Autonomic Dysreflexia

This post is an example of " everything went wrong that could have gone wrong".
Yesterday, I recalled the story of Sue a patient who needed and received some excellent nursing care from a curly haired, potty mouthed and naturally funny staff nurse called Ruth, who I have been dear friends with for over 25 years.
The story, had a somewhat sad ending for after four months or so on the rehab ward, Sue suddenly suffered a major physical complication and died unexpectedly on intensive care . She was only 26 years old.
We had become very close with Sue during her admission, and so it was natural for us to want to attend her funeral, which was across the Pennines in her home city of Manchester, and so early on the morning of the service three spinal injury nurses and three spinal injury patients left Sheffield in two cars to show their support.
Now Ruth and I travelled in one car and with us was a young man called Nick who had been paralysed from the waist down in a car accident and Marie, a young woman injured from the neck down following a fall. Both were wheelchair bound and both had developed a special bond with Sue during their admission.
The other car was driven by a nurse called Paula and with her was another patient called Pete, who was able to walk very shakily on two sticks.
Things didn't bode well after we stopped at traffic lights in rural Derbyshire  for as Ruth muttered her signature oath of " Hell's Teeth!"  her car stalled and refused to start. It was only then when I realised that we were totally responsible for three patients, each one with their own individual care needs.
It was a sobering thought.
Anyhow we eventually arrived at Sue's family home in a back street of Manchester just as the hearse left for the Church, then everything went tits up.

• Ruth's car finally died, leaving us stranded with no knowledge of where we were going
• Ruth started to flag down passing cars in a desperate effort to elicit help as Paula and I managed to lift Nick and Marie into her car so that at least we could get them to the service
• Ruth then incredibly stopped a cheerful plumber called Mick who agreed to transport me, her and the patients' wheelchairs across the city as a favour. Never was a stranger so helpful
• After getting to the Church we unloaded both van and car, set the patients up in their chairs then bolted to the service which was just finishing. By this time Ruth was literally inconsolable 
• The " wake" we were then told was located in a working men's club back across the city and Sue's family insisted that we all attend, so after organising more spaces in more stranger's cars we eventually arrived fraught, sweaty, and extremely stressed at one of the grottiest  council estate clubs I have ever seen.
• Then everything REALLY took a turn for the worse. 
• As we were setting up the wheelchairs ( brought for us by a couple of pensioners driving a nissan micra), Marie suddenly complained of a pounding headache. She looked flushed and unwell and couldn't quite focus  and we all suddenly knew that she was suffering from autonomic dysreflexia, a condition that is a medical emergency in high spinal cord injury patients. The condition can occur when a urinary catheter is blocked and if the cause is not rectified patients can have a pathological rise in blood pressure which can effectively kill them. The only treatment is to immediately change the patient's catheter.
• " Get her into the club" Ruth yelled and between three of us , we lifted Marie out of the car and raced THROUGH the wake where a few hundred people were drinking beer  and eating sandwiches) 
• Luckily a white faced club official saw us coming and pointed to the " ladies snug" which was deserted and on a polished table top , Ruth and Paula managed to change the blocked catheter which immediately reversed Marie's symptoms. 
• While we were busy, several red faced drinkers had helped Nick and Pete into the club and were plying them with bottles of beer. This was just after 1pm
• By seven pm, the AA had got Ruth's car started and we were on our way home. Nick and Pete were much the worse for wear and Ruth was beside herself with the stress. " I'm going to get sooo drunk tonight " she promised as we eventually got back to the spinal injury unit and after having to explain ourselves to the matron for our late return, she did exactly that, after talking a bottle of rum from another friendly rehabing patient!

The last thing I remembered of the evening was when I opened the taxi door  outside Ruth's house in

the wee small hours and she fell out onto the road drunk as a skunk. " HELL's TEETH" she slurred cheerfully "'I think I've just broken me finger.........hey ho" ......and I am afraid to say that she indeed had...but it wasn't diagnosed until the following afternoon....

Now you all know where " hey ho" comes from!

Me, Ruth's husband Allan, their kids and Ruth on a visit to Wales

Several years ago!