The week that's been

We see things. 

We see things that otherwise are seen only in movies, 

or in overactive imaginations. 

We see things that should never be seen 

and that cannot be unseen. 

We see the amusing, we see the frightening. 

We see things that others can only wish to see,

and that we are privileged to share. 

We see the sublime, the ridiculous, 

and everything in between. 

We see magic at its very best, 

and life at its very worst. 

We see trust and betrayal, belief, 

and the loss of all hope. 

We see acceptance of fate, we see denial. 

We see life end and life begin, 

first breaths and last. 

All in the space of a week. 

Unwritten Rules

The first clue was the fact that the apartment was on the fourth floor. It's the internationally recognised, first unwritten rule of ambulance work that the higher up the patient is in the building, particularly if there's no lift, the more likely they are to need carrying down. A voice hollers out of the window, through the security bars that seem totally unnecessary on a window so high up. 

"Bring some bandages, you're going to need them!" 

We're already carrying a supply, along with oxygen, a defibrillator, a carry chair and all other manner of equipment that we may or may not need. Unwritten rule number two is that whatever piece of kit you leave behind, is exactly the one you're going to need for the patient, so often we carry too much, rather than be stuck with too little. 

The trail of blood that greets us at the front door leads us to Berhanu, an ancient looking Ethiopian man, surrounded by concerned family. Three people start talking to us at once. 

"It happened yesterday too!" 

"He's on all these tablets!" 

"We tried to stop it, but it keeps filling up again!" 

Eventually, we calm the scene and reach Berhanu, finding him chirpy and unconcerned, unwritten rule number three proving yet again that often the family panics a great deal more than the patient. He was sporting a self-made blood collecting device around his foot, proudly showing off the handiwork that we were just about to dismantle. First, we remove the plastic bag, within which must have been a couple of hundred millilitres of blood. Next, we gently removed the DIY bandage that was held in place by sellotape and electrical tape, and that was made up of blood-soaked tissues, cotton wool and torn up pieces of newspaper. Finally we could see the ruptured vein just above the ankle. It was pouring out his blood as though someone had left a tap running. The tourniquet that he'd fashioned out of several elastic bands was doing nothing other than leave nasty marks further up his leg.

Within seconds, we applied a new bandage, lots of pressure and raised his leg, all in an attempt to stem the flow. It took some time, but eventually it slowed to just a trickle and then all but stopped, meaning it was stable enough for us to move Berhanu to hospital. 

"I'll walk!" he says, watching me open the carry chair. 

"I think it's better if you don't. We don't want that to start bleeding again." 

"I have walked every day of my life for the last eighty-five years, and up and down those flights of stairs for the last ten. You're not carrying me!" 

We pleaded with him. His family suggested, begged, shouted, instructed and cried at him. Nothing would convince Berhanu to sit in the carry chair. As a final attempt, my crew mate told him that the rules said that anyone who was bleeding, even a little, had to be carried. 

"Where does it say that?" 

"In my rulebook!" 

"Show me." 

"I don't have it with me. But believe me, it's there." 

"I don't believe you, and I won't be carried. Rules or no rules." 

He stands up, refusing all offers of assistance and takes a step towards the front door. All of a sudden, a trickle of blood appears below the bandage and within seconds it's dripping onto the floor at an ever-increasing rate. Defeated, he sits down again, allowing us to start the process all over; redress the wound, raise the leg and wait until the pressure and some gravity do the job again. 

When we're ready, Berhanu looks up at us and motions towards to the carry chair. 

"Good choice, we don't want to go through that again." 

"It's not really in the rulebook, is it, carrying bleeding people?" 

"Well, not specifically, no." 

"Unwritten rules, I guess. I suppose you have to have them too." 

Then and Now

At a Remembrance Day parade, several hundred war veterans, many of them well into their eighties and nineties, marched past an equal number of supporters who lined the streets of Whitehall, me amongst them. As long as I was in the country, I had attended every single parade for as many years as I could remember, supporting my grandfather, my great-uncle as well as all the other veterans. As they reached the Cenotaph, the cold, grey war memorial reflected the overhead skies. A fine drizzle had fallen all morning, coating the roads and pavements, but in an apparent show of respect had stopped falling as the veterans started to march. The Royal Air Force band escorted the veterans, the mix of young and old stark, but reassuring. A continuation of the generations, a knowledge that freedoms had been bought at huge cost, but that there were still those who would go on paying the price. It is both encouraging and tragic all at once, the knowledge that there are those who will continue to fight, alongside the reality that the need still exists. 

At the sound of the bugle, the flags are lowered and heads are bowed. An air of solemnity replaces the noise as a minute's silence begins, a silence crudely broken by the crackle of a police radio nearby and the words "Possible cardiac arrest on parade, St John Ambulance staff on way." 

When I look up from my place in the crowd, I can see the first shuffling of feet, clearing a path for the medical team and I approach the police officer to offer my help. He immediately pulls the gate aside and allows me through. I arrive at the same time as the team, explain who I am, and they gratefully welcome an extra pair of hands.  

The normal frenzied actions of a full resuscitation attempt are underway, but there is an acute awareness of the moment. Instructions are whispered, actions carried out in silence, even the ambulance arrives with blue lights flashing but the siren mute. The only loud instructions come from the defibrillator, as it advises to all who care to hear "Shock advised! Stand clear!" The orange button lights up and I press the button, wishing that there was another button to be pressed that would silence the instructions too. 

I never found out my patient's name, and the last I saw of him was in the back of the ambulance as he was taken to hospital, his chances of survival in single percentage figures. 

Against the odds, a few months later I found out through the grapevine that he had survived, and at the following year's parade, my grandfather pointed him out as he stood proudly alongside his comrades once more. 

Over a decade has passed since that day. Since then, I have left London, moved countries, and started on a new EMS path with a new organisation. The system may be different, but the patients are the same. They call when they are at a loss for any other options, sometimes they really need us, sometimes they just don't know where else to turn and hope for someone to share the burden and hopefully offload it.

Outside of work, we have made our home in a welcoming community, have made new friends as well as reconnecting with friends from days of yore, have moved nearer to some family whilst leaving others further away than ever. The number of expats is also fairly large, and so there are frequent visitors from overseas. Yesterday, I was introduced to one of the visitors, a friend's mother.

"Oh, so you're the paramedic?"

I'm not sure why I still find that question a little ominous.

"That's me."

"Did my son ever tell you about our story with ambulances?"

"Don't think so!"

"Well, about ten or eleven years ago, my dad was on a Remembrance Day parade and collapsed. St John Ambulance were there, they started doing CPR and they got his heart started again, and..."

I finished the sentence for her.

"And he was on parade the following year."

We both stopped in our tracks; the coincidence incomprehensible. She went on to tell me that her father lived another seven years after that day, long enough to meet his great-grandchildren, to see how the family continued to grow.

It is an occupational hazard, the knowledge that we almost never find out what happens to our patients once they are conveyed to hospital. But every so often, even if it takes a decade, we hear of remarkable stories such as this one.

My first successful resuscitation was on a gentleman whose grandson, years later, became my friend.