The other night, I took a call about an 84 year old woman with abdominal pain. Nothing unusual about that — I get several calls each night about old people with stomach ache. So routine it was, in fact, that I’m struggling to remember much about the call. I remember it was rung in by a young female relative, who was quite distressed, and who told me to “hurry up” whilst she was giving me the address (which is one of the most frustrating things on earth — how can you “hurry up” when you’re waiting for an action by the person telling you to hurry up?) but other than that, it seemed perfectly routine. I hung up, I took the next call.
Then, four hours later, an A+E nurse rang saying that one of the crews had forgotten to leave paperwork for a patient they’d brought in earlier. “No problem,” I said, “I’ll get them to drop it off with the next patient.” I took the name and address of the patient. It was the old lady with stomach ache.
“Thank you,” said the nurse. “Please make sure this message gets through — it’s quite important because the patient has died.”
Died? But she only had stomach ache! A rising sense of panic filled my chest and I quickly looked up the call I had taken. There it was, an amber (medium priority) call. “Collapsed with abdominal pain” was my description of the problem. The call had come in at a busy time, and after twenty minutes an ambulance hadn’t been sent. At that point, the relatives had called back saying the patient had stopped breathing. An ambulance had been sent but it was too late and the patient was pronounced dead at hospital.
I looked at the call closely — from what I could see and what I could remember, there was nothing to indicate that I should have stayed on the line or that the call should have been triaged in a different way. On the other hand, sometimes instinct tells me that I should manipulate the caller into giving me the answers that makes a call come out as category A; sometimes instinct tells me to stay on the line even though protocol does not demand it. And on this occasion, instinct let me down. Of course, I don’t know if anything I could have done would have saved the patient, and I will probably never know. And this is the worst thing about this job, worse than being sworn at, worse than listening to idiots demanding an ambulance for a stubbed toe, and worse than listening to 16 years olds taking their last breaths.
I gain some consolation from the fact that when the relations rang back to say she’d stopped breathing, they didn’t want to do CPR. Maybe they thought it was her time to go. And maybe that is what my instinct was trying to tell me. I hope.
January 23rd, 2006 at 7:31 pm
Sounds like you did your best, unfortunately I guess these things happen. Don’t beat yourself up over it. Keep up the good work.
January 23rd, 2006 at 8:26 pm
Ruptured AAA? That would be my guess.
And, I got that feeling from a patient in surgery once. We could do whatever we wanted, she had other plans, and I knew it, felt it. A rare death on the table in surgery. Huge emotional family, I think we provided the privacy, the permission, for her to let go.
I’ll believe your patient in that call was staying your hand, and the family will, eventually, be more peaceful with the way she ended.
Weird things do happen around deaths.
January 23rd, 2006 at 8:36 pm
Don’t beat yourself up over it Mark - I agree with zhoen - it sounds like an aneurysm burst.
Unfortunately, because the aorta is such a large vessel, when it blows a person will bleed out and die often within a minute, and there is nothing anybody can do about it.
The patient suspended 20 mins after the initial call - so even if a crew had been sent straight away, she’d have suspended on the crew, but if it was a burst AAA (Abdominal Aortic Aneurysm) it wouldn’t have made a difference.
January 23rd, 2006 at 8:42 pm
And you’ll remeber that kind of call the rest of your life. You’re not a mind reader even though that talent would certainly come in handy in our job. However, God not only guides the surgeon’s hands in some instances but the dispatcher’s mind as well. Be well, Mark.
January 23rd, 2006 at 9:25 pm
Mate,
I’ve called the ambulance service numerous times. For my friends, for co-workers and for members of the public. No matter how much I flap the call taker calms me down and gets help on the way.
you guys have always helped me out.
You asked the right questions, they gave the answers that ment an amber call. You did your job. Your not telepathic, you can’t see whats wrong with a patient if your not given the information.
January 23rd, 2006 at 9:51 pm
Instinct didn’t let you down, I don’t think. Instinct was there all the time, and was the reason you didn’t stay on the line, or upgrade the call. She’d had her time.
January 23rd, 2006 at 11:21 pm
It may sound heartless, but at 84 years old, going from stomach ache to dead in 20 minutes is a good ending. Both my parents died quickly in their old age and this is a great comfort to me. There are much worse alternatives.
January 23rd, 2006 at 11:31 pm
I know you reasonably well and I believe without a shadow of a doubt you will have done everything you could’ve done.
January 24th, 2006 at 3:20 am
You can second guess yourself all you like, it probably won’t change the facts on how you feel. If I were 84, I’d like to die with someone I loved close by. It sounds like that’s what happened. Had the ambulance got there any earlier, chances are she would have been in the back of an ambulance with ’strangers’ when the inevitable happened.
January 24th, 2006 at 4:06 am
Well said.
January 24th, 2006 at 6:42 am
All you can do is your best.
Sometimes you do everything you can, and they still die.
Basically, when your numbers up, your numbers up.
Death is a sad but natural thing unfortunately.
Hope you’re feeling less sad.
Don.
January 24th, 2006 at 7:46 am
As Rich said, you’re not telepathic, you can’t see whats wrong with a patient if [you're] not given the information
January 24th, 2006 at 11:45 am
I concur, Spike and Rich.
January 25th, 2006 at 2:00 am
As the other guys think, I firmly believe you do the rigth thing.
Al
January 25th, 2006 at 10:14 pm
Hind sight not be for feeling bad, but to help the next time.
Knowledge be when you do know and when you do not know. That is the key to appreciate that one can never know all , but be always learning.
January 26th, 2006 at 8:18 am
A ruptured AAA is indeed, usually, a death sentence, particularly if there is already haemodynamic compromise.
Surely “collapsed” indicates top level priority, though ? I am unfamiliar with UK ambulance codes…
January 26th, 2006 at 9:46 am
No, “collapse” on its own doesn’t mean anything, triage wise. People often collapse because something hurts, and can quite easily feign a collapse. It was an amber call because the collapse was caused by near fainting. You can’t actually get a category A out of an abdominal pain call.
January 27th, 2006 at 5:34 am
Burst appendix? Purely out of interest… !
January 27th, 2006 at 2:23 pm
No category A out of abdo pain ? That’s a worry. Could be a few things..such as referred chest pain or a perforated ulcer, as well as burst AAAs, that might warrant immediate transport. But I guess ‘collapse’ and ‘unconscious’ are two different things.
No-one can make an accurate diagnosis, or triage priority without the occasional oversight, over the phone. Hard to clinically assess with such limited info !
But this one would surely, sadly, have been well and truly deceased even if she’d been in A+E 2 minutes after the call. I’ve seen it happen in front of me, actually. An elderly ward patient who complained of back pain…I happened to be on the ward so popped my head in within 5 mins. By then it was abdo pain and I could feel a tense abdomen and pulsatile AAA - patient was stat to theater, but deceased on route.
BTW do you mind if I add you to my recommended sites list ? (sorry to “comment” this but you don’t seem to have an email)
January 29th, 2006 at 8:51 am
mon frere, i can certainly empathize with that moment…
January 31st, 2006 at 12:06 am
I agree with the others, sounds like it could of been a AAA. Unfortunately we all get a call like this every so often. All you can do is your best, we dont sit there with crystal balls, and unless the caller tells us something, we dont know!! You did you best and that all anyone can ask!
January 9th, 2007 at 2:56 pm
Research has shown that instinct can be more reliable than logical thought:
http://news.bbc.co.uk/1/hi/health/6243787.stm