Monday, 17 August 2009


My shift finishes at 3am. The call comes in at a quarter-to.
The door's open. A bad omen I fear. Nursing homes are almost never ready for us when we arrive. It doesn't seem to matter what the emergency is, it always happens to be somebody else's job to meet the ambulance and direct them. That Somebody Else who's almost never to be found, so finding the door as it was seemed more threatening than welcoming. The building, however, is huge. Two storeys with at least two dozen rooms on each floor, and as usual, despite the open door, Somebody Else wasn't there again. I yell "Ambulance" several times up and down the corridor, and eventually a member of staff hears me and without so much as a glance in my direction yells back "It's upstairs".
The call came in as "patient fitting". Something told me that unlike the vast majority of calls we receive to patients who are having seizures, this one probably still was, so I took all my luggage with me, ready for anything, and waddled up the flight of stairs. (I've worked out that if I take everything in with me, it weighs about 20 kilos. Or 40 pounds. Possibly more. About the same as normal luggage allowance on a European flight.) The lift was the other end of the corridor and would have involved double the waddling distance, so I decided on stairs. That and the fact that I don't really like lifts.
In the room is Barbara. And about seven members of staff, all of whom were trying to tell me a story, none of them really succeeding. After ascertaining who was in charge, I found out that Barbara needs full time care due to various medical problems, hence the nursing home, but has never before had a fit. This one had been going for a full 15 minutes before I got there, and was still in full force.
Barbara's eyes are open, but the vacant stare just looks back, pleading for help. I give her a first dose of medication, hoping that it would bring a stop to the seizure, but it has no effect at all. I get IV access, so I can give her some faster acting medication. It all seems to take forever, but looking at my watch as I time the drugs, it's not really the case. I start to give IV drugs, slowly watching and waiting for it to take effect. At this point the ambulance arrives, having received my message that the patient was in Status Epilepticus, or an ongoing seizure.
One of the side-effects of giving Diazemuls IV, is that it can reduce the patient's respiratory rate. The drugs are taking effect, and Barabara's seizure finally stops. Unfortunately, her breathing rate is now less than six a minute. We assist her with ventilations through a bag-and-mask, ensure she is as settled as possible, and then take her to the ambulance. We put a priority call to the hospital, and I travel with the crew. An extra pair of hands with a very poorly patient is always helpful.
Barbara's respirations don't pick up on route, but with our help her oxygen levels remain at 100%. The blood gas test when we arrive would show that despite an exceptionally long seizure, and despite the fact that she was hardly breathing on her own, we still managed to maintain a good airway and good ventilations. Easy to do in a sterile, non-moving environment such as a hospital, not so easy in a moving vehicle. These are basics, I know, but sometimes easy to overlook with the organised chaos that is a poorly patient.
We hand Barbara over to the hospital staff, and even get a pat on the back for our treatment. Now that IS rare. Back to reality, tidying up, writing up, restocking. Just before we leave the hospital, I go back in to check on Barbara one last time. She's breathing on her own, looking a lot more settled. Family starts to arrive, and I sneak out, pleased that my training has once again been put to good use, and with a good result. Or at least I hope it was a good result. I don't know what happened to Barbara after that.
Eventually I get back to station, start to pack up and go home. I take a look at my watch as I leave the station. 4.45am. The sun is starting to rise, the early-birds are beginning to stir, the world is just commencing it's early-morning ritual. Not for me though.
For me it's late. Very late.
But very worthwhile.

1 comment:

Anonymous said...

Well done Ben, on a job well done! It makes a pleasant change to be given a pat on the back too.

Just one thing to ponder. Why is it all the "good" jobs are always the ones that make you late off???