Last Light of Day

The first I saw of Mel was a late summer's evening, when we were called to her house for a very simple transport. Arriving ten minutes earlier than the scheduled pick-up time and understanding the significance of the call, we waited outside in the ambulance for those few minutes. As the clock struck on the hour, we knocked on the front door and waited. 

"Oh, you're here! Sorry, we're running a few minutes late." Rob looked tired and hassled as he moved a small suitcase out of the way so that we could get in.  "I've never been a good one for time keeping, that's always been Mel's job. Speaking of which, you'd better come in and meet her." 

Rob shows us to their bedroom, as Andy and I size up the corridors and turns to see which will be the easiest route out again - on a wheelchair or the trolley bed - but the last corner is too tight for the latter. Mel's eyes are closed as we walk in, but she still manages to welcome us. 

"Hi guys. Let me guess, he's running late, right?" 

"Well, yes, but take your time. We're in no hurry. We're either here in your lovely home, or out there fighting with drunks. I know which I'd prefer." 

"Has he offered you tea yet?" Mel gives Rob a look of resignation, as if all the lessons she's been trying to teach him have failed to register. 

"No. We're good thanks. Too much tea is an occupational hazard we need to avoid. Not enough toilet stops, you see." 

Mel manages a smile as Rob steps out to finish packing. All around her are cards and flowers, messages of support cover the bedside table and windowsill. A single picture in a frame sits in the middle of all the cards. A photograph of two young children, one boy, one girl, both in school uniform, lazing on a wooden bench in the shadow of an enormous tree. 

"Twins?" Andy asks, pointing to the picture. 

"Twins. But born a day apart. Well, ten minutes really, but one each either side of midnight. I'd always heard stories like that, but never thought it would happen to me!" 

"Cool. How old are they?" 

"Eleven. That picture was taken two days after I was diagnosed, three years ago, so I guess they must have been eight then. I'm sure they'll be down in a second." 

Rob comes back into the room with a glass of water for each of us and behind him, as if on cue, are the twins. 

"Ah, maybe I have taught him something after all!" 

"Oy, be nice! Or I'll tell 'em to drive you over every pot hole from here to the hospice!"

"You wouldn't make my last ambulance ride a bumpy one, would you guys?" 

"We wouldn't dare! Well, not unless the money was good enough!" 

Last minute logistical arrangements meant that the twins would come with us in the ambulance, whilst Rob would drive his car, leaving them with transport to get home again. As we wrapped Mel in a blanket on our wheelchair, she remembered to check a few things with Rob. 

"Are the kids' uniforms ready?" 

"Yes." 

"Their lunches?" 

"Yes!" 

"You set the alarm for the morning?" 

"For heavens' sake, Mel. YES! Have some faith, won't you? Now, I'll be back in a second, just going to lock the back door." 

We wheeled Mel to the front door and waited for Rob. The twins stood just outside, half staring into the back of the open ambulance, its tail lift sitting on the floor waiting to swallow its precious cargo. 

"Shall I switch the hall light off?" Andy asks Rob. 

"Actually," says Mel, "do you mind if I do it?" 

We lift Mel just high enough in the wheelchair so she can reach the switch, and as the sun sets through the clouds outside, the hall is engulfed in the orange glow of the last light of day. 

Big Problems

Remember this post about drunkenness, and the discussion it generated? I still don't have the answers, but I'm always coming up with more questions!

So, here's another one. Go read the following article and watch the video, then come back.

http://www.bbc.co.uk/news/health-12287880

How do we deal with another one of society's big problems? And yes, the pun was intended. These ambulance and hospital adaptations are not for the almost run-of-the-mill 100+ Kilo (220+ pound) patients. A two-person crew will regularly need to carry these sorts of patients down a flight of stairs. 

These specialised beds, equipment and ambulances are for patients double that, sometimes, as the report suggests, even triple and more. I sat listening to an overnight radio presenter talking about it, and listeners calling in adding their suggestions, frustrations and solutions. As usual, there were the calls for these patients to pay for their specialised care, or be refused it. Passions ran high between those who have clearly never experienced the problem, and those who face it on a daily basis. People were claiming that as morbidly obese patients bring their condition upon themselves, they don't deserve free NHS treatment, whilst the obese themselves (by their own admissions, this was radio after all), claimed that life-style choices are not the benchmark by which the NHS allocates treatment.

So I ask again.

What about smokers who suffer lung cancer as a direct result of their habit?

What about extreme sportspeople who get injured in their pursuit of adventure?

What about drunks who fall and crack their heads open due to their intoxication, be it acute or chronic?

Do we bar all of them from free treatment, as these are all self-inflicted?

The NHS is still, for the most part, a free service, and proudly calls itself the envy of the world. Its staff, for all their grumbles, are proud of what they do and are dedicated to it.

But everything comes at a cost.

For every bariatric ambulance, somebody, somewhere, will be denied some other treatment.

And whilst the ambulance in this report seems to have all the equipment, there's still one glaringly obvious omission.

What happens when there's a flight of stairs to contend with?

What about the physical cost to the crews?

I only have the questions, and an undecided mind.

Answers are another thing all together.  Education is clearly one of them, as with everything else, but over and above that, I really don't know.

Do you?

Real World

In her late 30s, she's barely older than either of us, but her body's betrayed her already. Lying in her bed at home, her face is gaunt and gray, her limbs little more than skin-covered bones. Her breaths shallow, laboured attempts at feeding the cells with the oxygen they crave, whilst sunken eyes share their fear and sadness with all those present.

We're there on a mission of mercy. The call is neither an accident or an emergency, but a penultimate journey that no-one wants to be a part of, one where everyone understands its necessity. A hospice bed awaits at the end of this transfer, a gentle room, surrounded by large windows, the other side of which is a beautiful garden, lovingly tended to by a gardener who clearly realises and appreciates the significance of the nature he maintains.

Kara's cancer had almost beaten her. She'd been given weeks to live, and she, her family and their doctor had agreed that she should spend that time with round-the-clock palliative care on hand. There was nothing left to do, other than make those final hours and days more comfortable, as pain-free as possible. Tony, her partner of three years smiled through his tears, making no attempt to hide them as we moved her as gently as we could onto the trolley. Her parents stood either side of the door, a guard of honour testament to her bravery, and whilst her mother's tears flowed, her father's tear-soaked eyes were held back by a stoic dam, ready to burst at any moment.

We wheeled Kara as slowly as we could, feeling every bump almost as much as she did, whilst she'd reassure us.

"It's fine, I know it's not you. I'll get Tony to sue the council". I'm sure the reassurance should have headed in the opposite direction.

Tony travelled with us in the ambulance and brought with him a large pink, flowery case with a few of Kara's things. Pyjamas, some make-up, her favourite books.

"Not really my colour, is it?", he says, as he drags it up the back steps. Kara smiles, and everyone else forces one too, especially Tony.

A few minutes travel down the road, and we arrive at our destination. A suburban setting, hidden in its very own forest, away from prying eyes and the noise of the real world. It's a truly beautiful place, serene but never sombre. The staff have an amazing talent of making everything seem just right, nothing is ever too much effort, from simply spending as much time as needed to make a pillow just right, to attending to all the medical needs.

We wheel Kara into her room, number 3, and help her settle before handing over to the tender and experienced hands of the hospice nurses.

We turn and leave, saying goodbye to Kara, Tony, and her parents, and they in turn thank us for our kindness. Why is it that it's always the people who don't need to say "thank you" who are the first to do so?

We load the trolley back into the ambulance and sit for a while in silence. The radio blares out a song that seems completely at odds with what we've just done and where we are, and we both reach for the off button at the same time. The comedy of hands slapping each other breaks the tension, and we leave the grounds, back out onto the main road and into the real world.

Two weeks later we were back there, taking another patient to be cared for, just for a while. In her late 80s this time, Lira was going into respite to give her equally elderly husband some time alone, time to care for himself a little.

"It's just a week, Lira", he tells her, "just some time for me to tidy the house properly for you". He looks exhausted, and explains that he'll be living with their son for the week, just as a break, so he can go back to looking after her as soon as she's home.

Elaine, one of the nurses, directs us. "Second room on the left".

"Isn't that room number 3?" I ask.

"That's the one. Beautiful view of the gardens", she adds, turning to Lira as she does so.

"We know it". We look at each other and think back to the previous fortnight.

And back to the reality of the real world.

Far Too Young

The unusual sounding family name on the screen rang bells, but I couldn't remember why. The call was for an inter-hospital transfer, so no clues from the address either. As we walked into the department with the trolley, as requested by the all knowing computer screen, we saw the critical transfer bag sitting innocently near one of the rooms.

She was lying on the bed, barely conscious. Her dad was sat next to her, his eyes filled with sadness. The type of sadness and fear a parent tries to hide from their child, but can't.

As soon as I saw them, the name fell into place. They were an amazing family who I'd met a couple of times before, and she was always there to help with whatever we on the ambulance or her parents asked her to do.

Once, I'd delivered one of her siblings, and she ran around bringing towels and looking after the other little kids.

Calm, unflustered, more mature than her tender years. Far younger than she acted.

Once, I'd taken one of her siblings to hospital after an accident involving a trampoline left their arm in pieces, and she ran around gathering clothes and bottles.

Responsible, obedient, respectful. Far younger than she behaved.

And this time, I was transferring her.

Taking her to where they might be able to do something.

A last, lost hope.

In reality, it'll probably be the place where she'll live out the last few days of her terminal illness.

She'd been diagnosed a week before.

Far too young, at eight years old.

At Home

And so, with no pomp or circumstance whatsoever, it came to an end. A mundane call just before six o'clock in the morning, a simple handover to the crew, and a slightly solemn and very lonely drive back to station. I don't know what I was expecting or hoping for.

Almost five years ago, I started it for the first time. It lasted 6 months, and I hated almost every minute of it. I stuck at it because it was challenging and different, but I still couldn't stand it. At the end of the allocated half-dozen moons, you couldn't see me for dust in my haste to get away. Maybe I was just too young and inexperienced, maybe I was just lacking in confidence. Whatever it was, I was pleased it was over.

Almost two years ago, through lack of choice and with fear and trepidation, I went back to it. Last week it came to a halt, again through no choice of my own. My time on the FRU, the single-manned (personed) Fast Response Unit, has ended. All the things I hated about it the first time round, I loved this time, and I will sorely miss. I guess I'd grown up a little in the interim, and eventually started to feel at home in the FRU.

The most appealing is the challenge of having to think on your own, often for extended periods of time, and sometimes with very ill patients.

Starting a resus on your own and having to carry it out with no back-up for quarter of an hour.

Managing the asthmatic patient who's deteriorating before your very eyes.

Relieving the pain in the elderly patient who's fallen and fractured their hip.

And being unable to transport any of them.

Delivering a baby and praying for it to take its first breath.

Supporting the dislocated shoulder of a brave kid and watching them get drunk on entonox.

Sticking a plaster, or a band-aid, depending on where you are, on an adult who's behaving like a spoilt child.

And telling him so.

Being the first at the scene of a suicide attempt, working hard to save a life, only to see the patient whisked off in the ambulance or the helicopter, and staying at the scene filling in paperwork.

Being the first at the scene of a fatal accident, and having to call it before anyone else even turns up.

Being the first at the scene of a cardiac arrest, a terminally ill cancer patient, and grieving with the family.

And being left alone with your thoughts and a cup of coffee.

Travelling with a crew and them hating you for pulling rank.

Travelling with a crew and them loving you for pulling rank.

Travelling with a crew and the patient thanking you all. Together.

And having to justify it all. To control, to the crew, to the patient, to yourself.

Now, it's back to a mix of real ambulances and a few FRU shifts, but it won't be my car.

It'll be nice to have someone to share with, someone who I can look at over my shoulder when I'm unsure, and hopefully vice versa, someone to sing along to the radio with between and on the way to calls.

They say, whoever they are, that a change is as good as a holiday. Truth is, I could really do with one right now. It's just that I'll miss being at home.

Who'd have thought it?

Hero

I met a true hero the other day.
Not a celebrity. A hero.
Here was a man, who after surviving the horrors of one war, went back to fight another.
Voluntarily.
Not because he wanted to, not because he was made to.
Because he felt he had to.
A very public war.
He went to defend his Country, his People.
His Way of Life.
Now he was fighting his own, private war.
Three wars in one lifetime may be just one war too many.
Still, once a hero, always a hero.