The Fallen

I am sitting quietly in a cafe with MrsRRD, enjoying a few precious moments between dropping a MicroRRD off at a friend and picking another MicroRRD up (we have three of these, along with a MiniRRD and a Princess RRD, remember), when my phone rings, asking me to attend a call.  A 50 year old man has fallen down some stairs, and is unconscious and fitting.   With only one car between us, MrsRRD is forced to endure a heartstopping journey on blues to the patient (she LOVES it really) and then she drives off, after leaving me her oyster card, so that I can get back from the Major Trauma Centre that I am sure I will be going to, based on what I have been told.  Unusually, the story is as given, and I rapidly make an assessment:

The man is lying on his back, feet on the bottom step, head in the kitchen.  There is very little room to work, and I have to squeeze past the paramedics already in attendance.  They tell me he has been very agitated since they arrived, and that the son has told them that he watched his father miss the last few steps and fall into the kitchen, off the hallway, and then proceed to fit.

I take a look at Tom, kneeling on the kitchen floor in my jump suit.  His airway is maintained, despite him being on his back, and his breathing is good.  There is no sign of blood loss, and his pulse is regular and strong.  His Glasgow Coma Score at this moment is 11 out of 15, made up of eyes 4 out of 4 (they are open spontaneously), verbal 2 out of 5 (he is moaning incoherently) and motor 5 out of 6 (he is moving purposefully, but not obeying any commands).  That's not bad for someone who has hit his head, and is on the cusp of whether I intubate and ventilate on scene or not.

The crew are very keen for me to get on and intubate their patient.  They are worried about how they are going to get Tom out of the house.  He won't lie still, and they cannot control his head movements.  If he has sustained a spinal injury he is in danger of making it a lot worse.

I begin to get the kit ready for an intubation, hoping that Tom will begin to come round a bit more.  After all, he has had a fit, and after someone has fitted they are usually a bit confused and out of it, what is known as post-ictal.  I ask Tom's son if his father has ever had a fit before.  He tells me that this is his first.

There is something about Tom's son that doesn't seem to fit (sorry about the pun).  He seems a little too calm, considering the fact that his father is lying on the floor, semiconscious.  I think how I might be reacting if it were my dad, and he is just standing there, writing down his details for the paramedics to take with to the hospital.

I wonder for a few fleeting seconds whether he had pushed his dad down the stairs (far too many crime novels to be good for me!) and then it hits me.

"Does your dad drink much?" I ask him gently.  He nods, and tells me that his dad is an alcoholic, drinking about three bottles of wine a day.  He had been trying to cut down, and hadn't drunk any alcohol for 2 days.  This all made sense.  When someone comes off alcohol too quickly, especially if they are a long-term heavy drinker like Tom, they are very prone to fit.  I can picture Tom coming down the stairs, and having a fit just as he reaches the bottom step, falling forwards, unable to stop his fall.

I am directed back to Tom, who is trying to sit up.

"Where am I?" he asks, querulously.  We explain what has happened.  He does not appear to understand, but is far more awake than he was when we first arrived.  I look to the crew for confirmation that they are happy to take him awake to the nearest hospital.  They signal that they are.  We carefully get Tom on to the ambulance trolley, and in to the back of the waiting ambulance.

I look around, remembering: I have no car.  I jump in the back of the ambulance.  "We'll be fine without you," chirps one of the crew helpfully.  I suggest that, while they might be fine, I would rather be taken to the local hospital to be picked up, rather than wait outside Tom's house.

As we speed up to the doors of the A&E, I see my car drive sedately in behind us.  MrsRRD has my coffee.  Now, that's service!

Training Update

Well!!  It's all going swimmingly!  Those of you keeping track may have noticed that I am getting into my stride now.  I am starting to run and cycle every couple of days.  I have managed to run 5.5km non-stop in 40 minutes, and I'm really proud of how I am getting on.

Or, I was until I made the mistake of looking at some of last year's finish times - just to see, you understand.  You just enter a runner number, and their time is displayed.  There are thousands of numbers to choose from, so I will start with runner 1000.  Hmmm.  10km in 44 minutes.  That doesn't sound promising.  Must be a good runner.  Try another one... Runner 179.  Erm, 10km in 37 minutes.  How about runner 2659?  Nope, 48 minutes.

I'm going to be last, behind the granny on her Zimmer frame.

Tachycardia

He lies there on the ambulance trolley, waxy skin, pale, tachycardic.  His pulse rate way above normal, a sure sign of blood loss.  I don't need his tachycardia to tell me that: the pools of blood on the floor of the ambulance is sign enough.  I sit next to the trolley, my hand pressed firmly against the pad applied to his mangled limb, but it seems to do little to stem the flow of blood.

His eyes roll up, and Para-Girl calls to him.  His eyelids flutter, and he is with us once again.  But for how much longer?  His skin is drenched in sweat, and yet his body feels alabaster-cold. We are losing him, and we know it.  I tinker with the intravenous fluid, but know that what he needs is blood.  I have already called ahead to the hospital to tell them to have some ready for when we get there, but will he last the journey?

As we come off the motorway, and slow to a crawl behind the selfish drivers, who want their lane and will not even relinquish it for us, I want to jump out of the ambulance, run up to the drivers and thrust my blood-stained hands against their windows.  But I sit there, pressing harder, while Para-Girl, almost as pale as our patient, mouths something unintelligible to me.  I know what she is saying, that we are not going to make it.

G-Man, our driver tonight, hunts down the spaces like a heat-seeking missile, and we are moving once again.  As we approach the last few minutes I grasp our patient's wrist, feeling in vain for a pulse.  He is hanging on by a thread, as we storm up the ambulance ramp, to the waiting Trauma Team, to bags of blood, and to a life snatched from the jaws of death.

The Phone Call

What a lovely day! We are all very bubbly, despite the lateness of the hour, as we drive home. I've spent the day with Besty, Mad Dog, our wives and children. We have eaten too much, spent too long in the sun, even played some rugby with the kids, and now it's off to Chez RRD, and then to pack the kids off to bed.

My phone is ringing. We are in Mrs RRD's car, so the Bluetooth remains inoperable, and by the time I have wrested it out of my pocket, and passed it to Mrs RRD, it has stopped. We wait for a few seconds, and sure enough my other phone starts its insistent ringing. I am just parking up, so grab the phone and answer the call from Ambulance Control. A stabbing victim awaits me. I open the door to the house and usher the waiting hordes in. Mini RRD keeps asking me what the call is - I know that if Mrs RRD knows I am on the way to a stabbing she will worry, so I blank him, and rush out to my waiting car.

Damn! I have been out in the garden all day, and when I slip off my trainers to change into my boots, the sight of my naked feet is a reminder that I haven't got any socks on. Oh well, no time to waste. They'll just have to rub a bit.

I arrive at the address I have been given. It's all very dark. I can see a few police cars (phew!) and an ambulance, but there are no blue flashing lights, and, while there are quite a few people milling around, none of them are in uniform. Hmmm. It's not just Mrs RRD that is worried this time. I am the first to admit that I am a coward. I will avoid danger, and never walk into a difficult situation.

So, I could sit here, and wait for someone to come and get me. But that does seem a little silly. So, I put my blues on, and sit and wait for someone to pop their head out of the back of the ambulance, and beckon me in. It was only a few seconds, but I wasn't getting out of my car until I knew where I was going.

There are quite a few people in the ambulance. There are two ambulance crew, and a paramedic off of the car. There are two police officers. There is Dave - seeing as he is the one lying on the ambulance trolly, his clothes soaked in blood, I thought he might be my patient. It wasn't all that obvious, as he was on the phone! Not many people who need my attention at midnight are chatting away on the phone, you see. But Dave was.

"Hello, Dave! I'm RRD, a doctor."

"F*** off! I'm on the phone!" replied Dave.

"Yes, I can see that, but I can also see you are bleeding, and in need of medical attention" I countered, helpfully.

"When I have completed this conversation with my dear mother, then I will be happy for you to attend to my chest wound, kind Sir". Or words to that effect.

We all wait patiently, while Dave relates the evening's events to his mother, before dealing with the very well spoken patient.

I do love being appreciated!

Last Passage

They come out in their droves: the young and the old, in dressing gowns and slippers. They have their mobile phones and their cameras, all the better to record this moment.  Held back by the police tapes, they crane their necks, anxious to see all they can.

I kneel down gingerly by the bonnet of the lorry, and peer beneath. He is lying there, his head resting by the wheel that has run him over.  He is still, no signs of life.  I slide under the lorry, taking heed of the blocks that have been placed there by the fire team, raising it the few centimetres I need to be able to reach him.   My hand reaches out, and I feel his neck.  No pulse beats beneath his skin.  I place my stethoscope in my ears, and press the bell against his chest.  No heartbeat, no respiratory sounds.  I slide out, and shake my head at the paramedics, police and fire crew waiting for my verdict.

He needs to be moved, from under the lorry and into the waiting ambulance, for his last journey.  The crowds remind me of spectators in a Roman Colosseum, baying for blood.  I don't want to be the one to provide them their sport.  I don't want him to be the object of their scrutiny.  I direct the fire crews to grab some tarpaulins and hold them up as screens against prying eyes, as we gently, reverently draw him out from underneath the lorry, place him on the ambulance trolley, and wheel him into the back of the waiting ambulance.  Behind closed doors, we complete our paperwork, before arranging for him to be transferred away from here.

As I leave the ambulance, as I grab my bag from the ground and walk slowly back to my car beyond the police line, I am afforded no such privacy.  The crowds, denied what they have come for, call to me, begging for whatever scraps of information they can get.  I shut myself in the relative safety of my car, and drive home.

Excuses

Some of you eagle-eyed readers may have noticed that my training has dropped dramatically.  Here are my excuses, one of which may be true.  See if you can spot which one...

1.  My phone has stopped working, so I have been unable to upload any of my training episodes.

2.  I have been too busy at work.

3.  My trainers (sneakers, for you on the other side of the pond) don't fit any more, and I haven't had the time to get a new pair.

4.  I decided I would have an unfair advantage over the other runners, so I should stop and give them a chance.

5.  I have had man-flu.

6.  I broke my leg.

7.  I broke someone else's leg.

8.  I've been on Jury Service.

9.  It's been too cold / wet / hot / snowy to run.

Yes, you guessed it, number 5.  Seriously, it's no fun having man-flu.  Everyone takes the Mickey, and you still feel as sick as a dog!  So, not only are you suffering, you get no sympathy either.  And, being medical as I am, I know all about the dangers of exercising while you are ill.  You can get myocarditis and everything!!  Not pleasant.  So, I've been taking it easy for the past week or so.  I am sure it all started with my hepatitis jab.  There was definite blood, and a very big bruise, that's still there a week later.

But anyway, today I decided that enough was enough!  I decided to start off nice and easy, with a gentle bike ride in the park with Mrs RRD and one of my Micro's.  Checking my pulse every few hundred yards for any signs of irregularity, I soldiered on through the shortness of breath, and it felt good!!  So good that, when I returned home I decided to go for a run afterwards.

Big mistake!!  Even a very gentle run (overtaken by a little old lady and her Zimmer) left me gasping for breath, and aching all over.  Still, I'm back on track, if a little far behind everyone else.

Please make this worth my while, by pressing that tempting "Donate" button on the right of the screen.  Whatever you can afford, every little helps...

Thank You To JB

I have been told about a group of 15 people who have clubbed together to raise some money for BASICS-London.  They each changed their name by Deed Poll to a famous Formula 1 driver, then raced round a track for a few hours, all to help those in need of the services we provide.

So, a big thank you to Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button and of course my good friend Jenson Button!!