The A to Z of 2011

Abuse on some staff, and Booze bus galore,

car crashes, drugs deaths of children and more.

Some eavesdropping stories and unhelpful friends,

girlfriends who cry when their boys make amends.

Hysterical children, invisible men.

Jokes on the nurses, knives out again.

Lives are saved and more memories learned,

Nero's a hero, a man's overheard.

Police under threat, questions ignored,

Riots in London and strikes 'cross the board.

Teddies tell stories that children can't share,

Uniforms and vests can't hide that we care.

Visions that haunt me, the writer's block time,

Arms that need X-rays, and yawning in rhyme.

And now as we near year's end, and this verse, 

I'm still lacking Zzz's, the Insomniac's curse. 

Responding

Lt Michael Morse writes one of the best EMS blogs out there - Rescuing Providence, and has the guts to put his real name to it! If you've never read it, you need to fix that now. Three years ago, he published his first book by the same name. 

Now there's a second book, called: Responding. 

I'll be honest, I've yet to read the book, but it's on order. If it's anything like his blog, it'll be well worth every penny. The fact that yours truly has a small mention on the acknowledgments page is nothing short of an honour and privilege. 

Welcome Home

A grand old house, maybe a century old, maybe even older, stands at the top of the long, dark road. Balloons and a Welcome Home sign hang over the front door, but once inside, more traditional decorations greet visitors walking into what looked from the outside like a stately manor, but inside was yet another nursing home. A tree in the corner, tinsel around the door handles and frames, cards strung from one side of the dining room to the other. The staff were all in a jovial mood, some wearing festive hats, many wearing badges and gimmicky trinkets on their uniforms. Even the dozen or so residents seemed to be enjoying themselves.

A carer meets us by the door and shows us to Mr Hella's room.

"He is unconscious. He's diabetic and his sugar is low. We've tried to give him glucose tablets and that gel stuff, but nothing is working, so we've had to call you."

"No problem. That's what we're here for." We notice the spotless carpets, the freshly painted walls and the furniture that looked either brand new or just very well cared for. "Nice to see a home where people actually take time to look after the place! Have you had it done up just for Christmas?"

"Something like that. We're trying to keep it that way and hopefully it will last." He points to the room at the end of the corridor and tells us that the nurse is there to help us further.

"Oh, good. You're here. We've tried everything to bring him round, but nothing's working. Hope this isn't a waste of your time."

Mr Hella's blood sugar has dropped so far, that the machine won't even give us a reading. A digital "LO" flashes up on the screen, although we didn't really need to check it. All the classic signs were there. A thready, rapid pulse, sweat pouring off him in buckets and an odd sounding snore when he breathed.

"We've only known him three days, he's a lovely chap and nearly ninety, but this is the second time he's done this to us in two days. Last time we managed to bring him round. He's not on insulin, just tablets, but they must be too strong for him."

"Good work!"

As we find a vein and draw up some glucose to feed his blood with some much needed sugar, we have time to talk to the nurse, complimenting her and the staff again for keeping the care home so clean, making the effort, and especially for being helpful to ambulance crews. Too often when we're called to care homes we're met more by apathy and resignation than by helpful, knowledgeable staff. Assuming, that is, that we're met at all. Sometimes we have to guess which of the rooms is hiding our patient, often having stood outside the building for some time before anyone let us in. 

This place was a timely reminder that not all care homes are the same. 

"Good to see that you seem to have a system that works well when you call an ambulance." 

"You think it works?" 

"Well, we were met at the front door, given a brief idea of what's going on, shown the way to our patient, and had a handover from someone who knows the patient and their condition. I'd say that's a pretty good system." 

"Isn't it the same in all these places?" 

"You're kidding, aren't you?" 

"Well, I'm glad you think it works. You're our first ambulance." 

"Today?" 

"No." 

"This week?" 

"No. First ambulance ever." 

"What? You've never had to call an ambulance before?" 

"No. Never." An amazingly rare feat for any care home, and a record to be proud of.

Mr Hella starts to come round, the sugary water coursing through his blood and up into his brain. 

"Who are you?" 

"Ambulance service, sir. It seems you gave these people a bit of a fright." 

"Oh, I'm so sorry. Did my sugar level drop again?" It seems that he's more used to his condition than the staff who are looking after him. 

"Just a little. They seem to take good care of you here." 

"They are truly amazing. I only wish I could have moved here sooner." 

"When did you move here?" 

"Three days ago. My family have been trying to convince me either to move in with one of them or move into a home ever since my wife died. I needed someone to care for me when I pulled these sorts of tricks." 

"So what took you so long?" 

"First, I'm a stubborn old fool, and proud of it. Secondly, all the places I looked at were awful. Or worse. But I had a look around here when they were just putting it together and when they opened, I jumped at the chance!" 

"Jumped?" asked the nurse with an amused grin.

"Well, gently moved in a positive direction." 

We all laughed. "I think, since this is your second attempt at being difficult in as many days, we should probably get you checked at hospital. Just to make sure you're going to behave." 

"Hospital already? I've only been here five minutes!" 

"But," said the nurse, "you do have the distinct honour of being our first ever ambulance patient." 

"Well, that's no surprise, is it?" 

Confused, I had to ask the obvious question. "Why isn't that surprising?" 

"Well, they've only been open for three days. I was their first ever customer!" 

No amount of pleading would convince him to take a seat on our wheelchair out to the ambulance. "I'll walk, thanks. Just get me my frame. I might be old, but I'm not that elderly. And you," he said, looking back to the nurse, "make sure you look after the place until I get back. Can't have my new home going to ruin whilst I'm away." 

"Don't worry. We'll keep the sign up just for you, Mr Hella." 

Nero's Virus

Clouds are building, the forecast downpour seems just minutes away. Set against the dark background is an unassuming row of terraced housing, the exact same kind that's seen in every part of town. One house, however, stands out from the rest. The brickwork is painted a glorious yellow, the window frames green, the colours complementing each other and brightening up a boring row of houses. The front door, its paintwork matching the windows, is opened by a character just as colourful.

"Oh good, you're here!" Burgundy trousers, black shirt and multicoloured waistcoat with matching bow-tie on a man who can only be described as a pantomime giant. "She's just upstairs. Think she's got that horrible winter bug. What do they call it? Nero's Virus? Not that I know what a Roman emperor's got to do with viruses."

"That'll be norovirus."

"I prefer my version. Got more class to it."

"To be honest, I do too. I think we'll use that from now on."

As is always the case when patients are sick, she's in the bedroom on the top floor of the townhouse, two flights of stairs up. Vera is John's total opposite. Dressed in dark pyjamas and wrapped in a plain dressing gown, her dress sense and tiny body are completely out of character with her house and incongruous with her theatrical husband.

"It's been three days now," John tells us. "She can't keep anything down. It just comes out almost instantly, one way or the other. Even water."

"I'm sorry we had to call you gentlemen." Vera talks in between attempts to empty any remaining contents of her stomach. "We just didn't know what else to do. We've tried all the over-the-counter stuff. Nothing works. Every time I try to stand up, I feel like I'm going to keel over."

We check her vital signs and find that her blood pressure is low, which explains why she feels faint whenever she stands up.

"Lets get some fluids into you before we move, then we'll get you on a chair and up to the hospital."

"Do I really need to go?"

"I think it's probably for the best. You can't keep going with the blood pressure of a five-year-old."

She sighs. "I've never had to go to hospital in my life. And when you're as old as I am, that's a long time!"

"Well, if that's the case, it's about time you saw what all the fuss is about. I'm sure they'll look after you."

"Alright then. Do what you need to do."

We give Vera some medication to help stop the nausea and she gets some fluids too, enough to make sure her blood pressure is a little more settled before we start moving her down two flights of stairs. Once we're ready, she takes a seat on the folding chair, we wrap her in a blanket and secure her with the bright yellow strap. Half way down the first flight of stairs, the lights go out, and the house is left in complete darkness. I manage to fish the pen-torch out of my top pocket whilst balancing the chair with one hand and with the aid of my belt, bite the torch between my teeth, and we manage to get down the last few stairs. There was another flight to go and dim light wasn't quite enough, so we stopped on the landing. 

"Hang on a minute," says John, "I think I remember seeing a candle in the draw upstairs. Lend me that torch and I'll go find it." A minute of darkness later, he comes back with the candle. "Only one problem," he says. "The matches are downstairs in the kitchen." 

"Don't worry," laughs my crew mate, "I've got a lighter." 

"Well, how about that then! Haven't had a powercut in these parts for years! It's a miracle I still had that one candle. Left over from her birthday cake, the one the kids brought over last month." 

A combination of candlelight and torchlight saw us the rest of the way, until we reached the street that was lit up by the flashing blue lights. As we were about to step out of the house, Vera remembered the one thing she wanted. 

"Will you bring my walking stick with you? I can't go anywhere without it."

"Are you sure you want it? We've strapped you in to the chair, it's on wheels, and you're going on a trolley bed. You're not exactly walking anywhere."

"Still, I'd really rather have it." 

"OK, where is it?" 

She hesitates, almost scared to answer the question. "It's in the bedroom." 

Vera smiles as I tut theatrically and roll my eyes. "Let's get you comfortable in the ambulance, then I'll go and get it. But you're sure you want it? Walking sticks have a habit of going for walks without their owners in hospitals." 

"And the way I feel, it could probably walk a darn sight quicker!" As we helped her across to the bed, she vomited once more, and we got a bowl to her just in time. 

"Wouldn't want to get your pyjamas in a mess, would we?" We covered Vera in the blanket that had kept her safe as we carried her downstairs and tightened the strap around her legs, telling her it was just to make sure she didn't run off. "By the way, you don't own a fiddle by any chance, do you?" 

"A fiddle? Why do I need a fiddle?" 

"Oh, you know, it'll give Nero and his virus something to do..." 

The Secret of Medicine

Ah, the joys of plagiarism. 

"Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better. The human body is exquisitely talented at healing.  If bodies didn’t heal by themselves, we’d be up the creek. Even in an Intensive Care Unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you gave it plenty of gas, oil and brake fluid, and then expect the transmission to  fix itself."

What a fabulous paragraph, even if the article is a couple of years old. Click on the quote above to read the rest of the article by Dr. Thomas A. Doyle. No, I don't know who he is or anything about him either, except for the bit of blurb at the end of the article. But he has some very interesting things to say, don't you think? 

Change "America" for "UK", or anywhere else in the developed world, and I suspect that the same problems are present all over. 

So what do you think? Does he have a point? Are we really a nation of wimps? More to the point, does the medical system here just pander to too much? 

Case in point, particularly after the weekend just gone - The Booze Bus. Look at the photo. A transport ambulance, with a fully trained paramedic crew, loaded with three (that I can see, anyway) people who have nothing wrong with them other than an under-developed sense of responsibility and self-awareness. Should the health system really be paying for what is no more than a babysitting service for people who, a few years ago, would have spent the night in a police cell and woken up to a hangover, a steel door, a charge of drunk and incapable, and a large fine? Nothing's changed since then, except for the fear of litigation, and that in itself is well on its way to bankrupting our health system. 

I know the arguments for and against the concept of the Booze Bus (or, Alternative Response Vehicle, to give it its official title). I understand both sides, and I know that had it have been available last night around where I was working, I would have had four fewer patients. Or at least different ones. But I still feel that society as a whole needs to realise that the days of personal responsibility need to return, that the pot of money is not unlimited, and that sooner or later, whether we like it or not, charges will have to be made on certain categories of patients. I just think that the Booze Bus is as good a place as any to start. 

Threatened

I'm not entirely certain what I'd done to offend you, other than come in to help save your mother's life (which would be the last on my list of things to get ticked off about), but as it seems clear that I have upset you in some way, allow me to offer you a little bit of advice. 

If you're going to threaten, in a language other than English, to kill me and my family, maybe you should check one thing first - check that I don't understand what you're saying. 

Otherwise, you will be left with only one of two options: 

Either you leave the house. 

Or I do. 

Seeing as I'm the one with the knowledge, skills and equipment to actually help your ailing relative, I would suggest the first option as the more prudent of the two. Acting all innocent and pretending that you didn't say what I heard, or didn't mean what you said, or, more likely, didn't mean for me to hear and understand it, is all a little bit too late. 

A moment passes, you stand your ground, shout at all those around you. Even your family know you're in the wrong, that you've been rumbled. They want you out as much as I do, but you refuse to leave, or at the very least, apologise. As I stand up to leave, having made sure to leave the oxygen with the patient so that she suffers a little less, you block my path, holding a fist up to my face. 

"I'll kill you if you leave!" 

"A second ago you were threatening to kill me if I stayed. Now make your mind up. Either get out of my way, let me out of the house and you can deal with the consequences, or you can leave and let me treat your mother. Your choice, but the longer we stand here, the worse things get for her." 

You shout some more, a mix of languages. You push your brother out the way, storm out to the street and slam the door behind you. 

After you leave, several sighs of relief can be heard, and amongst them one voice, quiet and muffled by a plastic oxygen mask. 

"Good choice, son." 

Picture on the Wall

A smiling face adorns the walls,
in frames all shapes and sizes,
Holding trophies, hugging dad,
bringing home surprises.

A quick look round the house again,
whilst clearing up the mess,
Certificates of excellence,
no signs of any stress.

Yet here we are, police are too,
looking at the rope.
That piece of ragged, torn up towel
that's stolen all your hope.

Your smiling face, a child so proud,
watched us as we tried.
Tried to save your dying dad,
'Til that silent face then cried.

I never met you, little one,
but know one thing for sure.
We tried our hardest, tried it all,
until there was no more.

All that pride there in your eyes,
as you stand with your team.
Your face will stay there, in my mind,

play havoc in my dreams.

I'd hate to see those eyes go dim,
I'd hate to see those tears.
Just to imagine your heart break,
brings out my deepest fears.

Your smiling face adorns the walls,
despite the sight so grim.
I'm sorry we weren't good enough,
to give you back to him.

Bragging Rights

Sometimes, I look at the career I've chosen,

and think back to my biology teacher. And laugh.

(No more than the most basic grasp of the subject.)

Sometimes, I look at the blog I write,

and think back to my English teacher. And laugh.

(Poor writing style, no imagination, little effort.)

Sometimes, I look at the job I do,

and think back to my careers adviser. And laugh. 

(Back-office job, contact with the public ill-advised.)

I laugh at how wrong they were. 

I laugh at how I believed everything they said. 

I laugh at how, despite the fact that I believed them at the time, I proved them all wrong. 

A very good friend of mine recently told me that he used to read my blog, but stopped because it was too self-centred, sounded too much like a self-portrait of a hero in the making. Initially, I was a little troubled by his comments, well, actually, more than just a little troubled. I didn't perceive that this is what this blog is all about. However, thinking about it, I guess he was at least partially right. It is very self-centred. But that's only because I can only write what I feel. I can't express the feelings of the people I meet, although I can often have a good guess. And for anyone who's known me for any length of time knows, expressing what I feel is a very new (and exceptionally frightening) concept that I still fail at doing in a face-to-face situation. It's precisely why I took to writing. 

As for heroics? Pah. Anyone who does the same job I do is as much a hero as I am, although I am almost totally certain that none of us looks inwards and sees anything suchlike. We see a person who may have a special skill, maybe even a special connection with people we've never met before and may never meet again. We may even be opportunists who are presented with a statistically skewed number of chances to help preserve a human life. But heroes? Soldiers who save their comrades whilst under heavy fire are heroes. Random members of the public who jump into a raging sea to save a drowning child are heroes. We have a job to do, a special job maybe, but we wear uniforms, not capes. 

All of that doesn't mean that I'm not proud of who I am and what I do - alongside my colleagues. I may have recently had some second thoughts, well, more of a crisis of confidence really, but hopefully I'm back to  what passes as almost normal. I'm still pleased that I chose the path I did, even if it did take me some time to realise what that path should be. And if that comes across in this blog as being too self-centred - well, good. Because, whether my friend likes it or not (and yes, we're still friends), I've still got much to brag about. Even if it is self-centred. 

More Drunken Logic

Drunks. 

Love 'em or hate 'em, they're always there. Some obnoxious, some difficult, some driving when they really shouldn't be, risking their own lives as well as the lives of all around them. 

Every so often, we come across a gem, the entertainment value often carrying us through the rest of the shift. Recently, a friend of mine, previously nicknamed "Little" told me of the following conversation:

Medic: "Who's your next of kin?" 

Drunk: "What's that then?"

Medic: "You know, someone you'd want to contact in an emergency!"

Drunk: "Oh! That's you then!" 

Once again, another case of infallible drunken logic. 

Enjoy your weekend, go out, have a drink, have a good time. Just stay safe. 

Silence

Two faces in the dead of night, staring out of the front windscreen of a destroyed car. One's talking to me,  bragging, apologising, part regaling in their achievements, part regretting their actions. He tells me of their drink fuelled night, how they argued over who would drive, how they agreed that they'd have one go each at making the car fly over the bridge. His friend is quiet, eyes staring into the distance.

They succeeded. The police estimated that they must have been driving at over a hundred miles an hour when they hit the brow of the hill. The car's front was unrecognisable, make and model only clear from the back, airbags deployed all around. As we strap him down to a board, hoping to prevent any further injury, he tells us that once they'd left the road, the car just seemed to fly sideways instead of straight, and there was nothing they could do. In the meantime, the police dealt with his friend.

He kept saying that he wasn't brave enough to drive that fast, and when they failed the first time, they turned around, lined up again, changed seats, and had another go. He talked to us all the way to hospital, barely noticing any checks we did, any treatments we provided, just boasting about their tricks, about how impressed he was with his friend, the one we'd left on scene.

"Car's a write-off, isn't it?"

"I'd guess so."

"How come you guys got me out first? Is it because I was making so much noise?"

"Something like that, yeah."

"Well, my leg is smashed, isn't it?" It was. 

"Guess my mate's OK then, he didn't seem too hurt, just sitting back like that in his chair." 

A police officer travelling with us shuffles uncomfortably in his seat, and gives me a quick look. He makes a few more notes in his pocket book, checks once more for our call sign, and asks the passenger again what happened. He goes through the stories again, tells how they took a longer run up the second time round, makes sure that we know that he wasn't driving, that his friend was.

"I was in the driver's seat first time, but we didn't take off. So he took over. Called me all sorts of things for chickening out. But he did it! It was so cool! Shame we hit that fence though, won't be able to do it in that car again!"

It wasn't the fence that was the problem. It was the street light after the fence, the one that had smashed through the roof and the windscreen of the car. On the driver's side. The passenger, our patient, notices the looks, senses the unease. 

"Is my friend OK? Is there another ambulance looking after him? How come you didn't get him out too?" His world crashes in around him as the reality dawns, and he shouts. "I asked you, is he OK?"

I look across at the officer, who gives me an almost imperceptible nod of the head. 

"No. He's not OK. He's dead." 

Suddenly, silence engulfs the ambulance. 

Images

When insomnia seems a blessing rather than a curse, I know that it's time to take a break. When sleeping leads to dreams, nightmares, that wake me up, sometimes it's better just to stay awake. It's then that I know that I need to step away, albeit briefly. For some reason, working the day (well, two nights) of the strike last week, led me to exactly that point.

Working those shifts led to a torrent of emotions, from fear to pride, from anxiety to hatred, from fulfilment to total despair. Finishing my shift on the morning after, I got home and was ready to throw my uniform away for good. I was exhausted and frustrated, and calls that I would normally deal with on a regular basis, and that would have no lasting effects on me, suddenly turned into difficult calls. I heard of other calls that night, calls that I thank my lucky stars that I didn't attend but that colleagues, friends of mine did, because I think that having to deal with those calls as well, would have left me a broken shell. It seems that the world was going all out to make it as difficult as possible to do our job. Fewer ambulances, more calls, more serious calls. 

And I left work that night with the image of a smiling child burnt into my mind. A picture that was hanging on a wall. A child, no older than my youngest, with a grin like a Cheshire cat, holding a trophy, beaming with pride.  That child was about to have their world crumble all around them, as soon as the police had done their job - a job I didn't envy one little bit. 

It all conspired to leave me wondering whether it was all worth it, with what the police officer in the blog I've linked to refers to as an involuntary slide show. The politics, the trauma, the arguments, the abuse, the emotions. I had to step away, just for a few days. Not read any blogs or write them, not think about the ambulance service, not talk about it, not consider the possibility of working some overtime. I had to spend some time with friends and family, some time not seeing things in perspective, but seeing them through slightly rose-tinted glasses. 

The image of that child will, I'm sure, stay with me, even though I never met them in person. One day, I might write about the call itself, but not yet. For now, I'm ready to go back to work, if a little anxious. The tensions of the strike are no longer there, everyone is just there to do what we do best: saving people's lives. Or at the very least, improving them. 

Time Off

It's only a weekend, but it's hopefully long enough.

I'm taking some time away from anything ambulance related, including this blog. It's been a tough few days, what with strikes and some recent calls that are playing (preying?) on my mind a little too much.

So no posts for this weekend, just some time away.

I'm taking the advice of someone with vast amounts of experience more than me, and I'm sure he's right.

Hope you understand.

Politics, Strikes and Goodwill

Those of you who read my ramblings on a regular basis, will know that 99% of the time, I try to avoid any of the politics involved in this job, and concentrate on real people and real events. This time, however, the politics are a little bit too big to ignore. 

In under nine hours time, a huge strike by some two million public-sector workers will begin. I wrote about my feelings on this strike in a post at the beginning of the month, and I still stand by what I said then. In fact, I resigned my membership of the union last week, so as not to be in a position where I had to decide at the last minute where my allegiances lay, or leave me any room for second thoughts. 

Over the past few days I have spoken to many of my colleagues, all with differing views on the strike. Some are supporting it wholeheartedly and will down tools, some who are still torn between the patients and the greater cause, some who agree with me that this is the wrong way to go about things. The unions and the ambulance service have been in negotiations as to what sort of cover will be provided, and the agreement that has been reached is that the vast majority of calls that we normally attend will still have an ambulance arrive. At times the response may be slower, but the most serious calls will still hopefully receive the normal fast response. 

This agreement, whilst seen by many as turning the strike into a something of a damp squib rather than a strong statement, did something positive for those who were unsure as to the best course of action. Many, many paramedics (and nurses) felt very uncomfortable with the idea of striking and leaving their patients in need. There was a general uneasiness, something that I think the government (or Government) relied on a little too much, amongst many public servants, particularly those with direct and immediate public contact. An uneasiness that leaving our jobs for a day would impact badly on people who, through no fault of their own, are some of the most vulnerable in our society. 

The uneasiness felt by many, certainly in the health service sector, took yet another battering this afternoon. Just a few hours ago, the Chancellor announced that at the end of the two year public-sector pay freeze, a fiscal policy that still has some time to run, there will now be another two year period of only 1% pay rises. With an annual rate of inflation somewhere around the 5% mark, that pay-cap, in real terms, means a pay cut over four years in the region of some twenty percent. At the same time, tens of thousands of people on benefits, some genuinely, some whose claims range from dubious to outright fraudulent, will enjoy a rise in line with that rate of inflation. I'm no economist, but surely, the best way to get the economy jump-started is to encourage more work, not less. 

Many of those who were left confused and unsure about a strike, and who were going to work through it, are now left battered and bruised by another swipe taken at their goodwill and desire to serve the public. There's a limit to how many times a person can be beaten and bounce back. There's a limit to how much goodwill can be stretched. Every person has their breaking point, even the most public spirited of us. 

I'll be working through the strike, but with a little more personal turmoil than I had anticipated. I will try to tweet throughout tonight and tomorrow night, bringing a selection of sights, sounds and thoughts from the front line. Who knows what lays the other side of the picket lines. 

Sad or Depressed?

It's so easy to overlook, to underestimate. "Cheer up, it might never happen." It's easy to say. Often easy to do, too. Sometimes, however, suggesting that a smile will cure all ills, only shows a lack of understanding. Sometimes it takes a big name, a celebrity, a high-flying politician to be affected enough by something that whatever that something is, suddenly hits the news. 

Gary Speed, a well known footballer and football manager, took his own life. The news only broke today so one can only assume, at this very early stage, that Gary was trying to cope with some unenviable hardship. He was a man who seemingly had everything to live for, a loving family, a place in the history books of both national and international football, a career and direction in life envied by many. And yet, somewhere in the deep recesses of his mind and soul, a dark, endless depression loomed. 

It's a tough one, depression. I see patients practically daily on anti-depression medications. Depression is the only illness named and described with the same word. Diabetes is an illness where a person's sugars are out of control. Hypertension is when blood pressure is too high. Asthma is when the lungs aren't working properly. 

Depression is when a person is depressed. 

The other problem is that depression is a word that is bandied about all too freely. People are depressed when they miss out on a good night out, they're depressed when their boss tells them off, they're depressed when their football team loses. But depression isn't sadness or upset. It's a state of mind caused by one of many factors and triggers, some physical, some chemical, some emotional, where a person can appear happy and content with their lives, and yet not be able to cope with all that is happening around them. 

Often, in the depths of these depressions there is only one viable option, and that's the option that Gary Speed seems to have taken. Some will claim that this is a selfish option, but to be honest, my uneducated mind tells me that for something to be selfish, there needs to be conscious and coherent thought. Depression allows for neither. The mind's inability to cope, to rationalise, to comprehend, leads the body down a path of self-destruction. 

It's also not something that we can solve in a twenty minute meeting in the back of an ambulance. Sometimes, however, just being able to spot the first signs, may be the trigger that leads a patient to treatment and save them and their families heartbreak in the long term. Most of the knowledge I have about depression isn't from books or classrooms, it's from witnessing it first hand. It's not something we're taught as paramedics to really deal with, because most of the time we're dealing with the consequences, not the disease itself. 

We can bandage wounds, or we can pronounce death. Understanding that there's a stage before this, a stage that we should be able to spot, may be the most life-saving action we can perform out on the front line. 

Bother vs Bovvered

Rule number one of EMS:

The likelihood of a patient apologising for calling the ambulance,

is diametrically opposed

to the patient's actual need to apologise

for calling the ambulance in the first place.

Examples from a recent shift:

The patient who was practically blue,

wheezing and gasping for breath,

who uses one of those precious breaths

to utter the words

"I'm sorry to bother you."

Or, the patient who, without a second thought

having had a sore throat for an hour

decides that they need to see a doctor now,

whatever the time of day,

and when asked if he realises that he's called

an emergency ambulance,

shrugs his shoulders,

looks down his nose,

and grunts: "Bovvered?"

Meant To Be

It's so easy to be dismissive, so easy to drive along, thinking that this is just going to be yet another one of those calls. A young girl, in her twenties, complaining of the ambulance service's number one call. Abdo pain. Another twenty-something, self-entitled, all-deserving, all-demanding twenty-something who can't be bothered to take any pain killers and like most people, wait for the pain to go away. 

It's so easy just to assume another late night out, another curry gone bad, another Chinese take-away with more after-effects than the alcohol it was meant to be soaking up, another case of food-poisoning victim seeking a non-existent magic cure. 

But with only half a story, it's so easy to be wrong. 

The tear-stained face, the look of real pain, the blood-soaked trousers, the shocked and saddened eyes, tell the other half of the story. 

A story, a history, of broken hearts and shattered dreams, of hopes raised and dashed time and time again. Through sobs and tears, she looks at him, she shrugs, she says We'll try again, neither of them really knowing if they have the strength.

Twenty two weeks, the furthest she'd ever got. But once again, for the fifth time in as many years, it just wasn't meant to be.

Just a Thought

A blog post so short, that it probably should have just been a tweet, but I felt it was more important. 

Remember - you're not just treating a patient. You're treating a person.

There you go, just a quick thought for the day. 

Putting Their Lives on the Line

I was at home enjoying some family time when it happened. But just hours after the horrendous incident in north-west London that left four police officers with serious injuries after being stabbed, I was back on duty, and this time, not a million miles away from the scene.

At a totally unrelated call, an RTC, the police had to block the road for a few minutes so that we could treat our patient safely. A driver caught up in the traffic approached one of the officers, stood toe-to-toe, and through gritted teeth and a with a horrible snarl commented: "It's no wonder you lot get stabbed."

I'm not sure I would have been as restrained as this officer was.

The police have to put up with a lot more abuse than we do, and take greater risks too. If there's a call that sounds a little suspect, we'll ask for police attendance and hide around the corner until we know it's safe. Yesterday's incident proves once again how big that risk often is. I have a great deal of respect and admiration for the police, what they do, and what they sometimes have to put up with, especially as they've saved me from a serious pounding on numerous occasions.

I hope and pray that those injured make a full and speedy recovery, both of body and soul. They deserve it.

And as far as the idiot driver who had been inconvenienced for a few minutes, well, I can't really tell you what I hope and pray for him. But I'm sure you can well imagine.

Thursdays

Lying on the pavement in a puddle which I hope is just rain, but fear that it probably isn't, Val starts cursing the second he sees me approach. 

"Now, now, there's no need for that! We should be best friends by now!"

"Oh! I'm sorry." Val says. "I didn't know it was you. I thought it was the old bill again."

Somehow his clothes are filthy, even though I remember for certain that they're not the ones he was wearing the day before. He's a regular, but as regulars go, normally a fairly friendly one just looking for somewhere warm to spend the night. The truth is, it's rarely Val that calls us, but some unsuspecting member of the public worried that they're looking at a dead body in the street. So far, he's never been dead. I fear for the day when he really is, it'll probably be the one time that nobody bothers to call. Along with the rest of the usual observations, I check his temperature which shows that he's hypothermic, four degrees below the normal body temperature. 

"How long have you been out here?"

"Don't know, what time is it?" 

"About eleven o'clock." 

"At night?"

"It's dark, isn't it?" 

"True, but it could have just been cloudy." I raised an eyebrow, and he saw the flaw in his own logic. "Anyway, if it's eleven, it's probably been about eight hours. I got thrown out the pub at about seven." 

"That would make it only four hours, Val." Unsure as to whether it's alcohol or hypothermia that's causing his confusion, I decide on another line of questioning. He wasn't sure where he was or which pub he'd been in, but knew his date of birth and even where he was born, or at least claimed to have been. With time for one final question as the ambulance pulled into view, I decided on an easy one. 

"Do you know what day it is?" 

"Pass me the bag will you?" Val takes the plastic bag, pulls out the large bottle of cider, turns the label towards him to read the name and proudly announces: "It's Thursday. I always drink this one on Thursdays." 

Traffic Stop

Knowing that police are on scene and knowing that the scene is safe are two very different things. Once we know that the latter is true, we approach at speed. 

A bystander runs up to us and practically pushes me off my feet. 

"What the hell took you so long? The police have been here for ages." 

I push him off, lift the police tape that marks the outer cordon, and head into the neutralised area.

One of the officers signals to us to head towards the idling car, the headlights of a police van on full beam illuminating our approach. Sitting in the front passenger seat of the car is yet another officer, looking pale and wearing a blood-soaked shirt. A crowd stand around the cordon, some hurling abuse at the police, some at us, some at each other. The atmosphere is on a knife-edge, teetering on the brink of an all-out riot. In the driver's seat, unconscious and bloodied, sits London's latest gun-crime statistic. 

Two holes through the windscreen, almost perfect circles, the rest of the glass undisturbed. 

To the police, he's a victim; to us, a patient. The work we do could mean the difference between attempted and actual murder, between a life-threatening injury and a fatal one, between life and death. We move him out of the car, looking for injuries, and finding them too. 

Two holes in his chest, almost perfect circles, the rest of his body untouched. 

Entry wounds only, leading to only one conclusion: the bullets are still lodged within him. The visible damage is only a small part of the story. It's impossible to know what damage was caused after those tiny projectiles entered the body, where they veered off to, what organs they hit, what arteries they missed, how much blood has been lost. 

"Are you gonna just sit there looking at him all day?" 

The call comes from one of the irate crowd, someone who doesn't understand that just moving the patient could be the wrong thing to do. We need to have an idea of what we're dealing with, whether his lungs will hold out for long enough, whether we think his heart's been hit, whether there's anything we could possibly do to give him a better chance. 

There's no one else to send to help us out so we package him up into the ambulance, give a report over the radio and head to the trauma unit. Luckily, for a change, we're not too far away. On route to the hospital his breathing becomes more noisy, more erratic, and then silent. His heart changes from a rapid beat to a slow beat, to no beat at all.

The officer in the bloodied shirt meets us at the hospital and asks how the victim is doing. We tell him. 

"Damn. I only pulled him over because he had no headlights on, I had no idea that anyone else was watching him too." He shakes his head. "Can I go and see him?" 

We walk with him in the direction of the resuscitation room, and he knocks gently on the door. A nurse peeks through to see who's disturbing their work, sees the blood on his shirt and lets him in immediately. It takes a minute for him to convince her that he's not injured, that he just wants to see the victim. 

The third cubicle along has the curtains drawn. Monitors all around ping with electronic bells, whine with wavering warnings, but the monitor in cubicle three is silent. The officer steps in, the nurse follows and we stand by the curtains. The victim's face is already covered, and the nurse slowly, gently, mournfully pulls the cover back. The officer takes one final look, shakes his head again and turns to leave. 

"A traffic stop. Just a simple, damned traffic stop." 

Patch Adams

"Our job is improving the quality of life, not just delaying death." It's like everything I keep trying to say, but just said so much better.

Two things have come out of a friend of mine sending me the link to this: The first, considering how much I like Robin Williams, is how have I never heard of this film?

The second? I think I may have found my new career, should I ever decide to change.

Stories and Poppies

Rarely, very rarely, my grandfather will tell some stories. Usually, they're the funny ones, the ones that many in the family have heard over and over again, the ones I will never tire of hearing. 

Stories of chasing a barge full of watermelons down the river through Baghdad. Or playing tank football in north Africa. Or running around the streets of Paris with a necklace made of onions.

Sometimes, when it's just me and him, he trusts the soldier in me with a little more. I'll hear a little more of the battles, of manoeuvres, of his comrades. He never tells me who fell and who came home, but some names are harder for him to mention than others. Some raise a smile, some cause the hint of a tear. But just a hint. Some manage to raise both emotions at the same time. 

And me? I just listen, and wait in hope for the day when he trusts me with a little more. In between, once a year, I wear a poppy and stop to remember. It isn't much, but I know it means the world to him and to his comrades. 

Those who came home, those who didn't, and those who are still doing it today. 

Care?

If you're a carer in a care home, your job is to care, and all that your caring entails. 

If you're a nurse in a nursing home, your job is to nurse, and all that your nursing carries with it. 

Don't you dare tell me you've only known one of your residents for only a few weeks, or a few days, or even a few hours, as an excuse for your inaction and lack of care. 

I only get to know my patients for seconds, literally seconds, before I have to decide and act on their needs, and be able to do so with care and compassion.

You may only be temporary staff, but your nursing diploma stretches as far as giving a patient oxygen when they need it, whether you know them well, or not. 

You may be new to this particular establishment, but your nursing experience should tell you how unwell your patient truly is, and that now's the time to act. Now's not the time to lean over the bed with your hands in your pockets and your head in the sand.  

Don't you dare excuse your mistreatment by claiming to not know the resident well enough - abuse and neglect can never be excused. 

I know my patient for only moments, and I still treat them like human beings, not like bed-filling, revenue-raising, income-generating pieces of unimportant meat. 

Damn you for making me care so much as to make me hate you and your actions - or lack of them. 

Damn you for being so blasé about the desperate needs of those in your care. 

Damn you for choosing a caring profession, when clearly you just don't care. 

White Van

Downtime is a rare commodity on the ambulances these days. Socialising with colleagues is limited to snatched moments in between handing over patients at the hospital and the next call. Rarely is that time more than a few brief minutes. More often than not, the second a crew is ready to go, there's a call already waiting for them. The same is true from shift's start to shift's end. I try to arrive for my shift about half an hour before the official start time. It gives me a chance to get all my equipment ready and catch up on the news, whilst not having the stress of having to go out on call the second the clock ticks over at the start of my shift. 

The evenings are getting cooler, and darkness seems to fall in the middle of the afternoon. Standing out the front of the station, I start to get the car ready for my shift. Checking the stock, changing the oxygen cylinders and making sure that all the lights are working, whilst at the same time catching up with the oncoming night shift crew. One of them is a brand new trainee, in only their second week on the road, the other with only a year's worth of experience, having a new probationer to look after for the first time. 

"You guys make sure you hurry to my rescue tonight, won't you?" I know that at night, sometimes waiting for the ambulance to back me up can take some time. 

"More like you're going to rescue us!"

The chit-chat continues, some along professional lines, some less so. A bit of good, off-the-record banter can work wonders sometimes, giving the time to replay calls that we're unsure of, seeking backup for good decisions, learning from others about things we don't know or understand. With ten minutes to go, we all finish our checks, the crew head inside and I'm only a step behind, hoping for a quick cup of coffee. Just then, a white van pulls up outside the station and the driver steps out.

"Excuse me, I don't feel very well."

He looked pale, and the sweat was dripping off him. He walked up to the car and as he came within touching distance, collapsed to the floor. Practically tasting their coffee, the crew turned round and came straight back outside. Within a few seconds of hitting the floor, our unnamed patient started to come round.

"Stay there a second," I tell him, as he tries to get up. "We'll get you in the ambulance and check you out." A check of his blood pressure confirmed our suspicions - it was so low that it was barely readable and his pulse was much slower than it should be, at less than forty beats a minute. We get the trolley from the back of the ambulance, and lift him gently from the floor,.

"What's your name, sir?"

"Mani."

"How old are you?"

"Thirty." One of the crew, the new probationer, looks shocked. Mani looked probably double the age he claimed to be, but confirmed his date of birth without having to stop and think about it. The maths adds up. He really is as young as he says. As usual, several things need to happen at once. Observations, an ECG, cannulating a vein ready for any drugs he may need. It's always a good indication of the seriousness of an illness when a patient's reaction to the threat of being stabbed in the arm with a large needle is almost no reaction at all. He managed to give us various other details, including his home address, only one street away from the ambulance station. He'd decided when he started feeling unwell that it was quicker for him to drive to us, rather than the other way round. By the end of the call, we would all realise that he was lucky to drive that far.

Despite raising Mani's legs on the stretcher, giving him drugs and some fluids, his blood pressure fails to rise. We have difficulty attaching the sticky dots to his chest because he's so clammy, but eventually we succeed and the machine complies, printing out the tracing of his heart. His heart was sick.

At thirty years old, Mani was having a heart attack, the part of the heart that affects his pulse and blood pressure blocked and dying. It was no wonder that he wasn't responding to any treatment we were giving him. I abandon my car at the station before I'd even had the chance to turn the wheel, and travel with Mani and the crew to hospital, hoping to get there before his heart gave up altogether. With a twenty-five minute journey, there were no guarantees, and there was little more we could do to help improve the odds.

Mani listened anxiously as we explained what was happening, but accepted it. His greatest worry after his health was getting a parking ticket on his van. or worse, having it towed, having left it in front of the ambulance station with the keys still in the ignition. I promised to do what I could to make sure that wouldn't happen.

He was lucky. Still conscious when we got him to hospital, and amazingly calm as the team did their work. As we stood watching what is effectively a plumbing procedure on the heart, the response was almost instantaneous. Blood began to flow back around his heart, feeding oxygen to the parts of it that had been starved for some time. His pulse improved, as did his blood pressure, and the hospital team seemed pleased with their work and Mani's response.

"We'll keep him here for a few days," the consultant tells us through the lead-lined window, "then if all's well, he'll be sent home to restart his life. Good work guys!"

"Don't forget my van, will you?"

"Don't worry, Mani. We'll sort it out for you. You concentrate on getting better. I'll leave a message with the hospital when we work out what to do."

"Thank you. Thank you for everything." He waved at us, a relieved smile on his face, and then rested his head back on the trolley that had been brought to wheel him to the ward.

Having tidied up the ambulance, we drove all the way back to station, and I discussed with control what would be the best plan for Mani's van. Having made all the arrangements and received agreement from on high, I called the hospital and asked them to let Mani know that his van was parked outside his house, and the keys had been put through the letter box.

"You know," said one of the crew as I walked back into station, "you've got a new career ahead of you if you give up on ambulance work!"

"Oh yeah? What's that then?"

"Well, the world always needs more white-van men..."

"Yeah, thanks for that guys. Should we start our shifts now?"  

Crisis

The front door is ajar and as I knock and enter, a voice from upstairs directs me to the drama. Two people are in the room; one frantic, one calm. Violet, lying on the floor with a weeping head wound is relaxed and resigned to her fate. Her son, Donovan, tries to sit still and move out of the way all at the same time, causing him to trip and almost fall on top of his mother.

"I'm sorry," he says, "I'll just... Well, I'm... Oh, I'm not much use in a crisis. I'll get out your way now."

"Donovan!" calls his mother. "Will you settle already. I'm alright. They'll look after me now!" The gentle sing-song of her West Indian accent finally seems to have an effect, and he's able to step out of the way and relax a little.

Distraction tactics at the ready, I ask him to find me his mother's medications, write down a few basic details and generally try to keep him out of the way for long enough to assess some basic observations and wrap a bandage round Violet's head.

"Oh, that's better!" he says, returning to the room once some of the mess had been cleaned up and the bandage hid the injury. "Did I mention that I'm not much good in a crisis?" 

"Don't worry. I'd fret too if it was my family." Turning back to Violet, I gently break the news, worried that I was about to have a fight on my hands. "Now, miss, we need to get you off to hospital. There's a hole in your head that needs some proper fixing." 

"I knew you were going to say that. Can you just get me my slippers?" 

Without a word, Donovan turns to find the footwear. 

"And I'll need my keys." 

"Keys, right." 

"And don't forget my handbag."

"Handbag too."

By the time he's half way down the stairs, the list has grown to almost a dozen items, each call from Violet repeated with a resigned sigh from Donovan and an amused smile from the ambulance crew and me. Whilst he runs around the house turning off lights, checking doors and gathering medications, we get Violet as comfortable as possible in the carry chair and move her downstairs and into the ambulance, the crew carrying Violet as I carried the bags. 

After a few minutes, Donovan knocks on the back door of the ambulance and hands a bag through. 

"Did you find everything?" Violet quizzes him.

"It's all in there!"

"Keys, money, tablets, phone?" 

"Yes Mum. Keys, money, tablets, phone."

"Slippers?" 

"They're on your feet, Mum." 

"Oh yes. So they are." 

"What about the lights? Are they off? Did you check the back door's locked?

"Yes, Mum. Off, and locked." 

"Oh, and what about my hairbrush?"

"Hairbrush? What do you need a hairbrush for? You're going to hospital, not a fashion show!"

"Donovan, don't argue with your mother. A woman always needs a hairbrush in her handbag, no matter where she's going!" 

As he runs inside to retrieve the hairbrush, muttering the whole way there and back again, Violet relaxes back on the trolley bed, and allows herself a smile. 

"Kids, you know what they're like, don't you? Even when they're grown up they're hard work sometimes. I mean, look at all of this. Just a simple trip, and he falls to pieces. But he's a good boy really, always looking after his mum. He's just not very good in a crisis." 

Are you sure?

Lights and sirens help us part the traffic a little like the Red Sea would have done, walls of cars forming on both sides of the road, just slower and with greater apathy. A few stray waves decide to make a stand and not get out of the way, one racing to see if he could beat the ambulance, only to have his plan ruined by a red traffic light. Another just stops dead right in front of us, clearly having more faith in our brakes than we did. A tug on the steering wheel, a slam on the anchors and a few choice words had the desired effect, and we avoided the back of their car by an air particle or two. 

Emergencies come in three broad categories: Life-threatening, possibly life-threatening, and not life-threatening. This call was the former. An unconscious twenty-year-old girl, believed to have taken some sort of drugs, the quantity and type as yet unknown. 

"It's my girlfriend, Clara," says the panic-stricken gentleman who greets us in the car park, barely giving us a chance to open the ambulance doors. "I think she's tried to kill herself!" 

"Is she breathing?" We talk as we walk towards the patient. 

"Yes, but she won't talk, won't open her eyes. I think she's unconscious." 

"Do you know what she might have taken?"

"She's lying on top of the box, so I can't see it. They told me on the phone not to move her." 

Having climbed the two flights of stairs, we find Clara lying on the floor of the lounge. Flickering eyelids tell us all we immediately need to know - she's not unconscious. Some gentle persuasion and asking Dean to leave at the realisation that as her boyfriend, he was possibly the catalyst to the drama, finally convinced Clara to open her eyes. 

"Dean seems to think you might have taken some tablets. Is he right?" 

A nod of the head. 

"Can you tell us what they're called?" 

A shake of the head. 

"OK, how many have you taken?" 

Clara holds up four fingers. 

I decided to end the game of charades, and ask a question that would require a spoken answer. "Were they prescription tablets, or something you bought by yourself?" 

"Bought them from a friend." She looked down at the floor, thought for a second and then went on. "They're not going to kill me, are they?" 

"Do you still have the box they came in?"

Clara went back to nodding her head. 

"Can I see it?" 

Slowly, she moves to remove the box from the pockets of her pink hoodie, and hands it to me. 

"You took four of these?" 

A nod. 

"And nothing else?"

A shake. 

"I think you'll be fine."

"Are you sure?" 

"I'm sure. Four Strepsils have never killed anyone." 

"But I didn't have a sore throat, so isn't that dangerous?" 

"No it's not. Not sensible, possibly, and might give you a bit of belly ache, but it's not dangerous." 

"Are you SURE?" 

"I'm sure." 

"Can you take me to hospital, just to be sure?" 

"If that's what you want? Sure." 

"Yes please. Y'know, just to be sure." 

My persuasive skills that managed to bring her back from unconsciousness were no match for her concerns about four throat lozenges. 

"Sure."