Simple

It's a question I get asked on a fairly regular basis:

What makes a good medic?

In my simple mind, it's a simple answer.

Here's the test:

Would I be happy with you treating a member of my family?

If the answer's no, then in my eyes, you've some work to do.

If the answer's yes, then in my eyes, you're a good medic.

The test works when I look at myself in the mirror and check on how I treat my patients too.

Simple.

Lives

Some, over the years, have been badly hurt. 

Some, over the years, have been only lightly grazed. 

I guess they're the lucky ones. 

Assuming it's lucky to be stabbed.

Some had a wound so deep, they needed surgery right away. 

Some had a wound so shallow, the hospital sent them straight home, 

with a stitch or two and a warning. 

Some, bravado and ego getting the better of them, 

refused any treatment at all and ran off.

Two died. In front of me. 

When there was nothing I could do.

Others may have died later, but I'll never know.

Drop the damned knives, people. 

Stop destroying lives, people. 

Go live your lives, people, 

and stop tearing those lives apart. 

Experts and Law Suits

This post over at Rogue Medic reminded me of the day our youngest child was born. Being as stubborn as his older siblings, it was decided that two weeks after his scheduled arrival, it would be a good idea to serve him notice and have him evicted. Bags were packed, plans made, babysitters arranged, and a fortune was spent in the hospital car park. 

As we headed towards the main entrance, a scene so familiar to me, yet alien to a heavily-pregnant-about-to-be-induced MrsIM, played itself out in front of us. A group of people were stood in an almost perfect circle looking down at the ground, as a middle aged lady lay on the floor crying in pain. Much like Rogue Medic's story, the lady probably had a fractured hip. The crowd were a mixed group. Some visitors to the hospital, and several staff, including a few doctors, at least one of whom I knew and several nurses who looked familiar. All told, a group of about twenty people, standing, talking, gesticulating. 

A bed had been wheeled from a nearby ward and stood next to the patient as a discussion took place on the best method of getting the patient from the floor to the trolley. As we neared the actual scene at the rate of a nine-plus-month-pregnant-waddle, I could see six pairs of hands trying to move the patient up to the height of the trolley in a tangled mess that would have any back-injury specialist cringe and cry for their mother.

The upshot of it all was that none of them, not the visitors, or the nurses, or the doctors could work out how to do what comes to any EMT or paramedic as second nature. Having admitted to being a paramedic, I offered my help, and after a couple of "What do you know that the doctors don't?" type questions (from certain nursing staff no less), and using only two pairs of hands, the lady was moved gently, safely and with minimal pain from the floor to the bed.  

I don't claim to know what doctors know, I don't claim to have the skills to nurse a patient either. I do, however, claim to be an expert at what I do for a living. I've said it before - we need to have pride in our profession. We need to know that our skills and expertise are exactly that. We need to know that we are the specialists in our field, and that any doctor or nurse worth their salt would do well to understand and respect that. My remit may end at the entrance to the A&E or ED, but up until that point, the patient is my responsibility. That responsibility extends past mere transport - it can also include extrication, removal from scene, treatment, resuscitation and stabilisation. And just simple pick-ups from the floor.

I would love, one day, to hear news presenters, career advisers and general Joe Bloggs speak about paramedics in the same respectful tone as they do about doctors and nurses. Actually, first of all, I'd like to hear paramedics speak about paramedics in that same respectful tone, instead of doing ourselves a disservice by constantly saying things like "Well, I'm no doctor..."

Whilst the USofA as a whole needs to learn a little more about caring for others, as opposed to staving off law suits (not that the UK is all that much better), paramedics the world over need to learn that we are no less experts than the doctors and nurses to whom we're compared, often in such an unfair light. We need to show that we don't do things just in order to avoid yet another American-style law suit, or just to cover our over-exposed behinds. We do things because they are the right things to do, the expert thing to do, and are in the best interests of our patients. 

Windows

Tiny drops trickle down, zigzagging along

the inside of the steamy window, 

leaving streaks,

like tears, 

on a pockmarked face. 

Inside, they lie, 

side by side. 

He watches her, holds her, 

caresses her lifeless, cooling hand,

begs her to stay, despite knowing,

knowing she's gone. 

We step inside and take one look. 

Inside, the image in the window is mirrored, 

as tears stream down his gentle, pockmarked face. 

Animal Farm

Towering over me, with arms as big as a normal person's torso and wearing a vest that showed off tattoos from his shoulders to finger tips, Tom struck an imposing figure. As he opened the front door to let me in, I could hear barking from somewhere else in the house. 

"Is that dog locked away?" 

"Are you kidding me? He won't do you no harm! He's only a little thing."

"Yeah, the last person to say that to me then suddenly had to apologise and explain that Ooh, he's never done that before!"

"OK," Tom said, a mischievous grin crossing his face, "I'll go get him and lock him in the garden. Mum's in the back room with him, so you can follow me." Tom led the way, making sure to grab the dog as he went. "This is what makes you nervous? And I don't?" Every word dripped with sarcasm, and he had a point. The dog was probably no bigger than a child's football, and looked even smaller in the arms of his giant owner.

"Yes, and no. I can read people, they don't often bite, and I can usually run faster than they do. Dogs on the other hand, I can't read, often bite, and have four legs that are quicker and better than my two." 

Tom was still laughing at me when the crew arrived to take his mum to the hospital, but he did shake my hand and thank me for my help. He took great pleasure in telling the crew, Jill and Rachel, of my nerves, and they joined in the laughter at my expense, Rachel even going as far as asking him to get the dog so they can meet it. 

One-nil to the crew, but revenge is a dish best served cold.

An hour later and another call. This time the only noise I can hear at the front door is the wheeze coming from the lounge. A girl of mid to late teens opens the door. She looks frightened and worried, and practically drags me through the door to see her eight year old brother who's sitting on the couch struggling for breath. I kneel down next to him to start reassuring him and begin his treatment.

"He's got really bad asthma, and his inhalers aren't working. Mum and Dad let me babysit him for the first time tonight, and I didn't know what else to do." 

"You've done just fine, you did absolutely the right thing, so don't worry." Sometimes part of the treatment is treating the family too. "We'll have him sorted in no time at all, but you'll have to go with him to the hospital in the ambulance. Just give your mum a call and let her know what's happening." 

Mum instantly asks to speak to me, and I did all I could to calm her down. I apologised for disturbing their evening out and tried to ascertain a few more details.

"Does he have any allergies?" 

"Well, not to any medicines, but he's allergic to furry animals. You know, cats, dogs, guinea pigs, that sort of thing." I was relieved by that bit. "That's why we eventually let him get a snake." 

"A what?" 

"A snake. It's still quite small, only about five feet long, and he normally leaves it in the tank under the couch." 

Slowly, I lower my head and peek under the couch. There, staring at me from a glass fronted box, is the snake. It makes me jump a little, which probably had more of a therapeutic effect on the little man than any medicine I was throwing at him, making him laugh at my fright. 

"Don't you like snakes?" 

"Don't mind them too much, just didn't expect to be sitting next to one for so long without realising it." 

The room lights up in flashing blue as the ambulance pulls up outside, and two familiar voices are shown into the house.

"Aha! So we meet again." 

"No dogs for you to be afraid of this time then?"

"Well, as it happens, there is. He's terrified of me this time, and won't come out from under the couch. Maybe he knows I don't like animals much." 

They both crumbled at the thought of another tiny dog worrying me, so both knelt down to see if they could entice him out. I gave the brother and sister a quick signal to keep quiet. In an instant, there was a scream in stereo. Jill and Rachel both glared at me as I served up my revenge. 

One-one. And the dish wasn't even cold yet. 

As dawn approached, Jill, Rachel and I met on our third call of the night. We both arrived at the same time, and still just about had the energy to tease each other. 

"I'll tell you what," I said, "we'll make a deal. I'll make sure there are no snakes, if you take care of any dogs." 

"Deal," they replied in unison, as we walked up to the front door. 

A mother introduces us to the patient, her six month old baby, and immediately apologises. She talks in hushed tones, explaining that two other children are sleeping upstairs.

"You'd think I'd know better by now, after three kids, but I think I panicked a bit. She just coughed up a bit of her feed, and couldn't catch her breath for a few seconds. I'm sure she's fine." 

As Rachel checks the baby, Jill and I spot a huge fish tank, an aquarium that was more part of the wall, separating between two rooms. Dozens of beautiful fish swam around, adding colour and calm to the room. 

"Finally," says Jill, "an animal we can all agree not to be nervous of!"

"Well," I said, and Jill looked gleefully forward to me admitting another irrational fear, "I don't mind them if they're swimming, as long as I don't have to eat them!" 

"You don't eat fish?" 

"Can't stand the stuff. Can't eat it, smell it, look at it, or be within a mile radius of the stuff without feeling ill." 

"But you're not actually scared of them then?" 

"No. Not scared. It's just that I'd rather meet a live shark than a fillet of salmon or tuna steak."

At shift's end, I pack up and head for the animal-free sanctuary that is home. No dogs, cats, snakes, fish, or other creatures. Just as I was about to go to bed there's a yell from downstairs.

"Are you asleep yet?"

"Yes!"

"Good. Get up. My dad's had a fall in the high street and is a bit of mess. Can you go get him and see if he needs hospital?"

A grump, stomp and re-clothing later, I was back downstairs and ready to go out.

"Where is he?"

"He was helped up by some people but he didn't want an ambulance, so they helped him into some shop."

"Which shop?"

"The one next to the bank."

"There are two. One each side. Which. One?"

"Um, your favourite."

"My favourite? What's my favourite?"

"Umm, the fishmongers."

At least Jill and Rachel wouldn't find out.

The Keys to the Asylum

The council estate is a maze of rat-runs, dead end roads and multi-storey buildings. There's no logic to the numbering, and most of the buildings are unnamed, just to make it all that more exciting. The computer must know something I don't, as I turn into yet another alley and a disembodied voice from the sat-nav announces You have arrived. I drive around in circles, zooming in on the digital map trying to locate the tiny alleyway that was given as the address I was looking for, and try to find the man with the broken leg.

With no luck at finding the patient, I leave the blue lights flashing and give a couple of blasts on the siren. It's not too late at night, but still late enough that some of the neighbours, particularly children, may have been tucked up for the night. A few minutes later the crew follows me in to the multi-tentacled cul-de-sac. 

"No idea where this alley is, and no-one's come to find me." 

"We went up the other way first, no sign there either." 

After a few more minutes of searching up and down the same tiny roads, a figure appears at the top of a fire escape. "Oy! He's up here! Come on! Hurry up! What took you so long?" 

Not lying half dead in an alleyway then, and three flights of stairs up, probably not nursing a broken leg either. Nevertheless, between the three of us, we take all the kit we might need in case the call really is all it was stated to be, including a carry chair. As we reach the top of the stairs, Neil is sitting on a picnic box, his legs intact but his left arm bowed right in the middle of where it should be straight.

"How'd you do that then?"

His first words engulfed us all in a haze of alcoholic breath.

"Fell over, didn't I? Down that stupid alley. I told 'em someone was gonna get hurt, didn' think it'd be me now, did I?!"

We stabilised his arm in a splint and cleaned up a wound that he'd opened up on his eyebrow. It looked like it was an old scab that had opened up again.

"Do you fall often?"

"Nah, not really. Just a bit unlucky the last couple of weeks."

"How much have you had to drink tonight, Neil?"

"Oh, not much. Two, three pints maybe."

"Any other medical problems?"

"Yeah. My liver's knackered. They might have to replace it soon. 'Swhat the docs said, anyway."

"How'd that happen?"

"Well, I used to be an alcoholic. Not any more now though. Now I only have a couple of drinks a night, you know, when I'm at work."

"You used to be an alcoholic, but you're still drinking?" Then it hit me. "Hang on a minute. You drink at work?"

"Yeah. Course! There's got to be some perks to my job."

"Why, what do you do?"

"I'm a mixologist."

Oh. He's got an ology. "A what?"

"A mixologist. I mix all the cocktails at the bar."

"You're an alcoholic, and you work in a bar?"

"You bet. Does it get any better?"

"Well, your arm says it could probably get a lot worse." 

Cars

I don't know a great deal about cars, whether they have "Ambulance" plastered all across them or otherwise. 

I know that they need fuel, oil and water.

I know that you turn the ignition to start them, and turn the key the other way to turn them off.

I know what most of the controls do - which pedal does what and how far to turn the steering wheel.

I can, if needed, change a tyre.

Recently, I even ventured as far as changing a headlight bulb. If you own the same car I do, you would understand my sense of achievement.

But when it comes to cars going mechanically wrong, I have no idea where to start.

I have no idea what a cam belt looks like, or how many extra holes it would need if the car lost weight.

I have no idea what a clutch looks like. Then again, most Americans don't actually know what a clutch is.

I'd be too scared to change a battery or replace a spark plug. Do cars even have spark plugs?

However, I do know one thing for sure about cars.

If, when you start the engine and are about to head out on yet another call in the middle of the night, there is a loud THWUNK type of noise, and then, all of a sudden, sitting two metres in front of the car is a large, round metal piece of the engine, I know absolutely for certain that this is not a good thing.

Not a good thing at all.

Cycles

A children's channel shows quietly in the background. A young boy sits in a corner of the entrance hall trying his hardest to keep his eye on the television, as all around him chaos reigns. Dozens of people are in the house, men in one room, women in another. Children wonder between the two, the younger ones chasing each other, playing happily, their childhood seemingly unaffected by the grown-up reality all around them. 

A middle-aged, grey-haired man meets me at the door and guides me towards a side room. The house suddenly becomes silent as they see, hear and sense the intrusion of an unknown guest. Dozens of eyes follow me through the narrow corridor. Another man, of similar age and strikingly similar features to my guide joins us. He puts his hand on the handle, and just before we enter, he stops to explain.

"My name is Deepesh, and this", he says, pointing to the other man, "is my brother. I'm sorry you were called. There is nothing for you to do, but they said this was the only way." 

Deepesh opens the door, and motions me in. Two women are sitting at the other end of the room, their chairs angled gently towards each other. One wipes tears away as the other sits reading prayers from a book. Between them, lying on the floor and covered up to his face in a white sheet, is an elderly man. 

"He died a few hours ago," said Deepesh. "We called the family just before, when we knew he was in his last moments. Many of them have been here since then, many have joined us in the meantime. It is how we help his soul on its way. My sister and aunt, his sister, are the ladies in the room." 

It was the aunt who was crying. 

"We called the doctor to tell him that my father had died, but it was after hours, so they said we had to call for you. All we need is the certificate so we can prepare the funeral."

The call had been dispatched as a cardiac arrest. That would mean at least another three pairs of hands were on the way, possibly even four. I'd left the car and headed for the house with several bags full of kit and ready for a resuscitation. As soon as I had reached the front door, I knew that the equipment was surplus, and that any efforts would be futile. The calm, sad acceptance written on Deepesh's face told me all that I needed to know. As soon as I had seen his father, I called off the reinforcements. Distant sirens fell silent moments later. 

"We knew he was dying. A year ago, he was given three months, but he fought on. He wanted to see his first great grandchild. She was born last week, and he held her yesterday for the first and last time." 

Deepesh called to one of the children, and following an apology to me, asked them something in a language I don't understand. The child, a young girl of six or seven, her long dark hair tied in a plait, looked at him as if he was crazy. He, in turn just confirmed his request with a gentle nod of the head. A minute later she returned holding a digital camera, and handed it to him. He pressed a couple of buttons, and showed me the screen. Sitting there, a broad smile across his face and cuddling a tiny baby, was the same man who lay lifeless on the floor only one day later. 

"He knew it was his time." Deepesh wiped away the hint of a tear and stopped for a few seconds. "Only yesterday he sat holding the baby, and all he kept talking about was the cycle of life." 

Grown up children

It's always good to have helpful family on scene, 

particularly children assisting their parents. 

Sometimes, however, I forget,

that if my patient is 90-something years old, 

the "son on scene", 

or "daughter on scene"

are not going to be kids,

but very likely to be in their seventies... 

Medics are from Mars...

Transcript of a recent conversation with a patient:

"Do you have any chest pain?"

"No. Not pain as such. It just hurts." 

"Have you ever had any heart problems?"

"No. Never. Had a heart attack once, but never any problems." 

"When was the last time you had an ECG?" 

"An ECG? I've never had one. But they did check my heart last month with all those sticky labels on my chest." 

"Have you ever had palpitations?" 

"Never. Every so often I feel like my heart wants to jump out my chest, though." 

"Any other medical conditions?"

"No, no. Take medicine for blood pressure and diabetes, but no medical conditions." 

Patients are from Venus. Well, some of them, anyway. 

Oil Spill

Monday morning. 

Early. 

As the world begins its weekly ritual, a few tired night workers are preparing for their midweek weekend. Empty milk floats head back to their depots, their early morning rounds completed, many a front doorstep adorned with their goods. Autumnal sunrise greets the early risers, the sun shedding plenty of light but not yet enough warmth to clear the dew from the grass and the roads. 

Mike is one of the masses, joining the rat-race and heading into work. In an effort to make his journey easier and quicker, he abandoned his car in favour of two wheels. For months, he'd enjoyed the fact that he could cut through London's standstill rush hour, leave home a little later, arrive back a little earlier, adding a few precious extra minutes with his family every day. 

The call on the screen brings back memories, ones that I'm not keen to relive. Motorcycle under a van, status of patient unknown. When the call comes in, I'd just finished dealing with an acute case of probable paediatric schoolitis, a common childhood ailment, regularly apparent on Monday mornings. There were twenty minutes left of the shift. The call was some five miles away, and would take me straight past the front door of the station, frustratingly close, yet so desperately far. My relief was probably already there drinking coffee and awaiting my return. A few minutes later, Mike and I meet for the first time. 

Unlike the call I'd feared, Mike's head was visible, and he was actually sitting up, helmet off, and talking quite happily. His right leg, however, is wedged between the two back wheels of the van. His bike is lying on its side in front of the van, smashed shards of shimmering glass mingling on the road and glistening in the sunlight. Just in front of that is a small pile of powder covering what we presume is some oil on the road. 

"I don't really remember what happened, I just lost it on the wet road I think. Next thing I know, there's a van on top of me!" 

A quick conversation with the van driver gives us a few more clues and leads us to believe that Mike's had his leg run over by both the front and the first of the back wheels, with the van coming to a halt before the third wheel added insult to injury. 

Unsure of the exact circumstances, Mike's neck is immobilised in a collar and he's laid flat. The fire brigade, having arrived a few minutes later, have secured the van and lifted it high enough for us to get to see Mike's leg. His leathers are intact with only a few scuff marks, but his foot is lying at an unnatural angle, giving away the secret hidden beneath the leathers. As we cut the trouser leg away, the damage is obvious. Several breaks, the worst at the ankle. 

As usual, several things happen at once. A cannula is placed in Mike's arm, giving easy access for some pain relief. A scoop stretcher is placed under him, ready to move as soon as he is secured. Some bandages and a splint are applied to his leg. All while someone else checks for any other injuries, and luckily, finds none.

In the ambulance, once Mike was settled and his pain controlled enough, there are a few moments for a quick conversation.  

"I think you might have slipped on some oil, or diesel. There's a patch already covered up with some gravel, just by where you came off your bike!" 

"You talking about the white grit-like stuff?" 

"Yeah, that's it. Someone must have put it there not long before, it still looked quite clean." 

"Ah. That's not grit or gravel." 

"How do you know that?"

"Well, I work for a pet shop." 

"And?" 

"Well, I was on my way to work with a big bag of cat litter hanging off the handlebar..."