Signs of Life

A thin sliver of sky turned from dark to dawn as a new day started to break over the horizon. Birds hidden in the leafy trees sang their chorus as two ambulances arrived simultaneously, shattering the peace. A police officer stood banging on the front window trying to raise the occupant's attention. As we joined him, a neighbour approached. 

"She hasn't moved from that chair for days. I reckon she's dead by now!"

"And what made you call us this morning, instead of days ago?" 

"Not sure. I was just about to go to work, I'm a tube driver, y'know, that's why I start early and thought that this is ridiculous. So anyway, I called the Old Bill. Why don't they just smash the door in?" Six sentences all at once left me wondering which to deal with first. 

"I think they need to make sure that that's absolutely necessary before they take drastic measures. Believe me, if they think that they need to, they will." 

I stood alongside the officer at the window, and could see now why they weren't breaking the door down. Despite the occupant being somewhat obscured by a television and some other household furniture, we could clearly see the rhythmic movements of someone breathing regularly. 

"She's deaf y'know!" We all turned to look at the neighbour. "Last fifteen years she can't hear a bloody thing if she ain't got 'er aids in! I think she leaves 'em out on purpose sometimes!"

"You didn't think to tell us that ten minutes ago when we started waking the neighbourhood?" 

"Errr... Sorry." 

"How old is she, anyway?"

"Dunno. 'Bout eigh'y, nine'y I guess." 

A police van turned up carrying the duty sergeant who was quickly brought up to date on the story so far. I shot him a mocking look, knowing that it's rare for stripes to come out when it's dark. 

"Slow night." He shrugged and smiled. "Fancied some action!" 

He suggested using the van's search light as a last attempt at waking the probably slumbering lady before having no option and breaking in through the front door. All we needed was a sign of coherent life, and we could leave her alone. 

The van was moved onto the vacant driveway. Apparently she "gave up driving when she gave up listening." 

"Well," said the sarge, "if this doesn't wake her up, we'll have to use a heavy boot. Just make sure that if she does wake up you turn the beam off straight away. Either that or she'll be blind as well as deaf!" 

The light was switched on, and the beam hit the target straight in the face. She stirred after a few seconds, and the searchlight was turned back off again, as ordered. As we all breathed a sigh of relief, she opened her eyes, picked up one of her hearing aids from the coffee table next to her and marched towards the window. She fumbled with a small key, unlocked the double glazed window, opened it only a few millimetres and turned her ear towards it. 

"Sorry to wake you ma'am," starts the sergeant, "we were worried something was wrong, and had to make sure you weren't injured or ill." 

"Thank you officer. As you can see, I'm fine. No need for anyone to worry." 

"We have the ambulance here too, if you'd like to let them in. They can just make sure." 

"I don't think that's necessary, thank you." 

"Are you sure?" 

"I'm sure. Don't worry... Actually," she said having paused for a few seconds, possibly debating the idea of a home-visit check-up, "there's just one thing you could do for me, if you don't mind?"

"Sure. What's that?" 

"Just F*** OFF AND LET ME SLEEP!"

She slammed the window shut, locked it, and made a point of showing us all that she was once again removing the hearing aid. As she sat back down in her armchair, she looked round the television that obscured our view, raised her arm, and as a final wave goodbye, stuck up her middle finger.

"That'll do!" I said. "I reckon that's enough signs of life for me!"

Crosswords

Mrs Vine and I could easily be on first name terms by now, except that she's very much old-school. I learnt that very quickly the first time we met on what was supposedly a "Breathing Problems" call. Control called me on the radio and let me know that she'd already called half a dozen times in the past few hours, each time claiming to have a serious problem, each turning out to be nothing of the sort. 

With the key to her front door locked away in a coded key-safe, she never had to leave her room to let anyone in. She would just tell the control room the number we need to crack the safe, and they send it down the computer screen in the car. I'd hardly set foot in the house and was looking for somewhere to put the key so I wouldn't forget to replace it, when a shrill yell cascaded down the stairs. 

"Close that bloody door already! I'm getting cold up here!" An ominous start.

Her voice reflected the night - cold and miserable. I tried to be a little more cheerful. 

"Good morning, Miss. What's made you call the ambulance out tonight?"

"Don't call me Miss. I have a name!" 

I didn't expect to have to ask the question, having been already chastised, but as she seemed to be waiting for it, I obliged. 

"And what is your name?" 

"My name is Mrs Margaret Vine and as we're not related, I'll expect you to address me as Mrs Vine." 

"Right then, Mrs Vine. I understand you've been having some problems with your breathing?" 

"There's nothing wrong with my breathing. It's just what I told that woman on the phone, because she kept banging on with these stupid questions and I just wanted to make sure that I got one of you here." The contempt in her voice almost made me want to leave, or at least explain the reasons behind all the so called stupid questions, but in the end I decided that both plans were futile. In the first instance she'd call again, and in the second, any explanation would probably go in one ear and straight out the other. 

"So how can I help you?"

"Well, first of all, my carer's left me." She was still shouting as if I was stood downstairs by the front door, despite the fact that there was no more than a metre between us. I'm a little ashamed to admit that the idea of her home help abandoning her didn't surprise me in the least. "And then, the cleaners don't come when they're meant to, and my doctor's completely useless and won't do what I tell him to!" 

"I see." I wasn't sure that I did, but I was trying. "And how can I help?" 

"You can pass me the newspaper and a pen, and sort these pillows out for me.Then I'll be able to do the crossword and hopefully fall asleep!"

"You called an ambulance to pass you your newspaper?"

"Yes. And to sort out these pillows. I shan't ask again." 

"And then you're going to sleep?" 

"As soon as I finish the crossword." 

"Fine then." 

As I found the paper and the pen, and fixed the pillows, I thought about offering to help with the missing crossword clues just to hurry the process along, but decided to leave her to it. I found the key, and as I stepped out across the threshold, Mrs Vine's voice once again filled the night air. 

"Close that bloody door already! I'm getting cold up here." 

I left the house and hoped she finished the crossword before I finished my shift.

Everything and Nothing

The email arrived last week, subject matter - "Appreciation." 

"Please see attached letter." 

The attachment was dated well over a year ago. 

"I'd like to thank the crews who attended our house on what was a very distressing day for us. If it wasn't for them, their professionalism and skill, their dedication and especially their kindness, our father would have died. Please convey our heartfelt thanks and appreciation to them all."

For us, it was just another call. So much so, that I don't actually remember the call at all. 

To the patient, and to his family, it was everything. 

Coping

Eyes glazed and bloodshot, he stands in a corner at the side of the building trying to hide his tears, but to no avail. His colleagues avoid his eyes, fearing that they'll make things worse. Last time him and I met on a call, it was after a man had been shot in the head. He sat holding a bandage over the bleeding wound whilst we worked to save the man's life, none of us fazed by the scene or its consequences. 

"It's never the big things that get you. It's always the ones you least expect!" A word at a time, sobbing through a simple sentence, he managed to verbalise what we all felt. 

His police uniform, bullet-proof vest and all might shield his exterior, but his insides were in turmoil. We all were. He was just brave enough to show it, even with his colleagues and superiors around. I'm not that brave.

At the scene, blood trailed around the house. 

There were no screams. 

No shouts. 

No reaction at all. 

And just for once, I wish there were. It might have made things seem less surreal, and maybe we'd have had less time to think. 

When it was all over, the scene was cleared, the ambulance had taken the patient away, and I was left with my car and a dozen police officers. I tidied up outside and went to talk to him, trying to rationalise the medical side of what we'd just seen. 

But a dead baby can't be explained. 

It can't be rationalised. 

It can't be forgotten. 

Our uniform makes people think that we can deal with anything, sometimes we think the same too. Sometimes we believe that we can see anything and just go home at the end of the day as if we've had just another day at the office.

But we're as human as a bank clerk, a teacher, a garbage collector. Each of us finds a way to cope, because we have to, just so we can go back to work each day and do it all again. 

And for now, at least for me, coping means that I travel to and from work using a different route, just so I don't drive past the scene every day and see those vacant eyes. The eyes that stared back at me from the blood-soaked crib. 

Natural Wastage

We're in the media... for all the wrong reasons.

The news has hit the mainstream news outlets shortly after we heard about it internally.

Almost nine-hundred jobs are to go at the London Ambulance Service.

Two thirds of them will be front-line.

There are tough times ahead.

Possibly tougher for our patients than for the staff, if the "natural wastage" policy is adhered to.

I just hope I'm wrong.

Monday Mornings

Monday morning. A curse for many, a blessing for some. The day breaks on the horizon as I head towards what will almost certainly be the last call of the weekend, with the car sounding almost as tired as I am. Thirty six hours over three night shifts, almost seventy activations, with over thirty patients attended. It's been a busy weekend. 

Henry, well into his eighties, is woken by a crushing pain in his chest and his jaw. 

"Call an ambulance, love. I think my heart's playing up again." He tries to stay calm, putting on a facade for Lena's benefit, but after more than fifty years together, she sees straight through it. Once she's called the ambulance, she wakes up her neighbours and asks them to come in. 

"Just to help me keep an eye on him. You don't mind, do you?" 

Their neighbours are young, and always willing to help. I meet them first as I pull up outside, barely five minutes after the call has started. 

"Thanks for coming so quick. I've hardly even put the phone down! Henry's upstairs." Lena's calm exterior  as she watches me climb the stairs does little to hide her anxiety, and as I step in to the room, I ask her to take a seat next to her husband so she can see and hear everything that's going on. 

Craig, the neighbour, gives me a quick rundown of Henry's history, a heart attack nearly twenty years ago leading to a series of another four over the years. 

"I think I'm running out of lives!" Henry says, only half joking. "I guess I'm lucky to get this far. I think it's Lena's fault that I'm still going. Who else is she going to nag to take out the rubbish?" 

She glares at him and tells him to keep quiet. 

Henry's pulse is irregular, a rate of anything from the low thirties up to nearly one hundred. The ECG shows that the heart's struggling, not getting enough oxygen to where it needs to be. Another heart attack seems just around the corner, and as the second ECG strip prints, I hear the crew arrive. 

"Bring a carry-chair up with you please!" I call down. One set of footsteps keeps heading up the stairs whilst the other heads back out to the truck to get the chair. 

"Meet Henry," I say to the attendant. "He's eighty-five years young, and has a habit of causing Lena stress by having had five heart attacks in the last few years, and his heart isn't particularly happy at the moment." I show the attendant the ECG strip, and he concurs. 

The pain had eased a little since I'd given Henry a lemon-flavoured aspirin and spray of GTN under his tongue. That should help open up the blood vessels that feed the heart, easing the problem at least temporarily, if not solving it altogether. The ECG remained unchanged after we had loaded Henry into the ambulance. His heart was sick, and so was he. Lena wasn't far behind, worrying about her husband. 

Once we had reassessed Henry, cannulated him, taken some of his blood, and given him some more medications, I stepped out of the back of the ambulance and headed back to my car, closely followed out of the treatment area of the ambulance by one of the crew. As she was about take her seat behind the wheel, Craig approached her. 

"Make sure you take good care of both of them, won't you?" 

Loading the luggage into the boot of my car, and with my back to them both, I couldn't believe as I overheard her answer. 

"I'll do what I can. But it's late, it's Monday morning, I've worked all weekend, I'm tired, and I just want to go home." She got in the cab, and within seconds was driving away. 

I left half my kit on the road, and went back to speak to Craig. I don't know why I felt the need to apologise for somebody else's behaviour, but I just felt it was inexcusable. 

"I'm sorry about that. I don't really know what to say!" 

"Don't worry about it. It's not you who needs to say anything. Anyway, thanks for your help. I hope Henry'll be OK." 

"They're taking him to the best hospital in the area for cardiac care, and I'm sure they'll do all they can for him.  If you wait an hour or so and then give them a call, the hospital might be able to give you some details on how he's doing." 

"Hope so. I suppose I'd better go get ready for work now. Back into the real world again after the weekend." 

"Ah. Yes. Forgot about that. It's Monday morning for you normal people." 

"Yup. For normal people and grumpy ambulance drivers." 

*****

We meet dozens of people every week, be they patients, relatives, friends, or neighbours. They all blur into one after a while. For us, these calls become routine, emotions become dull, and we feel disconnected. For us, it's a coping mechanism. There's no way we could feel what they all feel, and still be able to do our job.

The patients, however, their friends and family too, may only ever meet one ambulance crew. If the impression they're left with is one of "grumpy ambulance drivers", somewhere along the line, not only do they fail their patient, but we all do.

In amongst all the skills we use, and the knowledge we possess, showing that we care, even if sometimes we struggle to do so, may be the most important thing that we do.

Especially on Monday mornings. 

The Vow

With her head in her hands, Lea sat on the torn green seat at the back of the ambulance. Perched on the edge in total silence, trapped in a world of fear, as the shuddering of her shoulders told a tale all of their own. I remembered meeting her once before when she told me of her dream to move from her job as a health care assistant to that of a paramedic. 

I was packing my kit back into the car as the ambulance took off in a hurry with a badly injured cyclist. The driver of a car parked at the side of the road didn't look before opening their door, and the cyclist had no way of avoiding the collision. Riding downhill at high speed meant that his injuries were severe, and a doctor was called to scene to help stabilise him for travel. The doctor traveled with the crew, leaving me to tidy up the carnage.

Lea was the first one on the scene, having seen the accident from her bedroom window, and when I arrived I was glad of her help. Initially I left her holding the patient's head, and then, when pairs of more experienced hands arrived, she kept running backwards and forwards getting whatever piece of equipment we needed. 

When the action was over, she came over to help me pack up. 

"I'd love to be out on the road, on the front line, but they told me I needed a driver's license." 

"Very difficult to drive an ambulance without one!" 

"Well I hoped they'd just let me do all the other stuff, you know, the real fun bits!"

"Oh, you mean like talking to people who can't cope with a bit of a sniffle, you mean?" 

A look of mock horror crossed Lea's face. 

"You mean it's not all trauma like this?" 

"'Fraid not. It's one percent trauma and ninety-nine percent routine. Sorry to shatter your illusions!" 

"You haven't really. I know it's not always like this. I did my homework, you know! Now all I've got to do is learn to drive."

"For what it's worth, I love this job, even with the sniffly people. You come to work, ignore the nonsense, ignore the politics, and try to make a difference in just one person's life. It's that one call in a hundred that makes it all worthwhile. And it doesn't have to be a trauma job, either. It could be just talking to a ninety-year-old war veteran." 

I cleared what was left on the road of the mess that we'd created, and got ready to leave the scene. Lea approached the car window again. 

"Thanks for letting me help. Now I'm even more determined to get in!"

"Well, you were more than helpful. Good luck. I really hope you make it!" 

Our second meeting was a year, maybe even two years later. Now she sat, a broken woman in desperate need of help, and not knowing where to look. There were bruises down both her arms, a palm print on her cheek and a deep cut to her forehead. Tiny shards of broken glass reflected the light as they sat on her face and clothes. A police woman sat next to her, held her hand and told her that she could talk whenever she was ready. Two other officers had removed her partner from the house. He put up no fight, showing his cowardice for all it was. 

"Lea," my voice as gentle as possible, "we'll need to take you to hospital. You'll probably need some stitches, but you'll be fine. Is that OK with you?"

She nodded. 

"They've got him, so he can't do you any harm, and this police lady will be with you the whole time, alright?"

Again, with the tiniest movement, she nodded her approval, and we set off for hospital in an impenetrable silence. As we arrived, she finally spoke.

"You know what this was all about?" Now she was practically shouting. "He didn't want me to go to out to work. He didn't want me to ever leave the house. All he'd do is scream 'What do you want to go to work for?' or 'What do you think you can do that's any good?'"

She dried her eyes, summoning up the courage to speak out.

"I told him I wanted to do what you guys do. I told him that I was learning to drive so that I could work on an ambulance. Do you know what he did? He slapped me round the face and threw the glass at me! Told me that now I've got a reason to be on an ambulance." She stopped and took a deep breath.

"I'll show him!" She said. "I'll prove to him that I don't need him, or his approval. And while he sits in jail, I swear I'll be the best damned paramedic there is!"

From what I've heard, she's kept her vow. 

Simple

As road-staff, we regularly have to contend with doctors and nurses complaining about our choice of whether or not to cannulate a patient, which vein we use, or why we didn't bother at all sometimes. 

Trying to explain at hospital that the patient was trapped in a car that was upside down and on fire, surrounded by a herd of elephants that were corralled by a pride of ravenous lions, which in turn were being shot at by hunters, doesn't seem to hold much water. 

Strangely, therefore, sticking lines in people out in the field isn't always quite as simple as dealing with a patient in the relatively sane (I said relatively) of the hospital. Some IV's are easier than others, but until now, there has been no actual scale on which to compare and contrast the complex nature of one of the most basic aspects of our job. 

However, a while back, The Happy Medic came up with one. 

So as a weekend treat, I hereby attach a link to a "difficulty scale" for sticking needles in people. 

It includes bonus points if the lighting is less than ideal, if you're hanging upside down, and various other "normal" variants to the tricks we must employ to do what in theory is a very simple task. 

Simple, if your patient is four feet off the ground and horizontal in a well-lit hospital bed, and with several pairs of hands to do everything else, that is.