Pulse(2)

‘Ask the lab to specifically check for a drug overdose,’ I said to the nurse who was filling test tubes of blood from the cannula in the man’s arm. ‘Can we also get a urine sample?’

Seeking to discover what was wrong with the man was a bit like a murder mystery in an Agatha Christie novel, with me taking on the role of the detective. There were many possible suspects for the cause of his condition and I had to determine the guilty one by eliminating each of the others in turn.

I let my team do the intricate work while I stood back trying to take in the bigger picture.

On the periphery of the group hovered a very young-looking uniformed policeman.

‘Can I help you?’ I said. ‘I’m Dr Rankin, Chris Rankin. I’m in charge of A&E this evening.’

‘PC Filippos.’ He instinctively put out a hand but I didn’t shake it because I was wearing sterile latex gloves.

‘Filippos?’ I said.

‘Yes.’ He smiled. ‘Half Greek. I came in with your patient.’ He waved a hand towards the man on the trolley. ‘The racecourse called us first. They thought he was drunk. It was me who called the ambulance.’

I had wondered why it had taken so long for the man to get to hospital.

‘Well done,’ I said to him.

‘What’s wrong with him?’ the policeman asked.

‘I’m not sure yet. We have to run some more tests. But I don’t think he’s drunk.’

There was a slight trace of alcohol on the man’s breath but not the usual overpoweringly sweet aroma of the unconscious drunk. I was well used to dealing with those on a Saturday night. We called them VIPs – very intoxicated persons.

‘Any idea who he is?’ I asked.

‘None at all. I searched his pockets while waiting for the ambulance. All he had on him was eighty-two pounds in cash and one crumpled bookmaker’s betting slip. No cards, no wallet, no keys, nothing.’

‘He must have had a coat,’ I said. It was far too cold in mid-November to be at the races in only a thin shirt.

The constable nodded. ‘He did, and a jacket and tie. I have them bagged up.’ He lifted a clear polythene bag to show me. ‘Shall I take the rest of his clothes to add to it?’

‘He’ll need them to go home in.’

‘If he does go home,’ the policeman said flatly.

I glanced at him. ‘Do you know something I don’t?’

‘No,’ he said, but I wasn’t sure if he was telling me the truth.

One of the nurses interrupted us. ‘Dr Rankin, we’re ready for the CT.’

‘Excuse me,’ I said to the policeman. ‘I have to go with the patient.’

‘I’ll wait here,’ PC Filippos said with determination.

I raised my eyebrows at him in surprise.

‘It’s probably not necessary,’ he said, ‘but I’ll wait anyway. Then, if he does come round, I’ll be able to inform his family. He reminds me a bit of my dad, you know, in looks and the way he’s dressed. I’d want someone to tell me if my dad was found unconscious in a racecourse toilet.’

‘You can wait in the relatives’ room,’ I said. ‘There’s a coffee machine in there.’

‘Thanks.’

The CT scan was clear – no visible clots or bleeds in the brain, and no tumour.

More suspects had been eliminated.

Now what?

I began to feel shaky again.

Stop it. Keep control.

I looked at the monitor that showed the man’s heart beating 196 times per minute, even higher than when he was brought in. And the cardiac trace on the screen was becoming increasingly random, strikingly different from the nice smooth, repeating pattern produced by a healthy organ. But, in spite of the irregularity of his heart, his blood pressure was holding up, indeed it was far too high, and the oxygen saturation was steady at 98 per cent.

‘I’m worried about him,’ I said to my senior staff nurse.

We had been unable to obtain a urine sample for a dip drug test. Did that indicate that his kidneys were not working properly? I also thought his skin displayed the slight yellowing of jaundice, so was there a problem with his liver function?

Both could be a direct result of his cardiac arrhythmia.

In medicine, as in life, one initial problem could all too quickly spawn a whole raft of secondary troubles.

The blood-test results should give us the answers but we were still waiting for those to come back from pathology. Nothing, it seemed, happened quickly on a Saturday anywhere else in the hospital. But accidents and emergencies didn’t respect the normal working week. Indeed, Saturdays and Sundays were by far our busiest days.

‘His pulse is still far too fast and getting very irregular,’ I said. ‘His heart’s clearly tiring. If it is SVT, then it’s high time we tried to reset his rhythm back to normal.’

I took a deep breath.

‘We’ll give him six milligrams of adenosine,’ I said decisively.

‘We don’t know what else he’s taken,’ the staff nurse said with a note of caution.

Adenosine was an antiarrhythmic medication used to slow an abnormally high heart rate, but it could occasionally react badly with some psychotic drugs.

‘I think we’ll have to take that chance,’ I said. ‘Have you checked him for puncture marks?’