Any healthcare professional will tell you the value of your gut feeling in the assessment of a patient. The British Medical Journal published an article citing it as:
“clinician’s intuitive feeling that something is wrong, even after examination that suggests otherwise, appears to have diagnostic value, even greater diagnostic value than most symptoms and signs”
In this case, stood looking at the patient in front of me. I knew something was wrong. We were in the living room of a family home – children’s toys were strewn across the floor and we were surrounded by pictures, ornaments and children’s pieces of art.
I was working with a student paramedic and an emergency care assistant. It was the early hours of the morning after a busy night shift. The patients wife had phoned 999 – she did not speak any English and gaining a history from her was proving to be difficult.
The patient – a tall man in his 40s was sat on the chair on the sofa. He was leaning slightly forward. He was pale, clutching his head and vomiting.
The student was doing the initial observations – the patients blood pressure was extremely high and his pulse low. He had slurred speech. I asked the ECA to get us a chair.
In the ambulance service this is a code phrase – it means we need to get moving quickly. Whilst the ECA was doing this the patients daughter came downstairs.
The daughter was around 10, she was young. However, she was the only person there at the time that was able to tell us what had happened. Her dad was struggling to speak, her mum spoke very little English.
She told us that her dad had been working that night on the late night bus. She then started translating for her mum – she told us that the patient had come in and complained of a sudden, severe headache.
This was all I needed, I knew what this looked like. The patient was presenting with a subarachnoid haemorrhage – a dangerous bleed in the brain. He was very unwell.
We managed to get him onto the chair, our sense of urgency reflected by the flashing blue lights on the windows around us. We carried the patient out of his front door and down the steps outside.
At this point we noticed a change. The patient slumped to the side. His eyes fixed and glazed to the right. His arms were trying to draw up to his body – a position called decorticate posturing. The brain was injured and was pulling the limbs in to protect the bodies core and central organs.
We managed to get the patient onto the trolley. As we did so the patients wife was getting more upset. There, stood next to her. The patients daughter. She was silent.
I had to get my student to help me hold a limb straight. I needed to get a cannula in. The patient needed medication to stop him vomiting and protect his airway. We managed it between us.
I was acutely aware that the patient was possibly still aware. His eyes were open and fixed to the side, I was trying to reassure him as tears rolled down his cheek.
At this point – the patient started fitting. I quickly got my ECA to close up the ambulance and instructed the student to get the oxygen on the patient. I drew up the diazepam and administered it. The seizure stopped.
There was a gentle tap on the door. I opened it and found the daughter stood at the bottom. She asked me what had happened. I was honest. I told her that her dad was unwell, it was critical that we got him to hospital quickly.
She translated this to the patients wife, her mother. This 10 year old was having to deal with something that she would be dealing with for years to come. The mother vomitted. We got her a bowl.
“She wants to come with you”. The girl said.
We only had the seat in the front spare and one seat in the back. The daughter was doing a great job of remaining calm and collected as well as translating for me.
I kept her in the back. Wether or not this was the right thing to do, I am still unsure. I needed a translator. I also needed calm. She was both. She was amazing.
The patient remained stable the whole way to hospital. The daughter held his hand tight the whole way. The mother sat in the front.
Sadly, I don’t know the outcome of this job. I watched in the resuscitation room as the patient was put to sleep and prepared for transfer to a neurological unit.
I like to think the patient survived. The resolve in the face of the ten year old girl as she gripped her fathers hand as we raced towards hospital will forever be with me. Our treatment did half the job – she did the rest.
Sometimes holding a hand is the most important treatment you can give. It encourages hope, gives purpose; and sometimes – can make someone fight.