Sunday, August 12, 2012

a very bad patient

It starts with me scratching the outside edge of my right palm. A little while later, when I grip the head-end of the carry chair, the hand feels puffy and tight. When I turn my hand over to investigate, I find an angry, reddening lump. Bitten, then – but by what? A mosquito? Horse-fly? Snake? I scratch it again before I remember I shouldn’t.
When we get back to base I take some Loratadine I have in my locker.
An hour later and my hand is markedly swollen. I show it to one of the A&E doctors. She turns my hand over gently, presses the oedematous flesh of it, rests the back of her hand against it to gauge the temperature.
‘That’s quite a reaction,’ she says. ‘Have you taken anything?’
‘Just some Loratadine.’
She tuts like she thinks that’s as effective as prayer. She gives me Chlorphenamine, tells me to keep an eye on it. ‘If this red patch starts to spread up your arm, speak to me again,’ she says.
The shift finishes.
I go home to sleep.

When I wake at midday, I’m already scratching. I hold the hand up in front of me. The whole thing looks like a rubber glove that I’ve blown up and tied off at the wrist, ballooning with fluid. It’s so tight that if I bunched my fingers into a fist the back of my hand would rip and a shower of gunk hit the ceiling.
I feel hectic, invaded.
I get dressed, go downstairs, wave the hand in front of Kath.
‘Oh my god! You’ve got to get that seen to,’ she says. ‘I’ll drive you down there.’
I pack an emergency bag of stuff – iPod, phone, wallet, book. The only thing I don’t pack is a Very pistol and some mint cake.
Kath drops me at the entrance.
‘I’ll call you,’ I say.
She drives away and I walk inside.
There are half a dozen patients distributed about the waiting room, all of them with a murderous, bedded-in look. A woman gets up to go to the water point; it’s like watching a prisoner exercising in the yard.
I hesitate.
Should I go in via the ambulance entrance and speak to the doctors there? But I rarely get up this way and I don’t know the staff all that well. I recognised one of the nurses as we drove in, but it looked as if she was going home. I decide to be brave. At least this way I’ll get to see what happens as a regular punter.
I go up to reception and rest my comedy hand on the counter for dramatic effect.
After a long, professionally extended moment, the receptionist looks up.
‘Yes?’ she says.
‘Hello.’ I smile and pause, expecting her to recognise me.
She doesn’t.
Out of uniform, out of context, out of luck.
‘How can I help?’ she says.
I lose my nerve and lean in.
‘I’m actually a member of staff.’
‘A what?’
‘I’m a member of staff. Ambulance,’ I whisper.
‘Just tell me what’s wrong,’ she says, hitting a key on the computer like it’s a panic button.
‘I’m supposed to be working tonight, but I’ve been bitten by something. On my hand. It’s become infected. Look at that! God knows what it was. A scorpion, maybe.’
She sighs.
I wait, then go on.
‘I don’t suppose I could have a chat to one of the doctors to get their advice,’ I say.
‘I’ll book you in.’
‘Couldn’t I just have a quick word with one of them? Only I’m supposed to be working tonight.’
‘Like I said, I’ll book you in.’
She frowns and sighs at the same time, her eyebrows and shoulders all part of the same pressure release mechanism.
‘Name?’ she says.
I give it.
She fills out the form.
‘Take a seat.’
‘Any idea how long?’
‘I don’t know,’ she says. ‘The Triage Nurse will see you presently.’
‘But it’s tracking up my arm.’
‘Speak to the Triage Nurse.’
I take a seat.

I settle in.
Take out a book.
Look around.
This is good, I tell myself, smoothing out the page. It’s good to know the patients’ experience. Maybe this’ll make me more sympathetic.
I self-consciously hook the thumb of my right hand into the v of my t-shirt, to help with drainage. Maybe someone will see that. They’ll see how ill I am. They’ll see my oedematous hand, and come running.
This is what’s it’s like to sit in a waiting room.
Seen by a receptionist.
Waiting for a triage nurse.
For how long?
What if something’s terribly wrong? Will these minutes and hours count?
Oh my god! How long have you been like this? And you came in through reception? Jesus Christ! The poison is running up your arm and you sit and read a book?
I look around me.
No movement. No sign of anything happening at all.
No-one else remotely ill.
There’s a young couple laughing, holding hands, stroking each other like they’re waiting at the Town Hall to get married.
An elderly man snoozing over a puzzle magazine.
A woman texting beside a child as it picks over a ragged box of A&E toys.
Nobody looks ill at all.
I remember a story I heard about a flamboyant A&E consultant who, when the department was completely overrun with patients, went into the waiting room and asked everyone to stand up. ‘Good. Go home. You shouldn’t be here.’ Probably apocryphal, but bracing nonetheless.
I sigh and go back to my book.
My hand throbs like Wile E Coyote slammed his paw with an Acme mallet.
A coach party arrives at Reception.
I joggle my knee.
Massage my hand.

Time passes.

‘Mr Kennedy?’
I feel like jumping up and throwing my book in the air. But instead I collect my stuff together and go in to see the triage nurse.
‘Take a seat.’
I take a seat.
She takes my temperature.
Fills in another form.
I smile and play the brave ‘Tsch! What a nuisance!’ card. ‘I’ve no idea what bit me. An alligator, maybe.’
‘I’ve seen lots of these infected insect bites this month,’ she says, clicking her pen definitively.
‘Yes. Take a seat back in the waiting room. The nurse practitioner will see you soon.’
I go back into the waiting room.
I re-open my book, make a savage fold along the spine, breathe, look around.
It feels like I’ve been rejected by the parole board.


There’s a shot I saw in yesterday’s paper – a panoramic, composite photo sent back from the Martian Curiosity explorer from where it landed. A vast expanse of desert wasteland, fringed with mountains in the distance.
This is how far away I am from seeing a doctor here.
A name is called. The boyfriend / girlfriend combo detaches with kisses and the man strolls happily in to see the nurse practitioner. The girl hums and picks up a magazine. What can be wrong with him? An STD, I hope.
I go back to my book, hating the world.
Check the time.
Go back to my book.

The light eases outside, blue to gold, summer to autumn.

If I ever make it outside again, how will the world have changed? Will I even recognise it?
Everyone will be travelling around in pods, wearing foil suits.
‘What year is this?’ I’ll say.
They’ll hurry past.
Me and my hand.

The man comes out again and his girlfriend stands  up to throw her arms around his neck. He made it!
The Nurse Practitioner smiles, then checks her list.
‘Mr Kennedy,’ she says.

The doctor rotates my hand, probes the swelling.
‘Hm. It looks like it might be getting a little cellulitic, but I don’t think we’re at the IV anti-biotic stage just yet. Let’s give you a course of oral Flucloxacillin, see how we go with that. Keep on pushing the Chlorphenamine. You need to go home, keep your arm raised and watch the rest of the Olympics in style. Okay? Okay.’
He slaps my shoulder, sculls backwards on the office chair, stands and goes away.
The Nurse Practitioner finishes the paperwork.
‘There!’ she says. ‘A scrip for the Olympics! That can’t be bad, can it?’
I shake her hand with my comedy mitt, and stride back out into the world.


Mike said...

You should have called an ambulance.:-p

Hope that your affliction hasn't spread ans that you're able to sit up and take nourishment.

Spence Kennedy said...

Feeling much better thanks, Mike. God bless a/bios - and thank God I'm not allergic to them. The hand is almost back to normal i.e. a big fat farmer's mitt. I don't suppose anyone really noticed the difference.

Able to take on nourishment, too. That's high on my list of priorities. I'll always try to force a little something down. And maybe just an egg-cup of wine... *brave smile*

The Girl said...

Awww Spence... you fell at the first fence by telling them you were staff. what were you thinking!

It's always bad when you show up and NO ONE recognises you...
have children AND be a white taxi driver that'll increase your chances.
have boy children and be 'one of them' and it'll increse your chances even more. lolz.

Although I am just wondering WHY you went to A&E (especially as it wasn't an accident and wasn't an emergency... well, not really!)
when you could have used the out of hours doctor's thingy (you call the surgery, they give another number to call NOT NHS redirect, you get to see someone, sometimes it's even located locally or near the A&E)

i'm with Mike... you should have called an ambulance, then the nice FRU person could hav given you a shot of antihistamines and given you the Fluxclox and you wouldn't have had to move from the TV / Limpits (r)
Hope you're better now... and back to work in no time!

Spence Kennedy said...

You're right, TG. I could've gone to see an OOH in an Urgent Care Centre. Except the A&E is closer, and all I wanted was some anti-bios to treat the infection. I actually work quite a few miles from where I live, so I was 'off piste' in many ways. If I'd been on my patch, I could've had a quiet word and been done...

In my own defence, it was damn painful and was actually a medical emergency. If the infection spread up my arm it could've been quite dangerous (I don't think I'm being alarmist to say that).

A Paramedic Practitioner can't prescribe a/bios for this kind of thing. They can only give it for UTIs (and Benzylpen. for meningoccocal meningitis...)

Def feeling much better now, thanks.

jacksofbuxton said...

Well I'm pleased you're obviously feeling better Spence (unless you've typed this out with one hand following the amputation) but fancy trying on the "I work here" script.I know R.H.I.P (rank has it's privilege)but that was a fatal error.

Still,you'll know for next time.

Spence Kennedy said...

I know, I know. A bit shame-faced. But at least I'm honest about it - and who wouldn't try to play their 'get out of jail free' card when faced with ... erm ... jail. But you're right, I'll know for next time (to drive the extra distance and go to my usual hospital).

Not really.

Oh - one thing I meant to say in my last comment - the other reason I didn't go down the doctor route was because I thought I might have to go on IV a/bios - that would've meant a referral on to A&E, and more delay.

I feel I'm on the back-foot here! Probably deserved. But anyway - it all goes to show the kind of things that happen when you get sick, which is the theme of the whole blog, after all. It's rarely ever straightforward - treatments, motivations or outcomes.

Anyway, thanks for the comments! :)

Eileen said...

Always turn up in uniform - on the grounds "I'm working later and I didn't know if I'd have time to go home and change".

Establishes the relationship, demonstrates you aren't being soft. Possibly the quickest way is to go to work and then make sure someone notices ;-) Unless it's one of those "Q" days/nights - but I bet you don't get too many of them.

Spence Kennedy said...

Ironic that I was actually supposed to be working later that night! So you're right - I should've had the uniform on. I'm sure it would've been a different experience.

But having said that, I'm suitably chastened now - I swear I'll do my bird with a clean conscience like everyone else ;)

Unknown said...

Consider this a taste of what its like entering A&E without arriving in an ambulance prone on a trolley. As someone who went there with a trapped and bleeding finger, I've had the same experience. Wearing your uniform would have been cheating...

Spence Kennedy said...

Absolutely, TG. That's the first time I've gone through it - albeit in very minor way - and I would have to say I found it a distressingly passive experience.

Even though in total I was only in the department for a couple of hours (and I know many of you will snort when you read that), still it felt like a long time, esp. as there didn't seem to be anything happening and precious little prospect of it everhappening.

And this from someone who's spent the last eight years in and out of A&E in a professional capacity, dropping people off, settling them in, reassuring them as best I can, generally preparing them for the hospital stage of their treatment.

I don't know that my own experience will change how I treat the patients when we deliver them to hospital. There's not much we as ambulance crew can effect that side of things. Giving them accurate information & expectations is one thing I can tighten up on, maybe.

As far as resorting to the 'I work here' ruse - it's hard to resist handing yourself over like that in those circumstances. It's more to do with the fact that as staff you're so used to horse-trading patients (in a nice way) it comes automatically. Bumping them - or yourself - up the order...

Not proud of it, though. And I won't do it again (probably) :)

Hope your finger's better, TG x

Unknown said...

Yes thanks! My daughter trapped it in a door, and as it bled so badly I panicked, so did she and sent for (gulp!) an ambulance! Lol. He did all he could at home but advised me to go to A&E with it to get it checked out (x-rayed) I was there longer than you, about three or four hours sat looking stupid with my finger up in the air...

Spence Kennedy said...

Ouch! And poor daughter too. I once shut the car door on my daughter's fingers and I can't express the dreadful feeling of guilt - it makes your legs go wobbly!

Sorry you had such a long wait in the dept. I would've sympathised before, but now I double do! x

Unknown said...

I'm sorry about your hand and hope you have healed up nicely but I spent most of my time laughing while reading this. From the moment you first spoke to the receptionist to gettig your scrip, I was losing it.

Sitting here at the office, trying to conceal my little explosions of giggles with coughing fits instead. Not sure why I would think that would be better from my co-workers but nevertheless.

Still, I hope you are well and I apologize for laughing at your plight. Also, I have finally completed my review of your book on Amazon but it is under the US Kindle version since that is where I purchased it.

Spence Kennedy said...

Hey Nari!

Thanks for such a lovely review on! I really appreciate it. Thank you so much for taking the trouble to write. It's like I've said before - I owe you one.

My hand's healed up beautifully, thanks. You'd never know how mortally sick I was (or how brave). A/bios are the nuts. I want to live in Antibiotica, and call my first-born Floxa - and wear t-shirts with comedy bacteria being hit on the head with mallets...

BTW - I'm glad you laughed at that post. I meant it to be funny but I think my ropey old attempt at queue jumping superceded the humour in this case.

:) x

Anonymous said...

Ha, ha poor you. Be thankful you didn't go down the IV route, When Mr UHDD found himself amongst these poor lost souls (when he had a DVT), spending thier days hanging around in the unit next to A+E waiting and waiting for the next drip.
Maybe it was quiet in minors because the green gods kept wheeling the big sick in through the back door.
I remember waiting in the middle of the night with sick todler in my arms, for what seemed like hours, I could have wept when the pizza delivery guy walked in the unit with tower of pizza boxes, I knew I'd got a longer wait

Spence Kennedy said...

I have to say it was definitely a relief to be off the hook - or the cannula - in that respect. For all my moaning and bad grace, I was still aware of how lucky I was, free to walk out of there in short order with a bottle of a/bios in my pocket.

That sounds like a really rough time you both went through, UHDD. Hope everything's good with you now. Thanks v much for the comment x