Patient number one.
He's 34 years old and lives (like an increasing number of my 'client group') in a hostel. We have been called because he has 'Chest Pain'. Chest pain calls are pretty much all 'Cat A' calls and therefore whizz round there on blue lights to jump through the government mandated eight minute hoop.
He has chest pain and is feeling a bit dizzy. The most likely reason behind this is the four lines of cocaine and five ecstasy tablets that he took a few hours ago. His hugely dilated pupils stare up at me as he tells me how worried about the pain he is. To try and stop the pain he has also self-medicated with some illegally gained sleeping tablets.
This isn't the first time this month he has been in the back of the ambulance for chest pains – last time the pain came on after smoking some cannabis. He asks me not to tell the hostel owners about his drug use as if they find out they will throw him out on the street. It's a Christian faith-based hostel and it strikes me as a particularly unchristian thing to do. But what do I know, I'm just the Hell-bound atheist that looks after him an takes him to hospital. I agree that I won't tell the hostel staff about it, it's never been my job to be an informant if no-one else is getting hurt.
In the back of the ambulance I do an ECG – cocaine is well known for causing heart attacks. Thankfully it's all normal. We then talk as we travel into hospital. He tells me of all the things that he has lost due to his drug use – his girlfriend, his family, his friends. He tells me about losing the middle part of his nose due to all the drugs he'd been stuffing up there. He starts crying.
A month ago he had been 'clean' for six months – then for reasons he can't, or won't, tell me he started using again.
What can I do? I tell him that he is foolish to start using again, and that drugs, while nice in the short term, never solve any problems – they only create them. I tell him that he should talk to the nurses so that they can refer him on to someone who can hopefully stop him backsliding.
What else can I do?
Patient number two.
He's in his late seventies and as fit as a butcher's dog. He'd been to the GP for the first time in years and had been diagnosed with a simple heart arrhythmia (AF for the medically minded). He'd been referred to the hospital for further assessment and treatment. This would be in a few weeks.
Then he got some chest pain and, like many men, ignored it for a while. Then it got a bit worse so he called for a cab and made his own way up to the hospital. I saw him when he walked in and told the receptionists that he had chest pain.
Twenty minutes later I was transporting him to another hospital for a primary angioplasty in order to treat the heart attack he was having.
If he'd called an ambulance we would have diagnosed the heart attack and transported him straight to the specialist centre, cutting out the middle-man of the local hospital. It hadn't crossed his mind to dial 999 and ask for an ambulance.
I gently told him off. I also told him that, seeing as he'd spent his whole life working to pay his national insurance contributions, it would be a good idea to call an ambulance if he had chest pain again and that it would be our pleasure to pick him up.
He'll make a good recovery – but I wish he'd called us first rather than getting a cab. We spend so much time going to people who don't need an ambulance it drives us mad to see 'genuine' patients muddling through without our help.
Two jobs in the same night, both with the same job description. Both very different.