Monday, 5 October 2009


It's that time of the year again. Our antipodean cousins are anticipating a long, hot summer of cricket (without the Ashes in their back pockets for a change), whilst here we're starting to pile on the layers, preparing for that world-famous phenomenon called The British Winter. The days are growing shorter and the night shifts seem longer than ever. It never seems quite as bad when I have only six hours of darkness on a shift, as opposed to the whole twelve. Give it a couple of months and when I'm on nights I'll see possibly an hour's daylight in every 24 hour period. Very SAD.
Just in case we weren't sure of the imminent arrival of the cold, our airways have a habit of reminding us. Large increases in the cases of asthma, bronchitis, chest infections, croup. Croup is a funny thing. If an ambulance is called to a child aged between 6 months and 4 years (ish), between 11pm and 3am (ish), any time between September and December (ish), because they're having difficulty breathing (not so ish), there's a pretty good chance you're going to meet a croupy kid. The vast majority of the time its bark is much worse than its bite. Literally. The characteristic seal-bark cough is a scary thing for any parent to be woken by. Been there, done it, bought the T-shirt. Scared me half to death the first time I heard it at home, so I fully sympathise with any parent going through it.
Mickey is a normal three-year-old child. He runs around, plays, falls over, scrapes his knee, cries, gets up again and runs around as if nothing's happened. But Mickey's parents weren't sure that he'd ever make it to three. Or two. They weren't certain that he'd make it past the first few weeks. Mickey was born only three-quarters cooked, at 30 weeks instead of the more normal 40 or thereabouts. His lungs were under-developed, his heart wasn't at full capacity, all his internal organs not quite ready for the real world yet. It wasn't Mickey's fault. He was violently evicted, cut away from his mother, just when he was enjoying the comfortable, warm surroundings where he was happily developing. Mum had developed severe pre-eclampsia, causing her to have dangerously high blood pressure, a pre-cursor to eclamptic seizures and all manner of life-threatening problems. In an attempt to save both mother and baby, it was decided that the best option was to deliver Mickey by caesarean-section. Mickey was to be cared for in hospital for the next few weeks, allowing his continued growth, but along the way the medical team discovered that he had several holes in his heart where there shouldn't be any. He had to have several operations, but eventually, after a year or so, Mickey was finally discharged from hospital with an almost clean bill of health. Mum and Dad were told that he might be a little more prone to chest infections than other children his age, but otherwise he should be completely fine.
At the age of two, Mickey had a chest infection. A bad one. So much so that he stopped breathing. Luckily (if it can be termed lucky), he was in hospital when it happened. Mum and Dad had watched him become more and more unwell, and decided it would be best to call an ambulance. Mickey was blue-lighted to hospital where his breathing continued to deteriorate to the point where it stopped. The medical team at the hospital worked tirelessly, and two weeks later Mickey was well enough to go home.
A year after that, for the first time in over three years, Mum and Dad decided it was safe enough to have a night out.
Midnight. The computer rings and tells me of a 3-year-old with difficulty breathing. "Making a funny noise", apparently. Croup. Should be easy enough. Oxygen if necessary, hospital, steroids maybe, back home. Not for Mickey. He's in real trouble. Blue around the lips, the spaces between his ribs noticably sinking with every breath, oxygen levels (Sats) in the high 70s at best. A barking cough that's interrupted only by a horrible screeching stridor. Sounds like he's got a coin stuck in his throat that interrupts the air with every intake of breath. To make matters worse, the babysitter's in hysterics. She's worried that she's done something wrong, when in fact she'd done everything right. She called an ambulance as soon as she heard the noise, and whilst she waited she picked Mickey up and placed him in a steamy bathroom to try and relieve the symptoms.
The babysitter was a family member, so knew all of Mickey's history and retold the tale. His early arrival, his lung problems, his heart problems, his last chest infection, the fact that he'd stopped breathing. The ambulance backing me up arrived only a few minutes after I did, and saw that even though Mickey was on oxygen, his Sats were only in the top 80s now. I retold the story as we walked briskly out to the ambulance, hoping that the cold night air may help as we went. The crew placed a priority call to the hospital, stuck on the lights and took off.
As Mickey was carried in through the doors of the department, he barked. One of the staff was heard to mutter "Oh, it's only croup. What's all the fuss for?" A few raised eyebrows were also spotted. There was a definite atmosphere of "unnecessary ambulance-crew panic" in the resus room. Until, that is, Mickey's story was retold.
The A&E staff had done exactly the same thing I had. Jumped to conclusions before even laying eyes (or ears) on the patient. I'd assumed that it'd be straight-forward. They'd also done the same. I'd assumed that it'd be run of the mill. They'd also done the same. I'd had to switch gears very quickly. They, to their credit, also did the same.
Lesson 1: Don't jump to conclusions.
Lesson 2: Don't jump to conclusions.
Lesson 3: Don't jump to conclusions.
I think Mickey's got a glowing career path ahead of him. I hope he stays well enough to follow it. I reckon he's going to a make a damned good teacher.


GrumpyRN said...

Aye, doesn't matter what you think you know, something will always turn round and bite you.

Fee said...

One of mine scared the life out of us with croup. Sound advice from the GP enabled us to cope without dialling 999 but it was a close-run thing.

Anonymous said...

Thanks to a fantastic team of paramedics and an OOH GP (those were the days!!), my youngest daughter is still alive after stopping breathing (and her heart stopping) with croup, in the back of the ambulance on the way to hospital.

My middle daughter still gets croup aged 12 (and I'm told she probably always will due to complications following surgery), and is also asthmatic - we've had some white-knuckle rides with her too, and no doubt will again.

Each and every time one of my children has been in trouble, a wonderful team of paramedics have been there to help, and I cannot say how grateful I am to them all, past, present and future!!

Tom said...

As a fledgling front-liner I attended a call to a baby with croup. At that time an OOH GP arrived a minute before we did. As I was in the 'back' it was up to me to deal with severely distressed parents, and a very sick baby, who was making noises I'd never heard from my own.


The GP, who I was to see several times over the years was a kindly and patient man who had already set about steaming the bathroom up, and while I clutched the baby we waited in the temp. sauna for the easing the GP expected in breathing.

It was an alarming experience, and though my children have given me a fair share of heart in the mouth moments, I was still shaken by the shout.

I would love to say that I used the experience to say I treated all calls as a learning curve, but I didn't, hence like grumpyRN says 'something (would) always turn round and bite (me).'

Ben Yatzbaz said...

I'm also often on the receiving end of that "bite". It always happens when you become just a little too laid back, a touch too complacent. I don't always realise the lesson that I'm learning there and then, but the "library" of calls is always there to look back on and learn from....