Greenpeace

Once again, we stand, trolley and patient between us, and we wait. The department is manic. Patients in every cubicle, trolleys in the corridors, nurses rushed off their feet, porters running backwards and forwards to x-ray and the wards, reception staff fending off the masses, and doctors sitting down drinking coffee. (Cheap shot, I know. But it made you smile, right? Unless of course, you're a doctor. And I don't mean it really...)

Jenny, one of our favourite sisters is in charge tonight. Even in the heat of a Saturday night A&E battle she remains composed and calm. A tap on the shoulder and a sheepish "Sorry, we've got nothing for a while!" at least acknowledges our presence, and lets us know that we haven't been forgotten. Not that it's easy to ignore us, both six-foot tall and dressed in blood-hiding green. Her only downfall is her gullibility, especially when it's busy.

Derek, our patient, well into his late seventies, must have been a stand-up comedian in a previous life. From the minute we met him and his probably broken hip, we were in fits of laughter, ranging from giggles to full blown hysterics. The added bonus of giving him some entonox and morphine to help relieve the pain only made matters worse. Trying to settle down once we'd stepped inside the hospital was a little like telling a kid who's having a mad half hour in the evening to calm down and go to bed.

As we stood in the middle of the department, we had time to hatch a plan and had the routine rehearsed to perfection. All it would take was a little composure - easier said than done.

"I'm sorry boys, and you sir," Jenny said as she turned to the patient, "but we're just trying to shift some people from here. We should have half a dozen spaces within ten minutes. I'll be back then and we'll sort you out."

"No problem!" I said, "I'm sure Derek won't run off anywhere in the meantime."

Composure? Lost. Awful joke, I know, but when you've already got the giggles, it doesn't take much. 

Jenny eyed us suspiciously, but went back to her duties and clearing the department. We watched as one by one she kept her promise. Some went up to the wards, others sent on their way with boxes of antibiotics or pain killers, and whilst it all happened, I had the chance to finish writing my paperwork.

Calm seemed to return. When a patient leaves A&E, whatever their destination, their entourage leaves with them, so it's not just one person leaving. Six patients sent on their way can easily mean twenty people exiting stage left. The decibel volume drops noticeably and the overall chaos seems to dissipate, if only a little.

Only five minutes later than the promised ten, Jenny comes back to us.

"Right, now where were we?"

"Morning Jenny. This is Derek. He's a Greenpeace activi..."

"You DO KNOW about Greenpeace, don't you?" Derek's interruption was perfectly timed.

Jenny looks momentarily taken aback, but maintains composure.

"I do know about them, yes. Let me find out what the problem is, Derek, and then we can discuss it later."

"OK."

"As I was saying, Derek was on a protest at the local building site. Apparently they're building on what he says should be left as a nature reserve, so he decided he would start a one man protest. Up a huge crane."

"You were where?" Jenny asks.

"Up a crane. They can't use the damn thing if I'm sitting half way up it!" Derek's performance was so convincing, even I was starting to buy it.

"Right."

"Anyway, we were asked by the police to be on standby, should anything go wrong, whilst they sent some climbers up to bring Derek down. As they neared the bottom of the crane, Derek decided to jump about two metres, fell onto the grou..."

"I didn't fall!" He looked genuinely angry. "Those damned coppers brought me down!"

"Either way, he landed quite heavily, and we think he might have broken his hip. The rest of his observations are fine, and he's normally fit as a fiddle."

"Right." Jenny looked a little puzzled, had a quick look at the side of the paperwork that has all the observations but none of the story, and allocated us a bed without any further questions. "I'll help you get him across."

Derek took a few more deep breaths on the entonox as we lay him almost flat in order to slide him onto the hospital bed.

"We'll have you over in seconds, you won't even know it's happening."

"OK, just do it."

I placed the paperwork on the tray at the edge of the bed, and between us we moved Derek onto the slightly more comfortable hospital trolley. We had to take our cylinder of entonox back, so before we did, I went to find a hospital supply rather than leave him without. By the time I came back, Jenny was reading the paperwork. Story side this time, and tapping her foot on the floor.

She read about Derek's fall at home. How he'd been on the way back from the toilet and slipped. How we got him down the flight of stairs, strapped onto a board and dosed up on laughing gas.

"Assaulted by coppers, huh?" She glared.

"Stuck up a crane, huh?" A hint of a smile.

"Greenpeace, huh?" We knew we'd won.

"You sir, shouldn't help these clowns to get away with this!" Jenny shook her head in disbelief. "You two, just you wait! I'll get you back yet! In the meantime," she paused, "thank you for cheering up a mad evening."

We laughed, all of us. Derek and Jenny included.

"Excuse me, nurse. Can I ask you just one question?" Derek suddenly looked serious again.

"Of course you can."

"Do you really know anything about Greenpeace?"

Two green-uniformed men turned and ran, giggling away like school kids.

Drunken Logic

A man lies on the pavement, missing a tooth and hair matted in blood.

"What happened sir?"

"I fell."

An all too familiar aroma fills the air.

"Have you had a drink tonight?" 

Stupid question, I know.

"Oh, only one or two!"

"Pints?"

"No. Bottles."

"Bottles!? of what?"

"Whisky of course."

Of course.

"What's your name, sir?"

"I don't want to tell you."

"Why not?"

"Because I'm not drunk."

"Well, what do we tell them at the hospital about your injuries?"

"Tell 'em I tripped over my shoelaces."

"But I still need your name to book you in!"

"No you don't. Just call me Shoelace Man."

"Is that your first name or your surname?"

"Both."

"In which order?"

"Either."

"And how do we contact your family to tell them where you are!"

"Call them."

He had the look of a man who'd outwitted his prey.

"I can't call them without knowing your name!"

"Don't worry. My family already know my name."

I give up.

Just in case you haven't already heard...

... 999Medic, Mark Glencorse, is hanging up his quill and closing down his blog. This time on his own terms. An action that will leave another huge void especially in the UK based EMS blogging world.

An inspiration to many people, both in EMS and outside thereof, Mark has much to be proud of. A worldwide movement to improve the job we both love, is just part of the legacy of his blog and his vision.

I couldn't let him just disappear without publicly expressing how he has inspired me, and this blog, and how much his writings, his enthusiasm and his professionalism will be missed in the EMS blogosphere.

Unluckily for him, however, I still know where to find him...

Good luck, Mark.

And thank you.

Making Friends

Michael Morse, one of the best EMS bloggers out there, has written a humbling, haunting, heartfelt post as he hits twenty years on the front line, both in Fire and EMS. In it he speaks of the sights, sounds and smells of all those years, the ghosts and how he thought he could face them all, and how they have affected him over the years. Follow the link and read the post.

Dozens of people commented, offering support, strength and reassurance. Some even expressed their gratitude.

One response in particular stood out for me. This one from Ambulance Driver - another one of the big hitters in the EMS blogging world.

"You will never, ever be able to banish all the faces.

But you can, with a little time and perspective, make friends with the ghosts."

I'm nowhere near twenty years in. But I know exactly what they mean. Both of them.

And I'm still making friends.

Matching Description

Disused, misused, abused.

Once a proud London family home, now a squat for all and sundry.

A solitary ray of light fights its way through the boarded-up windows.

Tiny flecks of floating dust flicker as they pass through the beam,

Disappearing as quickly as they came to life.

The call came from a mobile.

Gave an address, "I think she's dead!" the only scream,

before cutting off the call and turning off the phone.

We arrive, police and ambulance, and all step tentatively into the house.

Not a sound, not a soul, no response to our calls.

Glass breaks underfoot, floorboards creak,

needles shimmer in the torchlight.

Two flights of stairs, rooms on every floor,

each deserted,

dark,

cold,  

unloved.

In the furthest room, in the darkest part of the house,

surrounded by filth, and blood, and human waste, we find her.

Curled up in a corner.

Deserted.

Dark.

Cold.

Unloved.  

And matching exactly the caller's description.

First Steps

A parent's life changes forever on an almost daily basis.

The day a baby's born.

The first smile.

The first tooth.

The first "Mama", "Dada".

The first crawl.

The first steps.

The first fall down an unguarded flight of stairs.

The first broken leg.

The first ambulance.

The first hospital visit.

The first steps again.

Months later.

You Lot

Balancing on the icy pavement, Alfie flags me down and watches the car practically skate down the road towards him. The snow has finally stopped, and what's left on the roads is now compacted into thick sheets of ice. The nights seem brighter, moonlight and streetlamps reflecting off the shimmering surfaces. Abandoning the car in the middle of the road, I step out onto the frozen pavement making doubly sure of each step. Non-slip boots might work on oil, or water, or blood, but they're useless when competing with ice, so I put a bag on each shoulder, hoping for some extra balance.

"She's in here, mate," Alfie yells, already standing back in the front porch. I follow him in, and as I catch up he starts telling me a little about her.

"Mum's got dementia, so you have to take some of what she says with a pinch of salt. Other than that, she's pretty good. Only takes an aspirin every day." He shows me into the bathroom, a favourite haunt for elderly fallers.

"What's her name?"

"Loretta Dent. But just call her Loretta. She's not really one for formalities."

"Hi Loretta," I turn towards the patient, kneeling down beside her, "what are you doing down there?"

"Well, I'm not really sure! I was just on my way back from the loo, about to go to bed I think, and the next thing I know, Alfie's in here with me, a phone plugged to his ear, and he's telling me not to move!" She looks around her, making sure that she really is on the floor, and that she's not going to fall any further.

"Alfie!" She calls. "Alfie dear, be a good boy and pick your school bag off the floor. Your father will be home any minute, and you know how much he hates things in the middle of the lounge!"

Alfie takes me to one side, and explains that his parents divorced when he was twelve years old. He hasn't heard from his dad since, some forty years or more.

"It's alright Mum, everything's clear. Let's get you sorted. This nice gentleman has to come to help you up off the floor." A mock look over my shoulder to locate said nice gentleman fails to do so, and I tell Loretta that I presume he means me.

"Are you a doctor?"

"No. A paramedic. An ambulance man."

"Oh, well you're better than doctors anyway, you lot."

"Must be the dementia!" I say to Alfie, outwardly humble, and inwardly proud. Even a little smug.

"Oh no," he replies, "this time she knows what she's talking about. You lot always have the time for us. When I have to get the doc out for her, they're in and out in five minutes. Hardly bother checking her blood pressure. Sometimes they just guess over the phone, and prescribe something. Think that absolves them of responsibility!"

I don't really know what to answer. I try to defend the doctors, saying that they're on a much tighter schedule than we are and joking that maybe they get paid by the patient, and we get paid by the hour. Alfie just shrugs his shoulders.

The crew turn up a few minutes later, and together we help Loretta off the floor, recheck all the numbers, and prepare to leave her at home so she can get back to sleep. We place her gently back in bed, and Alfie makes sure she's tucked up, the thick duvet covering her up all the way to her chin. I think of how many times I do that for my kids, checking on them several times a night to make sure they're warm enough and all wrapped up, and how many times over the years Loretta must have done the same for him. Years of motherly kindness partially repaid with each gentle gesture. 

"Goodnight, Loretta!"

"Goodnight you lot! Thank you ever so much!"

As we leave, Alfie turns off the light in her room, and walks us to the door.

"Call us again if you need us." I tell him. "If it's before seven in the morning, you might be very unlucky and it'll be us lot again!"

"Careful what you wish for!" Alfie answers. "You never know what she'll get up to in the night. You lot might be back sooner than you think."

Two hours later, we were.

"Oh, am I glad to see you lot again..."

Going Soft

The regulars.

Some are because they have to be, and we really don't mind.

Some are, but really don't mean to be, and we treat them just the same.

And some are, because they just don't know what else to be, and sometimes, despite my best efforts, they do my head in.

Remember this one, the one I complained about? This is the one about whom I regularly think that I'd be glad never to see them again. They'd never been violent or aggressive, but just difficult, obnoxious and regularly lied, and I always worried that they would catch me out with the "boy who cried wolf" syndrome.

Well, I hadn't seen them since, and I remembered musing at the time about the fact that they may not survive the winter, their stubbornness and reliance on alcohol being their major downfall. I happened to have a conversation with one of the receptionists at our local hospital, who also hadn't seen them for ages. There was another crew there at the time, from a different area.

"You talking about such and such? Looks like this, talks like that, smells like something else?"

"Yeah! That's them! You've met them too?"

"Yup. Took them into FarAway hospital only last week!"

I breathed a sigh of relief at the news that they're still alive.

I must be going soft.

Next Time

I hear myself say it out loud,

voicing the thoughts of two hundred people,

friends, teachers, paramedics alike.

"Breathe, damn you, breathe!"

The school playground is cleared of kids,

but nervous, inquisitive eyes stare out from every window.

For all their teenage bravado, they're still kids, and they're scared.

Green uniforms work in a frenzy of organised chaos,

whilst blue uniforms ask questions, keep the peace.

His heart beats, but his lungs are still and silent.

The eyes, the windows into his soul, are glazed, the pupils tiny.

The mask breathes for him, oxygen rushing into the bag and then pumped into the lifeless body.

Cannulas, drugs, oxygen, more oxygen.

And then, suddenly, as the drugs and oxygen nudge into his brain,

he finally breathes on his own.

Minutes later, on route to hospital,

he's sitting on the bed, asking what happened.

We tell him.

And warn him.

And threaten him.

Next time, if there is a next time, he might not be in the playground.

Next time, if there is a next time, he might be all alone.

Next time, if there is a next time,

He might not be so lucky.

Rag Dolls

So far this weekend, I've seen several vehicles whose wheels have been in a somewhat naturally untennable position. Here's one that I didn't witness, but makes for shocking viewing!

Watch as the bus is hit. From inside the bus involved. Watch how they all stand mortified at the impending crash, and how they're each affected by it. Like rag-dolls in a washing machine. Makes you wonder how there were no serious injuries, and think about what happens in a crash. Especially when there are unrestrained passengers...

Now THAT's what I call Mechanism of Injury.

Remember - wear your anti rag-doll device. Popularly known as seatbelts.

On and Off

Through the frosted glass of the front door, we see the outline of a small figure walking down the stairs to let us in. 

"Wonder why there's a kid up at this time of the night?" I say to Lara. 

"Probably wanted to see the ambulance!" she answers.

It's not a child that opens the door, it's Doreen, a silvery-haired octogenarian, as sprightly as someone half her age. We step into the house, and she immediately apologises.

"Sorry it's a bit dark in here. As soon as I switched the light on in the hallway, the bulb blew!"

Even Lara, a good foot shorter than me, towers over Doreen, making me feel like a giant. I look up at the darkened lamp shade and imagine Doreen having to stand on a ladder to get up there.

"Don't worry. Let's go help your hubby, and before we go I'll change the light bulb."

"Oh, would you? That would be wonderful! I won't have to trouble the neighbours again." She looks so relieved, it was as if we'd just told her that she'd won the lottery. "Let me show you to the troublemaker then."

We went upstairs and met Morris, the reason for our call. He'd been unwell and hallucinating for the last few hours. A fever and a strong smell leading directly to the conclusion that he's probably got a urine infection, a regular cause of confusion, especially in the elderly. He'd become very unstable on his feet too, and I didn't want him to even attempt walking on the icy pavement, so I asked Lara to go back for the carry chair. He made it down the stairs under his own steam, pride and determination forcing him to refuse to be carried. It was a compromise to stop him walking all the way to the ambulance. As we got down the stairs, the light was on in the hallway.

"Your lovely young lady here changed the light bulb for me!"

I gave Lara an evil grin.

"A woman changing a light bulb?" I said. "That's a first for me!" It earned me a slap on both arms, one woman on each.

We wheeled Morris out to the ambulance, and Lara went back to help Doreen across the slippery pavements. Once they were both settled, we set off for hospital, and Doreen took a look out the window.

"Oh no!" she cried, "I've just realised I've left the light on!"

Lara stopped the ambulance, took Doreen's key, and went to switch the light back off.

Zapped

The alleyway's smell would linger for a long time. It seemed to cling to my uniform, my boots, the ambulance, and in particular, my nostrils. Boxes of discarded food, bags of waste, animal waste, probably human waste too. And in amongst it all stood Larry.

"Come one step nearer, and I'll kill you. Then I'll kill myself!"

The machete in his hand proved the seriousness of his threat. I'd met Larry before, only once, at a nearby bus garage. Just another homeless man in the sea of misery and despair that still shocks me in a first-world city such as ours. Looking twenty years older than the early forties he really was, all he wanted then was somewhere warm and dry to spend the night, and we obliged. Much to the disgust but resigned acceptance of the local hospital. They placed him in the waiting room where he slept the night away, awkwardly perched on one of the wooden seats.

This time was different. He was angry, frustrated by the cards that life had dealt him. He was desparate.

"I just want to end it all. You can't help me, and I don't want you to try!"

I didn't dare open my mouth yet. There was a line of police officers between Larry and us, each carrying a shield and covered in body armour. The absurdity that the only people who regularly carry weapons in this country are the criminals, seemed all the more frightening as we waited for the armed response unit to arrive. One of the officers, taking on the role of negotiator tried to talk to Larry, eliciting nothing more than threats that were becoming more real by the minute. We heard more sirens in the distance, the distinctive sound of the armed unit's cars speeding their way through the streets, and as they arrived, there was a definite change in the atmosphere around us.

We had no idea he was armed until we turned up on scene. All we had was a call to a distressed male threatening passers by. No one bothered to tell us that the threats were more than just verbal, and when we were told that the police were on scene, we expected nothing more than a panda car and a couple of local officers.

The police seemed to have a little more information, but it never reached us, and as we pulled up to see several vehicles and a dozen officers dressed ready for battle, we realised that the call was a little more than the initial disturbance we'd assumed. As he started swinging his arms at the cordon, we finally saw what we were dealing with. The alleyway was a dead end, but humans when frightened and cornered, just like animals, will try to battle their way out. Larry could only see one way out, and he seemed determined enough to take it.

He took one swing with the machete towards the line of officers, more a threatening gesture than a real attempt at causing harm. The entire line shuffled a step backwards and erupted into loud calls to put the knife down. Larry laughed. A manic, full-bodied laugh that turned unexpectedly to tears.

"Go away," he sobbed, "and leave me alone to get on with it! I don't want to hurt anybody. I just want to die!"

Two armed officers had joined the ranks, with several others a row behind, using the shields already present for their protection. The standoff tensed, and the sight of a dozen armoured personnel standing over a lone, tormented soul, protected by nothing more than a t-shirt and frenzied arm-waving, turned almost surreal. Negotiations continued, Larry shouted some of his replies, whispered others, and intermittently threatened to put the knife to its intended use.

We stood there for over an hour, a dozen or so paces behind the front line. Crowds of people had gathered at all the police tapes, trying to catch a voyeuristic glimpse of the drama unfolding on their streets. Dozens of police cars and vans were both inside and on the edges of the cordon, along with a solitary ambulance. The presence of the large yellow box on wheels looked almost symbolic rather than functional in the sea of silvery-blue.

In an instant, the mood changed. A chorus of voices yelled at Larry, and two red laser dots appeared on his chest. Over the top of the line of officers, a glint of steel reflected the blue LED lights from the police cars and seemed to come a little nearer. Larry screamed back, frantically flailing and warning the police to stay back. A combination of stupidity and curiosity made us take a few steps forwards, just in time to hear more warnings in both directions, hear a crackle through the air, and see Larry's torso get hit by two spikes. 

The moment he was hit, Larry let out an almost primeval shriek, his body stiffened, the machete fell one way, and he the other. Seconds later, it was all over. Half a dozen officers were on top of Larry, securing him, ensuring his safety and theirs. The knife was removed and placed in a large plastic tube, and Larry was carried face down onto the back of the ambulance. I'd only had the training two days earlier on how to remove Taser barbs, and was probably inappropriately pleased to get the chance to use the training so soon after.  

Larry was sat up on the trolley bed, restraints in place around his legs, handcuffs holding his wrists behind his back. He was no threat to anyone now, least of all and most importantly to himself. We removed the barbs from his chest, at which he flinched but hardly made a sound. Two officers were stood by the top of the bed, ready to pounce in case he made an unlikely and frankly impossible dash for freedom. Once the barbs had been removed, we lowered the head of the bed down a little, allowing Larry to lay on there a little more comfortably, on his side facing us, easing the pressure off his cuffed hands.

As we took Larry to hospital with what seemed like a battalion of police officers accompanying us, there was an eerie quiet, each of us mulling over everything that had just happened. I was writing notes, the officers were standing guard. Only the noise of the sirens made any impression on the surroundings. Finally, Larry broke the silence, as he turned to one of the officers.

"Are you the guy that zapped me with that thing?"

The reply was gruff, pointed, matter of fact. "Yeah, it was me. What of it?"

He broke down again. "Thank you for saving my life."

And I thought that was our job.

More Big Problems

Rather than a reply in the comments section of the Big Problems post, it seemed easier and probably more effective to write a continuation. I know I'm not very good at replying to comments, something at which I intend to improve, but just so you know, I read and appreciate them all! Well, except the spam ones wanting to sell me watches, bank accounts in the Far East and prescription drugs...

It's a difficult issue to tackle, because I genuinely believe that there's no one simple solution, much like a large number of issues within health care. Luckily, I'm not big, brave, clever or well paid enough to make these decisions, but as they do impact me directly, I see no reason why I shouldn't have my say.

Paying for health care has always been, and will continue to be a contentious issue in these shores. In North America this argument, to a certain extent, is incongruous with reality, as the vast majority pay into an insurance scheme and receive their health care dependant on if and what they've paid. However, on both sides of the Atlantic - times, they are a changin'...

As far as taxing foods that are bad for us, and those taxes going directly to health care, well, in truth, that already happens. There's no VAT (purchase tax) on food that isn't considered a luxury. Fruit and vegetables are tax free. Chocolate isn't. Simple. Putting up tax in a way that would make these luxuries only affordable to the upper echelons, will only mean that we have very fat rich people. Well, maybe not. But the question remains of how much of a nanny state do we want to live in? Do we want a government scheme by which you must clock in the exact number of calories you've consumed every day? The idea is impossible to manage, and is the antithesis of living in a land where we are free to make our own choices. And as Fee said, taxing cigarettes and alcohol more and more every year, seems to have done nothing to reduce the overall number of smokers and drunks.

Girliebob made a fantastic point. We can't judge whether a person's worthy of an ambulance just because they're overweight. She's paid umpteen years worth of income tax and national insurance into the system with no obvious return from health care, and should be no less entitled than the young mum next door who's feeding three kids on state benefits, despite having paid in nothing. Irrefutable logic.

A private message I received also questioned the charging of patients who self-harm. More often than not, self harm is caused by mental health issues, whether short-term, temporary issues, acute moments of madness if you will, or some who are chronically ill, clinically depressed, and on a downwards spiral that society struggles to understand and accept. Do these people, those who take blades to their arms, those who genuinely attempt suicide, deliberately overdose on drugs, also deserve to be charged when using the health care system? I'd find it very difficult to justify that these people should be charged, despite the fact that these injuries are self inflicted.

Charging for medical services does occur,  even in the UK. We have to pay for prescriptions (certainly in England and Scotland, although the Welsh get them, errr, scot free), we pay at least part for dental care, even under the NHS, and I suspect that more charges are coming. Minty mentioned frequent callers and also questioned at what point on the overweight scale would we start charging. They're good points, and I wish I had the answers. But then, I'd be a politician and have to make them up, so I think I'll stick to what I hope I'm good at.

I've said it before. The NHS is the victim of its own success, and we're all going to have to get used to the idea that the free ride is well and truly over, at least to some extent. I still don't have the answers, but the questions are fascinating, and the discussions you all prompt are even more so.

I'll leave you with yet another point to ponder.

What about the smoker who improves their life by giving up the cigarettes, but then puts on the weight because of it?

How Many???

Sometime overnight, it happened.

If I'd have really been hit that many times, not only would I be battered and bruised, but broken completely.

Three B's.

Luckily, hits in this blogging business are a good thing.

Each milestone astonishes me. Each new post, each day, each month, each visitor to the site is one more than I ever expected.

So, two-hundred-thousand visits later, the three B's are no where to be found.

Instead, there are the three H's.

Honoured, Humbled, and Hopeful you'll keep coming back.

Thank you all.

Big Problems

Remember this post about drunkenness, and the discussion it generated? I still don't have the answers, but I'm always coming up with more questions!

So, here's another one. Go read the following article and watch the video, then come back.

http://www.bbc.co.uk/news/health-12287880

How do we deal with another one of society's big problems? And yes, the pun was intended. These ambulance and hospital adaptations are not for the almost run-of-the-mill 100+ Kilo (220+ pound) patients. A two-person crew will regularly need to carry these sorts of patients down a flight of stairs. 

These specialised beds, equipment and ambulances are for patients double that, sometimes, as the report suggests, even triple and more. I sat listening to an overnight radio presenter talking about it, and listeners calling in adding their suggestions, frustrations and solutions. As usual, there were the calls for these patients to pay for their specialised care, or be refused it. Passions ran high between those who have clearly never experienced the problem, and those who face it on a daily basis. People were claiming that as morbidly obese patients bring their condition upon themselves, they don't deserve free NHS treatment, whilst the obese themselves (by their own admissions, this was radio after all), claimed that life-style choices are not the benchmark by which the NHS allocates treatment.

So I ask again.

What about smokers who suffer lung cancer as a direct result of their habit?

What about extreme sportspeople who get injured in their pursuit of adventure?

What about drunks who fall and crack their heads open due to their intoxication, be it acute or chronic?

Do we bar all of them from free treatment, as these are all self-inflicted?

The NHS is still, for the most part, a free service, and proudly calls itself the envy of the world. Its staff, for all their grumbles, are proud of what they do and are dedicated to it.

But everything comes at a cost.

For every bariatric ambulance, somebody, somewhere, will be denied some other treatment.

And whilst the ambulance in this report seems to have all the equipment, there's still one glaringly obvious omission.

What happens when there's a flight of stairs to contend with?

What about the physical cost to the crews?

I only have the questions, and an undecided mind.

Answers are another thing all together.  Education is clearly one of them, as with everything else, but over and above that, I really don't know.

Do you?

Flowers

Behind the familiar yellow sign stood a tree scarred by violence. The impact had been unforgiving, shattering bones and shredding skin, leaving Yvette barely conscious, moaning in pain. She lay on the ground, her head by the tree and feet stretched out into the road. Her bike a hundred paces further down the tarmac, collapsed on its side like a mortally wounded animal. We treated and packaged her gently, efficiently, whilst at the same time graciously waving off offers of help from well-meaning yet misguided passers by, each with something to say, yet nothing to offer.

I didn't witness the accident, only the aftermath. I had nothing to offer to the phone number on the sign. I was only a witness after the fact, to its immediate repercussions. Behind the sign stood a wall, tall, mercifully untouched by human tragedy, but bearing the weight of so many flowers and cards. The sight of these took me back, and left me reeling. Yvette seemed so alive, fighting so hard when we left her at the hospital. I knew that she'd made it to theatre the very same day, and knew nothing more now that the weeks and months had passed. I didn't expect the tributes to be there, but couldn't stop to read them, and hoped to get back to the distant hospital to find out more.

She had an unusual surname, one that for some reason stuck in my memory, even weeks later. When I finally got to the hospital, I asked the receptionist if she could find out what happened. As she typed in the surname and a range of dates, the sand-clock timer turned slowly on the screen making me even more anxious. I finished the paperwork for the patient I'd just delivered whilst I waited.

"Yvette," said the receptionist, making me look up quickly from what I was doing, "was taken to theatre, and admitted to one of the wards."

"And then what happened?"

"Exactly a month later, to the day, she was discharged home!"

I finally exhaled, the breath I'd been holding flying free as relief washed over me.

Instead of mourning a life lost, I left, celebrating a life saved. 

Yet I still wonder about the sign, the untouched wall, and all those flowers.

Often, Sometimes

Dozens of times, each time different, yet each time the same.

"I'm sorry. There's nothing else we can do."

Often at home,

Sometimes at hospital.

Often, there are tears,

Sometimes screams.

Often silence.

Sometimes hugs.

Often phone calls.

Sometimes, oddly, smiles.

Often confusion.

Yet always, as we leave, we leave nothing but an empty, dark void.

And questions. Always questions.

Each time may be different, yet each time is the same.

And each time, I'm sorry.

Countdown

I know I posted this on Twitter yesterday, but it was too good not to share here.

Normally, on Countdown, the contestants have thirty seconds to solve the letter and number puzzles.

Do you think they should have 8 minutes to respond to this one?

Wanderings

My head takes me to a different time and a different place. It's somewhere around eleven o'clock in the morning there, a city I hadn't seen for almost twenty years. The famous bridge looking over a beautiful harbour, ferries sailing across from Circular Quay to oddly named suburbs like Manly, the shell-shaped opera house that its creator never lived to see completed.

I have fond memories of Sydney. It presented me with my first experiences of rugby and cricket, and even my first ever international football match. The beach was never more than twenty minutes away and so much of life was based on being outdoors. As we were chilling in the big freeze in London, the person I was calling was enjoying their summer. Well, all except for the cricket scores.

It's not a habit of mine, making long-distance calls from other people's phones, but this time, I have no other choice. Leon lived on his own, his nearest living relative the son we were now trying to reach. Friendly neighbours were plentiful, but how friendly they would be if woken at midnight was another question. The police had found him wandering the streets in the middle of the night, dressed in nothing but a dressing gown and slippers. He had no money and no keys with him, and was completely lost. The police had discovered his address, and luckily he had a key-safe by the front door to which he somehow remembered the number so they could get back in. The police then called on us just to "check him out" and put his mind at ease.

Physically, Leon was fine. His numbers all added up, he felt generally well, but from what we could ascertain he had never before gone strolling in the middle of the night. He also couldn't remember where he lived, and didn't recognise the fact that when the police found him they were only a block away from home.

Dementia was listed as his only medical condition, and having finally got through to his son, we discovered that it was still fairly mild. His short term memory was affected intermittently, but he would normally function day-to-day quite happily and capably on his own. He had a cleaner come in once a week who would also take him shopping since he'd had to give up driving. Otherwise, he did everything on his own.

Nocturnal travels, however, were a new, potentially hazardous occurrence, and left us all with a problem.

I was loathed to take Leon to hospital, but had no other way to guarantee his safety. There was no-one we could ask to come and stay the night, just to make sure he stayed home. Leon was reluctant, and his son even more so, but both saw the logic to the argument that we couldn't just leave him alone. Hopefully the hospital would be able to care for him until his son arrived from the other side of the world.

"We've been thinking about a residential home for Dad." He tells me that they'd had honest discussions, and that the plans were in the pipelines. Now they'd have to be brought forwards. "I can be there in thirty-six hours."

"Don't forget it's winter here," I told him.

"Oh, I know. I'll say goodbye to summer as soon as I take off from the airport."

As we all stroll out to the ambulance, my mind takes its own little walk and wanders back again to Sydney's Kingsford-Smith, my last sight of it, and its runway that ends in the beautiful blue sea.