You Know You're in EMS When...

So this is the tweet I posted that started it all off: You know you're in EMS when you sit eating breakfast whilst watching amputations and impalements on TV.

After that, I thought it'd be good to hear what some other people think too, and the snowball started it's journey. These are the others that were posted. Read all the way to the end if you want to see my absolute favourite. Actually, there were two that I couldn't choose between. Having said that, I can identify with almost every single one of these!

Enjoy, and feel free to add some more in the comments...

You know you're in EMS when...

... you call a bunch of friends to meet up only to realise that they're all working because it's a weekday. Ah shift work. @flobach

... you're more unconscious than your "unconscious" patient at 3am. @goforfink

... a great sense of humour and no sense of smell are essential. @thesmurse

... you have extra gloves in your car, house, everywhere. @texaschef

... you consider asking your partner to start a line on you after a night at the bar. @texaschef

... you decide which hospital to transport minor calls to based on the food choice in the EMS room. @texaschef

... you somehow you manage to treat the patient with toe pain with the same respect as the patient with the genuine emergency. @justmyblog

... you've had to wait for hours in the emergency department for hours, without being a patient. @goforfink

... bed is a missed friend. @seanhfitz

... you've responded to back pain that's getting better, but they still call at 3am. @texaschef

... you have no shame taking the ambulance through a drive-through, and expect a discount! @justmyblog

... 2 hours sleep is considered a full night. @texaschef

... your crew mate takes the bumpy route when you're in the back. @ambulance_999

... you watch "Trauma" and wonder when your service is going to get stretchers like that. *drool* @goforfink

... you drive up to a width restriction and think "will I fit?" @MadMedic1

... you identify random places around town by the call you attended there. @seanhfitz

... you don't remember working a cardiac arrest at the end of your shift because you were asleep. @seanhfitz

... townspeople and ER nurses only recognize you when you're in uniform. @justmyblog

... you drive by an MVA (RTC) and not look at it, because you've seen worse. @texaschef

... you can eat, use the restroom and sleep, all in 20 minutes. @texaschef

... Friday and Saturday become the worst nights of the week. @goforfink

... you can work a 17 hour shift, running all night, and still find the power to go to the pub. @grindermedic

... you look at a person in the street and think "5 loops and call it!" @MadMedic1

... you can live off two hours sleep per night - as long as you have coffee. @justmyblog

... when you get ideas for your lunch from your patient's vomiting. @seanhfitz

... you tell patients "the gloves are for your protection". @ambulance_999

... you drive a Mercedes all day, then get in your car and try to indicate with the windscreen wipers. @goforfink

... you become a dustbin for everyone's poo. @christopher_mcg

... you've mastered the art of getting dressed whilst still dripping from the shower and still looking somewhat ok. @justmyblog

... you drive home after a night shift and realise you've treated the last three red lights as give-way signs. @999donkey

... you're looking for a friend's house at night and reach for the centre console to turn on the floods. @flobach

... when you use all your sympathy at work, and leave none for your family. @mrsinsomniacmed *ahem*

... when the flight attendant asks if any medical people are on board and you try to become invisible. @seanhfitz

... for you to have a good, challenging day at work, someone has to have a really bad one. @ColdGh0stR1der

... when your house is always an organised mess, and your rig looks like something out of Martha Stewart Home. @justmyblog

... you can judge exactly 350 yards, with or without the satnav. @MrTom_Abbott

... you can smell what's wrong with your patient before you can see them. @ambulance_999

... you eat every meal like it's your last, because you know the alerter will go off any second. @ambulance_999

... hot girls walk past you and you notice they have a curvaceous body, slender arms, and beautiful... veins. @flobach

... you utter the phrase "that's not that much vomit!". @510medic

... you turn off the radio to hear the sirens. @EMTDani

... you never have a wardrobe malfunction at work. @flobach

... you can pick the type of vehicle responding by hearing a far away and faint wail of the siren. @flobach.

... even at home, when the phone rings, without thinking you answer it "Ambulance". @multistar

...you know the streets of your patch like the inside of your pocket, but are hopeless outside. @flobach

... you walk into the messroom at 1900, and bid everyone "Good Morning". @insomniacmedic1

... you're off duty and hear sirens, and for a second think they're your sirens. @texaschef

... you go to grab a pen from your breast pocket... but you're off duty and in a T-shirt. @flobach

... you see a trauma in a movie, and immediately run through your assessment. @texaschef

... your wardrobe has a disproportionate amount of green in it. @saintpara

... you refer to you mirrors as whiskers for judging gaps in traffic. @idle_paramedic

... your life is ruled by three-letter abbreviations and complex terminology. @christopher_mcg

... you categorise people by what you think they'll die from. @saintpara

... you can't watch a medical drama without screaming at the TV every time some actor does something wrong. @multistar

... you've answered your personal mobile phone with your callsign. @thesmurse

... you have to stop yourself waving at ambulances / police cars when not at work. @saintpara

... you're constantly tired, over-worked, and under-paid. @multistar

... you're a passenger in any car and out of habit you say "clear left". @thesmurse

... you look on YouTube for car crash vids, and wonder how you'd extricate them. @yellowspanner

... you discuss decapitated bodies at the dinner table. @UKmedic999

 And my two favourites? These two laugh out loud moments of pure genius:

... you have too much blood in your caffeine stream. @theroaddoctor

and

... when anything over 8 minutes is just too long. @saintpara

For Sale

For Sale: 

Brand new car.

100 miles on the clock.

Good for spare parts and scrap metal,

also some empty beer cans.

One previous owner.

Now deceased.

Street Escalator

A misunderstanding that led to an argument.

An argument that develops into a fight.

A fight escalates into acts of revenge.

Revenge takes form as a bullet.

The bullet takes a life.

A life, so young.

A waste.

At the top of the escalator, flat on the floor, lies the misunderstanding.

Light Bulb

"You have a scratch on your cheek."

"The dog did it."

"Where's the dog?"

"It's in the back room."

"Can we see it?"

Door opens, and rat-sized dog appears.

"That's it?"

"Yup. That's it."

"And you called an ambulance for...?"

"Well, it scratched my face and I was bleeding."

"You had a scratch on your face and you called an ambulance?"

Friends and family all laugh.

"Ever cut yourself shaving?"

"Yup."

"I see. Ever call an ambulance for it?"

"Nope."

A look of understanding registers on his face. You can imagine how the rest of the conversation went.

It's like a light bulb suddenly came on in a dark, dark room.

Six Hundred Patients

There are regular callers.

There are frequent callers.

There are nuisance callers.

There are abusive callers.

Recently I took in one of our locals who is all of the above.

It was a milestone A&E visit for this year.

All by ambulance.

It was their 600th visit.

That's six hundred patients who had to wait.

Loco Parentis

The door is opened by a middle aged woman, cigarette hanging off her lips, her attitude delighting us almost as much as the smoke in our faces.

"You take this bag, and I'll bring her out in a minute!" She dumps a pink hold-all in my surprised arms, and shuts the door almost completely, leaving us in the pouring rain. The inch of artificial light shining between the door and the frame means the gap is just wide enough for us to hear our patient and her cries of pain. Our requests to be allowed in to at least see and start to assess the patient are met with defiance.

"You stay out there. I don't want your muddy boots in my house. I told you she'll be down in a minute."

The tirade changes direction and is re-aimed at the patient.

"Come on already. They're here. And you make sure that you don't have any of that gas stuff they're gonna offer you. You don't need it!"

A minute or so later, Mina appears. 18-years-old and a week overdue with her first baby, she looks just about ready to pop. She has a look about her that's a mix of excitement and anticipation, as well as fear of the unknown.

We invite Mina into the back of the ambulance, and ask her whether she'd be more comfortable sitting on the chair or lying on the trolley. She chooses the chair, and as she sits down, another contraction begins. I write the exact time down on my glove, ready to time the frequency and length of each contraction.

Her pregnancy notes suggest that all has been well for the duration, that the health of mother and baby is satisfactory, and even, from just the day before, that the baby was head down and ready to be born. Her vital signs are normal, and contractions now two minutes apart. She seems to be at the stage of labour that makes most ambulance staff nervous about a BBA, a baby Born Before Arrival at hospital, and start to think about the mess they're going to have to clean up.

I offer Mina some entonox, the magic pain relieving gas. She takes the equipment in her hand, only for her mother to snatch it away.

"I told you, you don't need that rubbish. I never had any when you were born, and you're certainly not going to have any with your baby either!"

Mina looks downtrodden.

"I'm sorry", I say to her mother, "but you're not the patient in this case. If Mina decides she wants the gas, then she is more than welcome to use it".

"You. Are not. Her mother", she spits through gritted teeth, "And you're not going to make the decisions. She's MY daughter, MY responsibility, and it's MY decision!"

"You're absolutely right, it's not my decision. But it's not yours either. It's Mina's. She's old enough to make her own decisions. If she wants to use the entonox she uses it. I understand you're almost as anxious as she is, but right now you're not the patient. Mina, would you like the gas?"

She's terrified, struggling with the conflict between the pain she's in and her mother's overbearing presence. She nods an almost imperceptible "yes", and I hand her the entonox once again, just as another contraction starts.

"Well, if she keeps using the gas, then I'm not going with her to the hospital!"

Shocked looks are exchanged between Mina, her mother, and the crew.

"That's your choice! You decide! Yes gas, no mother!"

Another contraction starts, and I tell them both that we're leaving, as this baby wants to make an entrance, sooner rather than later. Mina screams with the contraction, takes another few lungs-full of entonox, and her mother storms out the back door and back into the house.

"You do it on your own then!" she screams, as she slams the door behind her.

Mina's resolute, and tells us to go, as her partner should be at the hospital within the hour anyway.

The transport is relatively uneventful, other than the contractions strengthening and becoming more frequent, causing us to move Mina onto the trolley. Just in case. We arrive at hospital, and Mina moves across onto the delivery suite's bed. As she does so, her waters break, and a baby's head appears.

"Stay with me", she begs the two of us. We do.

A minute later, her baby boy is born, and in loco parentis we witness her joy.

"Thank you, both of you. And don't worry about my mother. She'll be up here apologising soon enough. Stubborn cow that she is."

We congratulate Mina, refuse to have our photo taken with her and the baby, and head back to the ambulance to pack away the trolley.

As we sit back in the front completing the call, a car races into the car park, its driver rushes straight past us and into the department, begging to be allowed to see her daughter.

Head for Heights

The message comes down the MDT from the police. "Please approach with caution - no lights or sirens. Patient threatening to jump".

Out of area as usual, we don't really know the names of the buildings, but this one has its name on a sign that can, for a change, be seen from a couple of blocks away. As requested, we make a silent approach, as much as is possible in an almost 5-ton truck with a large diesel engine, and await further instructions from the police officers on scene.

In front of us, still about 100 metres away, looms a large apartment block, and I count at least 12 storeys. If she jumps from there, our presence will be superfluous. In contrast to our orders, the police seem to be turning up in force, blue lights bouncing off the surrounding buildings, giving the street a look of a club on a Saturday night, the staccato lighting beating in time to the music. The street is cordoned off at both ends preventing traffic from approaching, and any pedestrians, though very few at this time of the day, are shepherded away from the scene on a long detour. A chorus of complaints comes from one group of bystanders who want to see the action, as they are firmly removed and asked not to return. A police Inspector approaches us, his two-pipped shoulders confirming his command, and explains the situation.

"At the moment, we're talking to her on the phone. She says she's in flat 55, and threatening to jump from the balcony. It sounds like she's had a lot to drink too, so anything could happen. There are, we believe, six flats on each floor, so she's probably on the 10th. We're just trying to see exactly where she is and what she's doing, and then we'll decide what we're going to do about it. You two just hang back and wait." He ends abruptly and walks off, retaking his position in control of the out-of-control situation.

Only once before have I been involved in something similar. Back then, when I was still only in my probationary year, we sat waiting for four hours. We drank tea, read books, snoozed and generally sat still as nothing continued to happen. At the end of it all, despite negotiations and attempts to get into the building, he jumped, and there was still nothing that we could do.

So once again, we sat. I don't tend to take a book with me to work any more - there's never really any time to read it - this time, my phone would have to suffice for entertainment. A police officer was sent over to us and informed us that she was our liaison. As soon as it was safe for us to approach, she'd get the message on her radio, and advise us to advance. We made ourselves comfortable for what could be a long stay.

The message arrived after less than fifteen minutes.

"Suspect detained indoors, advise ambulance safe to attend."

We drive the short distance to the block, and find that it's split into three separate entrances. Several more officers walk out of the middle of the three. Some are smiling, some are laughing, some just walk by silently. We take out our equipment, and advance on the entrance.

"I hope there's a lift. Don't fancy a walk up 10 flights of stairs."

"Wouldn't worry about that", chimes in an officer, a mischievous grin on his face. "The lift's working, tells you which floor you need just outside the door".

We look at the sign stuck on the wall by the lift. Graffiti is sprayed and scrawled all over it, some of it legible and unrepeatable, some of it just looks like streaks of dirt. Through it all, a list of floors and it's corresponding flat numbers is just about distinguishable. All the while, officers are streaming down the stairs next to us. You've had a long walk down.

Eventually, we actually pay attention to the sign.

Ground floor - Entrance

First floor - 53 - 56

Second floor - 57 - 60

Third floor - 61 - 64...

And so it goes on. Up to the twelfth floor, and flat number 96, four flats per floor, not six.

"What number did we want?" I ask my partner.

"55".

"Are you telling me that all this was for someone who was going to jump from the first floor?"

"Apparently so..."

We don't bother with the lift, and walk the dozen or so steps up onto the first floor and into flat number 55. The room is littered with empty bottles of vodka and ashtrays filled to the brim. The patient looks up at us and before we even get the chance to say a word, starts yelling.

"I would have jumped you know! If it wasn't for these coppers I'd have done it! There wouldn't be nothing left of me except bits of brains on the floor, and it'd all be your fault!" She points randomly at one particular officer, who'd only just entered the room, and was forced to respond as the patient was being clasped in handcuffs.

"You might, if you were really unlucky, have broken your leg. There'd be no brains anywhere!" "Especially in your head", he adds, just loud enough for us to hear.

"Well I'd have jumped from the top floor", she bites back, "but I might've hurt myself. And anyway", she rasps, years of smoke having damaged her vocal cords, "I've got no head for heights".

Ambulance Matters

The UK's first ever ambulance based podcast, Ambulance Matters, has posted it's first episode.

It was started, and is hosted by none other than Mark of 999medic fame, who realised that after several similar ideas are up-and-running in the US of A, it was high time that we had one based here.

This first episode has a raft of guests from across the globe, and they discuss a blog posted by yours truly about the changes coming to the ambulance service, at least in London.

I'm honoured that something I've written is the first port of call for another leap in the world of social media in the UK ambulance service.

It's just a shame that my shifts prevented me from joining in.

You, however, now have no excuse. So go, listen, and join in the discussion, at least in the comments section!

I tried, didn't I?

A normal residential road, cars parked either side, and a 20 miles per hour speed limit enforced by signs and re-enforced by speed bumps.

I look right and left, see nothing, but hear the screaming engine and decide to wait. The two delicately balanced trays, full of sandwiches, aren't worth risking for the few extra seconds I decide to wait as the car appears round a corner, probably doubling the speed allowed on this road.

No more than ten paces to my right is one of the speed bumps, and the engine is slowed through the gears so that the lowered suspension has every chance of making it over without the raised hump of traffic-calming tarmac causing any damage to the precious undercarriage.

In those seconds, they see me, and the sandwiches.

And as they arrive beside me, they stop.

"Any of those for us?" asks the passenger, a giggly, over made-up and unrestrained girl of probably 18.

"Only if you and your friend buckle up and promise not to drive around like idiots", I reply.

They look at each other, and laugh.

"Nah", says the passenger, "we're not really that hungry!"

Their raucous laughter is soon drowned out by their tyres, as they screech their way down the road.

Laughing Gas

As the nights draw in, the hours of darkness rise as the temperatures fall, and I find myself longing back to the long, warm, days of summer.

*****

A Sunday evening, towards the end of the school holidays, and the kids are making the best of the last of the late sunlight. The park is full of children, some accompanied, some not, and the sounds of the joys of the summer break fill the air. The park is a large expanse of green with a large play area in the middle, a few trees surround it giving sporadic shade, used mainly by the parents enjoying the respite whilst their children soaked up the freedom.

The sound of playing children is shattered by a scream.

A mother runs to her child.

An ambulance is called.

*****

We're greeted at the park gate by an anxious looking man wildly waving his arms. The air conditioning has failed, so the windows are wound down, and as we draw nearer, the sound of a distressed child can be clearly heard. Even from 200 metres away.

"He came down the slide Superman style", he starts, even before we've opened the doors.

"And then he just screamed. Now he can't move his arms." Suddenly the realisation dawns on him that if he wants us to treat the child, he needs to move away and let us get out.

The scream sounds even louder now we're out of the ambulance.

"Well, at least his airway's OK", says my crew mate, pointing out the obvious.

We grab our equipment and start to make our way to the playground.

Harrison sits on his mother's lap, sobbing and screaming intermittently, his pain seeming to make him shrink in his mother's arms to half the size of his nine years.

The description of the event leads us to check his neck first, then his arms, where we find no injury and no pain.

We hand Harrison the entonox and explain how it works. "This is a special gas to help with the pain. It might make you feel dizzy, and it might even make you laugh. That's why they call it laughing gas!"

I try to hand it to him, but he won't move either arm to reach for it, so we ask mum to hold the nozzle for him. After a few short moments, the anxious, pained look on his face eases a little, and he's able to speak for the first time and tell me where it hurts. I feel one collar-bone, and then the other, and find them both to be probably broken. No wonder then that Harrison won't move his arms.

Superman style, head first down the long slide, his arms out in front clearly meeting their Kryptonite in the form of the solid ground.

Harrison starts on the gas, and after about ten minutes, he's calm and relaxed enough to let us put one arm in a sling, as his mum cradles the other one. I check the gauge on the entonox to see that it has just about moved out of the green zone and into the long, colourless middle area. There's a long way to go before he reaches the nearly empty red section, and I doubt he'll ever get anywhere near it. I've never seen anyone other than a labouring woman come anywhere near to using a full cylinder of entonox.

Slowly and very gently we move him to the ambulance, the hiss of the cylinder punctuated by frequent yelps of pain as one or other arm moves even the smallest amount. Thinking about giving him something stronger for the pain, I ask Harrison's mother about any medical conditions he may have, and medications he takes, and any allergies.

"Yeah. He's allergic to morphine! We found that out two years ago when he fell of a trampoline and broke his leg."

Entonox it is then. The only needle for this kid is going to be the one on the cylinder gauge.

A few minutes into the journey, as Harrison drinks the elixir of pain-relief through an overgrown straw, he suddenly giggles.

"You OK, Harrison?"

"Of course I am!"

"Is the gas helping you then?"

He giggles again, on the verge of laughter, but too scared in case it hurts. "It's much better thank you. Can I go home now?"

Mother and medics laugh instead. "Not right now. You need to go to hospital to see what they're going to do to fix you."

"OK", he says, closes his eyes, and goes back to concentrating on the gas. I fill in the paperwork, explain to Harrison's mum what I think has happened and what will possibly happen after we leave them at hospital, and her husband follows behind in the car, refusing to let us out of his sight.

Harrison is relaxed, pain still evident as we hit the unavoidable pot-hole or two, but he seems a lot more care free about it. The cylinder hits the red zone just as we're pulling into the hospital. It'll leave us just enough to get him into the department.

"This may hurt a little as we get you off the ambulance, but we'll be as gentle we can, OK?"

"OK! Let's go!"

We unhook the trolley from its securing clasp on the floor, and get ready to move.

"Happy, Harrison?"

"Very happy", he says. "Can I ask you a question?"

"Sure!"

"Do you know what to do when you're happy?"

"Errr, clap your hands? But I don't think that'll be a good idea for you right now!"

"I know that", he answers back, with a voice that's a kid's way of saying I'm not stupid, y'know!

And so, drunk on a whole bottle of entonox, he sings his way off the ambulance and into the children's department.

"If you're happy and you know it, clap your feet!"

Laughing gas indeed, except it worked on everyone.

The Mask

Patients;

Managers;

Ego;

Publicity;

Public education;

Anonymity;

Pride.

Go balance that lot!

I sent out a challenge, and dozens answered it, in comments on the blog, on Facebook, on twitter, in person. I have received suggestions, thoughts, ideas, humbling compliments, and on the whole, a strong recommendation not to reveal the face hidden behind the Insomniac's mask.

The main reason, although not the only one - an anti-management stance of mistrust. That in itself, is a sad reflection of the way social media is still perceived as foe rather than friend by the establishment. There is, of course, the potential to bite the hand that feeds you by blogging, but that was never one of the reasons for writing this blog. I'd like to take on the challenge of changing their view, but I'm not sure I'm up to that task.

Patients and their right to anonymity and confidentiality are clearly king. They are the reason we do what we do, they are the people who allow total strangers into their homes, their lives, and their vulnerabilities, with the promise that we don't then divulge their most intimate details to the world. To this end, as you all know by now, I change everything. Locations, ages, genders. I combine different calls to make one story, or divide one event into several different, unrelated posts. The tales I tell are effectively that - tales. Fiction based on real-life events. No patient has had their identity compromised.

And then there's the challenge of public education. Ideas such as the Chronicles of EMS, groups of visionary paramedics looking to advance their profession via open social networking and public media, could never work if we all hid behind masks. I'd love to get more involved, but at the moment, as an anonymous blogger, that's impossible. I could get involved in podcasts, as my face is probably more suited to radio anyway, but the options for exposing this to the public are limited, and therefore flawed as a plan for mass education.

Personally, my anonymity used to mean everything to me. It's still important to a certain degree, but every time someone guesses or knows outright that I'm the author of this blog, the pride I feel when they tell me they enjoy reading it, outweighs the shadows of anonymity that I crave. There's a voice that says I should be proud of what I have achieved, and that I should have no reason to hide, but then there's the other voice.

The voice that continuously asks "What if?".

What if there were repercussions from management? (Maybe one of them is reading this, and will have the courage or foresight to contact me? The email address is in the profile...).

What if I slipped up and did reveal a patient's identity?

What if I had to give the blog up all together?

For now, and I stress for now because this whole decision is finely balanced and on the brink of collapse, I'm staying hidden. It might well be the worst kept secret in the Ambulance Service, but for now, it stays a secret.

One day, hopefully, common sense, mutual trust, and pure, unadulterated ego will prevail.

When that happens, I'll lose the mask.

Identity

A simple question has led to some soul-searching. Again. The question?

"You're the guy that writes InsomniacMedic, right?"

This from a new paramedic student who I've only just met.

It would seem that this anonymous blog isn't quite as anonymous as I'd thought.

Many of my colleagues know who I am. Several other bloggers too.

But I've never officially linked me and my blog.

Now to rethink making it official.

My only fear - the same as any EMS bloggers out there.

The Management.

I try to portray my profession through positive eyes - some might even call it rose-tinted glasses, so no worries there.

I don't tend to criticise the establishment or anyone in particular. So no worries there.

And I adhere strictly to a self-imposed policy of protecting patients' confidentiality. No worries there either.

And still, there is an institutionalised fear of social media in the upper echelons, so admitting my identity in public is still a risky move.

Once again - I ask for your opinion.

Yes, or no?

Should the InsomniacMedic reveal his true identity?

Fog

I remember the fog as a kid, driving in fog so thick, that we had to pull over and wait for it to clear.

I remember the fog on a school trip, walking in fog so thick, that we had to stop and turn back.

I remember the fog whilst on a recce, lying in fog so thick, not hearing the bullet that left the hole in my collar.

I remember the fog round the ambulance, and being warned of thicker fog lying ahead.

I remember the fog as we crawled through it, finally seeing the lights of those who'd arrived before us.

I remember the fog as we pulled up on scene, and were told there were four confirmed dead.

I remember the fog as we stepped out into it, seeing the dazed driver of the bus as he sat with his head in his hands.

I remember the fog as we treated his passengers, how he swore that next time he'd slow down.

He'll remember the fog and his speed.

He'll remember the fog and his passengers.

He'll remember the fog and the crash.

He'll remember the fog.

Outside the A & E

Accompanied by the police, our abusive, threatening and generally unpleasant patient was taken into the care of the hospital. The police wouldn't have her in the cells until she'd been medically cleared.

Outside the A&E department, we can hear her screams and profanities, aimed at anyone who would care to listen.

Mostly no-one.

A police van pulls up, and I ask if they're here for our patient.

"Nope", shrugs the sergeant. "She can die in there for all I care. In fact, if it helps, I'll give her the rope to help her on her way".

I know this sergeant, know him well. He was one of the first officers I met on a call when I started, and he'd been a sarge for years before that. I've never once seen him lose his cool like that.

"What's up?" I ask, concerned for his state of mind, rather than wondering who he was here to pick up.

"While she's sitting there screaming her head off, I've got to go and pick up the piece of dirt who tried to kill a 5-year-old, his own kid, by smashing a glass bottle over his head." He paused just long enough to regain his composure.

"I've just seen the kid." His eyes glaze over again.

I don't know what to answer, and struggle to avoid his teary eyes.

We stay outside the A&E department long enough to finish a cup of coffee, and for the sergeant to put his professional head back on.

A few calls later was an inter-hospital transfer to a paediatric unit.

When I got to meet the kid too.

Brick Walls

A short observation:

Children's heads do not do well in collisions with brick walls.

Ask any of the kids I had to treat during my so-called days off...