Globetrotting

I can hear the murmurings clearly. “He goes and wins the award for Blog of the Year and then promptly stops blogging!” I grant you, it’s a fair whinge. But trust me, the reasons are good ones.

I’m sitting in a room surrounded by suitcases, packing my life into bag after bag, ready to fly off in just a few hours. My London adventure ends here, whilst just over the horizon await a whole new set of challenges. Guesses have been made, since I first mentioned the fact that I had left the London Ambulance Service as to where I was going. Guesses ranged from the south coast of England, to the north coast of Scotland, to the west coast of Australia.

The truth is that I’m heading to the east coast of the Mediterranean – to a little country that punches above its weight in almost every aspect of its existence – Israel.

Let’s start at the beginning: My name’s Aryeh – and I’m an Insomniac. So you see, one of the reasons my blog had to remain anonymous was the fact that with an unusual name like mine, unique in the LAS (in more ways than one, I hear my friends cry), there was no hope of hiding behind a smoke-screen of a more common name such as Adam, or Chris, or Dave. At least in Israel, I can hide amongst the masses of others Aryehs.

It’s a funny old place. Laid back yet highly stressed, open-minded but highly suspicious, and people who are exceptionally friendly or incredibly abrupt – sometimes both at once.

The national ambulance service is completely different from the UK based one. There’s no government funding and it’s privately run as a fee-charging charity. The paramedics and EMT’s who work for them are divided between volunteers who live their normal lives around sporadic shifts and actual paid staff whose day to day life is the ambulance service. Working for them, assuming they accept my paramedic skills as good enough for them, will be a very different experience indeed.

In the meantime, I’ve discovered that I really enjoy teaching first aid to the general public and that might become a new string to add to my bow, either in between ambulance shifts, or, at least at the beginning, instead of them.

It’s a new start for my family and me – but it’s a new start that we’ve been planning for some time, so excitement is, at least for now, overruling the sheer terror of such a big move.

As for the blog, well, I’ll definitely keep writing. What started off as a purely cathartic exercise in creative writing has turned into a project of which I’m exceptionally proud. The writing may be a little sporadic over the next few weeks as we settle into a new reality, but stick around.

We may still have a lot to learn together.

Plumbing

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

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

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

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

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

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

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

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

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

"So my heart hasn't stopped yet?"

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

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

"Is it safe, this angioplasty thing?"

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

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

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

"Oh."

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

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

"Do you need me to stop?"

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

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

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

His body jerks with yet another shock. 

More compressions. 

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

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

"We're sure." 

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

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

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

"What's that?" 

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

Coffee Table

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

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

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

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

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

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

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

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

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

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

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

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

"You want to do what?"

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

"And your third option?"

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

"Do it."

"And it might take time."

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

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

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

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

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

Tammy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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