Angels

Some days I feel like the Angel of Death's right hand man. It's almost as if he's sitting on my shoulder, bidding me to do his work, waiting for me to feed him another soul.

The shift starts with a family member or a carer discovering that their relative or ward has died peacefully during the night. We march in, carrying equipment that we know will be totally redundant. Oxygen, where the tap will remain unopened. A box full of drugs that will number the same when we leave as they did when we entered. A monitor that will do nothing but paint a long, straight, lifeless line on a strip of paper, telling us and the family what we already know. All too often we are still there as the reality of loss strikes home. Sometimes slowly, gently creeping into the minds of those around; sometimes it hits with the full force of a tsunami wave. Before we leave, we comfort the bereaved, we mutter words, platitudes, practicalities, and then go back into the world outside that just carries on as if nothing has happened - unlike the four walls that we have just left, within which the world has suddenly stopped. The Angel has won.

Then there's a call for someone who's dizzy.

Yet another for someone in pain.

And we treat them with care, give them attention, tend to their needs, transport them to the hospital. In the short time it takes me to walk back from the emergency department to the ambulance, all too often I have forgotten their basic details, like a name, or age, or chief complaint. By the end of the day I barely remember these calls at all. And the Angel lurks bored in the background.

And then again there's a call: to someone who has stopped breathing. But this time, someone was watching as they took their last breath. We drive fast, arrive into the confusion and chaos and panic and fright. This time we have a chance. We open the oxygen, we give them the drugs, we beat hard on their chest, we breathe for them, pump blood around the body for them. Try our damndest for them as all around people are crying or screaming or praying or silent. But after a while, twenty minutes, forty minutes, an hour, we are defeated. Death has beaten life, as if the Angel is ironing out the last of the ups and downs on the monitor, leaving that long, flat, lifeless line again.

Then there's a call for someone short of breath. They have nothing more than a cold.

Then there's a call for someone whose blood sugar has fallen so low that they're unconscious, or confused, or violent. We fill their blood stream with dextrose which brings them out of their stupor. All too often they are embarrassed and apologetic. Nine times out of ten we leave on the best of terms, but every so often we need to force a trip to the hospital. All the while, the Angel slumbers.

Then there's a call for someone who's fallen and can't get up. We help them up, dust them down, sometimes make them a tea or coffee. We look at pictures of their grandchildren, or take an interest in their books, or listen to an abridged life story. Often we leave with a smile and a smirk at the Angel. Sometimes, that smile fades in the blink of an eye.

There's a baby turning blue. Can't breathe. Floppy. And we're miles away.

These sorts of journeys happen in an eerie sort of silence. No words are spoken, no thoughts-out-loud. Only the wail of the siren permeates the air, helping us push through traffic as fast as we can, but it never seems quite fast enough. Yet, when we arrive, with the Angel looking over our shoulders, we take hold of the baby.

She's breathing. Shallow, struggling breaths, her shoulders and ribs working twice as hard as they should be, trying to expand her lungs and feed them the oxygen they crave. And the Angel stares, prepares, dares us as he heats his iron, yet all the while we beat him back. We feed her oxygen, drugs, put up defensible borders, give her a fighting chance. We carve our way through the traffic again, to hospital, hand her over to the staff and breathe a sigh of relief when we hear a beautiful noise.

She's crying.

We clear up, tidy the back of the ambulance and prepare it for the next call, and finish the paperwork. Just before we leave, we go back to check on the baby, whose cries have subsided as she finally catches her breath and her face slowly breaks into a wary smile. As we step into the room, her mother finally sees us, as if for the first time, even though she was with us all along. 

"Do you know what you people are?" she asks, as she gently strokes her baby's face. "You're angels. Nothing short of angels."

I look over my shoulder, see no-one there,  and smile. 

Jealousy

Red 2, the second highest priority for a call coming in to the ambulance service. In the main determinant - the old favourite - Difficulty in Breathing. In the extra information the screen tells of a 40-year-old with a history of asthma. We race to the scene, find the front door open, and call in to find where the patient is hiding. We take in the oxygen bag, defibrillator, and all manner of equipment to deal with this life-threatening emergency.

A voice calls from the front room, and we follow the noise. The room is one of several in a large house, clearly now divided into several micro-apartments. A shared bathroom and filthy kitchen the only rooms with no external locks on the doors. The patient is sitting comfortably on the bed in the tiny room that is a bedroom, living area and laundry room all rolled into one.

Recently I've been charged with mentoring a student paramedic, (a brave decision by the powers that be...) and for most of this mentorship, he's in charge of the patients.

"Good morning. My name's Sash, what's your name?" Confidence is one of his strong points.

"Adam". A man of few words, obviously.

Adam seems to be having no difficulty in breathing at all, so Sash is a little confused.

"What seems to be the problem this morning?" Morning at this point is just after 5am, after another very long and busy night.

"I can't sleep." The words resonate well with your local friendly insomniac, yet at the same time grate a little.

"How long have you not slept for?"

"Since I woke up yesterday morning."

Whilst Sash is questioning, I'm checking his basic observations. A matter of course, and of course it matters. I think.

"So it's just been tonight that you've not been able to sleep?"

"That's right." I look up, just to make sure I heard correctly.

"Has this ever happened before?" Sash's perseverance is starting to show signs of frustration.

"No."

"So why have you called the ambulance? What would you like us to do?"

"Just take me to hospital. Maybe a doctor can tell me why I can't sleep."

Home remedies were suggested, a visit to the GP was suggested, an attempt to go to back to bed with a cup of cocoa was suggested. And all were rejected out of hand.

"I just want to go to the hospital. You're not doctors. I want to see a doctor."

At a loss for options, Adam was invited into the ambulance, took his seat, and we set off for hospital. We still can't refuse to take people to hospital if they're adamant they want to go.

I stay in the back of the ambulance to keep an eye on Sash and his ambulance aid, whilst our driver for the shift takes her place in the pilot's seat. We all know that there's not much to be said or done, yet I'm keen to see how Sash deals with a call that really shouldn't be.

The hospital is about a fifteen minute journey away. Sash starts to fill in the paperwork, name, address, baseline observations. Adam's not in any mood to talk, Sash has nothing to say, and I sit observing from the sideline.

About two minutes into the journey, I cough quietly. Sash looks up from his scribblings, and I mouth a 'Well done' to him. Confused, he asks me what for. I nod in Adam's direction and congratulate Sash on fixing the patient.

I can only stare at the patient as a strong feeling of jealousy starts to creep over me.

Adam's sitting there, held in place by his seat belt, quietly snoring and sleeping like a baby.

Possibly, Probably

I had to be honest. "Possibly not", was the best answer I could come up with.

How do they do it? How do kids always know to pick that one moment? The split second sometimes when the adult's gaze is averted, their attention diverted, is the exact moment that their child decides to do something dangerous.

*

A year and a half is a long time in the life of a toddler. Long enough to fill them with a sense of adventure, a love of excitement, a curious wonder, and no fear of danger whatsoever. Milly was a typical 18-month-old girl, waddling and toddling from one new find to the next. This time, the next find happened to be a marble. Well, a bag of marbles, but one marble in particular was to be the cause of all the excitement over the next few minutes.

The bedtime routine was more or less adhered to. Milly and her big brother Dan, had dinner at six, bath time at half past, story at seven, lights out at quarter past. Their parents split their nights, taking it in turns to make sure that both of them read to each of their elder children on different nights. Milly and Dan's baby sister, only two months old, didn't yet believe in timekeeping and routines, and during this one bedtime decided to scream, just after bath time. Milly was left in pyjamas and ready for bed, whilst mum went to tend to her sister. Her dad was just sorting Dan out upstairs. It was a perfect time for Milly to go discovering her big brother's collection of marbles.

As mum was dealing with baby and dad was settling Dan, Milly started to cough. A strange cough, one like Milly's mum and her intuition had never heard before. She rushed back in, baby in arms, and saw Milly struggling to breath.

"Tony! Tony, get in here now!"

Dad ran downstairs, saw what was happening, picked Milly up and looked in her mouth, hooked a finger in to see what he could find, and then tipped her upside down to see if he could dislodge whatever it was.

Mum was on the phone to the Ambulance Service.

Milly continued to struggle for breath.

Parents were frantic, Dan was scared to the point of tears, when all of a sudden, after a lifetime of being held upside down and patted harshly on her back, Milly coughed once more, screamed, and cried.

At that point, we walked in. Ninety-nine times out of a hundred, when called to a choking, the call will downgrade whilst we're on the way. What will start as a call to a non-breathing patient will often, through the wonders of the human body and its capacity to fix itself, turn into a post-choking, now breathing normally call. This time, it didn't happen, and until the second we walked into the house, we were on the way to a child still choking. Five minutes from the start of the call until the second we clambered over the building site of a driveway and into the house.

As I stepped across the threshold, I heard her scream, and breathed a sigh of relief. You can't choke and scream at the same time. It's physically impossible, so I knew Milly was no longer choking. The look in Milly's parents' eyes told the story. There was a mix of fear and panic, along with tears of relief welling up, threatening to burst their banks.

"She must have picked up a marble when we weren't looking. That's all I can guess, because they weren't all over the floor before".

I left Milly in dad's hands whilst I listened to her lungs, and checked that her breathing was completely back to normal.

Dad started to tell me what he did. "I just picked her up and stuck my finger in her mouth to see if I could find anything, but there was nothing there!"

Alarm bells rang. "I don't mean to tell you off, and I certainly don't want to scare you, but please don't do that again. If you blindly put your finger in, you could push whatever is there in the wrong direction, which could be the worst thing to do". He looked shocked.

"And then I tipped her upside down, and patted her on the back, and then you came in and saw what happened." Now, that's a better idea.

"Can I ask you a question?" said mum. Questions always welcomed, I just hoped I had the answer.

"If she'd have kept choking, and you'd have been another couple of minutes, would you have been here in time?"

I had to be honest. "Possibly not", was the best answer I could come up with. "But that's where you come in. That's why control give you the instructions, to give us the extra time to get here. You need to be able to help us to help you".

On the way to hospital, we talked about how kids are there to scare us as parents, how, even with all my training as a paramedic, I still hate it when it's one of my kids that's unwell or injured, and how MrsInsomniac has the luxury of panicking whilst I deal with whatever crisis may arise. Except, obviously, when I'm not there.

"So what can I do?" Milly's mum asked.

"Well, a first aid course would be a great start". It's something I strongly believe every parent should be offered and something I recommend regularly to all parents I meet in the line of duty.

It's true. First aid courses can't prepare you for every eventuality, but they can give you the confidence to know that what you're doing is definitely going to help, at least until the ambulance arrives. Whether it be CPR, how to deal with burns, with injuries, or, just like in this case, with a choking baby. Those few minutes of immediate care can make all the difference. They could change the outcome, they could improve survival chances, and they could even change my answer to Milly's mum's question, and in fact, the question itself.

Instead of saying "probably not" to the question she asked, she could ask a different one, a question with a very different answer.

"Could I be the one to make the difference?"

With just a little bit of training, even of the very basic kind, very probably.

Knowledge

There are certain things in this world that I know I do not, can not, or will not understand.

1) Women. But I think that's the same for any man.

2) Children. But I think that's the same for any parent.

3) Smokers. But I think that's the same for any non-smoker.

Category 3 has a sub-category. Smokers, who are still smoking, despite the fact that it is close to killing them. And they know it.

I know that it was your stressful job that started off the habit in the first place.

I know you can't turn the clock back, and not start smoking.

We both know that that's no excuse.

You know that the inhalers are less effective than they were.

You know that your breathing is getting worse by the day.

We both know that it's killing you.

Your daughter knows that you've called an ambulance, again.

Your daughter knows that she has to spend hours with you in hospital, again.

We all know that each time could be the last time.

Your daughter knows that you should stop.

You know that you could stop.

I know that you won't.

Do you think that your daughter understands?

Who knows...

Scaredy Cat

Oh, for the sake of all that is holy! Man up, man!

Category A.

Immediately Life Threatening.

Lights and Sirens.

16 year old male.

Difficulty in Breathing.

"Do you have asthma?"

"No."

"Do you have any medical conditions?"

"No."

"Do you know why you're breathing quite so quickly?"

"Um, yes..."

Normally, people with breathing problems who are struggling for oxygen have a habit of turning grey, or even blue. They don't tend to turn a tomato-like shade of red, especially their cheeks and ears. I wait until he decides he wants to tell me what happened. His mates are all trying to suppress their laughter. One is laughing so hard, he has tears running down his cheek.

Now, I know that as human beings we have a very nasty (but irresistible) tendency to mock the afflicted, but, other than the fact he was having a panic attack, I couldn't quite work out what he was afflicted by. Eventually, he manages to control his breathing enough to tell me what had really happened. He handed me the box that the latest horror DVD had come in, and with the most embarrassed look, and just the hint of a resigned smile, just said:

"It scared the hell out of me..."

I was glad that just at that point, the ambulance crew turned up. I had to leave the room in a hurry, just before he'd see me join his friends in the fits of laughter.

I really couldn't help it. Sorry.

Switched Off

It's always the little things. The small, almost invisible details, that are most strongly etched in the memory. The daily sights and routines that just blend into the background, and yet give life its real meaning.

*****

Their wedding anniversary was coming up in a couple of months, and since the day they married, he'd gone through the same daily ritual. Every night before he went to bed, he'd set his alarm, place a small chocolate on her pillow, and get the old-fashioned teas-maid machine ready so that the tea would be freshly brewed for the minute they wake up. It'd been exactly the same for more than forty years.

Last night, he'd set the alarm, prepared the tea, and left the chocolate. This morning, his alarm never even had a chance. He was awake a full hour before it was due to go off, woken by a crushing pain in his chest and a desperate inability to catch his breath. When we arrived, he was blue. His face was blue. His hands were blue. His oxygen levels 40% lower than they should have been. His breathing laboured, hardly moving any air at all. He was fighting to stay alive.

She stood there, helpless, terrified, lost. Silently sobbing and wiping away the tears that were flooding her cheeks. We rushed around treating him, willing the oxygen into his body faster than the cylinder could push it in. IV lines were inserted, drugs administered, chairs brought up to the third floor apartment. Everything seemed to her to be happening in a blur. We were hurrying out the flat, when she stopped to take one last look at the room.

She walked back in, stood by his side of the bed, and shedding another tear, turned off the teas-maid.

Lifesaver

The darkness is compounded by the cloudy, moonless sky, the heavens showering down their vicious tears with all the contempt they can muster. At least it helps the house stand out like a beacon. It's the only one in the street with all the lights on, shedding some brightness on the otherwise depressing night. As I approach the house through the overgrown jungle that covers the garden path, the door is already open. Standing on the doorstep is Rita, leaning forwards, hands on her knees, struggling for breath. She can barely get one word out at a time.

Rita's man is there, comforting her, encouraging her, keeping her calm. He's doing a good job of it too. It's especially impressive, as Ryan is only 10 years old, and Rita's his mum.

"I'm used to it", he claims. "She sometimes gets very sick and I have to help her".

"Did you call the ambulance?" I ask him.

"Yup. I've done it before. They always ask me the same questions, so I know what to tell them now".

It's about 4 o'clock in the morning. Ryan is wide awake, dressed, has got all of Rita's medications together, and written down the details that we need. It took me less than 5 minutes to get to the call, so he's obviously well trained and very organised. His little sister is half asleep on the couch, still in pyjamas, but with her coat on, ready to go.

While I prepare the nebuliser for Rita, he tells me that his mum has bad asthma attacks sometimes, and that she always has to go to hospital. He was woken up by the sound of a loud wheeze, and knew immediately what he had to do. He'd got everything ready while he was still talking to the call-taker at control, all the while doing his best to calm his mum's anxieties.

Rita's condition and observations mean that she's going to need some aggressive treatment and to be blue-lighted into hospital, and there's no-one else to look after Ryan and his sister, so I'm left with the babysitting duties. The crew and I decide that it's best if they don't travel in the ambulance, as we don't want to distress them any more, so they watch mum being loaded into the back of the ambulance, stare as the blue lights of the ambulance reflect off the vertical sheets of rain, and then climb into the car and out of the deluge. I've got the duty of transporting them to A&E until another responsible adult can be found to look after them.

On the way there, they both remain calm, although Ryan's sister is a little teary. Ryan tells me all about the schools they go to, how he helps at home, how he looks after his mum. More importantly he tells me about the football team he supports, and laughs when I threaten to throw him out of the car for supporting a team that are the sworn enemies of mine. Although, I have to admit it, they're much better than mine. But then, most teams are...

We arrive just after the ambulance, and the kids say a quick hello to mum and see that she's looking a little better and in good hands. They're happy to find the kids' waiting area and go to find some toys. Ryan keeps up his role of babysitter and looks after his younger sibling, finding toys that he knows are her favourites. I watch from outside and am impressed by all I've seen and heard. At just ten years old, this young man is so much already.

Son, big brother, mini-dad, carer. And, of course, whether he realises it or not - a lifesaver.

Training School

I was new at the time. Very new. Not even two months out of training school. It was a time when I was keen, eager, and very very scared. I arrived at the station at least half an hour before the shift, which I still do to this day, just to make sure everything that I may need for the shift is available and ready for use on the ambulance. Obviously still keen and eager.

Ten minutes later my crew mate for the day arrived. I introduced myself and told her that I was new, and would need all the help I could get. She asked if there was anything in particular that I was nervous about, anything that I really wanted to see, that she'd see what she could arrange. I didn't really believe it, but I did mention that I'd not yet been to a cardiac arrest call. I'd practised the scenario endlessly in training school. Everyone seemed to die there. All the scenarios seemed to end in cardiac arrest.

Asthma attack scenario? Cardiac arrest.

RTA scenario? Traumatic cardiac arrest.

Pregnancy/Labour scenario? Double cardiac arrest.

Drug overdose scenario? Self inflicted cardiac arrest.

And the scenarios would always be as difficult and unlikely as possible. "Worst Case Scenario" the trainers would call it. We all took it with a pinch of salt, they were just so far-fetched.

In a broken down lift.

A crane at full height.

Stuck behind a toilet.

In the middle of a muddy building site.

On and on it went. Weeks of "people dying". If that was the real world, I wasn't so sure I was ready for it. The real world, however, was anything but constant cardiac arrest calls. Six weeks on the road, and I hadn't seen it or had to deal with it once. So I told Anne about it. She laughed and told me that the chances were slim. It was a day shift, and people tended to die at night.

Those were the days before we had computer dispatch on the ambulances. The calls would come off a printer, and the Control Room would call the station to find out who was to be the next crew out. I can still hear the distinctive whirr of that printer and find that if I ever hear it anywhere else, I instinctively expect to hear a phone ring.

We'd been out on a couple of calls and had managed to get back to station. There was nothing to challenge my knowledge yet. But now, we were the next crew out. I sat anxiously waiting for something to happen. Eventually, the blue piece of paper appeared at the top of the printer, and the phone made me jump half out my skin. This was it. My turn. And for some reason I had butterflies in my stomach. I looked at the piece of paper and saw that we were on our way to a man in his 40s with difficulty breathing. In the special instructions section there was a line about the patient being in a "hard hat" area on a building site. Could be interesting.

Half way there, we get a call on the radio: "ETA request from the scene. Patient deteriorating".

"We're approx 5 minutes away."

"Thanks, we'll let them know."

Anne presses the accelerator a little closer to the floor, the engine screams in response, but the ambulance doesn't seem to move any quicker. Two minutes later, the radio operator calls over the noise of the engine. "Update from the scene. They're on the 3rd floor of a building site. Stairs still unsafe. Ladders in use. Patient turning blue." Leave the important bit until last, why don't you?

"ETA two minutes. Thanks."

Accelerating makes no difference other than the noise, so we will the ambulance to go a little faster.

As we're no more than half a mile away, the radio chirps in once more. "Patient now in cardiac arrest!" I expected panic to set in, for the shakes to take over, for my brain to freeze. None of that happened. It was as if I'd been programmed for just this moment. The adrenaline rush was incredible. In my head I'd made a detailed list of what equipment to take, how we'd get to the patient, how we'd get him down again, and what else needed doing. All this before I'd even got out of the ambulance.

We arrived to find that our patient, had been carried down one floor by the other builders. Now at least we only had stairs to contend with, and no ladders. Two of the builders had started CPR whilst the others looked on anxiously. Anne and I took over and with the oxygen we were giving him his colour started to improve. The defibrillator looked at the chaotic heart rhythm and decided that it needed to be shocked back to life. Shocks, CPR, Shocks, CPR. We were in hard hats, covered up to our knees in mud, on the second floor of a building site, surrounded by exposed beams and electrical cables, with a 100kg patient. A real "worst case scenario".

Moving him to the ambulance was much easier than expected, thanks to several pairs of builders hands helping us carry him. The ambulance visibly sank by several inches and audibly groaned its complaint as the group of 4 ambulance staff, 6 builders and one patient either climbed in or were loaded into the back.

We continued our attempts all the way to hospital where the staff took over. They knew Anne and the other crew, but I was a new face. I overheard one of them ask Anne who the "new guy" was.

"Oh" she said. "He's a bit like this job. Come straight out of Training School."

Mother & Baby

Throughout her/our pregnancies, my wife complained on numerous occasions that I had no idea what it's like being pregnant. Now, whilst I can't refute that (and if I could, I'd be earning a fortune), I did constantly remind her that she had no idea of what it's like to be living with someone who's pregnant. The mood swings, the cravings, the going shopping for mango sorbet at 3 in the morning, the vomit all over my clothes on the way to friends' weddings, and a multitude of other sins. Admittedly it's a lame argument, but it's an argument nonetheless. And it's the best I could come up with. All I can say for sure is that babies clearly start causing trouble well before they're even born.

*****

Helene was on her third pregnancy, but she was a little out of practice as her 2 kids were already teenagers. She felt almost like it was the first time all over again. She'd almost forgotten about the twinges, the kicks, the nausea. She'd tried not to remember the sleepless nights, the discomfort and the anxieties that were caused by growing a small person inside you. Over the 38 weeks all her memories flooded back and she knew she could cope with them all.

*****

Until she woke up one morning and thought her world was about to end. The meaning of having your breath taken away had never had such relevance, or filled her with so much fear. Helene had the sensation that she'd been stabbed in the chest and just couldn't take in enough air. She'd had a strange sensation the day before like a muscle cramp in the back of her leg, but put it down to another one of those pregnancy things. "Only 2 weeks to go," she thought, "then it'll all be worth it." At three in the morning she'd woken up and thought she was going to die.

*****

Patients should most definitely not be blue. Unless they're smurfs, and I've never had one of those yet. Helene was blue. Her lips were blue, her finger tips were blue. It was as if she was being lit by an ultraviolet light. No need for an oxygen saturation reading before applying oxygen. It's low. Probably dangerously so. I place a 100% oxygen mask on her and then start checking observations. Pulse rapid, at about 140, oxygen levels unreadable at the moment, air entry greatly reduced, especially on one side. Blood pressure low and dropping. Helene is very poorly. My initial assessment leads me to think that it's a Pulmonary Embolism, or PE, a blood clot in the lungs. Pregnancy is one of the known causes of a PE, where it's either due to the fact that the blood's clotting is increased, or sometimes due to amniotic fluid escaping into the blood stream.

*****

I start to hope that the ambulance is nearby, as there's not much more that can be done pre-hospital for a PE. Luckily they turn up only a few minutes after I complete my set of observations. We wheel Helene into the ambulance and she is whisked to hospital with due haste, while I'm left alone in my car with the paperwork, wondering if I was right or wrong, and what would happen to her now. I have no idea what happened after that. All I know is that, in pregnancy, if the mother's ill, the baby's ill too. So if you treat the mother, you treat the baby. If all's gone well since, the baby should be a few months old by now. I hope that's indeed the case.

Teacher

It's that time of the year again. Our antipodean cousins are anticipating a long, hot summer of cricket (without the Ashes in their back pockets for a change), whilst here we're starting to pile on the layers, preparing for that world-famous phenomenon called The British Winter. The days are growing shorter and the night shifts seem longer than ever. It never seems quite as bad when I have only six hours of darkness on a shift, as opposed to the whole twelve. Give it a couple of months and when I'm on nights I'll see possibly an hour's daylight in every 24 hour period. Very SAD.

Just in case we weren't sure of the imminent arrival of the cold, our airways have a habit of reminding us. Large increases in the cases of asthma, bronchitis, chest infections, croup. Croup is a funny thing. If an ambulance is called to a child aged between 6 months and 4 years (ish), between 11pm and 3am (ish), any time between September and December (ish), because they're having difficulty breathing (not so ish), there's a pretty good chance you're going to meet a croupy kid. The vast majority of the time its bark is much worse than its bite. Literally. The characteristic seal-bark cough is a scary thing for any parent to be woken by. Been there, done it, bought the T-shirt. Scared me half to death the first time I heard it at home, so I fully sympathise with any parent going through it.

*****

Mickey is a normal three-year-old child. He runs around, plays, falls over, scrapes his knee, cries, gets up again and runs around as if nothing's happened. But Mickey's parents weren't sure that he'd ever make it to three. Or two. They weren't certain that he'd make it past the first few weeks. Mickey was born only three-quarters cooked, at 30 weeks instead of the more normal 40 or thereabouts. His lungs were under-developed, his heart wasn't at full capacity, all his internal organs not quite ready for the real world yet. It wasn't Mickey's fault. He was violently evicted, cut away from his mother, just when he was enjoying the comfortable, warm surroundings where he was happily developing. Mum had developed severe pre-eclampsia, causing her to have dangerously high blood pressure, a pre-cursor to eclamptic seizures and all manner of life-threatening problems. In an attempt to save both mother and baby, it was decided that the best option was to deliver Mickey by caesarean-section. Mickey was to be cared for in hospital for the next few weeks, allowing his continued growth, but along the way the medical team discovered that he had several holes in his heart where there shouldn't be any. He had to have several operations, but eventually, after a year or so, Mickey was finally discharged from hospital with an almost clean bill of health. Mum and Dad were told that he might be a little more prone to chest infections than other children his age, but otherwise he should be completely fine.

At the age of two, Mickey had a chest infection. A bad one. So much so that he stopped breathing. Luckily (if it can be termed lucky), he was in hospital when it happened. Mum and Dad had watched him become more and more unwell, and decided it would be best to call an ambulance. Mickey was blue-lighted to hospital where his breathing continued to deteriorate to the point where it stopped. The medical team at the hospital worked tirelessly, and two weeks later Mickey was well enough to go home.

A year after that, for the first time in over three years, Mum and Dad decided it was safe enough to have a night out.

*****

Midnight. The computer rings and tells me of a 3-year-old with difficulty breathing. "Making a funny noise", apparently. Croup. Should be easy enough. Oxygen if necessary, hospital, steroids maybe, back home. Not for Mickey. He's in real trouble. Blue around the lips, the spaces between his ribs noticably sinking with every breath, oxygen levels (Sats) in the high 70s at best. A barking cough that's interrupted only by a horrible screeching stridor. Sounds like he's got a coin stuck in his throat that interrupts the air with every intake of breath. To make matters worse, the babysitter's in hysterics. She's worried that she's done something wrong, when in fact she'd done everything right. She called an ambulance as soon as she heard the noise, and whilst she waited she picked Mickey up and placed him in a steamy bathroom to try and relieve the symptoms.

The babysitter was a family member, so knew all of Mickey's history and retold the tale. His early arrival, his lung problems, his heart problems, his last chest infection, the fact that he'd stopped breathing. The ambulance backing me up arrived only a few minutes after I did, and saw that even though Mickey was on oxygen, his Sats were only in the top 80s now. I retold the story as we walked briskly out to the ambulance, hoping that the cold night air may help as we went. The crew placed a priority call to the hospital, stuck on the lights and took off.

As Mickey was carried in through the doors of the department, he barked. One of the staff was heard to mutter "Oh, it's only croup. What's all the fuss for?" A few raised eyebrows were also spotted. There was a definite atmosphere of "unnecessary ambulance-crew panic" in the resus room. Until, that is, Mickey's story was retold.

The A&E staff had done exactly the same thing I had. Jumped to conclusions before even laying eyes (or ears) on the patient. I'd assumed that it'd be straight-forward. They'd also done the same. I'd assumed that it'd be run of the mill. They'd also done the same. I'd had to switch gears very quickly. They, to their credit, also did the same.

Lesson 1: Don't jump to conclusions.

Lesson 2: Don't jump to conclusions.

Lesson 3: Don't jump to conclusions.

I think Mickey's got a glowing career path ahead of him. I hope he stays well enough to follow it. I reckon he's going to a make a damned good teacher.

Losing Trach...

2am, Tuesday: "97 Local Close, Nearbury. ?75 year old female, Breathing problems, unable to hear patient properly".

Could be anything really, especially at 2 in the morning. I park the FRU outside the address and remember to leave a space for the ambulance. They're going to be doing the carrying after all... I find the front door open, so knock and walk in. I find Gillian sitting at a table, breathing about 60 times a minute, and a great rasping noise coming from her neck.

Gillian has a surgical tracheostomy. You can read about these here. At least I now know why control couldn't hear her. She's grey, clearly distressed, and tries but fails to tell me what's happened. Her oxygen levels are very low, so I attach an oxygen mask to the trachy site as best I can. Within a minute or so Gillian's oxygen levels begin to improve, and she's breathing a little slower, but she is still very much struggling to breath. Her chest sounds like there's an army marching through it. Her other observations are ok, other than a slight fever. She tells me in two-word sentences that the last time she felt like this she had pneumonia, but it took 3 visits to hospital until it was discovered.

The ambulance arrives after a few minutes, Gillian is feeling a little better, but nevertheless we take the decision that she should be "blued" into hospital. I suspect that she has a chest infection that's turned nasty, and promise her that the hospital will look after her.

2 am, Wednesday: "97 Local Close, Nearbury. ?75 year old female, Breathing problems, unable to hear patient properly". What? What?? I was there 24 hours ago! But back I went, knocked on the door and walked in again. Gillian looked, and smiled as if to say "Oh no! Not you again...!". This time she wasn't quite as grey, but still finding breathing difficult.

"They cleared my trachy site, and sent me home. But I just don't feel right."

We started everything all over again. The observations, the oxygen, the words of comfort. I remember telling Gillian that the hospital would look after her, but I'm not sure they were able to back up my confidence in them, and feel bad for promising something I couldn't really deliver. A different crew turn up this time, I lock up the house, and say goodbye to Gillian.

"See you later" she says back to me.

"I mean this in the nicest possible way, but I hope not..."

Guess I'll have to wait and see.