We’re driving back towards the station mid way through the 14 hour night shift. Things have been slow for a Saturday night, which we’re very happy with. The page comes through, and it raised eye-brows: although it didn’t read anything overtly sinister or obtuse, our gut feelings just told us that it was a serious job. 17 year old female having convulsions/seizure activity. Ingested alcohol. The job was 30 minutes drive away, with no one else available. So off we went, lights flashing in the night with the sirens blaring as we went through the empty intersections.
There are many things you think about when you’re on the way to a job like this: why is she having convulsions? How much alcohol has she had? How many people will be at the house and how drunk are they going to be? Where’s our nearest hospital/back up and how long will it take for us to get there?
We turned up to a farm, finding a bonfire and tents set up within a paddock. Around 30 teenagers in various states of inebriation roamed the cold night air.
As we arrived we saw a bad sign: the family had loaded the patient into a car and were preparing to drive her to hospital themselves. Her breathing was rapid and shallow, as her eyes rolled back in her head. Vainly, she attempted to talk to us, each breath and thought a struggle.
Looking over my shoulder to see the patient for the first time, my partner’s attitude changed entirely. “What’s she had?” he stated to the bystanders, demanding a response. A scared, skinny looking teenager piped up from the rabble. “Nothing, she’s just had two cruisers, she shared them with me”. A middle-aged woman burst in, seemingly proud of herself, “There’s nothing here but smokes and alcohol”.
A look of intense frustration came over my partner’s face. “That’s not alcohol” he muttered. With a stern voice he commanded them find out exactly what was at the party shouting “and tell them not to be stupid!”
In the mean-time we’d asserted that this girl was in serious trouble. Her heart rate was bouncing from extremely fast to very slow. Her blood pressure was crappy, radial pulse was barely palpable. Thankfully she was light. We picked her up and carried her bodily into the ambulance. Calls for back up were made. A bag of fluid was hung. Clothes were cut off and dots placed on so ECG’s could be taken. Busy with the patient I handed my notepad to the girl’s mother, telling her to write down all the patient’s medical and personal details. With a big smile she took it off and went away.
The woman had no idea how sick her daughter was. It was all just a fun exciting spectacle to them.
I wasn’t about to tell her. We had enough to worry about without a distressed mother getting in the way.
With lights and sirens on, we raced to hospital. VT appeared on the monitor as our patient became unresponsive. Chest compressions were delivered and just as we were preparing to do a full resus she became began making incomprehensible noises again.
She survived to hospital. Things were a little touch and go in ED, with the Doc on duty not taking things seriously until the runs of VT started again. As we left to write our patient reports the mother gave me a death stare. She’d finally arrived and began to realise how serious the situation had been.
You get that sometimes.
A week later I found out that our pt had been diagnosed with a cardiac condition called long Q-T syndrome. She had been mere seconds from being defibrillated multiple times, and without interventions would likely have died sometime during the night.
Jobs like this aren’t rare. But it’s common to not know why a patient is sick. Sometimes all you can do is treat what you see, pray you don’t miss anything, and hope that you get it right. Thankfully, this time we did.