Monday, 8 March 2010

Green and Genuine

Just for a change, the weather is grim, and my mood along with it. Nine hours into the shift, and I've had nothing but coughs, colds, and kids with fevers to deal with. I was on the last of four long, dreary, cold nights, and all I wanted to do was crawl into bed and hide. As usual, there were different plans for me.
Despite working on my own, as soon as the computer rang with my next call, I sighed out loud, as if hoping for someone, somewhere, to hear me. They must have done, because at that point the phone rang too.
"Hi InsomniacMedic, it's Dave at control. This call we've sent you, we know it's only a low category Green call, but they've been waiting hours, we've got nobody else, and it sounds like they really need some help!"
I look at the screen, and read the details. Green 2, Male, 30s, back pain. Uncomplimentary thoughts instantly enter my mind, a combination of winter, unnecessary calls and sheer exhaustion. Only 6 hours sleep in four days is enough to make anyone lose the plot, even a seasoned insomniac. On route to the call, I can't help thinking that all I'm going to need to do is throw a box of Nurofen at him and tell him to man up and deal with the back ache. Most times, people seem to go from having back pain and not taking pain killers, and jumping straight to "Code Red" and call an ambulance. I often wonder at what point it is that you go from coping to not coping, without trying to help yourself first. Anyway.
I open the car door, and instantly hear the screams. Something tells me that all my prejudice has just been proved wrong. This sounds like real back pain. Not the sort that goes away with a heat pad and some anti-inflams. I take the entonox (an analgesic otherwise colloquially known as laughing gas) with me as a matter of course on any call stating that the patient is in pain, and laden with my prized possessions of kit and analgesia I walk up the driveway. The sound emanating from the house sounds like a woman in labour, which, had I not have been told that the patient was male, would have had me worried. Then again, it's not unheard of for the system to get the sex of the patient wrong.
The door is opened by a most definitely not labouring lady, at a guess late twenties, who looks anxious to the point of real fear. "What took you so long? He's in agony!" I mumbled some sort of apology about it being exceptionally busy, and that I'd been sent as soon as was physically possible. I skipped the bit about having not been to a single patient who actually required an ambulance the whole night.
I'm shown in to the front room and meet Jake for the first time. He's on his hands and knees, his face resting on the couch. He's pale, sweating by the bucket-load, boxes of used pain killers on his right, a half full vomit catcher by his left, and he's literally screaming in pain. Even the slight movement to see who's just walked in racks his body with more spasms.
I take the entonox out of its bag, connect the bits together, and briefly explain to Jake what to do with it. "Breathe in and out through the straw-like gadget, deep, slow breaths, and give it just a few minutes before you start feeling the effects". He follows the instructions to the letter, and drinks the entonox like it's the elixir of life. After five minutes and almost half a cylinder of the laughing gas, Jake was still crying. Time for the big guns.
Morphine is great stuff. I have never used it and had it not do what it's supposed to. I know full well that as soon as Jake gets to the hospital there'll be eyes rolled at another overkill job of using morphine for a simple back ache, but I know that it's the right choice. I need to treat what I'm presented with, and not what the hospital will assume was happening.
Finding a vein to cannulate in a person on all-fours is a little difficult, but by far not the most awkward I've had to contend with. The line goes in smoothly, and I give Jake an anti-emetic to stop the vomiting, closely followed by the magic potion. Moments later, probably no more than 90-seconds, the relief is plain for all to see. Jake's whole being relaxes, the colour comes back to his face, he's not trying to bring up whatever contents are still left in his stomach, and he even manages a smile.
The crew that finally turns up can't understand what all the fuss was about. They were on a "Green Bus", the ambulances crewed by people who have been trained to deal with low priority calls, such as GP referrals, minor injuries, and things like simple back aches. As they are not paramedics, and I have given drugs that they're not licensed to, I'll have to go with them to the hospital.
We get the looks and the tuts that I expected, but by this point I didn't care. I knew what had really happened, and I was safe in the knowledge that I did what was best for my patient. More to the point, my patient knew it, and was grateful too.
So when is a Green call not a Green call? When it's a genuine call.


Anonymous said...

interesting - any idea what it was?

i've heard that you could (theoretically) get gout in any joint in the body (including the spine), and as someone who gets it in more normal places from time to time (big toe, ankle etc) i can only imagine just how painful it would be in the spine...


Deborah said...

Kidney stones?

RapidResponseDoc said...

As you say, Ben, pain is pain, whatever the cause. We get hundreds of patients a day in to A&E, and 90% of them are in pain. We perform a pain assessment, and if the pain is deemed to be severe, we will give morphine. End of. Doesn't matter what the cause is, if there is pain it gets treated.

So, good call, is what I am saying

InsomniacMedic said...

BA and Deborah - Unfortunately, I never found out what the cause of such grim pain was, although I'm fairly certain it wasn't kidney stones - which was my first impression. The pain just didn't seem to be in the right place... But I honestly had no idea. All I knew was that he was in pain and needed something doing about it.

RRD - thanks for the back up!