A Christmas Tear

This is a guest post by the person known on Twitter as @MadMedic1, and I thank them for it.
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A drizzly morning outside. Much like any other December morning of late. Inside, carols and banter filled the air in the warm mess room. Christmas greetings were being exchanged. It was, after all, Christmas Day.

Hoping for an easy start to the shift, we were treated to an hour or so on station to enjoy our little slice of Christmas before the world went mad and started to demand ambulances for the usual run of the mill calls such as abdo pains, chest pains and injuries sustained by adults testing kids toys/power tools/ drinking too much. One by one the crews left station, probably not to return till the end of shift, to go home and be with their loved ones.

Our turn was next. We were ready to face the day having had sustenance in the form of tea and shed loads of chocolate – surely the norm on Christmas Day? The phone rings, obscenely loud in the now almost empty mess room. No pleasantries exchanged from control. Never a good sign, especially given the day. Two words. “Cardiac Arrest”. Oh… Followed by another three words I certainly wasn’t expecting. “6 years old”.

My face must have said a thousand words. The colour felt like it had drained. My crew mate, now out of his seat as I repeated those words as I put the phone down and began to head for the garage doors, at a run. I almost never run. I’m built for comfort not speed, but I run. I run for jobs like this. Jobs where every second counts.

Soon we are flying or so it seems. Willing the ambulance to go faster. Thankfully, the roads are clear. Thankfully, my crew mate got new lead boots for Christmas, or so it seemed! Thoughts of this call being not as given run through my head. My crew mate for the day and I barely say two words to each other, which is unusual. Normally the mickey taking flows. Not now. We remain focused and hoping. Hoping this call is a mistake. We arrive on scene to find an FRU already stranded in the road outside the address. Abandoned quickly. Door not quite shut, left ajar in haste.

I grab my paramedic bag and run for the house. The front door is already open. I knock and go straight in. The scene of festive cheer in front of me immediately throws me. 4 children. Laughing. Playing. Shouting. Enjoying their day. Wrapping paper strewn within a 15 foot fall out zone that is the norm on Christmas day. For a split second I think the job’s not as given after all. Then a sudden realisation. Where is the FRU person? Where are the Parents? Remaining as calm as possible and with as much happiness as I can muster I ask the children where our colleague has gone and they point me upstairs without so much as looking up from their festivities.

Leaving behind the raucous laughter and happiness I make my way upstairs. Mary’s Boy Child by Boney M is playing softly alongside muffled and calm voices as I walk towards the bedroom door. Hung on the door, in anticipation of a morning of rejoice and celebration, a suit. Jacket, waistcoat and trousers. Festive red bow tie and crisp white shirt. All in miniature size. A size to fit a child. My heart lurches and I push the door open. Inside, the FRU paramedic is stooped slightly with her back to the door. In front of her is a bunk bed. Sat on the lower bed is a woman, rocking gently back and forth, quietly talking. The FRU paramedic straightens up and turns to me, drops her eyes and sadly shakes her head. As the FRU para moves out of the way I see that the woman is holding a small child in her arms. Gently kissing his head. His tiny body motionless apart from the rocking prompted by his mother. Dressed in pyjamas he looked asleep. Peaceful. Safe.

Mum looks up from her child and thanks me for coming, a wan smile on her face she also wishes me Merry Christmas. I nod, my gaze now dropped to the floor and I shift my feet from side to side, not knowing how to respond appropriately. Mum continues to talk to her child for a few moments more then becomes quiet, her eyes now shut. A single, fat tear rolls down her cheek. An awkward silence envelopes the room broken only when a man then joins us. Tall with a commanding presence he says hello and he too thanks us for coming. His gaze glassy but full of emotion. He is a larger version of the boy in Mum’s arms. This must be Dad. Numb with sadness and seeing that the FRU paramedic is now struggling with emotions I say that we’ll give them some time with their son but we’ll have to do some checks in a short while and we leave the room.

Stood on the landing we all have a moment lost in our own thoughts. Some tears shed, all silently wishing this wasn’t happening. Not today. Not at all. Not ever. Police and a duty officer are called to scene – formalities for situations like this. Still downstairs are the siblings. Blissfully unaware. Composure and strength regained we knock on the bedroom door. Certain procedures needed to be done. The parents leave us to do the formal part of our job and we continue in hushed tones and a great, overwhelming sense of sadness.

He had died some time during the night. He looked peaceful. Apparently, he always liked a lie in. Liked his sleep. But he had Cystic Fibrosis. A mild form that was being managed and wasn’t giving him much trouble of late. He had been well and very excited before going to bed last night. Ready for Father Christmas. His stocking hung on his bed ready…

We called the parents back into the room and left them once again. Paperwork to be completed. Such empty formalities but formalities just the same.

There was nothing left for us to do. The police had arrived and were downstairs talking to the children. Our time to leave had come. Unsure as to what to say we made our apologies and went to leave. Once more we were thanked. Thanked for coming. Thanked for giving them the time they needed. Thanked for doing the wonderful job we do.

As we left the house, all in quiet reflection, we were thankful that child had the most wonderful, loving family in his life. Bitter that his life was too short. That the outcome was so very wrong…

Social Networking

Courtesy of a good friend of mine over at Jumblerant - I've been directed to another discussion regarding the use of social media in the workplace in general, and EMS in particular. Admittedly this was an infraction that harmed no-one else but the person involved, and no patients or their confidentiality were compromised, but nevertheless the discussion points are there.

Is there an argument for total freedom of speech in and about the workplace, or should there be some limitations? Is chatting to a friend in private any different from posting a rant on Facebook or Twitter?

To my mind, and the rule I've tried to follow whilst writing this blog is that biting the hand that feeds you isn't particularly wise. So, say what you think, but think about how you say it!

What do you think?

Comments welcomed!

You Know You're in EMS When...

So this is the tweet I posted that started it all off: You know you're in EMS when you sit eating breakfast whilst watching amputations and impalements on TV.

After that, I thought it'd be good to hear what some other people think too, and the snowball started it's journey. These are the others that were posted. Read all the way to the end if you want to see my absolute favourite. Actually, there were two that I couldn't choose between. Having said that, I can identify with almost every single one of these!

Enjoy, and feel free to add some more in the comments...

You know you're in EMS when...

... you call a bunch of friends to meet up only to realise that they're all working because it's a weekday. Ah shift work. @flobach

... you're more unconscious than your "unconscious" patient at 3am. @goforfink

... a great sense of humour and no sense of smell are essential. @thesmurse

... you have extra gloves in your car, house, everywhere. @texaschef

... you consider asking your partner to start a line on you after a night at the bar. @texaschef

... you decide which hospital to transport minor calls to based on the food choice in the EMS room. @texaschef

... you somehow you manage to treat the patient with toe pain with the same respect as the patient with the genuine emergency. @justmyblog

... you've had to wait for hours in the emergency department for hours, without being a patient. @goforfink

... bed is a missed friend. @seanhfitz

... you've responded to back pain that's getting better, but they still call at 3am. @texaschef

... you have no shame taking the ambulance through a drive-through, and expect a discount! @justmyblog

... 2 hours sleep is considered a full night. @texaschef

... your crew mate takes the bumpy route when you're in the back. @ambulance_999

... you watch "Trauma" and wonder when your service is going to get stretchers like that. *drool* @goforfink

... you drive up to a width restriction and think "will I fit?" @MadMedic1

... you identify random places around town by the call you attended there. @seanhfitz

... you don't remember working a cardiac arrest at the end of your shift because you were asleep. @seanhfitz

... townspeople and ER nurses only recognize you when you're in uniform. @justmyblog

... you drive by an MVA (RTC) and not look at it, because you've seen worse. @texaschef

... you can eat, use the restroom and sleep, all in 20 minutes. @texaschef

... Friday and Saturday become the worst nights of the week. @goforfink

... you can work a 17 hour shift, running all night, and still find the power to go to the pub. @grindermedic

... you look at a person in the street and think "5 loops and call it!" @MadMedic1

... you can live off two hours sleep per night - as long as you have coffee. @justmyblog

... when you get ideas for your lunch from your patient's vomiting. @seanhfitz

... you tell patients "the gloves are for your protection". @ambulance_999

... you drive a Mercedes all day, then get in your car and try to indicate with the windscreen wipers. @goforfink

... you become a dustbin for everyone's poo. @christopher_mcg

... you've mastered the art of getting dressed whilst still dripping from the shower and still looking somewhat ok. @justmyblog

... you drive home after a night shift and realise you've treated the last three red lights as give-way signs. @999donkey

... you're looking for a friend's house at night and reach for the centre console to turn on the floods. @flobach

... when you use all your sympathy at work, and leave none for your family. @mrsinsomniacmed *ahem*

... when the flight attendant asks if any medical people are on board and you try to become invisible. @seanhfitz

... for you to have a good, challenging day at work, someone has to have a really bad one. @ColdGh0stR1der

... when your house is always an organised mess, and your rig looks like something out of Martha Stewart Home. @justmyblog

... you can judge exactly 350 yards, with or without the satnav. @MrTom_Abbott

... you can smell what's wrong with your patient before you can see them. @ambulance_999

... you eat every meal like it's your last, because you know the alerter will go off any second. @ambulance_999

... hot girls walk past you and you notice they have a curvaceous body, slender arms, and beautiful... veins. @flobach

... you utter the phrase "that's not that much vomit!". @510medic

... you turn off the radio to hear the sirens. @EMTDani

... you never have a wardrobe malfunction at work. @flobach

... you can pick the type of vehicle responding by hearing a far away and faint wail of the siren. @flobach.

... even at home, when the phone rings, without thinking you answer it "Ambulance". @multistar

...you know the streets of your patch like the inside of your pocket, but are hopeless outside. @flobach

... you walk into the messroom at 1900, and bid everyone "Good Morning". @insomniacmedic1

... you're off duty and hear sirens, and for a second think they're your sirens. @texaschef

... you go to grab a pen from your breast pocket... but you're off duty and in a T-shirt. @flobach

... you see a trauma in a movie, and immediately run through your assessment. @texaschef

... your wardrobe has a disproportionate amount of green in it. @saintpara

... you refer to you mirrors as whiskers for judging gaps in traffic. @idle_paramedic

... your life is ruled by three-letter abbreviations and complex terminology. @christopher_mcg

... you categorise people by what you think they'll die from. @saintpara

... you can't watch a medical drama without screaming at the TV every time some actor does something wrong. @multistar

... you've answered your personal mobile phone with your callsign. @thesmurse

... you have to stop yourself waving at ambulances / police cars when not at work. @saintpara

... you're constantly tired, over-worked, and under-paid. @multistar

... you're a passenger in any car and out of habit you say "clear left". @thesmurse

... you look on YouTube for car crash vids, and wonder how you'd extricate them. @yellowspanner

... you discuss decapitated bodies at the dinner table. @UKmedic999

 And my two favourites? These two laugh out loud moments of pure genius:

... you have too much blood in your caffeine stream. @theroaddoctor

and

... when anything over 8 minutes is just too long. @saintpara

The Mask

Patients;

Managers;

Ego;

Publicity;

Public education;

Anonymity;

Pride.

Go balance that lot!

I sent out a challenge, and dozens answered it, in comments on the blog, on Facebook, on twitter, in person. I have received suggestions, thoughts, ideas, humbling compliments, and on the whole, a strong recommendation not to reveal the face hidden behind the Insomniac's mask.

The main reason, although not the only one - an anti-management stance of mistrust. That in itself, is a sad reflection of the way social media is still perceived as foe rather than friend by the establishment. There is, of course, the potential to bite the hand that feeds you by blogging, but that was never one of the reasons for writing this blog. I'd like to take on the challenge of changing their view, but I'm not sure I'm up to that task.

Patients and their right to anonymity and confidentiality are clearly king. They are the reason we do what we do, they are the people who allow total strangers into their homes, their lives, and their vulnerabilities, with the promise that we don't then divulge their most intimate details to the world. To this end, as you all know by now, I change everything. Locations, ages, genders. I combine different calls to make one story, or divide one event into several different, unrelated posts. The tales I tell are effectively that - tales. Fiction based on real-life events. No patient has had their identity compromised.

And then there's the challenge of public education. Ideas such as the Chronicles of EMS, groups of visionary paramedics looking to advance their profession via open social networking and public media, could never work if we all hid behind masks. I'd love to get more involved, but at the moment, as an anonymous blogger, that's impossible. I could get involved in podcasts, as my face is probably more suited to radio anyway, but the options for exposing this to the public are limited, and therefore flawed as a plan for mass education.

Personally, my anonymity used to mean everything to me. It's still important to a certain degree, but every time someone guesses or knows outright that I'm the author of this blog, the pride I feel when they tell me they enjoy reading it, outweighs the shadows of anonymity that I crave. There's a voice that says I should be proud of what I have achieved, and that I should have no reason to hide, but then there's the other voice.

The voice that continuously asks "What if?".

What if there were repercussions from management? (Maybe one of them is reading this, and will have the courage or foresight to contact me? The email address is in the profile...).

What if I slipped up and did reveal a patient's identity?

What if I had to give the blog up all together?

For now, and I stress for now because this whole decision is finely balanced and on the brink of collapse, I'm staying hidden. It might well be the worst kept secret in the Ambulance Service, but for now, it stays a secret.

One day, hopefully, common sense, mutual trust, and pure, unadulterated ego will prevail.

When that happens, I'll lose the mask.

The Curse

The curse is well known. You can be busy as anything for days before, then on the day itself, nothing happens. Closely followed by something happening, but it'll be very mundane, dull, even boring. It is the Curse of the Observer. I've had many observers out with me over the past few years, some on a Vanbulance, and some on the Carbulance, but the vast majority have been the same. Cursed. Not every shift with an observer is so, but it does seem to be more often than not.

In fact, just as an illustration, I once had a very eager young lady join me for a shift. She worked for one of the big medical supplies companies, and had travelled from overseas, sent by her bosses, to see first hand how one of their new pieces of kit worked out on the front line. I was one of six people in London trialling it. She spent eight of the twelve hours of my shift hours with me and we did nothing. I mean nothing. We didn't see a single patient for the whole eight hours. Later that afternoon she had a flight to catch, so I dropped her off at a train station, and off she went. Moments later I was called to a hanging, and she missed exactly what it was she had come to see. I also had another few calls before the end of the shift, all of which requiring proper intervention. She missed them all. See what I mean? Cursed.

Having an observer has its positives too. It gives me the chance to learn from these people. Often they are medical students, nurses, or doctors. All cleverer than me, and will instantly fall into the trap of being asked a million questions about one of the many things I don't know or understand.

More importantly, however, is that it gives me the chance to show off. Not necessarily my skills per se, but to show off the world of Prehospital Emergency Medicine. To show how far the Ambulance Service has come in the last few years. To show how we are able to deal with situations that even the best doctor would find challenging. To show off what happens before the patient arrives in the hospital and is presented packaged, 4 foot high, and horizontal. And I love doing it.

Now, whereas I do my little bit in this promotion of EMS to the non-ambulance world, there are those out there who have gone above and beyond the call of duty, and have started a small revolution. This weekend coming, is the premiere of a production called the "Chronicles of EMS". What started as a trans-Atlantic, glorified shift swap between two of my fellow bloggers, 999Medic from England, and HappyMedic in San Francisco, has turned into a huge project that promises to try to change the Ambulance world forever. The initial idea of sharing and swapping thoughts and working practises between two people, has now got thousands involved through all sorts of media, social and otherwise.

The whole concept has taken off in ways that no-one had envisaged. It'll give us all a chance to pool ideas and ideals, to highlight what separates us and, more importantly what we share, and to make us all think about how we can go about improving what we do, as well as how we do it.

So as I go on entertaining observers and their curse, really and truly, I should count myself lucky. More than that. I'm not really cursed at all. In fact, I'm anything but.

Normal Service

Due to technical stupidity and incompetence, as well as some other unwanted problems, I've had to close down my twitter account and start up a new one. You are more than welcome to follow the newly restarted and originally renamed account at @insomniacmedic1. Yup, the 1 makes all the difference. Apologies to those of you who thought that I'd dropped out of the ether, which I kind of had done, but I'm now back.
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Along the same lines, I've had to change my email address as well. So should the spirit take you - feel free to email at insomniacmedic [at] gmail [dot] com.

Oh, and while I'm at it - I now feel that I have finally arrived in the world of blogosphere - I had my first ever spam comment yesterday! Woohoo!

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But for now, normal service is resumed...

Prayers Answered?

Conversations with patients and their relatives often turn to the weird and wonderful whilst waiting, ever longer, on scene for an ambulance. Ambulances are scarce at the best of times, but especially at this time of the year.

There's an absurd fascination in this wintry weather with attempting to stand on that frozen stuff on the ground and see if it really is slippery, and really does make you fall over, and really makes you break your arm/leg/hip. Let me help. It is. It does. It will do. So unless you absolutely have to - don't. Enjoy the view from the window, hot chocolate in hand, heating all around. Don't get me wrong - I fully understand, appreciate and endorse the need for building snowmen. And snowwomen, if you prefer. But stay off the ice! (The publication of this blog has been delayed due to MrsInsomniac doing precisely the opposite...)

Anyway - I digress.

Marik was one of those I'd term the "Worried well". He bought himself a blood pressure machine, just in case. And he had an hour-long head-ache, so he checked his blood pressure, which was fine.

Which worried him. So he took it again. And it went up.

Which worried him more.

So he took it again, and up it went, and he panicked. A little.

He spoke to the doctor on the phone who told him he was having a CVA, or stroke. Thanks Doc.

Well, that was it. Full scale panic. The FRU (aka clock-stopper), was sent, with the promise of an ambulance as soon as one became available. It may be a while. A history was taken, observations checked and found to be in perfect order, advice was given, and a request to be taken to hospital made. For various reasons I was unhappy about taking him in the FRU, so we'd have to wait for the snow/ice/leaves-on-the-track delayed ambulance to arrive and convey.

Whilst passing the time of day, I have a good look around the room and check out all the books. I have a bad habit of doing that, as it gives me a very good clue as to who the people in front of me are. I find that you can learn a lot from books, and not necessarily just by reading them. I see books on all the sciences, especially physics and maths. Books about stars, planets, discovery, the world, and its place in the universe.

Then I see bibles. Dozens of them, in a dozen languages. Shelves of them, 3 books deep, each shelf holding one of the languages. I'm a little surprised. Not at the fact that there is a bible in the house, but at the sheer volume and variety. I'm forced into a corner. I try not to show my curiosity/nosiness or whatever you want to call it, but on the other hand, I have to ask.

"Do you sell bibles for a living?"

"Well, in a way, I guess you could call it that."

"OK. What do you mean?"

"As you ask, I have to be honest. I don't like to tell everyone, but I'm a Prophet of the Lord!"

Now, how do you respond to such a statement? I want to say "A What???" or "Are you sure???" or, probably less appropriately, I want to shout "What the hell are you on about???" I didn't say any of them. I was much more profound.

"Oh", I said. For good measure, I think I even added an "I see".

Then he went on to talk about how he uses his knowledge of science to help him spread the word of God, help him understand, help him make the world a better place. He told me how he received his information, how he knew what to teach. He told me about the messages he received. They were the equivalent of the Twitter Direct Messages. @Prophet. @God. Cool. Wish I had that sort of inside information.

I also wondered if he'd been sent to help out an old friend of mine. I wonder if his prayers have finally been answered.

Tweet Tweet

I'm going to give this a go. I've been on Twitter for a little while, keep trying to use it, and I'm slowly getting the hang of it. I've even got a few followers. Which I think is cool. So, if you feel so inclined, and can cope with even more of my ramblings, you can now follow me on Twitter @insomniacmedic. It's going to be a bit of an experiment, and if I seem to get the hang of it, I'll keep it going.

You could always let me know whether you think it's worth it! For now, Tweet Tweet!