Official Letter

A look of grave concern greets us as we pull up outside the concrete building. Dozens of blue-barred balconies overlook the square, and grey clouds overlook the balconies.

"It's been at least a couple of days, maybe even three or four."

Reg is one of the faces that makes up the character of this estate. His daily walks, regularly picking up his newspaper and a bottle of milk from the traditional corner shop. His cordial greetings to all and sundry were so much part and parcel of the area and had been going on for so long, that it was as if the buildings had been put up around him. Even the kids in the area showed him respect that was rare to find, clearing a path for him to pass, offering to carry his shopping - an offer his pride always forced him to decline. Sometimes he'd just take off on his own for a weekend, visiting some old army friends, but never without telling at least one of the neighbours.

No one had seen or heard from him for days, and he hadn't told anyone he was leaving. Eventually, someone called the police.

The glass panel in the door of the second floor flat was reinforced with wires, as were the only accessible windows. One of us called through the letter box at the bottom of the door, but heard no reply. A neighbour, suddenly remembering she had a spare set of keys, ran home to find them.

"He gave me these years and years ago. Never used them." One word at a time, catching her breath after running down and up six flights of stairs and across the square and back.

The keys wouldn't work.

"Maybe he's changed the locks? It's got to be twenty years that I've had these and never used them!"

Shining a torch through the keyhole, one of the police officers told us he could see the keys in the other side of the door, a sure sign that Reg must be at home, and a probable explanation as to why the spare set wouldn't work.

We contact local hospitals to make sure that he hadn't been taken there already, a task we knew was futile. Another police unit arrives with an enforcer, a heavy metal battering ram, and two forceful swings later, the door swings open. Splinters from the door frame rain down and shards of glass crunch under the heavy boots of the rescue party.

"Police!"

"Ambulance!"

"Reg, can you hear us?"

There's no answer. Each of us heads in a different direction. Bathroom, kitchen, bedroom, lounge. All impossibly empty. An officer decides to look under the bed.

"That's where my kids would hide!" he adds with a shrug of the shoulders, as if trying to convince himself that his idea isn't quite as ridiculous as everyone seems to think. Ten seconds later, as we're preparing to leave and packing up the bags, and with the police already arranging for the door to be fixed, there's a shout from the direction of the bedroom.

"I've found him! Get in here quick!"

In a space big enough for nothing more than a small animal lies Reg, stuck between the bed and the wall. He's unconscious, his breathing noisy and laboured. His leg is burned from lying against the hot water pipe that runs along the skirting and his head cut from where it hit the wall, leaving a dark red-brown smear at the point of impact. There's no reaction from him to any movement, noise or treatment. 

The key-holder, haunted by the thought she'd waited so long, is trying her best to help, but becomes more of a hindrance. A police officer alert to her anxiety as well as Reg's needs, moves her gently away, allowing us to do our job with a little more ease. We move Reg into our wheelchair, carry him down to the ambulance, and rush him to hospital, where we're met by a whole team of people who take over his care. After watching them for a while and helping where we can, we went back outside, prepared the ambulance for the next crew, and left Reg fighting for his life as we prepared to fight the traffic home. 

With the end of the shift came the knowledge that I'd probably never find out the outcome.

Months later, an official-looking letter appeared at work with my name on it. 

The Coroner wanted an account of the day's events. 

Reg had died two days later. 

Wings

It was 4:30am, and I was sitting on the relatively comfortable couch on station, during a relatively quiet shift on the car. Ten hours in, two to go, and I'd only seen four patients. It would normally be double, even triple that number, sometimes even more. On the car it's easy to do, especially if the patients aren't too emergent. You attend, assess, and hand over to the crew for transport, then you're ready to go again. 

My phone rang, the controller on the other end asking nicely if I could move from where I was and take up a standby position a few miles down the road. A groan, moan and miserable tone later, I drove to my new spot, parked up, reclined the seat back, and hoped for some peace and quiet. 

A few minutes later I could see a jogger running towards me, his fluorescent jacket reflecting the street lights and a rucksack on his back bouncing with each step. As a recently started runner, I admired his dedication at being up and running at such an early hour. Clearly a man with more self discipline than I could even wish for. 

As he ran past the car, I nodded a "Good Morning" in his direction, which he returned. I rested my head back in the seat, and started counting down the minutes until I could return to station. 

Thirty seconds later there's a knock on the window, and I wind it down as I see the luminous figure standing still. 

"Here," said the jogger, "you look like you need the wings more than I do!"

With that, he threw a can of Red Bull into the car, and jogged back up the road... 

Survivor

Today is International Holocaust Memorial Day. This repost is my attempt at keeping one story alive, honouring one memory, and teaching just one extra person, in the hope that if we remember our history and learn from it, we are unlikely to repeat it. 
__________________________________

Like a herd of elephants, we charge into the sanctuary that has been their home for the last forty years, maybe more. Eyes withered with age and a hand crippled by arthritis, a tattooed number just visible below the three-quarter length sleeve, pointed us in the direction of the upstairs rear bedroom. She lay there, exactly as she had done for probably several hours, a peaceful look on her immobile face. There was nothing left for us to do. Back downstairs, waiting for confirmation of the inevitable, was the person who had lived with her and cared for her for the best part of seventy years. 

As soon as we broke the news, the lifelong protector broke down in tears, and after a minute or two, composed herself, and began a breathtaking monologue.

"She's my baby sister, younger than me by three years. She was five years old when our parents were dragged out of our house, along with our six other siblings, and machine-gunned. I saw it, couldn't help but watch in warped and terrified fascination, through a darkened window in the cellar of a neighbour's house. Eva was still hiding in a drain when they marched off. To this day I don't know how she ended up there."

Rosa's perfect English is betrayed every so often by a Germanic twang to some of her words, labeling her for all eternity with a past she'd rather forget.

"When it was all done, they were dumped into large wheelbarrows, taken just past the tree line not fifty paces away, and thrown into a mass grave. As a parting gesture, the soldiers fired on them again, silencing the few voices still calling for help. Or praying for the end. Whichever would cease their suffering quicker.

"After they disappeared to look for more fun, I ran out of my hiding place and went to find Eva. We had seen death around us, heard it, tasted it, but this was the first time it hit us directly, and we knew we had no-one left. For a few days we hid where we could, and once a day I left Eva and went to steal any food I could. One day, when we heard more soldiers coming, we ran into the woods, and never looked back. 

"For over a year that forest was our home. We even hid in the graves, where we learnt to play dead if we heard anyone coming. Bodies were dumped on top of us, and we'd have to dig our way out. We slept in barns when we could sneak in, found abandoned houses where they at least had a roof, even if no windows. We stole food, ate dead animals that we found, every so often a friendly home owner would give us something small, but they'd never let us stay. The fear in their heads ruled the compassion in their hearts. 

"About two years later, we were finally caught. It was a blessing in disguise. We were taken to a camp and forced into different jobs. The Kommandant's wife took a liking to Eva, and decided she'd take her in as a maid. It saved her life. All other children her age were taken away, often literally snatched out of the arms of screaming mothers, and never seen again. I was put to work in the camp itself, anything from scrubbing floors to sewing uniforms and repairing soldiers' socks. Beatings were a regular part of life, but so was a daily slice of bread and clear soup. No more fighting for food, or stealing it. I saw Eva every few days, when one or other of us managed to sneak across the camp.

"We survived so much that others didn't. We were the lucky ones. At the end of the war, after we were liberated, we eventually found our way to London. I was fourteen, and Eva eleven, but our life up until that point gave us a look of several years older. We were taken in by a children's charity and cared for until we decided we'd never again trust anyone else. We worked hard, saved some money, with it we bought our own home, and have lived here ever since.  I don't know how I'll live without her here."

Once again, the tears flowed. Rosa's mainly, but we weren't doing a great job of hiding ours either. I sat, pen and paper in hand to fill in the necessary forms, but as Rosa's sobs ended her story, I found that I'd not written a single word.

"I'm sorry", she said, wiping her face dry. "I have more than sixty years worth of crying to do. This is the first time since."

At her request, we contacted a friend who arrived within minutes of our call. We left the room to allow them to talk and grieve together. To comfort each other. To shed those reluctant tears. Whilst they did, we reloaded the ambulance with our equipment, sat in silence as I completed the paperwork that I'd struggled to fill in while in the house, and fought to comprehend all that we'd heard. After writing the empty words that described all that had clinically occurred, we returned to the house one last time to explain to Rosa what would now be happening.

Once we'd finished and offered our condolences, Rosa got up and saw us to the door.

"Don't worry about me", she started. "I've got my friends and neighbours. They'll help look after me".

And as we stepped back out over the threshold, as a farewell comfort from her to us, she called us back again.

"I'll be fine", she said. "I'm a survivor".

I know she is. I just hope I've done her story justice.

Motorcycle Response

A motorcycle response unit is parked on the edge of a pavement, keeping both road and pavement clear for traffic as well as pedestrians. 

The paramedic, a friend of mine, is in the house tending to a critically ill patient. 

When they return to their bike, this is the graffiti they find scrawled on the clearly marked, safely parked, bright yellow, blue-light, emergency ambulance motorbike:

It's not too clear, so just to help, it reads as follows: 

"Learn to park. Roads for vehicles, pavements for people!" 

The audacity of some people in this wonderful city of ours, often astounds, upsets and saddens me. I just hope the "artist" never needs our help. 

Vote Now Open!

The voting for the "Blog of the Year" has kicked off in earnest over at FireCritic's blog. There are two categories - one for EMS blogs, and one for Fire blogs. 

Although I was nominated, an honour in itself, I wasn't included in the shortlist of finalists, so luckily for you, dear reader, no begging letters from here. 

I do, however, know how much effort goes into writing these blogs, and understand that recognition is an important part of keeping these blogs alive. 

I think I know who I'm voting for. Since you can vote once every twelve hours, I'm probably going to split my vote two ways in the EMS category, and another one for Fire. 

So, please, head over to the Voting Page, and show your support. It will truly be appreciated! 

Birthday Boy

The shift had been relentless:

Two unsuccessful resuscitation attempts, including one young person. 

One serious motorbike accident, unlikely to survive. 

One serious stroke, unlikely to survive.

Two asthma attacks. 

And a twenty year old with tonsillitis somewhere in the middle of the mess.  

There was still an hour left of the shift, and we hadn't stopped once in the previous eleven. I was working with Gary, 50-something in body, still a teenager in spirit. He'd joined a little before I did, his previous job having lost its sparkle, as he looked for a new adventure whilst headed towards the end of his forties. In the short few months we'd worked together, we'd found a rhythm. We each preferred different types of calls, we could tell when the other was off-colour, but would both kick into gear when it was really necessary. Sometimes there was no need for words. Whatever needed doing was just done. 

This time, it was his turn to drive and mine to attend, yet as with most regular crews, it was more a case of who was in charge of the writing, and who of the driving. The actual caring for the patients was done by both of us irrespective of what was on the actual ticket. 

"You OK?" Gary asked, as I rested my head back on the attendant's seat, closing my eyes for a second. 

"Think so," I sighed, "just a bit tired. It's been one of those again, hasn't it?" 

"Well, they can't throw anything else at us now, can they? There can't possibly be anyone really sick left!"

With that, we pushed the green button to let the Brain know we were ready to go. Just one more call, and then it'd be home time. Within seconds, the computer rang, and another call appeared out of the ether. 

Toddler-aged, fallen, bleeding from the ear, unconscious. Address? Two hundred metres from the next hospital down from where we were.

I stared in disbelief at the screen, my head and insides screaming for some sort of respite. This doesn't sound like the sort of call that is going to be an easy, end-of-crazy-shift, non-thinking, walk 'em on, walk 'em off the other end type. 

Gary drove as quickly as the rush-hour traffic would allow, the flashing lights and blaring siren apparently  completely invisible and inaudible to the people rushing home to their families after a long day at the office. The frustrations were building, the anxiety of the unknown trauma caused to the child beginning to play havoc with my already shattered brain and body. Adrenaline was building up and coursing its way through my bloodstream, and was only increased when what seemed like half the street were stood outside and waving frantically to show us the right house. 

As we pulled up outside, I jumped out the door, grabbed the bags from the ambulance, and ran up the stairs following the man who said he was the baby's uncle. 

"What's happened?" I ask the uncle. He either doesn't hear the question, or doesn't understand it. 

"Just come quickly, look, see!" Gary's a step behind me, and equally as anxious. 

We step into a lounge, balloons and streamers are everywhere, and a banner that reads "Happy 2nd Birthday" hangs above a shelf that is covered in cards. There are at least thirty people in the room, some eating cake, some drinking tea or coffee, all chatting amongst themselves. The birthday boy sits in the middle of the floor, surrounded by presents and wrapping paper torn to shreds, beaming from ear to ear. Cake crumbs are strewn all around him, and blue and red icing covers his face, leaving him with an almost clown-like appearance. 

The adrenaline build-up had no practical escape, and I lost it. 

"I thought he fell?" It was more a demand than a question. "I thought he was unconscious? And I thought he was bleeding from his ear?"

"He IS bleeding!" It was a new voice, another male, who identified himself as the father. "Come and look!"

He picked up the toddler, who cried at being dragged away from his new toys, turned him sharply round, and made me gaze at his left ear. There, at the top of his ear, was a pin prick of dried blood. "He scratched it with this toy, and we want you take him to the doctor. I knew if I said he was unconscious, that you'd come quicker. He needs to be back for the rest of his party!"

Through gritted teeth, I started to answer him back. I got two words into my sentence, when there was a hand on my collar, pulling me back. 

"Go out to the ambulance, and get the bandages ready." Softly spoken as ever, Gary prised me away from the situation, and gently threw me out the house. "We'll be down in a minute." 

The parents demanded that their little boy be seen at hospital, and we obliged, but this time Gary stayed in the back, and I drove. I couldn't guarantee that I'd bite my tongue long enough to get us through the two minute journey. Gary took them into the department, and as they walked past the front of the ambulance, I wound down the window and called out to the patient.

"Happy Birthday," I yelled, as I sat and pondered just how close I had come to losing everything I had worked for, if Gary hadn't have stepped in when he did.

The little boy grinned back, and shyly hid his head in his father's shoulder.

"That was some day," Gary sighed as he stepped back into the cab.

"Could've been worse!" I answered, not entirely convinced myself. "Here," I said, handing him the keys to the ambulance. "Drive us home."

It was a silent ten minutes back to station, as we both mulled over the day's events. Back at the station, we gathered our belongings, tidied up the ambulance ready for the next crew, and set about going our separate ways. As Gary was stepping out the back door of the station, I called after him.

"Thanks for today, especially that last one. You probably saved my job!"

"See you tomorrow, we'll do it all again."

"Isn't it your birthday tomorrow?"

"Yup. But I'm not planning on cutting my ear, so I reckon I'm safe."

He laughed, and I threw an empty plastic bottle at him, which dropped a couple of feet short, but made him trip over his own feet as he tried to beat a hasty retreat. It was my turn to laugh.

"See you tomorrow Birthday Boy." 

Hysterics

As I mind my own business walking around the local supermarket someone I've never met starts a conversation. 

"You don't remember me, do you?" 

I get nervous when I hear things like that. She'd walked past me down one of the aisles a few minutes earlier, and gave me a funny look that I just shrugged off. Her daughter, probably three-years-old, was sat in the half-trolley, half-car, trying to grab anything off the shelves that took her fancy. I recognised the constant struggle with a toddler, and was pleased that I no longer have to deal with it. Having said that, bigger kids, sometimes bigger problems.

"Sorry, I don't remember." 

"Well, do you remember my daughter?" 

"Also not. I'm sorry. " I'd put the idea that she could have been a patient out my head, as I live and shop some distance from where I work. 

"Well, really, you should remember her more than me, as you met her first!"

"Pardon?"

"Well," she said, clearly enjoying the exchange as much as I was confused by it, "this is Aleesha, and you and your colleague brought her into the world!" 

A few seconds passed as I regained my composure. 

"Oh! Wow! I've never met anyone I've delivered before!"

"Well, now you have!" She turns to Aleesha, just as the toddler's about to take some chocolate from the shelf.

"What do you say to the nice man?" 

Aleesha quickly hides the chocolate in her car, looks sheepishly down at her feet and mumbles a barely audible word. 

"Sorry..." she says, as mum and a very strange man burst into hysterics. 

Inside Out

She tells us she's scared, as she hasn't been out the flat in years.

Her carer does the shopping, but hardly seems to care. 

Her cleaner launders a few clothes, yet does very little cleaning. 

Her doctor attends by phone call, and just extends her prescriptions.

Her pharmacy delivers the medication, leaving it on the doorstep.

Her family, and her hope, have long since gone.

And as we leave with her on a chair, 

Out into the big wide world for the first time in a decade,

We notice the "Welcome" mat by the front door. 

Facing from the inside,

Out.

Three Meetings

The first, when I was a teen, at a seaside resort. The theatre was packed full of excitable kids as you made your appearance on stage. The cheers, the jeers, the laughter, watching you make a fool of yourself, as you appeared to love every moment. A classic children's story brought to life on the colourful stage to an appreciative, childish audience.

The second, as an adult, on the silver screen. A rare visit to the cinema with my wife. A hushed respect from a more mature audience as you displayed your talents and masterfully portrayed the plot the scriptwriters had presented to you. Their story, but you made it yours.

The third, as a paramedic, in the lounge of your apartment. You lie on the floor, silent, motionless. As you're unable to tell a story of any sort, emptied cans of beer, spent syringes and bloodied razor blades tell the tale for you.

As we leave the hospital, I wonder if there'll be a fourth. 

Destiny

The fact that it's a regular occurrence doesn't make it any more comfortable. At least once a month, there's a call into the Custody Suite at one of the local police stations. The word "suite" belies the stark reality of concrete boxes with no more than a tiny window and an open toilet. The stench of both the current resident and all those who had spent miserable hours in the grey, gloomy cells is often overwhelming, sometimes bearable, but never pleasant. Calls to this place are more often than not an attempt to fake an illness or injury in order to end hours claustrophobic hell. Five minutes is more than enough for me. 

This time the call was for leg pain, post fall.

A police van was parked in the middle of the car park, just by the entrance to the cells. There was some yelling from the van, an incoherent babble about police brutality. Threats and promises of revenge, complaints about treatment and talk of lawyers all doing nothing to rattle the officers standing outside. I thought to myself that he'll probably be our next customer, when he also gets bored of the solitude. Between the van and the building is a wire cage, just large enough for a prisoner and two accompanying officers, leading to the heavy blue door with the one-way latch. We step in to the wire cube, the crew and I, and as we are about to enter the building itself, a call from the van spins us round. 

"He's in here!" I'm thankful not to have to step back into the cells. 

We walk back, and a sergeant quickly fills us in on events. 

"We nicked him for shoplifting. He saw us coming, ran for about a mile, and after running down something like forty stairs, he fell over a simple kerb. Ironic really." The sergeant couldn't hide the smile. "He kept going for another hundred yards, then fell to the floor. Once we got hold of him, he walked to the van, assisted by these gentlemen, and only started screaming about his leg as we pulled into here. Probably the usual trick, but he won't let us move him, and every time we try, he screams like a woman in labour!" 

Rob's still in the back of the police van, shut in the cage that will make a custody cell seem like a penthouse. As soon as the van doors open, his rants become louder and he starts to spit at the officers. As well as the metal housing, the cage is surrounded by perspex, so the spit just rolls down the plastic and onto the floor. One of the officers shouts at him. 

"We've got the ambulance here for your leg. Now shut up, calm down, and stop behaving like an idiot, and then we'll let the crew look at you!" 

A different person answer from inside. 

"Yes, sir." His tone was suddenly calm, he sat bolt upright, and waited for the cage door to be opened. Three officers stood by the door, just in case he ran. 

"Where do you think I'm gonna go?" He laughed. "Have you seen my leg?"

The police stood back, and let us in. 

"A word of warning." I said to Rob, taking a wary step forwards. "You spit at me, and police witnesses or not, I'll knock you out!" I've never knocked anyone out, but if anything's likely to bring me close, it'll be a spitter.

"No way, sir. I'd never do that to you guys. I respect you too much!" The alcohol on his breath could have knocked out a rhino at a hundred paces, and I was concerned that intoxicated, he'd soon change his behaviour again. 

"Right, well you make sure you remember that then." 

Rob smiled and rested his head back on the wall of the van. As we tried to remove his boot, Rob screamed in agony, even with all the alcohol on board. A pair of shears, a lot of entonox, a touch of morphine, and some choice words from Rob, and we could finally see the problem. Both bones of his lower leg were visible through the skin, the sharp edges of a traumatic fracture making easy work of the thin flesh. How he walked anywhere after his fall was a miracle. 

Once the pain killers joined the alcohol, Rob was calm enough for us to pull his leg straighter, splint it and move him to the ambulance. I didn't dare risk much more of the morphine, not wanting to take the gamble of stopping Rob's breathing all together, so I handed him back the entonox. 

"The police told me that you were screaming like a woman in labour. So here's the stuff they give them, should you need it." 

"Thanks," he answered, and took a large, deep breath on the gas. 

He refused to give us too many details. He either didn't want to give us an address, or genuinely didn't have one. He gave his date of birth as the 31st of September. 

"There isn't a 31st of September!" said one of the crew. 

"There was in the year I was born. It was a double leap year." After we all laughed, he clammed up completely, until we opened the doors at the hospital, ready to take the trolley off the back. 

"It's not my fault that I steal, you know," he started, "it's my parents'. Just look at the name they gave me! I mean, what do they expect if they call me Rob?" 

"Surely it's short for Robert?" asked the accompanying officer. 

"Well it is, but they've always called me Rob. It's obviously my destiny." 

"Not with that leg it isn't", mumbled the officer as we stepped out of the cold air and into the hospital. 

Nominations...

... are open for the following competition.

The 2010 - 2011 "Black Diamond" Fire and EMS blog of the year.

Follow this link for the rules and regulations on how to vote for your favourite. There are two strands as you can see. One for Fire, one for EMS.

There are a huge number of great blogs to choose from. Go and lend your support!

Irony

You're sending me? To this?

Lift Assist

Normally, the two-word title of this post indicates what is a frequent and relatively easy call. A faller, most often elderly, just needs help getting back up off the floor again. No life and death emergency, no injuries to treat, just a helping hand.

Norman pushed the pendant round his neck which called the careline, and they called us.

"90 year old male, on the floor, unknown injuries. Possible assist only. Key safe by the front door, number 1234. No further details."

I arrive to find that we don't need the key safe - the door's ajar. I knock and yell as I step over the threshold.

"Ambulance service, where are you?"

"In the front room. Come through."

I walk in past the stairs and through the dated hallway and breakfast room. The lounge is warm, a gas heater blowing full force. Family photographs grace the walls and shelves, some recent, some from times gone by. A black and white of a bride and groom, an enlarged reproduction of the seventy year original, takes pride of place in the centre of the room, right above the fireplace. A younger Norman smiles down onto the room, as an elegant bride stares lovingly into his eyes.

Present-day Norman is sitting quite comfortably in a large recliner arm chair.

"I thought you were on the floor!"

"Where did you get that idea from?"

Apparently careline didn't quite understand the problem before calling for ambulance help.

"So what has happened this morning then, sir?"

"All I said," he laughs, "was that I couldn't get upstairs to bed. I get around alright on my own, but I use the stair-lift to get up and down. Can't quite manage the stairs any more. Damned stair-lift won't work, so I asked if they could send someone to help."

"And here I am. You sit tight for a minute and I'll go have a look at it."

Back at the staircase, the chair stubbornly refuses to move. I push all the buttons I can see, until suddenly I find a key hidden under one of the arm rests. It has two positions.

On.

And off.

A quarter turn and click later, the chair comes to life. I push the buttons, and then it glides all the way up, and gently all the way back down again.

"Norman! Fixed it!" I shout into the lounge. I walk back to help him up, only to find he's already half way to the stairs.

"Well done sir!" The relief is evident. "I've spent the last two hours trying to get that thing to work!"

I explain how I won the battle with the disobedient lift, and he roars with laughter. He takes a seat, presses the button, and I follow the quietly whirring mechanism as it climbs the staircase. Norman makes his way from the top of the stairs to the bedroom and sits himself down on his bed. A small framed photograph sits on the bedside table. The seventy year old original, sitting next to a an empty mug.

"Pretty girl you married."

"Very pretty, until the day she died. She left me four years ago. Used to make us both a cup of cocoa every night as we came up to bed. That's what the mug's from. Every so often I'll make myself a cocoa, but I never use this mug. It's just there for me to look at and remember." 

He stares silently into space, trying to cram in as many memories into a short space of time. 

"I'm sure it's her that gets up to all these high jinks, just to keep me on my toes." He adds after a moment.

"And I'm sure it makes her smile every time, too." 

"More than likely. Thank you so much for your help. At least I can sleep easy now." 

I left the room, turning off the lights as I went, and shut the front door behind me. All that's left to do is the paperwork.

Name: Norman.

Age: 90

Presenting condition: Lift assist.

Shortlist

It all seemed so simple. We turned up at the house for what appeared to be yet another "maternataxi". An ambulance being called to a woman in early labour for simple transport, where after nine months of preparation, buying clothes, painting nurseries, and building cots, no-one had thought about how to get to the hospital. Either that, or it's just that we're the cheapest option. Taxis cost money, as does parking, so an ambulance that will deliver you (sorry) to the front door and not cost a penny is a very attractive proposition.

Zara had two days to go according to her notes, but babies rarely arrive exactly when expected unless it's by planned Caesarean. Whoever called the ambulance told the call taker that the contractions were two minutes apart, whereas in reality it was nearly five. Her waters hadn't broken, this was her first pregnancy, and she wasn't too troubled by the contractions even when they did occur. Her husband said he'd make his own way in the car. He could have taken Zara too, but probably feared the mess if she delivered on route. Either that or he panicked. I gave him the benefit of the doubt as it was their first baby.

"Which hospital are you booked into?"

"Faraway hospital," she answered. Not the answer we'd hoped for. There were at least five other maternity units that were nearer in all directions, but if that's where she was booked, that's where we were taking her. It was over half an hour away, if the traffic was bad it could be double that, and the only reason she wanted to go there was because she had heard from friends that it was a good place to go. She never quite took into account the fact that she actually had to get there, and possibly in a hurry.

"Lucky you're not booked into Edinburgh hospital!" I commented, only half joking, trying to hide the nervousness I felt at a long trek with a labouring mother-to-be. Zara's husband stuck his head back in and asked if we would take the luggage as well and then he'd follow us to hospital.

"I'll be right behind you. Don't have the baby without me!" I hoped Zara's husband was right. We told him that if the traffic was particularly bad, we'd cheat and use the lights, and he had to make sure that he got there safely, even if it meant a slight delay.

I was fairly new, with only one delivery under my belt, an easy home birth where the midwife turned up less than five minutes too late. I was working with a partner who'd long ago lost interest in treating patients. He was working out the years until his retirement and spent most of his time driving the ambulance, ignoring both patients and crew mates alike.

"She'll be fine," he said, "we'll make it there with enough time for us to grow the coffee beans and still drink them before she has this baby." With that, he shut me and the patient in the back, and started gently trundling to hospital. Half way there, something about the way she was contracting changed. The look on her face was more anguished, the mix of gas-and-air in the bottle with the chipped blue paint no longer worked its magic quite so effectively. I called through to the front and explained what was happening. My crew mate looked up briefly in the mirror, switched on the lights and pushed the engine a little harder. The engine roared a response, but the actual change in speed was barely perceptible. Zara certainly didn't seem to notice the difference. I placed a maternity kit on the trolley, just by her feet, hoping the clear plastic case would remain sealed.

We called ahead to the hospital and asked them to make sure we were met by the front door, as it was notoriously difficult to get into the unit in a hurry. It involved two doors that required remote access, and a lift in between the floors where the doors were located. Waiting at each stage could easily add ten minutes to the journey. The lights and sirens had no real effect on the speed, but at least we could weave a little easier through the daytime traffic. Fifteen minutes and six or seven sets of strengthening contractions later, we pulled up outside the hospital. As expected, despite our prior warning and plea, there was no one there to meet us.

Zara screamed. She yelled about needing to go to the toilet. Desperately. There are two sets of patients who tell us that. One set is those having some sort of cardiac event, who if allowed to go will probably collapse, or worse. The other set is mothers in labour who are about to deliver their babies. As we lowered the trolley out of the ambulance, I was in a way glad of Zara's panic. It was doing a great job of masking mine. We pressed the button and waited for what seemed like an eternity until someone answered. We didn't need to identify ourselves, Zara once again did it for us.

"Get the lift down here, and get these doors open!" yelled my crew mate. It was the first time I'd seen any sense of urgency about the man.

Dragging the trolley up a slight ramp into the building, I prayed for the lift doors to open, and a midwife to be standing inside. Neither happened. I pressed to call the lift, and the square button lit up, its dim red light stopping us from proceeding. As the lift arrived, the light went off and a bell chimed to announce the blindingly obvious. Another chrome button, this time with a large "2" embossed both as a regular numeral and in braille. Once again I cursed hospitals everywhere for not having all maternity units on the ground floor.

We stopped on the first floor, a frightened looking mother and child taking one look inside and deciding to wait for the next time round. Another delay, another contraction, another scream. I frantically looked for the button that closed the doors again, only to find that there wasn't one. Instead I pressed the number 2 again, willing the lift to move. Zara had practically finished the entonox, and I promised her that there was more on the unit. All she had to do was hold on another minute.

I timed it. Forty-five seconds from when we stopped on the first floor, until we starting rising again, another thirty for the doors to open on the second door. As we landed, Zara contracted once again, and begged us not to move until it was over. We stood, waited, and prayed.

"It's coming!" She yelled. "Now!"

My crew mate got out the lift and pressed the buzzer to ask the staff to let us in. A distance of no more than five metres. As he got out and pushed the button, Zara pushed the baby.

There was a gush of water as the amniotic fluid escaped from the sac, and a scream as the baby's head appeared an instant later. The scream was Zara's, but it might as well have been mine. In the meantime, the unit's doors remained firmly shut, the magnets holding them in place still secured by an electrical circuit. Finally, training took over from panic, and I gently held the babies head as it turned. The next contraction didn't move anything, and in between the pains my crew mate resorted to bashing on the ward doors instead of pressing on the buzzer. But it was too late.

One more contraction, and Zara was able to hold her beautiful baby girl.

"Time of delivery - 13:14. Born in a lift."

She seemed, from my limited experience at the time, to be quite a big baby. Thirty seconds after she made an appearance, a midwife finally came to open the doors.

"What gives you the right to make such a noise? We're very busy in there, and if we don't answer the door, you'll just have to wait!" She emphasised each of the last four words through gritted teeth.

"Unfortunately," I said, somewhat cooler than I'd imagined possible given the circumstances, "this young lady couldn't wait any longer." I pointed to Zara and the little bundle she was cuddling, each wrapped in an appropriately sized ambulance issue blanket.

Instantly, the attitude changed. We were led inside, shown into a delivery room, and assisted Zara to move across from our narrow and uncomfortable trolley onto the hospital bed. There was the small issue of the cord and placenta to deal with, of which the midwives now took charge. The baby was taken to be cleaned and weighed, a shout from across the room announcing that what I'd guessed at being 'quite big' turned out to be well over four kilos, some nine-and-a-half pounds.

Zara was given an injection in her thigh, and with that chemical encouragement, the placenta too was delivered. She was free to hold her baby again now she'd been cleaned, and at that point her husband appeared. He was puffing and panting as if he'd been through the labour himself.

"I thought I told you to wait for me!" he gasped, leaning over to kiss both his girls.

"Have you got a name for her yet?" asked the midwife who'd initially let us in, now suddenly full of smiles.

"Not yet," they answered in unison.

"We've got a shortlist," Zara added, "but we hadn't definitely decided. We had a definite name for a boy, but this little one will have to wait a little while."

"How about Ellie?" I ventured. Zara looked offended.

"You mean short for elephant? Just because she's a big baby?"

"Actually, I meant Ellie as in short for elevator. I didn't think about the weight!"

"She was born in the lift?" asked the new dad, his voice an octave higher than it should have been. "How did I miss out on all that action? I can't believe it!" He sank into the armchair next to the bed, gently stroking his little girl's wispy hair. "What do you think Zara?" he added after a few moments. "It's quite a nice name? And what with all the circumstances, it really fits too..."

"I'm too tired to think about it right now." Zara replied. Single tears from each eye took a gentle stroll down both her cheeks as she gazed lovingly at her newborn daughter. "Why don't we just add it to the shortlist?"

December Handover, 2010

The Handover Carnival seems to be back to full strength. This month's edition, initially meant to be about Christmas cheer, but is a bit of a free for all. It has been hosted over at JustMyBlog, whose author now officially ranks amongst some of the best friends I've yet to meet. Maybe one day...

Once again, there are posts from some of your old favourites, some from bloggers I've only now heard of and even one from yours truly. All are worth a read! Well, maybe except for yours truly's.

So head over there, and take a few minutes to catch up.

Reflections

It's that time of year again. A year ends, a new year begins. Everything changes, and yet nothing does. It's a time to reflect on all that has passed, and then resolve for the future.

Reflect on the year in general.

Reflect on my achievements. Have I achieved all that I set out to do?

Reflect on my students. Have I taught them the best practices? Have I taught them anything new at all? More importantly, have I learnt anything from them, as they probably have more to teach me than to learn from me?

Reflect on my studies. Did I attend all the classes I could? Did I spend enough time studying of my own free will?

Reflect on my skills. Did I use them well? Did I learn any new ways of using them? Did I improve them?

Reflect on my attitude to patients. Did I treat the patient at the beginning of my shift the same as the one at the end when I'm tired? Did I treat all my patients with the respect they deserve?

Reflect on the way others see me. Did I give people the need to criticise or praise? And what did I do with either? And when they talk behind my back, are they armed with the sword or the shield? 

But for me, the most important of all the reflections I look at, is the one that looks right back at me.

And for now, as I stand in front of the mirror in an ironed uniform and polished boots, a star-of-life proudly hovering over my left breast pocket, the reflection's looking happy.

Happy New Year to you all.