After-Dinner Mint

A midsummer's night, a cool breeze shakes off the last of the day's stifling heat. The trees wave a silent farewell to the day, and usher in the perfect evening. The streets are still aglow in the last moments of the red sunset, and as darkness falls, they step into the restaurant for a quiet birthday dinner. It's still their favourite eatery, the place where they first met, he a waiter in his parents' business, putting his teenage years to good use and saving some money. She was the shy daughter of regular diners. When they married, they took over the business.

They had sold the restaurant several years ago, but it had retained its character under the new ownership, and as it still felt like home, they would always go back for special occasions, and were always treated as royalty each time they did. Her birthday was one of those special occasions.

They sat at their usual table, hidden away in a corner behind a screen. It had been their own private hideaway when they were teenagers, and it remained so well into their adult life. The service was, as always, excellent, the food was top grade, and, most importantly, the company was intimate and loving. They sat and talked about their lives, their jobs, their futures. Their kids, babysat at home by their grandparents, were central to their plans. They talked about school achievements, nursery drawings, friends coming to play, and how they were growing up so fast.

"We have everything we wanted, and everything to live for", he said.

"I know. But if I don't go to the bathroom now, I may explode, and that might ruin our plans!"

They laughed, and as she left the table after their dessert bowls were emptied, she picked up a striped mint sweet and popped it in her mouth.

Less than ten minutes later, there were four of us crowded into that bathroom, as well as her frantic, distraught husband and the restaurant manager looking lost and scared. She lay on the floor, her breathing stopped, her heart firing a useless, chaotic attempt at a rhythm, she was a vision of suspended animation.

Equipment flew in all directions, instructions given, actions undertaken. We would breathe for her, we'd pump her heart for her, forcing the oxygen and the blood to fulfil their duty against their will. The air from the mask was going nowhere. Her lungs wouldn't move, declining the offer of the oxygen that was being forced into them. Something must be sitting in the way and fighting our actions. After another round trying to beat and shock the heart into action, someone took another look at the airway.

It wasn't there the first time we looked, I could swear to it, but now it sat staring innocently back at us, just out of reach. It was the round mint, all along, that had lodged itself in the airway, trying to complete her circle of life, and kill her on her birthday. Five seconds later, a pair of forceps flew across the bathroom and were used to fish the mint out of her throat. We breathed a few more breaths for her, whilst all the while her heart was being operated remotely, from the outside-in.

In the ambulance, it finally happened.

She took a breath.

We all stopped to watch her, to check the monitors, to make sure that our imagination wasn't playing tricks on us.

There were no tricks. She was pulling through.

By the time we reached the hospital, there was nothing left for us to do but hope and pray.

As the adrenaline wore off and the ambulance was being returned to its normal state, I had a weird thought.

Crazily, I wondered what had happened to the mint.

Hilltop Hospital and CoEMS

Look out for the line starting at about 0:55 seconds. Kinda says it all. This is what Chronicles of EMS is all about! This is sort of the thing I was aiming for with the last post, but more EMS based. That comment said it all. There's a lot of work to be done to change the image of the ambulance service in the public's eyes, and to change the image of social media in the eyes of the management and the system as a whole. Some great people have started doing it. If you haven't seen their website, now is a good time to start getting involved.

Stay safe this weekend!

Kids' TV

Postman Pat.

Bob the Builder.

Fireman Sam.

Handy Manny.

PC Plod in Noddy.

Need I list any more? All these children's programmes have as either their central or sideline characters someone with a fun job, one that the creators of the shows want to show in a positive light.

You know what, there are even the mundane jobs - Peppa Pig's dad is an office worker!

The truth is, I can't think of any kids' TV character as a doctor, but how would you portray God on kids TV?

(Keep yer hair on, it's a joke...)

So where, I ask you, is the kids' show about ambulances? Where is Peter Paramedic? The only ambulance that I can think of in a kids' show is in Fireman Sam, and that's driven and, ahem, manned, by Nurse Flood!

I vote to start another TV revolution!

All those in favour say AYE!

And whilst you're voting, send me suggestions for what we'd call it...

The Newbie

Those who can, do. And those who can't? Teach. Apparently.

I tried teaching once. Lasted all of a year and then gave up. Couldn't cope with the formality of educating in a school setting, probably because I was no good at it as a student.

Then I found a career I loved, studied hard for it, passed all the exams with flying colours, and have loved almost every minute of it since then.

Now, Lizzie, a newbie, is asking for help and advice. For the Handover Carnival, she asks a simple question. "What would you teach me?"

There's no better way to learn in this job than from those with all the experience. I've written before how learning to be an EMT or paramedic is a little like learning to drive. You learn to pass a test, but the real learning only starts once you've passed it. The wealth of information that is available is all there for the taking, there are blogs, websites, journals, research facilities, memberships of associations, and so on. If, however, I'm asked for one piece of advice to give a new recruit, it would simply be the following:

Keep an open mind.

This could be by not pre-judging a patient before you've ever set eyes on them. Not every unconscious patient lying on the ground outside a pub is a simple drunk.

Remain open-minded enough to question other's actions, even if you think that as they've been paramedics or doctors or nurses for dozens of years, they must know it all. We're all human, and all fallible.

Not every bruised or broken-limbed child has been abused. In fact most aren't. But keep your mind alert for the possibility.

The same goes for the elderly and vulnerable.

And keep your mind open for continued education. Every scenario you meet is a learning opportunity. Every patient you meet has something you could learn from.

Every new disease or medication you come across shouldn't just become another one of those long words on a list of things you don't understand. They should become part of your dictionary.

Every person you work with, has something to teach you. Many will be positive role-models. Some will show you exactly the type of medic you don't want to be. Be prepared to learn both.

Not every family model you come across will meet your expectations. Some may even break your heart.

Be prepared to be shocked and saddened, thrilled and delighted, broken and yet filled with hope, all in the space of one set of shifts.

Most of all, be open minded enough to know that you can't know everything. No-one can, and those who claim they do, usually know the least of all.

And be prepared to ask for help.

Oldies or newbies, sometimes we all need it.

Good luck!

Jealousy

Red 2, the second highest priority for a call coming in to the ambulance service. In the main determinant - the old favourite - Difficulty in Breathing. In the extra information the screen tells of a 40-year-old with a history of asthma. We race to the scene, find the front door open, and call in to find where the patient is hiding. We take in the oxygen bag, defibrillator, and all manner of equipment to deal with this life-threatening emergency.

A voice calls from the front room, and we follow the noise. The room is one of several in a large house, clearly now divided into several micro-apartments. A shared bathroom and filthy kitchen the only rooms with no external locks on the doors. The patient is sitting comfortably on the bed in the tiny room that is a bedroom, living area and laundry room all rolled into one.

Recently I've been charged with mentoring a student paramedic, (a brave decision by the powers that be...) and for most of this mentorship, he's in charge of the patients.

"Good morning. My name's Sash, what's your name?" Confidence is one of his strong points.

"Adam". A man of few words, obviously.

Adam seems to be having no difficulty in breathing at all, so Sash is a little confused.

"What seems to be the problem this morning?" Morning at this point is just after 5am, after another very long and busy night.

"I can't sleep." The words resonate well with your local friendly insomniac, yet at the same time grate a little.

"How long have you not slept for?"

"Since I woke up yesterday morning."

Whilst Sash is questioning, I'm checking his basic observations. A matter of course, and of course it matters. I think.

"So it's just been tonight that you've not been able to sleep?"

"That's right." I look up, just to make sure I heard correctly.

"Has this ever happened before?" Sash's perseverance is starting to show signs of frustration.

"No."

"So why have you called the ambulance? What would you like us to do?"

"Just take me to hospital. Maybe a doctor can tell me why I can't sleep."

Home remedies were suggested, a visit to the GP was suggested, an attempt to go to back to bed with a cup of cocoa was suggested. And all were rejected out of hand.

"I just want to go to the hospital. You're not doctors. I want to see a doctor."

At a loss for options, Adam was invited into the ambulance, took his seat, and we set off for hospital. We still can't refuse to take people to hospital if they're adamant they want to go.

I stay in the back of the ambulance to keep an eye on Sash and his ambulance aid, whilst our driver for the shift takes her place in the pilot's seat. We all know that there's not much to be said or done, yet I'm keen to see how Sash deals with a call that really shouldn't be.

The hospital is about a fifteen minute journey away. Sash starts to fill in the paperwork, name, address, baseline observations. Adam's not in any mood to talk, Sash has nothing to say, and I sit observing from the sideline.

About two minutes into the journey, I cough quietly. Sash looks up from his scribblings, and I mouth a 'Well done' to him. Confused, he asks me what for. I nod in Adam's direction and congratulate Sash on fixing the patient.

I can only stare at the patient as a strong feeling of jealousy starts to creep over me.

Adam's sitting there, held in place by his seat belt, quietly snoring and sleeping like a baby.

Shut. Up. Den!

They married the day after he was de-mobbed, seven years to the day after they had become engaged. The day of their engagement was tinged with sadness, as on one hand she placed the ring which betrothed them to each other, and yet with her other she waved him off, not knowing if or when they would finally exchange their vows. They didn't meet again for almost five years, whilst he spent that time at the request of His Majesty fighting in the war that followed the War to end all Wars. They marked their seventh anniversary with a new one, the start of sixty more.

"Sixty years we've been married", he tells us. "Not once has she listened to anything I have to say." His wicked grin was met with a sharp tongue.

"Shut up, Den!"

The pain had kept her up all night. The effects of the tablets she took wearing off before they'd even reached their peak effect. Eventually she could take the pain no more, and reluctantly agreed for the ambulance to be called. When we arrive, she's sitting in an armchair, trying for all the world not to show us that she's suffering. The colour of her face and the fine beads of perspiration on her forehead tell us more than we need to know.

"How long have you been in this much pain?" Seemed like a good place to start.

"Well", starts Den, "It's been getting worse all night. She didn't want me to call, but in the end I don't really think I had a choice!"

She glares at him. "Shut up Den! I can talk myself you know!"

"Oh, I know all right..." He mutters, just loud enough for us all to hear.

I try to hide the smile.

"It's not too bad now. It was much worse before. Keeps coming and going. I think I'll be fine if I just get some sleep."

"You've been like this all night, love, and I can tell it's not getting better. Why don't you let them help you?"

"Shut up Den!" she retorts. There's a clear theme developing.

"Lets have a proper look at you", I suggest, and reluctantly she agrees.

Her observations are mostly unremarkable, just an increased pulse suggesting once again that despite wanting to hide her ailment, the body will always give its secrets away. She can't help but admit it now. The pain is becoming just too much to cope with.

"How about we give you something for that pain then?"

"Good idea", ventures Den. "You could do with something stronger than those tablets!"

"Shut. Up. Den!" she growls at him, rests her head back on the trolley-bed and briefly closes her eyes.

"Maybe I could do with something. It is coming back a bit."

A few moments later, as the morphine courses its way through her veins and works its magic, the relief starts to show. Her whole body relaxes, the colour, so drained before, returns to her face, and the beads of sweat fade away.

"Feeling better?"

"Much better. Thank you."

"We're going to take you to hospital so they can find out a bit more about what's happened. Hopefully stop it from happening again."

"That's fine. Suppose I could do with a check up."

Den shakes his head, one part frustration to ten parts relief.

"One of these days, you'll realise that I do talk sense sometimes!"

"And one of these days", she shoots back, "you might just be right!"

Her voice softens, they smile at each other, and Den reaches across the ambulance to pat her on the hand.

"You know", he starts, "it IS my name on the front door! You would do well sometime to remember that!"

"Oh, do shut up Den!"

She rests her head back on the bed, and for the first couple of minutes of the journey there's a calm silence. I start the paperwork, and they look at each other, holding hands like they were still love-struck teenagers.

"You know what, Den? You're right. It is your name on the front door!" There's a sudden glint in her eye that wasn't there before.

"Just don't forget that the sign with your name on it is on the outside!"

Sleep

"Have you ever seen something at work that you wish you'd never seen, or that you'll never see again?"

"Sure there is."

"Was it a bad crash or something?"

"No, it wasn't. There are much worse things to see than that."

"Such as?"

"Well, if I never ever again see another neglected, abused child, it'll be too soon."

"So you've actually seen it? Bad child abuse I mean?"

"Yes. I've seen it."

"How did you cope?"

"I called the police, looked after the child, took them to hospital, and made sure they were cared for."

"And then what?"

"Then, I saw another dozen patients in the shift, and carried on as normal."

"And that's it?!"

"Nope. Come the morning I went home, hugged my kids, had some breakfast, and cried myself to sleep."

Purple

The streets are lined with market stalls, selling flags, scarves, team-branded items of all sorts. Blues to the right, Reds to the left. Home team advantage to the Blues, but it's a local derby, so feelings are running high, the tension in the air is palpable and threatens to erupt at any moment.

Thousands of fans on the streets walk, talk, shout and sing their way to the match. Some are sucked in by the stall-holders, but most have come prepared. The seasoned professionals in this game are the supporters, not the players. Years, even generations of loyal, unwavering support. The traditions remain strong, even when the reasons behind them can no longer be recalled. The sea of people converge on the ground, Reds from the left, Blues from the right, meeting to create a purple haze as they mingle at the gates.

It's a daunting sight, all the more so if you're trying to find one needle-like patient in a haystack of raucous colour. At least we know he's a Red. Eventually, thanks to the police, stewards and several drunken antics, he's found. Lying face down on a bench, his scarf loosely dangling from around his neck, the back of his shirt proudly displaying the coveted number 10.

Around us are more stalls, this time each plying their trade with an added bonus of advertising by aroma. Food and drink on sale at extortionate prices, yet being bought by hundreds of fans, each allowing themselves one more luxury to complete the day. All the while, there's an added smell in the mix, lavender-like, seemingly, almost impossibly, coming from the comatose patient.

Under the bench we see the can. Lavender air freshener. An officer picks it up and with one shake announces that it's empty. He hands us the can as he reads the warning printed boldly, menacingly on the back.

"Solvent abuse can kill instantly".

A Red fan amongst his own, away at the home of the Blues, gone in a self-inflicted haze of purple.

Eating Habits

The famous adage, "You learn something new every day", is especially true if you have kids, or spend any length of time with them. Kids have a way of saying things, seeing things, questioning things, that we as adults seem to lose. It's a kind of honesty and direct approach that where an adult would think twice about the ramifications of what they are about to say, children just want to know. Their inquisitive nature is their no-holds-barred method to a greater understanding of the world around them.

This week, one of my kids found out that in a previous life I used to be a soldier. It's not a fact I hide, neither is it something I'm ashamed of. It's just never come up in conversation. She found a photo of me in greens, carrying a semi-automatic, and looking every part the soldier. She looked, digested, dissected, and then came out with the question that I could clearly see was troubling her 6-year-old mind.

"Did you kill anyone?"

Woah.

I didn't see that one coming. I thought about it for a minute, and told her about people not joining the army to kill people. Soldiers are in the army to care for other people. To secure their land. To safeguard their way of life. Forget the politics. Six-year-olds don't care about it. If she did, she'd have asked about the legal ramifications for the Iraq War, the troops being in Afghanistan, and what the new coalition government plans to do about it all. Clearly not very likely.

She wanted to know about her dad, and I answered her intended question.

All my kids know what I do now. Obviously. They're proud to say that their dad's a paramedic, and if you were to ask any of them what my job description is, they'd each tell you, in their own inimitable style, that I save people's lives, or I go and help the sick and injured, or something along the same sorts of lines. Sometimes, if I come home looking particularly harassed, said 6-year-old will ask if I saved anybody at work, or how many people did I look after, but she has never yet asked me if anybody died. Her question about the army taught me a little about how the little people around us perceive the confusing world around them. To my six-year-old, the following is her view of the world:

Soldiers kill, Paramedics save.

As adults, on the other hand, we look at the world through completely different eyes. Our vision is blurred by stereotype, cynicism, media portrayal, politics, and a small dose of reality. After the "army question", I was left thinking about perception in general, and of the ambulance service in particular. I sent out a tweet to my followers asking a very simple question: "What is the first question/reaction you get as a paramedic/EMT when being introduced to someone new?" A simple question, but the answer to which is probably reduced to a bare half-dozen similar answers.

"Wow, that's interesting", or "How cool", or "You must see some horrible things".

Of course there are the silly ones, like "Do you drive on lights and sirens just to get back for a cup of coffee?" I'd love to say yes to that one, but no. Unfortunately not.

I find that there's one more. Often not the first question or reaction, but is asked on a very frequent basis.

"What's the worst thing you've ever seen?"

I refuse to answer that one honestly. The adult in me forbids it. Anyone asking that question doesn't really want to hear what the worst things are to see, and I know they don't. I know because once upon a time when I was much newer, I'd answer with the truth. Except that after the first three words they'd cover their ears and yell for me to stop. "Stop! No more! I can't understand how you do it!" Now my answer tends to be about the latest delivery I assisted with, and the mess all over the place. It's enough for most.

There's an element in all of us that wants to hear the gory story, to hear about the trauma. It's what makes any person driving past the scene of an accident drive slower in order to take a look, but drive much quicker if there's any risk of actually finding out. The childlike curiosity that is in all of us often makes way for the cynicism of an adult's view of the universe. We really want to know, but not at any cost.

Children have a thirst for knowledge that we as adults have quenched by reality.

Children are on a quest, a treasure-hunt searching for understanding, whilst we as adults we want to rest at the starting line, ignoring all the clues and helpful hints.

As adults we always have much to learn, but not always the hunger to do so. We'd do well to look at the children around us, and learn a little from their hunger. And from their eating habits.

That's what helps them grow.

Bus Stop

Fate sometimes has a strange way of playing with your mind.

After yesterday's post about rarely discovering the outcome of patients, and how it can be the most frustrating part of our job, I had a little closure on one patient.

The last time I saw her, many months ago, she was on a trolley in the resus room.

Unconscious, post resuscitation.

Given a 10% chance to survive the night.

This morning, on my way home, I drove past her address just in time to see her locking her front door, shopping bags slung over her shoulder, and walking to the bus stop just outside her house.

I'll take part of the blame for her shopping bill.

The Best

We all do it. We try desperately to avoid it, but in our line of work, it's an occupational hazard. And over the last couple of days, two of my fellow bloggers have, in one way or another, written about it.

JustMe in her blog reflects on what seemed a routine call that gives her no peace.

FishMedic in his blog reflects on all the What Ifs, where he'll never know.

Go read their blogs, and see how sometimes the knowledge that we'll never discover the outcome, is the toughest part of this job.

Ninety-nine times out of every hundred, we'll not know what happens to our patients once they've left our care.

Once in every hundred, or maybe thousand, or even more, that fact will bother us.

I don't think any of us can answer the questions that they're left with.

But we can all offer them a shoulder to lean on and our support, and leave our colleagues in no doubt that we all experience the same, we all have our own questions, we all sometimes have sleepless nights. Whether we are brand new to this job, or seasoned old-hands, sometimes we'll also need that shoulder.

Last night, I think I missed a trick too, on something we don't see very often. As soon as we'd delivered our patient to the A&E department, I kicked myself for not thinking about it, and hoped that the staff at the hospital would be a little quicker on the uptake than I was. I'll never know.

Questioning is good. Reflecting is good. We need it to ensure that our patients always get the best treatment, and that we are always striving to be the best we can.

Even if we don't always have the best answers.

Rude

An ambulance, parked in the middle of the road, sometimes obstructs the traffic. We apologise, but if there's nowhere else to park, there's nowhere else to park.

An ambulance, parked up, doors shut, but lights on, probably has some dedicated staff inside tending to a needy patient.

That dedicated staff, it may surprise you to know, is not only dedicated, but skilled.

And that patient, despite the indignity of being in an ambulance that may be obstructing the traffic, is still entitled to privacy.

On the outside of the ambulance, on each of the doors into the treatment area, there is a notice. "Please knock and wait. Patient treatment in progress". It's printed in large red letters.

When a doctor is seeing a patient, in their own surgery, the door is shut. For privacy reasons. People knock before they enter, and wait to be invited in.

So why, Doctor, did you feel it was your right to swing the doors of the ambulance open whilst we were treating the patient?

"I'm a doctor!", you sneered. No knock, and no wait. "Do you need my help?" you asked.

"I'm important!", is what we heard. "And can you please get out of my way?", you must have added.

"I don't remember inviting you in", was answered. "And you certainly didn't knock", was added.

We don't barge in on your patients when you're treating them. Don't you dare presume that you're allowed to do it to us.

Rudeness and oneupmanship will guarantee you one thing, doctor. And it most certainly isn't that we'll clear the road any quicker for you.

Noise

Opening the door of the ambulance, there's a noise.

An almost feral scream.

Entering the house, there's a noise.

An accusatory shout, querying the delay.

As the kit is prepared, there's a noise.

A low groan, panting, pushing.

As it's being born, there's a noise.

A parent's question, checking the baby's welfare.

Once the baby makes a full appearance, there's no noise.

No noise at all.

As it arrives, it's blue, lifeless. Silent.

We warm it, dry it, breathe for it.

After a few forced breaths, there's a noise.

The noise of a newborn's cry.

As the lungs open up and greet the world, there's a noise.

A loud, high-pitched, life-saving noise.

The most beautiful noise in the world.