DVT Confusion

When is a DVT, or deep-vein thrombosis, more dangerous to an ambulance crew than it is to the patient who's had one? Consider the following conversation:

Medic: "Does your husband have any medical conditions?"

WifeOfPatient: "Yes, he's diabetic and has high blood pressure."

Medic: "Any medications?"

WOP: "Oh, lots, I'll show you the list." A list is promptly produced. On there, alongside medications for the ailments already mentioned, is warfarin.

Medic: "Why is he on warfarin?"

WOP: "Oh, that's to thin the blood."

Medic: "Yes, well we know that bit. But why does he need his blood thinned?"

WOP: "Oh, he's got that thing, you know, the thing that's like a video or television thing."

Medic: "Pardon? What's TV got to do with blood thinners?"

WOP: "You know, that new-fangled thing they use to watch films now!"

Medic: "Nope. Still confused."

WOP: "Oh! I remember now. It's that thing in his leg. A DVD! Told you it was like a telly..."

Just so you know, it's a little difficult to treat your patient when you and your crew mate are having fits of the giggles...

Edna and Eddie

Surrounded by his wife, children and grandchildren, Eddie sits in an armchair so huge that it seems to almost swallow him up. 

"I'm alright," he says. "Don't know what all the fuss is about!" 

His face is pale and the sweat is pouring off him, whilst his arms hang down lethargically by the side of the chair. He denies any pain but does admit to feeling a little dizzy. 

"He's had heart trouble for years," says Edna, his wife of almost sixty years. "Never makes a fuss. Always ignores any problems until they get really too much." This time, he'd passed out for a few minutes, giving the family enough time to call for the ambulance before he came round enough to object. 

"I'm fine, I tell you." 

"Let's have a look at you and we can see what's going on. It'll only take a few minutes." 

"Oh. Do what you have to do. But I tell you there's nothing wrong that a drink down the pub with a couple of young ladies wouldn't sort." 

Edna shakes her head and rolls her eyes. "Oh, do stop messing around Eddie. You frightened the life out of the children you know. And me for that matter!" 

It takes only for me to feel for a pulse at his wrist to tell me what the problem is, or at least part of it. 

"Eddie, do you have a pacemaker?" 

"Not yet. They were talking of giving me one a while back when I kept getting dizzy spells, but whatever the problem was went away so they didn't think it was necessary." 

"Ah. I think they might have to think again. Your pulse is less than half what it should be!" Attaching him to the monitor, I hit the alarm silencing button before the irritating whine even has the chance to tell me what I already know. The number 28 appears in a bold yellow highlighted box at the top left of the screen and the flicker of a heartbeat flashes across the monitor only every other second. At least his blood pressure was behaving itself. "You're definitely going to need to pop up to the hospital. Can't have your heart only doing part time labour for full time pay." 

Moments later, the rumble of a diesel engine struggling up the steeply inclined street tells us of the ambulance's arrival. Tanya and Michelle step into the house, bringing a carry chair with them and a smile to Eddie's face. I introduce them to Eddie, explain the situation and tell them what I'd found so far. 

"He says that a drink down the pub with two young ladies should sort the problem." 

"Well," says Tanya, "it doesn't seem to be working so far. We've turned up, and your heart rate still hasn't picked up!" 

"Oh," Eddie replies, "well it might not be beating any faster, but, I can tell you, since you two walked in, it's certainly beating much stronger." 

Edna, for what must be the millionth time in their marriage, shakes her head and rolls her eyes.

Two Feet

The rain is pouring down and I can't help but step across some muddy grass to get to the front door. I ring the doorbell and am thankful when it only takes a few seconds for Wendy to open the door - a torrential downpour is not my favourite choice of climate. As she pushes the door outwards, she looks back into the house and shouts. 

"They're here!" 

I wipe my feet and as I walk in I accidentally catch the strap of the bag on the door handle. 

"Can't your mate help you carry any of that?" 

"It's just me for now. There'll be another ambulance along soon enough." 

"Well, I don't know how you're going to get him off the floor on your own! I mean, he's been there for hours, and I've tried all I can do. He just keeps shouting at me that it hurts!" 

"Let's have a look and see. If I can help him on my own, then we'll do that. If not, I'll make sure he's comfortable, and we'll wait for a couple more pairs of hands." 

Clive's lying flat on his back, his legs in the kitchen, whilst his head and torso are out in the narrow corridor. It's rarely that these falls occur somewhere simple, and I have no choice but to step over him repeatedly, assessing for injuries and vital signs. 

"As long as I lie still," Clive's voice has a sing-song quality to it, "I really don't feel that ill. But if I try to get up or move, well, that's a different kettle of fish altogether." 

"Where's the pain?"

"In my left hip. I've already had the right one replaced, and I expect I've got the same treatment coming up now on the other side." There's no way I can move him on my own, and I've just been helpfully advised that the nearest crew may as well be in France. 

"The boss tells me you've been down here for hours. What time did you fall?"

"Oh, no. I only fell about ten minutes before she called you. She gets a little confused at times." He whispers the last bit, hoping not to upset his wife of more than fifty years. 

"I heard that!" She yells, out of sight, but clearly not out of earshot. "I don't get confused, thank you. Just forgetful!" 

Clive beckons me nearer. "Forgetful then, but selectively good hearing too."

"OY!"

"Told you!"

The crew arrive over half an hour later. In the meantime Clive's had all the pain relief I can safely give him, any minor wounds have been bandaged and I've strapped his legs together to try to take some of the strain off his hips. It takes about the same time again to manoeuvre a scoop stretcher into place to try to get him out the house. 

We split the scoop in two, separating the hinges at each end and gently move each side underneath him. We need to keep him as straight as possible to avoid moving his hip, but there's no way the now rigid stretcher will make the turn around the tight corner and into the narrow corridor. We try moving further into the kitchen to get a different angle, then try again to move in the opposite direction. The only success we have is in leaving dark footprints on the cream carpet. 

"I'm sorry, Clive, but there's nothing for it. We're going to have to stand you up. But don't worry, we'll keep you on this stretcher, strapped in, so you won't actually be standing at all. Is that all alright with you?" 

"No problem. Just do what you have to do." 

We add some extra straps for support, forming a "figure-8" around his feet and the bottom of the scoop, ensuring that when we stand him up, he won't move anywhere. 

"You can close your eyes if you like, it's probably a bit of weird sensation rising like a zombie." 

"With all that stuff you've given me, I feel like a zombie anyway!"

"Ah. That'll be the morphine. Told you it was good stuff." 

"You weren't kidding!"

After more to-ing and fro-ing, furniture moving and a few more wet, muddy footprints on the carpet, we finally manage to get Clive out to the ambulance and make sure he's as comfortable as possible for the journey. His wife joins him, and just before I shut the doors, I apologise. 

"Sorry about the footprints. If there's a next time, which I hope there isn't, I'll come in barefoot. Failing that, you could try calling when it's sunny instead." 

"Don't worry about it," says Clive. "Hopefully the next set of mucky footprints on there will be when I'm back on my own two feet." 

Sppel Chekking

I admit, I'm a pedant. I don't claim to be perfect at it, but to me, spelling matters. 

I have an editor and a sub-editor for this blog who regularly pick up on mistakes I make, as well as using the sppel chekking fasility, because grammatical errors aren't picked up. 

So, in a begging open letter to our call takers, I ask you to please check your spelling. 

I know that if the message on the screen tells me the patient has "palpertayshuns", I can understand what it means. 

I know that if the patient apparently has narrowed "artoreys", he's at risk of heart problems, and not, as would seem at first glance, that he's a high-risk attorney. 

Vomiting. It has one 'T'. Lots of carrots and a dreadful smell, but - Only. One. T. 

Assmah. Really? Or are you just sending coded messages as to what you think of me? 

Stares. As in "The patient fell down the stares." Into my deep, dark, bloodshot eyes? 

And many, many others. Some amusing, some confusing. 

So please, dear call takers. I know it all happens in a hurry, I know the callers aren't always calm, clear and concise. And believe me, I know, that for all the tea in China, I couldn't do your job. But I beg of you; please, please, check your spelling before sending it down the computer to the often baffled crew... 

Anyone else out there got some good ones to share? Feel free to add your comments!

English for Americans

It's multiculturalism at its best. London's a melting pot of people, of languages, of cultures. 

My Hindi is coming along nicely, I understand a few Polish sentences, and I still remember some Japanese I learnt in school. 

Arabic is on the tip of my tongue, Spanish is a rare necessity, and I can count to ten in a variety of others.

Thanks to a very good friend I even understand and speak a slice of Dutch. 

Gouda. 

See? 

French still eludes me, but I can always ask any passing school kid. 

However, there's one language that I still cannot understand. There seem to be no online translators for it either. Which language? 

Americanish. 

I gather that the Americans feel the same about English. 

So, in the spirit of co-operation, and with many thanks to Jumblerant (a compilation blog with regular posts of genius), I present the English for Americans poster. 

Clear as mud, right? Now if only we could get the ambulance service equivalent... 

Signs of Life

A thin sliver of sky turned from dark to dawn as a new day started to break over the horizon. Birds hidden in the leafy trees sang their chorus as two ambulances arrived simultaneously, shattering the peace. A police officer stood banging on the front window trying to raise the occupant's attention. As we joined him, a neighbour approached. 

"She hasn't moved from that chair for days. I reckon she's dead by now!"

"And what made you call us this morning, instead of days ago?" 

"Not sure. I was just about to go to work, I'm a tube driver, y'know, that's why I start early and thought that this is ridiculous. So anyway, I called the Old Bill. Why don't they just smash the door in?" Six sentences all at once left me wondering which to deal with first. 

"I think they need to make sure that that's absolutely necessary before they take drastic measures. Believe me, if they think that they need to, they will." 

I stood alongside the officer at the window, and could see now why they weren't breaking the door down. Despite the occupant being somewhat obscured by a television and some other household furniture, we could clearly see the rhythmic movements of someone breathing regularly. 

"She's deaf y'know!" We all turned to look at the neighbour. "Last fifteen years she can't hear a bloody thing if she ain't got 'er aids in! I think she leaves 'em out on purpose sometimes!"

"You didn't think to tell us that ten minutes ago when we started waking the neighbourhood?" 

"Errr... Sorry." 

"How old is she, anyway?"

"Dunno. 'Bout eigh'y, nine'y I guess." 

A police van turned up carrying the duty sergeant who was quickly brought up to date on the story so far. I shot him a mocking look, knowing that it's rare for stripes to come out when it's dark. 

"Slow night." He shrugged and smiled. "Fancied some action!" 

He suggested using the van's search light as a last attempt at waking the probably slumbering lady before having no option and breaking in through the front door. All we needed was a sign of coherent life, and we could leave her alone. 

The van was moved onto the vacant driveway. Apparently she "gave up driving when she gave up listening." 

"Well," said the sarge, "if this doesn't wake her up, we'll have to use a heavy boot. Just make sure that if she does wake up you turn the beam off straight away. Either that or she'll be blind as well as deaf!" 

The light was switched on, and the beam hit the target straight in the face. She stirred after a few seconds, and the searchlight was turned back off again, as ordered. As we all breathed a sigh of relief, she opened her eyes, picked up one of her hearing aids from the coffee table next to her and marched towards the window. She fumbled with a small key, unlocked the double glazed window, opened it only a few millimetres and turned her ear towards it. 

"Sorry to wake you ma'am," starts the sergeant, "we were worried something was wrong, and had to make sure you weren't injured or ill." 

"Thank you officer. As you can see, I'm fine. No need for anyone to worry." 

"We have the ambulance here too, if you'd like to let them in. They can just make sure." 

"I don't think that's necessary, thank you." 

"Are you sure?" 

"I'm sure. Don't worry... Actually," she said having paused for a few seconds, possibly debating the idea of a home-visit check-up, "there's just one thing you could do for me, if you don't mind?"

"Sure. What's that?" 

"Just F*** OFF AND LET ME SLEEP!"

She slammed the window shut, locked it, and made a point of showing us all that she was once again removing the hearing aid. As she sat back down in her armchair, she looked round the television that obscured our view, raised her arm, and as a final wave goodbye, stuck up her middle finger.

"That'll do!" I said. "I reckon that's enough signs of life for me!"

On and Off

Through the frosted glass of the front door, we see the outline of a small figure walking down the stairs to let us in. 

"Wonder why there's a kid up at this time of the night?" I say to Lara. 

"Probably wanted to see the ambulance!" she answers.

It's not a child that opens the door, it's Doreen, a silvery-haired octogenarian, as sprightly as someone half her age. We step into the house, and she immediately apologises.

"Sorry it's a bit dark in here. As soon as I switched the light on in the hallway, the bulb blew!"

Even Lara, a good foot shorter than me, towers over Doreen, making me feel like a giant. I look up at the darkened lamp shade and imagine Doreen having to stand on a ladder to get up there.

"Don't worry. Let's go help your hubby, and before we go I'll change the light bulb."

"Oh, would you? That would be wonderful! I won't have to trouble the neighbours again." She looks so relieved, it was as if we'd just told her that she'd won the lottery. "Let me show you to the troublemaker then."

We went upstairs and met Morris, the reason for our call. He'd been unwell and hallucinating for the last few hours. A fever and a strong smell leading directly to the conclusion that he's probably got a urine infection, a regular cause of confusion, especially in the elderly. He'd become very unstable on his feet too, and I didn't want him to even attempt walking on the icy pavement, so I asked Lara to go back for the carry chair. He made it down the stairs under his own steam, pride and determination forcing him to refuse to be carried. It was a compromise to stop him walking all the way to the ambulance. As we got down the stairs, the light was on in the hallway.

"Your lovely young lady here changed the light bulb for me!"

I gave Lara an evil grin.

"A woman changing a light bulb?" I said. "That's a first for me!" It earned me a slap on both arms, one woman on each.

We wheeled Morris out to the ambulance, and Lara went back to help Doreen across the slippery pavements. Once they were both settled, we set off for hospital, and Doreen took a look out the window.

"Oh no!" she cried, "I've just realised I've left the light on!"

Lara stopped the ambulance, took Doreen's key, and went to switch the light back off.

Early Christmas Present

Deciduous trees stand barren in the biting breeze, their branches, undefended from the airborne frost, wave a muted welcome as I drive gently down the road. It's a long dual carriageway, leading from one built up area to the next but a large section in between is sparsely built and poorly illuminated. The blue, strobing lights do more to show the way ahead than the dull orange street lamps intended for the purpose. My chances of finding the reported faller were reduced further by the fact that the caller was too vague to give an accurate location, and too much in a hurry to hang around and wait for the ambulance to arrive and show us the particular hedge in question. The only helpful detail they managed to convey was that the patient was wearing a red top.

Driving on roads that were more sheets of ice than tarmac delayed my arrival as I chose safety over speed. The rapid response unit that night would be more response than rapid, a case of better to be late than The Late. Having no exact address meant that I crawled the length of the hedgerows, bright search lights showing up the left side of the car. If I couldn't find the patient on the first run, it was a two mile run until I could turn round, check the other side and come back again. The first northbound trawl was unsuccessful. At the roundabout at the top I came across a lone officer in a police car, advised him of the call, and he joined the search. One of us would search the hedges, whilst the other would look in the central reservation.

We headed southbound, matching speeds and each blocking a lane, we drove with one eye on the road and the other looking out for our prey. During the day our slow march would have caused traffic chaos, but in the dead of night there was only one unlucky driver stuck behind us. Seasonal spirit prevailed and I slowed enough for a gap to open, and the driver, a confused look evident on his face, took his chance and snuck through the temporary opening.

I caught back up and signalled to the policeman to wind down his window.

"Does this count as heading south for the winter?", I yelled across the lanes.

"Doesn't seem to have warmed up much!", he called back and pressed a button next to him. The electric window smoothly wound its way up and cocooned the officer back in the warmth. I quickly followed suit.

The southbound drive was equally as unproductive, and the officer received another call and was forced to abandon the search. I stopped at the side of the road and asked the control room to give the original caller a ring back to try to extract at least a snippet of information that might help me in my search. A couple of minutes later they advised me that the patient was definitely on the northbound carriageway, and near the northern end of it, supposedly lying at the base of a hedge. I didn't really expect them to be lying at the top of it. But the latest update did mean skating the entire length of the ice-rink of a road. Again. Two hundred metres from the end, having almost driven straight past them, I finally found the patient.

As promised, a red top.

As promised, at the bottom of a hedge.

A sleeve and the bottom of what looked from the car to be a thick woolly jumper peered out from the hedge, and I presumed the rest of the patient was hidden in the bushes. I stopped the car by the kerb, still a good fifty metres from the hedge, called out to the patient to "Hang on, I'll be there in a second", and went to grab my kit out the boot. Still talking out loud, I finally approached and prepared for the worst. The temperature was well below freezing, they had been there for at least an hour from the original call, and were wearing nothing more than just a jumper. And just to worry me a little more, they made no attempt to move or call back.

Carrying the two bags of kit, more for balance than anything else, I slipped and skated my way across to the hedge, eventually arriving at the side of the patient. I knelt down beside them, moved to shake their arm at the top of the sleeve, only to find that the whole red arm was unoccupied.

I'd been searching for a discarded, unloved and unwanted jumper.

The shop tag was still attached to the collar.

As I was just about to call control and ask them to cancel the crew, their blue lights appeared behind me and they pulled up to help. The odds on a white Christmas were shortening as the frozen weather continued with only days to go, so I decided to let them stay in the warm comfort of their ambulance.

"We'll need the stretcher", I said, "but I'll bring the patient to you. That way you don't have to get out of the truck. They're not that heavy!"

I slid across, holding the patient gently in my arms, and presented it to the crew. It was just too dark for them to see exactly what I was holding until I was right beside them.

"Merry Christmas!" I grinned as I handed the patient over. "It's the early Christmas present you've always wanted!"

Worldwide Alert

The threat of international terrorism is rising worldwide. More is being done to prepare the common person for this threat, as governments the world over are trying to defeat it. The way your government is dealing with it, depends on where you are in the world. Here are the latest updates from the International Ministry of Funny Farms:

The English are feeling the pinch in relation to recent terrorist threats, and have therefore raised their security level from "Miffed" to "Peeved". Soon, though, security levels may be raised yet again to "Irritated" or even "A Bit Cross". The English have not been "A Bit Cross" since the blitz in 1940, when tea supplies nearly ran out. Terrorists have been re-categorized from "Tiresome" to "A Bloody Nuisance". The last time the British issued a "Bloody Nuisance" warning level was in 1588, when threatened by the Spanish Armada.

The Scots have raised their threat level from "Pissed Off" to "Let's get the Bastards". They don't have any other levels. This is the reason they have been used on the front line of the British army for the last 300 years.

The French government announced yesterday that it has raised its terror alert level from "Run" to "Hide". The only two higher levels in France are "Collaborate" and "Surrender". The rise was precipitated by a recent fire that destroyed France's white flag factory, effectively paralyzing the country's military capability.

Italy has increased the alert level from "Shout Loudly and Excitedly" to "Elaborate Military Posturing". Two more levels remain: "Ineffective Combat Operations" and "Change Sides".

The Germans have increased their alert state from "Disdainful Arrogance" to "Dress in Uniform and Sing Marching Songs". They also have two higher levels: "Invade a Neighbour" and "Lose".

Belgians, on the other hand, are all on holiday as usual; the only threat they are worried about is NATO pulling out of Brussels.

The Spanish are all excited to see their new submarines ready to deploy. These beautifully designed subs have glass bottoms so the new Spanish navy can get a really good look at the old Spanish navy.

Americans meanwhile, and as usual, are carrying out pre-emptive strikes on all of their allies "just in case".

Canada doesn't have any alert levels.

New Zealand has raised its security levels - from "baaa" to "BAAAA". Due to continuing defense cutbacks, New Zealand has only one more level of escalation, which is "I hope Australia will come and rescue us".

Australia, meanwhile, has raised its security level from "No worries" to "She'll be right, mate". Three more escalation levels remain: "Crikey!", "I think we'll need to cancel the barbie this weekend" and "The barbie is cancelled". So far no situation has ever warranted use of the final escalation level.
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Have a safe, peaceful and smiley weekend - and Happy Thanksgiving weekend to our American brethren.
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Edit: I wish I could say this was my own work, but it isn't. It was sent to me, and I felt it was too good not to share...

Driver's Duties

It's a relatively rare thing for me to drive the ambulance, unless of course, I'm solo responding in the Fast Response Unit. I'm almost always more comfortable in the back, with the patients, and allowing someone else to pilot the ship around the never deserted streets of London. Apart from anything else, it's the driver's job to tidy up if there's any mess at the end of each call, and I'll happily pass on that duty.

Just for once, I fancied a change, and so took up the position of helmsman, and watched as another newbie took control of the patients.

The screen rings and displays a message about a choking baby, turning blue. Not normally known for being the fastest of drivers, my lead foot takes over and we cover the couple of miles at warp factor 9. As we turn into the quiet cul-de-sac, the computer updates us that the baby is now breathing normally and no longer choking. Even the ambulance breathes a sigh of relief.

We're met at the front door by the baby, cradled in his mother's arms. Mum's eyes tell a tale of their own, bloodshot and swollen, the drying streaks of tears running the length of both cheeks. Newbie is a little lost, not yet having learnt the art of treating a now non-existent problem. We talk to mum, find out what happened, and discover that once again we're meeting a baby who probably tried to inhale its milk rather than drink it. All is calm, except the excitable older sibling bouncing Tigger-like on the couch and telling us how they once had a fire engine and an ambulance come to school. I ask to take a look at the baby, and mum hands him over. A quick check, a listen to the lungs, a look at skin colour, an assessment of mood, and everyone's happy that a disaster has been averted.

We offer to transport mum and baby, and discover that Tigger will have to come with too, as no-one else is around to babysit. Mum wants to go, just for peace of mind, and I can understand. I stay holding on to the baby whilst newbie writes down all the details necessary and mum gets organised with all the essentials. The vast majority was already packed in a baby bag, and it just involved getting dressed and making a bottle.

As soon as we were ready to leave, I try to give the baby back to mum. He clings and refuses her outstretched arms. Flattered I may be, but now we have a problem.

"Well", I suggest, unlooping the ambulance keys from my belt and handing them to mum, "I guess that means you're on driving duties!"

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

Kids' TV

Postman Pat.

Bob the Builder.

Fireman Sam.

Handy Manny.

PC Plod in Noddy.

Need I list any more? All these children's programmes have as either their central or sideline characters someone with a fun job, one that the creators of the shows want to show in a positive light.

You know what, there are even the mundane jobs - Peppa Pig's dad is an office worker!

The truth is, I can't think of any kids' TV character as a doctor, but how would you portray God on kids TV?

(Keep yer hair on, it's a joke...)

So where, I ask you, is the kids' show about ambulances? Where is Peter Paramedic? The only ambulance that I can think of in a kids' show is in Fireman Sam, and that's driven and, ahem, manned, by Nurse Flood!

I vote to start another TV revolution!

All those in favour say AYE!

And whilst you're voting, send me suggestions for what we'd call it...

Jealousy

Red 2, the second highest priority for a call coming in to the ambulance service. In the main determinant - the old favourite - Difficulty in Breathing. In the extra information the screen tells of a 40-year-old with a history of asthma. We race to the scene, find the front door open, and call in to find where the patient is hiding. We take in the oxygen bag, defibrillator, and all manner of equipment to deal with this life-threatening emergency.

A voice calls from the front room, and we follow the noise. The room is one of several in a large house, clearly now divided into several micro-apartments. A shared bathroom and filthy kitchen the only rooms with no external locks on the doors. The patient is sitting comfortably on the bed in the tiny room that is a bedroom, living area and laundry room all rolled into one.

Recently I've been charged with mentoring a student paramedic, (a brave decision by the powers that be...) and for most of this mentorship, he's in charge of the patients.

"Good morning. My name's Sash, what's your name?" Confidence is one of his strong points.

"Adam". A man of few words, obviously.

Adam seems to be having no difficulty in breathing at all, so Sash is a little confused.

"What seems to be the problem this morning?" Morning at this point is just after 5am, after another very long and busy night.

"I can't sleep." The words resonate well with your local friendly insomniac, yet at the same time grate a little.

"How long have you not slept for?"

"Since I woke up yesterday morning."

Whilst Sash is questioning, I'm checking his basic observations. A matter of course, and of course it matters. I think.

"So it's just been tonight that you've not been able to sleep?"

"That's right." I look up, just to make sure I heard correctly.

"Has this ever happened before?" Sash's perseverance is starting to show signs of frustration.

"No."

"So why have you called the ambulance? What would you like us to do?"

"Just take me to hospital. Maybe a doctor can tell me why I can't sleep."

Home remedies were suggested, a visit to the GP was suggested, an attempt to go to back to bed with a cup of cocoa was suggested. And all were rejected out of hand.

"I just want to go to the hospital. You're not doctors. I want to see a doctor."

At a loss for options, Adam was invited into the ambulance, took his seat, and we set off for hospital. We still can't refuse to take people to hospital if they're adamant they want to go.

I stay in the back of the ambulance to keep an eye on Sash and his ambulance aid, whilst our driver for the shift takes her place in the pilot's seat. We all know that there's not much to be said or done, yet I'm keen to see how Sash deals with a call that really shouldn't be.

The hospital is about a fifteen minute journey away. Sash starts to fill in the paperwork, name, address, baseline observations. Adam's not in any mood to talk, Sash has nothing to say, and I sit observing from the sideline.

About two minutes into the journey, I cough quietly. Sash looks up from his scribblings, and I mouth a 'Well done' to him. Confused, he asks me what for. I nod in Adam's direction and congratulate Sash on fixing the patient.

I can only stare at the patient as a strong feeling of jealousy starts to creep over me.

Adam's sitting there, held in place by his seat belt, quietly snoring and sleeping like a baby.

Shut. Up. Den!

They married the day after he was de-mobbed, seven years to the day after they had become engaged. The day of their engagement was tinged with sadness, as on one hand she placed the ring which betrothed them to each other, and yet with her other she waved him off, not knowing if or when they would finally exchange their vows. They didn't meet again for almost five years, whilst he spent that time at the request of His Majesty fighting in the war that followed the War to end all Wars. They marked their seventh anniversary with a new one, the start of sixty more.

"Sixty years we've been married", he tells us. "Not once has she listened to anything I have to say." His wicked grin was met with a sharp tongue.

"Shut up, Den!"

The pain had kept her up all night. The effects of the tablets she took wearing off before they'd even reached their peak effect. Eventually she could take the pain no more, and reluctantly agreed for the ambulance to be called. When we arrive, she's sitting in an armchair, trying for all the world not to show us that she's suffering. The colour of her face and the fine beads of perspiration on her forehead tell us more than we need to know.

"How long have you been in this much pain?" Seemed like a good place to start.

"Well", starts Den, "It's been getting worse all night. She didn't want me to call, but in the end I don't really think I had a choice!"

She glares at him. "Shut up Den! I can talk myself you know!"

"Oh, I know all right..." He mutters, just loud enough for us all to hear.

I try to hide the smile.

"It's not too bad now. It was much worse before. Keeps coming and going. I think I'll be fine if I just get some sleep."

"You've been like this all night, love, and I can tell it's not getting better. Why don't you let them help you?"

"Shut up Den!" she retorts. There's a clear theme developing.

"Lets have a proper look at you", I suggest, and reluctantly she agrees.

Her observations are mostly unremarkable, just an increased pulse suggesting once again that despite wanting to hide her ailment, the body will always give its secrets away. She can't help but admit it now. The pain is becoming just too much to cope with.

"How about we give you something for that pain then?"

"Good idea", ventures Den. "You could do with something stronger than those tablets!"

"Shut. Up. Den!" she growls at him, rests her head back on the trolley-bed and briefly closes her eyes.

"Maybe I could do with something. It is coming back a bit."

A few moments later, as the morphine courses its way through her veins and works its magic, the relief starts to show. Her whole body relaxes, the colour, so drained before, returns to her face, and the beads of sweat fade away.

"Feeling better?"

"Much better. Thank you."

"We're going to take you to hospital so they can find out a bit more about what's happened. Hopefully stop it from happening again."

"That's fine. Suppose I could do with a check up."

Den shakes his head, one part frustration to ten parts relief.

"One of these days, you'll realise that I do talk sense sometimes!"

"And one of these days", she shoots back, "you might just be right!"

Her voice softens, they smile at each other, and Den reaches across the ambulance to pat her on the hand.

"You know", he starts, "it IS my name on the front door! You would do well sometime to remember that!"

"Oh, do shut up Den!"

She rests her head back on the bed, and for the first couple of minutes of the journey there's a calm silence. I start the paperwork, and they look at each other, holding hands like they were still love-struck teenagers.

"You know what, Den? You're right. It is your name on the front door!" There's a sudden glint in her eye that wasn't there before.

"Just don't forget that the sign with your name on it is on the outside!"

A Conversation

On the 100 metre walk to where the patient lay in the middle of the makeshift football pitch:

"I've put a bandage on his leg".

"Great. What happened?"

"He was playing football, stepped on the ball, and fell over. There was a wicked crack."

"Have you moved him?"

"No. I just put a bandage on his leg."

"Is there lots of bleeding?"

"Well, no. Not really. The bone is sticking out of his leg, but not a lot of blood."

"Hm. Sounds broken to me".

"Don't think it's broken. The bone's sticking out, but there wasn't a lot of blood, so it can't be. Yeah. Pretty sure it isn't broken."

"..................."

Toilet Humour

So I know that it wasn't Jeramedic who started this meme (I had to learn what a meme was too...), but as he tagged me, I'm blaming him for it. He wanted to know, and now you'll all find out...

I'm not normally one to partake of these 21st century chain letters, but as I know that the whole subject is one of constant irritation to MrsInsomniacMedic, I couldn't really resist.

This whole idea was started by Lissa. Nope, I've no idea who that is either - but as she's started the whole thing, I guess she gets the credit too.

And now, whether you wanted to or not, you'll find out what sits on the bookshelf in the bathroom. OK, it's the window sill, and not yet a bookshelf, but still.

1) There are the books that are there permanently. Probably my favourite cartoon strip of all times. Because of the sleeping issue. Because of the coffee issue. Because of the wicked sense of humour issue.

I. Love. Garfield.

So I have two books of the comic strip in there.

2) There is the book that I'm currently reading. My taste in novels ranges from the sublime to the ridiculous, from new to old, from Harry Potter to To Kill a Mockingbird, but at the moment it's Enigma by Robert Harris, on the Enigma machines used by the Nazi regime to send coded messages, and the attempts at breaking that code.

3) Then, of course, is my favourite book ever. The book which this blog was originally named after, and to which there are many references, some subtle and some not so, throughout. It is, of course, The Hitchhikers Guide to the Galaxy. I started reading this book (and the other four of the increasingly inaccurately named trilogy) on the train to school. I'd giggle quietly to myself and get some funny looks, which then became stares of embarrassment and even concern when the giggles turned to roaring laughter. Today, it's my insomnia partner. When, once again, I can't sleep, I pick it up out of the bathroom and read it in bed, knowing lots of it almost off by heart. And still roaring with laughter. I guess you could call it toilet humour...

So now, who do I tag? I think I'll try to send this round the world.

I guess I'll have to pick on Fishmedic to start with as our European representative, despite the recent football score.

For someone in the UK, but outside of the medical field, I'm going to tag The Buffoon, as his blog has much the same effect on me as Hitchhikers.

And last but not least, all the way on the other side of the world, Flobach is invited to share his readings too!

*****

Happy Reading!

Defeat

After my election manifesto of a little while ago, I received some feedback and suggestions of improvements and additions. I nominated members of the Cabinet in the comments section, and prepared for my move to the seat of power.

It would seem however, that not everyone liked my proposals. I was sent the following copy of the minutes from a secret meeting of medical specialists:

*****

The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.

The Gastroenterologists had sort of a gut feeling about it, but the Neurologists thought the Administration had a lot of nerve.

The Obstetricians felt they were all labouring under a misconception.

Ophthalmologists considered the ideas short-sighted.

Pathologists yelled, "Over my dead body!" while the Paediatricians said, "Oh, Grow up!"

The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.

Surgeons decided to wash their hands of the whole thing.

The Internists thought it was a bitter pill to swallow, and the Plastic Surgeons said, "This puts a whole new face on the matter...."

The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.

The Anaesthetists thought the whole idea was a gas, and the Cardiologists didn't have the heart to say no.

In the end, the Proctologists won out, leaving the entire decision up to the arseholes in Government.

*****

In light of the above, I concede defeat.

Thanks to my secret souRCe. You know who you are...

Rats

Below is a screen shot of a recent call. Now I have to say, I can understand the kid for calling. Not sure I'd know what to do if I found one of these lying dead in my lounge. I mean, it's not as if it'd be covered in a normal first-aid course, is it?

What I don't understand, is why the system triaged it as a cardiac arrest call, and despite human protestations, the computer still insisted and sent me on blue lights and sirens.

Not for long though. Human intelligence eventually took over and cancelled the call with some bemused apologies.

I did have to wonder what the ratio of compressions to ventilations on a rat was. I think I may have verbalised that thought slightly too loudly, much to the amusement of several people standing around at the time.

Rats.

A Giggle

I know I've not written for a few days - apologies, the world has gone a little nuts.
Depending on my insomnia, I may get something posted tonight.
In the meantime - have a laugh.
Head over to Flobach Republic's blog and have a read of his latest post. I'm still smiling.
And when you've only had 6 hours sleep in the last week, a smile looks a little manic, but still.
Go.
Read.
Enjoy.