Posted by: medicblog999 | June 30, 2009

Meet Ken!

Imported WheelchairI would like to introduce you all to Ken.

I met Ken on Sunday whilst working on the ambulance (not the RR car). Whilst on the way to the hospital, we were having a general chat when we got onto the subject of America for holidays etc. I mentioned my upcoming trip to San Francisco, which took the conversation around to my blog. Ken is actually fairly computer literate and knows what blogs are, and he told me, without me asking, that I could write about him if I wanted to.

I had already decided that he was going to be the subject of a post, but now, for the first time I can actually introduce you all to one of my patients without changing a single thing.

So back to the story….

We were called to back up Rapid Response for a patient who was suffering with severe abdo pains. We drove the 16 miles to the address with lights and sirens and arrived on scene a short time later.

As I walked to the front door, the rapid response paramedic came out to tell me about the patient. He informed me that Ken (real name!!) had recently been discharged from a local hospital following palliation of his symptoms that he was getting from his metastatic cancer (from an unknown primary). He was supposedly not happy with getting sent out as he felt he was still unwell, and my colleague on the car felt that he may ‘just’ be seeking a return admission to the ward as he was struggling at home.

I always find it a little odd when a RR paramedic comes outside to meet me when I am coming to take over care of a patient. Maybe its because of my nursing background, but I always feel that the patient must think that we are talking about them in some derogatory way….what are they saying out there that they cant say in front of me??. There are some times when it is necessary to do this, when the information that needs communicating may ‘kick off’ a situation or when something confidential needs to be handed over which the family aren’t aware of etc, but that wasn’t the case here.

Anyway, once I had received the handover I walked in to see Ken for the first time, It didn’t take a trained paramedic to see that he was a very poorly gentleman!

Ken was suffering from Cancer in his stomach and lungs. He also had a large fungating mass on his throat which had eroded through the skin above his larynx. He is a left above knee amputee and had to wear a calliper on his right foot. He was cool and sweaty and had a horrible colour to his skin, not quite jaundiced but getting there. He appeared very weak and lethargic.

I knelt down in front of him and introduced myself..

M999: Hello Sir, my name is Mark, and I am going to be looking after you now. Can I ask your name?

Ken: Ken Bennett

M999: Ok, would you like me to call you Ken, or Mr Bennett?

Ken: Ken is fine, its nice to meet you Mark

M999: You too Ken, it looks like your having a really rough time at the minute.

(I am guilty of usually calling my patients ‘mate’, ‘boss’, ‘honey’, ‘petal’, ‘flower’ etc, etc but a recent post on ‘the emt spot’, got me thinking about why I do this, and I came to the conclusion that it is just laziness on my side, so I am making a real effort to ask my patients names straight away and then remember them and use their chosen name instead of the easy option of ‘honey’, ‘petal’ etc. Have a read of Steves post, as it may make you think about how you approach your patients too)

Ken told me that the pain he had was across his entire lower abdomen, coming and going in waves, and scored at an 8 out of 10. He takes oromorph every morning and night and as required, so you know that he is used to pain, and if he is calling 999, then he really needs our help. He was already sitting in his wheel chair, so my colleague went off to get the tail lift down, whilst I maneuvered Ken out of the very small and cluttered bungalow that he lives in.

Once on the ambulance and on the stretcher, I started to look for a vein to cannulate so that I could top up his oromorph with some IV morphine. I had one of those horrible moments when you really want to get a cannuala in, but when you look for veins, there is just absolutely nothing there. He was so shut down, that the only vein I could find that I thought may take a cannula was one at the base of his right thumb. I told him what I was wanting to do and he gave me his consent to have a go.(I had already pictured the image in my head of walking in to A&E and seeing the look on the nurses and doctors faces when they see the size and position of the cannula). To my joy, I got it in, flushed easily and started him on his Morphine.

After 7.5mls of Morphine, his colour improved a bit and he started to perk up a little, becoming more orientated and alert (which I thought was a little weird as usually the opposite happens). He started thanking me for what I was doing and we got chatting. We had a  fairly long drive in to hospital (40mins), but during the whole transfer I didn’t write a think on my PRF until we were nearly at the hospital.

I couldn’t pull myself away from Ken. He was telling me about everything he had been though during the last 18 months of treatment, he told me all about his family and asked all about mine. I showed him a photo of my 3 boys and we discussed the joys and frustrations of having kids. We talked about his prognosis and if he was treatable or not (although I had a far idea of the answer before I asked). He was tired though, tired of the pain, tired of the treatments and the to an fro from hospital, but this time he knew he needed to be in hospital.

I told Ken that he was a remarkable man with a remarkable spirit. Even in the condition he was in, you could see his strength of spirit shining through, albeit a bit dimmer than I’m sure it was 18 months ago.

Ken made a real impression on me. He has been added to my memory banks of patients that I will never forget. There was nothing out of the ordinary about my treatment, nothing memorable about the interventions, just the memory of a wonderful man nearing the end of his life. I hope the surgeons and oncologists manage to pull something out of the bag, but being an ex oncology nurse, I can see that Ken is running out of options (and Ken knows it too). Ken said they may be going to give him a bit more chemo, but he knows its not doing any good anymore and he wonders if it is even worth it. He just wants to feel a bit better.

We handed him over to the nurses at the hospital, I told them all what a wonderful man he was, hoping that they will go the extra mile for him to ensure his comfort (although in all honesty, I feel my  local A&E department is second to none anyway) and I shook his hand and said goodbye.

I know I wont see him again, but I wont forget him either.

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Responses

  1. Great post Mark! Indeed too many folks speed past the introduction and default to pet names with patients. A smooth introduction and respect goes a lot farther than one can imagine!

    And I’m sure Ken is now a follower, so Hello Ken and maybe you can comment about the service from your side of the cot?
    HM

  2. I’m only a CFR, but in our training we were taught to ask the patient’s name, and advised to give ours.

    My usual opening is “Hi, I’m Mark; what can I call you?” as that gets round the Ken/Mr Bennett bit straight away. I’m old enough to be no more than 30 years younger than most of my patients. OK, I tend to greet our frequent fliers by name straight away – my patch is quite small.

    After dealing with any immediate needs, I then explain that I’m a volunteer, that an ambulance IS on its way and that control have sent me because I could get to them a bit sooner. That I’ll do what I can and that my professional colleagues will be able to do a lot more.

    That usually gets the patient on my side (“Oooh, you’re doing a wonderful job” as if I’d do it if I didn’t get something out of helping them.)

  3. It’s patients like this that make me glad I’m in this line of work. They’re part of the 10-20% that make the job worthwhile.

    Excellent post.

  4. Medic999,

    I just discovered your blog and this is a great post.

    First, to Ken: I wish you well and I wish you comfort. May God bless you for all the things that so many will learn from this brief encounter. I hope you have the opportunity to read this and understand.

    Next, to my fellow Paramedics (all over the world…I’m in the US): Pain obtunds.

    Ken’s level of consciousness improved with opiates. It is, at first blush, counterintuitive. But if you think about it, pain can sometimes be so intense that it is all-consuming, causing the patient to “check out”. I’m not sure this process has a name, and it certainly is rare, but it exists.

    My first encounter with this was in the early 1990s (yep, I’m old). A man had his arm crushed in an industrial press from his fingers to just proximal to his elbow (which was now 10cm wide and 1.5cm thick). It was a heated press so he had 3rd degree burns the length of the injury.

    The man was moaning and had a GCS of 13, but what got me thinking was that there was no reason for the decreased LOC…there was no way for the press to have caused a brain injury. He didn’t even fall…he was still stuck in the press when we got there. No reason except pain, that is. He got morphine, he got comfortable and his GCS climbed to 15.

    My wife, (a Manx babe) who works in a pediatric recovery room at a teaching hospital, has used this war story to benefit her patients and, consequently, others who aren’t even sick yet. Whenever she has a patient with a decreased LOC that has no possible link to any other metabolic or physiologic cause other than whatever the surgery was for, she thinks of pain as a cause.

    When this happens, which even in her occupation is very uncommon, she asks for an order for extra analgesia. Frequently, the surgeon or anesthesiologist doesn’t get why she would want such an order (this is why I don’t think it has a name). She invites them to sit down next to the patient, give her the order for extra analgesia, and watch. She has a nearly perfect track record of relieving the patient of unnecessary pain, increasing their LOC, and leaving a doctor duly impressed and with more knowledge than they had when they entered the room. In the future, most of them will recall the lesson.

    Remember, pain obtunds.

    Tim

  5. wonderful post Mark. I am sure Ken has had many a trip to the A&E via ambulance and your compassion at least made it somewhat bearable for him

  6. A sad post but one I can relate to..thank goodness there is such compassion and caring services available to us here in the UK. What would we do without you all to help in our hour of need. Thoughts go to Ken who must have been suffering so. Thank you for being so kind.


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