Football Pictures

A young father meets me at the door, his face wracked with worry. He ushers me up the stairs and in a rare gesture even offers to carry one of the bags for me.

"He's just not stopping!"

"What's his name?"

"Harry. He's only five."

A quick look into the room allows me to take in my surroundings and looking at the posters and t-shirts, I see that we support the same football team. Maybe a little later it'll be a good conversation piece, but right now, this little boy needs help. The seizure that's taken hold of him is relentless and, according to his dad, has been going for almost fifteen minutes. It's the first time he's ever had a fit.

"I wish his mum was here, she'd have known what to do! She's a doctor. She's on her way back, so she'll be more help."

Great. A doctor. Just a little bit of added pressure - as if treating sick kids isn't bad enough. As promised, she walks in less than a minute later, after I'd given Harry oxygen and some other medications and just as I'm about to cannulate. The needle and tiny plastic tube need to pierce his skin and a vein, giving me access to his blood stream and the ability to give him some more medications to help stop the fit. It's not a skill I use often on children.

I turn round to see mum as she walks in and realise that she's a doctor I know. She used to work in one of the local A&E departments and was one of the more positive when it came to attitudes to ambulance crews. She would always take the time to listen to handovers, talk through a call if we needed to, show us x-rays and blood results and generally involve us more in a patient's continued treatment.

"Hey Doc." I tell her what's been happening, what I'd already done, what I was planning to do. "You're welcome to do the cannula if you want." She declines and I have to say that I agree. I'm not sure that if it was my child that I'd want to play any role other than the parenting one. With a little skill, a little help and a little luck, the cannula goes in first time. The drugs hit his system moments later and after seconds that seemed to stretch for hours, the seizure finally stopped. 

Harry's breathing needed a little support on the way to hospital, but by the time we arrived, he was starting to come round a little. Mum came in with us, blending into the crowd as just another parent until one of the nurses recognised her. 

"You been helping out the paramedics again?"  

"Not this time. Just been trying to stay out their way for a change."

Harry starts to notice his surroundings, the unfamiliar faces, sterile walls and disposable curtains leave him confused and scared, but a familiar voice and the gentle, welcome hand across his face do something to allay his fears.

"Mummy, is this where you go to work?" 

"Sometimes it is. Do you like it?" 

"No."

"Why not?" 

"Because there's no football pictures!" 

"But is it OK that I come to work here?" 

"Yes, but only if you're my mummy first. Then you can be a doctor too." 

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.

Late

My shift finishes at 3am. The call comes in at a quarter-to.
*****
The door's open. A bad omen I fear. Nursing homes are almost never ready for us when we arrive. It doesn't seem to matter what the emergency is, it always happens to be somebody else's job to meet the ambulance and direct them. That Somebody Else who's almost never to be found, so finding the door as it was seemed more threatening than welcoming. The building, however, is huge. Two storeys with at least two dozen rooms on each floor, and as usual, despite the open door, Somebody Else wasn't there again. I yell "Ambulance" several times up and down the corridor, and eventually a member of staff hears me and without so much as a glance in my direction yells back "It's upstairs".
*****
The call came in as "patient fitting". Something told me that unlike the vast majority of calls we receive to patients who are having seizures, this one probably still was, so I took all my luggage with me, ready for anything, and waddled up the flight of stairs. (I've worked out that if I take everything in with me, it weighs about 20 kilos. Or 40 pounds. Possibly more. About the same as normal luggage allowance on a European flight.) The lift was the other end of the corridor and would have involved double the waddling distance, so I decided on stairs. That and the fact that I don't really like lifts.
In the room is Barbara. And about seven members of staff, all of whom were trying to tell me a story, none of them really succeeding. After ascertaining who was in charge, I found out that Barbara needs full time care due to various medical problems, hence the nursing home, but has never before had a fit. This one had been going for a full 15 minutes before I got there, and was still in full force.
Barbara's eyes are open, but the vacant stare just looks back, pleading for help. I give her a first dose of medication, hoping that it would bring a stop to the seizure, but it has no effect at all. I get IV access, so I can give her some faster acting medication. It all seems to take forever, but looking at my watch as I time the drugs, it's not really the case. I start to give IV drugs, slowly watching and waiting for it to take effect. At this point the ambulance arrives, having received my message that the patient was in Status Epilepticus, or an ongoing seizure.
One of the side-effects of giving Diazemuls IV, is that it can reduce the patient's respiratory rate. The drugs are taking effect, and Barabara's seizure finally stops. Unfortunately, her breathing rate is now less than six a minute. We assist her with ventilations through a bag-and-mask, ensure she is as settled as possible, and then take her to the ambulance. We put a priority call to the hospital, and I travel with the crew. An extra pair of hands with a very poorly patient is always helpful.
Barbara's respirations don't pick up on route, but with our help her oxygen levels remain at 100%. The blood gas test when we arrive would show that despite an exceptionally long seizure, and despite the fact that she was hardly breathing on her own, we still managed to maintain a good airway and good ventilations. Easy to do in a sterile, non-moving environment such as a hospital, not so easy in a moving vehicle. These are basics, I know, but sometimes easy to overlook with the organised chaos that is a poorly patient.
We hand Barbara over to the hospital staff, and even get a pat on the back for our treatment. Now that IS rare. Back to reality, tidying up, writing up, restocking. Just before we leave the hospital, I go back in to check on Barbara one last time. She's breathing on her own, looking a lot more settled. Family starts to arrive, and I sneak out, pleased that my training has once again been put to good use, and with a good result. Or at least I hope it was a good result. I don't know what happened to Barbara after that.
Eventually I get back to station, start to pack up and go home. I take a look at my watch as I leave the station. 4.45am. The sun is starting to rise, the early-birds are beginning to stir, the world is just commencing it's early-morning ritual. Not for me though.
For me it's late. Very late.
But very worthwhile.