His wife lets us in, it's one of those houses that are so clean I feel bad about traipsing my boots all over the carpet. Our patient is a man in his eighties sitting in a chair. He's spotlessly clean, wearing a shirt and a tie, hair brushed back.
He looks like a ghost, the blood has drained out of his face. As I enter he looks up at me and smiles.
We had been called from pretty much around the corner, the wife has already thanked us for getting there so quickly. She's called us because, as she describes it her husband had a fit.
He's normally fairly healthy, a bit of a cardiac history but no epilepsy or diabetes, nothing that would suggest a seizure.
I bend down to his eye level and start talking to him, my hand snakes out and automatically takes his wrist. I feel for a pulse.
His heart is beating around 25 times a minute. It should be sixty or more. It's no wonder he looks so ill.
I give my crewmate the look. The look that says, “Uh-oh, something's wrong here, we need to speed it up a gear”.
I tell her, “Let's get the gentleman in the back of the ambulance eh?”
She understands and jogs out for the carry chair, we don't normally move faster than a stroll. Given the type of call it was given as we've brought loads of equipment into the house with us, we can't always carry the chair in as well.
“I feel sick”, says the man and his face drains of even more colour, something I didn't think was possible.
He vomits, his eyes roll back in his head. Warm brown liquid flows over his tie, down his shirt and onto his lap.
I look at this and scrabble to find that pulse again. I'm just about to grab his ankles, pull him off the chair and start CPR when he opens his eyes.
“I feel a little better now”, he says.
His wife tries to help me remove his tie, but I'm the one with the gloves on so I tidy him and wipe him down a little while I wait for my crewmate to return. It's only been seconds but it felt much longer than that.
After being sick his pulse had come up a bit but it soon starts to drop again. We bundle him into the chair and rush him out to the ambulance.
We are only three minutes from the hospital and normally we wouldn't 'stay and play', but there are medicines that we can give to speed up his heart, fluids we can give to bring up his blood pressure and an ECG to do to see if the cause for this sudden slow pulse is due to a heart attack.
If it's a heart attack we'll be bypassing the hospital three minutes away for the angioplasty centre, which depending on the traffic, is at least twelve minutes away.
The ECG show a complete heart block not a heart attack, something I'm extremely grateful for.
I often joke with patients that they should only worry if I look worried. In this case I'm trying to keep the worry off my face.
“Let's get a line in him and give him some atropine”, I say to my crewmate – then make a mental note to apologise to her later, she's the paramedic she knows her job. It's just that when things start to get serious I can get a little… directive. I think it's because I tend to think aloud and because I used to be a nurse – a rather bossy nurse sometimes.
Despite the medicines his pulse remains the same but at least his blood pressure is coming up with the fluids and with him being laid down.
We blue-light him into the hospital. Three minutes later he is on the hospital bed being looked after by two nurses and a doctor.
His wife is in the relatives room, the resus room is full and another call is coming in (another patient with much the same problem as ours), so the staff can't take the time to talk to her.
I fall back into my nursing mode. I sit with her and hold her hand, she thanks me again and I apologise that the hospital staff haven't spoken with her yet. I explain that they are very busy and she tells me not to worry. I explain to her what the doctors are doing and that the likely outcome is good now her husband is in hospital.
Meanwhile in the ambulance the timer is ticking up, someone in Control is watching this and will be wondering why we are spending so much time at the hospital. I don't even give it a thought.
I pop my head back into the resus room, the doctors are happy that our patient is stable – he's looking a lot better although his pulse is still a little low. I let the wife know. She thanks us again.
We clean the ambulance and get ready for our next call.
A little later one of my colleagues takes our patient to another hospital to have a pacemaker fitted, I hope it's all going to go to plan and that there is a happy outcome.