cardiac problem that I haven't come across for at least the last three years. Two people from completely different backgrounds, different ages, different life styles. Two people who've never met each other, probably never will, joined by a common thread. Weird coincidence. Makes me wonder what other strange things are going to crop up during the night.
I'm brought back to reality with the computer screen yelling at me that there is a patient with the dreaded Swine Flu who's having trouble breathing. My heart sinks at the thought of another unnecessary ambulance call out. I'm starting to think, somewhat cynically, that this whole pandemic has been magnified in this country just to get the government expenses scandal off the front pages for a while.
This time, however, it's different. I must have seen at least fifty patients who've got, or think that they have, Swine Flu. Or, as I've seen and heard it called, Hamthrax. I can genuinely say that this was the first time any of them really needed an ambulance. This time, I could hear the wheeze before the front door was even opened.
Along with probable Swine Flu, Zohara has asthma. She's had it since she was a little girl, and now she has two little ones of her own to worry about. She's done everything right. Stayed home, called the GP, was prescribed the magic cure, taken paracetamol regularly and used her inhaler. In fact, she's used a whole inhaler in just the last few hours. Usually they last weeks. But Zohara has her kids to worry about. No time to be ill.
She lets me in and collapses back onto the couch. Her breathing is rapid, noisy. She sits leaning forward, using all her chest muscles to try and get her lungs to open up just a little bit more. I don't need a stethoscope to determine that she's in real trouble. I put the probe on her finger that tells me her oxygen levels. They should be, at a bare minimum, 94-95%. The numbers read a dozen percentage points lower. Her pulse is double its normal rate, over 150 a minute. In broken sentences she tells me about her kids, how she'll have to get someone over to babysit. The maternal instinct, once again, over-riding everything else. I suggest that I start treating her first, and then I'll help arrange the baby sitter. A little reluctantly she agrees. The nebuliser, a noisy combination of oxygen flowing forcefully through liquid medication, is only just louder than her breathing. She takes some deep breaths on the misty air that presents itself through the mask, and after a few minutes her oxygen levels start to rise. Just a little.
Zohara's stringing a few more words together, enough to make the phone call and get a local family member to come and look after the kids. Ambulance and baby-sitter arrive simultaneously. Zohara is still trying to give instructions as she's taken to the ambulance, but can't yet manage to concentrate on breathing and talking at the same time. Breathing takes precedence, and she's left with no choice but to trust that all will be taken care of.
As the ambulance drives away, I'm left wondering once again, especially in light of my previous post, why? Why did she wait so long? Why did she think that she could do it all on her own? Why is it that a mother's instinct often doesn't stretch to looking after the mother too?
Most incomprehensible of all, why is it that so often, the people who need us the most, are the ones most reluctant to call us out?