Playing Dead

Saturday night. 

In fact, it's worse. 

It's a post pay-day Saturday night. 

The calls are coming in faster than the customers can spend their hard-earned cash. Call after call is alcohol related, leading either to faints or fights, pass-outs or punch-ups. Suddenly, in the middle of it all, a genuine call. 

In fact, it's worse. 

It's a genuine call made by a child. 

The call comes in as a mother who isn't breathing. The child is barely able to contain their emotion as they  follow instructions from the call-taker. Luckily, I'm less than a mile away. Under a minute later, as I step across the threshold, a bag on my back and another two balanced on my arms, a young child grabs me by the hand and practically drags me off my feet. 

I walk into the room to see a sight that worries me even more; it's not just one child who's distraught, but four. The oldest is ten years old. All are crying, worried, scared. One begs me to help their mother. 

"She's not breathing! Do something!" 

Another asks me the awful question. "Is she dead?"

All it takes is one look at the mother. Her eyelids flicker like no dead person's can. As I call her name loudly, she jumps a little, but tries to stifle it to keep up the pretence. As a crew arrives, I usher the children out of the room, asking them to let me treat their mother whilst reassuring them that she'll be absolutely fine in a few minutes. 

"Right," I say, "the kids have gone, and it's just us. Now do you want to tell me what this is all about?" It's  rare for me to lose my temper with patients, but I'm close. She opens one eye, then the other and after a moment or two, decides to pretend that she remembers nothing and that she doesn't know where she is.

Leaving the crew to treat the so-called patient, I go to speak to the children. One of them tells me that the two oldest siblings were fighting, their mum shouted at them to stop and when they didn't, she collapsed and stopped breathing.

"She just dropped to the floor?"

"No. She sat on the couch with a bit of a bump, shouted again, and then fell back with her head on the cushions."

"I understand. Just so you know, your mum's going to be absolutely fine. We'll let you in soon so you can see her and talk to her."

"You mean she isn't dead?"

"No, she's not. She's just a little upset."

Back in the room with our now alert patient, I could bite my tongue no more.

"You realise what you've done to your children, don't you?"

"It's their fault. They know how to behave. I just wanted to show them what it would be like if their mother wasn't here. When they fight, they pretend like I'm not here anyway, so I thought I'd show them what it would be really like."

Speechless and angry, we invite the children back into the room. As the youngest runs into her mother's arms, I leave the house, wondering what would force a parent to be so cruel to their own child. 

The Secret of Medicine

Ah, the joys of plagiarism. 

"Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better. The human body is exquisitely talented at healing.  If bodies didn’t heal by themselves, we’d be up the creek. Even in an Intensive Care Unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you gave it plenty of gas, oil and brake fluid, and then expect the transmission to  fix itself."

What a fabulous paragraph, even if the article is a couple of years old. Click on the quote above to read the rest of the article by Dr. Thomas A. Doyle. No, I don't know who he is or anything about him either, except for the bit of blurb at the end of the article. But he has some very interesting things to say, don't you think? 

Change "America" for "UK", or anywhere else in the developed world, and I suspect that the same problems are present all over. 

So what do you think? Does he have a point? Are we really a nation of wimps? More to the point, does the medical system here just pander to too much? 

Case in point, particularly after the weekend just gone - The Booze Bus. Look at the photo. A transport ambulance, with a fully trained paramedic crew, loaded with three (that I can see, anyway) people who have nothing wrong with them other than an under-developed sense of responsibility and self-awareness. Should the health system really be paying for what is no more than a babysitting service for people who, a few years ago, would have spent the night in a police cell and woken up to a hangover, a steel door, a charge of drunk and incapable, and a large fine? Nothing's changed since then, except for the fear of litigation, and that in itself is well on its way to bankrupting our health system. 

I know the arguments for and against the concept of the Booze Bus (or, Alternative Response Vehicle, to give it its official title). I understand both sides, and I know that had it have been available last night around where I was working, I would have had four fewer patients. Or at least different ones. But I still feel that society as a whole needs to realise that the days of personal responsibility need to return, that the pot of money is not unlimited, and that sooner or later, whether we like it or not, charges will have to be made on certain categories of patients. I just think that the Booze Bus is as good a place as any to start. 

More Drunken Logic

Drunks. 

Love 'em or hate 'em, they're always there. Some obnoxious, some difficult, some driving when they really shouldn't be, risking their own lives as well as the lives of all around them. 

Every so often, we come across a gem, the entertainment value often carrying us through the rest of the shift. Recently, a friend of mine, previously nicknamed "Little" told me of the following conversation:

Medic: "Who's your next of kin?" 

Drunk: "What's that then?"

Medic: "You know, someone you'd want to contact in an emergency!"

Drunk: "Oh! That's you then!" 

Once again, another case of infallible drunken logic. 

Enjoy your weekend, go out, have a drink, have a good time. Just stay safe. 

Red Rags and Suits

To a non-suit wearer, all suits look expensive, and there were several suits sitting around the table. 

"We're sorry to call you," said one of his friends. "We think he's just had too much." 

As I approached the table where he and his colleagues had hidden in the corner of the pub, the patient looked up and stared. His eyes were glazed and his look wavered as he probably tried to stop the room from moving. 

"Oh. Good. You're here. What took you so long?" The fact that it had taken less than four minutes from the call coming in had no bearing on his skewed sense of time. "I pay your wages, you know!" 

Oh. That one again. Red rags don't normally set me off, but this one did. 

"You do? How's that then?" One of these days, I'm going to come across a patient who actually works for our payroll department. Then, at least, they'd have a point to that claim. 

"Yeah, I do. My taxes pay for your job. So now, you can just do your job." 

"I'm doing my job sir," I said, as I started to check some basic observations. "And what, may I ask, is your job, sir?" 

"I'm a city banker!" He even told me the name of the bank, just for good measure. I guess I was right about the suit. 

"Oh. Then I think we're quits." 

"You what?" 

"Your taxes may pay for my job, but my taxes saved your bank and your job. And right now, sir, I'm trying to save your dignity." 

Just in time, I recognised the signs of a drunk about to eject the contents of his stomach, and side-stepped the impending eruption. Seconds later, his suit didn't look quite so expensive. 

"Ah well. There goes the dignity." 

The Keys to the Asylum

The council estate is a maze of rat-runs, dead end roads and multi-storey buildings. There's no logic to the numbering, and most of the buildings are unnamed, just to make it all that more exciting. The computer must know something I don't, as I turn into yet another alley and a disembodied voice from the sat-nav announces You have arrived. I drive around in circles, zooming in on the digital map trying to locate the tiny alleyway that was given as the address I was looking for, and try to find the man with the broken leg.

With no luck at finding the patient, I leave the blue lights flashing and give a couple of blasts on the siren. It's not too late at night, but still late enough that some of the neighbours, particularly children, may have been tucked up for the night. A few minutes later the crew follows me in to the multi-tentacled cul-de-sac. 

"No idea where this alley is, and no-one's come to find me." 

"We went up the other way first, no sign there either." 

After a few more minutes of searching up and down the same tiny roads, a figure appears at the top of a fire escape. "Oy! He's up here! Come on! Hurry up! What took you so long?" 

Not lying half dead in an alleyway then, and three flights of stairs up, probably not nursing a broken leg either. Nevertheless, between the three of us, we take all the kit we might need in case the call really is all it was stated to be, including a carry chair. As we reach the top of the stairs, Neil is sitting on a picnic box, his legs intact but his left arm bowed right in the middle of where it should be straight.

"How'd you do that then?"

His first words engulfed us all in a haze of alcoholic breath.

"Fell over, didn't I? Down that stupid alley. I told 'em someone was gonna get hurt, didn' think it'd be me now, did I?!"

We stabilised his arm in a splint and cleaned up a wound that he'd opened up on his eyebrow. It looked like it was an old scab that had opened up again.

"Do you fall often?"

"Nah, not really. Just a bit unlucky the last couple of weeks."

"How much have you had to drink tonight, Neil?"

"Oh, not much. Two, three pints maybe."

"Any other medical problems?"

"Yeah. My liver's knackered. They might have to replace it soon. 'Swhat the docs said, anyway."

"How'd that happen?"

"Well, I used to be an alcoholic. Not any more now though. Now I only have a couple of drinks a night, you know, when I'm at work."

"You used to be an alcoholic, but you're still drinking?" Then it hit me. "Hang on a minute. You drink at work?"

"Yeah. Course! There's got to be some perks to my job."

"Why, what do you do?"

"I'm a mixologist."

Oh. He's got an ology. "A what?"

"A mixologist. I mix all the cocktails at the bar."

"You're an alcoholic, and you work in a bar?"

"You bet. Does it get any better?"

"Well, your arm says it could probably get a lot worse." 

The Other Leg

Late evening in the city, where another weekend heads to a close as the world prepares to face another Monday morning. There's a definite chill in the air, a disappointing summer fizzling out as the nights begin to draw in, yet all around people are spilling out of pubs and clubs wearing no more than the bare essentials. The street sweepers are out in force, one of them earning a torrent of verbal abuse for daring to complain to yet another youth for throwing an empty cup on the floor.

Rash and his friends walk away laughing, alcohol and bravado fueling yet more antics until, suddenly, he loses his footing on the edge of the kerb. His leg twists, snaps and gives way, and he crumples in a heap on the floor. The street sweeper sees it happen, yells something about karma and walks away to continue his never-ending litter hunt. 

We're dealing with a drunk no more than ten paces away, another victim of just having a good time and she doesn't usually get like this. Each of us, Dean and I, has one eye on our patient making sure we don't get covered in vomit, and another on the altercation, looking for signs of a fight breaking out. When Rash falls, we're close enough that we see his leg change direction and clearly hear the crack in the bone. 

"Stay there!" I shout. "We're coming." Dean calls for help, asking for a second ambulance.

Unable to move even if he wanted to, Rash lies on the ground screaming in pain. Two police officers patrolling the area hear the noise, which even in the bustling surroundings was out of the ordinary, and come to investigate. The bad timing on their part means they get to stay with the vomiting drunk and her overly exuberant friend.

Dean brings the trolley bed and a splint over, the need to see the injury first seeming superfluous having witnessed the noise it made. Nevertheless, a pair of shears always beats a pair of jeans in the trauma version of "rock, paper, scissors" (where the rock or paper are any item of clothing which may be hiding any part of the anatomy that needs to be viewed directly, in a hurry and with a minimum of movement), and seconds later Rash sees his leg for the first time since getting dressed earlier in the evening. He looks down at his ankle, and instantly looks away.

"Do you think it's broken?" It's more of a last gasp attempt at denying what he already knows than a real question.

"Well, I think the fact that your foot is facing the wrong way and there are two bones sticking out of your ankle would probably confirm that." Ten paces away, as if on cue, our drunken patient vomits for the umpteenth time. One of the police officers sends us a grateful stare, all the more grateful now that another ambulance has arrived to deal with her.

We load Rash into the ambulance, dose him up with some pain relief, and straighten his leg out as much as possible before heading to the nearest hospital. The screams of pain as we pull his leg straight subside once his foots faces front again, entonox and morphine leaving him a little dazed. When I ask his date of birth, he hesitates, looking at his friend for guidance. A shrug of the shoulders was the only reply.

"How old are you Rash?"

"Nineteen."

"And what's your date of birth?"

He tells me a day and a month without hesitation, but when it comes to the year, all he could say was "Ummm..."

"OK, so how old are you really?"

"Sixteen. And a half." And a half. Of course. That makes all the difference.

"And why didn't you want us to know that?"

"I didn't want those coppers to arrest me again. You know, for being drunk under age and all that."

"What do you mean arrest you again?"

"Well, I've already been arrested five times before. I was twelve the first time!" He high-fives his friend, seemingly proud of his criminal record.

"Twelve? What were you arrested for at twelve?"

"Fighting!" Another laugh, and another high-five.

"And you were twelve?"

"Yeah man. I've still got the scars now!"

"And you're proud of that?"

"Well, yeah, why not? But not as proud as I am of something else." He shoots his friend a knowing look, and they both smile.

"What's that, Rash?"

He pulls up his other trouser leg and proudly shows off his electronic tag. "Got this last month, didn't I! All my mates want one now, it's, like, so cool!"

"You know that you'll probably get nicked now anyway, out after what I presume is your curfew time?"

"Oh what? Even if I'm in hospital? Pull the other one, yeah?"

"I already did." 

The Night After

It was one of those nights. I only saw five patients. 

1) Drunk, fallen asleep in the street. Told me to get lost. Not quite as politely as that, however. Then proceeded to walk straight into a wall.

2) Drunk, fallen over in the street. Told me I need a shave, which I do, and that I speak good English for a Chinaman, which I'm not. Also, I need to go back to China, where I come from, "'cos we don't need no more foreigners in the country." Nice.

3) Drunk, fallen over at home, slightly apologetic. Slightly better natured than the previous two. Things were looking up. But not for long.

4) Drunk, violent and nasty, high on drugs to boot. I got covered in his blood as well as mine as I tried to stop him killing both himself and me, before the police turned up and looked after him. Things were looking grim again. 

5) Drunk, unconscious and very seriously injured after a high speed impact with the road. Definitely grim. Grim for me, as it was pouring with rain, but that's nothing. It's much more grim for him. He's probably going to die, assuming he hasn't already.

I'm back at work in a few hours. The night after the night before. I hope it's a better one. For everyone.

The Other Look

It's the look. The look of someone totally unaware of their surroundings. The room is filthy, a pile of dirty clothes here, cat litter-tray there, drug paraphernalia everywhere. Rena, his girlfriend pretended to be concerned but at the same time seemed totally disinterested. On the floor of the back room, in amongst the filth and grime, lying unconscious on the sticky carpet, we found Dan. 

Dan's face was pale, the colour drained totally from his face. His breathing was slow, shallow, barely enough to sustain his life. 

"What have you been doing today?" I asked Rena.

"Dunno." She shrugged her shoulders for good measure.

"Where have you been?" 

"Here. Didn't go nowhere." 

"Has he had anything to drink?"

"Maybe." 

"Has he taken anything else?" 

"Dunno. Don't care."

Her acting as the concerned girlfriend didn't last very long. 

"I only called you lot 'cos I didn't want no cops coming round." 

Too bad, I thought, they came with us anyway. 

Dan's pupils were tiny, pinpoint sized, leading us, alongside all the other evidence, to an obvious conclusion. We'd guessed it anyway, for once jumping to the right conclusion as soon as we'd walked into the flat. When we asked Rena if she's had the same stuff, she denied knowing what "stuff" we were talking about. In the meantime a bag and mask were helping his breathing as we prepared the injection that would reverse the effects of the heroin and bring him back to life. 

Moments later, already strapped in to the wheelchair, Dan started coming round. The look in his eyes changed, the life returned, and as we wheeled him to the ambulance, he began to respond in earnest. 

"What're you doin'?" 

"Taking you to the hospital. You overdosed and nearly stopped breathing. They need to keep an eye on you for a while." 

"Did you give me that damn injection again?" 

"If by damn injection you mean the drug that saved your life, then yes. We did. "

"I hate you. That gear cost me money!"

"Well, no money in the world would have helped you if you were dead!" 

"I don't give a damn. I might not be dead - but I hope you die instead!"

That look in his eyes, the one so recently changed from death to life, turned suddenly from life to hate. 

Two Seats

A pair of expensive-looking trainers adorned the feet that stuck out from behind the bush. It was the only part of Jacek that was visible from the street. A concerned member of the public walking home late at night called the ambulance when he thought someone must be lying dead. It's a good thing he waited, because we'd never have spotted the shoes from the road.

"He's in there. Not sure if he's breathing or not, didn't want to get too close."

At five in the morning I had to ask what he was doing walking around the streets.

"I was on my way home from work. I do funny hours too."

"Oh really? What do you do?"

"I'm a nightclub bouncer."

I should have guessed really. Six feet four in every direction, close cropped hair, and a badly fitting suit - a perfect stereotype. The fact that someone who intimidates people for a living was a little nervous about approaching a pair of shoes, or at least whatever or whoever was attached to them, seemed a little ironic. I shook the patient's legs and one of the shoes fell off, making our bouncer friend visibly recoil.

A groggy mumble of "Go away!" from deep inside the bush only added to his discomfort.

"Do you still need me here, or am I alright to go home?"

"Yeah, sure. We're OK here. Thanks for your help."

He practically ran away from the scene.

After a few more attempts at waking up our patient, he finally relented and climbed out of the branches, hampered slightly by the thorns of a lone yellow rose. His face appeared last bearing a five o'clock shadow, but at the wrong five o'clock.

"Go away! I'm sleeping!"

There's gratitude for you.

"You can't sleep here. People will think you're dead and call ambulances!"

"Go away! I'm sleeping!"

"Where do you live?"

"I live here. Go away."

His clothes, other than the odd branch and a few green leaves, were clean, maybe even new. Not exactly the attire of a long-term homeless man. 

"Do you have any family in the area?" 

"No. They not live here." I guessed by his accent that he must have left his family in Eastern Europe somewhere. 

"And friends?" 

"My friend he is here." 

"Where's here?"

He turned round and looked back into the bushes.

"Here!" He points aggressively at the broken branches. "Don't you speak English good?" 

I looked at him, looked at my crewmate, shrugged my shoulders, and climbed half way into the bushes looking for a drunk friend. 

"Jacek, There's no-one in here!" 

"He is there! You not see him!"

I look again.

"There's definitely no-one here!" 

"He is there! Only I see him. You no see him!" 

I climb back out of the greenery, and look much the same as our patient with leaves and bits of broken branch all over me. 

"You mean to say I've gone looking for an invisible man?" 

My crewmate takes one look at me and tries to stifle a giggle. We help Jacek into the ambulance and as I'm about to take my seat, he suddenly shouts. 

"You not sit there! Friend - he is there!"

All of a sudden, the trolley seems a much better choice of seat. At the hospital, the waiting room is busy, and I take a minute to look around.

"What are you waiting for?" asks my crewmate.

"Just trying to find two seats together." 

A Sister's Pain

I search for the right words, the strangled words that will express my pain, but they won't come. Nothing is enough to express the anger I feel, the disappointment, the insult and the sadness that now engulfs me. I'm the sister of that thirteen year old, the one who you hit last year.

An accident. That's the technical term, but I refuse to accept it. In the middle of that dreaded afternoon you drove drunk, mounted the pavement on which she stood waiting for the green light that would allow her to cross safely. And you hit her, your impaired judgement showing no mercy. 

She lay in hospital for a week hanging by a thread between life and death, and another month in a coma. That whole time the doctors repeatedly told us that there was no hope.

She wouldn't live.

She wouldn't wake up.

She wouldn't recover.  

Funeral arrangements were prepared, and discussions about organ donation were started.

Then, in defiance, she started to breathe on her own.

This whole time since, she hasn't spoken once. She hasn't stood on her own two feet. She hasn't laughed. I keep waiting. I stand and watch her, and I pray for that one sign that she's coming back to me. But no one can tell me that it's going to happen.

As you stood in court, the judge delivered the verdict. The judge spoke of an accident with devastating consequences, told of your extenuating circumstances, and how difficult your life had become since you hit her.

And for all of that, all that devastation, you got nothing.

A fine and a suspended driver's licence.

Someone who drives whilst talking on the phone gets a fine.

Someone who breaks the speed limit gets a fine. If they do it twice, maybe thrice, they might lose their licence too.

You, you who took my sister's life away and destroyed her future and her family, you get to walk away and live your life as if nothing ever happened.

I wonder if you even gave her a second thought, or if you only ever thought of yourself.

I don't care if you admitted your guilt in court, saving your own skin and supposedly precious time.

Time is something I have plenty of. Over a year of her life has already been taken away. I can wait a little while longer for justice. But it doesn't seem forthcoming.

My heart, already broken, has been ripped out of me and stamped on. My baby sister, my parents' child, is no more than another statistic, another number in the eyes of the courts, and to you she means nothing at all. But to me she's my fun-loving, animal-friendly, bad-taste-in-music, drives-me-crazy sister, and I want her back, body and soul intact.

So whilst you walk the streets in peace, drinking away the days until you can drive again, she lives in a state of constant war. She fights for the tiniest movement, the smallest glimmer of hope, the simplest of signs to show that she's still with us, that she knows us, that she wants to keep up the fight.

As you walk back to your own life, I'll be here fighting her battles with her.
__________________________

The translation and some literary license is mine. The story, however, isn't.

Drunken Logic

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

"What happened sir?"

"I fell."

An all too familiar aroma fills the air.

"Have you had a drink tonight?" 

Stupid question, I know.

"Oh, only one or two!"

"Pints?"

"No. Bottles."

"Bottles!? of what?"

"Whisky of course."

Of course.

"What's your name, sir?"

"I don't want to tell you."

"Why not?"

"Because I'm not drunk."

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

"Tell 'em I tripped over my shoelaces."

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

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

"Is that your first name or your surname?"

"Both."

"In which order?"

"Either."

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

"Call them."

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

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

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

I give up.

Matching Description

Disused, misused, abused.

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

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

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

Disappearing as quickly as they came to life.

The call came from a mobile.

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

before cutting off the call and turning off the phone.

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

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

Glass breaks underfoot, floorboards creak,

needles shimmer in the torchlight.

Two flights of stairs, rooms on every floor,

each deserted,

dark,

cold,  

unloved.

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

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

Curled up in a corner.

Deserted.

Dark.

Cold.

Unloved.  

And matching exactly the caller's description.

Going Soft

The regulars.

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

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

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

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

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

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

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

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

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

I must be going soft.

'Tis the Season to be Jolly

Need I say more?

Safer

The patient we'd just dropped off at the hospital only became a patient when the police turned up. Far from being police brutality, it seems that they just seem to have an overwhelming effect on some people. Paulo had driven home from the pre-Christmas office drink, a warm up for the main event that was scheduled for mid-December. It was only supposed to be the planning meeting, but he decided to sample some of the drinks to help him decide what to make available for everyone else. Then he drove home. Well, about half way, before he met the kerb, burst a tyre and was stopped by a grass verge. A good Samaritan witnessed the incident, and as he drove past and kept going, he called for an ambulance. Paulo was uninjured, the crash and his escape a dichotomous result of his drunken state. The police turned up a few minutes later, and as soon as they said the magic words informing him of his arrest, Paulo collapsed.

Paulo fell to the ground, making sure he found somewhere soft to drop. His eyelids held tightly shut and hands making tight fists, he failed every test for unconsciousness known to any paramedic worth their salt. However, he still refused to open his eyes or speak, and therefore won the first round. The police had no choice but to send him to hospital, although rather than being let off by them, Paulo was accompanied all the way, and would be watched until he recovered from his mysterious ailment. Round two would be won by the police as soon as he woke up. Far from being sent home, Paulo would spend hours in A&E, and then more hours in a police cell. Round three would be up to the judge.

Having transported an officer and their quarry, we were then free to go back out on the road. We left the hospital, and half way back to station, saw a car veering across lanes, bouncing off the pavement, and showing a general disregard for any rules of the road. We called control and let them know that there was probably another drunk driver on the road and asked for police to attend before anyone was injured or worse. Following the car, we were given permission to use lights and sirens to see if that would help stop the driver, but both were completely ignored.

The car seemed to be accelerating away from us, and was heading directly for a line of traffic waiting at a set of lights. Assuming that our presence might be making the driver act more erratically and dangerously, we turned off the lights and sirens and slowed down. We waited for it to skirt around the line of cars, jump through the red light and across a busy junction. That wasn't even close to what happened.

The car didn't even brake. It slammed into the car at the back of the line and stopped dead, steam pouring out the hood seconds after impact. We pulled up behind the car, radioed in to let control know what had happened and requested another ambulance, as we'd probably have at least two patients. 

The blue van that had been stationary was shunted forwards a good distance right into the middle of the junction. Luckily the lights had changed, so there was no cross traffic and the car in front had already moved off, missing an impact by the thinnest of margins. The driver got out, and looking a little dazed, walked over to us cradling one arm in the other. Even from a distance we could see that he'd fractured his wrist. The police turned up at that point, and were tasked with babysitting him until we could assess the other driver.

The front of her car was half the size it should have been. She hadn't moved since the impact, and as we approached we could see that she was conscious, breathing, and seemingly uninjured. The expected smell of alcohol didn't materialise when we opened the door, although her speech was slurred, she was confused and her behaviour was erratic. Sure drunken signs, but lacking evidence, we carried out further checks. Within under a minute, we had the answer. As a police officer looked for physical clues, we searched for medical ones. A blood sugar check was all it took. Her sugar level had dropped to less than one (or eighteen for you Stateside persons). Most people I've seen with that level have been totally unconscious, and nowhere near a steering wheel. A few hundred drops of sugary water directly into her blood stream were enough to bring her back to reality, although not the one she remembered.

"What happened?"

"Well, you've had a hypo, and crashed your car. It seems that you've come out of it OK."

She took a moment to digest the information. A look of horror suddenly crossed her face. "What about the person I hit? Are they hurt?"

"Don't worry. They're on the way to hospital for a check-up." I didn't have the heart to tell her about the broken arm. "What's the last thing you remember?"

"I was having a meeting with some guy. I run an inn, and we were planning their Christmas do. He had a couple of drinks, maybe more than a couple, and I told him he probably shouldn't drive, but he went anyway. I hope he made it home in one piece! Maybe I should've taken my own advice too..." 

We asked about her medical history, whether she'd been eating regularly, all the other relevant questions for a diabetic whose blood sugar levels have dropped so low. She'd been doing everything right, so the reason remained unclear. There was still one thing we wanted to quiz her about.

"Do you remember the name of the person you met?" I couldn't believe the coincidence, and I didn't expect the answer. 

"Yeah. It was a foreign sounding name. Pablo I think." 

"Pablo? You sure?" 

She sat looking thoughtfully into the distance. "Oh. No it wasn't. It was Paulo. Not Pablo. Definitely Paulo." 

Two ambulance crew stared at each other in total silence, barely accepting the answer we'd just heard.

She broke the silence after a few seconds. 

"Instead of telling him to get a cab, maybe I should have asked him to drive me! It would probably have been much safer..."

Sleeping Partner

The bed is covered in blood. The floor is too. Apparently there's loads of the stuff in the bathroom as well.

"We left it there, unflushed, just in case you wanted to see it!" I'd seen enough already, without having to go snooping in someone else's toilet bowl.

Another one of my return customers, Greg and I had met on a previous similar occasion, and probably about a year had passed since then. Maybe eighteen months. The alcohol he'd taken on board over years, slowly destroying him from the inside out. He looked pale, gray even, and was sweating as though he'd just run a marathon in the Sahara Desert.

"I'm gonna die, aren't I?" Greg asks. The fear in his voice is only too real. "Not in my ambulance you're not". I think it, but don't say it. Patients who genuinely fear it, and voice that fear, often know.

"No, Greg, you're not. We're going to get you up to the hospital as quick as we can, and get you sorted."

"We? You're the only one here!" And he's right.

"Another ambulance is on its way. They'll be here soon enough!" I hope my prediction is a self-fulfilling one. I need them in a hurry. In the meantime, I start getting some fluids into him. It's another case of salty water replacing blood, but at least it gives the heart something to work with until we can get him the real stuff he needs. The blood that's left inside him will have to work extra hard to pump round the oxygen that's free-flowing into him through the mask on his face. At least he's stopped vomiting for a while. I don't know how much he's lost internally, but just from what I can see in front of me, he must have expelled a third of his blood volume. By the time the crew arrive, he's had about a litre of fluid back in through a thankfully large vein in his arm.

I hear them downstairs and yell: "Bring a chair up with you!" Often crews backing up first responders will come in to see what's going on, and only then decide what extra things they'll need. Usually it works just fine. Luckily the crew recognised my voice, and the urgency in it, to know not to ask questions.

"Last time I needed surgery. And they gave me nearly twenty bags of blood apparently. But I don't really remember anything. They told me if it happened again, if I didn't stop drinking, that I'd probably kill myself."

He started sobbing.

"I have, haven't I? I've killed myself! And now, two days before my son's due to be born!"

A neighbour was with Greg the whole time we were there, but no-one pregnant.

"Where is she Greg? Where's your partner?" I thought that a friendly face might help calm him a little.

"She went up to her mum's last night, up north somewhere. I've got her mobile number, but I don't want to call her now. It's too early!" Barely in control of his own body, he was still worried enough about his partner and unborn child. "I didn't mean to drink so much. I shouldn't have had anything at all. It's the first time in months!"

We moved Greg to the ambulance, a creaking flight of wooden steps leading down to the front door and out into the cold night's air. Dawn was breaking across the horizon, and the traffic was just starting to build as normal people started another working day. Leaving my car on scene, I travelled with Greg, an extra pair of hands always helpful with a particularly ill patient. The siren blared its way, ensuring the cars cleared the way for us to make a smooth but rapid journey to hospital.

"I don't want to hear the sirens! I don't..." He wept again. "I just want to hear my baby cry..."

We arrived at the hospital, a team ready to meet us was standing round the designated bed.

A doctor listened to the handover and asked for some blood almost immediately, as a student nurse hooked him up to the machines. A nurse thanked his luck for finding a decent vein and put a second needle in the arm I'd left alone.

Greg's tears flowed, and he was barely able to catch his breath between sobs. "Just help me see my baby! Just once! Please... Please..."
Another nurse left the cubicle without a word, and hurried to wake his partner.

For Sale

For Sale: 

Brand new car.

100 miles on the clock.

Good for spare parts and scrap metal,

also some empty beer cans.

One previous owner.

Now deceased.

Head for Heights

The message comes down the MDT from the police. "Please approach with caution - no lights or sirens. Patient threatening to jump".

Out of area as usual, we don't really know the names of the buildings, but this one has its name on a sign that can, for a change, be seen from a couple of blocks away. As requested, we make a silent approach, as much as is possible in an almost 5-ton truck with a large diesel engine, and await further instructions from the police officers on scene.

In front of us, still about 100 metres away, looms a large apartment block, and I count at least 12 storeys. If she jumps from there, our presence will be superfluous. In contrast to our orders, the police seem to be turning up in force, blue lights bouncing off the surrounding buildings, giving the street a look of a club on a Saturday night, the staccato lighting beating in time to the music. The street is cordoned off at both ends preventing traffic from approaching, and any pedestrians, though very few at this time of the day, are shepherded away from the scene on a long detour. A chorus of complaints comes from one group of bystanders who want to see the action, as they are firmly removed and asked not to return. A police Inspector approaches us, his two-pipped shoulders confirming his command, and explains the situation.

"At the moment, we're talking to her on the phone. She says she's in flat 55, and threatening to jump from the balcony. It sounds like she's had a lot to drink too, so anything could happen. There are, we believe, six flats on each floor, so she's probably on the 10th. We're just trying to see exactly where she is and what she's doing, and then we'll decide what we're going to do about it. You two just hang back and wait." He ends abruptly and walks off, retaking his position in control of the out-of-control situation.

Only once before have I been involved in something similar. Back then, when I was still only in my probationary year, we sat waiting for four hours. We drank tea, read books, snoozed and generally sat still as nothing continued to happen. At the end of it all, despite negotiations and attempts to get into the building, he jumped, and there was still nothing that we could do.

So once again, we sat. I don't tend to take a book with me to work any more - there's never really any time to read it - this time, my phone would have to suffice for entertainment. A police officer was sent over to us and informed us that she was our liaison. As soon as it was safe for us to approach, she'd get the message on her radio, and advise us to advance. We made ourselves comfortable for what could be a long stay.

The message arrived after less than fifteen minutes.

"Suspect detained indoors, advise ambulance safe to attend."

We drive the short distance to the block, and find that it's split into three separate entrances. Several more officers walk out of the middle of the three. Some are smiling, some are laughing, some just walk by silently. We take out our equipment, and advance on the entrance.

"I hope there's a lift. Don't fancy a walk up 10 flights of stairs."

"Wouldn't worry about that", chimes in an officer, a mischievous grin on his face. "The lift's working, tells you which floor you need just outside the door".

We look at the sign stuck on the wall by the lift. Graffiti is sprayed and scrawled all over it, some of it legible and unrepeatable, some of it just looks like streaks of dirt. Through it all, a list of floors and it's corresponding flat numbers is just about distinguishable. All the while, officers are streaming down the stairs next to us. You've had a long walk down.

Eventually, we actually pay attention to the sign.

Ground floor - Entrance

First floor - 53 - 56

Second floor - 57 - 60

Third floor - 61 - 64...

And so it goes on. Up to the twelfth floor, and flat number 96, four flats per floor, not six.

"What number did we want?" I ask my partner.

"55".

"Are you telling me that all this was for someone who was going to jump from the first floor?"

"Apparently so..."

We don't bother with the lift, and walk the dozen or so steps up onto the first floor and into flat number 55. The room is littered with empty bottles of vodka and ashtrays filled to the brim. The patient looks up at us and before we even get the chance to say a word, starts yelling.

"I would have jumped you know! If it wasn't for these coppers I'd have done it! There wouldn't be nothing left of me except bits of brains on the floor, and it'd all be your fault!" She points randomly at one particular officer, who'd only just entered the room, and was forced to respond as the patient was being clasped in handcuffs.

"You might, if you were really unlucky, have broken your leg. There'd be no brains anywhere!" "Especially in your head", he adds, just loud enough for us to hear.

"Well I'd have jumped from the top floor", she bites back, "but I might've hurt myself. And anyway", she rasps, years of smoke having damaged her vocal cords, "I've got no head for heights".

Vans

Day or night, mid-week or weekend,

sometimes we see them in action, sometimes all we see is the aftermath.

Sometimes, all too often, we're the intended target.

Fights are a common occurrence. Too common.

Often alcohol-fueled, they invariably end in injured limbs, injured heads, and injured pride.

Oh, and a criminal record.

A gentle reminder to those of you thinking of fighting:

You may well have phoned for an ambulance,

but you're just as likely to leave in a very different kind of van.

Especially if Ambulance staff are the threatened or injured party.

No Answers

Saturday night, the scourge of all police officers and ambulance crews. These days, all nights are busy, but weekend nights are often like being in a war zone. Trust me. I've done both. Sometimes I think that it was safer in the other one. As I work only nights, my weekend night shifts come round more often than most, and without fail, I regret them.

A list of a weekend night's proceedings often resembles a list of the wives of King Henry VIII. Divorced, Beheaded, Died. Divorced, Beheaded, Survived.

A Saturday night on the street runs something like this: Drunk, Assaulted, Trashed. Drunk, Assaulted, Crashed. The last of these might only appear once a night. If that. If you work in the centre of London, there are probably even fewer. I work out in the suburbs, so there's a chance that once the pubs, clubs and fast food shops have shut, I may actually have to treat someone who genuinely needs an ambulance. By that time, I'm tired, cranky, and struggling to give them my best attention and care. That which they genuinely deserve.

Last night, I tweeted about treating drunks, by asking a simple question. Do you think that people who call ambulances because they've had too much to drink, should be charged?

All dozen or so replies were positive. Some just said "Yes". Someone said "Yes, without a shadow of a doubt". And one even went as far as saying "YES!! YES!!!! A THOUSAND TIMES YES!!!" It seems that I received some support for the idea.

It's a knee-jerk, almost default position by health care professionals, and even some who aren't in the medical field at all: You're drunk. It's of your own doing. You should know your limits, or suffer the consequences. You don't need an ambulance. You don't need to be in A&E. And we most certainly don't want to be the ones who have to clean up all the bodily fluids you emit in your sorry state. Therefore, we all want to charge you. I'm as guilty of it as the next person. Not so much the drunk bit, but the wanting to charge bit. But there's a problem with this thought, once taken to one of its logical conclusions.

We should charge those who overdose on drugs. The heroin addicts who should know their limits, but who take a little more than their normal amount, end up not breathing, and who we administer Naloxone to to get them breathing again, ready for their next hit.

We should charge drunks who wonder out into the middle of a busy road and get hit by the car whose driver had no chance of avoiding them. Or by the same account, charge the drunk driver who's hit the lamp post that's sat on the pavement for years, but suddenly jumped into the middle of the road.

We should charge the wrist-slitters, crying for attention at the age of 18 after being dumped by the love of their lives, and who next week will have another life's love.

We should charge drunks who we convey not for being drunk, but whose drunken state has led to some sort of illness or injury.

We should, therefore, charge anyone who should have had some degree of responsibility for their own presenting condition.

Smokers with emphysema? Charge.

Footballers with broken legs? Charge.

Diabetics with high blood-sugars? Charge.

So how far do we take this knee-jerk reaction, this desire to charge drunks? Is it a question of all or nothing, in which case we charge everyone, or do we continue as we are, charge nobody, and just have to keep putting up with it, whilst we all, as taxpayers, foot the bill? Once upon a time, drunks were taken to police cells, given a mattress to sleep on and sober up, generally ignored, and were then sent home in the morning. Just that cost money.

Now, they get an emergency ambulance, often accompanied by the FRU, as they are frequently supposedly unconscious or not alert. If they're in town, they might get the dedicated "booze bus", a multiple-patient-transporting, baby-sitting service staffed by EMTs and paramedics who are clearly a lot less averse to dealing with alcohol-induced vomit than I am. They get a hospital bed, an overworked nurse, a disinterested doctor, and sometimes a bag of fluids as well. All very often whilst abusing those who are caring for them. And that's if all they have is a serious case of overindulgenceitis. That's a lot more expensive, and a lot more frustrating, which is part of the reason we feel that we want to charge. But is it right? In the overall spirit of the NHS, free to all at the point of treatment, can we really justify it? And if we are going to start charging, who do we charge, what for, and how much?

I have lots of questions when it comes to charging drunks.

I just wish I had some decent answers.

What do you think?