Plumbing

The first beads of perspiration appear on his forehead as we attach the monitor leads to his limbs and chest.

"I don't think it's a heart attack," he says, more hopeful than certain, "the pain's in my shoulder, not my chest. It can't be a heart attack, can it?"

As the beats begin to dance across the screen, appearing at regular intervals of just over one per second, the picture begins to emerge. A corner of his heart is screaming for blood, for oxygen, as more cardiac muscle dies every second. The strip of paper that spills out the front of the machine, pink paper with tiny red squares all covered in black lines of the ECG, answers his question and leaves no room for niceties.

"You're having a heart attack. It means that one of the blood vessels in your heart is blocked and we need to get you to hospital so that they can unblock it."

"You make it sound like some sort of plumbing job!"

"Well, in a manner of speaking, it is. They'll plumb their way into your heart, remove the blockage and fix your heart."

He has some medication to relieve the pain, some to prevent the blockage from worsening, some to stop him feeling so sick. His blood pressure is a little low for the first part of the journey to hospital, but his pulse remains steady and constant.

"And you're sure this is a heart attack? I thought you die when you have a heart attack?"

"You can blame the media for that. They need to learn the difference between heart attack and cardiac arrest. One is when your heart is sick, the other is when your heart has stopped."

"So my heart hasn't stopped yet?"

"Thankfully not, otherwise we wouldn't be having this conversation."

The dancing heart beats continue on their way crossing the monitor screen from left to right, looking as though each one is holding hands with a beat either side. Speeding our way down country lanes heading for the hospital, he continues to ask some more questions.

"Is it safe, this angioplasty thing?"

"Of course it's safe. They do hundreds of these every year. You'll even get to stay awake whilst they do it."

"And what if I decide I don't want it?"

"That could be one of the last decisions you ever make." I'm not one for dodging answers to serious questions. 

"Oh."

I look back up at the monitor. Suddenly, one strange-looking beat skipped across, the shape and pace very different from all the others. A messy, irregular beat, it's often the precursor to bad news. Quietly and hidden behind his head, I take the shock pads out of their wrapper and have them ready. Just in case. As the ambulance takes a sharp left turn some seven or eight minutes from hospital, his eyes roll back and the beats on the monitor turn from an organised rhythm into an uncoordinated, mangled mess.

"He's arrested!" I shout through to the front.

"Do you need me to stop?"

"No! Keep going and just get us there in a hurry!"

The pounding on his chest keeps the blood pumping round as much as possible, but it's nothing like it should be. The pads are stuck firmly on his chest and the monitor whines as it charges them ready to deliver a shock. I have one pair of hands where ideally I need two, but the other pair of hands is doing work of equally great importance - getting us to hospital. The orange button lights up, flashing away to tell me that the machine is ready. 

His body jolts up, the useless, erratic beats on the machine register the shock and then proceed to go completely flat, just for a few seconds. More compressions on the chest. Just a few more corners and we'll be there, several pairs of hands will be waiting to help, to take over. 

His body jerks with yet another shock. 

More compressions. 

Suddenly, there's resistance, even a groan as he appears to push my hands away. Not unconscious, but not quite conscious either. Breathing on his own and with heart beats that are once again holding hands. We wheel him off the ambulance and into the lab as he slowly seems to regain his faculties. 

"You're sure this is a heart attack, are you?" Totally unaware of the drama of the last few minutes, he still seems reluctant to accept reality. 

"We're sure." 

One of the lab technicians helps us move him across on to their bed, leaving him surrounded by monitors, machines and staff all dressed in x-ray blocking lead outfits. We move behind the clear, lead-lined screen  as the well-oiled machine of the cardiac team gets to work. One of them introduces himself as the cardiologist and explains once again about the procedure, despite our patient's protestations. 

"It's quite simple," explains the doctor, having tried the softly-softly approach but getting nowhere, "you've already died once. If you wish to do so again, but this time stay that way, then I'll be happy not to operate. However, considering the fact that the ambulance crew have worked hard at getting you here alive, I think it might be worthwhile to try to keep you that way." 

"Yeah," said our patient, "that's basically what he said. Go ahead then. But just one thing." 

"What's that?" 

"I just hope you're as good at plumbing as they say you are." 

Coffee Table

When the package was due to be delivered, Poojah made sure that her grandson was there. After more than half a century of living in the South East of England, having moved in her youth from the South East of Asia, her English was good. She had made the effort over the years, especially in the early days to learn the language by becoming immersed in the mixed community around her. But she always felt that she wanted the added security of having the latest generation, her home-grown family to help her. It wasn't just dealing with the delivery man, it was also the fact that she knew that even without being asked, her grandson would put the package together. 

Poojah's days of youth were long gone and she relied more and more on the wheelchair to get around the house, as well as outside. She would often curse her legs for failing her whilst her arms remained strong and her mind sharp, but she was resigned to the fact that she needed extra help now and then.  

It arrived in a simple cardboard box, flat-packed for easy assembly printed on the side in large black letters. They debated whether to move some of the lounge furniture to accommodate the new arrival, musing as to whether it would be a replacement or an addition. The old coffee table was full of memories, but it was shaky, damaged and splintered, risking injury not only to herself but to her increasingly mobile great-grandchildren. 

As she knew he would, Poojah's grandson got to work straight away. Less than an hour later, the table stood in the middle of the room, coasters from the old table placed on top of the new one, and newspapers and magazines placed in the narrow space between the tabletop and the open shelf below. Thinking ahead to the toddlers who regularly visited, Poojah had ordered some rounded plastic covers for each of its corners.

Minutes later, an ambulance stood outside Poojah's house, the crew who emerged from within barely able to suppress their giggles at the sight that was in front of them.

"If you two laugh at me, there'll be big trouble!" The grandson couldn't help but laugh either. "And you too! I don't care how old I am, or how old you are, I'll beat you all with my walking stick!"

And then it happened. Poojah laughed too. Sometimes, in the face of adversity, even the one directly affected must see the funny side.

"Don't make me laugh! It hurts being stuck here like this!"

All we saw as we stepped in to the room was an upturned wheelchair, newspapers strewn across the floor, and a pair of legs flailing in the air, about a foot off the floor. Poojah, by some miracle of inexplicable science and against all the laws of gravity, had fallen out of her chair and head first onto the lower shelf of the coffee table. She was wedged in the small gap and no amount of manoeuvring by her grandson could release her from her trap.

"As I see it, we have some options. The first one is to get the fire brigade to come and cut through the table. It'll be noisy, messy, but quick."

"Don't you bloody dare call the fire brigade! My neighbours will never let me forget it. It's bad enough your van is here."

"Fine, no fire brigade. The other option is that we all try to pull you by your legs and see what happens."

"You want to do what?"

"Just kidding." I didn't need to see the glare to feel it.

"And your third option?"

"We take the table apart screw by screw. It just might be a bit uncomfortable, because we're going to have to move the table to get to the bits and pieces."

"Do it."

"And it might take time."

"That's fine. I'm not going anywhere." We all laughed again.

As gently as possible, we started to take the table apart. The way it was built meant either just unhitching the shelf, risking Poojah hitting the floor and sustaining injury, or to work our way backwards, remove the tabletop whilst maintaining a steady base. We chose the safer, but more prolonged route and eventually lifted the wood that had become an accidental cage. Poojah was lifted gently off the shelf and helped back into her wheelchair.

She was uninjured in body, although her pride was severely bruised. There was no way she was going to hospital and no convincing her to allow for a doctor to visit, just for a check up.

"We'll just put this back together, then leave you in peace to enjoy your new table."

"Don't bother. I'm sending the damn thing back."

Tammy

A crescent moon hangs in the sky, fighting for supremacy over the scattered clouds. Street lights and unnecessarily illuminated buildings pollute the atmosphere and hide the stars, but the blue lights twinkle in their stead. The night is drawing to an end, the last night. The last shift. As it heads to a close, I think back to my first day, my first call, my first patient and wonder if my last call is going to be quite as bizarre.

The calls all night have been routine. No major trauma, no critically ill patients.

"What would you like your last call to be?" My observer for the shift had been quizzing me all night on all aspects of my years on the front line. What had I seen, what had I missed, how had I coped with the mundane, the bizarre and the upsetting.

"I'd love to deliver a baby. Bring one more life into the world. I think that would round everything off very nicely."

It's a far cry from my early years. Maternity calls used to terrify me, even the simple transports. The thought that a routine call could go so horribly wrong, the thought that I could suddenly be thrown from caring for a straightforward pregnant woman to suddenly fighting for two lives at once, used to scare me more than any other call.

A healthy dose of reality, six months on the Baby Bus and delivering almost a dozen babies in just one year (I wonder if that's some sort of record?) put paid to that fear. In total, over the years, I delivered sixteen, but none in the last year. Just one more would be a nice way to end.

"I guess it'll be nicer than a resus!"

"Pretty much anything would be nicer than a resus."

The address appeared on the screen but there were still no other details. A minute later, an update gave the patient's age and gender. Forty-eight year old female. There was still some hope that it would be what I'd asked for, although the chances were slim. Eventually, the call was completed and categorised. Red 2, Breathing problems. Delay as caller very distressed. Caller is patient's mother.

It could be anything from a panic attack to an asthma attack, from back pain to a head ache. It might, just might, even be the wished for maternity. Approaching the address in the early hours of the morning whilst watching the horizon start to brighten, the two of us travel the last mile in silence, trying to prepare mentally for what we could be about to see and the fact that at least for one of us, it'll be for the last time.

An elderly lady, presumably the caller, stands outside the property, one hand on a walking stick and the other using a car bonnet for balance.

"Quick, quick! She's just in the lounge. She won't talk to me!"

Between the two of us, we grab all the bags we're likely to need, at least to start with, to deal with anything from a simple faint to a cardiac arrest. At least five decades younger than our host, we overtake her on the way to the patient and find Tammy sitting in an armchair, eyes wide open but unable to speak. Her mum had finally caught up with us, automatically accepting the two strangers in her front room as if she had known and trusted them for years.

"There's been nothing wrong with her. She's always in and out of here making sure that I'm alright, but she doesn't even take paracetamol!"

Tammy's blood pressure is high and her pulse slower than normal. Her speech is slurred and confused, and she seems troubled by her lost faculties. One arm is strong, the other has no power at all. She can move her head with no problems, so we ask questions with yes or no answers. She understands some, appears confused by others, but keeps trying to answer.

The ambulance arrives, a crew I recognise and who both immediately understand two things; the seriousness of the patient's condition and the fact that this will be my last patient. One unfolds the carry chair, the safety rings clattering into place as they rattle metal on metal. Tammy is helped into the chair, wrapped in a blanket to keep her warm and secured with a strap to keep her safe.

Loaded once more with the bags on our backs, my observer and I walk out behind Tammy and the crew and watch as she's loaded into the ambulance. The tail-lift shuts into place with a thump, the hydraulic whine easing as the pressure is taken off. Moments later, the back door closes too, the blue lights are switched on and Tammy is rushed to hospital.

The return journey to station is almost silent. Traffic is starting to build as the world begins to go about its daily business. A thousand thoughts run through my head. A thousand faces, a thousand places, a thousand cases. But as we finally pull in, driving into the garage for one final time, only one face remains. Tammy looking back at me through the open ambulance door and nodding a wordless thank you. 

Monologue

An all too familiar scene awaits us as we swing open the door to the doctors' surgery. A waiting room full of coughing, spluttering children, parents losing the battle between enforced immobility and a pile of old toys that have all seen better days. A receptionist pretending to work sits at the front desk playing Spider Solitaire on the computer.

"One of your doctors has called for an ambulance?"

In one swift movement and a click of the mouse the green, card-bearing screen disappears and a computerised table of doctors and appointments appears in its place.

"One of the doctors, eh? The doctors don't do anything here without my say so. Who called you do you think? The doctor, or me? They can't dial anything on their phones without it going through me. First they dial 'zero' to get an outside line and only if I approve it can they make a call."

She barely takes a breath and any attempt to stem the flow is like the little boy with his finger in the dam.

"You know what, they probably don't even need you, they're forever calling ambulances these doctors. They've got no idea what they're doing half the time. Covering their own backsides just to be a pain in mine. I mean, it's not as if they actually make the calls themselves or have to sit watching all these people come in and out, day in - day out, with their coughs and colds and ear aches and ingrowing toe nails. Do you even know what an ingrowing toenail looks like? Have you ever seen one? They're gross, I tell you, but they don't really need a doctor, do they? Just pull it out themselves."

Just for a second, she stops, but before answering the question of where the patient is, the engine starts up again and heads straight into top gear.

"And this one, the one you're here for, do you know what's wrong with them? Nothing! Nothing, I tell you. Came in feeling dizzy, pretending he can't stand up, leaning on their friend, or wife, or girlfriend or whatever that slummy looking woman was. Torn jeans and a see through white t-shirt with a fluorescent pink bra. Who goes out like that? And to a doctor's surgery, no less! I'm surprised she was strong enough to hold him up anyway. He's about six foot, she's only about five. He's probably just faking it for the attention."

She pauses and picks up the phone, pressing just a single button.

"Did you call an ambulance?" From our side, the answer is inaudible, but obvious.

"Well why didn't you tell me? I should have placed the call, not you. How was I supposed to know where to send them?" Yet more one sided silence.

"Next time, make sure you let me do the ambulance arranging." Then, looking back at us, she finally gives us directions.

"Room eight. Down the corridor, second door on the right. It says Dr. Craig on the door, but actually it's Dr. Iain that you're seeing. And don't let the patient give you any sob stories, alright? I know what they're like round here."

We were already half way down the corridor as she finished her last sentence, but still she made sure it was heard. The door opened before we even had the chance to knock and the tall, balding doctor introduced himself and the patient.

"Hi guys, I'm Dr. Iain. This young man is Adam. He came in complaining of severe dizziness. I've called you because he really can't walk unaided, and I've referred him to hospital. It looks like he's got two ruptured ear-drums."

"Both ear-drums?"

"Certainly looks like it. Some accident at work. He's a little bit coy about it all."

"I doubt it was work related. I reckon he must have just been talking to your receptionist."

Five Words

Stepping into the office with an envelope in my hand, I was about to take one of the biggest steps in almost a decade.

"Need my signature on an application form, do you?"

It was an obvious question for my boss to ask considering the fact that once again, the coveted places on the air ambulance had been advertised. That, and the fact that he had no idea of my real motives.

"Not quite!" I answered, handing him one of the copies of the letter. He looked down at the piece of paper, the cheap and nasty stuff that the ambulance service has started to use recently in yet another cost-cutting exercise. The confusion on his face said it all.

"You're sure about this are you?"

"Quite sure."

"Can we do anything to change your mind?"

"Not unless you're packing the LAS into a suitcase and sending it with me."

Handing in my notice was a great deal more traumatic than I had ever anticipated. I have loved my job. If not every minute of it, certainly as a career, as a way of life, I have loved it. But the time had come for a change that MrsInsomniac and I had been planning for some time. I'll write more about the change we're making in another post.

I've already had my final shift. It was initially scheduled to be a lonely solo shift on a rapid response unit, but luck had it that there was a student who needed a few extra hours out and about, so she joined me, hoping that my reputation for attracting "real" jobs would prove itself in reality. It didn't, but it gave us time to talk. Time for me to pass on a little of my questionable wisdom and for her to ask questions, question my answers and answer my challenges too.

Towards the end of the shift, she threw me a curve-ball.

"If you had to sum up your career in four words, how would you do it?"

"Four words? I'm not sure I can. Am I allowed five?"

"You can have five. It's my leaving present."

It took me some time. We attended another call, handed another patient to yet another crew and still my mind's rusty cogs whined and creaked to come up with some cohesive thought. Eventually, in a dull flash of panicked inspiration, I had it.

"Tried to make a difference." It really does some it all up.

It speaks of the patients who had no-one else to care for them, it speaks of the families suddenly bereaved, it speaks of the babies brought into the world.

It speaks of the children who were left battered and bruised by their very own flesh and blood, and others who were nothing if not heroes to their families.

It speaks of the people who just needed to hear a voice tell them that help is at hand, and it speaks of those pleading for help for their loved ones.

I hope it speaks of the students I worked with, studied with, taught and learned from.

I hope it speaks of the people who read this blog, those in the know and those who hope that they will become more in the know by reading it.

I tried. Sometimes I succeeded, sometimes I failed, but I tried. In most cases, I'll never really know.

My move takes me away from the London Ambulance Service, but not away from the world of the ambulance. The blog will continue (considering the accolade it has just received, it couldn't really not). For some time it'll be based on the scribbled notes that already sit in my diary, and soon stories will be told from new notes, new patients, whilst looking out over new horizons.

And if nothing else works out, I'm still proud of who I've become, what I've achieved, and the experience that I've gained. I'm proud of this blog. I'm proud to call some of the best ambulance staff out there my friends. And I'm still proud of those five words.

WINNER!

Maybe I should go away more often. I take some time out, a couple of days away from anything interweb-ish, and lo and behold, the miraculous happens. Whilst I'm away, the results of the EMS Blog of the Year Award are announced.

And there, in black-and-white-and-colours-all-over, is the name of this blog. Winner of the Readers' Choice category.

You're an amazing bunch of people, dear readers, you really are.

Thank you.

Thank you for reading the ramblings of a sleep-deprived paramedic, thank you for joining me for the ride, and thank you for voting too.

Stand by now, for there are exciting developments afoot over the coming days and weeks. You may be in for some surprises...

You've made a simple, if somewhat crazy man very happy.

Jimmy

One two seven High Street, Suburbia.

I know that address. I know that it's not where we're actually needed. It's the centre where emergency calls made by mainly elderly patients hitting a panic button are received. The computer instantly recognises the address from the phone number and dispatches us anyway. Two miles down the road, the address updates and sends us three miles in the other direction.

The call is given as a possible collapse. Someone has pressed the panic button and then contact was lost. All attempts to reach the ninety-four year old, either through the emergency call box or by phone, failed. There was even a mobile phone number on the records, a rarity for someone of that age, but it appeared to be switched off.

With no other options, we were sent. The next of kin, a great niece who lived somewhere in the middle of nowhere, had been woken up and informed of the problem, but even at top speed couldn't get there in under two hours. The police, as is so often the case, had sunk under a tidal wave of their own calls and had no units to send. If there was any need to break in to the house, we'd have to do it ourselves.

As we pull up outside the house, the computer updates with the latest message - there's a key safe hidden behind a pot plant - so no need to break down any doors. As I punch in the four digit code and push open the lock, a bunch of four keys falls onto the floor. There's only one door and one lock, so the need for four keys is unknown, but on the third guess, the key moves the lock and allows us inside.

The house is in total darkness. There's no sound either. Initially I use a torch to find our way round, but feeling too much like a burglar, we opt to switch on the lights. We search the downstairs and find nothing, except for the reason for the other keys. Each door, one to the kitchen, one to the lounge and one into a dining room that looked as if it had been accidentally left behind in the 1800's, was locked. On closer examination of each room, we find them uninhabited.

There were three rooms upstairs too - a bathroom and two bedrooms. In the second bedroom, oblivious to the two strangers wandering around his house calling his name, was Jimmy.

A gentle, almost inaudible snore emanates from the sleeping man and his breathing is calm and restful. Strapped to his wrist, unmoved by the commotion, is his panic button and next to him on a small bedside table is a barrier between between Jimmy and the outside world.

A pair of hearing aids.

We creep back down the stairs, turn off all the lights, lock the door and replace the key in the safe box. As it clicks gently back into place, we both, almost subconsciously, mutter the same three words.

"Good night Jimmy."

Seven Months

We approach only as far as the police tape allows.

"You'll have to wait here with us, just until we know what's going on."

On the screen in front of us, the special instructions fill us in on the latest details as they emerge. Caller states his girlfriend has a gun and is threatening to kill herself. The call is from a mobile phone, the mobile mast locating it two hundred miles from the address we've been given. Instead of playing Chinese whispers, I ask for the mobile number and hand it to one of the police officers. In a swift flip of his radio, he unbuckles it from his bullet-proof vest and with the radio on loud speaker dials the number.

There's no answer the first time and the call rings straight through to the answer phone.

"Hello, you've reached Michael's phone. Please leave a message after the tone, and if I remember, I'll call you back some time."

The officer doesn't leave a message, but tries to call again only a minute later. This time, a sleepy voice answers.

"Hello?"

"Hello Michael. This is PC Ryan from the Met Police. You called to tell us about your girlfriend?"

"Yeah. Natalie! She's at home, she phoned to say she had a gun and she was going to kill herself."

"Has she ever owned a gun?"

"Never. She probably doesn't even know how to use it."

In the distance, we can see other officers dressing as if for battle. Full body armour, helmets, gloves and semi-automatic weapons at the ready give an impression more of a unit preparing for war than a group of people attempting to save a life.

"Has she ever threatened suicide before?"

"Loads of times. She's taken tablets, slashed her wrists, all sorts, but never anything like this!"

"What's her name again?"

"Natalie."

Seconds later, a negotiator calls through a megaphone.

"Natalie - this is the police. Open the door." For some time, nothing happens. No lights are switched on, no curtains move, no doors open. He calls for a second time, but this time, as soon as he calls her name, light suddenly appears through a tiny gap in the curtain of a first floor window.

The face that eventually appears looks confused, perhaps even scared at the sight of a small invading army standing outside the front door. Slowly, reluctantly, she opens a window.

"What's wrong?"

"Put the gun down!" Screams the police team's sergeant.

"Gun? What gun?"

"Put your hands where we can see them!"

Natalie places both her hands very deliberately on the window sill. "I really don't have a gun. What's this all about?"

"Did you tell someone you wanted to hurt yourself tonight?"

Immediately, a note of understanding registers on her face. "You've had a call from Michael, haven't you?"

He puts down the megaphone and the rest of the conversation takes place at a more civilized volume, particularly as it's the middle of the night. Faces appear at various windows and curtains twitch up and down the street.

"We have. He's told us you have a gun and were threatening to kill yourself."

"Wait there. I'm coming to open the door."

Thirty seconds later, Natalie appeared at the front door, adorned in a pair of pink pyjamas for which she apologises.

"It's a hoax. It's the best one he's pulled yet. He can't get over the fact that we split up, seven months ago already."

She goes on to tell the officers about all the other problems he's caused, sending the fire brigade, calling out doctors and mental health teams, even getting the Samaritans to give her a call. Just as a formality, one of the armed response team searched the house and, as expected, found no gun.

"I told you everything was alright. I'm not suicidal, I'm not depressed, I'm just trying to get on with my life." She stared suddenly at the stars, then looked all around her and laughed. "I'll tell you one thing for free; it's been a long seven months." 

The armed response team packed away their kit, other police removed the tape that had cordoned off the street, and we could finally remove the heavy ballistic vests that we'd been asked to wear. As we sit back in the ambulance and watch all the other teams leave, life in the suburban road returns to what should be a normal night, especially in Natalie's life.

Quiet and undisturbed. 

VOTING NOW OPEN!!!

 

Right then, loyal readers, the voting is now open for the EMS Blog of the Year. 

I have, miraculously, been shortlisted. You now have seven days of nagging to look forward to. 

Therefore, GO VOTE! 

Subtle, ain't I? Or maybe, Subtle ain't me. Anyway, I'm up against some serious competition, most of whom I read regularly, and two of them I even nominated in the first place, so I really, REALLY need your votes. You get one vote each - so make 'em count! 

Thanks to all those who nominated me in the first place - I'm honoured to be on a list with some great bloggers. 

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. 

Intact

As luck would have it,

we were on the way to a patient and not transporting at the time.

As luck would have it,

they were stood at the side of the road and not above it.

As luck would have it,

the brick shattered the glass in the back, not the front.

As luck would have it,

the trolley caught the brunt of the hit and not us.

Stupid kids.

Stupid games.

Lucky break.

But our patient had to wait for an ambulance that had all of its windows intact.

Bad Weather

Heading through the terrible weather towards the scene at right angles to the accident, the level of carnage looks all the more brutal. We're the third ambulance to arrive, adding to the sea of flashing lights. Rain drops look like tiny blue specks of light, reflecting the LEDs from all the emergency vehicles. Police cordon off each end of the street as fire crews start to cut through the mangled remains of what used to be a private car. The two occupants of the first car have managed to escape their wrecked former mode of transport and walked away with nothing but scratched arms and, for the driver at least, a bruised ego.

The other driver wasn't so lucky. Trapped in his seat by the crumpled front of the car, his head pinned back by the first paramedic on scene, all Terry wanted to do was move. One quick glance and I realised that it wasn't going to be a simple question of taking the roof off and dragging him out. There would have to be pieces of metal bent against their natural direction, some cut away all together, before we could even begin to think about getting him out of the car. 

And all the while, the rain continues to fall. 

"You must be getting soaked out there!" said Terry, talking through a misty oxygen mask. 

"Drenched to my core, but I'll worry about that later." 

At least he was in fairly good spirits. 

"Have you got any pain anywhere?" 

"Just my legs, but that's probably because they're wearing part of the engine." 

"No pins and needles, no pain anywhere else?"

"Nope. Nothing at all." 

"That's good. Can you move your toes for me?" 

Terry tells me that he's following my instructions, but his toes don't seem to move. Maybe I just can't see properly, but in any case, there's not much I can do about it.

"OK, we'll check on you a bit more once we've got you out of there." 

It took almost two hours of the fire brigade cutting, stretching and bending metal to get Terry free. In the meantime, we did what we could; gave him fluids and pain relief to keep him stable and comfortable. He finally appeared, borne out of his car on a flat, rigid rescue board. One look at his legs was all it took to see that they were both broken below the knee. 

"Can I just see the car before you take me away?" 

"Well, not really. It's the other side of the ambulance and you're now joining the wet-suit brigade. Besides, I think you need to get to hospital." 

Terry looked disappointed. 

"I'll tell you what - let's get you inside and out of this tropical downpour, and I'll go and take a photo for you on my phone." 

"Sounds like a plan to me!" 

We moved the trolley inside, turn the heating onto the highest level and my crew mate checked him out from top to toe again. I ran outside into the pouring rain, took a photograph as promised, and ran back inside into the dry.

"So, you sure you want to see this?" 

"You bet. Might as well have nightmares about something I've seen, rather than something I've imagined." 

"Alright then, here you go." 

With his head strapped to the board and stuck between two head-blocks, only his eyes moved. 

"Well, it's taken me twenty years!"

"First accident in twenty years?" 

"No. Third actually." 

"So what's taken you twenty years?" 

"Well, I've always wanted a convertible. I just thought I'd pick better weather to put the roof down." 

AHEM!!!

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Storyteller

Elaine stood over my shoulder, watching my every move. She'd been there from the second I knelt down beside her husband Carl. She watched every chest compression, heard every rib as it cracked loudly beneath my hands. And as she watched and listened, she told Carl's life story. 

"He lost his leg last year. Diabetes, you know. Awful disease. But he didn't really look after himself. It was probably his own fault in the end." 

She watched as two more crews entered and made a little room for them and their equipment. Then, as we worked in streamlined silence, she continued her story. 

"We're a rare couple we are. Carl from Jamaica and me, a working-class white girl from the East End. When we got married, back in the sixties, my parents swore to write me out of their lives. They never visited, we never visited them, and eventually we didn't even speak. There was no such thing as racism back then. It was just black and white. And no mixing."

She watched as someone stuck a needle in his arm and started to give him fluids and drugs. 

"When the grand-kids came along, suddenly they wanted to visit. But only if Carl wasn't home. So I told them they could choose. They either accepted our family as it was, or they couldn't be a part of it. It was the toughest decision of my life." 

She watched as a tube went down Carl's throat, allowing us to help him breathe a little more. 

"Our friends stopped being our friends. Blacks and whites each going their own separate ways, all of them turning outwards, away from us, instead of rallying around us and learning from each other. We were left with no family, no friends. It was just us. Carl and me and the kids." 

She watched as the first of the shocks jolted Carl's lifeless body off the floor, the unnatural jerk phasing her just a little, throwing her narrative into a brief silence.

"Is he going to be OK?" 

"We're doing everything we can for him, but at the moment the signs aren't good." 

"He's a fighter you know. He'd have to be, putting up with what we have. We've had to fight for everything. Over the last few years, though, we've finally been winning that fight. Mixed couples are all normal now, aren't they?" 

She watched another shock violently wrack his body and begged him to keep fighting.

"I love seeing them. Walking through the park, doing the shopping, wherever. And those beautiful children. Remind me of my own kids when they were little. Not that my kids aren't beautiful any more!" 

She watched as half an hour later, we stopped. Carl lay where he fell and Elaine knelt next to his head, her story told, muttering in silent prayer.

"Maybe," Elaine said after watching us clear up, "I'll write our story one day. Be good to have it written down once I've gone too, then someone else can tell our story." 

The Corridor

Four of them, maybe brothers, maybe cousins, maybe friends, stand in the corridor. Flat-peaked baseball caps with hoods over the top and trousers hanging low revealing their underwear. Just their mere presence intimidated all who walked past or saw them there. Security moved them along a little, away from the doors, allowing more patients in without fear or impression of running a gauntlet on the way in to the emergency department.

Crew after crew came in, offloaded their patient and left to find yet another. As the night wore on, some crews ended their shifts and headed home, as the group of boys stood their ground, marking their territory in the hospital passageway.

They caused no problems, never raised their voices, never tried to upset a single person. But try as they might, they remained conspicuous and inviting to suspicious looks. If they'd been walking down a dark street, anyone seeing them would cross to the other side, or even turn round and head the other way.

Heavy gold chains rattle around one of their necks as he moves, pacing up and down as if hunting for prey. As I head for the doors with the trolley they make a path, two stand either side of the corridor, all in silence. Their staring gaze follows me out the door, accusing me of an unknown crime, blaming me for an unknown misdemeanor. Outside, I tidy the ambulance, put away the kit used on our last call and realise that I've forgotten to pick up a clean sheet to replace the one I'd just put in the laundry. 

The boys are still there, but as I pass by and head for the double doors, a doctor steps out of the resuscitation room. The boys gather round her. I watch from a few metres away as she says something inaudible, accompanied by a sad shake of the head. 

The brothers, or cousins, or friends, collapse as one to the floor and leave me to think. 

Even tough guys are human. 

Homework - The Old Trunk

As an incentive / threat / reward for my eldest to write a good story for her English homework, I told her that if I liked the story, I would publish it here. Being her father, of course I liked it. And a promise is a promise. So now - unassisted, unedited and untouched, I present - "The Old Trunk": 

___________________________________________________

Stepping out into the black eerie night, I stopped and I stared as a black blurry shadow towers upon me. Broken bricks, cracked, cobwebbed windows, a damaged roof and a battered door. Suddenly, the door swung open. 

"Hello?" My voice echoed throughout the house. Should I go in or should I stay outside? Do I explore or stand under the black blanket? Is it safe or should I turn around and go home? It reminds me of a film I watched last night, but surely ghosts don't exist? 

Step by step, I cautiously crept into the house. Every movement I made, every breath I took was heard in every dusty corner of the room. My nose was feeling itchy, there was dust everywhere. The mould felt damp and I thought that the house would collapse on top of me! 

Out of the corner of my eye, down the long dark hallway, I saw a large, brown, dusty, trunk covered in cobwebs and hairy tarantulas. I wonder what is in there? Could there be gold and silver, or could there be evil ghosts inside, trapped, waiting for someone to set them free from the old abandoned trunk. 

Slowly and steadily, I nervously walk up to the trunk. Half of me was saying to open it, the other half was saying don't. What if something happens when I open it? On the other hand, it could be to my benefit. I placed my hand on the top of the trunk. 

BANG!!!

What was that? 

Is anyone there? 

I slowly got up. I was shaking. I headed towards the door. 

I left. 

I left and never looked back. 

Password

Asthma had plagued Leanne's life for the past three years. Now, at only five years old, she was having yet another bad attack and as always, it was at bed time. The local crews know her well. They also know that her parents aren't the panicking type. They only call when they've tried to control everything on their own, but failing to do so always means a trip up to the hospital and an inevitable stay for a day or two.

Her little lungs struggle to cope with the narrowed airways, breathing in all the good stuff, but not breathing out the bad. Her shoulders move up and down with each breath, her stomach moves in and out, her chest muscles hurt with every move. Leanne's face is pale and tired, yet she still tries to force a feeble smile. 

We attach the mask with the misting medicine, willing it into her lungs, hoping it will work quicker than we know it really will. 

"You know what happens now Leanne, don't you?" 

She nods a silent reply, conserving her energy for more important things. 

"Good. Who's going to carry you down the stairs this time? It was Daddy last time, wasn't it?" 

Again she nods. She looks around the room at the four adults, two parents and two green giants, finally makes her choice, and points. 

"Well, I'm honoured!" I say, picking up Leanne as if she were one of my own. I hold her up to my shoulder and we can see eye to eye. Each time she breathes out, a little of the mist blows out the sides of the mask and onto my face, making her laugh a little. A strained giggle at best, but at least it's something. 

We double the dose as we settle her on the trolley and get ready to make our way to hospital. 

"Now, you know the drill. We're going straight in to see the nurses and doctors, and they might want to do all the tests they did last time. Do you remember?" 

Finally, she manages just a single word. "Yes." 

"And you know you have to show Mummy and Daddy how you're much braver than they are!" 

Each smile from Leanne paints a slightly brighter picture, her face has a little more colour, her shoulders  and lungs struggle a little less. Each small effort is rewarded with a small step forward and by the time we've slalomed our way through the early evening traffic, parting the cars with sirens and lights, Leanne is able to say a few words at a time. 

Leanne asks me to carry her back out of the ambulance again, but we decide that it might be more fun if she was wheeled in on the trolley. The familiar sliding doors won't open as we approach and she is confused. 

"Why don't the magic doors open?" 

I show her the numbered keypad and explain. "We need to tell it the password. Only special people are allowed through!" 

"Am I special?" 

"Of course you are." All four adults said it at the same time, causing Leanne to laugh again. 

"Do you think you can you guess the password?" 

She thinks for a few seconds and then talks loudly, straight at the keypad. 

"Please?" 

Eight Miles

The radio vibrates against my shirt, the phone beeps in my pocket and I run back to the car to see the screen flash up a new call. Eight miles isn't all that far, particularly at night, but even at an average of sixty miles an hour, it will take eight minutes to get there. To average sixty, I need to be going ninety for at least some of it. In London, even at night, it's barely possible and for the most part unsafe. Unsafe for me, unsafe for pedestrians, unsafe for other motorists, unsafe for my patient if I never make it to where they are.

Eight minutes is a long time to wait for an ambulance. I know. I've been there. I've had to make that call, had to wait that wait, watching and worrying. I understand. And I want you to know that when I have to travel that far with the screen shouting at me that someone isn't breathing, or someone is seriously injured, I feel the same as you do.

The trepidation that ninety miles an hour just isn't quick enough. The worry that eight miles is just one mile too far. The feeling that each and every speed bump in the road that's meant to slow me down and as I encounter it makes the patient's chance just a little worse. If I could somehow jump over those bumps, skip around the width restrictions, fly over the cars that block my path, I would. But I can't.

The address is eight miles away, 8.2 to be exact. The junction of two suburban streets is also the meeting point for a car and the bicycle carrying Hayley on her early-morning paper round. At six in the morning, traffic is starting to build and people city-wide are starting to consider their commute to work, just as I start to see the light at the end of the shift.

The caller is the car driver, distraught, distressed, disturbed. Scared not so much of the long term consequences, but more of the immediate danger to Hayley as she lies unconscious in the road. The call-taker gives some basic instructions, to check the airway, the breathing. Not to move the patient, but to wait for the crews to turn up.

We arrive on scene together, two of them in the ambulance and me in the car. 

"Six miles we've had to run for this!" says the frustrated attendant as he grabs another bag out of the side cupboard.

"Tell me about it. I ran eight."

One look at Hayley tells us we're going to need some extra help. She's starting to come round, moaning in pain and confusion. A large, dark patch is slowly spreading across her jeans from just above her knee. Her femur, the thigh bone, is clearly broken, the angle of her leg telling us more than we needed to know.

"I'll get HEMS running. I think we're going to need more pain relief than we can give her."

"Good idea. Bet they have further to run than we did."

During the hours of darkness, HEMS teams travel by car, leaving the helicopter to a better night's rest than most of the people who work on it during the day. It takes them some time to get to us, by which time we've tried to stabilise Hayley as much as possible. I give her a strong dose of Morphine, hoping to reduce the pain at least a little, at least enough to let us straighten her leg. It's not enough. Even doubling the dose to the maximum we're allowed to give doesn't allow us to move Hayley's shattered leg at all. HEMS arrive and the doctor on board gives Hayley some ketamine, finally relaxing her into a state where we can pull the jigsaw-puzzle femur straight enough.

We finally settle her on the stretcher, the minimal warmth of the blood-soaked blankets now assisted by the heater in the back of the ambulance. Hayley is well looked after - a couple of paramedics, a doctor, a mother who ran frantically to the scene when she finally heard what had happened. It leaves me with nothing to do but to clear up the scene as much as I can without upsetting the police.

I sit in the car and watch the clock tick over to the end of the shift. The tail-lift is raised and the back door is shut, the blue lights start to flash and the ambulance pulls away with its injured cargo, leaving me to wonder if we had done all we could, if it would be enough. I start the engine and begin my journey back. 

It's a lonely, subdued eight miles. 

Elves

Elves. It must be elves.

We have ECG leads, blood pressure tubing, oxygen piping. We have an oxygen saturation monitor on an electrical lead, charging leads for the machines and a suction unit with a hose that works like a vacuum cleaner.

And no matter how tidy you leave them, no matter how neatly you put them away, no matter which bag, or holder, or drawer you put them in ready for next time, the elves always get in there.

Because the very next time you take out the leads to do an ECG, or whenever you take an oxygen mask out of the packaging, or if you need to check someone's blood pressure, it's all back in a tangled mess. Again.

I keep looking for those elves, but have never spotted them. Somehow, these stowaway menaces appear on every shift, on every vehicle, for every patient. The solution is simple, but probably years away.

Wireless everything - that'll fox the blighters.

Until then, the hunt for the tanglers goes on.

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."