by Stuart Gray
He took us to a locked gate which we all had to clamber over (it was spiked at the top, so it was a delicate operation) and into an old and derelict factory. This really surprised me: prime real estate, smack in the middle of Central London; the space was worth a fortune.
We went up two flights of stairs, across an open floor maybe 2,000 feet square, and then up another flight of stairs which was barred off by dangling wires and cables (it looked like someone had done this to restrict entry). We then walked across another open area, at the far end of which another PC stood.
He pointed into a small room behind him. I couldn’t quite see what was in there but I noticed some personal effects lying around and so I picked up a driving licence. It bore the photo of a young man in his late 20s.
‘Is this him?’ I asked.
‘Yep,’ said the standing officer.
I went forward and had a look in the room. There was a body on a filthy mattress. He looked like he was asleep, lying on his left side with his legs drawn up slightly. All around us was evidence of rough sleeping and drug use. There was filth and rubbish everywhere - old needles, stained, doss-down mattresses, the discarded detritus of an informal drugs den. But the dead man was wearing a suit, and his black shoes were buffed to almost military standards. He looked healthy and well-fed. There was no needle in his arm.
I clambered over the mattress and stood astride him to carry out the usual examination. I checked his carotid pulse; none. His skin was cold, and as soon as I touched him a fly came out of his mouth. It was probably laying eggs in there. That was enough, really, but I checked for rigor mortis, too, and his limbs were indeed stiff and set in their terminal positions.
There was no sign of any violence. The police had checked, and I double-checked: no, he really did look as though he’d somehow found his way in here, lain down on the mattress and just died in his sleep. A proper autopsy would reveal all, but that would come later, and elsewhere.
It was a mystery: this was no street person, or obvious junkie, so why was he here? It obviously crossed my mind that he’d come here to use drugs, but he looked like a City boy - not a Porsche-driving broker, but certainly someone well-paid and pretty successful, hardly the type to use his gear in a squalid dump like this. Lines of coke in nightclub toilets, yes, but syringes full of H in deserted factories? Maybe I was being naïve, but I didn’t think so.
I left the man with the shiny shoes and the watchful police and made my way back outside. I wondered how he’d met his end here. And then I got in the car and got on with my day.
A few weeks later, I was treating another drug addict. We talked about the chances of him dying through drugs, and he said he knew this was a possibility because it had happened recently to a friend of his. In an abandoned factory. His friend turned out to be the shiny-shoed dead man. It’s a small world, the drugs world, and - as the big-eyed brunette had shown me earlier - not everyone in it is as you’d expect. They are not all skinny and ragged and desperate. Some of them have jobs, and good jobs, too. Their friends probably smoke a little weed and do a few lines of coke now and then. But if your drug of choice happens to be heroin or crack, you’ll struggle to get hold of it if you move in nice, middle-class circles. So you have to venture down into the sewers. Most times, I guess, you take your fix, drift off and stumble home when you come round. Mr Shiny Shoes just never came round.
DRUNK
MOST PEOPLE LIKE a drink. Most of them occasionally have a bit too much to drink.
Some people take it a lot further than that.
Every Friday night, they get dressed up and head into town. They start drinking at about 6pm, and they don’t stop until 2am, or 3am, or 4am. They stick glasses in people’s faces in nightclubs and get into fights in chip shops. They put their fists through shop windows and urinate in doorways. They have sex with strangers in alleyways and vomit in the gutter. They brawl with the police. They fall over and hit their heads. They walk out into the road and get hit by cars. They collapse unconscious, dehydrated, poisoned with the sheer amount of drink they’ve taken.
They do the same on Saturday night. Increasingly, they do it on any night of the week.
All those broken noses, smashed jaws, lacerated tendons, glassings and booze-induced head injuries end up in our hands. And they’re just the immediate problems: the hidden effects of the alcohol in which our country is drowning will catch up with us in the years to come, I can assure you of that.
The practical effect of all this is felt by you, even if you’re not out kicking in phone boxes or punching people: the taxpayer funds the emergency services, after all. I don’t know exactly how many of the calls I attend are drink-related, but it runs into hundreds each year. Certainly, on a typical Thursday, Friday, Saturday and sometimes Sunday night, most of my calls will be alcohol-related; ‘ETOH’, we call them. The acronym refers to Ethyl Alcohol (chemical formula CH3CH2OH), which is grain alcohol and so generally used to describe any relative alcoholic condition. It’s an inaccurate term, but well suited when we want to write ‘drunk’ or ‘affected by alcohol’, or are tempted to use other, less academic-sounding terms.
It’s worst of all among the young and dangerous. They believe that alcohol enhances their sex appeal. I can tell you that the sight of a swearing, vomiting woman - I’ve seen a few, and I don’t care if she’s a model in a miniskirt - has never been attractive to me. Likewise few sober girls get turned on by a guy staggering around, out of his tree.
They spend hundreds of pounds a week on booze and a few of them inevitably end up with a needle in their arm and a bag hanging from it. For some, just as ASBOs have become symbols of street credibility, IV lines and fluid are becoming the hallmark of a perfect evening of social interaction.
It doesn’t look like getting any better in the near future, either. Drinking has almost become a national pastime for our kids. According to research, more than 80% of 11-16 year olds have tried booze, even if that was only to have a few sips. Most of them will grow up believing that it’s a social necessity. In my own family, my teetotal older brother was the only one to abstain completely from drinking. I still remember the looks he got when I took him to a pub with my mates one time and he ordered a pint of milk. It’s almost a crime not to drink in modern Britain.
Speaking of crime, the Home Office says alcohol is responsible for almost half of the violence that scars this country every weekend and, increasingly, every day. It certainly sucks up a good chunk of NHS resources. And every time someone calls an ambulance or the police because of an alcohol-related incident, you - the taxpayer - are forking out. The Government thought the problem would ease with the introduction of 24-hour drinking. The great minds of Westminster thought a ‘cafe culture’ would develop and people would drink in moderation because there was no need to rush. You may as well introduce 24-hour fast food restaurants and say fat people will eat less.
We are being swamped, and the prospect for the future care and deliverance of alcoholics and other problem drinkers is bleak. It will cost the taxpayer more each year if we allow the trend to go on. Assaults will increase, alcohol-related deaths will increase and the financial burden will spiral ever higher, affecting each and every one of us, teetotallers included. Unless there is a money tree orchard somewhere I don’t know about.
Excuses for being so drunk that you cannot stand, or control your bladder or gag reflex, include ‘I think my drink was spiked’ and ‘I only had three pints of lager and I’ve had much more than that in the past’. This misunderstanding of the nature of alcohol and its collision processes within our bodies leads to a very heavy NHS workload on a Friday and Saturday night.
A common call for me is to a ‘collapsed female, possibly drunk’. They usually are, and when I get on scene I am greeted with the same words.
‘She’s never been like this before.’
‘Has she been drinking?’ I’ll ask as she vomits on my boots and flops around on the pavement.
‘Yes, but not a lo
t.’
‘What’s ‘not a lot’ - a little, or some, or many?’ I find sarcasm is missed by the drunken, so I can usually get away with it, watching my words flying over their heads and into the sunset (or sunrise, it’s a 24-hour thing now, remember).
‘Well, not a lot. She’s only had three or four.’
This is normal. Nobody ever gives me the exact number of drinks that have been consumed, neither do they tell me what kind of alcohol and in what measure it has been taken. Anecdotally, it seems that women who are menstruating get drunk quicker. Research carried out by The University of Chicago disputes this, but I’ve lost count of the number of times I’ve treated collapsed, drunken females who have been on or are near to their period. It’s almost become an instinctive question for me to ask them when I arrive on scene. This is definitely worth further study, I feel.
In men, it’s usually down to a lack of food. Lining your stomach does work - food helps to absorb some of the alcohol before it reaches the gut (where it is quickly taken up by the bloodstream). In my experience, blokes are more likely to ignore this common sense approach, so they face a depletion of sugar as a result of their recent fast and then the alcohol inhibits the release of supplies from their liver. This causes hypoglycaemia and it can lead to collapse. In fact, as few as two drinks can cause a sudden drop in blood sugar.
BM: Blood glucose monitoring. We measure blood glucose levels in almost every patient we attend, and in drunks as a matter of routine. The test involves pricking the skin to obtain capillary blood which is then placed on a measuring strip and into a light-reflecting meter. The meter (a glucometer) measures the level of glucose in the blood. Normal levels are between 4 and 10mmol. A reading below 4mmol indicates hypoglycaemia. Anything above 10mmol is called hyperglycaemia but is not necessarily dangerous until the levels reach the high teens. (Mmol stands for millimoles per litre; a ‘millimole’ is1/1000th of a mole and a mole is a molecular measurement.)
I went to the aid of a man who had become unresponsive after a heavy night of drinking. He was slumped against some railings next to a Kentucky Fried Chicken takeaway in the East End. His friends were gathered around him, unsure of what to do; they were about to lift him into a taxi when I showed up. It’s just as well they didn’t - when I examined him I found that his blood glucose level was seriously low. If he’d been left at home in his current state, he may have slipped into a coma before his body had time to recover and release much-needed glucose. That could have led to death.
Luckily, he was able to accept oral glucose when I gave it to him; Glucagon (which helps release stored glucose in the liver) would have been of little use, because the elimination of alcohol was keeping his liver busy and so the hormone wouldn’t have been able to do its job.
Combining drugs - of any kind - with alcohol is just asking for trouble. I’ve treated plenty of individuals who have taken their prescription meds, including anti-depressants, with drink. Notwithstanding the high risk to their liver, the result is a collapsed and usually very depressed person.
I have seen two or three examples of extremely unusual behaviour as a result of mixing business with pleasure. I remember one woman who was out on a works do with her colleagues. She’d had far too much to drink and I was called to the pub to help her. When I got there, I found a middle-aged lady lying on a sofa in the bar, thrashing around and screaming at the top of her voice for absolutely no reason. Every time I tried to speak to her I was met with a hateful glare and a mute response. I had to lean forward to grab her several times to stop her falling onto the hard floor, and was rewarded with a series of blows for my trouble. At one point, she stuck a finger in my eye, leaving me unable to focus for a while as my eye watered in protest. She relented only when the room was cleared of her work associates. Suddenly, she became a cooperative human being - only minutes before she had been a banshee. What’s that all about? I never found out.
Drunks on buses have become familiar calls for me. I can guarantee that on every weekend shift I will find myself at some point boarding a bus, shouting at a sleeping figure and trying to wake it up in order to get it off the bus. (Bus drivers aren’t allowed to do this apparently, they have to call an ambulance. They tend to use words like ‘unconscious’ or ‘dead’ to get the emergency response they need.)
I climbed aboard a No72 which had stopped on a high street after I had been summoned to an ‘unconscious male on bus’ - that’s the usual modus operandi for a sleeping drunk. The driver stood outside and pointed at the stairs.
‘He’s up there,’ he said, his finger indicating the way. As if there was any other way to get to the top deck.
‘Did you try to wake him?’ I asked.
‘Yes.’
‘How?’
‘I stood at the front and threw a shoe at him.’
I looked down at the bus driver’s feet. Both his shoes were in place.
‘What shoe?’ I asked.
‘His’.
Let’s get this straight. He’d gone right up to this sleeping drunk, pulled off one of his shoes and lobbed it at him (smacking him on the head) in order to get his attention. And when that hadn’t worked, he had dialled 999.
I went upstairs and saw the one-shoed man slumped across the back seat. He was big and he smelled bad. That might have been because his shoe was off and his sock was unhealthy. I shook him and shouted for him to wake up.
‘Whaa!’ he shouted back. He had a thick Russian or Polish accent. The most interesting change in recent times, for me, has been the massive shift in the nationality of drunks we deal with. We Scots have (had?) a reputation as boozers. It was never seen as a slur on the nation, just a broadly-brushed fact (though don’t call us tight-fisted). Now East Europeans are showing up in ever-increasing numbers on the streets of the capital, and they’re often off their faces. I mean, some of them have a real and incurable problem with drink. Of all the ‘unconscious on a bus’ or ‘collapsed, unknown cause’ calls I’ve attended in the past year where the patient has been smashed, I would have to say that more than 70% of them have been Russian, Polish or Lithuanian. Remember, this is my own personal statistic; other ambulance service personnel may tell a different story.
‘Time to get off. You are asleep on the bus,’ I told him, with a friendly smile.
‘Uh?’
‘You need to leave the bus, now. Do you need an ambulance?’ I think it’s best to cover all the bases, just in case, although I hoped he’d say no.
‘No,’ he said
‘Then you have to leave the bus. I’ll walk you off, OK?’
‘OK. I go,’ he said. Then he glanced down to his feet and up at me again. He looked confused and more than a little upset.
‘Where is shoe?’ his angry, pink face demanded.
* * * * *
Another serious side-effect of alcohol consumption is the loss of body heat. It may make you feel warmer, but actually it lowers your core body temperature. If you get slaughtered and fall asleep outside you are at risk of hypothermia and death. Even in London, wearing nothing but a thin shirt and a pair of jeans is definitely asking for trouble, particularly if you’re going to end up kipping on the pavement.
On a cold November night during a weekend FRU shift, I was asked to check on the status of a man ‘lying in the street’. When I read these words I am pretty sure I’m going to find a sleeping drunk, especially if I’m reading them on a weekend night.
I arrived to find a young man, lying on his back and out for the count, in a side street off The Strand. This part of town is usually busy up until the wee small hours, but it was now 4.30am and there wasn’t a soul around - not at this end anyway. Whoever had called the ambulance had taken to his heels shortly afterwards - obviously too busy to stop and actually do anything.
I went up to the guy and prodded him a few times, but he didn’t respond. He just lay there, arms folded, oblivious and unconscious. He was dressed in a cotton T-shirt and a pair of jeans. He had no head wear and nothing to prot
ect his hands from the cold, except his pockets or his arm-pits and he wasn’t using either at the moment.
I tried again, this time a little more energetically, but he remained resolutely unresponsive. Effectively, he was in a mini-coma. He was muscular and tall, and since he was a dead weight I knew I’d struggle to move him should I have to.
I ran my usual checks, but my main concern was with his temperature. His skin felt like ice but he wasn’t shivering. Shivering occurs when the body attempts to create heat from muscular activity. It does this automatically when your core temperature drops by one or two degrees - your normal average body core temperature being around 37°C. The shivering mechanism becomes more violent as the temperature drops a further one or two degrees. After that, as heat continues to be lost, shivering stops - usually at around 32°C.
I covered him with foil and blankets and tried to take his temperature. The equipment we use takes measurements from the ear, but for a more accurate reading it should be taken rectally - luckily for you (and us), that is always done at hospital. Unfortunately, my thermometer wouldn’t read properly. We’d both have to wait until an ambulance arrived to take him away.
In conscious people, as their body temperature falls, they exhibit strange behaviour. One key indicator is attempting to squeeze into the smallest spaces possible, like cupboards, in a vain and semi-lucid attempt to find warmth. This is known as ‘terminal burrowing’ and is often the last thing they do before they die. In an unconscious drunk, though, there is no way of knowing just how far down the line they are and how much the cold has affected their brain and other organs without an accurate core temperature.
During the journey he began to wake up, and by the time we arrived at A&E he was looking around, though he still wasn’t fully conscious. His temperature was checked accurately and found to be 31.2°C. It took hours of passive re-warming to recover him fully and the next time I saw him, sitting up in bed chatting to a nurse about his adventures, I was just about to go home. It’s entirely possible that, had he been left unnoticed, he would have died. Seriously, it’s only a matter of time before I come across a young corpse, lying in the street in trendy clothes with a drunken smile on its face.
