Happy to Help

Public education should really be at the forefront of the campaign against misuse of the ambulance service. Huge posters, TV and radio ads, even, as far as I'm concerned, parliamentary debates.

Even the occasional blog post.

There's a relatively new law that could see a person fined, and potentially jailed, for obstructing an emergency ambulance in its duties. From the news that I've seen, this has been used precisely once in London since it became law over a year ago. This is probably because being deliberately obstructive, whilst potentially lethal and exceptionally obnoxious, is a very rare thing. More often than not, the obstruction is caused elsewhere, when an ambulance is called unnecessarily, whilst somebody else, in desperate need, lies waiting nearby.

*****

The call was to an industrial site, a plastics factory, for a hand injury. The call taker has been told that there is serious bleeding. As per normal on these sites, the front gate security sent me the wrong way, but the array of white-overall-clad windmills soon had me turning 180 degrees and heading for the right factory. After grabbing the kit out the back of the car, I'm shown into the main office that doubles as the first-aid room. My tour-guide is walking double-time, and speaking twice as fast.

"I'm sorry we've had to call you. It's Stefan. He was slicing some plastic sheeting with a Stanley knife and it slipped. He's cut his hand. It's really bad! I've put some bandages on and tied them tight, but it's leaking through, so I've made him sit with his hand on his head!"

A first-aider with some knowledge, and putting it to good use. I'm impressed.

I find Stefan sitting on the office chair, feet up on the table, his right arm bandaged and resting on his head. Blood trickles out and drips down the side of his face, giving the impression that he's bleeding from his ear. He's paler than the overalls he's wearing, clammy and scared. I have to see the injury, so warn Stefan that I need to remove the bandages and he may want to look away. There's a definite reverse shuffle of feet heading for the door as I say that, as the few people who'd come to see what was wrong realised that they'd seen enough. With the bleeding still seeping through the bandage I presume an arterial bleed, and remove the bandages with some care to ensure I don't get covered in case of any spurting blood vessels.

The injury is serious. He has a deep laceration from the back of his hand by his little finger almost as far as his elbow, all along the top of his arm. It's like having a lesson in the anatomy of an arm - muscles, blood vessels, bone, all on view. The force being used on the blade to cut through thick plastic made easy work of Stefan's arm, as the knife slipped off its intended target and took out its venom on the next available one. With his arm re-bandaged even tighter than before, elevated in a sling, Stefan was blue-lighted to hospital for what would initially be an attempt to salvage his arm and its motor functions, and later on for the plastic surgeons to work their magic too.

As the back doors of the ambulance were shutting, Stefan looked up and said a drowsy "thank you".

"No worries Stefan. Happy to help."

*****

One week later, almost to the minute, and I'm called to a private home, for a man with an arm injury, again with serious bleeding. These sorts of things tend to happen in blocks. There'll be a few people all having heart attacks around the same time, then I'll attend RTCs as though they are going out of fashion, and obviously now a few days of people slicing their arms.

Kev meets me at the door himself. His hand and arm are wrapped in a colourful array of tea-towels. He starts telling me how the accident happened, and only half listening (big mistake), waiting to see another anatomy lesson, I start unravelling the towels that seem to have stemmed the serious bleed. Four towels later I can see his arm, but no sign of any bleeding. I ask him once more what happened, and he tells me again of the new DVD player and cutting his hand on the box as he opened it. For a moment, I'm lost for words.

There's no cut, no blood, at a stretch there's a small scratch. A paper cut. That's why he called the ambulance. For a paper cut. Sometimes, most times in fact, if I'm on route to a call that I think isn't either an Accident or Emergency requiring an ambulance, I'll rant, rave, threaten to scream and shout, but invariably, as soon as the door opens, I'm polite, professional and calm. I'll politely suggest that if there is a "next time" other alternatives, a GP appointment, a visit to a minor injuries unit, even self-conveyance to the A&E department are all possibilities.

This was a grown man, in his late 40's, with a supposedly responsible job, runs his own home, and seemingly has at least a normal level of intelligence. His justification for calling an ambulance for his paper cut was because he was on Warfarin - blood thinning medication - and was concerned that he wasn't going to be able to stop any bleeding. I tried to point out, gently at first, the fact that he needed to have been bleeding in the first place to be worried about it not stopping. I tried to tell him, calmly at first, that despite the fact that he was on Warfarin, he was at no greater risk than the rest of the general population of dying from a paper cut. None of this was being taken on board. Kev kept repeating the same mantra over and over. "I'm on Warfarin. I deserve an ambulance. I know my rights and that means that you have to take me to hospital, otherwise I might bleed so much that I'll die!"

In one final attempt to explain who we are, what we do, and when is the right circumstance to call us, I asked Kev if he had any family in the area. "Sure. My parents live not far from here."

"And if one of them was to have a heart attack, what would you do?"

"I'd call an ambulance."

"Well, sir, you wouldn't get one."

He looked incredulous. "Why the hell not?"

"Because, sir", I tried to answer with all the composure I could muster, "I'm here dealing with your paper cut!!"

Finally, the penny seemed to drop.

"Ummm... Errr... Maybe I over-reacted a little."

I sighed.

"Maybe you did, sir. Just a little."

*****

Fears allayed, Kev decided that he didn't really need to spend several hours in hospital for a paper cut, and after a short time and the traditional paperwork, he decided to stay home. We parted as friends, and he promised to think long and hard if he really needed to call an ambulance in future. I, on the other hand, after doing my little bit for public education, promised that if he did ever need us again, either for himself, his family or his friends, we'd be only too happy to help.

Trick up the Sleeve

Once upon a time, in a land not far from here at all, there was a brand new EMT. So new, that he'd only been let loose on the public a matter of a month earlier. He was a nervous, quiet, shy character, not yet quite at ease with his new surroundings, but loving them nonetheless. He wanted to see everything, do everything, know everything, all in the quickest time possible, but for now was always happy that there was someone there wiser, more knowledgeable and more experienced than he to rely on.

One fine day, along with female crewmate, he was sent to an RTC. A lady had fallen off the back of a bus. 'Twas one of the olde worlde, London icon type Routemaster buses, with no door at the rear, and said lady jumped off whilst the vehicle was still in motion. "Stupid", I hear you chorus, with a "serves her right" to boot, but with these buses, jumping on and off at low speed was part of their charm. This time, however, she landed awkwardly and had hurt her arm.

She sat on a wall with her friend, cradling her arm, obviously in pain. As brand new EMT and partner approached the lady, a comment was passed between the patient and friend in a language other than English. A derogatory comment, even a racist one. Said EMT ignored seeing and hearing the comment, registered it and stored it in the back of his mind, and went about attempting to treat the patient. The middle of the patient's lower arm had a shape to it that even to a brand new EMT said "Broken". No question about that one.

Patient wouldn't, couldn't, or didn't make eye contact, and just said, in perfectly good English, "I can't come in your ambulance". Brand new EMT wasn't too shocked, and played dumb.

"If you'd rather be treated by my colleague, that is fine with me. I understand you might wish to be treated by a female".

"No, no. I just can't come in your ambulance".

"Well, if that's the case, I'll just inform our control that you are refusing our aid, despite the fact that you clearly need it. They won't send another ambulance, just because you don't like the look of this one!"

"Oh", she said, and jabbered away in her vernacular to her friend. Clearly they were discussing their next move.

Brand new EMT's patience was wearing a little thin, but he maintained his composure as he asked "Are you refusing to be treated because of who I'm not, or because of who I am? Because you can't choose the crew that get sent to help you!"

Ruse possibly rumbled, patient and friend eventually agreed that they would travel with us and even allowed the brand new EMT to treat the patient. He gave her some entonox to ease the pain, explained that despite the fact that he had not yet been allowed X-Ray glasses that he was fairly certain that the arm was broken, and placed the arm in a splint.

All the while they talked between them about the fact that they'd had to travel in an ambulance with this brand new EMT, how they wished they didn't, how they hated him and his type, and how they'd have to make sure that their friends and family didn't find out about who it was that treated and transported them.

And all the while the brand new EMT sat and with a blank look on his face. Well, wouldn't you if everything around you was in a foreign language?

As they all arrived at the hospital, the back doors opened, and brand new EMT asked the patient how she was feeling now, and if she was ready to leave the ambulance.

Asked, not in English, but in their own language. One which I can't speak fluently, but can understand to a great extent, and speak just enough.

Two faces fell and became instantly beet red, and the two voices became instantly silent.

My face just had on it a small, wry smile.

I could have been angry, furious even. I could have complained, reported them. I could have even refused to treat and transport them.

Instead, I was just glad to have been the bigger person, and have a trick up my sleeve that left me with the last laugh.

A Giggle

I know I've not written for a few days - apologies, the world has gone a little nuts.
Depending on my insomnia, I may get something posted tonight.
In the meantime - have a laugh.
Head over to Flobach Republic's blog and have a read of his latest post. I'm still smiling.
And when you've only had 6 hours sleep in the last week, a smile looks a little manic, but still.
Go.
Read.
Enjoy.

Good Afternoon

So when is a Police Constable not PC? When the police force has issued even more guidelines of how to address people, or how to refer to the time of day. Or not, as the case may be - apparently it may cause confusion for "different cultural backgrounds" if you bid someone a "Good Afternoon".

Codswallop, Tishposh, Baloney and Tripe. I'm sorry. But it is. And I know that the beginning of this sentence sounds like some American legal firm. Sorry for that too.

I can understand not asking for a Christian name. I'm not Christian, and I wouldn't be upset if someone asked me for my Christian name, but I can, just about, understand that rule. I don't necessarily agree with it, but I can understand it. We don't need rules and regulations for every single little thing. There should still be some room for common sense.

The one thing that I have been left thinking about is names in general, and in particular, what do you call your patients?

Do you call all male patients "sir"? Really? Even the six year olds?

Do you call all female patients "madam" or "ma'am" or "miss"? Really? Even the really scared ones?

I know that if someone calls me "sir" it means one of the following. Either I've been knighted by Her Majesty, no-one told me about it and I've missed the Investiture, or someone is trying to sell me double glazing. I hate it. Don't call me sir.

If you call me Mr. M, I am equally as uncomfortable. Either I'm talking to one of my kids' teachers, who are trying to balance the tightrope of officialdom, distance and the personal touch, or I'm meeting the bank manager for another review of my ever-growing overdraft.

My parents were kind enough to give me a first name, so please use it.

I know that this isn't the case for everyone. I know there are many people who prefer to be addressed as Mr. SoAndSo, or Mrs. WhatsHerName, and they are entitled to that courtesy. The Rules say that this is how everyone should be addressed.

No room for manoeuvre, no room for the personal touch.

I think that this is what aggravates me the most. I disagree that calling people by their first names is unprofessional. Sometimes I find that it's just what they need to hear. Admittedly not ALL (ahem) our calls are life-threatening, and not at every given moment is either the patient or their relative in great distress, but if they are, then I think that addressing them by their first name, or whatever other name they choose, has a calming effect.

It portrays that we can walk that tightrope. Be professional at all times, and yet have the personal touch that shows you can empathise, sympathise and treat as necessary.

If, for example, Jill Greaves, was trapped in an upside down car after a high speed RTC, I'm sure she'd rather hear the strange multitude of voices saying "Don't worry, Jill, we'll have you out of the car and in the warm as soon as we can", rather than "Mrs. Greaves, we understand your concerns and are aware of your predicament, so we are undertaking your rapid extrication from the vehicle".

So what do YOU call your patients?

I vote for common sense.

I vote for asking your patient how they would like to addressed.

And I vote for bidding your patients Good Afternoon. But only if it really is.

Oscars Night

I know you're not unconscious.
You know you're not unconscious.
Even the non-medically trained police officers know you're not unconscious.
We all know you're faking because you don't really like the idea of being locked in a police cell for the night.
Your acting is poor.
Your eyelid-flickering, arm-not-falling, half-peeking-in-the-hope-we're-not-looking performance convinces no-one.
But I guess we have to play the game.
It's just that you'll get no sympathy from any of us.
We'll get the trolley-bed and place your pseudo-unconscious carcass on it.
We'll take you up to the hospital for them to know that you're not unconscious too.
We know you're probably going to try to run, so some police officers come with us.
Doors are unlocked, opened, and you feel the fresh breeze on your face.
Miraculously, the act over, you wake up, and try to jump off the bed and run.
Except that in your unconscious state, you failed to notice the obvious.
The thing about handcuffs, is that there are two halves.
One is attached to your hand.
The other is securely fastened to the trolley-bed.
For a moment you seem to bounce back as if on an elastic band.
We snigger.
The officers barely suppress their giggles.
The custody sergeant laughs out loud.
"You ain't going anywhere sunshine", he bellows.
"Well, except maybe to the Oscars".

Confidentially Yours?

CK over at Life Under the Lights has written a motivational post for all EMS staff, worth not only reading, but also acting on. Are you the best that you can be at what you do? Are you the sort of paramedic that you would want called for you or your nearest and dearest? If not, what are you going to do about it? Go read his post, and come back when you're done. His is definitely a worthwhile read.

For me, Chris's post raised a completely different subject, and took me back to a major dilemma I had quite a while back. I know this sounds a little strange, but it all started when I was 14 years old.

Back then, I had just changed schools, and on my first day I was marched into a classroom, told to take the one empty seat and just get on with it. The person I sat next to that day became my friend for life. He'd only been at the school a few months longer than I had, so was also finding his feet, and yet he always made certain that I wasn't left out of whatever was happening, knew where I was going, which classes were where, and most importantly where the nearest shop supplied with chocolate was. "KitKats", said the owner every single time we walked in. "33p each, but special offer for you guys, 3 KitKats for £1". Happy days.

Our lives have since taken very different paths, in totally separate parts of the world, and yet we always make sure to keep in touch. Life sometimes gets in the way, and we don't communicate as much as we'd both like to, but anytime there's any major news in my life, he's one of the first to know about it, and vice versa.

When he moved to the USA, his parents stayed here in the UK. After a while I got to see him again, when he had to return for his father's funeral. These were not the circumstances under which I'd envisaged seeing him again, but despite the tough times, it was still a great feeling to be in the same place at the same time, if only for a short while.

Not long after he returned home to the States, I had a call to a very familiar address. My face told my crewmate more than my voice did. The address, one where I had spent so many happy hours pretending to do homework, practising our different martial arts and generally beating each other up, eating, drinking, watching TV, being teenage boys, now appeared on our MDT screen, alongside "Female, fallen, ? conscious, ? injury". I wasn't sure I could face it, and briefly considered asking one of the other crews to take the call. However, I decided that if anyone deserved my help, it was the person who'd looked after me, welcomed me into her house and regularly force-fed me all those years ago.

We arrived to find that she was conscious, but confused and injured, and would require transport to hospital. As anxious as I was about attending this call, she was just as pleased to see me emerging through the front door again, albeit in a different capacity altogether, and she wasn't entirely certain why I was there. This time, I had to do the looking after. We transported her to hospital for them to tend to her injuries, and I made a mental note that at the end of the shift I'd call my friend and tell him what had happened.

This is where I had a problem. I have treated several people over the years who either know who I am, know my family, or have some other connection to people I know. I have never, will never, divulge even the hint of the fact that I've met someone like that to my family or friends. If the patient wants people to know that they've met me, that's their prerogative and they can tell as many stories about themselves as they like. Often I'll be met with "You didn't tell MrsInsomniac that you treated me???" and other such expressions of surprise. Where I come from, it's gossip first, worry later, then gossip again anyway. I'm just not like that, not in general, and definitely not at work. My patient's privacy is first and foremost, whether they know me by my first name or not.

This time, however, it was my childhood friend. And his mum. People I have known for so many years, who I am very close to, and who are very much part of my life. How do I now go about calling him and telling him that his mum's in hospital, not in any state to talk to him or to tell me to do so, after I was the one who treated her.

Do I wait for the hospital to contact him, and hope that he puts two and two together?

Do I make the initial contact, breaking every rule in the protocol book?

Or do I go to my next call as if the person I just treated meant the same to as any of my other patients that day?

Which option would mean that I had treated the patient to the best of my ability, and in the best interests of the patient?

Friendship versus Confidentiality.

What would you do?

Icing

Recently I've written a couple of posts reflecting disappointment and frustration at the system that guides the job that I do. I love my job, I'd just like to be able to get on and do it. Sometimes I need a reminder that when all else fails, there's someone somewhere, not very far away, who will call on us and we will make all the difference. They'll be relieved, appreciative, sometimes thankful, even if they don't necessarily show it at the time.

Often all it takes is one call. One short-lasting event to remind me why it is I do what I do. Sometimes it's an entire shift. One of the things I most enjoy about my job is the fact that not only are no two days ever the same, but that the huge variety of calls we receive keeps me constantly on my toes. Every time I get just a little too laid back, something jumps out at me and reminds me that there's always something out there that I know nothing about, have never seen, and will really have to think about how to deal with.

Mostly I feel that it's the variety that keeps me here, but sometimes, when the variety is only of the unnecessary sort, the multiple gear changes leave a burnt out clutch.
Sometimes that clutch just needs changing, and all is back to (ab)normal.

And just when I needed it, the clutch that needed fixing was sent the mechanic that it needed. A recent shift, and being in the right place at the right time, brought the following:

I went from dealing with a child who's been on antibiotics for 2 hours and hasn't yet miraculously recovered from their sore throat, to comforting the relatives of a cancer patient who had just succumbed to their illness.

Then from a mild allergic reaction caused probably by new medication, to extricating two people trapped in the mangled remains of the family car.

And last job of the night, I was called to a patient threateningly at death's door, danger lurking both for her and her unborn twins. I was, along with the crew, still in the maternity unit finishing the paperwork as we heard those same babies, abruptly c-sectioned from their mother, cry for the very first time.

I wasn't all that far behind.

I went home that morning once again knowing why I do this job, and why I love it.

That night, I came back to work to be met by one of our managers.

"Do you remember a call you attended a few weeks back?" He went on to describe a call of which I had a vague recollection. It was routine. An unconscious diabetic, hypoglycaemic, sugars too low. We reversed it, he recovered, and stayed at home to be cared for by his family. I feared a complaint coming my way, although I couldn't figure out why. I told the manager that I remembered it, bizarrely more because I remembered the house, than the patient.

At that point, he opened up the back of his car and handed me a box.

"Here. These are from them for you. They gave me 12 bottles of wine, 4 for each of you that were there!"

Very much taken aback, I took my share of the box and, not being much of a wine drinker, later donated the wine to a worthy cause.

This isn't even close to the reason I do what I do.

But after the night before, it was just the icing on the cake.

Excuses, excuses

Chronic insomnia is not an excuse for stupidity, but I'm going to try to use it anyway.

*****

It's been a long, busy night. At 0500, you are starting to see the light at the end of the tunnel, and are just getting hit by that end-of-night-shift-itis.

The patients, just for a change, have all, every single one of them, been in genuine need of an ambulance. You have treated some, stabilised some, resuscitated others, even transported them or travelled with them.

You've finally got back to base, and debate the pros of a cup of coffee in keeping you awake just until the end of the shift, and the cons of same-said coffee stopping you from sleeping when you finally get home.

The decision is made for you by the phone pinging its SMS Morse code sound, frighteningly similar to that of the SOS. The coffee will have to wait. The police have called for you this time, for an RTC. Possible arm injury. That's all the details you have, other than a general location.

As you approach the scene, there are several police cars with their lights illuminating the surroundings, the staccato of their lights reflecting off the buildings.

You park up behind the police cars, and walk to the front of the line, assuming that there might be a pedestrian on the ground in front of them with the arm at a funny angle. No one is there. Not even a police officer.

You look around, and see a couple of other cars a bit further up, but both seem to be parked rather than crashed. No sign of anything. You are confused. You are about to get on the radio and ask control to speak to the police and find out exactly where they, and the patient, are hiding.

And then you stop looking around, and for the first time in the 30 seconds (yes, all this in less than half a minute) since you arrived, you see it. The officers are on the other side of the road, by the block of flats.

The patient is standing talking to the officers. You guess he's the patient as he's standing there rubbing what must be a sore shoulder, and trying to move his arm. There is however, no car. There's a good reason for that too.

The RTC involved a truck.

A big truck.

One of those with 12 sets of wheels, 4 axles, 36 gears type of truck. Don't pick on me about the numbers - I've just made 'em up. Just take if from me, it was one of those huge delivery trucks, the ones you don't mess with on the roads, whether or not you have blue lights on the roof.

And it was parked in the side wall of the apartment block.

Rudely awakening the occupants of the ground floor flat as it appeared in their bedroom uninvited.

SO HOW IN THE WORLD DID I MISS THAT WHEN I FIRST GOT THERE???

*****

Chronic insomnia is not an excuse for stupidity, but if it was, it'd be the best excuse in the world!

10 Important Facts

Some surprising medical facts for you to consider whilst going about your daily chores today:

1) No-one in the entire world can touch all their own teeth with their tongue.

2) Mad people everywhere are now trying this.

4) You've just tried, and discovered this to be untrue.

5) Now you're sitting there with a crazed smile on your face.

5) Bet you didn't notice that I'd skipped number 3!

6) And now you've gone back to check.

7) Bet you didn't notice that I'd skipped number 6 either.

8) Fooled again...

9) Bet you didn't notice that number 5 appears twice!

10) Now that hopefully you've got a smile on your face, remember that that's what it's all about, and go back to your daily chores...

*****

Edit: For some reason, this post in particular has brought literally thousands of hits to this blog. To those of you who are new, welcome and thank you. And please stay around to read the rest of my ramblings. This one was only meant as an interlude....

Green and Genuine

Just for a change, the weather is grim, and my mood along with it. Nine hours into the shift, and I've had nothing but coughs, colds, and kids with fevers to deal with. I was on the last of four long, dreary, cold nights, and all I wanted to do was crawl into bed and hide. As usual, there were different plans for me.

Despite working on my own, as soon as the computer rang with my next call, I sighed out loud, as if hoping for someone, somewhere, to hear me. They must have done, because at that point the phone rang too.

"Hi InsomniacMedic, it's Dave at control. This call we've sent you, we know it's only a low category Green call, but they've been waiting hours, we've got nobody else, and it sounds like they really need some help!"

I look at the screen, and read the details. Green 2, Male, 30s, back pain. Uncomplimentary thoughts instantly enter my mind, a combination of winter, unnecessary calls and sheer exhaustion. Only 6 hours sleep in four days is enough to make anyone lose the plot, even a seasoned insomniac. On route to the call, I can't help thinking that all I'm going to need to do is throw a box of Nurofen at him and tell him to man up and deal with the back ache. Most times, people seem to go from having back pain and not taking pain killers, and jumping straight to "Code Red" and call an ambulance. I often wonder at what point it is that you go from coping to not coping, without trying to help yourself first. Anyway.

I open the car door, and instantly hear the screams. Something tells me that all my prejudice has just been proved wrong. This sounds like real back pain. Not the sort that goes away with a heat pad and some anti-inflams. I take the entonox (an analgesic otherwise colloquially known as laughing gas) with me as a matter of course on any call stating that the patient is in pain, and laden with my prized possessions of kit and analgesia I walk up the driveway. The sound emanating from the house sounds like a woman in labour, which, had I not have been told that the patient was male, would have had me worried. Then again, it's not unheard of for the system to get the sex of the patient wrong.

The door is opened by a most definitely not labouring lady, at a guess late twenties, who looks anxious to the point of real fear. "What took you so long? He's in agony!" I mumbled some sort of apology about it being exceptionally busy, and that I'd been sent as soon as was physically possible. I skipped the bit about having not been to a single patient who actually required an ambulance the whole night.

I'm shown in to the front room and meet Jake for the first time. He's on his hands and knees, his face resting on the couch. He's pale, sweating by the bucket-load, boxes of used pain killers on his right, a half full vomit catcher by his left, and he's literally screaming in pain. Even the slight movement to see who's just walked in racks his body with more spasms.

I take the entonox out of its bag, connect the bits together, and briefly explain to Jake what to do with it. "Breathe in and out through the straw-like gadget, deep, slow breaths, and give it just a few minutes before you start feeling the effects". He follows the instructions to the letter, and drinks the entonox like it's the elixir of life. After five minutes and almost half a cylinder of the laughing gas, Jake was still crying. Time for the big guns.

Morphine is great stuff. I have never used it and had it not do what it's supposed to. I know full well that as soon as Jake gets to the hospital there'll be eyes rolled at another overkill job of using morphine for a simple back ache, but I know that it's the right choice. I need to treat what I'm presented with, and not what the hospital will assume was happening.

Finding a vein to cannulate in a person on all-fours is a little difficult, but by far not the most awkward I've had to contend with. The line goes in smoothly, and I give Jake an anti-emetic to stop the vomiting, closely followed by the magic potion. Moments later, probably no more than 90-seconds, the relief is plain for all to see. Jake's whole being relaxes, the colour comes back to his face, he's not trying to bring up whatever contents are still left in his stomach, and he even manages a smile.

The crew that finally turns up can't understand what all the fuss was about. They were on a "Green Bus", the ambulances crewed by people who have been trained to deal with low priority calls, such as GP referrals, minor injuries, and things like simple back aches. As they are not paramedics, and I have given drugs that they're not licensed to, I'll have to go with them to the hospital.

We get the looks and the tuts that I expected, but by this point I didn't care. I knew what had really happened, and I was safe in the knowledge that I did what was best for my patient. More to the point, my patient knew it, and was grateful too.

So when is a Green call not a Green call? When it's a genuine call.

Happy Blogaversary!

1 year.
52 weeks.
365 days.
Lots of ramblings.
180 posts later, and I have reached the 1st anniversary of the Insomniac's Guide.
It started as a bit of an experiment, that no-one else would ever read.
Now it's a total addiction with its own withdrawal symptoms if I don't blog for more than two days at a time.
Those of you who follow my writings - be you one of the first or one of the most recent - thank you.
Thank you for sharing the undulations of emotion.
Thank you for your encouragement and your comments.
Thank you for reading the scribblings of a lunatic, whose thoughts should probably have remained his own.
Thank you for enabling this insomniac to try and improve his own little world - and hopefully, even just a little, improve yours too.
Here's to next year!

Sexist Pig

The house is one I can only dream of. More than a house, it's a home, warm and welcoming. Large enough to have an entrance hall bigger than my lounge, reception rooms galore, all before you go upstairs and see the multiple bedrooms, separate bathrooms, and a study. Everything neat and tidy, a multitude of toys, books and other items all in their exact place.

I'm allowed briefly upstairs before the patient decides she'd rather entertain the guests in one of the rooms downstairs.

Even though it's more like bedtime for the kids than the adults, she's wrapped in a dressing gown. The sad look is more than just on her face, it seems to be her entire being. She doesn't look at all unwell. Just sad.

"What's the problem this evening?" I thought I'd start with the easy questions first.

"I feel weak."

"And how long have you been feeling this way?"

"About an hour."

Not quite the life-threatening call we'd been initially called to, something along the lines of trouble breathing, possibly a stroke. I don't remember exactly what the call was given as, all I know was that I was given a crucially life-saving eight-minute time limit to get there.

We discussed exactly what she was feeling, how she was tired this evening and that she had no energy and just wanted to sleep. No priority symptoms of any sort, no evident medical problem, just the end of a long day.

I was forced to ask, as gently as possible, what it was that made her think that she needed an ambulance.

"She didn't call you", interjected the husband. "I did."

"And, sir, for what reason did you think she needed to be seen by an emergency ambulance crew or taken to hospital?"

"Well, normally when I come home from work, the children are ready for bed, the house is tidy and clean, and dinner is on the table. Tonight DINNER WASN'T READY!"

He really emphasised the last bit. Shouted it even.

She just rolled her eyes in desperation and invited us kindly to leave, our presence clearly unnecessary.

I left the house with a caveman vision imprinted on my brain.

"I am man. Hear me shout. See me beat my chest!"

21st century man.

Except

Came in to find that all the shifts are changing, and not for the better. Would love to stay doing what I'm doing after they change.

Except I can't. So onwards and upwards.

*

Well, at least the vehicle works. It stinks of cigarettes, but at least it works.

Except it doesn't - not to the extent I need it to.

*

It starts OK, but the flashing lights and computer screens on it don't. But at least I can get it to the people who can supposedly fix it.

Except they can't.

*

So I then spend the next five hours being told to drive from pillar to post to find a working car. Apparently you have the supposedly "bigger picture".

Except you don't. You have a severe case of LeftHandRightHandItis.

*

After driving from pillar number 4 to post number 5, you then phone me up, tell me off for not being back at point number 1, and that I'm shirking my duties.

Except I'm not. I'm doing anything but.

*

So I arrive at work almost an hour early, try to solve the problems, follow your instructions to the letter, and still get told off.

Except that you don't do it yourself - you send someone else to tell me off. Cowards.

*

Finally, despite risking being sectioned and put away for temporary insanity by screaming out loud, I have a working vehicle. I can do my job.

And just as an aside, I'm sure you felt good about getting the vehicle on the road. I'm sure you felt good about bullying one of your loyal members of staff. I'm sure you felt good that all the numbers tallied up.

Except that, despite your best efforts, I win.

*

How many of you up there went home knowing that they'd come to work and helped a mum deliver her baby? No hands up?

Oh well.

I know that I did.

Choices

It would be exceptionally helpful to all, especially grouchy children, sleep-deprived parents, and night working ambulance staff, if certain family doctors explained the following:

ANTIBIOTICS ARE NOT A MIRACLE CURE!

You still need paracetamol to bring down your fever. That alone will make you feel a little better.

But you won't be totally fixed after just one dose of antibiotics. Definitely not.

Neither will your child who you are now dragging out the house at 2am to see a nice doctor who will tell you exactly the same thing as the nice ambulance man.

It takes time.

In fact, in most cases, it'll clear after 7 days with antibiotics, or after a week without.

Your choice.

If you'd like to spend several hours of that week wasting your time in an A&E department, especially at stupid o'clock, after the medicine hasn't worked its magic, well that's your choice too.

Personally, I wouldn't bother.