by Stuart Gray
He was asked to put his hands where they could see them and then they checked his bag, very carefully. I listened in on one of the police radios as they described what was going on up the road and then I heard someone say ‘clear’.
The officer I had reported the man to approached me and told me that he wasn’t a suspect.
‘Why was he sitting there like that?’ I asked.
‘He was just waiting for the chemist’s to open,’ he said.
SENSORY INSULTS
I HAVE A GOOD constitution. I think I do, anyway. In my job, you learn to stomach almost anything, because you see and smell a lot of unpleasant things.
Of course, there’s always that one thing which triggers uncontrollable gagging and the potential to vomit in everyone, no matter how well-bound they think they are. I’m proud to say that I have never thrown up on a job in front of my patient, but you do come close.
When I started working with other people’s body fluids and general mess - they tend to expel aromas that range from bearable to outright offensive - I found it difficult to keep my composure; my face is a dead give-away when I am disgusted, shocked or emotionally injured. But you become acclimatized over time and with experience. For example, I got used to the smell of vomit when I was made to carry out buckets of the stuff and pour them down a toilet during a live concert at Crystal Palace years ago. After gagging and retching I simply stopped bothering and the smell (and sight) of vomit no longer troubles me too much.
A head injury at an underground station during the Christmas period tested my immunity, mind you. The man had fallen down a long flight of concrete steps and was lying, unconscious at the bottom of them. He was seriously hurt, with a significant amount of blood pooling around him, but he was breathing and he had a pulse.
My colleague and I stabilized him as much as possible and got him into the chair to be taken up to our ambulance. During this time of year we are so busy that support from a second crew or HEMS is unlikely. We tried but failed to get help, so we did what we needed to do - we roped in the Underground staff to help us carry this man all the way up the stairs to the top.
He was big and heavy. He was still unconscious, so he was unwieldy, too. His body kept trying to slump off the chair as we hauled him, one step at a time, towards the evening air. The line I had put into his vein came out when one of the staff pulled on it by accident. That caused a bit of a mess so I had to stop and re-do it. When we got him to the top and put him into the ambulance, he began to vomit violently.
I have never seen so much of the stuff come out of a single human being, before or since. The floor of the ambulance was being consumed by thick, pungent sick. He must have eaten and drunk an awful lot before his fall. It quickly became a nightmare trying to secure and manage his airway. It took both of us to pull him over onto his side while he emptied his stomach onto the floor. The smell was unbearable, but I had to stay with it for the journey. My colleague drove to the hospital and I was left in the back to manage my patient, who was still throwing up every now and then, though in ever decreasing amounts. My uniform was speckled with it, but it was my boots which bore the brunt: I couldn’t decide whether to clean them or chuck them.
We spent twenty minutes shovelling the stuff out of the ambulance after that. It took another hour to get it clean enough to continue the shift. Every piece of equipment we had used, and everything within the radius of his impressive projective range, was contaminated and had to be stripped and disinfected.
It turned out that our patient had suffered a massive brain haemorrhage before he fell. He was taken to a specialist neuro centre, and the last I heard he was still alive.
Some aromas come from specific sources, such as ostomy pouching systems (colostomy bags to you and me). There are a lot of people with these fitted; those with bowel cancer, for example. They are usually well maintained, but sometimes they are ignored and we have to deal with the consequences.
I was called to an elderly ex-drug addict, now an alcoholic on two bottles of wine per day, with cancer of the bowel. He had been bleeding from his rectum (PR) and I walked into his little front room expecting to deal with a mess to begin with.
He was in bed when I arrived and his sheets and covers were filthy with his own waste. They were toxic and I have no idea how many different gases were circulating around his home but I was breathing them in.
His problem wasn’t only that he was bleeding, which in itself is an ominous sign - he also had a problem with his colostomy bag. It was full, and I mean full. It was almost overflowing and smelled so foul I couldn’t stay near him for more than a couple of seconds at a time. It took me a long time to get his obs.
On top of that smell, hidden somewhere in the sensory background, was the worn-in stink of cigarettes and stale food.
He was living in this every day. He rarely went out and he rarely got a visit from anyone; thus his place was a shambles.
He was not in good health, so I fought the urge to run outside until I had checked and reassured him because, despite what I have described, he was a good person and he was genuinely concerned about his life. I didn’t go outside for fresh air until the crew arrived to take him away. I went out as they came up the stairs and I warned them about the olfactory hell that they were about to enter. One of the crew members was a trainee; I felt for her.
On an early morning call I was asked to investigate someone shouting for help at a railway station. I searched the area and found nobody who needed my help. Then I spotted a couple of police officers and realised they were looking for someone too. At the same time I noticed a ragged figure in a phone box and when he saw me he waved and gestured for me to stop. So I stopped and approached.
Inside the call box was a homeless old man and he had a particular problem which I could identify instantly by the smell alone. He, too, had a colostomy bag, and it, too, had over-filled and was now leaking. Watery faecal matter was running down his trouser legs and onto the ground. I had to keep him inside the phone box. He wanted to escape but I couldn’t allow it - people were passing by on their way to work. The smell was outrageous, and letting it escape from the box would have been some kind of environmental violation, I’m sure.
The police officers walked over but would not go near the man. I called for an ambulance (he was not getting in my car) and I prepared myself for the apology I was going to have to give the crew when they arrived. The smell was everywhere now and the old man was complaining that he couldn’t stand up any longer. I put a blanket over him and told him to sit on the ground inside the phone box. I felt cruel, but I had no choice. I couldn’t allow him to wander about spreading his faeces on the street. It was rush hour and I was serious about containing this mess. People were walking past with breakfast buns in their hands, recently bought from the nearby McDonald’s.
The old man began to retch and vomit because of his own stench. He had the stuff all over his fingers now. He was a health risk. I had nothing appropriate to clean him with, though even if I had he was in too cramped an environment for me to even attempt it.
The crew arrived ten minutes later and took him off to hospital. This kind of job is what really fuels my enormous admiration for nursing staff. Think about it next time you hear someone moaning about nurses, or the next time the question of their pay comes up: they have to finish cleaning up the jobs that the ambulance crews begin. That sort of smell doesn’t leave your nostrils for hours, and even though the old man hadn’t got in my car, for the rest of the day it smelled as if he had.
Dealing with faeces is never good. You find yourself looking out for it whenever you enter an environment where it is likely to be loose. Sometimes you find it on your gloves, or worse, your arms, as a consequence of moving or lifting a person. The elderly, incapacitated, the drunk and the mentally ill are all culprits for surprising you with their bodily waste. Obviously, it’s not as if they mean to contaminate you with it, they just don’t know they’re in a mess.
The worst ki
nd of faecal matter I have ever encountered is the bloody kind - ‘malaena’. The word describes black, tarry faeces produced when blood is partially digested and excreted. The presence of malaena suggests bleeding into the digestive tract from, for example, cancer or a ruptured ulcer. It is taken seriously and it has one other attribute: it smells very bad.
An elderly woman had got trapped in her bath and I was asked to go and help her get out of it. By her own account, which was vague at best, she had been there for as long as three days. She hadn’t actually taken a bath, because there was no water or evidence of water having been used. The mystery was how she had got herself in, why she was there and what had happened to her in there during those alleged 72 hours.
When I arrived on scene I could smell the problem from the bottom of the stairs leading to her flat. She had been found by her sisters and one of them told me that she had ‘made a mess’. Sure enough, when I saw her lying in that little bath in that tiny bathroom, the cause of the offensive smell became instantly obvious. She was lying in her own waste and there was a lot of it. No part of her body had escaped contact with it. I felt so sorry for her - she was completely unaware of her situation.
Her sisters were unable to help her because they, too, were elderly. I couldn’t get her out of the bath myself because she was too frail, too messy and there was nowhere to put her. I had to wait for the ambulance to arrive. In the meantime, I checked her obs and thought up a plan for her extrication; a plan that would leave me and the crew as mess-free as possible. My own arms were already contaminated.
When the crew arrived, I explained the situation and suggested we use a blanket to completely envelope the woman, making it easier to lift her out. This was the least hazardous way of removing her, I thought, but it was still going to be very tricky and messy.
We wrapped her in the blanket so that she was cocooned, and literally hauled her out of the bath and onto the ambulance carry chair. She struggled because she didn’t know quite what was happening, but eventually we got her to the ambulance and on to the bed.
The cause of her malaena needed urgent investigation, but her apparent confusion about how she got where she was and how long she had been there was also a problem. I honestly couldn’t see her going back to live on her own in that flat.
Blood from other orifices can provoke offensive reactions without warning too.
After a lazy morning start I was called to a man ‘coughing up blood’ in a police cell. When I arrived, the police Forensic Medical Examiner (FME) introduced himself and filled me in. The guy had been brought in drunk (he was a known alcoholic) and had recently started to cough up bright red blood. ‘He’s produced two cupfuls so far,’ said the doctor, his eyes twinkling with delight.
‘Thanks,’ I said. I had just eaten my breakfast, so I didn’t really need to know that much - well, I suppose I did need to, but I’d rather I didn’t.
I walked into the cell and recognised the man. He is a known homeless alcoholic whose health is questionable at the best of times. He was sprawled on the bed, looking drunk and unwell at the same time. There was a cup on the floor below him and I could see that it was full to the brim of blood and thick saliva. I had a quick look at it (I didn’t want to linger on it) and questioned him briefly about his health. I carried out my obs and before I completed them the ambulance crew had arrived.
Now I was a wee bit put off by the smell, the cup full of blood and congealed saliva and the general state of the man already, but when he reached over absent-mindedly and lifted the cup to his lips, with every intention of drinking the contents, I thought I should intervene before I was left with an unappetising memory for lunch time and quite possibly the rest of the day. He was about to sip it like it was a cup of the most delicious tea.
I ran forward, shouted at him to stop and put my hand between him and the horrible contents. He looked bewildered and obviously wondered what I was playing at. As far as he was concerned this was a tipple. He was insistent at first, but I think he got the message eventually.
* * * * *
Urine has a fascinatingly changeable smell. Ordinary, run-of-the-mill urine smells like... pee. Its aroma isn’t too bad, and providing the person excreting it doesn’t drink the wrong liquids, it should be fairly clear and dilute. Urinary Tract Infections (UTI) turn one person’s pee into another’s nasal nightmare. Every day at least one ambulance crew will take someone to hospital with a UTI. In some individuals it is borderline offensive, but in others it can be an insult you never forget.
I can pretty much always now recognise a UTI with some certainty just by the smell. It is acrid and clings to every hair in your nose. In greater concentration, it would probably stain clothing and strip paint from the walls. There have been occasions where I truly believe the paint on a patient’s walls has been removed in this way.
A call to an elderly lady who wasn’t feeling well and ‘not herself’ and I arrived at a house where the family had gathered to worry about Grandma. She was a lovely woman but she wasn’t making any sense. In fact, she was completely confused and thought I was there to take her home. Maybe she saw the analogy between an ambulance and a taxi and just put two and two together. I recognised the pungent smell of urine in the room and checked her temperature; it was high. She had an infection and I was willing to bet it was in her urinary tract.
She needed to go to hospital and an ambulance was arranged to take her. Meanwhile, she was drifting in and out of lucidity and perhaps consciousness. I didn’t really want to be resuscitating her in the condition she was in because her family would never forget the scene, so I did all I could and kept her awake until a crew arrived to take her away.
Then there’s the oddly numbing aroma of decaying bodies - dead, wet flesh is the worst kind of smell in my book.
One of the less attractive jobs thrust upon us is ‘recognition of death’. You can be as dead as a dodo but it has to be officially recorded by someone who is qualified to confirm life is extinct; the police can’t do this, and it’s unlikely that their on-duty doctor will show up on scene to say ‘Yep, he’s dead’, so the ambulance service are reeled in. Most of the time, it’s a routine task and the dead person had been found within a reasonable time and is in a good condition (for a corpse, obviously). Sometimes, however, this isn’t the case.
I was called to a flat in a sprawling estate to check on the status of a body that had been found by the police after a neighbour alerted them to a ‘strange smell coming from underneath the front door’. That’s the phrase that tells us something horrible is just the other side of the plywood.
I showed up with my crewmate and the police were happily waving us up from the third or fourth floor. We climbed the steps (why are there never any lifts in these places?) and arrived at the door of the address. One of the officers simply said, ‘I don’t think you’re needed; he’s been there for a long time.’ My crewmate thought this was a reasonable summation and decided he wouldn’t go in. Stupid me wanted to see what the fuss was all about.
I entered the flat and went down the dark hallway towards the front room, where a lone police officer was standing guard. I walked in and the smell hit me so hard that I couldn’t see for a few seconds. It was like breathing acid into my lungs. It didn’t so much provoke a need to retch as a need to douse myself in water.
On the floor there lay a lump - a human lump. It was clearly a man’s body, but it was no longer defined as one. Instead, it was a heap of fly-covered flesh. It was face-down, thank God. The part of the body that was in contact with the air was mottled and wrinkled, but the part in contact with the floor had melted into a goo of putrid liquid. The head was almost gone because most of the face had collapsed inwards. It looked like his body was attempting to escape through the floor. He must have been here like this for weeks: so many people die alone, go unmissed. It’s tragic.
As I left, I wondered how the neighbours had put up with the smell for so long. Perhaps they knew the truth but just didn’t want t
o face it. I dread to think what kind of stain was appearing on the ceiling of the flat below.
HIT AND RUN
UNFORTUNATELY, THESE INCIDENTS are all too common. The ‘hit’ part ranges from a slight knock against a pedestrian’s leg, to mowing someone down at high speed and killing them. The ‘run’ part comes when the driver leaves the scene.
If you hit someone on the road and fail to stop and report it, the maximum penalty the law allows is six months in prison or a fine. (As a comparison, you can go to prison for life for robbery.)
It’s scary how common it is. I read a piece recently in The Daily Telegraph which said that the most recent UK hit and run statistics (for 2004) showed 23,714 incidents, which resulted in personal injury to over 28,000 people, 145 of whom died.
I have tried to understand the mentality of drivers who ‘run’, but I guess until I am in the situation myself I don’t know how I’m going to react. Well, actually, that’s not true. I’m sure I’d do the right thing, regardless of the consequences to me, which explains why I struggle to understand those who don’t.
Could be the car is stolen, or the driver is uninsured (there are currently over a million of them on the roads). Alcohol may have something to do with it. There may be illegal drugs in the vehicle, or perhaps the driver has a previous criminal conviction. I think some of them are just plain stupid. A minority probably think they will get away with it and hide out at home for a while.
Many times, the injuries are horrible.
