Hope

The complex of buildings appears to have been built some time between when asbestos was the latest in safety and avocado green was the height of chic. An impossible maze of apartments, dotted around hidden, narrow side streets all with the same name, or no name, and a numbering system that bears no resemblance to today's recognised linear system. Buildings numbered in the hundreds sit in between buildings number four and six. The GPS always gives up and leaves us with either local knowledge or none. 

We call dispatch, ask them to link us up with the caller with a hope that they can give us directions. It seems like a simple call - a faint - but my gut tells me otherwise. The voice that comes on the other end of the phone is calm, so perhaps my gut is wrong. She gives us exact directions - to a completely different street - and tells us that someone will meet us outside. 

I see them running down the stairs as we enter the dead-end street, three pairs of legs rushing full pelt, one of them skipping the last few steps and landing in a heap at the bottom of the staircase. He gets up and continues rushing towards us, pulling open the door of the ambulance before we've even stopped. One of them is screaming about the fact that it took us so long to get there, all the while blocking me from leaving the ambulance. It's tough not to judge a person in their time of crisis, but this was only making his crisis worse, not better. 

"She's stopped breathing! She won't talk! What are you waiting for?!"

If what he's telling me is true, there is no time for niceties, so I shout back. "You to get out of my way!" 

It seems to snap him back into reality and he takes a step aside, lets me out and bursts into tears. 

Nothing seems to work in the building; the lift is out of order, the hallway lights don't work. The only light in the flight of stairs is that from their open door on the first floor. There's a conflict of unwritten laws in play: the first - seriously ill patients are never on the first floor; the second - if the lift's broken, the patient will be seriously ill. This time, the second rule was stronger. 

As we enter the apartment, we see her sitting by the table, her head slumped awkwardly like it does only in patients who are dying or dead. We move her to the floor, and with little need for words start the attempts to save a life. One person starts compressions, pushing hard on fast on the chest, mimicking the actions of the heart at ten times the effort with less than a third of the effect. I start the ventilations, two breaths for every thirty compressions, finding it easier to conduct the orchestra from the patient's head. Other actions happen all around - a monitor is attached, an IV line is placed ready to give adrenaline. The hands pumping the chest change, allowing time to recover. In between, I look at the monitor. There is no rhythm to shock, but there is a rhythm. A check of the pulse reveals none, and the orchestra continues. Another two minutes, a dose of adrenaline, hands relentlessly pump the heart. 

And a family waits.

The hands change once more and in those few seconds the rhythm does too. A pause, a check for a pulse, feeling for a flicker of hope. 

The miracle occurs. The pulse is strong, fast, effective. It remains so all the way to hospital. 

I have no idea what happened after that. But I saw the family walking around the hospital the following day with cautious smiles on their faces. 

I didn't dare to ask, but I can only hope. 

Back On The Road

My last post on here, some nine months ago, reads now as both a warning and a reminder. I was

warning myself, not aware enough at the time that the elephant in the room that I'm ignoring was precisely the thing that should have been uppermost on my mind. It took a couple more months and one critical incident to finally make me heed that warning. Although when I did, it was through necessity, not choice.

The fog floated across the highway, a surprise, unwelcome visitor on what had begun as a clear winter's morning. We were heading back to the station after the first call of the day, a patient with the body of the ninety year old she was, but a mind still that of a teenager. She spent the entire journey to hospital warning us never to get old, because "Your legs will want to dance, but you brain will tell them they can't even stand." We were still discussing her presence of mind and praying for the same level of sanity at that age, when our thoughts were shattered by a call from the control room.

"Find the first place you can to turn around and head in the opposite direction. Calls coming in of a serious incident. Details to follow as soon as we have them."

It was, in theory, nothing unusual. We're used to calls coming in and being told that someone had fallen from height, only to find that the height involved was the pavement. Or the call to a pedestrian hit by a car that turns out to be little more than a glancing blow at zero speed. Or even the unconscious patient who just happens to be walking around when we arrive. Something in the dispatcher's voice said otherwise. Something in the air on that highway turned decidedly cold as we travelled to an unknown serious call.

The last orange flames were being put out as we arrived at the scene.

All around were rivers of firefighting foam as plumes of smoke climbed into the air, the last signs of the now extinguished fire. Wreckage covered an area the size of a tennis court, an area that up until a few minutes earlier had been a holding area for enthusiasts waiting their turn to take to the skies. The marks of the tiny aircraft were clearly visible as one wing seemed to be the only part unclaimed by the fury of the inferno. One firefighter, stepping back out of the way now that his job was done, motioned to us that it was now safe to approach.

It took some time, but eventually we identified the victims. There was very little by which to be sure. At first it was uncertain how many there were. The human form had been disfigured beyond recognition, first by impact, then by fire, as the microlight lost control and hit the tarmac, cruelly ending their lives in an instant. 

The rest of the shift passed by in a blur. The images, too raw to process, remained locked away for the next few hours, even for days and weeks, and then broke out all at once without any warning. Since then I have learned a great deal about PTSD, about not hiding from it, about coping with it, about getting back to work, and most of all – about me.

I have learned that, unlike my thoughts on the previous post, it isn't just me. That there are plenty of others who struggle, some less so but some much, much more, and all that they required to start on the road to understanding and acceptance was a voice that would proclaim loudly – I'm here with you.

This is why this blog is back. I'm honoured to have you as readers, but first and foremost the writing has always been for me. It has taken me a while to realise that, but I'm back. If you're here to come along for the ride, to join me on this journey through a world hidden from most, then you're more than welcome back on the road, as always. 

Perhaps It's Just Me

"Is it really possible to have a career in EMS and be emotionally unaffected by the things we see?"

This is the question I posed on Twitter a few days ago. Many seemed to think that it's an impossible task, that, after all, we're human too. However, there were some who seemed to think it possible. To work through a career and remain untouched. Unharmed.

It seems I have joined an ambulance service where macho-ism, for all its pros and cons,  appears paramount, or at the very least, a lot more visible. Whereas in my previous place of work the male-female ratio was split almost straight down the middle, my new place of work is staffed mainly by males. Perhaps that lends itself to a culture of bravado. Perhaps having more females around allows for everyone to be braver with their emotions, whereas having fewer means that those left must be impressed. Perhaps I'm imagining it or over-analysing it. Or perhaps, as I'm beginning to suspect, it's just me.

Other thoughts have taken root. Paramedic burnout seems faster here. Turnaround is high. New paramedics are qualifying all the time, only to find that their best career options lie elsewhere, away from the front line and away from patients. Patient empathy seems less common and the emotional toll seems negligible. Maybe that's the answer. Ignore the reality around you, and treat every shift as another day on the production floor. No emotional involvement. All the while, I'm still taking calls home with me.

Questions still run through my mind. Are the hardened souls really that hardened, or do they hide their torment better than I can? Are the tougher types really that tough, their souls numb to the humanity we witness every day, or have they just learnt to compartmentalise better than I can? Are they just burnt out, their hearts and minds numbed after seeing so much, too much? Or perhaps, as I'm beginning to suspect, it's just me.

Perhaps it's a cultural issue? Perhaps I'm not quite as "at home" as I think I am? Perhaps I'm just being ridiculous?

PTSD amongst EMS staff is well documented, if not well recognised or well accepted. At least not well enough. There's too much stigma still attached. Those affected are seen as weak, not "man enough" for the job. Not strong enough. Too attached. Too emotional. Too ridiculous. 

I don't think I'm any of them. I don't think that anyone who carries these feelings with them is any of them. I think that perhaps they, we, just have a different way of connecting with our patients. Some see their patients as the latest gadget on a production line. Some see their patients as their next challenge. And some see their patients, imagining them as their very own parent, or grandparent, or child, or best friend. Not every patient, but enough of them. Enough to make the emotion raw enough, real enough, for it to affect them in the longer term.

I'm not sure whether that's a healthy thing, but I strongly believe it makes me a better paramedic.

But perhaps it's just me.

Behind Closed Doors

Midnight. The normally quiet residential street is a hive of activity, as busy and bustling as a midday marketplace. People have gathered from all over; neighbours, friends, relatives, all standing outside trying to make sense of the unfolding drama. We can see it all, hear it all from the bedroom, each of us taking turns to peek out to the street a dozen floors below as we rotate over and over again, each of us briefly the centre of the chaos, standing pumping his heart, then taking a break, a breath of fresh air and a glimpse out the window. 

The bedroom is tiny, the furniture within taking up the vast majority of the space, leaving us with very little room to work, yet somehow we all fit in. Through the closed door we can hear the sounds from the lounge. It too is packed full of people, some who heard the initial shrieks and screams for help, some who received the panicked phone-call. Some were further along the communication tree, receiving word as the news branched out exponentially. 

We know how much this means, how much is riding on our success or failure. Every call means the world to someone. Every patient needs our help equally at their time of distress, even if we don't always see it that way. It's hard for us to think that the patient who's had backache for a fortnight ranks as highly as our patient now. Sometimes we show our frustration, but mostly we treat what we see and who we are seeing as the centre of our attention, as though nothing else in the world matters now. 

Right now, however, we really feel it. Nothing else matters. In that tiny, closed room is the entire universe and all that's important within. We are fighting for a life in one room, as in the other they can only wait. Every few minutes someone goes out to update them on what is happening behind the ominously closed doors. 

It's all so different from the time before, when we worked in the lounge, watched throughout by a partner who knew she was saying goodbye to her lifelong companion. There was no noise, barely a sound uttered. Every few minutes she'd hover behind our backs and ask us if there was any change. At the third time of asking, when there was none, she calmly sat down and asked us to stop. 

This time we stopped when we saw that all our efforts were futile. We fought for over an hour, far longer than we should have done, far longer than the protocol requires of us. We fought because it felt as though we couldn't afford to lose, even when we knew we were losing. We fought until we lost. 

We sit silently behind the closed doors of the ambulance, tidying, cleaning, preparing the inevitable, intrusive paperwork. We are not quite hidden, more cocooned, yet unavoidably touched by the tragedy all around. More friends and family turn up at the scene, each showing grief in their own way. Some cry, some wail, some are silent and sombre. Some are more stoic, lending shoulders and strength to those who need it most. 

Back upstairs, behind closed doors, a mother and her young children sit stunned as the building in which they reside remains upright but the entire world around them collapses. 

War and EMS

This is a post I have written, deleted and rewritten several times. It is a risky post, as it has the

potential to delve into political wranglings that I do not wish to enter. Nevertheless, I want to write about a side to EMS that very few have seen.

Those of you who have followed this blog for any time, will know that just over two years ago, I left the relatively safe shores of the UK and headed to continue my life and my career in Israel. Just the name of this country evokes images in people's minds that I cannot control. Some for better, some for worse. Living here is a complex mix of normality and insanity, of the usual and the unusual, of war and peace. Few places in the world stir up as much feeling as Israel does. There are lovers and haters, there are the passionate and reserved, but there are very few who have no feelings one way or the other when it comes to Israel. That, despite the fact that too few could point it out on a map or describe its size. (Look on a world map for the eastern edge of the Mediterranean Sea in between Egypt, Jordan, Syria and Lebanon for a dot about the size of Wales, or New Jersey...)

The national ambulance service is called Magen David Adom - Red Shield of David - (follow them on Twitter here) and is an affiliate of the international Red Cross. It serves a population of some eight million people in times of peace and war. It has in the past sent crews to disaster zones such as the Philippines, Haiti and Turkey. It has dealt with mass casualty incidents from which the world has come to learn. It is, however, or at least tries to be when circumstances allow, just an ambulance service treating its population for all manner of illness and injury as is seen in any normal (for want of a better word) part of the world. 

The last two weeks have been a little unusual, to say the very least. Treating patients has taken on a different sort of urgency, when the decision making process doesn't only include what the best treatment options are, but also where is the nearest point of safety for when the air-raid siren sounds. Each ambulance now carries ballistic vests and helmets. Enough for each crew member plus one patient. 

However, what if there is more than one patient? What if someone is accompanying our patient? If the siren sounds, do we stop and seek shelter, taking time to help our patient out of the ambulance and into hiding and increasing the risk for all of us, or do we keep going to the hospital and hope that the inbound missile heads elsewhere? 

We have been sat on station when the siren has sounded. At the same time, a call comes in. The rules dictate that after any siren, we need to take shelter for ten minutes, giving time for the threat to disappear, for any shell fragments to stop falling, for the Iron Dome anti-missile system to do its job and destroy the inbound terror. Do we wait for those ten minutes? Do we follow the rules, or do we break them, heading out for whatever that call is that has just come in? What if the call is for someone having a heart attack? Or someone having a baby? Or for someone who has stopped breathing? 

At times when seconds count, can we afford the luxury of minutes? 

I'm fairly lucky. I'm not near where most of the missiles are landing. Parts of Israel, particularly the southern region near the Gaza border, are facing dozens of missiles every single day. Paramedics there are making these decisions call by call, minute by minute, whereas I've only had to think about it on a few occasions. 

It is somewhat of an understatement to say that these are very strange days and this is a very strange place to be part of the world of EMS. However, it is times like this that the significance of this choice of career is suddenly very much in evidence. 

I look forwards to calmer days, where my decision making process goes back to the best treatment and the most appropriate hospital for my patient, and that the list of decisions and thought processes don't include where all the available bomb shelters are on my route from station to patient to hospital. 

Nine Years Ago Today

London, 7/7/2005.

I remember, 9 years ago today, that it was my first day off after thirteen shifts in a row. 

I remember, 9 years ago today, driving my car to the garage for its annual MOT test. 

I remember, 9 years ago today, walking the mile or so home to be greeted by a yell from upstairs telling me that there'd been "Some sort of power surge on the London Underground." 

I remember, 9 years ago today, of a shiver going down my spine and me yelling back "That's no power surge, that's terrorism. Just wait ten minutes for the official news." 

I remember, 9 years ago today, of running upstairs, putting on the uniform and boots that I'd thought were going to have a day's rest. 

I remember, 9 years ago today, of calling the garage, explaining, apologising, telling them I need the car back and that I'd rebook the test. 

I remember, 9 years ago today, running back to the garage, finding that they'd done the test, refused to charge me for it, and the manager saying "I hope it really is just a power surge." 

I remember, 9 years ago today, that London was taken back to darker days. To days of fear and terror and explosions and loss of life. 

I remember, 9 years ago today, that I was one of the lucky ones. I went to work, but wasn't in any way directly involved in the rescue operation around the bombings. I sat on station as backup in case it was needed. Friends and colleagues of mine were first on scene; some climbed into the bowels of the Underground to help survivors; some climbed through wreckage of twisted metal and twisted bodies. Many showed bravery above and beyond the call of duty.

I remember, 9 years ago today, driving to work through eerily quiet streets, watching the horror unfold on screen, and wait and wait and wait for a call to come in, to be able to be a part of something, to be able to feel useful. For me, it was probably the quietest shift I ever had in London. For too many, it was a shift they'll never forget. 

Perhaps, next year, when the tenth anniversary comes around, there will be a more public acknowledgement of this day. For now, quiet reminders and private memorials will take place. The news outlets will remain resolutely silent, and the only people who will pause to reflect are those who were there - the injured, the families of those killed, the rescuers who raced into the inferno rather than run the other way. 

Trust

There are several posts, in fact dozens of them, sitting in the drafts folder, waiting to see the light of day. At times, I sit at the keyboard and, just like the ad for Yellow Pages used to say, let my fingers do the walking. Or, as in this case, talking. I wrote most of this post over two years ago, but wasn't ready to share it. Everything within it is still true today. 

There are times where I don't write the posts, don't compose the stories, they just magic themselves from memory to fingertips, skipping out any thought processes along the way. Sometimes, the opposite is true. There is a tale I wish to tell, if only I could find the way; if only confidentiality issues, or lack of descriptive skill, or plain and simple fear weren't preventing me from doing so. For me, writing is often a type of therapy, giving voice to the sights and sounds that sometimes torment or trouble or even tickle my thoughts.

I've never been one to talk about how I feel. I find it uncomfortable and always worry that the skeletons I keep hidden behind lock and key will be too much of a burden to anyone else, be they family, friends or total strangers. It takes a certain amount of bravery to open up and bare one's soul. Over the years, I've watched colleagues who seem to take everything in their stride, who never appear to be bothered or upset by even the most gruesome of scenes. I've wondered if perhaps I am the odd one out. 

Perhaps I'm the only one who's affected by the horrors of the scenes we see. Perhaps I just had an overload of them. If you've read my writings for any length of time, you'll know that I tend to attract more of the serious calls than would be a fair average. My colleagues look at me and wonder if the black cloud that follows me will be blown away on the winds, leaving a clear sky, or whether it's planning on raining down with a particularly torrential downpour. I've never asked or prayed for that to change. All I can do is face up to the challenges as and when they present themselves and hope that I deal with them to the best of my ability. 

This blog has been, and continues to be, a revelation to me. Despite the fact that I'd kept an old-fashioned (and now destroyed) diary for years before starting to write here, the realisation that there was someone, anyone, out there who would want to read about my thoughts and experiences was astonishing. As I head towards half a million readers, that realisation is all the more powerful. It is also daunting in the extreme.

MrsInsomniac has spent years trying to get me to open up, to be less afraid to trust others. Trust someone enough to reveal what I'm really going through. To talk. Not the babbling gibberish and hyperactive nonsense that I talk most of the time, but really talk. Express what I was going through. Describe the scenes, the experiences, the thoughts, the fears, the triumphs and tribulations. 

On the one hand, to talk about what it feels like when all I want is not to feel anything. To talk about what it feels like when despite all the knowledge, despite all the learning, despite all the experience, to turn up to a scene and realise with cool composure that there is nothing left to do. 

On the other hand, to talk about the scene that is so chaotic and confused and unusual when we arrive, with instructions and treatments and decisions flying in all directions, yet by the time we leave, all is much calmer, and there is warmth and a smile and appreciation and thanks.  

And in both of these possibilities, when we have either done good or when we have done nothing, is it right that sometimes I feel something when I shouldn't, yet at other times I feel nothing at all when perhaps I really should?

Honour

There is no honour in a so-called "honour killing." 

These horrendous pieces of news reach our eyes and ears all too often, streaming in from media the world over, yet for as many of these horrendous news items that make it to the front pages, there are so many others stories that never see the light of day. The trauma affects only those closely connected to the victim and the world can't share the pain, even if only for a brief, fleeting moment of reading a hastily clicked-away internet screen. 

I know these cases exist. I have seen them, or at least their results. A woman lies dead in the street. A man she chose to live her life with was found not far away. Their families, disapproving of their relationship, made an unholy union in order to sever theirs. Calm is restored. At least until the next victim in the cycle finds themselves at the wrong end of a knife or gun or blunt instrument; harbingers of doom; revokers of life; restorers of so-called honour. 

The cycle continued. One death led to another, each family seeking the upper hand, the glory. There would be news of a shooting, or a stabbing, or an inexplicable car accident. Then there would be quiet. Sometimes days, sometimes weeks or longer, but still the air was filled with the constant threat of the next retaliation. 

We were traveling through one of the tougher parts of town. The roads have more holes and fewer rules, housing is a mish-mash of prefabricated buildings and run-down apartment blocks, street signs and street lights are almost non-existent and the numbering system no better than guesswork. 

Only a few days had passed since the last honour killing. The latest in the neverending cycle of deaths that proved nothing except that yet another gun had tried to restore its owner's pride, yet at the same time now made him, or those closest to him, the next likely target. In the darkness, we could see the hazard lights of a car parked a few hundred metres ahead. The driver's door and the rear door directly behind it were both open, and all we could see was a pair of legs sticking out. As he heard us approach, he jumped out. 

He was wearing nothing but a pair of boxer shorts. No shoes, no trousers, no shirt, nothing. As we pulled up behind the car, the first thing we noticed was that he was covered in blood. 

"She's in here! I don't know if she's breathing!" It seemed as though the latest victim of honour was in the back of an almost-naked man's car. 

We jumped out of the ambulance, grabbed the bed so that we could at least move her into the ambulance and be able to see to start treating whatever gruesome injury was about to reveal itself to us. The man who greeted us jumped over the clots of blood that were lying on the floor by the passenger door and looked as though he was about to faint. He sat back down in the driver's seat with his head between his knees and his hands on his face. 

"Just help her. Please. Just help her." 

Two steps later, we could see that our victim was no victim at all, sitting as she was, cradling the baby boy that she had just delivered. 

Evidence

She's wearing a long black coat, fake fur around the collar, like she's wearing a fox for a necklace. And although the sun has already set, sunglasses rest on her head; gaudy, silvery arms that hold on to giant darkened lenses. One of the lenses is shattered but still intact, as though a spider had built its web all the way across. Her handbag, with its plaited rope handle still loosely around her arm, has spilled its contents across the pavement. Lipstick, coins, old receipts and chewing gum are sprawled across the ground much like their fallen owner. 

On the outskirts of the scene, it's like trying to empty flood-waters out of a sinking ship with a teaspoon. Two police officers fight back the threatening crowd, as a third attempts to tie the blue and white tape across the only access that doesn't involve climbing a fence. Each time he ties one end, someone tears down the other. It takes the threat of a taser before the massed mob take a hesitant step back and as they do, back-up arrives, giving the police more of a chance.

We're in the middle. Surrounded on all sides of the open ground by people who could be friends or foe of our patient. They could be idle bystanders too. Some may be able to tell a story, to give us some facts, some history. But none could tell the story as well as the obvious evidence on the ground.  

We walk up to her, through the mob, through the strategically placed line of officers, through the spilled contents of her bag, through the pools of blood and golden, gleaming bullet cases, through the torrent of screams and curses and cries for us to do something. 

As the mob takes a step closer and holds its collective breath, one look tells us that the evidence - the handbag, the glasses, the bullets and blood and broken skin - is overwhelming. Even the mob knows: there is nothing more to be done. 

The Best

As we march quickly into the resuscitation room, wading through the sea of people currently waiting for their turn in triage, one face looks directly at us. Most mumble amongst themselves, wondering what trauma had befallen our patient with his face a mangled, bloody mess, made all the more grotesque by the tube sticking out of his mouth. People stare. Human nature seems to render all those around unable to look away from the macabre scene. All except for her. Her gaze held for just long enough. Enough for me to realise that she recognised me, remembered me from some event in the past. Whether that past was recent or not was beyond me and in all honesty I was too busy with the patient we had right now. 

The chaos in the resus room was as organised as usual. Doctors waiting for a handover, nurses anxious to begin treatment, paramedics eager to deliver their patient to the next link in the chain fighting for his survival. His chances were slim - we knew that. Falling, perhaps jumping off a bridge onto the road below should have been lethal. Being hit by the car after he fell should have sealed his fate. Somehow, however, against all the odds, he was still alive when we reached him. Somewhere, the stars combined. The calls came in fast, we were nearby, the hospital was only a few minutes away. We treated him on the move, leaving us on scene for as short a time as possible. We had done our best. 

We spent some time cleaning our equipment in the resus room, keeping out of the way while trying to stay in the loop. As always, we knew that as soon as we left the department, chances were high that we would never know what happened next, so we took our time to grab more snippets of information. Anything from the results of an x-ray to the positing of a professor who happened to be in the area. Eventually, however, we had no choice but to head back out into the heat of the day, through the throng of people still hovering around the waiting room. Still, she sat there, a bandage wound round her head, with a small patch of blood showing through just above her left eye. 

Outside, by the ambulance that looked inside as though full-scale war had just taken place, we started to take stock of what we had seen and done just as one of the nurses who was in the resus room came out, cigarette in one hand and a lighter in the other. 

"They've done their best, but they've called the organ donations team," he said, as he flicked the lighter into life. I couldn't help but grimly wonder if one day he too would need a new set of lungs. 

We tidied up in silence, clearing the floor of the bags of fluids, of the empty wrappers from the kit we'd used, of the blood. The next link in the chain of survival meant that he wouldn't survive, but perhaps others would. It would be a tough call to make. They needed to find his family fast, give them the impossible task to make an impossible decision in an impossible situation - to do what's best. 

Suddenly, she stepped into the sunlight, bandage still in place with its crimson spot and walked straight over to us, stopping only very briefly. "You don't remember me, do you?" 

"No. I'm sorry, I don't." 

"I'm glad. It's probably for the best." 

Sounds of Life

We arrive at the hospital gates
mere seconds apart.
Two ambulances with lights flashing,
Sirens trailing off as we pull up
At the kerb.

They open their doors first,
Exposing their patient to nosey bystanders.
Some look shocked.
Some smile.
Some look away.
Pretend they don't see.
Or hear.
The hiss of the oxygen,
The ping of the monitor,
The instructions of the crew,
All the Sounds of a Life
being saved.

They turn right and disappear,
and as they do,
We turn left.

Our patient is bursting with life, albeit
In pain.
She's Expectant,
Ready,
Anxious.
Scared and excited all at once.
All of a sudden, she screams.
She screams and curses and yells and cries.
And then another noise. A sigh.
And a second cry.
All the Sounds of a Life
being born.

Mood Swings

The gesture is so unexpected, coming from someone clearly suffering as much as Leah is. Lying in her makeshift bed as she has been for two days, a look of pain etched on her face, silently spelling out the words that she refuses to say. Instead, all she does is smile and tell us that everything is alright. 

"It's just a little painful when I move," Leah tells us, except that she can't move at all. The tell-tale sign of one leg appearing shorter than the other leads us to the quick conclusion that she probably has a broken hip - fractured NOF - or neck of femur. I remember wondering in the very early days of my career what a "nekkafeema" was, only summoning up the courage to ask after I could no longer hide my embarrassment at not understanding yet another medical term. 

Leah's son, a tall, sickly looking man of fifty, appears almost as old as his mother and at first I mistook him for her husband. He tells us that she had fallen almost a week ago. Since then, the pain has gradually increased, her mobility slowly becoming more and more limited until eventually she could move no more. 

"It's taken us days to convince her that she needs help!" Leah's son explains. "Every time I've picked up the phone to call you, she screams at me that she'll die if she goes to hospital." 

The smile on Leah's face cracks a little, like an ice-cube in a glass of water, still present but a little changed, and the polished facade she has paraded for her family and initially for us no longer holds strong. "It does hurt, but not too bad. Are you sure I need to go to hospital?" I explain that there may be, in fact probably is, a fracture, but the only way to tell for sure is to have an X-ray done. The old, well-worn joke that I left my X-ray glasses in the other ambulance rejuvenates her smile a little. 

We're lucky. Leah is lying on a strong sheet that we can use to manoeuvre her. She has cushions for support all around and we use all of these to help move her as gently as possible onto the trolley bed. The first couple of attempts catch her off guard, despite my warning that she would feel a little pain when we helped her across. It makes her grab hold of the bed railing and prevents us from carrying her from her bed to ours. On the third attempt, I make her promise that she keeps her hands still and if necessary grabs hold of my arms. That way, at least we'll still be able to keep moving in the right direction. It's a successful move. We're grateful for the lift that means we only have to transfer her once, rather than into a chair and only then on to the bed. Fewer moves means less pain. 

At the hospital, Leah withdraws a little, showing the apprehension that her son had warned us about. "Are you leaving me here now?" 

"As soon as we make sure that you're as comfortable as possible on a hospital bed, then yes. It's the hospital's turn to take care of you." She doesn't seem too keen on the idea, but resigns herself to it nonetheless.

"I have to tell you something," she says once she's calmly lying on the hospital bed. She motions me to stand a little closer, as if she has some state secret to sell. Suddenly, Leah grabs my face and gives me a kiss on the cheek, loud enough for what seemed like the entire department to hear. My crewmate laughs hysterically, sensing and seeing my embarrassment as my face glows a warm shade of red. 

As the first call of the morning, I feel that that one moment sets me up for the day and set off out of the emergency department with a smile firmly planted on my face. 

On our second call, a man dies in front of us with his family all around, and there's nothing we can do. 

Birthdays

Five o'clock in the morning and for the first time all night, we finally arrive back on station. Within seconds, before the engine has had the chance to cool, or the water in the kettle given the chance to boil, the phone rings again, sending us out on our next call. It had been one of those shifts. Job to job, patient to patient, hospital to hospital. With barely the chance for a bite to eat, we had inhaled cups of coffee throughout the night to keep our energies, as well as our hopes, alive and kicking.

Five minutes later we arrive at the address, still with no real details of what awaited us on the second floor of the dilapidated building. The only information we knew was that an elderly lady had pressed an emergency button and there had been no contact with her since then. The three of us grabbed the four bags of equipment and a carry chair between us and started the march up the stairs. Any hopes of there being a lift in the building were dashed the second we pulled up outside and saw its age. 

A tired, but determined voice answered our first knock. "I'm almost there, just give me a minute!" We waited, each silently praying for the clock to tick a little faster, for the end of the shift to arrive, for the calls to end so we could go home. As we did so, a shuffling sound from indoors became louder, like a dog scratching on a door trying to get out. Eventually we heard a key turn and the door opened just enough for us to peer in. 

"You'll have to push the door to get in, I've got no more energy left." Gently we did as were asked, guessing that she was leaning against the door, when after a moment we were able to squeeze in through the gap that had opened. The smile that greeted us was like that of a child seeing its very first snow. Pure delight shone from Eva's face, as if she had stored up ninety years of smiles for just this one freeze-frame. 

"I'm fine, really I am. I just need help to get up off the floor. I've been here for a little while, thought I could manage to get up on my own. Looks like I was wrong." 

"How long have you been there?" 

"Since nine o'clock last night." All three of us do the mental maths. Eight hours on the floor. Eight hours trying to solve the problem by herself that we would now solve in thirty seconds. We checked Eva for any injuries and found that, other than a small graze on her elbow, she seemed to escape unscathed. "I need two things from you please," she asked, almost pleaded. "First, I need you to make sure I'm steady enough to get to and from the bathroom. Eight hours stuck leaves a lady just a little in need of refreshment." 

She smiled her child-like smile again. 

"Second, and more importantly, I'd like five more minutes of your time. Just to have a look at something for me." Presumably a medical issue had been bothering her and now that she had readily available access, she would use the opportunity. 

"We're not going anywhere. Get yourself settled and I'll make you a drink first whilst you do." Once Eva was up on her feet, it took only seconds before she regained her balance, walking around the flat in a manner almost as spritely as a  teenager rather than a nonagenarian. 

"Just a few minutes. I promise. No more." 

When Eva returned, she asked us to follow her into the lounge, where we were greeted to a picture gallery of immense proportions. Every wall was covered, every bookcase had pictures on the shelves, every picture frame hid several pictures within it. Hundreds upon hundreds of pictures, each with smiling faces that crossed ages, generations, and eras.  

"These are my children. And my grandchildren. And my great grandchildren. I should have lost count by now, but I know. I know all their names, I know all their birthdays. Sometimes I might need a small reminder, just that the date is coming up, not that it's their birthday." She stopped just long enough to look once all the way around the room. "It's a birthday today, too, so I'm glad I'm up in time to go and celebrate." 

"Whose birthday? Which generation?" 

"Mine," she said with a wicked grin. "And," as she pulled out a hidden envelope with an old photograph of a young couple at their wedding, "my husband's too." 

I'd had a quick look around when I looked for the kitchen to make her a drink. There was no-one else there. Just Eva and now an ambulance crew. Definitely no husband. 

"Where is he? Your husband?" 

"He's in a home, just a few minutes walk, not far away. When his mind started to wander, his body sometimes followed and he would end up lost, so about five years ago we decided it would be safer to have him move into a home. I see him every day except Tuesdays. That's when I meet with friends for a coffee. Every other day, I always leave the house at six in the morning to get to the home in time to make his coffee and have breakfast with him." 

All three of us looked at our watches. Almost six o'clock. 

"I'm presuming you don't want to go to hospital and get yourself checked after your eventful night on the floor?" 

"Don't be ridiculous. Spend my birthday, my Izzy's birthday in hospital? No way. The only place I'm going is to visit him. And if you people are as kind as you look, you'll help me get down these stairs." 

"We'll carry you down if you like!" 

"Most definitely not. I've still got legs that work, haven't I?" None of us dared argue.

With one of us either side, we slowly walked Eva down the flights of stairs to the entrance of the building. She refused any further offers of help, from us accompanying her on foot, to the offer of a lift in the ambulance. 

"It's only five minutes away, I'll get there the same way I do every day." 

"Happy birthday," the three of us called after her as she started to walk away. 

She stopped, turned around and smiled that smile once more. "Thank you for making it so." 

Thoughts on a Difficult Week

Each Friday, I post a poem, a rhyme, some silliness, to my family and friends on Facebook. Each week I look back, think of the events we have had as a family and as a way of keeping in touch with people, I share a little of what we have experienced. Some weeks it'll take me a dozen attempts to post something I like, even if it really is only a little moment of daftness. This week, the words just flowed, and I thought I'd share them with you too. 

Stay safe and have a good weekend. 

Thoughts on a Difficult Week

What happened this week? What passed us all by? 
Who did we see? Did we laugh? Did we cry? 
Where did we go? Was it slow or quite fast? 
Why did we do it? Will the memories last? 

Did we take some time out with our families and friends? 
Did we need to say sorry, to perhaps, make amends? 
Did we travel a little, did we smile a lot? 
Did we help someone whose needs they'd felt were long forgot? 

Some shifts make me look with a new pair of eyes,
As sun rises each day, or sets in the skies.
Some shifts leave me cursing at cruelty unbound,
Yet counting my blessings at the goodness all round.

As a change, just for once, from the silly and daft,
I thought I'd make you think back to the last time you laughed.
Spend time this weekend, with those who make you smile,
And carry those smiles through the week for a while. 

Angels

Some days I feel like the Angel of Death's right hand man. It's almost as if he's sitting on my shoulder, bidding me to do his work, waiting for me to feed him another soul.

The shift starts with a family member or a carer discovering that their relative or ward has died peacefully during the night. We march in, carrying equipment that we know will be totally redundant. Oxygen, where the tap will remain unopened. A box full of drugs that will number the same when we leave as they did when we entered. A monitor that will do nothing but paint a long, straight, lifeless line on a strip of paper, telling us and the family what we already know. All too often we are still there as the reality of loss strikes home. Sometimes slowly, gently creeping into the minds of those around; sometimes it hits with the full force of a tsunami wave. Before we leave, we comfort the bereaved, we mutter words, platitudes, practicalities, and then go back into the world outside that just carries on as if nothing has happened - unlike the four walls that we have just left, within which the world has suddenly stopped. The Angel has won.

Then there's a call for someone who's dizzy.

Yet another for someone in pain.

And we treat them with care, give them attention, tend to their needs, transport them to the hospital. In the short time it takes me to walk back from the emergency department to the ambulance, all too often I have forgotten their basic details, like a name, or age, or chief complaint. By the end of the day I barely remember these calls at all. And the Angel lurks bored in the background.

And then again there's a call: to someone who has stopped breathing. But this time, someone was watching as they took their last breath. We drive fast, arrive into the confusion and chaos and panic and fright. This time we have a chance. We open the oxygen, we give them the drugs, we beat hard on their chest, we breathe for them, pump blood around the body for them. Try our damndest for them as all around people are crying or screaming or praying or silent. But after a while, twenty minutes, forty minutes, an hour, we are defeated. Death has beaten life, as if the Angel is ironing out the last of the ups and downs on the monitor, leaving that long, flat, lifeless line again.

Then there's a call for someone short of breath. They have nothing more than a cold.

Then there's a call for someone whose blood sugar has fallen so low that they're unconscious, or confused, or violent. We fill their blood stream with dextrose which brings them out of their stupor. All too often they are embarrassed and apologetic. Nine times out of ten we leave on the best of terms, but every so often we need to force a trip to the hospital. All the while, the Angel slumbers.

Then there's a call for someone who's fallen and can't get up. We help them up, dust them down, sometimes make them a tea or coffee. We look at pictures of their grandchildren, or take an interest in their books, or listen to an abridged life story. Often we leave with a smile and a smirk at the Angel. Sometimes, that smile fades in the blink of an eye.

There's a baby turning blue. Can't breathe. Floppy. And we're miles away.

These sorts of journeys happen in an eerie sort of silence. No words are spoken, no thoughts-out-loud. Only the wail of the siren permeates the air, helping us push through traffic as fast as we can, but it never seems quite fast enough. Yet, when we arrive, with the Angel looking over our shoulders, we take hold of the baby.

She's breathing. Shallow, struggling breaths, her shoulders and ribs working twice as hard as they should be, trying to expand her lungs and feed them the oxygen they crave. And the Angel stares, prepares, dares us as he heats his iron, yet all the while we beat him back. We feed her oxygen, drugs, put up defensible borders, give her a fighting chance. We carve our way through the traffic again, to hospital, hand her over to the staff and breathe a sigh of relief when we hear a beautiful noise.

She's crying.

We clear up, tidy the back of the ambulance and prepare it for the next call, and finish the paperwork. Just before we leave, we go back to check on the baby, whose cries have subsided as she finally catches her breath and her face slowly breaks into a wary smile. As we step into the room, her mother finally sees us, as if for the first time, even though she was with us all along. 

"Do you know what you people are?" she asks, as she gently strokes her baby's face. "You're angels. Nothing short of angels."

I look over my shoulder, see no-one there,  and smile. 

Footprints

Bright red footprints, like they'd been painted in a playground, appeared on the steps that we were hurriedly climbing. Not every step, only some. Every second or third stair was marked by a print hastily left by whomever it was that had either caused this horror or, at the very least, discovered it. We would never know whose prints they were, but a clue had been left for the police to use in their hunt. Each mark, no more than half the sole of a shoe or a boot, was as red as the next, each as incriminating as the next, each as foreboding as the next. As we ascended three flights of stairs, the footprints descended at speed. 

The floor and the walls are awash with red; pools and clots and smears and streaks. And footprints. And in the middle of it all, she lies, barely breathing, barely conscious, barely alive. Two police officers search the house as we start to treat her. The scene is no better in the tiny bedroom or bathroom. She had tried to escape and was cornered, prevented from fleeing by the force of a knife, and by her lifeblood draining away. Eventually, she fell by the front door and there she lay, waiting, in a motionless race against time. 

It took time to get her out, as we stepped out of the sea of red, time she didn't have. We couldn't bandage each wound; they were too many, and the minutes too few. We could barely stem the bleeding, although, ominously, it seemed to be slowing of its own accord. Four pairs of hands carried her on the backboard down the stairs, following the footprints and leaving some more, but this time each step was marked. Prints of different sizes, different shapes, but each dipped in the same red paint. 

At the hospital, they're ready for her. Bags of fluids and blood hang at the ready the instant we set foot in the resuscitation room. Oxygen can already be heard hissing out of the tap. Nurses and doctors take over the treatment. Orders are barked, instructions carried out, messages relayed. She's still breathing, still conscious, still alive. 

Outside, as we start to clean up, the police are waiting for us. They want the prints from all our boots. One by one, each police officer who had entered the scene, each paramedic who took part in the call, steps somberly on and off shoe-shaped pieces of card. Each leaving a pair of gruesome footprints - the imprints that would rule them out of the investigation - but would leave a mark in their minds. 

Inside, in the meantime, as the footprints dry, she dies.  

An Insomniac's Guide to the Theatre

If I had to sum up the last week, it can be done in just one word. A word that I have repeated so many times over these past few days, that I'm a little nervous to utter it again. However, there is no better place to start. The word? 

Surreal. 

It all began with a throwaway idea by a friend who asked how I would feel about turning this blog

into a play that would appear at London's Camden Fringe. The throwaway idea began taking shape, delayed not a little by the tough decision of permanently shedding my cloak of anonymity. Take one playwright ready to bare all to anyone who will listen (I mean that in the nicest, most artistically possible way!) and one paramedic who has spent a lifetime building barriers to his innermost thoughts, and you have a potential recipe for disaster. 

Instead of disaster, however, we had a hit on our hands. Hundreds of people from all walks of life - ambulance crews, medical staff, other actors, general members of the public and even a blogger or two - came to see the play, to experience a little of what goes on in our insular world. "An Insomniac's Guide to Ambulances" draws on both my experiences as well as those of writer / producer / director / general dogsbody /chief cook and bottlewasher Rachel Creeger, who in a previous life tackled the world of social work. 

It is a mix of the hideous and hilarious, of the terrific and the terrorising, of the dangerous and the dignified, of the sublime to the (dare I say it again?) surreal. Conflicting emotions battle for room on the stage, work life impacts unintentionally on home life, idealism fights reality, insomnia wards off sleep. All of these are portrayed thanks to Rachel's excellent writing and some fantastic acting by people who, by their own admission, had had little to no contact with the ambulance world prior to taking part in this play. 

Back to where I started - what made it surreal? Well, if you mean something other than the fact that I travelled a round trip of 5,000 miles, just to see a play, the surrealism began by hearing my own words, my own thoughts spoken in somebody else's voice. I had read the script a hundred times, but I was used to seeing words written down. After all, I had written at least some of them. However, hearing them, seeing how they are portrayed, sensing them spoken with an outsider's emotion, was an experience that left me with a chill down my spine, as well as proud and not a little humbled. 

This blog started as nothing more than a figurative notepad for me to voice my thoughts, to tell some stories, to open a porthole into my world, even if no-one else was interested. The fact that it has taken on a life of its own and opened up to a whole new style of audience has left me with a renewed sense not only of pride in my job, but responsibility in its portrayal. 

As for the play itself - it still has two more days (14th/15th August) to run. You can book tickets here if you're quick! The audience feedback has been incredible and the giggles and knowing murmurings I heard from some of my old colleagues must mean that the nail has been well and truly hit on the head. 

I owe my thanks to Rachel and the cast - Dimitri Shaw, Josh Burdett, Stacey Evans, Alex Hall, Buchan Lennon and Laila Pyne - for bringing it all to life. 

Five-a-Day

Progress report: Situation normal.

Well, as normal as it can get in the world of EMS. Several months into my new adventure, treating patients from right to left, filling in electronic patient reports instead of paper ones, on a system that is a combination of awkward, clever, helpful and frustrating all at once, and generally getting back into the swing of things, I have discovered that even if the systems are totally different, the end result is the same. 

The patients don't change. 

There are calls for all the same reasons, some genuine, some not. 

There are drunks. There are assaults. 

There are those who are dying to live and those who are living to die. 

And there is everything in between.

I have been working at a number of different stations, in different towns, separated by distances that in London are probably the equivalent of boroughs and in Australia or the USA I guess it would be just popping by to the neighbours. Still, the people are all the same. 

The arrival of a new baby still brings joy to the parents. 

The passing of an elderly relative brings sadness, grief; sometimes relief. 

The feeling of impending doom of a critically ill cardiac patient is just the same, whatever language may be used to express that feeling. Often, words aren't required; the mere look in the eyes conveys the message all too clearly. 

***

Just a few short years ago, In her early thirties, Leah had a cardiac arrest. She was one of the lucky ones. The stars aligned and she collapsed whilst visiting a relative in hospital. The ward staff reached her in seconds and she was resuscitated, waking up in unfamiliar surrounding a few days later. She heard talk of her heart stopping. She heard talk of having a funny rhythm and could think of nothing but a set of drums, but then talk of electricity in the heart confused her even more. Nothing made sense. 

She heard something about a defibrillator to shock her heart each time it happened. Something about it being there for the rest of her life. A life that had been taken away, returned, and now seemed once again to be slipping through her fingers. 

Leah's deathly pale, beads of sweat covering her face and arms. The fear in her eyes, as if we couldn't see it, was reflecting in her voice, in her pleading. 

"Don't let me die. Not here. Not with my children in the next room." 

The voices of cartoon characters fill the background, muffled by a doorway that separates the innocence of childhood and the harsh reality of life. That reality was monitors, needles, drugs. A battle against time and an unruly heart, beating to its own chaotic rhythm, rather than the regular spike on a screen and the audible lub-dub in the stethoscope. 

A few tense minutes later, Leah's face eases a little. As drugs course through her veins, sending orders to the heart to regroup, we see the rhythm take on a semblance of order. Finally steady enough to move, we carry her down the four flights of stairs to the ambulance and start to head to hospital. A few minutes into the journey, she lifts the oxygen mask from her face and asks a simple question. 

"Do you think it would help if I stopped smoking?"  

"I'm sure you've been told several times prior to today to stop." 

"But I only smoke about five a day." 

"Even those five aren't helping your heart, are they?" 

Leah didn't answer, choosing to sit in silence for the rest of the journey. We wheel her in to the hospital, to be met by an all-hands-on-deck medical team. Leah is transferred to the hospital bed, a nurse detaches our cables so that she could reattach theirs, as all the while Leah appeared deep in thought. 

"They'll take good care of you now," I said as I started to walk away, "just make sure that you do the same."  

Leah called after me. 

"Wait. Just wait a second. I have something for you." She reaches into her handbag, pulls out a box of cigarettes and a lighter, and places them firmly in my hands. 

"Take them. Throw them away. I never want to see them again."