Number 01: Abdominal Pain

01.AbdominalPain

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WARNING: Contains explicit language and deals with adult themes

With a sigh, I swung open the passenger-side door and climbed into the cab of the ambulance. My crewmate, Scott Richards, was already sitting in the driver’s seat, savouring a swig of freshly brewed coffee from a takeaway cup. The aroma filled the interior, almost masking the lingering smell of Glen 20. Before I could speak, he pointed to the cup holder on my side of the dash. “Got you one, boss. Thought you’d need a pickup after that last job.”

“Too right, Scotty. Thanks. What a wanker!” I took a sip of the scalding-hot liquid and peeled off the lid to let it cool down. We’d just delivered a 28-year-old man to the hospital who had broken his little toe three days ago. “What amazes me is that he’s already had an ambulance out to take him in when it happened. Not sure what he thinks we or the hospital can do for a fractured phalange, other than pain relief and strapping. Again.”

“I’m surprised you didn’t leave him at home. You’re not goin’ soft on me are you, boss.”

I shrugged. “I always take them in if they insist. Anything to reduce my complaints tally. And anyway, he’d just call another ambulance.”

“True.” He took a gulp of coffee and rubbed his free hand over his receding close-cropped black hair, a feature that made him look a lot older than his late-twenties age. “Certainly was a doozy to start the shift. But look on the bright side, things can only get better from here.”

I sipped my drink. “Wouldn’t bet on it. I reckon the public would be amazed at the crap we’re called to every shift. In the last three days that guy’s cost the tax payer a fortune in ambulance costs alone. And for what? An injury that could’ve been fixed with first aid and paracetamol. Someone needs to do something about it, but I’d be surprised if the pollies have a clue how bad things have got. It’s not in the best interests of our brass to tell anyone that they’ve dropped the ball.”

Scotty gave me his trade-mark stubbly grin. “So, you gonna blow the whistle, boss?”

I smiled back. “Nah, Scotty. I’ll do what all ambos do: stick to whinging. It’s much safer. Whistle-blowers never prosper.” I replaced the lid on my coffee and reached over to press the ‘Clear’ button on the Mobile Data Terminal. “C’mon, let’s dance.”

The unit beeped a response and I picked the mic off its clip. “Comms, this is 964, clear at the Royal.”

“Roger 964. At the moment you’re good to return.”

“Wish us luck.”

“Roger that, I think you’ll need it.”

“Deep joy.”

Scotty pulled out of the ambulance bay and drove past the patient transport buses, picking his way through the taxis milling around the hospital’s entrance. He then eased onto Bowen Bridge Road and joined the traffic heading north. “Tunnel or topside, boss?”

“Topside. I’ll shout you pancakes at Maccas.”

“Only ’cos they give us a discount.”

“You know me too well.” I got out my phone and used a cable to connect it with the car stereo. “OK, Scotty. That job must be ripe for our last patient playlist. What’s your best suggestion?”

Scotty grinned. “Mmm… a broken toe. Let me think… err… Got anything by ‘Toe-toe’?”

I laughed. “No. Haven’t got any tracks by Birds of ‘Toe-kyo’ either.” I searched through my songs. “We could have ‘Toe-jo’, by the Hoodoo Gurus… no, hold on. It has to be this.”

I pressed play and as Freddy Mercury burst into song, Scotty groaned. “Oh Christ, ‘I want ‘toe-break’ free’. That’s even poor by your standards.”

I cranked up the music and we both joined in with a raucous rendition of the altered lyrics, almost missing the beeping of both the MDT and our pagers. “Ah crap. Guess Maccas will have to wait.”

“Any excuse to keep your wallet out of sight. What we got?”

I turned down the music and read the scant information. “Oh God no!”

“What?”

“Code 2 for abdominal pain at…” I gave a deep sigh lent forward and drummed my hands on the dashboard. “Carseldine Meadows!”

The location was a rundown caravan park well known to all Northside paramedics. It had an unerring ability to produce either low-quality call-outs, or drug-related emergencies. Scotty rolled his eyes and shook his head. “Oh crap!”

“I thought you assured me things could only get better?”

“Hey, unlike you I’m not afraid to admit I sometimes get things wrong. So what’s up with this latest caravan caller?”

“A 39-year-old woman’s had abdo pain since eight fifteen.”

“AM or PM?”

“AM.”

He glanced at his watch. “What, you mean for ten minutes?”

“Looks like it. She probably just needs a good shit.”

“Or a free lift into the city. You know decent ice dealers are hard to find in the burbs.”

I grinned at his implication. “Now, Scotty, don’t be so judgemental. We may be about to attend a fine upstanding pillar of the community.”

“At Carseldine Meadows?”

We looked at each other, grimaced and shook our heads, saying in unison, “Nah!”

I once remember working with a student paramedic who accused me of being judgemental when dealing with a patient. I had to point out that being judgemental was part of our job. There are some inescapable truths about prehospital work: the case description is often wrong; patients have a habit of withholding vital information; and when an address or patient looks dodgy, they usually are. You have to enter a scene with your eyes open and make snap decisions based on what you see, not on what you’re told. Paramedics who’ve been in the job a while can also pick up on hard-to-describe vibes, something we like to refer to as our Spidey senses. It only comes with working on the frontline where everything’s pencilled in shades of grey and nothing ever is black and white until the paperwork’s done. Our ability to judge people keeps us safe.

On the southbound lane, the traffic struggling its way into the city was at a standstill. Despite the new toll road beneath the bitumen, commuters were still resolute in their refusal to use the Airport Link tunnel. Northbound, the flow was less clogged and we were unfortunately making good progress towards our next patient. I took a slug of my coffee. “So, Scotty, what d’you reckons wrong with her?”

He rubbed his chin, causing the stubble to make a rasping sound. “My money’s on a urinary tract infection, or cystitis.”

“Could be, either that or gall stones. Thirty-nine means she’s near enough to forty to satisfy at least two of the ‘Five-Fs’ rule for cholecystitis.”

“Five? I thought it was only four.”

“Female, forty, fat, fair and fecund.”

“Fecund?”

“Had one or more kids.”

“Well, that’s three definites, boss. Any female at the Meadows older than fifteen will’ve had at least one offspring.”

“Good point. Mind you, she might be pregnant.”

“Or have an appendicitis.”

“Or a triple A.”

Scotty shook his head. “Do you always have to talk things up, boss?”

“Hey, if her aorta blows an aneurism at least I’ll get to do some intensive care stuff.”

He snorted a laugh. “If her aorta blows none of your toys’re gonna save her.”

“True. Still, we’d get to play.”

I smiled to myself. This was the sort of conversation that only two ambos could have. We all develop a rather warped sense of humour, it was another layer of our emotional armour. Somehow, belittling tragedies helped to reduce their impact, softening the blow, allowing us to cope with the unthinkable. The cab fell silent as we waited for the lights to change at Rode Road. Opposite us, another ambulance turned across our path, heading towards the Prince Charles Hospital, the driver returning our waves.

I relaxed back in my seat and kicked a foot up on the dash. “Hey, she could’ve been bitten by a snake.”

Scotty took his eyes off the road to give me a stare. “A snake?”

“Yep. Early symptoms often include abdominal pain.”

“Really? And the patient forgot to mention fighting off the reptile and the searing pain as the fangs went in?”

“I’ll have you know many snake bites go unnoticed, until it’s too late. Only high heat denatures the toxin, so if a snake dribbles venom on a carpet you can be exposed to it through a cut on your foot. Even years later.”

“Well, I guess that excludes this woman then.”

“How so?”

“You ever seen carpet in a Meadows caravan?”

“Good point.”

“One thing’s for sure, boss. I don’t know about our patient, but you’re certainly full of shit.”

I laughed as the MDT beeped. “What now?” I leant forward to press the button and check the screen. “Oh, at least this will please you Scotty, the job’s been upgraded to a 1C.”

“Yee-fuckin’-har!”

Gunning the engine, he flipped on the lights and sirens, pulling into the outside lane and speeding away as I sat upright and tightened my seatbelt. Scotty was someone who lived on the edge when it came to emergency driving. He liked to push the envelope, you know, the one that a postie drops off with a court summons for dangerous driving.

As cars, trucks, startled pedestrians and road furniture flashed by the side windows in a breathtaking blur, he turned to look at me. “Not that I’m complaining, boss, but why’s my inner rev-head been unleashed?”

I held my abdomen and panted, saying between breaths, “My… tummy… hurts… so… much…”

He nodded. “She’s now got breathing difficulties.”

“Yep.”

“Such bullshit.”

Due to the upgrade, Comms gave their obligatory dictation of the details over the airwaves. “Alpha 964, your case has been upgraded Code 1. You’re going to a 39-year-old female complaining of abdominal pain and shortness of breath. As this is at Carseldine Meadows, do you require police backup?”

I picked up the mic, but before answering looked over towards Scotty, who grinned and shook his head. “Negative Comms, I think we should be OK at this time of the morning. We’ll send up a flare if we need rescuing.”

“Roger that. Take care.”

“Always do.”

We flew up Gympie Road as if someone’s life depended on it, weaving through the traffic and lurching onto the other side when the cars backed up at the lights. Expletives punctuated the journey with Scotty swearing and blaring the horn at anyone who dithered or disregarded our tumultuous approach.

Eventually we swerved and skidded into the entrance of the caravan park, a cloud of brake fumes and gravel showering out in an arc beside us. Scotty gave me a big cheesy grin and I shook my head. “One of these days you’ll roll us doing that.”

“Nah, I had the traction control switched off. But if I do roll, I’ll make sure you’re my crewmate.”

“Gee, you’re all heart.”

He flipped off the lights and slowed down to a sedate pace, rolling into the park with its numerous trees that hid the place from helicopter surveillance. We wound our way around the maze of tracks, littered on either side with ancient caravans in various stages of decomposition. The numbering system must have been designed by someone on crack, so finding the right one was a process of elimination.

At night this was a dangerous place. Ambulances would often wait for a police escort, but at just gone eight in the morning there were few signs of life. Most of the inhabitants were like vampires, shunning the daylight hours. After all, few had jobs to get up for, with most being dependently poor.

Early in my career I came here for a patient who had to bring her four-year-old daughter with her into the ambulance. While I attended to the abusive teenage mother and her minor ailment, my vision was drawn to the angelic little girl, who was sitting on the captain’s chair playing with her blonde ringlets. I couldn’t help but feel pity. What chance did she have in life? The odds were stacked against her from birth. But then I realised: fifteen years ago, the woman that was now screaming at me like a banshee was just like that little girl. It was a lesson in the cyclical nature of poverty I never forgot.

By some miracle, we stumbled across the address, a rusty-coloured trailer with a small wooden deck built to one side with a canvas awning over the top. Tongues of material hung down from rips in the shade cloth, like the leaves of epiphytes in the rainforest. The deck even had its own form of anthropogenic leaf litter.

A bedraggled junkie-thin woman wearing a soiled floral dressing gown was leaning against the outside of her home, smoking a cigarette that appeared to be an extension of her lip. Smoking was the wrong choice of word; there wasn’t any active involvement. It was just a passive process, the result of years of addiction that had made the act of lighting up an automatic action. A drooping column of ash hung precariously from the tip as she gave a slight gesture with her hand to acknowledge our arrival.

I said under my breath, “Oh dear God,” before we both opened our doors and walked towards her.

As we approached, I nodded to the dingy doorway of her abode. “Good morning, is the patient through here?”

She either ignored or was oblivious to my irony. “No, it’s me, I called an ambulance.”

“Oh, I see. I’m just a little confused as we’ve come lights and sirens because you’re supposed to have abdominal pain and be short of breath.”

She shrugged. “I added the bit about the breathin’ ‘cos you fuckers take ages otherwise.”

I glanced at Scotty before replying. “How public spirited of you. Can you please put your cigarette out, we’ve got oxygen with us.”

She looked surprised and I wasn’t sure whether it was from my request, or the discovery she had a cigarette on her lip. Either way, she flicked the butt into the road without complaining.

“Thank you. Well, seeing as we’re here now, what’s actually the problem?”

She scratched her ear and snuffled before answering. “Y’see, I think I’m pregnant and I want a second opinion.”

“A second opinion?”

“Yer. I had a doctor out during the night, but he was only here a few minutes, said I couldn’t be and then fucked off. So I want you to take me to hospital to see another one.”

“So, you don’t have abdominal pain either?”

She shrugged again. “No, not really. I just want a pregnancy test.”

“Haven’t you heard of Clearblue? There’s a pharmacy about five hundred metres down the road. You could walk there and buy yourself a home kit.”

“Ain’t got no money for shit like that.”

“Right. So, why do you think the doctor was convinced you couldn’t be pregnant?”

She wiped a scabby forearm under her nose then scratched at her opposite shoulder. “He only said that after I told him I’d had a Bavarian-sister-techtomy, whatever the fuck that is. But I’m still sure I’m pregnant.”

I stared at her for a while before speaking. “Do you mean an ovariohysterectomy?”

“That’s it!”

A scene from ‘The Life of Brian’ popped into my head. “Your name’s not Loretta is it?”

There was a muffled snort from somewhere in Scotty’s direction and I thought it best to avoid eye contact.

Her brow furrowed. “No, Sharon, why?”

“No reason. I’ll tell you what. I can save you the trip to the hospital by giving you a second opinion now. Put simply, when you’ve had an ovariohysterectomy you can’t have babies. You don’t produce any eggs and there’s nowhere for the foetus to gestate, as in, the baby’s got nowhere to grow. So, just to make things absolutely clear, every bit of reproductive tissue has been removed from your body. For whatever reason, when you had that operation, you were basically spayed.”

“Oh.”

She looked stunned as if this was the first time anyone had bothered to explain it to her. But then again, it may have been the first time it was explained when she was on this planet.

“So I can’t be pregnant?”

“No. And as you’re not called Mary, I wouldn’t hold out for divine intervention.”

“Eh?”

“Don’t worry. Is there anything else we can help you with?”

She sighed. “No. You may as well fuck off.”

She pushed herself away from the caravan and slunk into its depths as she retrieved her pack of smokes from her dressing gown pocket.

We turned in silence and climbed back into the cab. As the doors closed Scotty let out a laugh. “I liked the reference to Loretta, boss. We could always fight the Romans for her right to have babies.”

I was too bewildered to respond. How had the concept of what constituted an emergency degenerated to such a low level? Were we somehow at fault for pandering to these people? I sometimes felt that I was the bad guy when it came to natural selection. 

Firing up the engine, Scotty slotted the transmission into drive and we retraced our tracks through the labyrinth of social decay. As we escaped the canopy of trees and approached the sunlit exit onto the main highway, I sighed and looked at my crewmate. “If we didn’t have a laugh about the shit we go to we’d all go mad. The paperwork’ll take five times longer than our on scene time.”

“What d’you mean ‘go’ mad. I thought we had to fail a psych test to get this job.”

“Good point. I guess sanity comes on a sliding scale.” I grabbed the Toughbook from between the seats and opened the laptop, waiting for the log-on screen to appear. “You know what really scares me, Scotty?”

He shrugged and grinned as he drove out onto Gympie Road. “Someone’s willing to have sex with her?”

I laughed. “Now that’s just put some disturbing images in my mind. But no, my friend. What scares me the most is that although reproduction is off her agenda, she still has the ability to vote.”

HCIcon

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