As the clock strikes 12...

A post by a friend on facebook has started a discussion. Where have you been when the clock struck midnight on New Year's Eve? As members of the emergency services, of whichever variety, the options are endless, and have so far included a padded cell whilst covered in all manner of unpleasantness. Mine have ranged from being mid-resuscitation of a pedestrian hit by a drunk driver, to the far more sedate call of assisting an octogenarian off the floor just in time for him to celebrate with his traditional glass of sherry. 

So, as we head into the new year, and as many of you will be out there protecting and serving the public, let's start the party early: 

Where is the strangest, funniest, weirdest, scariest or any-other-est place that you have been as Cinderella turned back into a pumpkin after attending her New Year's Eve ball? Or something. 

To all of you, whether you're going out with friends or having a quiet time at home, whether partying or protecting, and especially if you happen to be able to manage both at once, stay safe and have a good one! 

The View from the Back Row of the Classroom

Over the past few weeks, I've gone back to school. I've been sitting in the classroom listening to lectures I've heard before, albeit in a different language, surrounded by a group of paramedic students who are just about ready to be unleashed on an unsuspecting but hopefully grateful public. The vast majority of the students are about to start their lives as combat medics which has made for some interesting scenarios, but one or two are heading for civilian roles. And then, there's me. I've sat at the back of the room that is fit to burst, writing bilingual, multi-directional notes, taken a few exams and hopefully come out the other side unscathed and ready for the front line once more. 

It's been a bit of a struggle to get my paramedic licence recognised and accepted here, and has involved two steps backwards of bureaucracy for every one step forward in actual physical achievement. It's been frustrating. I've been on the ambulances, but in a limited capacity. My paramedic skills have been safely tucked away until the piece of paper that I need is finally spat out of the machine, hopefully sometime very soon. 

I don't mind jumping through the relevant hoops. I don't mind sitting in classes I've heard before, because the reminders that they're providing are more than useful. It has been, however, somewhat disheartening that it has taken this long to make the progress that I'm finally making. 

Yet, as always, there is a silver lining to the cloud. Going back to school has given me the opportunity to see another generation of people who are already loving their chosen path. There are those who are looking far into their futures, planning to change the world, or at least their little part of it. There are those who are talking about being a part of something bigger, part of an EMS world that is looking to expand, to improve, to change, to evolve into something better than it already is. I've had the chance to introduce some of these students to forums, to various forms of social media, to blogs, to ideas, to people, at least virtually, who share their vision. 

(In the meantime, I have another day in the classroom tomorrow, and a rather daunting exam, the equivalent of the end of the paramedic course, on Tuesday. No public holiday here. So those of you celebrating Christmas, spare a thought and send some positive vibes just before you tuck into your turkey and mulled wine.)

From my seat at the back of the class, the future is looking good. Hopefully, once I've defeated the monster that is bureaucracy I'm embedded a little more in the system, I'll be able to be a part of that future. I might even tell them that I know the person who writes this blog... 

Rules for EMS

I have, unashamedly, stolen this list verbatim (with permission, I hasten to add). I haven't changed a word, or the order in which these rules appear, although I think that number 18 should be much nearer number 1, if not the top one itself. Rule number 38 I'd consider removing. Scene time is dictated by the scene, not by the rule book. Expediency is important; rushing, isn't. Many of these rules are not just for EMS, so even if you're looking in from the outside, take a moment. Oh, and I have no idea what the last one is trying to say. If someone wishes to enlighten me, feel free! 

(To my UK readers, this was obviously stolen from someone US-based. I haven't corrected fixed changed the spelling.) 

So, EMS providers, which would you remove, which would you change, and what would you add? I have also noticed that social media doesn't make any sort of appearance. That should probably change! 

And as potential patients (although I wish this on no-one), what would you do with this list. The floor, as they say in the classics, is yours! 

1. You are there to solve a problem, not cause one. 

2. The ABCs will save you every time.

3. The scene is not the venue for retraining. 

4. Interview the patient, not the clipboard.

5. The patient should not be the recipient of your problems.

6. Treat the patient to the best of your ability.

7. We are guests in their domain.
8. Look for reasons to transport, not turf.

9. Do not base treatments on lifestyles.

10. Expect no more from others than you can provide.

11. Handle the call you are on, not the one that might happen.

12. The acuity of the situation is due to the patient’s condition, not your anxiety.

13. We do not interrogate over the radio.

14. We do not yell at the family or patient; we explain the problem.

15. Being nice never hurt anyone or cost money.

16. Do not judge lifestyles.

17. A clean ambulance is a happy ambulance.

18. Obey your gut instinct.

19. Being nice does not indicate that you are weak or naïve.

20. Leave tunnel vision for the Amtrak folks.

21. 35 mph is good for patient care.

22. The closest hospital is not always true.

23. Document truthfully; you never know.

24. Know your equipment.

25. Continue to study; dormant minds make Jell-O look smart.

26. Show me what you know, don’t tell me.

27. Level of certification does not guarantee respect.

28. Talk to the patient first, then everyone else—when possible.

29. If nothing else, do the ABCs, treat the problem, use TLC, keep the patient warm, transport.

30. Trouble breathing equals lung sounds.

31. Regardless of whether you are a career or volunteer provider, you are there to do the “JOB.”

32. It takes less energy to be pleasant; anger festers for the whole shift.

33. Each call is a new one.

34. If they can take a tube, they needed one.

35. Be nice to yourself; you have to start somewhere.

36. Scene survey, ABCs, pick a game plan, make a decision.

37. Have people doing things.

38. Ten-minute scene times are a good thing.

39. Certification cards x patches = ????

Sandy Hook

Rivers of ink have raged, almost as the rivers of blood that flowed all too freely have now stilled. I don't know when is, or even if there is, a right time to wade in to a discussion on a tragedy as raw as that of Sandy Hook School, where those killed are only now being buried, where their families have not even begun to really grieve. Parents of children are being forced to come to terms with a reality that none of us should ever have to face. Families of adults who died protecting the innocent battle with conflicting emotions; pride in the bravery displayed by their loved ones fighting for space in amongst the utter sadness at their deaths. 

And in the midst of it all, the all-too-familiar rhetoric begins. Pro-gun versus anti-gun is too simplistic. It's like saying that there are those who wish to live in a constant state of war against an enemy and those who want peace with the very same. In reality, everyone wants peace. It's just a question of how to get to that state. Rhetoric alone will not answer the questions that will race around the minds of a nation, particularly a nation in mourning. 

I have only questions, no answers, but feel the need to raise them here, if only as an outlet. I struggle to understand why this happens. Why it happens in America. Why is it that I live in a country where guns are a part of the daily view, yet we have mercifully been spared the awful scenes that have now been shown all over the world. 

I am torn. Torn between believing that weapons should be available so that it is not only the criminals and terrorists who possess them, and believing that they should be almost impossible to come by. Several times in the past, terrorist incidents in Israel have been halted by a passer-by who happened to be there and happened to be armed. Right place, right time. On the other hand, the readily available weapons allow for easier access to those who would use them to harm the innocent. 

However, one cannot walk into a gun shop here and buy an assault rifle "off-the-rack." The number of civilians carrying weapons is actually surprisingly low. Assault rifles are seen in the streets, but they are carried either by members of the armed forces or by members of response teams in the more volatile parts of the land. They can't just be stored at home as yet another item on a list of fixtures and fittings. Licenses are hard to come by and are enforced by strict regulation.

Arguments will appear on every media outlet, on social media, in conversations between neighbours and friends. Both sides will voice their opinion, all too often based on that cyclical rhetoric, bandied about by populace and politician alike. Slogans don't solve the problem, they just accentuate and polarise it. They certainly do not reunite grieving families with those that they have lost. Falling back on rights is as helpful as quoting often irrelevant statistics. It is, however, clear that something has to change, probably on both sides of the great gun divide. 

I don't have the answers. I may not even be in a position to ask the questions. I do know one thing for sure. I never want to see these scenes again. Not as a parent, not as a news reader, and not as a paramedic. Not on my own doorstep, nor on anybody else's. 

Yet another community will have to rebuild itself, brick-by-brick, one family at a time, united in grief for now, but hopefully in strength in the future. And all the while, the answers must be found to prevent anyone else from facing yet another unspeakable tragedy. 

Fail

All the way back in May (I could turn this into a poem now, but I shan't. I can already hear your sighs of relief) I posted a series of three posts, each suggesting ideas that I would recommend to paramedics new and old, but particularly new. The first, which I suppose is much more London-specific, was to join the BETS team, the second was about learning to read maps and not rely on GPS, and the third was about not only learning, but teaching. 

This is the fourth of my suggested ideas. 

Yesterday, I had to take yet another driving test. It was my tenth driving test. Considering I have never failed a test, it's a little confusing, but still, experience is always invaluable. The driving test involved three hopeful applicants, one driving examiner, and a specially modified ambulance with dual controls. 

You'll be pleased to know that I passed. We each took it in turns, and just like the other two, I had my 20, perhaps 25 minutes where I drove around the busy streets of one of the towns in central Israel, avoided the obstacles, navigated the narrow streets, slowed down for the speed bumps, stopped at red traffic lights, managed not to hit any pedestrians (apparently that's fairly frowned upon, as we were reminded at the start of the test) and talked to the examiner about life as a paramedic in London. It all seemed too easy and for the hour we had to wait between the test and calling back for the results, I fretted a little. 

Although, to be honest, I was more concerned for one of the others. 

No one seemed to tell her that equally as important as not hitting pedestrians, particularly on your ambulance driving test, is not driving on the wrong side of the road. 

Abandoned

I know, I've abandoned you. I'd even abandoned twitter for a few days. Well, at least one of my accounts, anyway.

We've had a hairy few days in Israel (he says, somewhat underplaying it), and whilst this is not the forum for political comment, I just thought I'd let those of you who care (and I know there are some - your messages have been truly appreciated!) know that we're OK. We've been within sight and sound of some missile hits, but luckily no worse. In the meantime, my writing efforts have been spent elsewhere and my so-called spare time has been taken up making sure that my family and friends aren't panicking too much. Particularly the ones who are too far away to go through it with us.

Life in this country is never dull; I had never, for example, had to run an air-raid siren drill with my kids; and whilst we're still technically at war, I am today heading for yet another ambulance driving test, so I can stay on the side of the life-savers.

Hopefully, some normality will return soon.

Stay safe.

Poppy Day

For the last couple of years, around the time of Remembrance Day, I write a post to mark the occasion. Last year was a story about stories. The year before that, I linked to a story, a single, solitary moment in the life of a soldier. One of my favourite posts to date, even if not the most popular.

This year, I apologise, but I want to raise a point that bothers me. 

Despite being thousands of miles now from the UK, we can still watch British television programmes. For the past few weeks, TV hosts, guests, audiences, even bit-part players in so-called reality or talent shows, have appeared with a poppy attached to their clothing. Anyone likely to appear in-shot is also given one to wear. I know for a fact that most of them do not buy the poppies, but are just presented with them in order to ensure that they appear suitably attired.

To my mind, this not only belittles the poppy, but also defeats at least half of its purpose.

The poppy is worn as a reminder. A reminder of those who fell in battle, those who never grew old, those who never returned home to their loved ones. But it is also a fundraiser. Selling poppies is by far the largest revenue generator for the Royal British Legion, a charity that supports those still serving, the ones who came home injured, as well as the families of those who never came home at all. 

Seeing sparkly, show-biz poppies doesn't achieve the desired effect, in fact, it misses the point completely. The poppy isn't a piece of jewelry, it isn't a fashion accessory, it isn't a part of a costume. The poppy is a mark of respect, a symbol of hope as well as remembrance. 

Tomorrow, as many millions around the world pause to reflect and remember at the eleventh hour of the eleventh day of the eleventh month, I will join them. I will wear a poppy. Not because I've been told to do it, or because it looks good on what I'm wearing, but as a simple symbol of respect to those who have served as well as those who continue to do so. 

The Bet

The door is opened by a late middle-aged man holding a wet flannel on his forehead. The call has come in as the lowest category of call, the infamous Green Call that can be anything from a back ache to a dizzy spell, from leg pain to a nose bleed.

"Come in boys, take a seat. I'm just turning the gas off and I'll be with you." 

We follow him in, his shuffling footsteps making a marathon of the short corridor until he points us into the lounge and we take a seat. The room is stuck in a time warp, the furniture and fittings in the enormous semi-detached home harked back to the 1970's and were all immaculately cared for, but dated nonetheless. Greg, my partner for the day, whispers as we're walking in that he'd bet a month's wages that the toilet is avocado green. 

"I can't afford a month's wages. How about a tenner? I reckon it's pink." 

"You're on." 

"How can we help you today, sir?" Greg asks, after the gas is turned off and our patient collapses with much drama into an armchair.

"Well, first, you can call me Ray. None of this sir nonsense. I've been having these stomach aches for a couple of days now. Having to rush off to the loo every few minutes. If it's not one end, it's the other. I just can't take it any more."

"Have you seen your doctor?"

"Went this morning. She told me to sit it out. I complained at the turn of phrase." All three of us rolled our eyes.

"Have you managed to eat anything? Or, more importantly, drink?"

"Water, yes. Food, no. Just can't keep it down. Or up. Depending on which way you're looking at it."

With that, he apologised, told us to make ourselves a tea or coffee, got up and went back to the bathroom under the stairs. I'd noticed it when we came in, a sign on the outside reading "Harry's Room" with a cartoon of a boy flying on a broomstick. Two minutes later, having been left to our devices, we'd decided what we could do to modernise this house, how much it would cost and how much we'd sell it for.

"We'd make a fortune!" Greg announced.

"Just one problem. It isn't ours."

"Well, a man can dream, can't he?"

The second those words left his mouth, he regretted them. We were snapped out of the dream by a crashing noise and a grunting sound that could only mean one thing. Ray had either fallen or collapsed. We both jumped up, tried to open the door and discovered it was, unsurprisingly, locked.  Greg runs out the front door to the side of the house to see if there's any access, only to discover that the window was no bigger than a cat-flap.

"We'll have to kick it in!"

"He'll be right behind the door!"

"Well, what other choice do we have?" 

A muffled voice comes through the door. "Don't kick the door. I'm alright. I'll be up in a second. Just slipped, that's all." 

Greg and I breathe a sigh of relief. Allowing a patient to go to the toilet is always risky, especially if they're already weak or particularly if they're suffering with a heart condition. Hearing Ray's voice put both our minds at ease. Until there was another thud. 

"It's alright lads. It's just me sitting back on the seat again." 

Finally, the door unlocks and Ray tries to walk out. There's a small cut on his eyebrow and some blood on the floor but nothing too worrying. I make sure he's stable as Greg steps back out to the ambulance, both of us noticing the colour of the bathroom before he walks off with a shrug of the shoulders. 

"Stay there Ray. Greg's just going to get the wheelchair. Don't want you walking anywhere else." 

"Probably a good idea, but I don't want you lads going to any trouble."

"Oh, don't worry about that. It's no trouble. Besides, you just won me a tenner!" 

"How'd I do that then?" 

"Your choice of bathroom colour. Pink was my bet." 

"That's only just gone in. It was green until last week. That awful avocado colour. Been like that for years. Couldn't stand it any more, so just went with whatever my sister suggested. She said that pink would be more attractive when I came to sell the place."

"Green, you say?" 

"Avocado green." 

"Do me a favour, Ray. Don't say a word to Greg, will you?" 

The wheels of the chair clatter against the floor as Greg reappears, opens the folding contraption and sets it up. Ray sits in the chair, we wrap him in the hospital blanket and secure the seat belt, keeping him warm and safe.

"Can you wheel me out via the kitchen? I need my keys and phone. Oh, and I've got a present for you Greg." 

Confused, we head backwards before going forwards. Ray picks up his keys and phone from the worktop, then asks Greg to open the fridge. I put my boot on the carry-chair's footplate to stop it from tipping as Greg does as he's asked. 

"What am I looking for?" 

"It's there. In the door. Second shelf down - little shelf with the lid-type thing on it." 

Greg lifts the plastic lid and takes out his prize. 

"Funny, gentlemen. Funny," Greg laughs, as he places the avocado in Ray's lap.

Unsung Heroes

Heroism is a term bandied about all too lightly. Teenagers describe the latest pop-sensation as their hero. Sports fans describe the latest world-class footballer, baseball-player or sprinter as their hero. And every so often, a short note in the media, or a new internet-based meme will try to portray unlikely people as heroes, including paramedics, nurses and other medical staff. 

Whilst I agree that all are undervalued, the stretch to the point of heroism is a little bit far-fetched. I've written about it before. The fact that EMS finds itself at the bottom of the heap of the medical world is unfortunate and not a little unfair. Yesterday, I saw a tweet that described it thus: "Whether EMS is part of the health system, or public services, it seems as though we will always be treated as the red-headed step-child." From my experience and understanding, through either virtual or actual meetings with EMS providers around the world, the feeling is mutual across the globe. And this is coming from a (albeit balding) red-head. 

Still, I feel that to reach the point of hero-worship, as some seem to feel should be the case, cheapens the meaning of the word as well as the act of heroism. 

Overnight, as the fury of Hurricane Sandy hit the eastern shores of the United States, a hospital in New York City had to be evacuated after both its regular and emergency supplies of electricity were cut off. According to reports, 215 patients, from the youngest to the oldest and in all manner of medical conditions, had to be moved to other hospitals. 

Staff ventilated patients manually, keeping them alive. They changed mains-powered machines to battery-powered back-ups. They climbed down and up flights of stairs to the ninth floor to rescue the tiniest of neonates, as brittle and dependent as it is possible for a human life to be. 

Ambulance crews braved the weather conditions and risked their lives in a manner which the rest of the population had been ordered to avoid. Not just advised - ordered. 

That, to me, is heroism. It isn't the constant calls, it isn't even the life-saving calls. That doesn't make paramedics into heroes; it makes them damn good at their jobs, as they should be. It's the paramedic who, despite everything he has learnt, despite the awareness of the risks he is taking, jumps into a dangerous scene because he knows he can make a difference. It's the hospital staff who, when faced with the most serious possible crisis, don't walk away, but run towards it, armed with knowledge, skills, awareness and, no doubt, no small amount of fear. 

It's occasions like these that show the world the reality, the true meaning of heroism. 

I certainly didn't see any footballers or pop-stars there. 

Stay safe. 

The Trolley

We pull up to the entrance at the back of the hospital, reversing the ambulance into what is no more than a widened alley. Cats roam free, picking food out of overflowing rubbish bins. It's almost as though the levels of cleanliness are saved for the public entrances, leaving areas such as this one neglected and filthy. 

It's always a strange feeling wheeling an empty trolley bed off the back of the ambulance at hospital. There's a sense that we're doing something wrong, backwards, coming to take someone away instead of bringing them in. At this time of the morning, just past the point of no return but not yet quite within sight of the end, conversations are more a series of grunts and confused looks, reinforced by acknowledging nods at the offer of a cup of coffee. 

The hospital corridors are empty, an almost ghostly air circulating through the concrete block. The concrete was supposed to be covered when they built the hospital, years ago, but the money ran out. So now, in amongst the surrounding greenery sits a blob of grey, cold, ugly concrete, as if just waiting for a truck large enough to pick it up and take it away. The hospital looks only marginally better on the inside, but the eerie silence makes it feel just as cold and unwelcoming. The wheels squeak and click-clack over the cracks in the floor and as we reach the entrance to the unit, the doors open as though somebody watched us approach. 

"Morning lads!" Lorraine, a short, bespectacled, red-headed nurse had moved up to the wards from A&E, preferring the gentler nights up in the tower to the hectic unpredictability of the ground floor. She was permanently smiling, always alert, a slight Scottish lilt making her sound as though it was always lunchtime on a bright summer's day and the picnic blanket had just been laid out on the grass in the park. 

"You've come for Mr Sanders I presume?" 

"If he's heading into town for an emergency operation, then yes, we've come for him." 

Lorraine's voice suddenly takes on a serious tone. 

"Seems so unfair. Someone so young. He's my son's age. Early thirties. Don't know how I'd cope if it really was my son." 

We read through the paperwork, Paul and I, meet Dr McKenna, the anaesthetist who's travelling with us and discuss our options and a plan of action. 

"We're just trying to get him stable enough to transfer. Give him the best shot we can," says the doctor. "There's a chance he won't make it through the doors at the other end." 

"Is there any point moving him?" 

"He'll definitely die if we leave him here. He'll probably die if we transfer him. I'll take probably over definitely in this case." 

We walk into the room, the mood suddenly sombre and heavy. Mr Sanders, or Daniel as his mother asks us to call him, is unconscious and ventilated. Machines follow his every vital sign, gentle pings alternating with silence. For a time the only sound is the ventilator, its artificial lungs hissing life into Daniel making his chest rise and fall as though he is no more than asleep. 

Lorraine comes in with another nurse and they start to untangle the lines. Some feed him with life, some with pain relief, others just monitor. One keeps him sedated. The hospital machines will need to be exchanged for more mobile ones, a move filled with inherent risk.

"This'll take a few minutes. Why don't you two go and grab a quick coffee. You look like you need it." 

"I'm not sure whether that's an insult or an attempt at being friendly." I look straight at Mrs Sanders and a hint of a smile crosses her face. I have no idea how she manages even that smallest ray of light as she sits here with her son. 

"Can we get you a drink too, before we go?" 

"No. Thank you. I'd rather just sit here. Hold his hand for a little longer." 

"You hold his hand, we'll get the drink." 

"Thank you. Tea, please. No sugar." 

Standing in the staff room gives us both a chance to reflect, a dangerous thing in the middle of the night. Seeing illness, misery and death so close may be routine in this job, but it's never easy, especially when we're both around the same age as the patient. We hear as the machines are switched over, the wailing alarms of those disconnected being silenced one by one as we head back into the room. Paul hands the steaming mug of tea to Mrs Sanders and she nods a silent thank you as she briefly lets go of her son to take the drink. 

One of the machines runs out of battery power almost instantly. 

"These damned syringe pumps! It's been on charge for the best part of 24 hours!" Lorraine's furious mood is so rare that it's almost funny, except that the setting was wrong. She plugs the pump back into the wall and scurries off to find another. It seems that no transfer happens without at least one of them running out of power on route. 

The monitor screen suddenly flashes red and several different sounding beeps happen all at once. The ventilator seems to be struggling and each time Daniel is moved even a little, his blood pressure and oxygen levels plummet. 

"Let's give him a few minutes to settle," suggests Dr McKenna. "We'll try again in just a bit." 

I call control to let them know that there's a short delay, but that hopefully we'll be on our way soon. When they ask how soon, the best answer I have is that it'll be as soon as it's safe. 

We try twice more to move Daniel across. Each time we do, his vital signs take a hit and we have to stop, wait for his oxygen levels to settle and then try again. Mrs Sanders sits and watches, silence speaking louder than words. On the third attempt, we get him across on to our trolley. The numbers are calm, the machines are quiet, Daniel seems settled and so are we. 

"Let's go, gentle as you can lads." Lorraine looks on, anxiety straining at her permanent smile. We walk the length of the corridor, almost reaching the doors, when the monitor starts it's ominous shriek once again. We wheel Daniel back to the room in a hurry, plug all the machines in to the wall to stop the batteries draining and wait. 

"No more." The voice is quiet. "No more. Please." 

"Mrs Sanders?" 

"Please. I beg of you. This is torture for him. And for me. Please. Just let him be." 

Doctor, nurse and ambulance crew exchange looks, silent, searching looks, hoping for an answer where there is none. Finally, Dr McKenna agrees. 

"OK. No more. Let's get him back to the bed." 

Mrs Sanders sits down, relief and agony etched on her face all at once as we gently move Daniel back on to the hospital bed and reconnect all the machinery. She picks up the mug of still warm tea and takes a sip, then looks down as though embarrassed at what she had done. 

"I'll get you a refill, so you don't have to drink it just warm. Just give us a minute to make sure he's settled." 

"Thank you again. Could I have some sugar this time please? I think I need it." 

"Of course."

The tea is made and handed to a grateful Mrs Sanders, a new sheet placed on the trolley and we're ready to head back on the road. 

"Sheesh," Paul exhales. "I don't think I've ever had such a difficult time not moving a patient." 

The wheels of the trolley squeak, the click-clack noise as they traverse the cracks in the floor, and we head back out the same way we headed in. Through silent, ghostly corridors, trolley in hand, but bereft of a patient. 

Drunk-Drivers United

Once again, the morning's UK news included a headline about a top-flight football player being caught drink driving. Ryan Tunnicliffe, who plays for Manchester United, was arrested after a crash on Saturday afternoon involving his Range Rover. In a momentary rage, I tweeted something about footballers having big money, big cars and small brains. Then, I remembered that this is not the first time that a story such as this had broken recently. 

So I dug into the archives. Or, if you prefer, Google. 

September - Guly Du Prado, who plays for Southampton. Charged with and admitted drink driving. Given a small fine and a short driving ban. 

June - Michael Johnson of Manchester City. Arrested on suspicion of drink driving. Convicted in September and given a slightly larger fine and a three-year driving ban. 

April - Jermaine Pennant, a Stoke City player. Handed a suspended sentence and a derisory fine, as well as a three year ban. 

January - Reading FC player Mathieu Manset, fined and banned after failing an initial and then refusing to be retested. 

Four footballers, guilty as charged, all this year. And those are after only a preliminary and brief search. That, along with the controversy surrounding Luke McCormick who killed two children in 2008 whilst driving drunk and recently released from jail, is a fairly damning indictment of the individuals themselves, but also, in my opinion, of the FA itself. The governing body of footballers in the UK have had some real problems on their hands recently - allegations of racism on the pitch as well as off it, in amongst them. 

However, the issue of drink driving doesn't seem to make headlines within the organisation. It isn't a new issue. Finding four in just this year doesn't even begin to look back at the long, miserable association that football in the UK has had with alcohol.

Perhaps it's time that the FA looked deep into its soul, assuming it has one hidden somewhere near its bank accounts, and asked itself what exactly is it giving these footballers that they can't handle.

Perhaps the courts need to realise that fining a player the equivalent of a couple of hours' pay isn't enough of a threat. 

Perhaps the police, the courts and the FA need to team up to deal with what is a very public problem, even if it is committed by private individuals. 

Whether they like it or not, and I presume they do, these individuals spend a lot of time in the public eye. That gives them extra responsibility, an extra burden on their shoulders. One that, I hope, their incredulous salaries helps to lighten the load. I don't begrudge them their salaries. If that's the going rate for a top-class player in their field, then good luck to them. 

Am I jealous? Maybe. I'd love not to have to juggle my priorities at the end of each month, worrying about whether I rob Peter to pay Paul or vice versa. But as well as being jealous, I'm not stupid. It's a simple rule, whether you're a multi-millionaire footballer or a struggling paramedic:

Drinking and driving do not mix. 

As a paramedic, if I was caught drink driving, my career would be over. And rightly so. 

I wonder how many of these all-entitled footballers would continue to act this way, if their career was also under the very same threat? 

Grandpa

A football appears suddenly in the street, flying out from between rows of parked cars, packed tightly in the premium spaces. The houses in this area have driveways the size of small streets, but still, cars are parked along the roads. Commuters perhaps, using the rare free parking to abandon their cars and walk the relatively short distance to the nearest station. 

The chance of a child following that ball are high so I hit the brakes and stop the car. I'd rather have one patient waiting a little longer than have to deal with an extra patient and spend a lifetime asking what-ifs. The ball stops in the middle of road, dancing a jig with the centre-line, playing a game of indecision.  Seconds pass, but no child appears; no-one seems to want to retrieve the lost ball. It's an unusual one too: Pink. I'm sure someone is interested in getting it back, but time being of the essence, I get out of the car, move the ball to the pavement and head back on route to the call which is on the parallel street. 

I pull up to the gates, large, ornate and ostentatious, push the button on the intercom and wait. After a few seconds, the gates swing open like a pair of open arms, welcoming anyone who is granted access. The driveway is smoothly paved, as though it had only been tarmacked today and is lined on both sides by pristine grass that looks as though each blade has been measured with a ruler to ensure that they are all of the exact same height. 

The door, an immense work of art designed to impress as well as intimidate, is opened by a member of staff, perhaps a butler. Stepping in to the house is an exercise in wonder and envy. Every surface is polished, marble floors are scrubbed to perfection. A spotless kitchen the likes of which couldn't even enter my wildest dreams is just within view. 

"This way please." 

He leads me down the corridor, past several reception rooms and to the back door of the house. It's inconsistent with everything else around. Just a simple, double glazed door leading from a corridor to the back garden, but as soon as it's opened, the grandeur returns. There's barely time to take it all in, the huge garden, the beautifully tended hedges and other plants. In the middle of it all there's a young girl lying on the grass quietly crying. 

Honey is six years old and as sweet as her name suggests. She's upset but not hysterical and is being comforted by her grandfather. He, in turn, is holding a wet tea-towel to her head. A crimson mark is starting to appear through the fabric. 

"Can I have a look, just to see what you've done?" 

Honey nods and I gently remove the towel. There's an open wound on her forehead that will need gluing or stitching back together and a quick check shows that there are no other injuries. She lets me bandage the wound without even the hint of a fuss. 

"It doesn't hurt me now," she says. "Grandpa told me that I was being brave. Am I really brave?" 

"You're braver than me! I bet I'd be crying a lot more than you if I got a bump like that on my head!"

"I'm not crying because I bumped my head. I told you. It doesn't really hurt me now." 

"Oh, really? So why are you crying?" 

"I was playing with Grandpa and we were throwing my favourite ball. Then Grandpa kicked it and it went over the wall and into the street!" 

Grandpa looked sheepish. 

"I'm sorry sweetheart! I promise we'll get you another one as soon as they've made your head better." 

"You promise?" 

"I promise. If the shops are still open when we're done, we'll go together." 

"OK. Let's go!" 

Honey jumped off the grass as if nothing was wrong and, with me having cancelled the ambulance, we headed for the car. It was only a mile to the hospital, ambulances were scarce as always, Grandpa was happy to take a booster seat with him and Honey was thrilled at the adventure. 

We walked into paediatrics and waited for a nurse to take a handover. Honey kept asking questions about what was going to happen, who the people in the department were, and if it was going to hurt when they fixed her head.

"Sometimes, it's like the Spanish Inquisition with that one!" Grandpa joked. "Always asking questions, always wanting to know more." 

"Guess she's a healthy six year old then," I said. 

"True, I suppose. Is it going to take long?" 

"I've no idea I'm afraid, but it doesn't look too busy." 

"Good." 

We stood in silence for some time, Honey taking in her new, temporary surroundings with Grandpa holding her hand. 

"Actually," Grandpa suddenly started, his voice quieter than before, "I've got one more question for you too." 

"Ask away." 

"Where on earth am I supposed to buy a pink football?" 

Memories

Flashback. 

A totally unexpected flashback that instantaneously took me to the scene, one I hadn't visited for several years. 

The mind plays tricks on me, sending me back into the adrenaline rush that I remember as though it was yesterday instead of yesteryear, I feel my heart pound with the same sense of urgency and excitement, hear the sounds as though I'm still there and see the sights as though looking at freshly printed photographs.

As I sit propped up against the wall, the view around me clears, the sounds of the crickets chirping away float in on the breeze through the window, the dimmed city lights come into clearer focus, I remember instead of dream. 

Sonia stood by the side of the road in amongst the crowd but strangely apart from it. In that early, drizzly evening the bus stop was filled with people, some genuine passengers waiting for the bus to take them home, some undoubtedly who had stopped especially to witness the scene. A few stood with their phones in their hands, taking photographs or videos to be shared later with their friends or family or perhaps the world. Maybe if I checked YouTube later that day, I'd see freshly filmed footage of our work. 

It's all too common, the menace of the casual observer. It's tempting to shout, plead for the crowds to disperse and respect the patient's privacy as though it was their own mother or father, but even when I do, nothing seems to happen. More often than not, it's easier to leave them be and carry on with the work that needs to be done. The privacy we are sworn to protect is trampled on by anyone on the outside with a digital recording device of any sort, but we are powerless to stop it. 

Sonia was different, telling me her name as soon as I got there. She stayed perfectly calm amongst the baying crowd that was now being held at arm's length by the police cordon and an angry sergeant. Her hands stayed either in her pockets or on her hips as she just watched, making sure she was always as near as possible. It was unnerving at first. She was already there when I first arrived in the car, holding his hand as they waited. But as soon as I stepped in, she took her spot on the pavement and just watched. 

"Do you know him?" I called out to her. She shook her head as I attached an oxygen mask to his face. 

"Did you see what happened?" Same response, an almost detached but fascinated look in her eyes. 

As I started to check his blood pressure I notice that his breathing has become a little erratic, making me abandon the pumped-up cuff on his arm and move back to his head where I take over the breathing, the reservoir bag on the bag and mask filling with life-saving oxygen which I then pump into his lungs one gentle breath at a time. The ambulance crew arrive just as he starts to become difficult to manage, fighting the mask, fighting us, fighting an invisible terror. 

Sonia takes an audible gasp. Someone in the bus stop laughs and turns their camera towards her. I look up to see her mouth one word: Sorry. 

He's loaded into the ambulance, the backboard and straps hold him in place as the crew prepare to transport him. 

As I'm packing away the equipment and a white tent is set up over where the patient was found, I notice the police are talking to several of the witnesses, Sonia amongst them. I leave the bags by the car, knowing that for now the kit was protected by the invisible force-field afforded by the police tape, and step over to her. 

"Are you sure you didn't know him? You didn't see anything that happened?" 

"I'm sure. He was just lying there and it felt like the right thing to do, just to hold his hand." A tear streamed down one cheek.

"You seemed interested in what we were doing, more than most. Are you OK with everything? I know it wasn't too nice to watch what we were doing." 

"I'm fine. It was just something I had to see." 

"Why?" 

"Because I don't remember anything." 

"What do you mean you don't you remember?" 

"Last month, that man lying in the road was me. And I just don't remember." 

Lost Keys

The door shuts gently behind me, bringing to a close another shift, one that ended at a time normal humans call bedtime. I've left the world of the permanent nights behind, at least for now, choosing instead to pick the shifts I like, while I still can. The times are different, the hours fewer, the system new to me, but the work and the patients remain the same. 

Calls still come in for bad backs, three day old coughs, tight, crushing chest pains and accidents of all types. Cars still fight with each other for a small space on the tarmac, denting bodywork and pride as the space in between goes from narrowed to nothing. Bodies give way to gravity when the ladders beneath them collapse down to earth. Knives and bullets pierce the skin and cause untold, perhaps irreversible damage to the organs hidden from view. 

Here and there a life is saved, a soul is comforted, a child is born. 

Until the door shuts behind me, the shift isn't over and the processing doesn't begin. Most days there is nothing to trouble my thoughts, the patients merging one into the next, each occupying my mind for the duration of our stay with them, or theirs with us. Some leave an impression, a smile, perhaps, maybe a frown. At other times a question mark looms over the lasting imprint of their faces, the tale of their woes, the miracle of their survival. 

Some days, shutting the door behind me, ending the shift with a turn of the key, only signals the start of the process. 

It's bedtime. 

I go in to check on each of my already sleeping children, a habit often repeated several times each night since each was born, thankful that I am able just to stand, and stare, and watch them sleep in peace. I lock the front door, but in so doing, open the door to my own thoughts, trying to process the day. 

That door needs locking too, but all too often I can't find the keys. 

Six Shifts

Half a dozen shifts at my new job, just over one handful of volunteer shifts, and I'm already known as a troublemaker.

I don't mean for it to happen, I just seem to attract it. That black cloud follows me even when the sky is a perfect blue for miles in every direction, the curse of the Jonah changing language and writing instead from right to left, merely translating the script rather than rewriting it.

My first two shifts were quiet. Very quiet. The traditional 3am maternity taxi on one shift and a simple chest pain to wake us at 4am on the other. With the average being one patient per shift, I started to believe that I was going to see as many patients in a fortnight as I used to see in a day. But then it happened.

The next two shifts were busy, starting slowly but once we were out, that was it for the rest of the shift, straying further and further from home until the clock finally ticked over to going home time. Only one call that really made us think, but that was more reflecting on reality rather than medically challenging.

The fifth shift started off the same - no call for over an hour. I'd warned the team on the ambulance that I used to attract all manner of trouble, but that I seem to have shaken off that curse somewhere over the Mediterranean. Although I did admit that the crews I had worked with on the previous two shifts had cursed me for making them busier than they had been in weeks. I made a coffee for the three of us and tweeted something about the quiet start.

I know. There it is. The Q word. I had barely pressed send when all hell seemed to break loose. The ghostly, detatched voice of the dispatcher came over the PA system and mobilised all three crews who were sitting on base at the time. The urgent tone in her voice wasn't lost on anyone, even the new boy.

"All units head for the highway, reports of multi-vehicle accident, possible fatality, possible multiple casualties."

The three ambulances drive in convoy, begging the traffic to move aside and let us through. The problem is a worldwide one, but sometimes seems worse in this country, as if giving way is some sort of slight on the pride of the driver, male or female, old or young.

Three cars, four trucks and a motorbike. Each one damaged in some way, mangled metal, twisted tyres and windows smashed to smithereens. One person is lying on the floor, intermittently wailing and screaming, then threatening that he's going to get the idiot that caused this, as well as his mother, grandmother and pet cat. It's the international sign of the nothing-wrong-brigade.

It's the silent ones you need to worry about. There's only one silent one, still sat at the wheel of his car. There's no-one for us to transport.

Clearing from the scene, barely two minutes pass before we are assigned to a new call.

"Unconscious child, fallen from height," says the dispatcher over the radio. "You're really having a day of it." Two pairs of eyes stare back at me, silence speaking louder than words. I shrug an "I told you so" type of shrug and we head off.

The child is fine, conscious and crying; possibly in pain, perhaps in fear. No obvious injury, but it's a little hard to be certain. Yet another example of children bouncing where adults would fall to pieces. Adventure is everything to a child, danger and fear are nothing, even when the danger presents itself as a fence three times the height of an average human. We transport him, a parent and a teddy bear, using my folder as a spinal board for the bear, taping him down and making him a collar out of the roll of tape.

At the hospital, I get the coffees and a bar of chocolate each.

"Any more tricks up your sleeve?" asks my paramedic colleague.

"Not planned any, unless you have anything in mind you'd like me to order."

"Let's just order a return to base. That's twice today that I've had to think."

A call to a shooting squawks over the airwaves the instant we clear at the hospital, but two minutes into the journey we're cancelled as two other ambulances cleared at a nearer hospital. The journey back to base is uneventful and we arrive as the clock strikes the hour for the end of shift.

"Just out of curiosity," says our driver for the day, "you back tomorrow?"

"No, not tomorrow. Got a couple of days off."

"Thank God for that." They both smile and head for home.

Two days later, as I'm walking with some friends down the main road near our home, there's a huge smash and a cloud of smoke billows up in the air. The incident itself is hidden from view by a 200 metre long and five metre high mound of earth that will soon be a park and playground. I walk up the mound of earth, reach the top and run down the other side. I'm just within earshot of my friend when he states the obvious.

"Oh oh. He's running."

The smashed front of one car and the destroyed rear of another come into view as I reach the top of the man-made hill. Airbags have been deployed, crumple zones crumpled, and the remains of a street sign lie tragically bent out of shape on the pavement. The driver of one car is already sitting on the pavement, shaken and shaking as I try to learn just the basics; name, age, pulse, medical issues, pain. The other car was parked, luckily unoccupied, its owner soon to discover his pride and joy is a tangled mass of metal. Someone, somewhere just out of field of vision, yells that they've called an ambulance.

Just six shifts in, yet I already recognise the growl of the engine as the ambulance approaches. They pull up alongside and the crew step out.

"I thought you had a couple of days off!"

"So did I..."

A Life Worth Living?

Life is difficult, I get that.

There are financial troubles,

family conflicts.

Friends who fall out, 

failed relationships,

failed studies.

A home barely suitable for

human habitation.

You can't cope,

you want out.  

You want to die,

you understand what that means,

clearly comprehend the closure,

the finality.

So you try, not once,

but twice.

You fail, and I'm glad.

Glad,

not because you've failed at life,

but because you've failed at death.

I'm glad,

mainly,

because you're only

ten years old.

You have a whole life yet

to live.

Uniform

Remember me? I used to blog here regularly. Somehow, recently, it just hasn't happened. I know I've already apologised for this once or twice before, but here I am again doing the same thing. Lack of material isn't the problem. The diary with the scribbled notes still exists, reminders of people and places, images and faces, but I just can't seem to bring them to life.

Almost four months have passed since I was last on an ambulance. The wheels of bureaucracy in the local ambulance service are grinding slowly and painfully, despite the fact that on more than one occasion I've been told how desperately they need more paramedics. Someone must have put some sawdust in the gears.

For now, writing about my life in EMS is difficult, not because I don't have stories to tell, but because my muse seems to be lacking. It's a strange concept. In order for me to write about tea, in one form or another and how it interacts in the life of a paramedic, maybe I need to be drinking the horrible stuff that awaits crews at fewer and fewer hospitals. 

In order for me to write about elderly patients, either the amusing or the heartbreaking, perhaps I need to be meeting them regularly, treating them, either their illness or their loneliness. 

For me to write about victims or witnesses of street-side carnage, the real or the perceived, perhaps I need to have a board and collar within easy reach, even if I choose not to use them. 

Violence is real, too real. Never-ending. Tragic and often inexplicable. 

Yet, I just can't seem to get to writing about them. I need that spark back in my life, the inspiration to put pen to paper, or fingers on keys if you prefer. Hopefully, that spark is heading back my way. 

Yesterday, I had a phone call. 

"What size are you? We're trying to sort out your uniform." 

Weekends

I sit and write this at the most despised moment in the Western World. 

Monday morning. 

Luckily, by the time Monday morning arrives here, we already have 24 hours of the working week under our belt and that Monday feeling already happened on Sunday. There's good and bad in that. The kids go to school six days a week, which they hate, but finish around lunchtime each day, which they love. They've also suddenly realised that the upcoming summer holidays are some three weeks longer than they would have had back in the UK, but that's just by the by. 

Monday to Friday. The so called normal working week. Or, as those in EMS (and other emergency services too, I guess) call it, Monday to Friday. There's no such thing in the twenty-four/seven world of EMS as the normal working week. Our Friday feeling can arrive any day of the week and any time of the day. Nights turn into days, days into nights, weekends into weekdays and vice versa. There's no real pattern that means anything to an outsider, when the weekend can just as easily begin on a Tuesday. 

"So how many days a week do you work?" is a common question from many who are looking from the outside, in. To answer it, first you need to define the terms 'days' and 'weeks'. 

The past few (normal) weeks as an unemployed paramedic have been a little frustrating. Bureaucracy has a wonderful knack of driving the sane to distraction and I was only semi-sane to start with. We're getting there, slowly but surely. Everywhere I've been and everyone I've spoken to has told me that they're desperate for paramedics, but it just takes time to get through the red tape. 

I have, however, found a new love for the concept of the real weekend, shortened as it may be. Saturday afternoons now involve leaving the kids to their own devices and sitting down with a good book, or if I'm really lucky, like last weekend, even a nap. 

Apparently, however, even an unemployed paramedic is still on call, especially when they're asleep. A crash of the front door is swiftly followed by a bash on the bedroom door.

"Somebody's collapsed in the park!" yells a child's voice. "Come quick!"

Thirty seconds later, somewhat more bedraggled than I would normally be when responding to an emergency, I meet my first real patient for a couple of months. He's young, eighteen at most, looks pale but indicates that he's pain free. The fact that it's 30 degrees Celsius means that it's a little difficult to ascertain whether the sweat is heat related or otherwise, but a sixth sense and a weak pulse make me opt for medical rather than atmospheric. 

As if I'd never been away, I start asking my questions, going through the mental list that has formed my initial patient assessment for years, but this time, in Hebrew. 

"I'm sorry," says the patient, looking a little confused and embarrassed, "but do you speak English?" 

As it turns out, had he have been at home, rather than on an extended stay with relatives, he could still quite easily have been my patient, living within spitting distance of my London ambulance station. Instead, I get to treat him in Israel. Treat may be pushing the boat out a little, as I had no equipment with me, but at least start to get some sort of history. 

In the meantime, someone had called for an ambulance. The first responder arrived three, maybe four minutes later, immediately followed by another, both on bikes. They're volunteers, much like the community responders in certain parts of London, who help back up the ambulance service which is spread too thin. So far, so familiar. They strolled over to where we were, hands in their pockets and with no equipment. My patient looked up and his first words were shocking. 

"Don't let them near me, they hate me." 

"Pardon?" 

"The same thing happened last week and these two turned up then, too. They basically called me a liar and told me I was faking." He told me about the treatment that he'd received, but more importantly, the attitude with which it was delivered. 

I didn't think he was faking, but I did hear one of the responders mutter something to the effect of Oh, him again. I sent one of them back to the bike to get me some kit, so I could check the basics at the very least and then try to make an informed decision as to a plan of action. The ambulance arrived shortly after I had checked the blood pressure and following a handover to the crew, I left them to continue the treatment. 

I walked away reeling from the patient's comment. They hate me, he said. They told me I was faking. Maybe he was, maybe he wasn't. I wasn't there the previous time, but I certainly didn't think he was lying on this occasion. These two responders fell into the most dangerous trap there is for an EMS provider. 

Presumption. 

We're all guilty of it. When you meet your regular leg-pain caller for the umpteenth time that month in the same phone box, it's difficult to act with the sympathy and open mind that you would otherwise have for somebody else. To fall into this trap, however, based on very minimal previous experience or exposure and all before you've actually seen the patient, is not only dangerous, but, to be honest, stupid and unprofessional. 

If you're a student reading this, or a fairly new EMS provider, you'll swear blind that you'll never do it. You'll never fall for it like the old hands do. I warn you now - you will. It's what defines you as an old hand. The trick to learn along the way, however, is when, how and at what speed can you recognise that you're doing it, that sometimes you're wrong, and what you need to do to put it right. 

The other trick, is to not become an old hand before you've earned that right. There's a fine line between confidence and over-confidence. Crossing that line can take you, very quickly, into territory that will not only grate on the nerves of anyone you work with, but also into a danger-zone for you and, most importantly, your patients. 

You need to constantly assess and reassess not only your patient, but your treatments and attitudes too. That way, you'll be safe in the knowledge that you'll be able to relax when you get to your weekend. 

Even if it is on a Tuesday. 

The Pink Bike

The silvery handlebar stuck out of the bottom of the hedge, colourful tassels hanging off the green grips either side. The front wheel was buckled and bent out of shape, rendering the bicycle useless. It looked otherwise new, well cared for. Stickers of princesses and cute animals adorned every inch of the front-mounted wicker basket. The only thing missing was the rider.

Nearby, still within earshot, children played in the park, filling the air with the joyful sounds of child's play.

Putting an end to yet another cup of coffee, the call came in of an accident; a neighbour had witnessed a bike hit the pavement and saw the rider fall and hit the ground hard. By the time we turned up, the rider was nowhere to be seen. After a minute or two, the caller came out of their house, unintentionally mocking us by holding a cup of steaming drink. Maybe tea, maybe coffee, it didn't really matter. 

"He really hit the floor. I heard the thump from my window!"

"He?"

"Yep, big chap too." He suddenly realised why we looked confused. "Oh. Weird. What the hell's a big bloke doing riding a pink bike?"

"That's exactly what we want to know. Knowing where he is would probably help too."

The police arrived, having been given the call as an accident. Chinese Whispers had led them to believe that there was a car and an unconscious patient involved. The neighbour repeated his story, adding the police to the list of now confused people. The blue lights had attracted the usual crowd, but the distinct lack of action made it disperse faster than usual. All they saw was one of the police officers pick up the bike and put it in the back of their van. My student and I were left with nothing to do but put our bags back in the car. 

Only two people kept walking towards us, hand in hand. A giant hand comforting a tiny one as sobs racked her body and tears stained her face. His voice carried the few dozen steps on the wind. 

"We'll go tell the police over there, shall we? I'm sure they'll be able to help - but only if you're really brave and tell them exactly what happened. Can you do that?" 

She nodded. 

One of the officers knelt down, meeting the child eye to eye. 

"What's happened to you then? We can't have your tears making such a mess on the pavement!"

She tried hard not to smile, tried to hide behind the man, seeming to want to climb inside him. 

"Is this your dad?" 

A nod of the head. 

"Has he been tickling you too much and you want us to tell him off?" 

A grin, a shake of the head, and finally a laugh. 

"Well then, you better tell us what happened." 

She took a deep breath, as if her narrative was the beginning of an epic saga. "I was in the park with my friends. My bike was by the fence and we all went on the swings. Then, a man came and took my bike and rided off with it, and now I don't know where it is!"

"He just rided off with it, did he? Well, let's see what we can do about that." 

The tears returned, but just sat threateningly close to the corners of her eyes, filling them like untapped wells. 

"I used to be a magician," said the officer. "I bet I can guess what your bike looks like." She gave him a quizzical look, but said nothing more. 

"I bet it's pink." 

"Yes," she said, her voice quiet and questioning. 

"And I bet it has little colourful ribbons on the handle-bars." 

"Yes," this time more hopeful than unsure. 

"And," he said, extending the single syllable until it seemed to stretch for miles, "I bet it's got a lovely basket on the front with pretty princess stickers all over!" 

She looked at her dad who just shrugged his shoulders. 

"Well, I don't know who the man was who took your bike, but I know where your bike is. Would you like to see it?" 

Without a moment's thought, she held out her free hand for the officer to hold. The three of them walked to the van together, the two men swinging the young girl through the air to the sound of shrieks of joy. I heard the officer warn them that the wheel was damaged, but neither seemed to be perturbed. 

"You don't mind?" 

"Nah," said the dad. "I own a bike shop." 

We left them to their reunion, returned to the FRU and opened the folder with the paperwork. 

"What do I write for this one then?" asked my student. 

"Easy. No patient, gone before arrival."

"More like Gone before they got spotted riding a girly pink bike!" 

"Go on then. I dare you!" 

"All right then, I will!"

At the end of the shift, I looked through all the paperwork before posting it in the internal mail box. As I arrived at the piece of paper with the story of the pink bike, three words appeared on the page. 

Gone before arrival.

"Oy! You!" I called after my student, watching him try to beat a hasty retreat. "You're such a..." 

And without letting me complete the sentence, he walked out of the station flapping his arms.