Cen-Tree

I have an ex-crewmate, Jim, who, when frustrated with the job and its ensuing politics, would threaten to go and work for the council as a lawn-mower. No, not as the machine, but as the operator of one. No grief, out in the open air, music blaring. What more could you ask for?

*****

Al, a local-council gardener for several years, loved his job. It wasn't taxing, he loved the open air, loved working at his own pace, loved listening to his music. No managers, no hassles, never home late. Just him, and the flora and fauna of the local area. Today was his turn on Daisy, the industrial-sized ride-on lawn mower. Daisy was used when the big jobs needed doing. Parks, large verges, anywhere that a normal sized machine would take days to complete, Daisy could do the job in a fraction of the time. Daisy's twin, Belle, was also sent out on the mission, piloted by Sue.

The weather forecast had promised a bright sunny day and for once had delivered on its promise. Al and Sue were thrilled. They moved from place to place, leaving behind them the scent of freshly cut grass whenever they journeyed on. Daisy and Belle were in their element. With Sue and Al chatting throughout, the morning flew by, and as the midday sun began beating down, they found a shady area that needed cutting too. A wide grass verge with several large trees dotted around.

Sue went left, and Al, right. He'd just remembered a funny story he was going to tell her and turned round to call out. Two seconds. That's all it took. Two seconds looking in the wrong direction. Sue barely had the time to scream: "AL! LOOK OUT!!!!"

Al turned round to face the front again, just in time to see the huge branch. Most trees would be proud to have that branch as their trunk, but on this tree it was just a branch. Perpendicular to the tree-trunk, parallel to the ground, and about six feet above it. Daisy was about four foot high. Al sitting down another two. He took the full impact straight in the face. Ten miles an hour isn't fast when you're surrounded by a tonne and a half of metal, but it's lightning speed if your face meets a tree and has no protection at all.

When we arrive, Daisy is the other side of the tree, with Al a crumpled heap on the floor. There's blood everywhere. I take a few seconds to assess and work out what's going on, in which time, Jim, my crewmate suggests that immobilisation may be a good idea. I wholeheartedly agree, and curse myself for not thinking of it immediately too. Right, brain back into gear. Trauma. ABCs.

Airway - clear at the moment, but some bleeding in the mouth. Unknown source. Regular reassessment required.

Breathing - yes. At the moment. Clear chest, no funny noises, no missing sounds.

Circulation - yes. At the moment. Several areas of blood loss, none that are obviously too heavy.

Disability - Sue's unsure if he lost consciousness, but thinks that he did. At the moment, he's conscious but very confused and a little agitated.

I'm still worried about Al's airway. We need to immobilise him on a board, with a neck brace, on his back. And there's something bleeding in his mouth. Not at all ideal. Ideally I'd like to have the patient knocked out and intubated. That would ensure that his airway and breathing are secure and I could deal with the other problems.

I ask for HEMS. They're unavailable. (Not once, in my whole career so far, have they come when I've called them. I've done calls with HEMS, when other people have asked for them, but never when I have. Either they've been busy, had no helicopter, or a myriad of other excuses. Once, they even crashed when they were on route to me. Before you scan old newspapers for news of a HEMS chopper crash, they were coming in the car. But still, it must be some sort of conspiracy...)

I ask for a BASICS doctor. The nearest one is at least 40 minutes away.

We're ten minutes at most from the nearest A&E, not one known for its trauma care. The nearest Trauma Centre is an extra twenty minutes drive away. Al has an airway problem, so we don't really have a choice. We package Al, load him into the ambulance, warn the local A&E that we're on the way, and apply diesel. Jim's driving, which is a good thing, as he's a much faster and smoother driver than I am. On route I constantly suction the blood from Al's oral cavity. I have flashbacks to the dental surgery. Not a good thing.

His observations remain stable. A quick look shows that he's lost several teeth, probably fractured his jaw and eye-socket, possibly fractured his skull. As his face took the full force whilst Daisy kept going, we had to suspect a serious spinal injury too. When we arrive at the hospital, there's a full trauma team to meet us. I'm impressed. They obviously understood the significance of the injuries that we'd tried to relate over the radio. Al's handed over to the team, and I never find out what happened to him after that.

Whilst we're cleaning all the blood, mud, and carnage we'd left in the ambulance, Jim mentions that he's not so sure about his alternative career path after all. I'm not surprised.

*****

PS. This is my 100th blog post. My century entry. What started out as a little bit of a trial run, has turned into something that has taken over my life! I'm shocked I've made it this far, and honoured that I seem to have captured the interest of so many people. I hope I keep going for a long while yet, and I hope you keep coming back. But in the meantime - thank you.

First Impressions

The call? 25 years old. Male. Chest Pain.

Go on, fellow medics. Admit it. Doesn't fill you with the joys of spring, does it? Didn't do much for my need for an adrenaline rush either. It's the sort of call that immediately throws up images of drunk and incapables. Or Man Flu. Or a bad takeaway dinner. Or something equally as life-threatening.

We weren't met by the frantic windmill that's the traditional signal either for a very poorly patient or for mass unnecessary panic. Good.

We weren't met by the patient lying in the middle of the street. Very good.

We were met by an open door, a filthy house, and a mixed aroma of alcohol and vomit. Bad.

However, so far, so predictable.

The front door opened straight to a flight of stairs, so nowhere to go but up. As we're climbing the stairs there's a call of "We're up here!". I roll my eyes and wonder to myself where else there is to go. Somewhere sunny, warm, and far removed from self-indulgent, self-harming drunks would be nice.

I'm a bit of a one for first impressions. I make instant, snap judgements on people as soon as I meet them. I try very hard at work not to make these sorts of decisions just by reading the call on the screen, but at times it's a little difficult. And I admit, this time I'd already made my mind up, and it wasn't particularly complimentary. Normally it takes a very long time to convince me of the error of my first impression. In fact, it almost never happens. I'm just too stubborn. Tom, for his part, was going to do everything to prove me wrong.

As soon as I'd set foot in the room, I could see that I was wrong. Tom was indeed about 25. And in pain. Not chest pain, but pain nonetheless. And he looked ill. Very ill. His pulse was well over 100 and climbing. His blood pressure was in his boots. His temperature sky high. His abdomen was very tender and he'd been vomiting, or at least trying to, for days. His partner told us his story.

The cause? A rotten tooth. Antibiotics for an abscess had failed to work. Painkillers had failed to do their duty. The doctor had told him to wait until he felt a little better and then go to the dentist, a thought that would have filled me with dread. And probably make me turn to drink, too.

The thing is, he wasn't feeling any better. He was feeling worse. He was short of breath. He could hardly talk. He couldn't eat. But he could drink. So in an attempt to numb the pain, he drank. And drank. And vomited. And drank. And vomited. And drank. Tom had been drinking constantly for nearly a week, and now his body was finally giving up.

It could be his liver, his kidneys, his pancreas, his bowels. Anything or everything in that region. They could be inflamed, they could be ruptured, they could be failing. Whatever it was, it was possibly killing him. When I put the priority call into the hospital, I didn't really know what to tell them. Not having a mobile CT scanner made it a little difficult. I think that I said something along the lines of "acutely unwell" and just reeled off a set of observations. Hopefully they would give the staff a clue. Once there, they continued our treatment of oxygen and fluids, gave him some IV antibiotics and rapidly handed him over to the surgeons.

The last I heard, Tom was still teaching me a lesson about first impressions. From his bed in the Intensive Care Unit.

I, Robot?

I may have mentioned this before. I don't like dentists. No, I mean I REALLY don't like dentists. The last time I went to the dentist, my pulse was still at over 140 an hour later. The time before that I passed out in the chair. I get palpitations if I just phone up to make an appointment. I get chest pain and break out in a sweat if I walk past a dental surgery, even if it's not the one I go to. In fact, as I write these lines, I can feel the dread coming over me in waves. I may have mentioned this before. I don't like dentists.

____________________________

The call came in for a man collapsed, unconscious, possible allergic reaction. Easy. I can deal with that. I'm a highly trained, highly skilled, highly motivated paramedic. Most of the time. Then, I look at the address. Dr Payne's Dental Surgery, Filling Road, Phobiatown. Instantly I feel the colour drain from my face, my pulse double. The cold sweat starts on my forehead, and within moments has spread all over me. And I have to drive to the call. I'm on an ambulance, not flying solo in the car, and it's my turn to drive. To be honest, it's probably a good thing, otherwise I'd have panicked even more. At least I had something to concentrate on before we got there.

I hoped that the patient would have had the good grace to collapse in the reception area. Or the waiting room. I prayed that he would be well enough for my crewmate to say that I could wait outside and he'll deal with the emergency. I begged that it would be straightforward, so we'd be in and out in no time.

No such luck. None of my prayers were answered. Well, strictly I guess they were, but the answer was a resounding NO. On our arrival, I scoured the reception area and waiting room. He wasn't there. A frantic looking receptionist sees us and yells directions. "Up the stairs, turn right, turn left, 15th door on the right, spin around and walk in". I'm not sure that the "spin around" bit was actually part of the instructions, but I was doing it anyway. And there probably weren't 15 doors upstairs, but it was starting to look like it. Damned phobia! Concentrate!

We find Phil, a gentleman in his 50's, as if to taunt me he's still sitting in the dentist's chair, and he's not at all well. He'd just been given a local anaesthetic injection, and had reacted badly to it. His body had swelled, he'd come out in a rash and was vomiting heavily. His breathing had started to be affected, soon his blood pressure could plummet too. We'd need to treat him before even thinking of moving him. He needs oxygen, he needs a needle in his arm, he needs drugs. My crewmate checks and double checks everything as I hand him, and keeps a close eye on me at the same time. I'm paler than an ill-looking ghost.

Luckily, one of the driver's duties is to fetch whatever is necessary from the ambulance, including the carry chair. I take the minute or so outside as much needed respite. I regulate my breathing, try to slow down my pulse, and tell myself to stop being so bloody stupid. It's not me at the dentist! Once more I enter the building with the chair, thinking that at least this means we're about to leave.

Phil's improving slightly, but still we have a flight of stairs to negotiate with him on the chair. I take the top end of the chair so that I don't have to go backwards in my state, and we make it down the stairs in one piece. Once we've loaded Phil into the ambulance, I go and sit back in the driver's seat to try and regain my composure. As I look in the mirror I can see my crewmate giggling to himself at my predicament. To top it all off, we had an observer with us that day who got to witness and mock my jelly-like state.

Phil still received the best care possible, and made a full recovery. Hopefully he didn't notice the turmoil that I was going through. Or maybe that he did. Maybe his experience has turned him into a kindred spirit.

As paramedics we face all sorts of unexpected situations and emotions. We're expected to face them all professionally, at times coldly. Most of the time I try to leave my emotions to one side, push them out of my head whilst I'm with the patient and deal with them later if necessary. I have a job to do. I need to focus on the task at hand.

Sometimes, thankfully very rarely, I have to deal with the patient and with what I'm going through at the same time. I'm no robot, no automaton. I think, therefore I am. It's just that sometimes, thinking is what gets me into trouble in the first place. Sometimes, I hate to admit it, but I guess I'm human too.