Priorities

We head towards the job with a healthy dose of scepticism. Its been a long start to the night shift and things just appear to keep getting better.

'Male, back injury can not move'

The address was in a less then nice part of the concrete jungle, in fact we always tend to approach addresses in this street with caution.

Of course the patient is in a top floor flat and my head is already thinking about having to get a true back injury down the long cold stair well.

I step into the front door as its opened by a skinny looking man. He looks like he hasn't washed in a month and a quick look and sniff of the flat confirms that his social situation and level of personal hygiene are not to the standard we like to see in patients.

"He's through here"

I enter the main living room and scan the area. Take away packets, cigarette boxes, empty lager cans and Buckfast bottle cover every part of the floor. Other piles of unknown detritus scatter the area making it difficult to find a path I would want to walk through. But needs must.

Our patient is lay on his front on a leather sofa. He is wearing a jumper and jeans which appear to be soaking wet. The strong smell of urine fills the room. He is laying on his right arm. His face is squashed into the sofa and is red and puffy.

Our patient has been lay in this very position for over 10 hours. He came back from the pub (early afternoon) with his carry out. He has had intermittent non-traumatic back pain for weeks but going to the doctor would interfere with his drinking time, and the doctor might tell him to stop drinking so he doesn't go.

So when his pain became so debilitating and the drink could not numb it he lay on the sofa in the position we find him and stayed there. He has been sleeping on and off and not even trying to get up to use the bathroom. He has lost he feeling in his right arm and his face feels funny.

You think?!

His son, the skinny figure from the door, came in (on his way back from the pub) to find his dad in this state. Called an ambulance because his didn't want to move him

With some firm encourage and gentle mobilisation we manage to get the patient on to a carry chair from removal. As we move he informs us the back pain is no longer there. Miraculous.

We carefully move him in stages to make sure we don't bottom out his blood pressure by getting him up too quickly. He's been there long enough to make his face swell, I don't fancy picking him up off this floor. Handling him is hard enough as it is, the smell of urine and general dirtiness permeate the air a new when he is moved. Being in the back with him is going to be fun.

His main concern as we leave the flat is where his cigarettes are and how he is going to get back from the Holy Hospital. En route his face begins to return to normal colour and shape although he still looks like he's gone a couple of rounds with Mike Tyson. The feeling begins to return to his right arm causing him some discomfort.

He asks if he can get a drink to help this. I give a look that could melt the ice caps but he is serious, he asks what time it is and where the nearest pub to the hospital is.

Its going to be a very long night with patients priorities being very different to ours.