A Tale Of Two Cardiacs

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.

20 thoughts on “A Tale Of Two Cardiacs”

  1. The Big Issue seller in our town is the size of a small planet. At the end of his day he goes into the supermarket where my friend works and spends what we can only assume is his day's take on cream cakes, up to about 20 of them, which he then sits and eats.This leads us to think that while the Big Issue concept is probably a good and worthy one helping all sorts of vulnerable people, it is also open to a certain amount of abuse.

  2. Sorry. Drug Addict Is Ill Too??? Dont Care. Self-Inflicted wound. No different from shooting yourself in the foot to evade serving in the forces, when you voluntarily signed up.Elderly people WILL help themselves, whereas today we have bred a generation which wants everyone else to sort their pathetic lives out. Do Drugs – Your Fault. Elderly people without careline assistance will lie on the floor for hours on end, and only ring for an ambulance after 07:00 ” Because I know how busy you are, and I didn't want to disturb you”.

    Do Drugs – Your Choice – Your Fault.

  3. Ouch. What was the old guy's lifespan likely to be if he'd received appropriate treatment? (I'm not a medic, as a statement of “vested interests” – ie I have none)The comments on that blogpost are also interesting.

  4. It is amazing the older generations, how they never think that what they are suffering with would ever warrant an ambulance. I have come across several who have indeed made their own to the hospital, or a concerned family member have called us, but still they don't want to “put us out”. Yet time and time again we are sent out on wild goose chases to people who wouldn't warrant an ambulance, let alone need one, in a month of Sundays.They are also very good at coping with pain I find, I came across a lovely old dear a little while back who had fallen and we were querying a fractured neck of femur (NOF) there was all the classic signs, rotation and shortening. She was such a lovely lady, but she said very clearly that she was fine, it was just a little bang, she just needed helping up and then she would pop herself to bed and if it was any worse in the morning she might pop over to the doctors to see about some tablets for it. Yet we go out to “young uns” who have got a tummy ache and its like world war three has broken out!

    (we did manage to eventually persuade her to go to A&E and indeed she did have a fractured NOF)

  5. I wonder when this fantastic government of ours will consider giving out the panacea of a 'fixed penalty notice' or order to address and combat this anti-social behaviour of using the NHS as a wet nurse to other social ills.

  6. It's a nice idea, but the problem is that it will also hurt the little old ladies, etc. Because they can't afford the potential bill, they'll be even more afraid to ring for an Ambulance for “Chest Pains”, etc in case it turns out to be “Heart Burn” or something!Something has to be done, but I can't see a viable solution. As with any Gov't incentive, there'll have to be an ounce of common sense applied to make it work out properly. And common sense is something the Gov't seem to have in short supply…

    Regards

    Nick

    http://nickhough.blogspot.com

  7. You managed to get the two ends of society in one night (although I suppose that happens alot). Working with the great unwashed really opens your eyes and makes you wonder how the human race made it into the 21st century.

  8. The drug addict is ill too.Yes he should never have taken drugs but obviously he is suffering for his own mistakes. Somehow we've got to find a way to get addicts off drugs permanently, will power isn't enough.Yesterday a man came to my door selling tea towels etc. He straight away told me he had been in prison (didn't say what for) and that the selling was part of his rehabilitation. Apparently, not long after he started the job, he was run over by a taxi and was in hospital for weeks.He showed me the scars. Now he's back at work and he should be getting compensation which hopefully will set him up for the future. I had no reason to doubt him, he seemed like a nice bloke. Cost me 40 though. I now have a lint remover,reusuable, a wind up torch and a laundry basket (the type you can get in cheap shops for about 1.99.

    Still I'd rather give to him than to the Big Issue seller in our local town who sits on a chair outside M & S, looking well fed.She has a mobile and lots of warm clothes and rugs and seems to have visits from family (presumably) regularly.

    I don't think I'm in favour of the Big Issue idea, I'm sure there are much better was of helping homeless?? people.

    I wait to be shot down in flames!

  9. until the goverment stop using the Ambo service as a crack filler in there failures within the Health services, then people will call a ambo as theyA) have no one else to contact

    B) dont Know who to contact

    C) dont want to contact the right dept as the service is poor.

    Sort out the out of hours services, tell the public where to find them. maybe have a OofH service working with CAC to redirect calls to the right service.

  10. I live in a hostel for 5 years and know of the drug culture that can invade these places. The ease with which drugs can be obtained is startling. I used to sit in the bar and have the pungent whiff of cannabis wafting in from the garden. The smell was prevalent in the corridors which, thankfully, were places the visitors rarely went.If you're not a drug addict when you go in, you stand a good chance of being so on departure. Naturally the dealers target these places and it's a deal can often be witnessed nearby.A few months ago I had a feeling in my chest like boiling water. Not wanting to get an ambulance on, what I thought was not an emergency, I called bruv and he drove me to hospital. Result? kept in for heart surgery.One question. Is it the younger members of society who are inclined to call an ambulance for a runny nose?

  11. 20 cream cakes? Sound like extreme comfort eating, maybe having a bit of money isn't enough to make you a bit happy.It is a 'big issue' and maybe it is the 'big picture' that needs fixing.

  12. When I was 15 I was stung by a wasp and had an allergic reaction. It didn't even occur to my mum to phone an ambulance – it took my face swelling up to get her to phone NHS Direct!A few months ago I phoned NHS Direct again for a different problem, and even though I explained that I was sitting in the back of my friend's car, they still insisted on getting me an ambulance. Luckily, the crew phoned me and asked me if I could make my own way (I said yes, of course) but if they had come, that would have been another ambulance off the road for half an hour!

  13. Or people, especially children, being cared for by people not their next of kin who are terrified of litigation – like the 'manager' of a local kids football team who called an ambulance for a 12 year old with a cut on his knee that most mums wouldn't have put a plaster on. But not only was he scared of not taking the injury seriously, he was also scared of taking the lad to hospital in his car in case he had an accident or got accused of abduction/being a paedophile. Sad sad sad.

  14. I don't want to start a controversy so I'll try to keep the wording for this as neutral as poss: for people for whom the AA/NA 12 step model doesn't work or doesn't appeal, there is an excellent alternative – “rational recovery.” It's free, doesn't require belief in any “higher power” and it's confidential – there's more info at http://www.rational.org/I wouldn't hesitate to recommend it to anyone who has tried and failed using the usual route of NHS “recovery group” treatments for quitting an addiction.

  15. Although I'm just playing (40 years practice!) at being a paramedic , I still get f***ing pissed off when I take a smashed up person into A&E with a drip at minimum rate to maintain a Pulse , it IS ALWAYS TURNED UP by DOCTORS

  16. Pardon my ignorance, but…I've had the privilege of shadowing some paramedics in Canada on a few occasions. Depending on which part of the country you're in, some paramedics are certified to perform EKGs / diagnose MIs / perform intubations / administer some drugs etc., and others are not. Some provinces have two levels of paramedics and therefore have both.

    Do all LAS paramedics have the training to diagnose MIs, or just 'advanced level' paramedics?

    Just curious – thanks!

  17. In London *everyone* (with the exception I think of 'urgent care') can do a 12-lead ecg, recognise ST elevation MIs and make the decision to take them to an angioplasty centre.It's one of the success stories of the LAS and something that we should be rightfully proud about.

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