THE FIRST TIME I dealt with a medical emergency on my own is an instructive demonstration of multi disciplinary work relevant skills. On a train going home from work one evening a stranger struck up a conversation with me. He was one of 3 passengers in the carriage and, indeed, the entire train seemed relatively empty. He had been visiting his sick wife in hospital, but while recounting his story his pallor changed to a sudden dull grey and sweat began to pour from his brow. The look of sheer terror and anguished pain as the man clasped at his chest, with so much strength, it was as if he wanted to literally reach into it and physically remove the pain by force. It frightened me. He promptly collapsed into unconsciousness and slid out of his chair.
I caught him and called to the other passengers to assist me in getting him in to the recovery position. The other passengers, both much older than me seemed as though they should be in charge; but as I watched them panic, dumbfounded expressions questioning every movement with their eyes, it occurred to me to ask if they had had experience with this sort of thing before. Secretly I was hoping that one was a nurse and the other a doctor; or at least a life guard. To my horror, neither of them so much as knew first aid. At that point I knew I had to take control of the situation.
So I did. Despite being the youngest member of our troupe, I directed the rather panic stricken woman at the gentleman’s feet to call the ambulance and push the button in order to make contact with the driver. I instructed the other young man in what he was to do in order to assist me in moving the man into, first, the recovery position for monitoring. But after a few rounds of a woefully confused man temporarily regaining consciousness, before again clasping his chest and going under with a “thump” (as his head hit the floor); a seated position propped against the wall occurred to me as the more reasonable option.
Now, all of this was on this was on instinct; I had only been at the hospital a year at this point and worked nearly exclusively out patient CT. In out patient, clients are generally pretty healthy (or at least think they are) and as such walk and talk and joke; it is very uncommon that anything goes too far awry.
Essentially, I was operating in mimicry of the confidence and decisiveness I had observed in the doctors responding to emergency situations; only within the limits of my rather menial practical medical know how. But one thing I had noticed, in my few shifts in inpatient, was that patients with COPD respiratory difficulties or potential pulmonary emboli had a far easier time breathing while sitting up. I knew for stroke it was often better to keep patients supine flat, and we would have to reposition, yet again, for compressions if things went further south. But with no monitoring equipment, no one to verify anything with, and given the gentleman’s definitive indication towards his chest while conscious; I made the decision to move the man upright with the hopes his new seating position may in some way assist him, as I had seen evidenced at the hospital. And, thankfully, this occasion on the train had proved no exception.
Once upright the man regained consciousness, though still with regular periodic expressions of extreme torment and grabbing of his chest. I asked (as I knew would be required by the paramedics at handover, and not knowing if he would be conscious then) if he was on any medications, had any pre-existing conditions or had any allergies, if he was pregnant. He indicated that among his daily medications was a low dose aspirin, which he had neglected in taking that morning. I asked if he consented to half a chewable aspirin under his tongue (which I perhaps shouldn’t have done, for a range of reasons: suffice it to say well beyond my pay-grade. But I was thinking on my feet and running largely on an automated “emergency” psychological system).
By this stage the train had stopped, security was there and the paramedics were arriving. We moved him onto the platform, sat him up against a wall and one of the paramedics went to give him 150mg of sublingual aspirin. Now, at this point I had to stop the medic and say that I had already done so, for which I was (rightly) scolded. But thankfully I had 2 witnesses that he had consented and, more importantly, the gentleman was so generously grateful for my help, for whatever it was, (and likely very relieved that the paramedics had arrived) that I was to be let off with a verbal warning.
And through all of this, the gentleman’s only concern was that his wife not be told that he is sick, for fear of exacerbating her condition. In speaking with the paramedics, they seemed confident that he would be alright from here on in.
Interestingly, in a cruel mocking of fate, the train had stopped at Auchenflower Station; no more than 100m from my hospital. Unfortunately, as the man did not have private cover, we could not even put monitoring equipment on the fellow were we to cross the road: protocol stated that, not being on premises, he had to be taken to the Royal Hospital.
Consequently, I also do not know how the story ends; other than to say he was alive and in good spirits when we parted company.
And that is why I believe I have what it takes to work front counter/window 3 at your McDonald’s family restaurant.
Dr J. J. Raphael, hc
Perhaps try “A Life Pre-Lived”
First Published for Powerhouse (1), 5/2/13, p6.