Saturday, February 21, 2009

one man and someone else's dog

There is light flickering out from around the upstairs curtains, but downstairs is dark, nothing moves and no-one comes to the door. I knock again, more loudly, and step back. There are no obvious neighbours to rouse; all the places round here look hollowed out and neglected. The call is a Cat A breathing difficulty. The patient could be unconscious on the floor – in which case, my next move will be to kick the door in. Just as I’m about to put the resus bag down and foot the door to see what locks he has on, there is the sound of heavy snuffling beneath the door, followed by a voice calling down: ‘Just a minute.’
And it is a full minute before a light snaps on in the hall and we hear heavy, uncertain footsteps descending. Then a latch is turned, the door swings open, and a Staffordshire bull terrier like an overstuffed, animated white footstool launches itself off the step in the direction of my trousers.
‘Down!’ I tell it, whilst at the same time the man says: ‘Don’t mind him. I’m looking after him for a friend. Come in.’
He turns and starts back up the stairs. I follow immediately behind with the dog glued by the nose to my leg.
‘Careful…’ I say to the man, but it’s too late. He steps squarely into a pile of dog crap curled neatly on the third or fourth step up. ‘What?’ he says. He seems pissed.
‘You’ve stepped in some dog crap.’
‘Oh. Okay.’
He carries on walking. I look at Frank. He shakes his head and bends down to fuss the dog behind the ears, his blue gloves contrasting strangely with the nubby white head. The dog transfers its devotion.
After picking our way up the stairs РI scan the treads with a hand torch just to be safe Рwe finally emerge into a boxy front room, the clich̩ set of yet another play about social deprivation.
‘Could you turn the TV off for a moment?’
‘What? Yeah. Go on then.’
Frank steps across the carpet like he’s being sent across a minefield. He pushes the button. The enormous screen blinks off, and the room darkens by a hundred candles, quietens by as many decibels.
‘And can we have some lights on?’
Frank obliges. The man and the dog scrutinise us from the sofa.
‘And would you mind putting your cigarette out? Only we don’t smoke, and we’ll just end up stinking the rest of the night.’
The man stubs it out, smashes it right up, scattering dead cigarettes and ash from out of the ashtray to make room for it.
‘Thanks. Sorry to be a nag. So – what’s the problem tonight?’
‘I can’t breathe,’ he says.
I look at him.
‘Forgive me for saying so, but you’re not really coming across as someone who can’t breathe. Their chests are usually heaving, they can’t speak, or only very little, they might look a terrible colour, even quite blue. They don’t usually smoke and move about. Generally speaking they’re struggling to cope. So when you say you can’t breathe, what do you mean?’
‘I’ve got a cough.’
‘And how long have you had a cough?’
‘Three weeks.’
‘Have you seen your doctor?’
‘Why not?’
Even the dog looks at him at this point.
‘Don’t know.’
‘Any health problems normally?’
‘Take any medication for anything?’
‘Quetiapine. S’it.’
He leans forward and takes a sip from a filthy pint glass. It is a third full of a viscous, whiskyish liquid. I want to tell him not to drink anything whilst we’re here, but I’ve already made a few demands and I don’t think there’s room for another.
He looks like Action Man after a harrowing tour of duty, except our patient’s eyes are flatter, less humane. There’s a ridge to his forehead so pronounced you could step up onto it. His hands are lumpish and stained, the fingers all gnawed up.
‘What I’ll do is give you the once over, see what your temperature is, your blood pressure, that kind of thing, and we’ll talk about what to do next.’
He places the pint glass back on the table, and a little skip of ash rises around it.
I put a Sats probe on his finger.
‘Good. Your oxygen levels are fine.’
He nods as if he knew that, and abstractedly runs the knuckles of his left hand up and down his right forearm. Janine 2002 in a Gothic script.
I put the probe back onto my belt, and then wrap a BP cuff around his arm.
‘Whoa,’ he says, suddenly stiffening up. ‘What the fuck’s this?’
‘It’s the blood pressure cuff. Don’t worry. I inflate it a bit – it’ll feel a bit tight – then I let it down and see what your BP is? Is that ok?’
‘If you say so, chief.’
I start to inflate it.
He stands up and yanks back his arm.
‘What the fuck….? What’re you doing?’
He stands there, swaying slightly, his legs apart, one arm bent slightly, the other one raised up in the air with the cuff swinging from it.
I step up to him, unwrap the cuff – because although he looks ready to fight, I bought this kit myself – grab the resus bag and say ‘Actually, I think what we need to do is just go.’
And then to Frank: ‘Come on, mate.’

We walk out of the door without another word, even in retreat still careful to light the stairs for crap. Outside in the truck Frank drives us to safety round the corner. I phone Control to let them know the situation. I especially don’t want a single responder pitching up alone there tonight.
Frank says: ‘Can I smell something?’
I look at him. He looks at me.

Anyone passing along that street at one in the morning would have seen two ambulance men either side of their truck looking at their boots.


Kaz said...

The last line really made me laugh!

uphilldowndale said...

Do you think your local MP would like to do a night shift with you?

Spence Kennedy said...

Hi Kaz!
Yeah - it's a glamorous life. We're out there living the dream...

I'm sure our local MP would hop on board - especially if someone had a camera pointed that way ...

:) x

Anonymous said...

I dare say there would be some editing to the programme though!

I'm getting used to just up-ing and walking out of a patients house when I don't like the situation. As much as I know its my safety first and (in your case) the patient is ok, I still feel slightly guilty.

Did anyone end up back there again? Known regular?

Spence Kennedy said...

Hey Louise
Yeah - if the patients looked a bit rough they'd photoshop in some better looking ones.

I know what you mean about the guilt factor when you leave a patient like that. But so much depends on the situation. In his case, I'd put money on the fact that there wasn't anything acute going on.

A lot of it's about instinct - how you feel the whole thing's going. Some people shout a lot but aren't a real threat. Some people only need to stand up suddenly and you know they're ready to blow.

Ironically, I was with a patient today who was only moderately unpleasant, and I wasn't at all worried - until two police cars turned up at a clip, and a PC insisted on riding in the back with me (apparently the patient had grievous previous!)

;) x

Carol said...

And was there any? On the shoes?

Spence Kennedy said...

All clear!
Life on the front line, eh? ;) x