There were two other times of excitement when John was
away on holiday. He was a part time police surgeon for the Isle of Thanet, and
needed a person to be named as taking his place. He said it was never onerous,
sometimes really interesting, and always good to be on the side of the police,
and you got paid. I accepted the job of a stand-in, probably mostly on the
grounds of being paid a little extra. A young family always costs more than you
ever think it will.
We got through the first week well, with no calls or
problems. Then there was a call from the Margate lockup. They had a young man
in custody behaving strangely. They thought he was mad; please would I give my
opinion and advice.
When I arrived at the police station, I was escorted
down to the cells. The young man, tall and lean, well bronzed and with the long
hair and beard of the era, was totally starkers – that is he had no clothes on.
He had discarded them, and police had gradually collected them into a rather dirty
pile. He appeared to have soiled himself rather badly, and was using his faeces
to write dirty words on the walls and draw odd diagrams. “I am sorry, doc, he
is really crazy and filthy. There was nothing we could do to stop him”, said
the young policeman holding his nose, and leaving the area “to allow you to do
what you needed to do”. I sat down on a chair outside the cells and several
feet away from our smelly young man (ie out of range). He smiled at me. “Look”,
he whispered, “I’m not mad, Doc. But I thought if I put on a bit of a show, they
might want to get rid me.” “So what did you do?” “Well I was at a party, and we
had all had a few. I guess I was a bit noisy, and a neighbor came across the
road and told us all to ‘quieten down’.” “You know how it is. I was a bit
pissed, and thought I would have a go at him, so I abused him a bit, and then
he called the police saying I had threatened him. I didn’t really; I was just
having a bit of fun.”
I checked out some basic facts about his background
and family, and whether he had done anything like this before. He denied it.
Had he ever had any psychiatric treatment? “No.” Rather miserably
(appropriately so), he said he just wanted to go home. He gave me his long-term
girlfriend’s home phone number, and I asked her a series of questions. Nothing
suggested any sort of genuine mental health problem. I asked the police what
they might charge him with? Probably ‘Being a public nuisance’. I decided it
was probably all a storm in a teacup, and the police were free to charge him
and let him go home; maybe after he had had a shower in their bathroom. I left,
shaking my head, but also slightly amused. The things you can et asked to do as
a doctor!
The other piece of excitement that fortnight was at
Haine Hospital; half way to Ramsgate. It was an old Sanatorium, now in part
turned into a convalescent home and in part a geriatric hospital. Again, this
was one of John’s extra jobs - being a part time assistant geriatrician. The
phone call suggested they had a man in his 40s who was convalescing from an
operation on his leg. He had begun to feel breathless for no apparent reason, needed
oxygen but was still beginning to turn blue. Staff members were anxious and did
not know what to do. “Yes, he has a drip up. Can you please come quickly?”
I would guess the journey took me about 20 minutes
taking the back roads, and I wondered why I had not suggested they call an
ambulance to take him to Margate Casualty. I arrived, and was raced to one of
the wards. Our patient was indeed very unwell, breathing hard, and with a slight
purplish tinge around the neck and throat. He could not talk much, but
complained of a sudden onset of pain in the left side of his chest. He had not
had an injury to his chest, but was post-operative, but I could detect no
evidence of pain in his legs to suggest a deep vein thrombosis as the cause.
They had done an ECG, and that appeared normal to my eye. So I began to listen
to his chest, which from the outside looked very normal. The right side was
normal, but on the left side I could not hear any breath sounds listening at
the front, side or back. When I percussed the side of his chest it sounded much
louder than the right side. There was no available Xray facility at Haine.
Somewhere deep in my brain it clicked that this man might have a pneumothorax?
I have no idea from whence that idea emerged. It was just there as the most
likely diagnosis. I took an enormous risk, asking for a large bore needle – the
widest they had – some local analgesia, and a scalpel. As soon as I could, I
pushed the wide bore needle in between two ribs, and was gratified to hear an
expulsion of air with the next struggling intake of breath, and the next and
the next. When I turned around I had three open mouthed nurses looking at me. I
suggested they call an ambulance. It was only then that I realised how much I
had perspired inside my three piece suit; I had not even taken off my jacket
and put on a gown. Perhaps I had heard stories back when I worked at King’s
Casualty; perhaps I had read about pneumothorax at some time. But I had known
it was an emergency and, from somewhere deep inside, dredged up what to do. I
had been right (but suppose I had been wrong)!
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