Greg

"GREG?" 

The man looks up, raises an eyebrow, shrugs his shoulders and finally shakes his head. 

As for us, there's still a child with an asthma attack waiting for our attention. 

Greg will have to find help elsewhere. 

Thinking back to the crash, maybe he's already receiving it. 

Missing

We spread out and search a room each. The police broke the door down, leaving the splintered remains of the frame lying all over the carpet, like a giant wooden pile of pick-up-sticks. Greg's worried neighbour had called the police having not seen him all day and seeing that his morning newspaper was still sticking half way out of the letter box. 

"He often goes out for the day, but he's never this late back and never leaves before reading the paper first." He stands behind us as we step into the house, brave and afraid in equal measure. "I just hope he's alright." 

Each door is opened slowly as the fear of what may be found behind it gnaws away at the back of all our minds. The kitchen and main dining room are empty, as are the other two downstairs rooms. One of them looks as if it had been locked in a time-warp for fifty years, with piles of newspapers tidily stored all around the room. 

Some houses give more of an eerie feeling than others and this is one of them. Only half the lights seem to be working, the doors creak and floorboards whine as the small army of police, ambulance staff and worried neighbours walks around fearing the worst, but hoping for the best. The search continues upstairs and follows a similar pattern. A gentle opening of the doors, initial relief at finding nothing and then a move to the next room. A more thorough search of each room, behind beds, in hidden corners, in the toilets and bathrooms reveals nothing. Greg isn't at home. 

Initial relief is soon followed by concern. The police start to take a more detailed report from Greg's neighbours, knocking on a few doors up and down the street to see if anyone could remember the last time they'd seen him, the latest time being the previous afternoon. The lady next door tells us that she's known Greg for over twenty years. 

"He has family, but they all live somewhere in the north of England. Come down for Christmas and his birthdays, but that's about it. He's fiercely independent and very stubborn. Never asks for help or anything. Loves his days out, goes everywhere by bus." 

We ask our control to contact the local hospitals, wondering if Greg had been taken ill in the middle of the night or whilst out and about on one of his gallivants. As they contacted each hospital they called us back to let us know the answer. No hospital within a ten-mile radius was looking after Greg and concern for his welfare was building. The police had called his relatives just to make sure that he hadn't headed north without telling anyone, but he hadn't contacted them either. 

As we were about to leave, a white van pulls into the road, the two men on board had come to fix Greg's front door and make sure the house was safe and secure. "We'd have been here sooner," said the driver as he stepped out of the cab, "but we got stuck behind a crash. Some old bloke knocked over about a mile down the road. They've only just let us through!" 

The coincidence isn't lost on anyone and worried looks cross a number of faces. Yet again, one of the officers gets on the radio and tries to find out the name of the victim of the crash. We all hear the reply. 

"No details yet. He didn't have any ID on him." 

We have no choice other than to leave the scene and leave the police and neighbours to deal with the missing Greg. As we drive up the steep hill towards the main road, we're given another call. A child somewhere is having an asthma attack. It puts an end to our mystery call. We turn left at the top just in time to see an older man walking in the opposite direction. Shopping bags in each hand, he strolls without a care in the world. On a whim, I wind down the window and shout. 

"GREG?" 

DVT Confusion

When is a DVT, or deep-vein thrombosis, more dangerous to an ambulance crew than it is to the patient who's had one? Consider the following conversation:

Medic: "Does your husband have any medical conditions?"

WifeOfPatient: "Yes, he's diabetic and has high blood pressure."

Medic: "Any medications?"

WOP: "Oh, lots, I'll show you the list." A list is promptly produced. On there, alongside medications for the ailments already mentioned, is warfarin.

Medic: "Why is he on warfarin?"

WOP: "Oh, that's to thin the blood."

Medic: "Yes, well we know that bit. But why does he need his blood thinned?"

WOP: "Oh, he's got that thing, you know, the thing that's like a video or television thing."

Medic: "Pardon? What's TV got to do with blood thinners?"

WOP: "You know, that new-fangled thing they use to watch films now!"

Medic: "Nope. Still confused."

WOP: "Oh! I remember now. It's that thing in his leg. A DVD! Told you it was like a telly..."

Just so you know, it's a little difficult to treat your patient when you and your crew mate are having fits of the giggles...

Familiar Arms

Wrapped in blankets almost up to her eyes, Liana's barely visible. Naz, her husband, met us at the door with a roll of the eyes, as if to say here we go again. It takes a few minutes before we coax the first words out of her and longer still until we could calm her breathing enough to be able to have a conversation. A little boy of about three, a mix of Middle Eastern features and Eastern European pallor, runs around the house without a care in the world. Every few minutes he would come back in to check on what was happening and satisfied that there was nothing untoward, would go back to playing.

Naz never left the room for more than a few seconds at a time. He stood by the door, watching our every move, listening to every word. 

"Is Liana on any medication?" I ask him. 

"Only some painkillers when she needs them." 

"Do you have the packet?"

"I'll go and find it." 

The moment he leaves, Liana moves the blankets a little away from her face. 

"Liana, do you want to tell us what's wrong? What's got you so upset?" 

She shakes her head so violently that the straight-flowing tears suddenly zigzag their way down her cheeks. But she can't bring herself to say it. She just looks in the direction of the door and a shiver runs through her. When Naz comes back, I suggest that we need to do some more checks in the ambulance.

"I'll come with you." It's a demand rather than a request.

"Why don't you stay here with the little one, we'll just be a few minutes, do a few checks, then we can decide what the best plan is." 

Reluctantly, he agrees, but tells us he would just get their son ready and then he would be down too. In the time it takes him to find coats and shoes, we've already got half a story and realise that we need to get Liana away from home. She told us a little of the terror she faces at home every day, how she's not allowed friends, how her family have been kept away, how the threats of harming their child make sure she's kept on a short leash. Before she can tell us any more, the door to the ambulance swings open and Liana jumps in fear.

"Well, what are you doing with her? She doesn't need hospital, you know. She just needs to get back home and calm down. She's always doing this." 

"Where's your boy?" 

He shuffles slightly aside to show us a frightened shell of a child, totally different from the one we met upstairs. 

"I think we need to take Liana to hospital. Her pulse and blood pressure are a little concerning, so we want a doctor to look at her." It's a white lie, one we hoped was real enough for him to accept. 

"You're sure, yes?" 

"I'm sure." 

"Can I come with you?" 

"Why don't you come in your car, then you've got a way of coming home?" 

"Fine. But I don't want this child crying all the way there. You can take him too." 

"Not a problem. We'll look after them both. We're only going to the nearest hospital."

"I'll be a few minutes behind you. I go to the emergency department?" 

"Indeed." 

For the few minutes in the ambulance, Liana was silent. Her little boy had calmed down a little, a combination of glove balloons and a bottle of bubbles easing his fears. He even managed a laugh when one of the bubbles flew up to the roof of the ambulance, drifted slowly down and suddenly popped on his nose. As we arrive at the hospital, an all too familiar queue appears in front of us, with two other crews and their patients waiting for triage. It gives us some more time to talk, but Liana chooses to keep quiet. 

As we reach the front of the line, I have one final chance. 

"Has he ever hit you?" 

A single tear escapes and rolls down her face, as a confused little boy wipes it away for her. She leans forward, kisses him on the head and lifts the back of her shirt. She's black and blue from top to bottom. Belt marks, cigarette burns and crude, jagged cuts cover her entire back. 

"Please don't tell anyone. Please!" Her plea is barely audible, no more than a tormented whisper.

"Liana, I don't have a choice. Some of these wounds need treatment. I have to tell the nurse."

After more tears and pleads, once we promise that both she and her little boy will be looked after, she finally agrees. Having waited almost half an hour, we hand over just as Naz walks into the department and immediately all the eyes turn on him. 

"You told them, didn't you? I told you what would happen if you told anyone!" His screams make every other person in the department turn around and make me clutch on to the little boy. "What are you all looking at? She deserved it!" 

A security guard hurries over and after a bit of a struggle promptly removes Naz from the department, all the while calling for police over the radio. Liana breathes a sigh of relief and holds on tightly to her little boy who I've handed back into familiar arms.

NHS

"I know what NHS stands for!" announced mini-Insomniac as he visited his mum in hospital. "It's Natural History Science!"

I can only presume he's alluding to his two favourite London museums. And it beats "No Help Service" that I've heard bandied about in the past... 

The best I could come up with in a hurry? "Not Healthy? Sick!"

Any other ideas? 

Transcript

The following is an almost word by word transcript of a phone conversation I had not long ago. It has nothing to do with EMS, ambulances or anything such like, except for the fact that the conversation took place when I was woken up by the phone ringing less than an hour after going to bed after a night shift. 

It was a conversation between ColdCaller (CC) and a slightly disgruntled, but surprisingly ever calm InsomniacMedic (IM). For the purposes of this conversation, IM lives at 123 High Street, Neartown, Z99 9ZZ. 

*RING RING* *RING RING*

IM: Unintelligible... "Hello?" 

CC: Overseas call pause and click... "Is this Mr IM?" 

IM: "Who's this?" 

CC: "This is Bill from PPI International. I'm calling you to help save you money."

IM: "Whatever you're selling, I'm not buying." 

CC: "I'm not selling anything sir. I'm offering you a service."

IM: "And what service might that be?" 

CC: "Like I said, I'm calling to help you save money, by claiming back payments on a loan that you shouldn't have made."

IM: "Which loan would that be?" 

CC: "You know the one, the loan you took out some time ago." 

IM: "Hedging your bets there, aren't you?" 

CC: "I'm sorry, I don't understand."

IM: "Never mind. Can you tell me the name of your company again please and where you're based?" 

CC: "PPI International, and our headquarters are in Karachi." 

IM: "And you're not selling anything, just offering a service, right?" 

CC: "Correct." 

IM: "Is this a free service?" 

CC: "Well, no, it is not free, we charge a fee." 

IM: "So you are selling something then?"

CC: "It is not selling, it is providing a service for a fee." 

IM: "Right. OK then. And who's the CEO of your company?" 

CC: "Why do you ask?" 

IM: "I like to know about any company which randomly calls and offers to help me. I just want to do some research and make sure that you are who you say you are." 

CC: "The CEO is Mr Khan." 

IM: "You say that your HQ is in Karachi. Where exactly is your office?" 

CC: "You want to know where my office is?" 

IM: "Exactly. Where do you go every day to make these phone calls?"

CC: "I'm not sure of the exact address." 

IM: "You don't know where you go to work every day?" 

CC: "I know where I go, I just don't know the address." 

IM: "I'll ask you one more time, and if you can't answer the question, I'm hanging up. Where do you go to work every day?" 

CC: Short pause. "OK, I don't normally give out my work address, but it is 123 High Street, Neartown."

IM: "Pardon? Can you repeat that? And tell me the postcode too please." 

CC: "My work address is 123 High Street, Neartown, Z99 9ZZ." 

IM: "You're sure? That's your work address? That's where you start and finish every working day?" 

CC: "Yes, that's right." 

IM: "Well then, how do you like your coffee???" 

CC: "Umm... Err..." Click, Beeeep

Moral of the story? Never, never, wake up an already sleep-deprived insomniac. 

Tick Tock

Times, they are a-changin'. Or so said Bob Dylan. Personally, I'd reverse the lyrics. Over the past few months I've had the opportunity to work with several student paramedics, either as a working crew, or when they're out on vehicles and I'm on the car. Some are good, some less so. Some who are too young, whilst others are either mature students or have maturity beyond their years. All, however, seem to have arrived bamboozled by the power of the clock. 

I'm going to be honest. I don't give a damn about the time limits we're given, particularly when it comes to turn-around times at hospital. It's probably best that I don't give a damn, because I suspect that my turn-around times are probably giving my management team nightmares. I do, however, give a damn about my patients, so I get to the call as quickly as I safely can, I treat them as best I can. We have fifteen minutes in which to hand our patient over to hospital staff, clean the ambulance, restock the missing bits of kit (if possible - sometimes it's a bit of a challenge to do anything short of reallocating resources from either hospital or another ambulance), use the bathroom if required, grab a quick drink and sometimes a bite to eat, and, of course, complete the paperwork. 

Admittedly, the fifteen minutes on which we're currently assessed don't start until our patient is on a hospital trolley or in the waiting room, so the three hours(!) I waited the other day with a patient on our trolley bed won't count against me. I do realise that we don't have to have a coffee or use the facilities after every call, but the pressure of this quarter-of-an-hour time limit has led to what, at least in my eyes, is an ugly new trend, particularly amongst these new paramedics and students. 

The trend? Completing the paperwork before we've even left the scene of the call. Not just the basic details, but every last bit of paperwork.

I hate it. The patient is in the back of the ambulance, a history has been taken indoors, observations checked and rechecked (after all, every patient must have two sets of obs - yet another box-ticking nonsense in many cases), the patient has received treatment if appropriate and/or required, all whilst the family are standing outside wondering what's happening. Often, the patient is wondering the same thing too. 

The patient is in the back of the ambulance for one reason and one reason only. You've made the decision that they need to go to hospital. Well, either that, or the patient has made that decision themselves and aren't going to be persuaded otherwise. In either case, the reason is the same. That patient is going to hospital. They don't want to be sitting on their own doorstep for an extra fifteen minutes with the blood pressure cuff aimlessly inflating automatically at five minute intervals. They don't want their family standing outside the ambulance concerned that something terrible has happened. They certainly don't want to be ignored for the time it takes to complete the scribbled account of everything that they've just told you. 

They want to go to hospital. 

Many (most?) of our patients need no treatment on route to hospital other than a smile and some friendly, calming banter. Talk about the weather, talk about their children and grandchildren, talk about their wartime experiences, talk about the football or last night's garbage television. Talk, and write. And if you can't do both, then just talk. If your patient isn't interested in conversation, then you can just write, but be on the move. And if, by the time you get to hospital you haven't completed your paperwork, do what I do, and take whatever time it takes. 

Paperwork, as well as being the bane of the life of any paramedic, is a legal document. If it's not written down, it didn't happen. Standing in front of a coroner and claiming that you provided treatment but failed to document it will leave the coroner with no choice but to accuse you of lying, so you do need to make sure that everything is written down. It is, of course, helpful to write down the patient's details as they tell you their name and date of birth. But as far as the story, the history and the symptoms are concerned, just listen, make mental notes or even quickly scribbled ones on a notepad and then write them down properly later, once your patient is no longer yours. If you can do it in the allocated time, all well and good. If you can't, if you need to pay extra attention to detail, if you need to ignore the clock, just do it. 

Concentrate on your patient, not on the clock. It takes a while to learn the knack of writing and talking at the same time as being on the move across the pot-holed London streets, but it's a skill worth learning. But if you can't manage it, then just wait. Arguing that completing the turn-around in the allocated time is beneficial to other patients by being back in service quicker, is no more than complete nonsense. If you've taken exactly the same time to complete the call by standing outside the patient's house for those precious minutes, then you're not back in service any quicker. 

Concentrate on your patient, not on the clock. It takes a while to develop a system that ensures that everything that needs to be written down actually makes it from thoughts onto paper, but it's a system that's worth having. If you can't manage it within the precious time allotted to you at hospital, then just take a little longer. Each patient is worthy of your personal attention. That tick-tocking noise in the back of your mind should come a distant second. 

A little more of the personal touch and a little less of the clock-watching paranoia can turn a good paramedic student into a great one. Try it. You may be surprised at the results. 

Edna and Eddie

Surrounded by his wife, children and grandchildren, Eddie sits in an armchair so huge that it seems to almost swallow him up. 

"I'm alright," he says. "Don't know what all the fuss is about!" 

His face is pale and the sweat is pouring off him, whilst his arms hang down lethargically by the side of the chair. He denies any pain but does admit to feeling a little dizzy. 

"He's had heart trouble for years," says Edna, his wife of almost sixty years. "Never makes a fuss. Always ignores any problems until they get really too much." This time, he'd passed out for a few minutes, giving the family enough time to call for the ambulance before he came round enough to object. 

"I'm fine, I tell you." 

"Let's have a look at you and we can see what's going on. It'll only take a few minutes." 

"Oh. Do what you have to do. But I tell you there's nothing wrong that a drink down the pub with a couple of young ladies wouldn't sort." 

Edna shakes her head and rolls her eyes. "Oh, do stop messing around Eddie. You frightened the life out of the children you know. And me for that matter!" 

It takes only for me to feel for a pulse at his wrist to tell me what the problem is, or at least part of it. 

"Eddie, do you have a pacemaker?" 

"Not yet. They were talking of giving me one a while back when I kept getting dizzy spells, but whatever the problem was went away so they didn't think it was necessary." 

"Ah. I think they might have to think again. Your pulse is less than half what it should be!" Attaching him to the monitor, I hit the alarm silencing button before the irritating whine even has the chance to tell me what I already know. The number 28 appears in a bold yellow highlighted box at the top left of the screen and the flicker of a heartbeat flashes across the monitor only every other second. At least his blood pressure was behaving itself. "You're definitely going to need to pop up to the hospital. Can't have your heart only doing part time labour for full time pay." 

Moments later, the rumble of a diesel engine struggling up the steeply inclined street tells us of the ambulance's arrival. Tanya and Michelle step into the house, bringing a carry chair with them and a smile to Eddie's face. I introduce them to Eddie, explain the situation and tell them what I'd found so far. 

"He says that a drink down the pub with two young ladies should sort the problem." 

"Well," says Tanya, "it doesn't seem to be working so far. We've turned up, and your heart rate still hasn't picked up!" 

"Oh," Eddie replies, "well it might not be beating any faster, but, I can tell you, since you two walked in, it's certainly beating much stronger." 

Edna, for what must be the millionth time in their marriage, shakes her head and rolls her eyes.

Last Light of Day

The first I saw of Mel was a late summer's evening, when we were called to her house for a very simple transport. Arriving ten minutes earlier than the scheduled pick-up time and understanding the significance of the call, we waited outside in the ambulance for those few minutes. As the clock struck on the hour, we knocked on the front door and waited. 

"Oh, you're here! Sorry, we're running a few minutes late." Rob looked tired and hassled as he moved a small suitcase out of the way so that we could get in.  "I've never been a good one for time keeping, that's always been Mel's job. Speaking of which, you'd better come in and meet her." 

Rob shows us to their bedroom, as Andy and I size up the corridors and turns to see which will be the easiest route out again - on a wheelchair or the trolley bed - but the last corner is too tight for the latter. Mel's eyes are closed as we walk in, but she still manages to welcome us. 

"Hi guys. Let me guess, he's running late, right?" 

"Well, yes, but take your time. We're in no hurry. We're either here in your lovely home, or out there fighting with drunks. I know which I'd prefer." 

"Has he offered you tea yet?" Mel gives Rob a look of resignation, as if all the lessons she's been trying to teach him have failed to register. 

"No. We're good thanks. Too much tea is an occupational hazard we need to avoid. Not enough toilet stops, you see." 

Mel manages a smile as Rob steps out to finish packing. All around her are cards and flowers, messages of support cover the bedside table and windowsill. A single picture in a frame sits in the middle of all the cards. A photograph of two young children, one boy, one girl, both in school uniform, lazing on a wooden bench in the shadow of an enormous tree. 

"Twins?" Andy asks, pointing to the picture. 

"Twins. But born a day apart. Well, ten minutes really, but one each either side of midnight. I'd always heard stories like that, but never thought it would happen to me!" 

"Cool. How old are they?" 

"Eleven. That picture was taken two days after I was diagnosed, three years ago, so I guess they must have been eight then. I'm sure they'll be down in a second." 

Rob comes back into the room with a glass of water for each of us and behind him, as if on cue, are the twins. 

"Ah, maybe I have taught him something after all!" 

"Oy, be nice! Or I'll tell 'em to drive you over every pot hole from here to the hospice!"

"You wouldn't make my last ambulance ride a bumpy one, would you guys?" 

"We wouldn't dare! Well, not unless the money was good enough!" 

Last minute logistical arrangements meant that the twins would come with us in the ambulance, whilst Rob would drive his car, leaving them with transport to get home again. As we wrapped Mel in a blanket on our wheelchair, she remembered to check a few things with Rob. 

"Are the kids' uniforms ready?" 

"Yes." 

"Their lunches?" 

"Yes!" 

"You set the alarm for the morning?" 

"For heavens' sake, Mel. YES! Have some faith, won't you? Now, I'll be back in a second, just going to lock the back door." 

We wheeled Mel to the front door and waited for Rob. The twins stood just outside, half staring into the back of the open ambulance, its tail lift sitting on the floor waiting to swallow its precious cargo. 

"Shall I switch the hall light off?" Andy asks Rob. 

"Actually," says Mel, "do you mind if I do it?" 

We lift Mel just high enough in the wheelchair so she can reach the switch, and as the sun sets through the clouds outside, the hall is engulfed in the orange glow of the last light of day.