Inside Out

She tells us she's scared, as she hasn't been out the flat in years.

Her carer does the shopping, but hardly seems to care. 

Her cleaner launders a few clothes, yet does very little cleaning. 

Her doctor attends by phone call, and just extends her prescriptions.

Her pharmacy delivers the medication, leaving it on the doorstep.

Her family, and her hope, have long since gone.

And as we leave with her on a chair, 

Out into the big wide world for the first time in a decade,

We notice the "Welcome" mat by the front door. 

Facing from the inside,

Out.

Three Meetings

The first, when I was a teen, at a seaside resort. The theatre was packed full of excitable kids as you made your appearance on stage. The cheers, the jeers, the laughter, watching you make a fool of yourself, as you appeared to love every moment. A classic children's story brought to life on the colourful stage to an appreciative, childish audience.

The second, as an adult, on the silver screen. A rare visit to the cinema with my wife. A hushed respect from a more mature audience as you displayed your talents and masterfully portrayed the plot the scriptwriters had presented to you. Their story, but you made it yours.

The third, as a paramedic, in the lounge of your apartment. You lie on the floor, silent, motionless. As you're unable to tell a story of any sort, emptied cans of beer, spent syringes and bloodied razor blades tell the tale for you.

As we leave the hospital, I wonder if there'll be a fourth. 

Destiny

The fact that it's a regular occurrence doesn't make it any more comfortable. At least once a month, there's a call into the Custody Suite at one of the local police stations. The word "suite" belies the stark reality of concrete boxes with no more than a tiny window and an open toilet. The stench of both the current resident and all those who had spent miserable hours in the grey, gloomy cells is often overwhelming, sometimes bearable, but never pleasant. Calls to this place are more often than not an attempt to fake an illness or injury in order to end hours claustrophobic hell. Five minutes is more than enough for me. 

This time the call was for leg pain, post fall.

A police van was parked in the middle of the car park, just by the entrance to the cells. There was some yelling from the van, an incoherent babble about police brutality. Threats and promises of revenge, complaints about treatment and talk of lawyers all doing nothing to rattle the officers standing outside. I thought to myself that he'll probably be our next customer, when he also gets bored of the solitude. Between the van and the building is a wire cage, just large enough for a prisoner and two accompanying officers, leading to the heavy blue door with the one-way latch. We step in to the wire cube, the crew and I, and as we are about to enter the building itself, a call from the van spins us round. 

"He's in here!" I'm thankful not to have to step back into the cells. 

We walk back, and a sergeant quickly fills us in on events. 

"We nicked him for shoplifting. He saw us coming, ran for about a mile, and after running down something like forty stairs, he fell over a simple kerb. Ironic really." The sergeant couldn't hide the smile. "He kept going for another hundred yards, then fell to the floor. Once we got hold of him, he walked to the van, assisted by these gentlemen, and only started screaming about his leg as we pulled into here. Probably the usual trick, but he won't let us move him, and every time we try, he screams like a woman in labour!" 

Rob's still in the back of the police van, shut in the cage that will make a custody cell seem like a penthouse. As soon as the van doors open, his rants become louder and he starts to spit at the officers. As well as the metal housing, the cage is surrounded by perspex, so the spit just rolls down the plastic and onto the floor. One of the officers shouts at him. 

"We've got the ambulance here for your leg. Now shut up, calm down, and stop behaving like an idiot, and then we'll let the crew look at you!" 

A different person answer from inside. 

"Yes, sir." His tone was suddenly calm, he sat bolt upright, and waited for the cage door to be opened. Three officers stood by the door, just in case he ran. 

"Where do you think I'm gonna go?" He laughed. "Have you seen my leg?"

The police stood back, and let us in. 

"A word of warning." I said to Rob, taking a wary step forwards. "You spit at me, and police witnesses or not, I'll knock you out!" I've never knocked anyone out, but if anything's likely to bring me close, it'll be a spitter.

"No way, sir. I'd never do that to you guys. I respect you too much!" The alcohol on his breath could have knocked out a rhino at a hundred paces, and I was concerned that intoxicated, he'd soon change his behaviour again. 

"Right, well you make sure you remember that then." 

Rob smiled and rested his head back on the wall of the van. As we tried to remove his boot, Rob screamed in agony, even with all the alcohol on board. A pair of shears, a lot of entonox, a touch of morphine, and some choice words from Rob, and we could finally see the problem. Both bones of his lower leg were visible through the skin, the sharp edges of a traumatic fracture making easy work of the thin flesh. How he walked anywhere after his fall was a miracle. 

Once the pain killers joined the alcohol, Rob was calm enough for us to pull his leg straighter, splint it and move him to the ambulance. I didn't dare risk much more of the morphine, not wanting to take the gamble of stopping Rob's breathing all together, so I handed him back the entonox. 

"The police told me that you were screaming like a woman in labour. So here's the stuff they give them, should you need it." 

"Thanks," he answered, and took a large, deep breath on the gas. 

He refused to give us too many details. He either didn't want to give us an address, or genuinely didn't have one. He gave his date of birth as the 31st of September. 

"There isn't a 31st of September!" said one of the crew. 

"There was in the year I was born. It was a double leap year." After we all laughed, he clammed up completely, until we opened the doors at the hospital, ready to take the trolley off the back. 

"It's not my fault that I steal, you know," he started, "it's my parents'. Just look at the name they gave me! I mean, what do they expect if they call me Rob?" 

"Surely it's short for Robert?" asked the accompanying officer. 

"Well it is, but they've always called me Rob. It's obviously my destiny." 

"Not with that leg it isn't", mumbled the officer as we stepped out of the cold air and into the hospital. 

Nominations...

... are open for the following competition.

The 2010 - 2011 "Black Diamond" Fire and EMS blog of the year.

Follow this link for the rules and regulations on how to vote for your favourite. There are two strands as you can see. One for Fire, one for EMS.

There are a huge number of great blogs to choose from. Go and lend your support!

Irony

You're sending me? To this?

Lift Assist

Normally, the two-word title of this post indicates what is a frequent and relatively easy call. A faller, most often elderly, just needs help getting back up off the floor again. No life and death emergency, no injuries to treat, just a helping hand.

Norman pushed the pendant round his neck which called the careline, and they called us.

"90 year old male, on the floor, unknown injuries. Possible assist only. Key safe by the front door, number 1234. No further details."

I arrive to find that we don't need the key safe - the door's ajar. I knock and yell as I step over the threshold.

"Ambulance service, where are you?"

"In the front room. Come through."

I walk in past the stairs and through the dated hallway and breakfast room. The lounge is warm, a gas heater blowing full force. Family photographs grace the walls and shelves, some recent, some from times gone by. A black and white of a bride and groom, an enlarged reproduction of the seventy year original, takes pride of place in the centre of the room, right above the fireplace. A younger Norman smiles down onto the room, as an elegant bride stares lovingly into his eyes.

Present-day Norman is sitting quite comfortably in a large recliner arm chair.

"I thought you were on the floor!"

"Where did you get that idea from?"

Apparently careline didn't quite understand the problem before calling for ambulance help.

"So what has happened this morning then, sir?"

"All I said," he laughs, "was that I couldn't get upstairs to bed. I get around alright on my own, but I use the stair-lift to get up and down. Can't quite manage the stairs any more. Damned stair-lift won't work, so I asked if they could send someone to help."

"And here I am. You sit tight for a minute and I'll go have a look at it."

Back at the staircase, the chair stubbornly refuses to move. I push all the buttons I can see, until suddenly I find a key hidden under one of the arm rests. It has two positions.

On.

And off.

A quarter turn and click later, the chair comes to life. I push the buttons, and then it glides all the way up, and gently all the way back down again.

"Norman! Fixed it!" I shout into the lounge. I walk back to help him up, only to find he's already half way to the stairs.

"Well done sir!" The relief is evident. "I've spent the last two hours trying to get that thing to work!"

I explain how I won the battle with the disobedient lift, and he roars with laughter. He takes a seat, presses the button, and I follow the quietly whirring mechanism as it climbs the staircase. Norman makes his way from the top of the stairs to the bedroom and sits himself down on his bed. A small framed photograph sits on the bedside table. The seventy year old original, sitting next to a an empty mug.

"Pretty girl you married."

"Very pretty, until the day she died. She left me four years ago. Used to make us both a cup of cocoa every night as we came up to bed. That's what the mug's from. Every so often I'll make myself a cocoa, but I never use this mug. It's just there for me to look at and remember." 

He stares silently into space, trying to cram in as many memories into a short space of time. 

"I'm sure it's her that gets up to all these high jinks, just to keep me on my toes." He adds after a moment.

"And I'm sure it makes her smile every time, too." 

"More than likely. Thank you so much for your help. At least I can sleep easy now." 

I left the room, turning off the lights as I went, and shut the front door behind me. All that's left to do is the paperwork.

Name: Norman.

Age: 90

Presenting condition: Lift assist.

Shortlist

It all seemed so simple. We turned up at the house for what appeared to be yet another "maternataxi". An ambulance being called to a woman in early labour for simple transport, where after nine months of preparation, buying clothes, painting nurseries, and building cots, no-one had thought about how to get to the hospital. Either that, or it's just that we're the cheapest option. Taxis cost money, as does parking, so an ambulance that will deliver you (sorry) to the front door and not cost a penny is a very attractive proposition.

Zara had two days to go according to her notes, but babies rarely arrive exactly when expected unless it's by planned Caesarean. Whoever called the ambulance told the call taker that the contractions were two minutes apart, whereas in reality it was nearly five. Her waters hadn't broken, this was her first pregnancy, and she wasn't too troubled by the contractions even when they did occur. Her husband said he'd make his own way in the car. He could have taken Zara too, but probably feared the mess if she delivered on route. Either that or he panicked. I gave him the benefit of the doubt as it was their first baby.

"Which hospital are you booked into?"

"Faraway hospital," she answered. Not the answer we'd hoped for. There were at least five other maternity units that were nearer in all directions, but if that's where she was booked, that's where we were taking her. It was over half an hour away, if the traffic was bad it could be double that, and the only reason she wanted to go there was because she had heard from friends that it was a good place to go. She never quite took into account the fact that she actually had to get there, and possibly in a hurry.

"Lucky you're not booked into Edinburgh hospital!" I commented, only half joking, trying to hide the nervousness I felt at a long trek with a labouring mother-to-be. Zara's husband stuck his head back in and asked if we would take the luggage as well and then he'd follow us to hospital.

"I'll be right behind you. Don't have the baby without me!" I hoped Zara's husband was right. We told him that if the traffic was particularly bad, we'd cheat and use the lights, and he had to make sure that he got there safely, even if it meant a slight delay.

I was fairly new, with only one delivery under my belt, an easy home birth where the midwife turned up less than five minutes too late. I was working with a partner who'd long ago lost interest in treating patients. He was working out the years until his retirement and spent most of his time driving the ambulance, ignoring both patients and crew mates alike.

"She'll be fine," he said, "we'll make it there with enough time for us to grow the coffee beans and still drink them before she has this baby." With that, he shut me and the patient in the back, and started gently trundling to hospital. Half way there, something about the way she was contracting changed. The look on her face was more anguished, the mix of gas-and-air in the bottle with the chipped blue paint no longer worked its magic quite so effectively. I called through to the front and explained what was happening. My crew mate looked up briefly in the mirror, switched on the lights and pushed the engine a little harder. The engine roared a response, but the actual change in speed was barely perceptible. Zara certainly didn't seem to notice the difference. I placed a maternity kit on the trolley, just by her feet, hoping the clear plastic case would remain sealed.

We called ahead to the hospital and asked them to make sure we were met by the front door, as it was notoriously difficult to get into the unit in a hurry. It involved two doors that required remote access, and a lift in between the floors where the doors were located. Waiting at each stage could easily add ten minutes to the journey. The lights and sirens had no real effect on the speed, but at least we could weave a little easier through the daytime traffic. Fifteen minutes and six or seven sets of strengthening contractions later, we pulled up outside the hospital. As expected, despite our prior warning and plea, there was no one there to meet us.

Zara screamed. She yelled about needing to go to the toilet. Desperately. There are two sets of patients who tell us that. One set is those having some sort of cardiac event, who if allowed to go will probably collapse, or worse. The other set is mothers in labour who are about to deliver their babies. As we lowered the trolley out of the ambulance, I was in a way glad of Zara's panic. It was doing a great job of masking mine. We pressed the button and waited for what seemed like an eternity until someone answered. We didn't need to identify ourselves, Zara once again did it for us.

"Get the lift down here, and get these doors open!" yelled my crew mate. It was the first time I'd seen any sense of urgency about the man.

Dragging the trolley up a slight ramp into the building, I prayed for the lift doors to open, and a midwife to be standing inside. Neither happened. I pressed to call the lift, and the square button lit up, its dim red light stopping us from proceeding. As the lift arrived, the light went off and a bell chimed to announce the blindingly obvious. Another chrome button, this time with a large "2" embossed both as a regular numeral and in braille. Once again I cursed hospitals everywhere for not having all maternity units on the ground floor.

We stopped on the first floor, a frightened looking mother and child taking one look inside and deciding to wait for the next time round. Another delay, another contraction, another scream. I frantically looked for the button that closed the doors again, only to find that there wasn't one. Instead I pressed the number 2 again, willing the lift to move. Zara had practically finished the entonox, and I promised her that there was more on the unit. All she had to do was hold on another minute.

I timed it. Forty-five seconds from when we stopped on the first floor, until we starting rising again, another thirty for the doors to open on the second door. As we landed, Zara contracted once again, and begged us not to move until it was over. We stood, waited, and prayed.

"It's coming!" She yelled. "Now!"

My crew mate got out the lift and pressed the buzzer to ask the staff to let us in. A distance of no more than five metres. As he got out and pushed the button, Zara pushed the baby.

There was a gush of water as the amniotic fluid escaped from the sac, and a scream as the baby's head appeared an instant later. The scream was Zara's, but it might as well have been mine. In the meantime, the unit's doors remained firmly shut, the magnets holding them in place still secured by an electrical circuit. Finally, training took over from panic, and I gently held the babies head as it turned. The next contraction didn't move anything, and in between the pains my crew mate resorted to bashing on the ward doors instead of pressing on the buzzer. But it was too late.

One more contraction, and Zara was able to hold her beautiful baby girl.

"Time of delivery - 13:14. Born in a lift."

She seemed, from my limited experience at the time, to be quite a big baby. Thirty seconds after she made an appearance, a midwife finally came to open the doors.

"What gives you the right to make such a noise? We're very busy in there, and if we don't answer the door, you'll just have to wait!" She emphasised each of the last four words through gritted teeth.

"Unfortunately," I said, somewhat cooler than I'd imagined possible given the circumstances, "this young lady couldn't wait any longer." I pointed to Zara and the little bundle she was cuddling, each wrapped in an appropriately sized ambulance issue blanket.

Instantly, the attitude changed. We were led inside, shown into a delivery room, and assisted Zara to move across from our narrow and uncomfortable trolley onto the hospital bed. There was the small issue of the cord and placenta to deal with, of which the midwives now took charge. The baby was taken to be cleaned and weighed, a shout from across the room announcing that what I'd guessed at being 'quite big' turned out to be well over four kilos, some nine-and-a-half pounds.

Zara was given an injection in her thigh, and with that chemical encouragement, the placenta too was delivered. She was free to hold her baby again now she'd been cleaned, and at that point her husband appeared. He was puffing and panting as if he'd been through the labour himself.

"I thought I told you to wait for me!" he gasped, leaning over to kiss both his girls.

"Have you got a name for her yet?" asked the midwife who'd initially let us in, now suddenly full of smiles.

"Not yet," they answered in unison.

"We've got a shortlist," Zara added, "but we hadn't definitely decided. We had a definite name for a boy, but this little one will have to wait a little while."

"How about Ellie?" I ventured. Zara looked offended.

"You mean short for elephant? Just because she's a big baby?"

"Actually, I meant Ellie as in short for elevator. I didn't think about the weight!"

"She was born in the lift?" asked the new dad, his voice an octave higher than it should have been. "How did I miss out on all that action? I can't believe it!" He sank into the armchair next to the bed, gently stroking his little girl's wispy hair. "What do you think Zara?" he added after a few moments. "It's quite a nice name? And what with all the circumstances, it really fits too..."

"I'm too tired to think about it right now." Zara replied. Single tears from each eye took a gentle stroll down both her cheeks as she gazed lovingly at her newborn daughter. "Why don't we just add it to the shortlist?"

December Handover, 2010

The Handover Carnival seems to be back to full strength. This month's edition, initially meant to be about Christmas cheer, but is a bit of a free for all. It has been hosted over at JustMyBlog, whose author now officially ranks amongst some of the best friends I've yet to meet. Maybe one day...

Once again, there are posts from some of your old favourites, some from bloggers I've only now heard of and even one from yours truly. All are worth a read! Well, maybe except for yours truly's.

So head over there, and take a few minutes to catch up.

Reflections

It's that time of year again. A year ends, a new year begins. Everything changes, and yet nothing does. It's a time to reflect on all that has passed, and then resolve for the future.

Reflect on the year in general.

Reflect on my achievements. Have I achieved all that I set out to do?

Reflect on my students. Have I taught them the best practices? Have I taught them anything new at all? More importantly, have I learnt anything from them, as they probably have more to teach me than to learn from me?

Reflect on my studies. Did I attend all the classes I could? Did I spend enough time studying of my own free will?

Reflect on my skills. Did I use them well? Did I learn any new ways of using them? Did I improve them?

Reflect on my attitude to patients. Did I treat the patient at the beginning of my shift the same as the one at the end when I'm tired? Did I treat all my patients with the respect they deserve?

Reflect on the way others see me. Did I give people the need to criticise or praise? And what did I do with either? And when they talk behind my back, are they armed with the sword or the shield? 

But for me, the most important of all the reflections I look at, is the one that looks right back at me.

And for now, as I stand in front of the mirror in an ironed uniform and polished boots, a star-of-life proudly hovering over my left breast pocket, the reflection's looking happy.

Happy New Year to you all.

'Tis the Season to be Jolly

Need I say more?

A Christmas Tear

This is a guest post by the person known on Twitter as @MadMedic1, and I thank them for it.
___________________
A drizzly morning outside. Much like any other December morning of late. Inside, carols and banter filled the air in the warm mess room. Christmas greetings were being exchanged. It was, after all, Christmas Day.

Hoping for an easy start to the shift, we were treated to an hour or so on station to enjoy our little slice of Christmas before the world went mad and started to demand ambulances for the usual run of the mill calls such as abdo pains, chest pains and injuries sustained by adults testing kids toys/power tools/ drinking too much. One by one the crews left station, probably not to return till the end of shift, to go home and be with their loved ones.

Our turn was next. We were ready to face the day having had sustenance in the form of tea and shed loads of chocolate – surely the norm on Christmas Day? The phone rings, obscenely loud in the now almost empty mess room. No pleasantries exchanged from control. Never a good sign, especially given the day. Two words. “Cardiac Arrest”. Oh… Followed by another three words I certainly wasn’t expecting. “6 years old”.

My face must have said a thousand words. The colour felt like it had drained. My crew mate, now out of his seat as I repeated those words as I put the phone down and began to head for the garage doors, at a run. I almost never run. I’m built for comfort not speed, but I run. I run for jobs like this. Jobs where every second counts.

Soon we are flying or so it seems. Willing the ambulance to go faster. Thankfully, the roads are clear. Thankfully, my crew mate got new lead boots for Christmas, or so it seemed! Thoughts of this call being not as given run through my head. My crew mate for the day and I barely say two words to each other, which is unusual. Normally the mickey taking flows. Not now. We remain focused and hoping. Hoping this call is a mistake. We arrive on scene to find an FRU already stranded in the road outside the address. Abandoned quickly. Door not quite shut, left ajar in haste.

I grab my paramedic bag and run for the house. The front door is already open. I knock and go straight in. The scene of festive cheer in front of me immediately throws me. 4 children. Laughing. Playing. Shouting. Enjoying their day. Wrapping paper strewn within a 15 foot fall out zone that is the norm on Christmas day. For a split second I think the job’s not as given after all. Then a sudden realisation. Where is the FRU person? Where are the Parents? Remaining as calm as possible and with as much happiness as I can muster I ask the children where our colleague has gone and they point me upstairs without so much as looking up from their festivities.

Leaving behind the raucous laughter and happiness I make my way upstairs. Mary’s Boy Child by Boney M is playing softly alongside muffled and calm voices as I walk towards the bedroom door. Hung on the door, in anticipation of a morning of rejoice and celebration, a suit. Jacket, waistcoat and trousers. Festive red bow tie and crisp white shirt. All in miniature size. A size to fit a child. My heart lurches and I push the door open. Inside, the FRU paramedic is stooped slightly with her back to the door. In front of her is a bunk bed. Sat on the lower bed is a woman, rocking gently back and forth, quietly talking. The FRU paramedic straightens up and turns to me, drops her eyes and sadly shakes her head. As the FRU para moves out of the way I see that the woman is holding a small child in her arms. Gently kissing his head. His tiny body motionless apart from the rocking prompted by his mother. Dressed in pyjamas he looked asleep. Peaceful. Safe.

Mum looks up from her child and thanks me for coming, a wan smile on her face she also wishes me Merry Christmas. I nod, my gaze now dropped to the floor and I shift my feet from side to side, not knowing how to respond appropriately. Mum continues to talk to her child for a few moments more then becomes quiet, her eyes now shut. A single, fat tear rolls down her cheek. An awkward silence envelopes the room broken only when a man then joins us. Tall with a commanding presence he says hello and he too thanks us for coming. His gaze glassy but full of emotion. He is a larger version of the boy in Mum’s arms. This must be Dad. Numb with sadness and seeing that the FRU paramedic is now struggling with emotions I say that we’ll give them some time with their son but we’ll have to do some checks in a short while and we leave the room.

Stood on the landing we all have a moment lost in our own thoughts. Some tears shed, all silently wishing this wasn’t happening. Not today. Not at all. Not ever. Police and a duty officer are called to scene – formalities for situations like this. Still downstairs are the siblings. Blissfully unaware. Composure and strength regained we knock on the bedroom door. Certain procedures needed to be done. The parents leave us to do the formal part of our job and we continue in hushed tones and a great, overwhelming sense of sadness.

He had died some time during the night. He looked peaceful. Apparently, he always liked a lie in. Liked his sleep. But he had Cystic Fibrosis. A mild form that was being managed and wasn’t giving him much trouble of late. He had been well and very excited before going to bed last night. Ready for Father Christmas. His stocking hung on his bed ready…

We called the parents back into the room and left them once again. Paperwork to be completed. Such empty formalities but formalities just the same.

There was nothing left for us to do. The police had arrived and were downstairs talking to the children. Our time to leave had come. Unsure as to what to say we made our apologies and went to leave. Once more we were thanked. Thanked for coming. Thanked for giving them the time they needed. Thanked for doing the wonderful job we do.

As we left the house, all in quiet reflection, we were thankful that child had the most wonderful, loving family in his life. Bitter that his life was too short. That the outcome was so very wrong…

Darkness

The instant the doorbell rings, a sharp bark pierces through the biting wind, a pitter-patter of paws runs towards the front door and starts trying to scratch its way out.

"Hold on one minute," calls a male voice, "I'll just put the dog away." Just above the sign warning would-be intruders of the presence of a menacing dog is another, more welcoming sign - Patterson Plaza. We wait outside as we hear the barks fade, and at the sound of a door shutting somewhere in the house, they turn into a distant, sad whimper.

Eventually he returns and opens the door to let us in. "She's in the back room, is Ada. You'd better go ahead of me, I'm a bit slow on the old pegs! Second door on the right. But just be careful, she's right behind the door!"

We peek round to see Ada propped up against a wall, using a glass-fronted unit for support. One of the glass panels is shattered, shards covering the floor and sparkling in the dull amber light. A wound in the back of her head has left her silvery hair tinged with a streak of red.

"I bet I look a right sight!" Ada looks up from her precarious seat on the floor to see two 6-foot plus green aliens in her lounge. The look is almost child-like, a stare upwards that slowly keeps going until reaching the top of the view.

"You look fine Ada, us red-heads must stick together, so we'll make a good job of looking after you." She laughs. "Not much left of your red hair, is there?"

"You noticed, huh?" I kneel down beside her. Apart from the impoliteness of standing bearing over a patient, it also means she no longer has to crane her neck just to speak to us. "Let's get you patched up shall we?"

The shuffling footsteps that had followed us down the corridor finally approached, and Ada's husband joined us in the room. "Mind the luggage, Mr Patterson, it's taken over your lounge a little."

"Oh, I'm alright. And call me Derek! None of this Mr Patterson stuff - you're not my bank manager!" Stern, but friendly and sincere. We check Ada for other injuries and find that she's probably fractured her hip. Derek's warned us that she has a habit of falling, as she uses a zimmer frame to get around, but sometimes gets too frustrated and leaves it behind. When she does, she often tumbles to the floor.

"I've told her she has to use the frame, but will she listen to me? Of course not!" After giving her a glare, he rattles off her list of medications, tells us what each one is for, and how many of each she takes and at what time of the day. "I'll just go get the box and show them all to you, make sure I haven't forgotten any." Derek walks off in the direction of the kitchen.

"He's been looking after me like this for years, ever since the arthritis has stopped me getting around easily," Ada whispers, "but I know he can't go on like this. We're both getting too old. We've been looking into moving into a home together. It's not as simple as it sounds." In the time we've taken to bandage her head and stop it leaking, Derek has returned. Ada stops talking, perhaps not wanting to upset him.

"Right," says Derek, pointing out each of the medications in the box, "this is the one for blood pressure, this one for her heart, this one for the pain from her arthritis, and the big box is full of calcium tablets."

"Thank you, Derek." In the background, the sound of paws clawing away at a door are a constant reminder of the caged animal.

"What dog have you got?" I ask. My knowledge of dogs is limited. I know they have tails, four legs, and bark. And I know that I don't like them particularly. Owners' assurances that "Oh, he's the friendliest dog in the world, you don't need to worry about him," are often followed by a nip on the hand and a now apologetic owner sheepishly mumbling "Well, he's never done that before!" I'd rather not take the risk.

"He's a beautiful Labrador. Wouldn't hurt a fly." At least I know what a Labrador is.

"And who walks him?"

"Mostly I do," Derek answers, a little insulted I fear. "Sometimes, when our son's in town, he'll come and do it for us. But normally I take him to the shops once a day, you know, when I get the paper and a few odds and ends, and he's happy with that." Knowing the area, I realise that the shops are a good quarter of a mile away. "Helps keep me fit, too!"

In the meantime, we've given Ada some pain relief and prepared to move her onto our chair and out to the ambulance. I'd have preferred to keep her laying flat and not moving her hip, but it was an impossible idea, the tiny corridor and curved walls not allowing for a stretcher of any kind. The morphine would hopefully work its magic and prevent her from feeling any more pain.

"She'll want her dressing gown, if that's all right with you? I'll just go get it from upstairs."

"Why don't you give me directions, and I'll go for you. Don't need you running up and down for no reason."

"Right. Well it's up the stairs, first door, right in front of you. It's the light blue one, hanging on the back of the door. The dark blue one's mine, so don't bring that one, or I'll never hear the end of it. But just so you know, it's the room where I put the dog."

Just for once, I decide to be brave. "Don't worry, Derek. I'm sure he won't bite me just for taking a dressing gown. It's probably not his colour anyway!"

"Fine, then. I'll just make sure everything's locked up and switched off downstairs, then I'll join you in the ambulance."

We wheel Ada out wrapped in the ambulance-standard red blanket to keep her warm as well as safe. "Matches my hair now, doesn't it," she muses as she looks down at the crimson cover. Once she's safely on board and as comfortable as possible, I go back into the house, and up the stairs to retrieve the dressing gown. Not before a plea from Ada.

"Make sure you help Derek out when you come back, won't you? He's not so good outside without the dog."

"Of course I will. Don't you worry about anything. That's what we're here for." She relaxes back on the trolley and allows my crew mate to check her blood pressure again.

As I open the bedroom door, the dog is lying on the floor and looks up at me with what seem to be almost contemptuous eyes. "Sorry," I mumble, "we have to look after Ada first." I can't quite believe I'm apologising to a dog. I take the dressing gown, fold it in half over my arm and leave the room with the door slightly ajar. Hopefully if I show the dog a small sign of trust, he'll understand my intentions are only good ones.

I meet Derek at the bottom of the stairs. "Got it!" I tell him.

"You sure it's the light blue one, aren't you?" His question confuses me.

"As you can see, sir, it is indeed! And I got it without being eaten alive!" I try to put on a show of pride.

"Actually, I can't see it. I forget to tell people sometimes, sorry. It's been twenty-five years now." It's then that I see the dog's reins, reflective strips on the straps and bars, and a white cane sitting by the door. I think back to everything he's done. Clear descriptions and directions, knowledge of exactly where everything is, drugs in perfect order, looking after the dog, looking after us, looking after Ada.

And all in darkness.

"Come on Derek, let's get you out to the ambulance. There's a young lady in there asking after you."

His hand holds onto the crook of my arm, and we walk out together, leaving the dog to watch from the top of the stairs.

Orders

By order of InsomniacMedic after last weekend's horrendous shifts:

All parents or soon to be parents of babies and young children must:

1) Undertake a basic paediatric first aid course. And refresh it regularly.

2) Have child-friendly Calpol / Tylenol / Ibuprofen on tap. I mean it. A never ending supply. And know how and when to use it.

3) Be aware that ambulances are for emergencies. We're here for you and your child whenever you need us. But we're not here for common colds.

4) If necessary, take a course in common sense. It's not as common as it should be.

This order has no expiry date.

Social Networking

Courtesy of a good friend of mine over at Jumblerant - I've been directed to another discussion regarding the use of social media in the workplace in general, and EMS in particular. Admittedly this was an infraction that harmed no-one else but the person involved, and no patients or their confidentiality were compromised, but nevertheless the discussion points are there.

Is there an argument for total freedom of speech in and about the workplace, or should there be some limitations? Is chatting to a friend in private any different from posting a rant on Facebook or Twitter?

To my mind, and the rule I've tried to follow whilst writing this blog is that biting the hand that feeds you isn't particularly wise. So, say what you think, but think about how you say it!

What do you think?

Comments welcomed!

Starfish Ward

The outside of the building is dark and miserable, much like the early morning itself. We walk in, straight past the lift where I have some mad memories of a call years ago (that story another time), and up a flight of stairs. Hospitals are miserable places. Full of sick people as well as unappreciated and overworked staff. The only place in a hospital that tends to have smiling faces is the maternity unit. Oddly, that's the building we walked into, but only because that's where the paediatric wards are, and we were taking our little one to say goodbye to his troublesome tonsils. Over a dozen episodes of tonsillitis and dozens more "Say Ahh"s in eighteen months do not make for a particularly happy young boy. For a change, the system agreed with us, and the NHS would take the kind donation of a pair of five year old tonsils.

The dark early morning confused the little one into thinking that we'd woken him in the middle of the night. We'd prepared him for the day by explaining as much as we knew. He read a book that he borrowed from a friend who'd faced the same ordeal not long ago and understood a little more, and we had decided up front - no tricks. He knew about the magic (EMLA) cream on his hands, he knew about the needle and that he wouldn't feel it, he knew that he'd be asleep when his tonsils were taken out, and he knew that, more importantly than his parents being there with him, so would his favourite Beddy Bear.

He pressed the button allowing us into the ward, and the instant the door opened, the hospital magically transformed. Starfish Ward is full of colour, the walls covered with sea creatures of all sorts, psychedelic jellyfish dangle from the ceilings, and the theme is continued into the rooms and especially the impressive play area. The first person we met smiled at him and made him instantly feel at ease. Not an easy feat at the end of a night shift. We were shown to a room where he was given a choice: bed by the window or bed by the TV. The view from the window was dull and full of hospital buildings. I'll let you guess which he chose.

After he was booked in he was asked if he wanted to head to the play area. The world land speed record was broken on route. Whilst he was entertained we met the nurse who'd be looking after him, the surgeon, the anaesthetist (add an -easiologist on the end if you're across the pond), and were constantly kept updated by the staff who couldn't do enough for us. MrsInsomniac kept a cool and calm exterior, even as we wheeled him down the long corridors towards theatre, helped in no small part by the staff and their caring attitude. The normal sized hospital bed made him look small and for the first time a little vulnerable as he was taken into the anaesthetic room.

The cannula went into his little hand, twice, without even a flinch. He even watched as they did it, probably making sure they were doing it right and that everything he was told was true. As the propofol went in I watched him fight a losing battle with sleep he gripped ever more tightly onto his bear, I gave him a kiss, and left to wait outside.

An hour later they came to find us.

We went to see him up in the recovery room, where he was just coming round and was a little confused. A bit like I feel most of the time. He tried sitting up in the bed, but his head looked as if it was made of lead and made him lie back down again. MrsI held his hand all the way back to the ward, back through the grey buildings, through a colourful mural painted in one tunnel as we approached our destination, and back into the full vibrancy of Starfish just moments later.

It took him just over an hour before he was back playing in the play area, as if nothing was wrong. Analgesics are wonderful things. He was eating and drinking a little, and the first "Can we go home now?" came after less than two hours. Barely six hours after the operation, we were allowed home. He couldn't wait to get home and show his non-existent tonsils to his big sisters.

The system is what it is. It's beauraucratic, it's cumbersome, sometimes it's slow and irritating. There are gripes, there are moans, there are those who, whatever you do for them, will always complain about the system and those who run it not doing enough. Behind the system, however, stuck in its grinding cogs, are the staff. The real people with real faces.

On Starfish ward they wear brightly coloured uniforms that match their surroundings. The staff we encountered are a credit to their uniforms, and their characters mirror in them. They were helpful, friendly and understanding, and of course highly professional. There were children on that ward who are, unfortunately, regular customers and the staff know them well. We were only temporary dwellers, yet were treated by the staff as if we'd been there every day for a year. They are a credit to their ward, to their hospital and most importantly to themselves. MrsI, JuniorI and I (heh) can't thank them enough. Instead of hanging your "Thank You" card stuck onto a wall or cupboard door somewhere, yours is going global.

Oh. And it was two operations for the price of one. Beddy Bear also had his tonsils out. Starfish looked after him too.

Early Christmas Present

Deciduous trees stand barren in the biting breeze, their branches, undefended from the airborne frost, wave a muted welcome as I drive gently down the road. It's a long dual carriageway, leading from one built up area to the next but a large section in between is sparsely built and poorly illuminated. The blue, strobing lights do more to show the way ahead than the dull orange street lamps intended for the purpose. My chances of finding the reported faller were reduced further by the fact that the caller was too vague to give an accurate location, and too much in a hurry to hang around and wait for the ambulance to arrive and show us the particular hedge in question. The only helpful detail they managed to convey was that the patient was wearing a red top.

Driving on roads that were more sheets of ice than tarmac delayed my arrival as I chose safety over speed. The rapid response unit that night would be more response than rapid, a case of better to be late than The Late. Having no exact address meant that I crawled the length of the hedgerows, bright search lights showing up the left side of the car. If I couldn't find the patient on the first run, it was a two mile run until I could turn round, check the other side and come back again. The first northbound trawl was unsuccessful. At the roundabout at the top I came across a lone officer in a police car, advised him of the call, and he joined the search. One of us would search the hedges, whilst the other would look in the central reservation.

We headed southbound, matching speeds and each blocking a lane, we drove with one eye on the road and the other looking out for our prey. During the day our slow march would have caused traffic chaos, but in the dead of night there was only one unlucky driver stuck behind us. Seasonal spirit prevailed and I slowed enough for a gap to open, and the driver, a confused look evident on his face, took his chance and snuck through the temporary opening.

I caught back up and signalled to the policeman to wind down his window.

"Does this count as heading south for the winter?", I yelled across the lanes.

"Doesn't seem to have warmed up much!", he called back and pressed a button next to him. The electric window smoothly wound its way up and cocooned the officer back in the warmth. I quickly followed suit.

The southbound drive was equally as unproductive, and the officer received another call and was forced to abandon the search. I stopped at the side of the road and asked the control room to give the original caller a ring back to try to extract at least a snippet of information that might help me in my search. A couple of minutes later they advised me that the patient was definitely on the northbound carriageway, and near the northern end of it, supposedly lying at the base of a hedge. I didn't really expect them to be lying at the top of it. But the latest update did mean skating the entire length of the ice-rink of a road. Again. Two hundred metres from the end, having almost driven straight past them, I finally found the patient.

As promised, a red top.

As promised, at the bottom of a hedge.

A sleeve and the bottom of what looked from the car to be a thick woolly jumper peered out from the hedge, and I presumed the rest of the patient was hidden in the bushes. I stopped the car by the kerb, still a good fifty metres from the hedge, called out to the patient to "Hang on, I'll be there in a second", and went to grab my kit out the boot. Still talking out loud, I finally approached and prepared for the worst. The temperature was well below freezing, they had been there for at least an hour from the original call, and were wearing nothing more than just a jumper. And just to worry me a little more, they made no attempt to move or call back.

Carrying the two bags of kit, more for balance than anything else, I slipped and skated my way across to the hedge, eventually arriving at the side of the patient. I knelt down beside them, moved to shake their arm at the top of the sleeve, only to find that the whole red arm was unoccupied.

I'd been searching for a discarded, unloved and unwanted jumper.

The shop tag was still attached to the collar.

As I was just about to call control and ask them to cancel the crew, their blue lights appeared behind me and they pulled up to help. The odds on a white Christmas were shortening as the frozen weather continued with only days to go, so I decided to let them stay in the warm comfort of their ambulance.

"We'll need the stretcher", I said, "but I'll bring the patient to you. That way you don't have to get out of the truck. They're not that heavy!"

I slid across, holding the patient gently in my arms, and presented it to the crew. It was just too dark for them to see exactly what I was holding until I was right beside them.

"Merry Christmas!" I grinned as I handed the patient over. "It's the early Christmas present you've always wanted!"

Boots

I have a serious problem. I don't deny it, and I don't plan on resolving it.

My problem is that I can't stand a scruffy uniform.

Your uniform represents who you are, the care you take and even the pride you have in who you are and what you do. An untucked uniform shirt is a sure way to say that you just don't give a damn.

And I can't stand unpolished boots. Those who know me will bear witness as they read and smirk at this post.

 

A clean, tidy uniform and a pair of shiny boots do a lot more than just look good. They portray an all important sense of professionalism which is sadly sometimes lacking in the world of EMS.

 

Slowly, one boot at a time, I'd love to be able to change that.

 

In the meantime, my students, as well as my kids, will just have to put up with my problem.

Feeling

Do you ever get that feeling?

You know,

the one where you've done everything possible,

done it to the best of your ability,

brought about a good result,

improved a condition that was rapidly deteriorating,

but nevertheless felt that something was lacking?

Yeah.

That feeling.

I did. Just the other day.

Now,

I just hope the kid's on the mend.

I couldn't have done any more.

The worst thing is,

that I'll never really know

why I had that feeling, or

what I should have done about it.

Snowman

Did you hear the one about the snowman? No?

Well, it's not really surprising.

He's been stolen...

I have only one word to describe the person in this story.

AAAAARRRRRRGGGGGGHHHHHHHH!!!!!!

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..."