The Nation's Health + Paramedic

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Memories

"74 year old male, back pain, feeling dizzy and weak"

I've met 1000's and 1000's of people through my job, some good, some bad, some made me happy, some made me sad. To be honest, as harsh as it sounds, most don't get a second thought. That isn't to say I don't care, but if I take the thoughts and feelings of every job home with me I'd be a jibbering wreck! Doing this job however, it is inevitable some things you see will stay with you forever. It's an unavoidable part of the job. That said, delivering twins is a memory I'm fond of, as is meeting a man whose life I saved, or seeing the child start breathing again who had been choking. These are memories that I will cherish. The flip side, is there are people, faces and events that I can't un-see or forget about. There are people who you share moments with who have a profound effect on you, who stay in your thoughts when you'd rather they wouldn't.

I was called to this guy with back pain and dizziness. At one point I thought that I'd be cancelled as it wasn't a high priority call, but due to my proximity to the address and the fact the service was busier than normal I was on scene before a cancellation appeared. The door to the flat was unlocked so after knocking, I let myself in.

Lying on the bed was my patient. He was smiled at me and I introduced myself. He was white as a sheep and pouring with sweat though didn't look in too much discomfort. He spoke very quietly to me, so much so, that I could hardly hear him. He had had back pain throughout the day which he scored at around 5/10. He was feeling very light headed and felt especially dizzy with blurred vision when he sat up. He had no other symptoms to mention but was understandably anxious. I set about doing his observations, already thinking that I'd probably want an ambulance sooner rather than later.

His blood pressure was in his boots. In fact, it was one of the lowest, conscious blood pressures I'd ever seen. I raised his legs with cushions and then nipped back to the car to get my paramedic bag. I also used the opportunity to request an ambulance ASAP, without having to worry the patient.

By the time I returned, his breathing was notably faster, but he wasn't complaining of feeling short of breath. It was still just the back pain causing him concern. Due to the extremely low blood pressure, finding a vein was a pig! Eventually I found one and got some fluids running. Despite his protests that he was feeling okay, as far as I was concerned, he was deteriorating and I myself begun to get anxious about not having an ambulance. It is one of the perils of working on a car. Sometimes you get stuck in a waiting game and it is a pretty helpless feeling. Luckily, the ambulance arrived a few moments later so my anxiety was put to rest for now!

I was aware that the guy's abdomen was somewhat distended, more so than when I arrived. There was still no pain but I was pretty confident in my suspected diagnoses. I had a horrible feeling that he was having an Abdominal Aortic Aneurysm (AAA) and that it was at risk of rupture. A ruptured AAA outside of hospital means death. A person can bleed out into their abdomen and die within minutes. We were all well aware that he needed surgery immediately if it was what we suspected. We also had to make sure of minimal movement and a very smooth, yet fast blue light run to hospital.

We get the bed into the flat and carefully transferred him to the bed. Without any delay we left, driving off almost the instant the door was shut. We put a blue call in to the local hospital on route. By now the patients breathing was visibly strained. His oxygen levels that had been 100% dropped rapidly so we put him on high flow o2. We were at the hospital within 3-4 minutes, his abdomen now distinctly distended. As we were wheeling him in I knew in my heart of hearts that he was going to die. I still really hope my face didn't show that.

We transferred him to hospital bed in resus and attached him to their monitoring. He turned to us and said:

"Thanks guys, you've been brilliant.......thank you.........."

At that point his eyes closed.

"Crash call!" shouted the nurse as his breathing stopped.

Within seconds, he was surrounded by nurses, junior doctors, SHOs, registrar's, surgical consultants and us. CPR was started as I handed over to 15 people surrounding him. Five minutes later, he was declared dead.

His medical records will show a 74 year old, male smoker who died of a ruptured AAA. A relatively common cause of death in male smokers aged 65-75. It's life and not something anyone will be too concerned about. He had no family to speak of and lived what a appeared to be a very solitary lifestyle. He is however, one of the patients which will stay in my thoughts.

There are some patients you create a bond with, not through common interests or friendship, but because you were there when they needed you most. You were the face that appeared when they called 999 for help. You were the person that reassured them when they needed reassuring. Yours was the hand they grabbed when they knew something was wrong. Yours were the eyes they starred into as they drew their final breath. And you were the person they thanked with that final breath.

I'm not naive enough to think I can save everyone. When he picked up the phone and called 999 he was dead. Nothing was going to save him and I know that. No one is to blame, there are no fingers to be pointed but sometimes that is of no consolation. What I can take solace from is that he didn't die alone, and as much as I don't want to still be thinking about him all these months on, at least someone is. At least he isn't forgotten.

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Thank you!

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