What would Mark do?

Dr Mark Greene

When Dr Crippen was a hospital doctor, he enjoyed rushing round to emergencies and officiating at cardiac arrests. Just like on television except in real life most patients do not survive cardiac arrests. Dr Crippen was particularly addicted to ER as are a lot of British doctors. Until Mark left, that is. You cannot get good staff anymore, can you? It is just the same in the UK. Of course, ER crammed a week into a day, but the emergency medicine depicted was more realistic than that in most medical soaps. And Mark was lovely. Even now, in challenging medical situations, my partners and I will say to each other, “What would Mark do?”

After twenty years as a GP I no longer have any enthusiasm for emergency medicine. I carry an appropriate selection of drugs in my medical bag, but I do not have the wherewithal to put up drips, intubate or defibrillate. With modern paramedics, and the kit they carry, it is not necessary. If a patient calls me with a dire medical emergency, I call 999. I go myself as well, but I rely heavily on the paramedics.

Betty called last week to say that Eric was having “a funny turn”. Betty did not sound worried. Eric was not in pain, and was breathing fine, but kept sighing and his pulse was racing. I did not tell her to dial 999. I went round myself.

Eric was partially lying on the sofa, on his back, with one leg on the floor. His eyes were open and, yes, you could say that he was sighing, In fact his breathing was laboured, he was making a sort of snoring noise. His lips were blue. He was twitching spasmodically. Eric was having what used to be called a grand mal fit. Betty was oddly calm about it. She said he had been doing it for a couple of hours and she did not like to call anyone because it kept stopping and starting. I told her it was a fit, and asked her to dial 999.

I wanted to get Eric onto the floor, into the recovery position, and give him an injection. Eric is nearly nineteen stone. I could not budge him. Simple things first. I put my hand under his chin and lifted it up. His breathing eased immediately. Betty was off calling the ambulance.

I had to let go of Eric’s chin whilst I opened by bag. My plastic airway was in my other bag still in the car. I did not want to leave Eric. I needed to stop the fit. I found a butterfly, syringe, needle, diazepam and a tourniquet. I had that assembled quickly, then paused to lift his chin up again to relieve his breathing.

A butterfly

Betty came back from the hall and said, “They are sending a man on a motorbike”. Betty was now shaking and frightened. I asked her to hold Eric’s chin up whilst I gave him an injection. She could not do it. Eric was still fitting. I managed to get the tourniquet on, found a vein, got the butterfly in, and was just about to give the injection when Eric had a violent spasm, his arm shook, and the needle came out. The tourniquet was still on. Suddenly there was blood everywhere. Probably only an eggcup full, but it always looks worse.

It was beginning to feel like something out of a Marx Brothers’ film. I got the tourniquet off, and put pressure on the injection site, but I could not hold his chin up as well. Betty started crying. The spare butterflies and diazepam were in the other bag in the car. Eric was still fitting. His breathing was fine provided I held his chin, and I still could not budge him from the sofa.

I was wondering what Mark would do, when there was a knock at the door and in came a man in green with a big box of tricks. The paramedic was called Paul. Early middle-age. Calm. Used to this sort of situation. Within seconds of being in the room, he had slipped an oral airway into Eric’s mouth, instantly solving the breathing problem. Amazing what a little bit of plastic will do.

Oral Airways

Together, we managed to get Eric into something approaching the recovery position. Betty started whimpering. Paul asked Betty if she could go upstairs and find all Eric’s medication. Off she went.

Paul had all the necessary kit but oddly was not himself allowed to give intravenous injections. With two of us it was now easy. Paul had a vice like grip to hold Eric’s arm. I was able to get the needle in safely and give ten milligrams of intravenous diazepam. Eric stopped fitting within twenty seconds. His breathing changed to a more natural rhythm. His pulse slowed to normal.

We tidied up. Betty arrived with a tray full of all Eric’s tablets. Eric was peacefully asleep on the sofa, breathing normally.

By the time Eric got to the hospital, he had made a complete recovery. He was sent home after a minute under four hours in hospital with the usual letter saying “go and see your GP and get him to investigate you.” In the old days, of course, the hospital would have initiated the investigations themselves without me having to send him back for a second bite at the cherry. Biting the cherry twice wastes a lot of time and money, but hospitals do not earn their three stars by keeping people in Casualty for tests.

An everyday tale of general practice? Absolutely not. This is only the second time in twenty years I have had to treat someone acutely for a prolonged fit. It was the most stressful experience of the year. I hope it never happens again. I could not have done it without Paul even if I had taken both of my bags in.

I am sure Mark would have done it better, but then he was doing it every day.