Drunk, or Diabetic?
At the time I joined the Ambulance Service in London, equipment and diagnostics were still fairly basic. We didn’t have defibrillators until later, and blood pressure had to be taken manually, with a stethoscope and wrap-around cuff. There was nothing to take a temperature with, and drug administration was restricted to the gases Oxygen and Entonox. It was to be some years before we progressed to things like blood sugar testing kits, pulse oximeters, and intravenous drugs. As as consequence, I once made a major mistake, and this the first time I have ‘gone public’ with it. Fortunately, it did not have any serious effects on the patient, or on my reputation.
When a person is affected by low blood sugar, the symptoms can vary, depending on the severity, or the individual. Some patients can quickly realise that they are about to experience problems, and can counter this by eating or drinking something sweet. This will give them a temporary respite, and allow them to seek medical help, or manage the problem themselves. Our main treatment of known Diabetics back then was to get some sugary fluid, or even powdered sugar, into their system as soon as possible, to help them recover enough to take them to hospital. If this failed, we had to move them on stretchers, unconscious, or semi-conscious, and convey them to the nearest casualty department. This worked reasonably well, if you knew the medical history of the person concerned. In their home, or perhaps that of a friend or relative, there was normally someone else to give you the patient’s history of Diabetes. On the street, or in public places like stations, you might discover a ‘medic-alert’ bracelet or neck-chain being worn. This distinctive item of jewellery opens up to give you the necessary information to confirm a diagnosis, and you can act accordingly. There are other situations where none of this information is available, and where the patient is not necessarily presenting with recognisable symptoms.
On one occasion, we had started a night shift at 22.00. After going straight out to do a transfer from one hospital to another, the next job was given as ‘a male in a collapsed state’. The address was outside a pub, and it was almost an hour after closing time. It is fair to say that we went off to this job expecting to find a drunk lying in the street, having had too much to drink in that very pub. As we arrived, we were directed by bystanders to a man rolling around the pavement, in an alleyway beside the building. He was shouting incoherently, and he appeared to have urinated in his trousers. When we approached him, he swung his arms at us, and kicked out violently. He continued to shout and swear, though it was hard to make out anything he was saying. Trying to make some examination of him was difficult. He looked to be in his early forties, and although he was reasonably smartly dressed, his clothes were filthy, from contact with the ground. He stared at us aggressively, and opened his eyes wide. He was spitting and slurring, and kept lashing out at us with his feet. We decided that it wasn’t worth the trouble of getting too close, and having to end up in a fight with this man. So we called the Police.
At that time, it was perfectly acceptable for the Police to remove someone who was being violent to an ambulance crew. Anyone refusing to cooperate with us was fair game, and very likely to be arrested. When the local van turned up some ten minutes later, the two officers tried to reason with the man, and to get him to stand up. He refused to assist them, and eventually managed to kick one of them in the leg. He was arrested for being drunk and disorderly, and for assaulting a Police Officer. They dragged him into the back of their van, and handcuffed him. We considered ourselves lucky to have passed him onto them, and continued with our shift. After a busy night of constant calls, we finally managed to get back to the base at about 04.30. I was just about to make some coffee, when the emergency phone went, and we received another job. This time, it was to the cells at Notting Hill Police Station. Apparently, they had an ‘unrousable male’ detained there, and they had called out the Police Surgeon (an on-call doctor) to examine him.
Of course, it was the man from earlier on, the aggressive drunken male, who had been collapsed outside the pub. The Police Doctor had determined that he was almost certainly in a diabetic coma, having been able to take a reading of his blood sugar. Occasionally, the symptoms of diabetic coma are very similar to drunkenness. Slurred speech, incoherent phrases, disorientation, and violent behaviour. This man was very unwell. He had not been drinking at all, and it turned out that he had been on his way to work on a night shift in a local factory, when he happened to collapse outside the pub. The doctor had no idea that we had previously attended him. The Police had said nothing, save the fact that he had been arrested as a suspected drunk. We took him off to hospital in Paddington, where he was given glucose via an intravenous drip, and soon made a full recovery. He remembered nothing of the original incident, or of being detained in a police cell. Chatting to staff in the early hours, we managed to get the full history of his case.
Nobody had mentioned us, or what served as our neglect of this diabetic patient. Some time after, Police would no longer take drunks in charge, in case underlying causes of illness surfaced later. We also received instructions to treat all ‘drunks’ as potentially unwell from other causes, and the hospitals had to cope with a sudden influx of drink-related problems. I learned a valuable lesson. Look beyond what you perceive to be obvious. Diabetes was and still is a massive problem, and the symptoms of coma are so easily confused with other problems, like being drunk, or a stroke. I escaped serious consequences that night, and fortunately, so did our unlucky patient. I didn’t repeat that mistake, during my remaining years in the job.