Die Me Dichotomy

It's a dichotomy this job. One minute you are dealing with a blithering idiot, the next you are working to save someone's life.

Take yesterday – we were called to a woman who *lives* on hospital property. The A&E department is less than 200 yards away. Our patient had dialled 999 for 'sore feet'. She was fully able to walk and hadn't taken any painkillers because 'they don't work'. Well they definitely don't work if you leave them sitting in the packet. For this I'd driven on lights and sirens halfway across town.

She also had me fuming because after our arrival at hospital she didn't want to sit in the waiting room, and then she wouldn't give our ambulance blanket back (even though I promised to get her a hospital one). I've got to admit that I *really* wanted to punch her in the face, right there and then. Instead I stormed off, my hands in fists. Let the nurses at the A&E department deal with her, we've done our part.

I may be getting anger management problems…

But then our next job was a beauty. A 72 year old man with a cough, a burning sensation in his chest and pain that got worse when he coughed. It looked (and sounded) like a classic pneumonia. We wheeled him out to the ambulance and did a 12 lead ECG to see what his heart was doing.

Yep – he was having a heart attack.

Yet again the patient didn't present with the classic picture of a heart attack and it is only because we are thorough that we discovered this.

So – off to the London Chest Hospital where they do the excellent and lifesaving angioplasty. It turned out that the patient had a blockage in the same place as the last person I took there. Another potential 'Widowmaker'. While they were clearing the blockage, they found another two areas of concern and cleared them at the same time.

I've got to make the point that the London Chest Hospital has always been extremely friendly towards me, I think that they are very 'pro-ambulance'; when we go there they are professional and are more than willing to let us watch the operation and explain to us exactly what they are doing.

I think that this partnership between us and the angioplasty centres around London is (one of the few) success stories of the NHS.

So there you have it – one of the reasons why I like this job, you can be dealing with utter rubbish one moment, and the next you can be doing something completely worthwhile.

And the job after that one? A Maternataxi.

10 thoughts on “Die Me Dichotomy”

  1. Nice one,When I'm on call for General Medicine at night, the ambulance crews bring suspected heart attacks straight to the Coronary Care Unit. We don't do primary angioplasties in our hospital so our patients get thrombolysed. If you're interested, you can read about my first on here. But I totally agree that the management of MIs and the partnership between ambulance crews and hospital staff is one of the (many) NHS success stories.#

    Keep up the good work.

  2. One minute you are dealing with a blithering idiot, the next you are working to save someone's life.And all too often they're one and the same person.

  3. Congratulations, another job well done!You seem to pick up a whole lot of heart attacks, and are very specifically trained towards them. I suppose one follows the other, but are you worried about peoples heart-care in relation to how they look after themselves? like obesity etc.

  4. Something tells me with the way that obesity is exploding in the population, you'll soon be seeing as many blocked LAD's as maternataxis.

  5. Driving past the nearest A&E department to get a patient to a hospital offering primary angioplasty increases pain to treatment time.Admittedly, delay is not quite so critical for balloon/stenting [as opposed to thrombolysis, when 'minutes = muscles'] unless the patient arrests, of course.

    We recently had a VF arrest when an 'out of area' patient took 30 minutes before the crew finally got him to the cath lab [he went off in the hospital corridor].

    Even so, despite various logistical issues, including the possibilty that paramedics will be required to resuscitate more patients, the research evidence suggests that angioplasty is the treatment of choice

    http://eurheartj.oxfordjournals.org/cgi/content/full/24/1/21

    It is also great to hear of the rapport between crews and hospital staff, it must make a refreshing change fromthe unmotivated shufflers in some of the nursing homes.

  6. Having four blocked arteries (one of which was 'Angioplasted' three weeks ago) I can understand the reason for the operation. The next day I feel so less tired than I had for years, which shows how these ailments creep up on you and gradually take you energy away. The only real side effect was a constant dizziness for a couple of weeks as (from what I understand) the heart goes from being starved of oxygen enriched blood to a state of oxygen overload and the body has to adjust.Now I have a new low cholesterol diet book which will hopefully reduce the other three blockages.

  7. wow – this and the last story about heart attacks suprises me as it took six weeks for my dad to get his after his heart attack becuase the ambulence kept not getting there to take him to the hospital in London before someone else gothis slot.He had three huge blockages too.

  8. I've noticed a huge difference in AE receptions here in the US. When you bring in one for angio the crew are ready and waiting for you and you work cohesively. When you bring in another type of emergency, the staff look at you like you've got three heads as if to say, “What are you doing bringing sick people in here?”..yet another dichotomy, eh?

  9. It is a shame there aren't more ambulances, if only so the first woman could be rushed to A&E say in York or Bristol.

  10. Just be careful not to write “dichotomy” on the chart, coz if your handwriting's bad, or the doc's in a hurry – OUCH!

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