Lost Keys

The door shuts gently behind me, bringing to a close another shift, one that ended at a time normal humans call bedtime. I've left the world of the permanent nights behind, at least for now, choosing instead to pick the shifts I like, while I still can. The times are different, the hours fewer, the system new to me, but the work and the patients remain the same. 

Calls still come in for bad backs, three day old coughs, tight, crushing chest pains and accidents of all types. Cars still fight with each other for a small space on the tarmac, denting bodywork and pride as the space in between goes from narrowed to nothing. Bodies give way to gravity when the ladders beneath them collapse down to earth. Knives and bullets pierce the skin and cause untold, perhaps irreversible damage to the organs hidden from view. 

Here and there a life is saved, a soul is comforted, a child is born. 

Until the door shuts behind me, the shift isn't over and the processing doesn't begin. Most days there is nothing to trouble my thoughts, the patients merging one into the next, each occupying my mind for the duration of our stay with them, or theirs with us. Some leave an impression, a smile, perhaps, maybe a frown. At other times a question mark looms over the lasting imprint of their faces, the tale of their woes, the miracle of their survival. 

Some days, shutting the door behind me, ending the shift with a turn of the key, only signals the start of the process. 

It's bedtime. 

I go in to check on each of my already sleeping children, a habit often repeated several times each night since each was born, thankful that I am able just to stand, and stare, and watch them sleep in peace. I lock the front door, but in so doing, open the door to my own thoughts, trying to process the day. 

That door needs locking too, but all too often I can't find the keys. 

Accents

A few weeks ago, for an entire twelve-hour night shift, my accent turned from being generally-screwed-up-due-to-moving-house-too-many-times to generally-screwed-up-with-a-terrible-Aussie-twang. 

I blame this guy - an Australian paramedic with a taste for worldwide EMS experiences. 

You can read part one his account of the night shift here. There's even a clue as to my real identity, with a partially disguised photo. 

According to MrsInsomniac, my accent has yet to recover...

(Part II is now up too!)

No Answers

Saturday night, the scourge of all police officers and ambulance crews. These days, all nights are busy, but weekend nights are often like being in a war zone. Trust me. I've done both. Sometimes I think that it was safer in the other one. As I work only nights, my weekend night shifts come round more often than most, and without fail, I regret them.

A list of a weekend night's proceedings often resembles a list of the wives of King Henry VIII. Divorced, Beheaded, Died. Divorced, Beheaded, Survived.

A Saturday night on the street runs something like this: Drunk, Assaulted, Trashed. Drunk, Assaulted, Crashed. The last of these might only appear once a night. If that. If you work in the centre of London, there are probably even fewer. I work out in the suburbs, so there's a chance that once the pubs, clubs and fast food shops have shut, I may actually have to treat someone who genuinely needs an ambulance. By that time, I'm tired, cranky, and struggling to give them my best attention and care. That which they genuinely deserve.

Last night, I tweeted about treating drunks, by asking a simple question. Do you think that people who call ambulances because they've had too much to drink, should be charged?

All dozen or so replies were positive. Some just said "Yes". Someone said "Yes, without a shadow of a doubt". And one even went as far as saying "YES!! YES!!!! A THOUSAND TIMES YES!!!" It seems that I received some support for the idea.

It's a knee-jerk, almost default position by health care professionals, and even some who aren't in the medical field at all: You're drunk. It's of your own doing. You should know your limits, or suffer the consequences. You don't need an ambulance. You don't need to be in A&E. And we most certainly don't want to be the ones who have to clean up all the bodily fluids you emit in your sorry state. Therefore, we all want to charge you. I'm as guilty of it as the next person. Not so much the drunk bit, but the wanting to charge bit. But there's a problem with this thought, once taken to one of its logical conclusions.

We should charge those who overdose on drugs. The heroin addicts who should know their limits, but who take a little more than their normal amount, end up not breathing, and who we administer Naloxone to to get them breathing again, ready for their next hit.

We should charge drunks who wonder out into the middle of a busy road and get hit by the car whose driver had no chance of avoiding them. Or by the same account, charge the drunk driver who's hit the lamp post that's sat on the pavement for years, but suddenly jumped into the middle of the road.

We should charge the wrist-slitters, crying for attention at the age of 18 after being dumped by the love of their lives, and who next week will have another life's love.

We should charge drunks who we convey not for being drunk, but whose drunken state has led to some sort of illness or injury.

We should, therefore, charge anyone who should have had some degree of responsibility for their own presenting condition.

Smokers with emphysema? Charge.

Footballers with broken legs? Charge.

Diabetics with high blood-sugars? Charge.

So how far do we take this knee-jerk reaction, this desire to charge drunks? Is it a question of all or nothing, in which case we charge everyone, or do we continue as we are, charge nobody, and just have to keep putting up with it, whilst we all, as taxpayers, foot the bill? Once upon a time, drunks were taken to police cells, given a mattress to sleep on and sober up, generally ignored, and were then sent home in the morning. Just that cost money.

Now, they get an emergency ambulance, often accompanied by the FRU, as they are frequently supposedly unconscious or not alert. If they're in town, they might get the dedicated "booze bus", a multiple-patient-transporting, baby-sitting service staffed by EMTs and paramedics who are clearly a lot less averse to dealing with alcohol-induced vomit than I am. They get a hospital bed, an overworked nurse, a disinterested doctor, and sometimes a bag of fluids as well. All very often whilst abusing those who are caring for them. And that's if all they have is a serious case of overindulgenceitis. That's a lot more expensive, and a lot more frustrating, which is part of the reason we feel that we want to charge. But is it right? In the overall spirit of the NHS, free to all at the point of treatment, can we really justify it? And if we are going to start charging, who do we charge, what for, and how much?

I have lots of questions when it comes to charging drunks.

I just wish I had some decent answers.

What do you think?

Excuses, excuses

Chronic insomnia is not an excuse for stupidity, but I'm going to try to use it anyway.

*****

It's been a long, busy night. At 0500, you are starting to see the light at the end of the tunnel, and are just getting hit by that end-of-night-shift-itis.

The patients, just for a change, have all, every single one of them, been in genuine need of an ambulance. You have treated some, stabilised some, resuscitated others, even transported them or travelled with them.

You've finally got back to base, and debate the pros of a cup of coffee in keeping you awake just until the end of the shift, and the cons of same-said coffee stopping you from sleeping when you finally get home.

The decision is made for you by the phone pinging its SMS Morse code sound, frighteningly similar to that of the SOS. The coffee will have to wait. The police have called for you this time, for an RTC. Possible arm injury. That's all the details you have, other than a general location.

As you approach the scene, there are several police cars with their lights illuminating the surroundings, the staccato of their lights reflecting off the buildings.

You park up behind the police cars, and walk to the front of the line, assuming that there might be a pedestrian on the ground in front of them with the arm at a funny angle. No one is there. Not even a police officer.

You look around, and see a couple of other cars a bit further up, but both seem to be parked rather than crashed. No sign of anything. You are confused. You are about to get on the radio and ask control to speak to the police and find out exactly where they, and the patient, are hiding.

And then you stop looking around, and for the first time in the 30 seconds (yes, all this in less than half a minute) since you arrived, you see it. The officers are on the other side of the road, by the block of flats.

The patient is standing talking to the officers. You guess he's the patient as he's standing there rubbing what must be a sore shoulder, and trying to move his arm. There is however, no car. There's a good reason for that too.

The RTC involved a truck.

A big truck.

One of those with 12 sets of wheels, 4 axles, 36 gears type of truck. Don't pick on me about the numbers - I've just made 'em up. Just take if from me, it was one of those huge delivery trucks, the ones you don't mess with on the roads, whether or not you have blue lights on the roof.

And it was parked in the side wall of the apartment block.

Rudely awakening the occupants of the ground floor flat as it appeared in their bedroom uninvited.

SO HOW IN THE WORLD DID I MISS THAT WHEN I FIRST GOT THERE???

*****

Chronic insomnia is not an excuse for stupidity, but if it was, it'd be the best excuse in the world!

Sexist Pig

The house is one I can only dream of. More than a house, it's a home, warm and welcoming. Large enough to have an entrance hall bigger than my lounge, reception rooms galore, all before you go upstairs and see the multiple bedrooms, separate bathrooms, and a study. Everything neat and tidy, a multitude of toys, books and other items all in their exact place.

I'm allowed briefly upstairs before the patient decides she'd rather entertain the guests in one of the rooms downstairs.

Even though it's more like bedtime for the kids than the adults, she's wrapped in a dressing gown. The sad look is more than just on her face, it seems to be her entire being. She doesn't look at all unwell. Just sad.

"What's the problem this evening?" I thought I'd start with the easy questions first.

"I feel weak."

"And how long have you been feeling this way?"

"About an hour."

Not quite the life-threatening call we'd been initially called to, something along the lines of trouble breathing, possibly a stroke. I don't remember exactly what the call was given as, all I know was that I was given a crucially life-saving eight-minute time limit to get there.

We discussed exactly what she was feeling, how she was tired this evening and that she had no energy and just wanted to sleep. No priority symptoms of any sort, no evident medical problem, just the end of a long day.

I was forced to ask, as gently as possible, what it was that made her think that she needed an ambulance.

"She didn't call you", interjected the husband. "I did."

"And, sir, for what reason did you think she needed to be seen by an emergency ambulance crew or taken to hospital?"

"Well, normally when I come home from work, the children are ready for bed, the house is tidy and clean, and dinner is on the table. Tonight DINNER WASN'T READY!"

He really emphasised the last bit. Shouted it even.

She just rolled her eyes in desperation and invited us kindly to leave, our presence clearly unnecessary.

I left the house with a caveman vision imprinted on my brain.

"I am man. Hear me shout. See me beat my chest!"

21st century man.

Bernie

The sky is once again dark and menacing. The threat of more of the snow that plagued us a few weeks back is on the not-too-distant horizon. There have even been a few flurries, just to whet our appetite this morning. Not really sure I'm all that hungry. During the last batch of snow more cars crashed, more roads were closed, more people fell and broke limbs, fewer trains and buses ran, and more people couldn't (or possibly wouldn't) get to work. We don't seem to cope with it very well, and now there's more on the way.

Someone should probably warn Bernie.

He's a nice old chap is Bernie, although when I first met him it was difficult to reach that conclusion, given the fact that he was lying in the snow in a heap, not responding. Another, younger man stood over him, barking orders at Bernie to get up. He even tried to physically lift Bernie from the wintry pavement, but his seemingly lifeless body wouldn't cooperate. It was at that point that I was driving past, on the way back from a separate call. I called in a "Running Call" to the control room, and asked for an ambulance to attend for an unconscious patient.

Bernie was unconscious but at least he was breathing regularly. It was one of those shifts where I had an observer with me (told you that they do sometimes get to see things happen), and I sent her back to the car for a couple of blankets. Always handy to have an extra pair of hands, as well as an extra blanket. One to put under Bernie to try keep him off the frozen ground, if only a little, and one to go on top of him. I asked the other man if he was a relative or if he knew what happened.

"Never met him before. I just bumped into him and he fell down. Now he won't get up!" He seemed unaware of the fact that he was shouting, much like someone conversing whilst listening to music plugged into their ears.

Bumped into him? Staggered was probably nearer the truth. The smell of several pints of alcohol on his breath would probably have made him fail a breath test whilst stood 30 feet from the machine. He instantly became aggressive and I had some difficulty moving him away from the patient and us, so as well as an ambulance, I asked for police back-up. Just in case.

Turning our attentions back to Bernie, we'd put him on oxygen, tried to get some baseline observations and elicit some sort of response from him. None was forthcoming. The roads were as treacherous as the pavements, and the call rates had increased exponentially, so we knew that back-up in the form of either the ambulance or the police may take a while. Just as I'd finally managed to get one arm out of a sleeve to check Bernie's blood pressure, he sat bolt upright, the look of bewilderment on his face complemented by the confusion in his voice.

"Where am I?"

"You're on the floor, sir, in NearBy St. Can you tell me your name?"

"Bernie".

"Hi Bernie. I'm Ben, and this is Shelly. We're from the Ambulance Service. What are you doing out and about at this time of night?"

"I've just been out for lunch. Now I'm going to meet Jerry. Where am I?"

And there, in one discombobulated sentence, the repeated question, the lack of time awareness, was our main problem. Was Bernie confused before the fall? Did he know where he was going when he left his house? Did he ever get there? Was it the fall itself that left its mark in the form of possible concussion? More importantly, did he fall, or did he collapse?

We tried to keep him still, but he kept threatening to get up off the floor and walk off. We compromised by Bernie agreeing to move as far as the back of the FRU. At least it was light, dry and warm in there.

The ambulance turned up, closely followed by the police, each to deal with one customer. We handed the once unconscious Bernie to a slightly disbelieving ambulance crew, and the once aggressive drunk, now sitting on the floor shouting at nobody in particular, over to the equally disbelieving police. I apologised to both for the call not being exactly as it had originally been described.

Bernie was moved into the ambulance, where the observations were repeated, the questions reinforced, but the confusion remained. The police had no reports of any missing person, Bernie couldn't remember where he lived, although he was adamant that he was going home, and the crew spent a while convincing him that hospital was the best option. At least for now.

At least until he doesn't have to wander the snow-covered streets in the middle of the night.

At least until we can find out more than the fact that his name is Bernie.

Positive

I know I don't usually use this forum for complaining, especially about the system that I work for. Something about not biting the hand that feeds me. However, at the moment, even I'm getting despondent - not a normal reaction for me at all, and not one that I'm enjoying.

Part of the problem, at least as I perceive it, is as follows:

There are two main focus groups at work.

One is the outlook of the number-crunchers, the ambulance big-wigs, the ivory tower-dwellers, and even the Government office residents.

The other, is that of the troops on the ground, the real front line. Slowly but surely, the latter group is falling victim to the whims of the former.

Not so slowly, but definitely surely, those troops are being put at greater and more frequent risk by the number crunchers, all in the name of targets. And the troops are not happy.

We are being brow-beaten into working faster, not smarter.

Responding to the never ending stream of calls as if each was a dire, life-threatening emergency, just so you don't get sued.

Activating on calls with all haste, just so you can say that we did.

Spending as little time on scene as possible, not treating, just transporting.

Turning around at hospital without delay, not for patient benefit, but to stop a countdown.

Taking breaks at the times when we don't really need them, just to fill a quota.

So, ivory tower-dwellers, come back to the real world for a minute. Let me tell you that if you're managing to depress one of your normally overly positive people, you must be doing something wrong. We're here because whilst we're at work, we want one thing, and one thing only. We want the best for our patients.

Government bods: you're expecting us to reach more calls in the state-prescribed magic eight minutes, whilst not giving us the resources to do so. Calls such as flu, panic attacks, coughs and colds, sprained ankles and chronically sore backs all become life-threatening, eight-minute demanding calls. For no reason other than the system said so. And the system is all-knowing, infallible. Law-suit proof. And often very wrong.

Big-wigs - it's all well and good sending the call down to the MDT with the barest of bare essentials, just so you can beat the clock. Not even giving an address, just a general direction to head towards. No details of the call. No warnings about the location, if there are any, until many a time when it's too late. Too many times recently, I've walked into a call on my own, only to find out that the crew, who are a few minutes behind, have been told to wait away from the address for the police, as there are threats of violence or other menaces awaiting. Sometimes quick can be too quick. And too dangerous.

Oh, and then you throw this sort of stuff at us, just to make it more difficult.

If all is going well, and I'm not being threatened by someone drunk, aggressive, or violent, but actually attending a patient who is genuinely unwell, I'm now being told to hurry up there too. Well, you know what, it takes whatever time it takes. Unstable patients are not easily stabilised in the back of a moving vehicle bouncing over every speed bump and pot hole on the way to the local hospital. Stable patients sometimes take time too. We need to spend time making sure that they remain stable. That they have the support they need, that they are well cared for, that they know where to turn if they need to. And I'll take however long is required to make sure that I have done what is best for them, not what is necessarily best for the paperwork.

For those who we do transport to hospital, we can't always just dump them and run back out for the next call. Sometimes the hospital is busy. Sometimes the paperwork that you are so concerned about takes time to complete. Sometimes the ambulance needs cleaning from top to bottom, not just the cursory wiping of obvious surfaces. Sometimes, especially on the busiest days, we just need a cup of coffee and a bar of chocolate.

It's also on those busiest days, the ones when we most need the break, that we are the least likely to have one. So we may stop at the hospital to grab a bite to eat too. Sometimes, especially on the FRU, where I don't often transport patients, I might not see a toilet for hours on end. I challenge you, number crunchers, to complete a 12-hour day, or night for that matter, with no break for food or the chance of a hot drink, and being at the mercy of a computer screen as to when you're allowed a convenience stop.

All we ask, is to be allowed to do our job. To be provided with the resources to help us do it. To use our training, to extend our training, and to put that training to good use. To have the positive support from above, rather than the overbearing threat of a whip. A happy workforce will lead to better results, whether those results are on paper, in the field or even in the overall reputation. We'll transform back from a bunch of glorified taxi drivers into a professional unit of Emergency Medicine Providers. And instead of being resentful, we'll be glad to do it too.

And then I can go back to being positive about the job I love.

Squashed

He lies flat on his stomach in the road, holding her head as still as possible. His dark blue uniform, ballistic vest, highly polished boots and all, normally radiates authority, control and discipline. Right now it portrays none of these, but gives him the courage to see through the job that he's trying to do, and helps him hide his anxiety.

I race to the scene of another RTC. A pedestrian hit by a van. Police on scene requesting urgent attendance of an ambulance. I arrive to see the police vehicle blocking the road, blue lights turning angrily and illuminating the dark surroundings as they spin. It shields the patient on one side, and I drive round to the other, effectively blocking the road completely, and ensuring the further safety of the patient as she lies sprawled and barely conscious in the middle of the road.

As I step out into the road, a smell that hangs in the air almost makes me vomit.

*****

The police officer who was holding the lady's head was shaking as he gave a garbled handover.

"She walked out without looking and got hit. I think she's got a bad head injury".

I ask if he knows if anyone else was involved, and he points to the pavement, where she's sitting, swamped by the same blue, authoritarian uniform, bawling her eyes out. At least she doesn't seem injured. After a few seconds of confusion, I finally grasp the reason the police were there so fast.

They'd hit the patient. Theirs was the van that had hit the pedestrian.

No wonder he was shaking. No surprise that she was crying.

That smell still lingered in the air.

*****

They were on their way to an immediate response call to an ambulance crew calling for police aid after being attacked. Travelling at 60mph, with lights and sirens, they had no chance of stopping as the lady didn't even bother to look or listen before stepping out in front of them. They'd caught her with the wing-mirror.

I leave the officer holding the head whilst I do some basic checks, connect some oxygen, and hope that the ambulance turns up quickly. He's doing a good job of immobilisation, and it helps calm his nerves if he feels he's being useful. Two birds, one stone.

I wish I could find the source of that smell.

*****

The crew turns up, as does an ambulance officer, who I send to check on the sobbing police officer. She's hysterical, but unhurt. It seems she was driving at the time of the accident, and couldn't calm down. Can't say I blame her.

The patient seems to be regaining a little of the awareness that had deserted her since she'd been hit. We move her bags of supermarket shopping away so that we can bring in the bed, the board and other bits and pieces. We've already decided that she has to go to a trauma centre that specialises in head injuries, which is a little further than the nearest hospital, but it's best for the patient. We think she has a fractured skull and she's been unconscious. A bad combination.

As we lift her off the floor, the smell becomes almost unbearable, and I physically heave, but just, and only just, avoid throwing up.

*****

Once she's packaged and in the ambulance, we reassess her, recheck that nothing has changed for the worse, and the crew then get ready to leave. As I jump out, they start the engine, switch on the blue lights, and start moving away. Other police officers are looking after their colleagues, trying to comfort and reassure them. One of them hands me the patient's bags of shopping, including the one that was underneath the patient.

The smell returns.

*****

I look through the bags for anything that will reveal some details on the patient, but all I find is her shopping, a week's worth of groceries. In amongst it all, looking as innocuous as fruit can, was a bunch of over-ripe and very squashed bananas.

I hate bananas.

Dear Doctor

Dear Dr G Practice,

Despite my seemingly, at least in your eyes, lowly position in the world of patient care, I would nevertheless like to raise the following points. This is due to the fact that recently I have repeatedly been met by an attitude which I would not wish on a rabid dog.

1) We are not your get-out-of-the-surgery-on-time assessment, referral, or taxi service. If I get called to a patient two minutes before the end of my day (or more usually, night), I still have to see them, assess them, refer or treat them, transport them too, if necessary. I can't, don't and wouldn't pass them onto somebody else just because I couldn't be bothered, especially without having seen them at all.

2) Just because you have seen your patient and called for an ambulance, does not discharge you of your responsibility towards them. It should not give you the right to dump them back in the waiting room, letter in hand, waiting for the ambulance to turn up. At best, it's unprofessional. At worst, detrimental to the patient. Especially, just as an example, when they are asthmatic, struggling for breath, hypoxic, O2 levels of 68% instead of nearly 100%, and literally climbing the walls, desperately near death.

3) I and all my colleagues, much to your chagrin, are not mere stretcher-monkeys any more. We are emergency medicine experts. We spend years studying, improving on and perfecting our craft. Much as you do with yours. As such, to have the professional courtesy towards a fellow medical professional and to give us a clinical handover would be greatly appreciated. Not to show that courtesy says much more about you than it does about us.

4) I'm fully aware that not ALL GPs are the same. I'm aware that there are plenty who do understand, comprehend and appreciate our role in patient care. I'm aware that there are many who are even pro-active in their dealings with paramedics. But I'm equally, and acutely, aware that there are those who hold us in disdain. So, even though I've said this before, I'll say it again. If what you think about the Ambulance Service and Paramedics hasn't changed in the last 10, 15, even 20 years, then come and spend a shift, maybe two on an ambulance. Relearn all that you thought you knew about us, but has changed so much since your early days as a doctor. You may be pleasantly surprised.

Show us the respect we're due, and once again I can guarantee we'll return the favour.

Lifesaver

The darkness is compounded by the cloudy, moonless sky, the heavens showering down their vicious tears with all the contempt they can muster. At least it helps the house stand out like a beacon. It's the only one in the street with all the lights on, shedding some brightness on the otherwise depressing night. As I approach the house through the overgrown jungle that covers the garden path, the door is already open. Standing on the doorstep is Rita, leaning forwards, hands on her knees, struggling for breath. She can barely get one word out at a time.

Rita's man is there, comforting her, encouraging her, keeping her calm. He's doing a good job of it too. It's especially impressive, as Ryan is only 10 years old, and Rita's his mum.

"I'm used to it", he claims. "She sometimes gets very sick and I have to help her".

"Did you call the ambulance?" I ask him.

"Yup. I've done it before. They always ask me the same questions, so I know what to tell them now".

It's about 4 o'clock in the morning. Ryan is wide awake, dressed, has got all of Rita's medications together, and written down the details that we need. It took me less than 5 minutes to get to the call, so he's obviously well trained and very organised. His little sister is half asleep on the couch, still in pyjamas, but with her coat on, ready to go.

While I prepare the nebuliser for Rita, he tells me that his mum has bad asthma attacks sometimes, and that she always has to go to hospital. He was woken up by the sound of a loud wheeze, and knew immediately what he had to do. He'd got everything ready while he was still talking to the call-taker at control, all the while doing his best to calm his mum's anxieties.

Rita's condition and observations mean that she's going to need some aggressive treatment and to be blue-lighted into hospital, and there's no-one else to look after Ryan and his sister, so I'm left with the babysitting duties. The crew and I decide that it's best if they don't travel in the ambulance, as we don't want to distress them any more, so they watch mum being loaded into the back of the ambulance, stare as the blue lights of the ambulance reflect off the vertical sheets of rain, and then climb into the car and out of the deluge. I've got the duty of transporting them to A&E until another responsible adult can be found to look after them.

On the way there, they both remain calm, although Ryan's sister is a little teary. Ryan tells me all about the schools they go to, how he helps at home, how he looks after his mum. More importantly he tells me about the football team he supports, and laughs when I threaten to throw him out of the car for supporting a team that are the sworn enemies of mine. Although, I have to admit it, they're much better than mine. But then, most teams are...

We arrive just after the ambulance, and the kids say a quick hello to mum and see that she's looking a little better and in good hands. They're happy to find the kids' waiting area and go to find some toys. Ryan keeps up his role of babysitter and looks after his younger sibling, finding toys that he knows are her favourites. I watch from outside and am impressed by all I've seen and heard. At just ten years old, this young man is so much already.

Son, big brother, mini-dad, carer. And, of course, whether he realises it or not - a lifesaver.

Close Encounters

It was dark. Probably because it was night.

It was cold. Probably because it was winter.

And I was lost. Probably because I didn't really know where I was.

But I did know that this wasn't an area known for its hospitality.

So far so normal.

*****

I'd been an EMT for about two years at this point, and had faced many fears, many unusual sights, and many challenges. I was still very much on the upward swing of the learning curve, but on this shift I had to learn and teach all at once, as Jill, my crewmate for the evening, had been out of training school for less than 3 months.

A call to an unconscious male on a Saturday night is a fairly normal one, usually leading to us finding someone under the influence of alcohol, drugs, or both. The vast majority of these cases occur in a public place, so getting a call to a private address for a 30 year old unresponsive man was a little strange.

As is the norm when we arrive at high-rise apartment blocks, the lift wasn't working, so it would be a hike up to the 6th floor with all our kit. As we arrived at the apartment, the door was open, so we knocked and walked in. The door shut behind us and made me jump. It was the first sign that something just wasn't right.

Jill and I found him lying on the floor, fully clothed and in a coat, eyes shut, but eyelids flickering. An almost certain sign of pseudo-unconsciousness. A fake. I took a step back and called out to him. Jill was still standing by the front door, uncertain how to proceed. Something still felt wrong, so I asked her to go and call for police back up. With hindsight, I should have gone with.

After a couple of attempts to get him to respond by appealing to his better nature, I approached him and shook his arm. In a blur, he jumped up from the floor, stood up over me, and pulled out a pistol from his coat. His eyes burned with an inexplicable hatred, and I was trapped. The "patient" stood between me and the door. I had no idea if the gun was real or not, and didn't really want to hang around long enough to find out that it was.

Jill came across a couple of officers on the 3rd floor who were there by chance dealing with a domestic incident and asked them to come upstairs. She couldn't explain to them any better than I could explain to her what the problem was, but as she was new, she told the officers that she was effectively just following orders on a hunch. The three of them ran back up the stairs and found the door locked. The police called for urgent back-up.

It felt like a lifetime before I heard the screeching of several sets of tyres outside. In reality it was apparently only 6 or 7 minutes. The gunman kept screaming through the doors for them to stay out or he'd shoot. I believed him. The sound of the army running up the stairs meant they did too. Within seconds of that sound, the door splintered into a million pieces, armed police came charging in, and in a fry of Tasers took hold of the gunman as well as the gun. His flatmates stood no chance either against the 40 or so officers who seemed to pile in from every which way.

Several hours of debrief and multiple cups of coffee later, it was time to go home. Just before I left the police station one of the officers came in and told me that the gun was a real one, and loaded. This had been a close encounter of the worst kind. I kept that night a closely guarded secret for a very long time. I'm still not sure I should have said anything at all.

*****

I gave my daughter an extra-long hug that morning when I got home. It was a very different, much needed, best kind of close encounter.

Under Cover

Many years ago, the ambulance station where I work used to be a fire station, so it has a large garage, a massive front and huge roller doors that let the ambulances in and out. They're made mainly of see-through panels, so as you pull back onto station you can see inside the garage. At night, the lights work on sensors, and only come on if there is someone walking about. The darkness gives the place something of a haunted feeling at times, and arriving back in the dead of night on your own can frequently be a little eerie. It takes the sensors a few seconds to register any movement, but once that happens the station and all the vehicles seem to come back to life. The station doesn't seem quite so spooky then.

Arriving back in the early hours one morning, I find that, as usual, there are no ambulances on the forecourt. The station is in its normal sleepy and abandoned state, and I'm about to step into the deathly quiet station. But sitting outside is a police car.

I notice that it's not one of the local units, but one of the armed response team. (For those of you in the States and elsewhere, not all our police are armed. Something I find weird as I didn't grow up here, and something I'd love to see changed. I think.) I take a slightly better look around and find that in a car park opposite, there are another half-dozen of the armed response units, along with various other police vehicles. Looks interesting. And possibly concerning, as they're parked outside the haunted house that is my station. Has someone broken in? Is someone being held hostage inside? More importantly, has someone raided our supply of coffee?

Before I have the chance to give in to my curious nature, one of the officers approaches me.

"Can we borrow you and your car for a small mission?" Well, now there's an offer! I can't refuse that sort of request, can I? What sort of man would I be if I turned down the opportunity to play at being an under-cover cop?

"Sure", I said, "just let me inform my control that I've been commandeered, and then tell me what you need".

I call control on the radio and try to explain without being too specific, concerned that anyone can listen in and hear about the police being in the area and on the hunt for someone clearly unfriendly. They struggle to understand, and in truth I was probably too excited to explain properly, so I just leave it at being used for police assistance, and that I'd call and let them know what happened when it was all over.

The officer goes on to explain that they'd had dubious reports of a shooting in a local club, and wanted to investigate without arousing too much suspicion of their presence. They wanted to clamber into the back of my car so we could drive past the location and get an idea of what was happening. How they expected a bright yellow car with a light-bar on the roof to look inconspicuous, I'm not entirely certain, but they were convinced it was a good idea.

Cramming a lone patient into the back of my car requires all sorts of manoeuvring of luggage. Getting two fully kitted, heavily armed police officers in, was going to be a small challenge, and not one I was willing to fail.

Eventually, car and kit adjusted, and me in a bullet-proof vest, we drove off. Me driving to the location, the officers in the back telling me to act naturally as we passed slowly past. All was quiet. No screams, no mass exodus from the club, no flagging down of an ambulance car. The police decided it was probably a hoax. I'm still not sure if I was pleased or secretly disappointed. I don't want people to be sick or injured, but I do want to be there if it happens.

We return back to the station, the officers decamp and I offer them a cup of coffee. At least I now know that the supplies are safe. I'm relieved when they decline, as there were more than twenty of them there...

I walk back into the quiet station, call control to tell them of my adventure, and let them know that my police career is over, and that I'm now back to being a paramedic. Back to the next call, back to kids with coughs. Back to normality.

I guess that someone in control decided that that's more than enough excitement for me for one night.

TwentyFour/Seven

If you'd have asked me a year ago which my least favourite shift was, the answer would be instant. Nights. I used to dislike them so intensely that I'd quite happily order a government edict that no ambulances are to be sent out at night. If you're ill, wait until daytime. If you can't wait, walk. No mercy. All this was whilst I was on a rotating shift pattern, so I'd go from morning shifts, to afternoon/evening shifts, to the dreaded, loathed and feared nights. But then, just under a year ago, I started working permanent nights.

I had no choice, family came first, and it was the only way I could work and have childcare arrangements that I could cope with. I dreaded the idea of it, and thought that I would never ever get used to nights. Now, I love them. I can't get enough. The peace and quiet of the world at night, no traffic, no mayhem, real patients. The insomnia is still there whether I'm trying to sleep at night or during the day, so no change there. And if I'm already awake at night, while the rest of the world is sleeping, I might as well get paid for it...

However, I had a night off last night, and knew that I could get to bed at the same time as the rest of the normal world. At least in my own time-zone. But I had to remember to set my alarm for seven o'clock to get the kids up for school. It was an optimistic idea, setting an alarm clock. There's no way in the world that I could sleep that late, and my son made sure of it with a bout of croup at 3am. So much for a night off.

Just before seven, I picked up my phone which is also my alarm clock, to turn off the alarm. No need for it now, is there? I took one look at it and had the final proof that I'm now a night-owl. I'd set the alarm to get the kids up for school. Time to get into uniform, have breakfast, clean teeth, brush hair, all in time for the school bus. There was a good chance, had I relied on my alarm clock, that they may have been a little late. I'd set it for 19.00...

Teacher

It's that time of the year again. Our antipodean cousins are anticipating a long, hot summer of cricket (without the Ashes in their back pockets for a change), whilst here we're starting to pile on the layers, preparing for that world-famous phenomenon called The British Winter. The days are growing shorter and the night shifts seem longer than ever. It never seems quite as bad when I have only six hours of darkness on a shift, as opposed to the whole twelve. Give it a couple of months and when I'm on nights I'll see possibly an hour's daylight in every 24 hour period. Very SAD.

Just in case we weren't sure of the imminent arrival of the cold, our airways have a habit of reminding us. Large increases in the cases of asthma, bronchitis, chest infections, croup. Croup is a funny thing. If an ambulance is called to a child aged between 6 months and 4 years (ish), between 11pm and 3am (ish), any time between September and December (ish), because they're having difficulty breathing (not so ish), there's a pretty good chance you're going to meet a croupy kid. The vast majority of the time its bark is much worse than its bite. Literally. The characteristic seal-bark cough is a scary thing for any parent to be woken by. Been there, done it, bought the T-shirt. Scared me half to death the first time I heard it at home, so I fully sympathise with any parent going through it.

*****

Mickey is a normal three-year-old child. He runs around, plays, falls over, scrapes his knee, cries, gets up again and runs around as if nothing's happened. But Mickey's parents weren't sure that he'd ever make it to three. Or two. They weren't certain that he'd make it past the first few weeks. Mickey was born only three-quarters cooked, at 30 weeks instead of the more normal 40 or thereabouts. His lungs were under-developed, his heart wasn't at full capacity, all his internal organs not quite ready for the real world yet. It wasn't Mickey's fault. He was violently evicted, cut away from his mother, just when he was enjoying the comfortable, warm surroundings where he was happily developing. Mum had developed severe pre-eclampsia, causing her to have dangerously high blood pressure, a pre-cursor to eclamptic seizures and all manner of life-threatening problems. In an attempt to save both mother and baby, it was decided that the best option was to deliver Mickey by caesarean-section. Mickey was to be cared for in hospital for the next few weeks, allowing his continued growth, but along the way the medical team discovered that he had several holes in his heart where there shouldn't be any. He had to have several operations, but eventually, after a year or so, Mickey was finally discharged from hospital with an almost clean bill of health. Mum and Dad were told that he might be a little more prone to chest infections than other children his age, but otherwise he should be completely fine.

At the age of two, Mickey had a chest infection. A bad one. So much so that he stopped breathing. Luckily (if it can be termed lucky), he was in hospital when it happened. Mum and Dad had watched him become more and more unwell, and decided it would be best to call an ambulance. Mickey was blue-lighted to hospital where his breathing continued to deteriorate to the point where it stopped. The medical team at the hospital worked tirelessly, and two weeks later Mickey was well enough to go home.

A year after that, for the first time in over three years, Mum and Dad decided it was safe enough to have a night out.

*****

Midnight. The computer rings and tells me of a 3-year-old with difficulty breathing. "Making a funny noise", apparently. Croup. Should be easy enough. Oxygen if necessary, hospital, steroids maybe, back home. Not for Mickey. He's in real trouble. Blue around the lips, the spaces between his ribs noticably sinking with every breath, oxygen levels (Sats) in the high 70s at best. A barking cough that's interrupted only by a horrible screeching stridor. Sounds like he's got a coin stuck in his throat that interrupts the air with every intake of breath. To make matters worse, the babysitter's in hysterics. She's worried that she's done something wrong, when in fact she'd done everything right. She called an ambulance as soon as she heard the noise, and whilst she waited she picked Mickey up and placed him in a steamy bathroom to try and relieve the symptoms.

The babysitter was a family member, so knew all of Mickey's history and retold the tale. His early arrival, his lung problems, his heart problems, his last chest infection, the fact that he'd stopped breathing. The ambulance backing me up arrived only a few minutes after I did, and saw that even though Mickey was on oxygen, his Sats were only in the top 80s now. I retold the story as we walked briskly out to the ambulance, hoping that the cold night air may help as we went. The crew placed a priority call to the hospital, stuck on the lights and took off.

As Mickey was carried in through the doors of the department, he barked. One of the staff was heard to mutter "Oh, it's only croup. What's all the fuss for?" A few raised eyebrows were also spotted. There was a definite atmosphere of "unnecessary ambulance-crew panic" in the resus room. Until, that is, Mickey's story was retold.

The A&E staff had done exactly the same thing I had. Jumped to conclusions before even laying eyes (or ears) on the patient. I'd assumed that it'd be straight-forward. They'd also done the same. I'd assumed that it'd be run of the mill. They'd also done the same. I'd had to switch gears very quickly. They, to their credit, also did the same.

Lesson 1: Don't jump to conclusions.

Lesson 2: Don't jump to conclusions.

Lesson 3: Don't jump to conclusions.

I think Mickey's got a glowing career path ahead of him. I hope he stays well enough to follow it. I reckon he's going to a make a damned good teacher.

Inspiration

Every so often I get asked where I get the ideas for my blog. And every so often I get asked why I ever became a paramedic.

********************

Late Saturday night on a dark, twisty, road. The family car is returning its cargo of parents and their three children from a family gathering in a small village, way off the beaten track. The road twists its way back and forth through the undulating countryside. If it wasn't pitch black, the breathtaking scenery all around would show its true desert colours. The road cuts through the sand and rocks on either side with a high-sided cliff one side, and a sheer drop the other. The blind bends hide unseen hazards. The family continues its journey home, totally oblivious to the imminent danger hiding round the very next corner.

The kids in the back are asking the all-time favourite question of "Are we nearly there yet". Ben, the eldest, all of seven years old, is half asleep. Moments before his eyelids give in to the lead weights that are hanging off them, he looks up out the front windscreen, just in time to see the truck coming towards the car, on the wrong side of the road. There's no time for any avoidance manoeuvre, and even if there was, the choice is either hit the rock face, or fall off the edge of the cliff.

The impact was instantaneous, the noise deafening, the damage to the car catastrophic. And then silence. The loudest silence ever. The dust settles, the debris is scattered all over the road, the family is in total shock. Ben is disorientated, confused, dazed. A dull cry comes from his left hand side, and he looks across to see that his brother and sister both seem OK. One of them is on the floor between the seats, the other is lying on the seat itself. He looks at his mum for answers, and finds only more questions. He looks at his dad for an explanation, but finds that just like dad's front teeth, the explanation is missing.

Blood and tears flow freely. A few minutes later an ambulance arrives. It's a military ambulance, and the sight of soldiers confuses Ben even further. They're there because the nearest point of civilisation is an army base, and their medical centre was the first to get the call about the crash. They explain that they're doctors, nurses, paramedics, it's a blur of flashing lights, of people and equipment. They do their best to calm everyone down, to gain the trust of adults and children alike. Ben's initial terror starts to subside once he realises that these soldiers are here on a peaceful mission. They're here to help. Other ambulances arrive, more paramedics, civilian ones this time. The family is divided amongst them to be treated and transported.

********************

I don't remember any more. I was only seven, after all.

********************

Every so often the scene gets replayed in a recurrent dream, when the insomnia finally gives in to exhaustion and a fitful sleep takes over. I guess, in the recesses of my mind, this is why I became a paramedic. I guess, despite the fact that it took me a long time to realise it, that these amazing people were, and still are, my true inspiration.

Baby Bus II

Driving the Baby Bus is completely different from driving a "normal" ambulance. Every turn, every bump, every acceleration or deceleration has the potential to be catastrophic for a poorly newborn. The little blood they have has a habit of pooling in one area if you brake too sharply, starving the rest of the body of its much needed oxygen. Hit a bump too hard and the jolt can damage their extremely delicate internal organs, not to mention potentially pulling out all the lines and tubes that the team have worked so hard to put in.

___________________________________

The traffic is appalling, made all the worse by the fact that we're all tired and our nerves are fraught. It's taken almost 5 hours, but finally we're under way with Adam to Bigtown Hospital. Mum and Dad have said goodbye and a few prayers before we set off. Despite the fact we all want to go home, there's no tearing round corners scattering the traffic left and right. The nearly 100 miles have to be driven smoothly, calmly, and with utmost concentration. Not a particularly easy thing to do after what has so far been a 15 hour shift. Adam plays his part nicely, staying calm, sedate, and fighting with all his might to stay alive.

Two hours later, and after stopping twice to resuscitate Adam, we arrive at Bigtown. Adam was the most settled he had been since he'd been born, despite trying to scare us a couple of times. I've never been so relieved to see a hospital before. However, unlike an A&E handover, which only takes a couple of minutes once we're acknowledged, a BETS handover can easily take half an hour. It's not just a question of telling the hospital team what's happened, but the transfer from our incubator to theirs is a delicate procedure. Finally, after what seemed an eternity, we returned back to base, luckily not very far from Bigtown Hospital. I drove home, but to this day I don't remember that journey. It was just before 2pm when I walked into my house, having left home at 5 o'clock the previous evening. Tired just doesn't come close. Probably not as tired as Adam. He had a 50/50 chance now. We'll call back in a week or so to see how he's doing.

_________________________________

Three days later I'm back on a day shift, just about recovered from the night to end all night shifts, scheduled to work on the Baby Bus that takes the babies back to their local hospital once they're well enough. The advantage of the "Elective" Baby Bus, is that all the journeys are planned, and it is extremely rare to finish late. After the other night, I'm not sure I'm ready to face another late finish. As I walk in, I'm told that we only have one transfer booked for the day, but that it's long-distance. The look of slight despair on my face must have shown, as I was then informed that it's not that far away, that I should be back by just after lunchtime, and that there's nothing else booked. I guess I can cope with that.

I look at the booking sheet, and can barely believe what I'm seeing. The booking is from Bigtown Hospital. Going to Outtatown hospital. 4 day old baby, not ventilated, breathing on his own, conscious, stable. After everything that had happened, after the trauma that his parents faced so bravely, after all the jangled nerves. Having survived a horrible start to life, having been attacked by all sorts of medical teams, having endured my driving, the unbelievable was happening.

Adam was going home.

We arrived at Bigtown, and I spoke with one of the doctors. I needed an explanation, but he had none. Adam had fought and won, and in a very short time, his battle for life. His recovery had been nothing short of miraculous. He was going home, via a couple of days at Outtatown Hospital for observation, with no lasting sign of all he had been through.

The journey back to Outtatown was a gentle one. No lights and sirens, no stops to retrieve signs of life, no fraught nerves.

Mum and Dad were almost unrecognisable as they stood waiting in the same side room where they'd had only a few minutes of troubled sleep just 3 nights ago. Their faces beamed as we wheeled Adam back in, and the tears this time were tears of relief, of happiness, of joy. All the weight of the world seemed to physically lift from their shoulders. I had the chance to talk to them for a short while, and their thoughts now were no longer in the past, barely even in the present. They wanted to think now in terms of the future. Adam's future. The one he very nearly didn't have and which he had fought so hard to hold on to.

A Mother's Love

Working permanent night shifts on an FRU means that I often spend a while with the patients before a crew is available to come to my rescue... Or that of the patient's, depending on which way you look at it. Although sometimes that extra time on scene allows me to make a much fuller assessment of the patient's needs, other than the presenting medical emergency.

Jim is in his sixties, with very bad mobility. I've met him a few times before, usually just to help him up off the floor. He normally walks using a Zimmer frame. Last night his frame let him down, literally, and Jim found his head going through a large glass door. When I arrived he'd managed to get himself propped up on a pile of clean laundry. Now not so clean, due to the blood. He was very much conscious and alert, and although he couldn't even see me as I came in to the house, his first comment was "I see you're back again..." .

The lounge is the first room you come to and it's tidy and clean. At the back of the lounge is what I guess was meant as an extension to the house, but has now become Jim's bedroom. The room's a mess, now even more so with all the blood and glass everywhere. It's a complete contrast to the rest of the house and I find it a little difficult to understand why. In his room he has all sorts odds and ends that he's collected over the years, as well as a painting that's only half way done. This seems to be his pride and joy and he tells me how much he's looking forward to finishing it.

In the meantime I've checked Jim's observations, found them on the whole to be OK, and tried to clean the back of his head where the hair is all matted with blood. I've found that he's still covered in shards of glass, there are about four or five cuts to the back of his head, one of which is still oozing. I'm concerned that the cuts still have glass in them, but it's impossible to see without properly cleaning the whole of his head and that's not really possible, so I place a bandage on his head and wait for the crew to turn up.

All the while, Jim's main carer has been there watching and trying to help where possible. The only problem is that Jim's main carer is his Mum. She walks better than Jim, she does his shopping, his laundry, his cooking. But she's in her 90's. 93 to be exact. She's as fiercely independent as she is deaf. I offer to help clean up the glass. I offer to try to get them some extra help. I offer to get social services more involved by filling in what's known as a Vulnerable Adult form. Both for her and Jim. But she's having none of it. All she's concerned about is how Jim's doing, how long Jim's going to be in hospital for and how he's going to get home. She won't let me back into the house to help clear the mess, and she really doesn't want me to fill in any forms. She just wants to continue to look after her home and her child.

She doesn't need help. She just wants to be his mother.

I hope I did the right thing. I went back to station and filled in the forms...

Nights

Accidentally came across this article. The more I read, the more worried I get...

Insomnia

I wonder what these researchers have to say about people like me who only work nights... Is sleeping until lunchtime the same as having a lunchtime siesta? Doesn't bode well, does it...?