Thursday, 17 March 2011

When Lewis Carroll Meets Richard Bachman

It's a Saturday morning. It's 2am. I get called to an assault, and blearily climb out of bed, don whatever is at hand (a t-shirt with the immortal words, "Ketamine, Just Say Neigh!", and go downstairs, trying hard not to trip over the cat, sleeping on the stairs.

I arrive to see lots of people milling around two ambulances, and, fortunately, a similar number of police. I still feel nervous, and breathe a sigh of relief when I am directed to the relative safety of the back of one of the ambulances.

Once inside, I am greeted by InsomniacMedic. We nod to each other, quietly, as if we do not in fact know the other's secret identity. It's odd, calling him by his real name. He has it easy, just calls me "Doc."

I am told by one of the other 6 ambulance crew that the patient, hidden from view by a sea of green, has been hit over the head by a road sign. "What sort of road sign?" I quip. "Hold on, I'll go and check," was not the response I expected, as one of the police officers also crammed into the sardine can scurries out to find out, only to return a few minutes later with the news that it was a Keep Left sign.

With that vital piece of information to hand IM and I are able to make our plans: the patient has a GCS of 8, but I think most of that is due to alcohol rather than his head injury. I decide that he should go to the Major Trauma Centre (MTC), because one can never be sure about what is alcohol and what is head injury until a CT scan is forthcoming. As he is lying quietly on the ambulance trolley I decide that I would try and get him there without resorting to intubating and ventilating him.

This is a bit odd for me. Those of you who read my blog regularly may have noticed a more conservative approach. Whereas anyone who closed their eyes for a short while would be tubed and ventilated, I now seem to be taking the opposite approach and holding off on doing so, unless the patient's airway was compromised. It has been a while since I have intubated a patient pre-hospitally, and I wonder to myself if I am losing it.

Still, we have a plan: as long as he behaves himself, he will be left alone. As I relate this to the others, and as IM raises an eyebrow in surprise, the patient makes the decision for me. Trying to get off the trolley, trying to remove his hard collar, and thrashing about in an altogether not-going-to-the-MTC-awake kind of way. So, it's a deep breath as IM gets intravenous access, and I draw up my drugs and prepare my equipment.

I wonder what on Earth is wrong with me - I have done this hundreds of times, in far more difficult situations than this one. And I don't always have someone like IM, whom I trust to help get me out of any sticky situations. I must be getting old, I muse, as the tube slides effortlessly into the patient's trachea.

Patient all settled in and comfy, I then turn to the thorny issue of my car. The last time I went to the MTC, it took over 2 hours to get me reunited with my vehicle, and I am in no mood to do that again. So I need someone to drive my car to the MTC for me. Guess who gets the job? Yep, my fellow blogger has the privilege of driving the RRD-mobile!!

An hour or so later, the patient off to CT scan, I have a quiet chat with IM, no-one else around, and the chance to speak openly about our "other" lives.

And, as I drive home, through the quiet streets of London, I reflect on the case, and on how it doesn't matter how many time you do something; it still has the potential to go horribly wrong. Maybe I am getting older. Maybe that's not such a bad thing.


  1. Safe to assume he didn't 'ding' the RRD-mobile then? Or plant a tuna sandwich in the glove box? Your colleagues are clearly nicer people than mine. I wouldn't trust any of them with a set of car keys (or the care of a stick insect in some cases).

  2. "Ketamine, Just Say Neigh!" - I like it! But my lungs don't,sorry, laughing at the slogan has just upset the recently settled brittle lungs..
    Off for a neb!

    I suppose you can deduct quite a bit of information about a road sign and the type of injury it causes.... are all road signs of the same density according to what they are telling us to do or does the density, weight etc vary according to where that particular keep left sign was manufactured?


  3. Fee - have you no faith in my driving skills? How rude.......... :D
    I did offer to swap his very nice RRD-mobile for our battered Vauxhall, but no dice. Oh well, maybe I should change careers!

  4. ....not a 'mobile' keep left sign? And Now For Something Completely Different!