We were called to a Cat A red call “Severe Respiratory Distress”for a gentleman in his late 60s. Arriving on scene I waited for my colleague to get the O2 resus bag off the truck and then I locked up. Our address was in the centre of Big City in a renovated block of Victorian tenement buildings originally built as a barracks in the middle of the 19th. C.
It was blowing a gale and the temperature had dropped a few degrees since yesterday making the air almost freeze on our breath. After what seemed like an age we gained entry through the controlled access main doors. Our patient resided on the ground floor almost next to the entrance. A party was going on next door with sounds of laughter and music coming from within.
On entering the gentlemans flat we were first confronted by the stale smell of alcohol and the familiar aroma of self neglect. The gentleman was sat on the edge of his bed and breathing very fast trying to take in air and talk to us at the same time. After a few words of encouragement we managed to slow his respirations down. No need for the O2.
It was plainly evident that he was a alcoholic as littered all around us were empty bottles of whiskey and other sources of alcohol dependence. (I dont think he was collecting them to put “ships in a bottle.”)He was emaciated and looked worse for wear. My colleague asked him questions about how he felt, had he any pains, did he suffer from anything, what meds did he take etc. He had no family left.
I asked him…”does your heating not work?” to which he replied that it did but he was afraid of the fuel bill! It was more cold in his flat than outside! We located the thermostat and turned his heating on. (Better to be warm and dead than cold and dead.) A quick look around and we could see that he was not coping and needed help. All the while he was telling my colleague about what he was going through. He seemed like a once proud man who had been taken over by alcohol.
His obs were acceptable…O2 sats 95%, B.P. 142/90, pulse 100, resps 24 per minute and his blood sugars were 6.5.He seemed to be anxious and shaking saying he had been like this for 11 days since stopping drinking the whiskey. Alcohol withdrawal can manifest itself in many ways…one way in which we were soon to discover.
Up until now he had been orientated and articulate in his responses and offered rational explanations for his predicament. He was obviously a social case and did not need to go to A/E. I noted the state of his bedroom…like a scene from Miss Havishams house in Great expectations, only this time the cobwebs were replaced by dried blood on the walls and wardrobes! This was due to the many falls he had recently whilst under the influence.
We attempted to contact the “Falls Team”who would be able to assess our patient and put in place a package of care. That was the theory…unfortunately we had rung outside of the allotted hours of their response. I did not want to leave an answer phone message which may or may not be picked up the next day! The next option was to arrange for a out of hours GP Doctor to call that night and hopefully arrange a direct admission to an elderly ward. (it sometimes works!) I passed on all the relevant details to the call handler and awaited for the Doctor to ring back…and waited……and waited……….and waited………..and waited!
Our patient seemed happy enough with the arrangements we were trying to put in place for him. (On reflection it would have been easier to have chucked him on the truck and dump him in A/E but that would not have been fair on anyone). Whilst chatting to our gentleman he turned around and called for “Maureen” to back him up on his answers to our questions!
“Who are you talking to Albert?” We knew that there was no one else in the flat. “I,m talking to Maureen, shes marvellous…” he said looking towards the back of his bedroom. I thought about this and asked him if he had “Life-Line” installed* saying that it was a brilliant system for people on their own. He agreed with a nod of his head.
Suddenly he piped up…”I cant sleep at night either!” Due to the coldness of his flat I was not surprised! He continued “…they come in the middle of the night and wake me up, making all kinds of noises!” I asked who it is that wakes him up? “Its his friends!” pointing to no-one at the other end of his bedroom. “He had about twenty people behind the wardrobe and on top of it….all of them having sex!” He then went on to explain in puzzlement that “I dont understand it….those wardrobes are flush against the wall!”
My colleague and I looked at each other, then looked at Albert. He was now becoming more and more animated and his breathing was coming in short gasps as he let fly into a tirade of abuse at his “friend”. We decided that perhaps the out of hours GP was now not an option. After calming Albert down we told him that it would be better for him to get a good nights sleep at the A/E. I re-contacted the GP and stood him down, not that I think he was in a hurry to attend anyway!
We carried Albert out and past his neighbours with the party just starting to get into full flow. We settled him comfortably on the truck and took him the 2 miles down the road to A/E. Handing over to the nurse I quickly explained our actions on scene and that we had brought him in as a last resort. She was not happy. But then she had not spent the last hour and a half in a filthy flat trying to get this once proud man the care that he desperately needs.
I,m just glad that we did not leave him waiting for the GP to attend as I,m sure he might have fallen again or even have had another visit from his “friends”or he may even have started up on the whiskey again. It just never ceases to amaze me that when people like Albert need help the most, the appropriate agencies only work day light hours Monday to Friday. Everything falls back onto A/E.
I hope Albert got some sleep!
* Life-Line…an alarm system linked to a regional control centre that can be contacted by pulling a cord or pressing a button.