Monday, February 23, 2009

late for the party

There are two things we have to step over as we go into the flat: an empty bottle of JD and a pink, iron piggy bank of the same size.
‘He’s in here.’
The man who let us into the flat seems magnified by his concern; even his height strikes me as an expression of anxiety.
‘Are you a relative?’
He wears a rucksack, bulgingly heavy. It rattles as he walks.
‘What’ve you got in there? Beer?’
‘It’s my mum’s birthday. I’m supposed to be there, not here. She’ll kill me.’
He leads us into a small sitting room filled up with a double bed, a sofa, and a couple of racks of plain wooden shelving stacked with metal pigs of all sizes and colours.
Paul is lying on his back on the sofa, his arms straight along his sides and his legs crooked over the end of the seat. He is wearing outdoor clothes – a fleece zipped up to the chin, baggy green trousers and rotten trainers. He looks as if someone had dressed him in an outfit then lain him aside whilst they sorted something else out.
‘Paul. Paul.’
He isn’t unconscious. His eyes flicker behind his eyelids, even before I touch his eyelashes. I prise them open and shine a light across. They seem fine.
‘Paul. Come on. Talk to us, mate.’
I pinch his shoulder. When there is no response I pinch him a bit harder. Nothing.
‘Paul. Come on. We need you to talk to us.’
‘He’s taken all these pills,’ says the friend, handing an empty bottle of Temazepam to Rae.
‘Whose prescription is this, then?’
‘His wife’s. His ex-wife’s. They got divorced recently. Hence…’ He shifts his weight uncomfortably, then shucks off the rucksack and dumps it on the bed. ‘I’m supposed to be at my mum’s.’
‘Give her a call.’
‘Do you mind?’
‘Go ahead.’
‘Come on, Paul. We’re not going to leave you alone until you talk to us, so you might as well open your eyes.’
I roll out my repertoire of painful stimuli, keeping myself in a position where I can either dodge or sit on a rising fist. I try The Supra-orbital Notch. The Rolling Pen on the Nail Bed. The Sternal Rub. He’s so thin it’s like running my knuckles over a cycling helmet.
Some wincing, but the eyes remain flutteringly closed.
‘Come on, Paul. Don’t make me carry on with this. It’s stupid and pointless. Why won’t you talk to us?’
I roll out the big guns. I give him The Mastoid Dig. He tries to smack my hand away.
‘Leave me alone,’ he growls, opening his eyes a crack.
‘We can’t leave you alone. What sort of people would you think we were if we did that? Come on, Paul. Just sit up and we’ll see what’s happened today.’
Inert, as before.
‘Let’s sit you up.’
We haul him doll-like into a sitting position. He lolls his head back and begins a half-hearted attempt at pseudo-fitting.
‘Jesus,’ says his friend, taking a step back.
‘It’s okay. He’s not having a fit. It’s just – the situation, that’s all.’
Paul has a long, pushed-back kind of face. With his large eyes slightly off to the side and a prominent pair of yellow incisors, he looks like a giant rabbit.
‘Let’s get you down to the ambulance,’ I say.
Even though I’m sure he can walk, we have to lift him into the chair.
‘Can I come along, too?’ his friend asks.
‘Sure. Maybe you could give us a little more information.’
Paul sits in the chair, passively uncooperative, flopping his arms and legs about and leaning his head back onto my chest.
‘Come on, Paul,’ I say, to no effect. I put a blanket between me and his greasy hair. We set off for the lift.

On the ambulance, nothing has changed. He doesn’t even respond when I cut his jacket sleeve off to take his blood pressure. All his obs are fine, but he will not talk to us.
‘Let’s just go,’ I say to Rae.
Just as she opens the door and jumps out, two police cars come hurling round the corner, pulling up behind and in front of the ambulance.
‘Oh, really?’ I say.
Four police get out. One of them waves at us in a massively friendly fashion and strides across to the vehicle.
‘Hi, chaps,’ he says. And then to the friend of the patient, ‘Would you mind travelling up in one of the police cars, mate? Only I think I’d better travel in the back. Okay? Thanks.’
The friend hauls up his rucksack again.
‘What’ve you got in there?’ says the policeman. ‘Beer?’
‘It’s my mum’s birthday today.’
‘Oh. Well. Many happy returns to your mum,’ he says as they pass, and smiles at me as he climbs inside. The ambulance drops an inch.

I want to step outside the vehicle with him and find out what all this is about, but I can’t leave Paul on his own. The policeman positions himself at the front of the ambulance with his back to the hatch. He pulls on a pair of leather gloves. Then, securely behind the line of sight of the patient, he canters through an emphatic mime, mouthing the significant words:
Points to the patient – psycho – bashes a fist into a hand, makes a stabby-stab motion – very violent – winces and shakes his head – nasty piece of work. Then says out loud, quite pleasantly: ‘Paul was posted as missing today, by his family. They were worried about him. So we’ve come along to make sure everything’s okay.’

I look at Paul. He lies on the trolley bed as lifelessly as he was back in the flat.
I look at the policeman and he smiles as benignly as before.
‘Well – let’s go to the hospital, then’ I say.

When we get there, the triage nurse displays her own techniques for painful stimuli, surrounded by police.
‘Come on, Paul,’ she says resolutely.

Everyone leans in.


Ben said...

oohhh! Bet your glad you stopped there and didnt try anything more intrusive. Brings home the risks of prehospital care but maybe you're better of not knowing sometimes, you just get on with the job. How did he respond in A&E?

tim said...


Spence Kennedy said...

Hi Ben
I didn't actually have much else I could've used, short of a spiked club. Of course, I would far rather have known what we were going into (I never did find out why the address wasn't tagged, for example), but sometimes I think you're right - ignorance is bliss.

Hi Tim
Well - A&E was absolutely crammed. It was a job to find a trolley for the pt, let alone a cubicle. It was like trying to handover in a rush hour ticket office. Pandemonium. Plus, as soon as we'd removed our trolley from the melee, the word was out that there were outstanding red calls all over town - so... we went straight back out and didn't get a chance to talk to the police. Blah, blah. Another story that hangs in mid-air. Sorry! But that was our experience.

I've said before that I should make more of an effort to follow up these things. Note to self etc.

Thanks for the comments!

Seb said...

I've heard of the "Sternal rub" but what is "The Mastoid Dig"?

Thanks! :)

Spence Kennedy said...

There's a little hollow just behind the ear - between the mastoid process and the angle of the jaw. It's uncomfortable if you press in there...

It's not officially known as The Mastoid Dig, I should say!

These are all part of the business of assessing someone's level of consciousness, and what their response to pain is for the GCS.