Breathing Again

They came in their masses. Call after call, day after day, week after week, for well over a month. In that whole period I don't think I saw a single person who genuinely needed an ambulance other than a few elderly fallers. Coughs, colds, three-week old ailments that suddenly needed immediate attention at four o'clock in the morning. It was infuriating and demoralising. And to top it all off, in the midst of this lull, before the days when I only worked nights, there was the dreaded "office week". A week of shifts that runs from Monday to Friday, nine in the morning until six in the evening, just like being back in an office.

I used to despise that week. It came round every three months or so. It meant fighting the traffic on the way to work and on the way home. It meant being left with the least suitable vehicle with the least amount of equipment. It meant, more often than not, coming in, taking the ambulance to get fixed, spending hours making sure it was working, ready, stocked and cleaned, seeing one patient, and then going home. Late. It meant always, always finishing late. And it meant that after spending a day making sure that the vehicle was fixed and ready, that someone else would come in and steal it, and you'd have to go and do it all over again the following day.

All in all, it left me frustrated, angry, and burnt out. Office week had finally destroyed the enthusiasm that I'd harboured since the day I joined several years previous. It was just a straw, but the camel's back had been well and truly broken. I had never before taken a sick day when I wasn't actually sick, but I was very close. The end of office week brought, as a reward for surviving its arduous torture, a long weekend. I wasn't due back until the Tuesday morning. Monday night, I picked up the phone and called in sick. Or at least I tried to. Three times I tried, and three times I hung up the phone as soon as someone picked it up. I slept even less than my normal two or three hours that night. Tuesday morning came, I had an ambulance that worked, it was equipped, and there was even a crew mate I was pleased to see.

Although not thrilled to be at work, I was determined to fight through the lull, and go back to enjoying my job. Whatever it may throw at me.

The first call came in seconds after the clock struck seven. The call was more routine. Abdominal pain. A young man with a tummy ache. The MDT updated with more details as we approached the address. A fortnight of pain now culminating in an ambulance being called. My hopes and determination lay in ruins once again. Normally I'm exuberant to the point of irritation. Ask any of my colleagues. Nothing at work really gets me down. Patients who called for inappropriate reasons would be fodder for venom only within the confines of my brain, whilst mostly I'd be all sweetness and light to them, as though they were the most important patient I'd ever had. But now, even I had lost my positive outlook. One minor abdo pain too many, and I was completely and totally fed up and burnt out.

I sat in the front of the ambulance after we'd dropped him off, another one ticked off on the list of the multi-drop delivery van-driver that I'd turned into. As I filled in the paperwork, I wondered how much worse was it going to get. I pressed the green button to tell control we were available and ready for the next call. Barely had we pulled away from the kerb, when the MDT rang again. Just an address appeared, no details as to what was happening. Another waste of time, probably. 

Less than a minute away from the address, and the details popped up on the screen. A lady in her 50s, asthmatic, breathing difficulties. In the extra information it mentioned about the husband who was making the call was difficult to understand as he sounded distressed and that he was possibly crying. We pulled up outside the house, took out the bags of equipment, and as we stepped over the threshold into the lounge where she was lying, she took one last, deep breath, and then stopped.

There was a blur of activity. We requested an extra crew, or at least another pair of hands. We plugged the mask into the oxygen bottle and started breathing for her. We added the kit that produced a cloud of steam containing salbutamol, a drug that would hopefully help to reopen her airways. Needles in, drugs administered, and more and more oxygen pumped into her lungs. Her heart still worked on it's own, whilst her lungs went on strike, but even that wouldn't last much longer if we didn't help it by taking control of the lungs. Another ambulance arrived, making the removal and treatment just that little bit easier and smoother.

Her lungs that were initially silent now had a harsh wheezing sound, a sign that they've opened just a little. Enough for us to be able to push the vital oxygen in just that little bit easier. Once in the ambulance, we warned the hospital we were on the way and a brief outline of what was happening. Half way to hospital things changed.

She took a breath on her own.

Then, after a few long, tortuous seconds, she took another. Still not enough on her own, but a huge leap in the right direction. We kept up our assistance with her breathing, arrived at the hospital, and handed her over to the team. As we stood watching, she took more and more breaths on her own, the regularity returning, the external interventions diminishing.

"Well done, guys", the doctor who'd met us with our patient treated us to a pat on the back. "You've saved another one." Another one maybe, but the first genuine patient in well over a month.

I was beaming as I walked out the department. A patient who not only desperately needed our help, but whose life we'd actually saved. A couple of hours later when we returned to the hospital, I peeked round the door to see that she was sitting up in the bed, a chest drain in place treating a collapsed lung. Her eyes were open and she was talking to her family.  

We breathed life back into her, and gave her another chance to face the world.

She'll never know that she'd already returned the favour.

Worldwide Alert

The threat of international terrorism is rising worldwide. More is being done to prepare the common person for this threat, as governments the world over are trying to defeat it. The way your government is dealing with it, depends on where you are in the world. Here are the latest updates from the International Ministry of Funny Farms:

The English are feeling the pinch in relation to recent terrorist threats, and have therefore raised their security level from "Miffed" to "Peeved". Soon, though, security levels may be raised yet again to "Irritated" or even "A Bit Cross". The English have not been "A Bit Cross" since the blitz in 1940, when tea supplies nearly ran out. Terrorists have been re-categorized from "Tiresome" to "A Bloody Nuisance". The last time the British issued a "Bloody Nuisance" warning level was in 1588, when threatened by the Spanish Armada.

The Scots have raised their threat level from "Pissed Off" to "Let's get the Bastards". They don't have any other levels. This is the reason they have been used on the front line of the British army for the last 300 years.

The French government announced yesterday that it has raised its terror alert level from "Run" to "Hide". The only two higher levels in France are "Collaborate" and "Surrender". The rise was precipitated by a recent fire that destroyed France's white flag factory, effectively paralyzing the country's military capability.

Italy has increased the alert level from "Shout Loudly and Excitedly" to "Elaborate Military Posturing". Two more levels remain: "Ineffective Combat Operations" and "Change Sides".

The Germans have increased their alert state from "Disdainful Arrogance" to "Dress in Uniform and Sing Marching Songs". They also have two higher levels: "Invade a Neighbour" and "Lose".

Belgians, on the other hand, are all on holiday as usual; the only threat they are worried about is NATO pulling out of Brussels.

The Spanish are all excited to see their new submarines ready to deploy. These beautifully designed subs have glass bottoms so the new Spanish navy can get a really good look at the old Spanish navy.

Americans meanwhile, and as usual, are carrying out pre-emptive strikes on all of their allies "just in case".

Canada doesn't have any alert levels.

New Zealand has raised its security levels - from "baaa" to "BAAAA". Due to continuing defense cutbacks, New Zealand has only one more level of escalation, which is "I hope Australia will come and rescue us".

Australia, meanwhile, has raised its security level from "No worries" to "She'll be right, mate". Three more escalation levels remain: "Crikey!", "I think we'll need to cancel the barbie this weekend" and "The barbie is cancelled". So far no situation has ever warranted use of the final escalation level.
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Have a safe, peaceful and smiley weekend - and Happy Thanksgiving weekend to our American brethren.
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Edit: I wish I could say this was my own work, but it isn't. It was sent to me, and I felt it was too good not to share...

Sleeping Partner

The bed is covered in blood. The floor is too. Apparently there's loads of the stuff in the bathroom as well.

"We left it there, unflushed, just in case you wanted to see it!" I'd seen enough already, without having to go snooping in someone else's toilet bowl.

Another one of my return customers, Greg and I had met on a previous similar occasion, and probably about a year had passed since then. Maybe eighteen months. The alcohol he'd taken on board over years, slowly destroying him from the inside out. He looked pale, gray even, and was sweating as though he'd just run a marathon in the Sahara Desert.

"I'm gonna die, aren't I?" Greg asks. The fear in his voice is only too real. "Not in my ambulance you're not". I think it, but don't say it. Patients who genuinely fear it, and voice that fear, often know.

"No, Greg, you're not. We're going to get you up to the hospital as quick as we can, and get you sorted."

"We? You're the only one here!" And he's right.

"Another ambulance is on its way. They'll be here soon enough!" I hope my prediction is a self-fulfilling one. I need them in a hurry. In the meantime, I start getting some fluids into him. It's another case of salty water replacing blood, but at least it gives the heart something to work with until we can get him the real stuff he needs. The blood that's left inside him will have to work extra hard to pump round the oxygen that's free-flowing into him through the mask on his face. At least he's stopped vomiting for a while. I don't know how much he's lost internally, but just from what I can see in front of me, he must have expelled a third of his blood volume. By the time the crew arrive, he's had about a litre of fluid back in through a thankfully large vein in his arm.

I hear them downstairs and yell: "Bring a chair up with you!" Often crews backing up first responders will come in to see what's going on, and only then decide what extra things they'll need. Usually it works just fine. Luckily the crew recognised my voice, and the urgency in it, to know not to ask questions.

"Last time I needed surgery. And they gave me nearly twenty bags of blood apparently. But I don't really remember anything. They told me if it happened again, if I didn't stop drinking, that I'd probably kill myself."

He started sobbing.

"I have, haven't I? I've killed myself! And now, two days before my son's due to be born!"

A neighbour was with Greg the whole time we were there, but no-one pregnant.

"Where is she Greg? Where's your partner?" I thought that a friendly face might help calm him a little.

"She went up to her mum's last night, up north somewhere. I've got her mobile number, but I don't want to call her now. It's too early!" Barely in control of his own body, he was still worried enough about his partner and unborn child. "I didn't mean to drink so much. I shouldn't have had anything at all. It's the first time in months!"

We moved Greg to the ambulance, a creaking flight of wooden steps leading down to the front door and out into the cold night's air. Dawn was breaking across the horizon, and the traffic was just starting to build as normal people started another working day. Leaving my car on scene, I travelled with Greg, an extra pair of hands always helpful with a particularly ill patient. The siren blared its way, ensuring the cars cleared the way for us to make a smooth but rapid journey to hospital.

"I don't want to hear the sirens! I don't..." He wept again. "I just want to hear my baby cry..."

We arrived at the hospital, a team ready to meet us was standing round the designated bed.

A doctor listened to the handover and asked for some blood almost immediately, as a student nurse hooked him up to the machines. A nurse thanked his luck for finding a decent vein and put a second needle in the arm I'd left alone.

Greg's tears flowed, and he was barely able to catch his breath between sobs. "Just help me see my baby! Just once! Please... Please..."
Another nurse left the cubicle without a word, and hurried to wake his partner.

Good Days, Bad Days

You finish a big project.

You close a big deal.

You build a house.

You paint it.

You sell a new product.

You use your skills, knowledge and training, and put them to good use.

In short -

You've had a good day at work.

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But what does that mean if you're in EMS? How do you have a good day at work? My friends and family alike struggle with the concept that for me to have a good day at work, someone, somewhere, has to be having possibly one of their worst. As I was writing this post, someone I follow on Twitter posted a very similar update. "Today was unfortunately a very good day", is how it ended. Good, yet unfortunate.

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How do I explain that I don't want people to have a bad day?

How do I explain that I don't want people to be seriously ill?

How do I explain that I don't wish a life-threatening injury on anybody?

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But then, there's the "on the other hand":

I want to have a good day at work.

I want to put my training to good use.

I want to feel that my journey to and from work was worthwhile.

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It's a conflict of interests. A conflict of emotions. A conflict of reasoning.

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The best way to sum it all up? I don't want you to be sick or injured, but it happens.

And when it does, I want to be the one there to help.

That way, hopefully, we can both look back on a good day, even if, at least for you, it started off badly.

Norma

Norma is usually a bundle of laughs, a handful, and was a real joy to meet. Bed-bound she may be, but her physical restraint had left her mind sharp. At least that was the case the last time we met. That first time, she was trying to escape the nursing home that had become her prison. She knew she would never make it past the bed guard. She'd never really recovered from the faint that led to her falling and breaking both hips. No longer able to walk unaided, she'd been forced out of her lifelong house and into the care of the nursing home.

She sat on the floor, refusing to accept in her heart that which her head was already telling her.

"I'll get up and walk. You ain't taking me to no hospital!" That before I'd even opened my mouth to greet her. Something told me that this battle of wits would be good natured rather than nasty, but it looked like it may well be protracted. As we checked Norma's injuries, it was difficult to know whether what we were seeing, and hearing for that matter, was from the previous fall or this one.

"I'm a war veteran y'know!" she said at one point.

"Which war was that then, Norma?"

"The Forty Year War!"

I had to admit that I'd not heard of it, which was a little surprising. You'd think that something that went on for that long would have registered somewhere in my brain during history lessons.

"Enlighten me", was the best I could come up with.

"Forty years it took me to realise that I wanted shot of that man! In the end, I took him for everything he was worth! Now he's got the kids, the grandkids and our house, and all I've got is a prison warden for a nurse!" She laughed the sort of infectious laugh that you can't help joining in.

I looked back on the information sheet that gave all Norma's details and saw that her next of kin was her husband.

"How come it says here that you're married then?"

"I didn't say I got divorced, did I? I just kind of moved out!" Another burst of laughter, but this time it hurt her hip when she moved. I just raised an eyebrow in her direction, and didn't dare say another word for a second or two.

"Alright", she growled, half joking, half serious, "you can take me to hospital. I promise to behave now!"

And behave she did. Before we moved her, I decided that it might be an idea to give her some morphine to help with the pain, and explained about putting a needle in her arm to be able to give her the medication.

"You miss this vein", she threatened, "and I'll pull the needle out myself and jab it in your eye!"

No pressure then.

Soon the needle was in, the morphine coursed through her veins and provided the much needed relief enabling us to get her to hospital as comfortably as possible. After we'd moved her onto the hospital bed, Norma even managed a thank you, put out her hand to shake ours, and gave each of us a kiss on our fingers as if we were each the Pope. At least. "You lot should be treated like royalty, not like bloody cab drivers!"

I smiled and wished her good luck. We left Norma at the hospital, and by the time we came back, she'd already been moved to a ward.

Now, Norma and I were meeting for a second time, this time I was alone, at least initially. There was none of her wit, no sharp tongue to contend with, none of the feistiness that made her such a pain in neck, yet a pleasure to help.

Norma was unconscious. The nursing home staff told me that she was diabetic. They checked her blood sugar which they found to be dangerously low, and so decided to force feed her a sugary drink to try to help.

Not such a great idea with an unconscious patient.

The rest of her basic observations weren't so good either. A pulse and blood pressure so low that they were barely readable, with an ECG that confirmed what I already knew - her heart was really struggling. She was hypothermic as well, her body temperature dangerously cold despite being in a room that was so hot I was sweating from the moment I stepped in.

The crew backing me up turned up after a few minutes. I'd made sure they were updated before they arrived as to what was really happening, and the fact that it wasn't exactly as the call had originally been sent. In fact, it wasn't even close. "Diabetic problems, patient conscious and dizzy" was what I had initially expected, although I'd learnt long ago that not everything the call-taker is told is what is really happening. The patient calling for an ambulance because their own heart had stopped is a real, if a little far-fetched example.

As they came in with the stretcher, Norma's breathing became erratic, the oxygen in the mask now needing some external assistance to make its way into her lungs. We moved her across from the nursing home bed to ours, with the staff complaining that we'd taken their sheet with the patient. If it had been some sort of expensive bedding, I might have had some sympathy, but it was nothing but a regular hospital sheet. We were followed out to the ambulance by two members of staff, one carrying an envelope with the photocopies of Norma's details and drugs, the other empty handed.

"Is one of you coming with Norma? If so, we'll be going in a couple of minutes."

"No. We're not coming. We don't usually send anyone, just the letter."

We load the trolley into the ambulance, and as the hydraulic ramp closes, a voice calls out.

"Can you please make sure you bring that sheet back?"

Incredulous, just as I'm about to shut the other door, I look out the back at the two people charged with the care of so many, but couldn't muster an ounce of understanding between them.

I open the cupboard at the rear of the ambulance, find a spare sheet, and throw it out at them, leaving them fumbling over the cascading linen.

Looking back at Norma, I'm left wondering what her sharp tongue would have replied. I'm sure she'd have found the words at a time when I was fuming, but completely speechless.

Handover Carnival - October 2010

Ladies and gentlemen, it's still happening. The Handover Carnival is still taking place, where a different blogger each month takes the reins and chooses a subject to be covered by EMS bloggers world-wide. This month, well, actually, we're about a month in arrears due to our Aussie friend over at Flobach Republic's world going a little nuts (it's OK, Flobach, we forgive you!) the subject was Wearing is Caring.

What do EMS providers world wide wear when they go to work? What do they carry with them? And why?

I'm surprised each and every month to find at least one more blog that I'd never heard of before, each telling their story of EMS from a different perspective.

And just as a bonus, an old post of mine made it onto the list too...

So go, click on the link above, and enjoy an easy Sunday's reading!

Driver's Duties

It's a relatively rare thing for me to drive the ambulance, unless of course, I'm solo responding in the Fast Response Unit. I'm almost always more comfortable in the back, with the patients, and allowing someone else to pilot the ship around the never deserted streets of London. Apart from anything else, it's the driver's job to tidy up if there's any mess at the end of each call, and I'll happily pass on that duty.

Just for once, I fancied a change, and so took up the position of helmsman, and watched as another newbie took control of the patients.

The screen rings and displays a message about a choking baby, turning blue. Not normally known for being the fastest of drivers, my lead foot takes over and we cover the couple of miles at warp factor 9. As we turn into the quiet cul-de-sac, the computer updates us that the baby is now breathing normally and no longer choking. Even the ambulance breathes a sigh of relief.

We're met at the front door by the baby, cradled in his mother's arms. Mum's eyes tell a tale of their own, bloodshot and swollen, the drying streaks of tears running the length of both cheeks. Newbie is a little lost, not yet having learnt the art of treating a now non-existent problem. We talk to mum, find out what happened, and discover that once again we're meeting a baby who probably tried to inhale its milk rather than drink it. All is calm, except the excitable older sibling bouncing Tigger-like on the couch and telling us how they once had a fire engine and an ambulance come to school. I ask to take a look at the baby, and mum hands him over. A quick check, a listen to the lungs, a look at skin colour, an assessment of mood, and everyone's happy that a disaster has been averted.

We offer to transport mum and baby, and discover that Tigger will have to come with too, as no-one else is around to babysit. Mum wants to go, just for peace of mind, and I can understand. I stay holding on to the baby whilst newbie writes down all the details necessary and mum gets organised with all the essentials. The vast majority was already packed in a baby bag, and it just involved getting dressed and making a bottle.

As soon as we were ready to leave, I try to give the baby back to mum. He clings and refuses her outstretched arms. Flattered I may be, but now we have a problem.

"Well", I suggest, unlooping the ambulance keys from my belt and handing them to mum, "I guess that means you're on driving duties!"

Somewhere Inbetween

I'm going to ask you a few questions:

Can a doctor ever refuse to treat a patient?

Is it the same for a paramedic?

Can there ever be mitigating circumstances?

What would you do when your conscience tells you one thing, whilst the rules tell you another?


I'm going to ask you to read an article from a German news website. Not my normal reading, but it grabbed my attention via another site.

Then go back and have a look at an old blog post.

And then, once you've had a while to think about it, to come back and comment on what you think.

I'm not asking for judgement, just opinion. Right, wrong, or somewhere inbetween?

Finally - be honest: what would you have done if placed in such a dilemma?

Clockwork

He comes home from work at six, regular as clockwork.

The loft ladder, normally his domain, is down.

The hatch is open, the cold air blows into the house.

She sits on the edge, feet dangling free.

"What are you up to?" he asks,

confusion in his voice, a wry smile on his face.

"This!" she shouts back.

And with just a moment's thought, she jumps, as if into his arms.

He smiles, and puts out his arms to catch her.

A moment too late, he sees the noose around her neck.

We try. We really try. Fighting against all the odds.

A blur of uniforms, green and orange.

A whirr of blades and flashing lights.

We hear his pleas, his screams, his sobs.

And suddenly, as if in answer to his prayers,

she breathes. Regular as clockwork.

And so do we.

Remembrance Day

A rainy day in London, as though the heavens themselves cry for those who made the ultimate sacrifice for their country and country folk. 

People have been sporting poppies on their clothing for the last couple of weeks, and many will have made a donation to the charity supporting not only families of those who never came back, but also helping those soldiers who did. They too face a daily struggle to rebuild their lives, recovering from both the physical and mental scars of the horrors of war.

We in the UK feel safe in the knowledge that the war is a million miles away. Out of sight, out of mind. It's almost as if there is no war. For some, however, even those who have returned, war is a constant figure in their lives. A constant fear too.

I wrote about just one of the many a while back. An ex-soldier named Sim.

Just as they have a duty in service, we have a duty to them too.

A duty to remember, a duty to help, a duty to thank.

Wear your poppies not only with pride, but also with gratitude and at least a moment's thought.

Off Duty

At a family wedding not long ago, I caught sight early of one of the relatives, and went over to say hello. Other than being the friendly thing to do, there was also an ulterior motive.

He's a doctor. When we're at joint family functions, the first one to remember always calls "Off duty", leaving the other one supposedly in charge if anything goes wrong. It never has done before. I called it on this one, since the next scheduled one is for his engagement, and I thought it fair to let him have that one day off.

As the evening went on, one of the older guests collapsed in the middle of the dance floor. I didn't see it happen, or even sense anything was wrong, until I saw the doc get dragged away.

Being the nosey type, and realising that for him to be pulled away like he was must mean something's happened, I followed closely behind, arriving at the patient less than thirty seconds later.

I listened in to the initial assessment whilst stood behind him, and only after that offered my assistance.

"Glad you're here. This patient's a bit out of my league!"

Yes, he's a doctor. And by all accounts a good one.

But he's a paediatrician.

And this patient was just, as he put it, "a little too big" for him.

A joint operation of looking after our patient was completed, thankfully with no paperwork for a change.

We both walked back to our seats and mulled on our joint occupational hazard.

"Off duty, huh?" I laughed. "Apparently there's no such thing!"

Eye of the Storm

A storm is brewing.

As the doors are opened by the sleepy-eyed night duty nurse, the gale force wind forces them wide and dumps the latest pile of leaves into the foyer of the nursing home. Laden with several bags, and not knowing which way to turn, we wait for her to regain her composure and lead the way. In the thirty seconds since we arrived, she has so far failed to complete a single one of the dozen sentences she's started.

"He's up on the..."

"We just found him and..."

"We've tried CPR but..."

"We knew there was something wrong so..."

"So you called us?" I ventured.

"Exactly!"

Not exactly the model of calm in a crisis you'd expect from an experienced member of the nursing staff, but we've met this problem before in this home. After another round of verbal stutterings, she finally remembers to direct us to the patient, and trots ahead in that sort of run that always looks as though it'd be quicker to walk.

A trail of green follows her, each back and shoulder laden with a different piece of luggage ready for the attempt at saving another human life.

The window in the room is slightly ajar, bringing the howling noise of the winds outside into the battlefield within. The first thing we notice is the blood on the wall, and the streaking lines that lead to his head. A quick look tells us that whether there was CPR or not, it was certainly not required now. Although deeply unconscious, he was breathing on his own, and a strong pulsating artery could be seen in his neck. A mix of good signs and bad.

Unsure of what's happened, we protect his neck and spine from further injury, apply a bandage to the gaping head wound, and stabilise him as much as possible before the unstable transfer to hospital begins. A look in his eyes reveals one pupil larger than the other, an insulted brain showing signs of fatigue, a clue to the possible cause.

The short gap between the building and the ambulance is filled with swirling gusts and the ambulance itself sways in defiance of the forces of nature. It's going to be a rough ride.

Late evening calm is fractured by the siren as it wails its mournful tones to the rhythm of his breathing. At times we're forced to help him a little. The trees along the route are shaken loose of their leaves, blanketing the cold, darkened roads with the warm oranges of autumn. A warmth seen, but not felt, as the storm whips up into a frenzy.

Yet the eyes at the centre of this particular storm lay calm and lifeless, their brutal honesty betraying the secret of a battle fought and lost.

Shake Up

A short disruption to your day:
The blog roll at the right hand side of this page has been updated.
Some who have started blogging have been added.
Some who have stopped blogging have been removed.
And some who I've been following for ages, but forgot to add to the list, have now found their rightful place.
Go. Read. Learn. Enjoy.
And if you're a blogger who links to me, and I haven't linked back, let me know.
As you were.