Behind Closed Doors

Midnight. The normally quiet residential street is a hive of activity, as busy and bustling as a midday marketplace. People have gathered from all over; neighbours, friends, relatives, all standing outside trying to make sense of the unfolding drama. We can see it all, hear it all from the bedroom, each of us taking turns to peek out to the street a dozen floors below as we rotate over and over again, each of us briefly the centre of the chaos, standing pumping his heart, then taking a break, a breath of fresh air and a glimpse out the window. 

The bedroom is tiny, the furniture within taking up the vast majority of the space, leaving us with very little room to work, yet somehow we all fit in. Through the closed door we can hear the sounds from the lounge. It too is packed full of people, some who heard the initial shrieks and screams for help, some who received the panicked phone-call. Some were further along the communication tree, receiving word as the news branched out exponentially. 

We know how much this means, how much is riding on our success or failure. Every call means the world to someone. Every patient needs our help equally at their time of distress, even if we don't always see it that way. It's hard for us to think that the patient who's had backache for a fortnight ranks as highly as our patient now. Sometimes we show our frustration, but mostly we treat what we see and who we are seeing as the centre of our attention, as though nothing else in the world matters now. 

Right now, however, we really feel it. Nothing else matters. In that tiny, closed room is the entire universe and all that's important within. We are fighting for a life in one room, as in the other they can only wait. Every few minutes someone goes out to update them on what is happening behind the ominously closed doors. 

It's all so different from the time before, when we worked in the lounge, watched throughout by a partner who knew she was saying goodbye to her lifelong companion. There was no noise, barely a sound uttered. Every few minutes she'd hover behind our backs and ask us if there was any change. At the third time of asking, when there was none, she calmly sat down and asked us to stop. 

This time we stopped when we saw that all our efforts were futile. We fought for over an hour, far longer than we should have done, far longer than the protocol requires of us. We fought because it felt as though we couldn't afford to lose, even when we knew we were losing. We fought until we lost. 

We sit silently behind the closed doors of the ambulance, tidying, cleaning, preparing the inevitable, intrusive paperwork. We are not quite hidden, more cocooned, yet unavoidably touched by the tragedy all around. More friends and family turn up at the scene, each showing grief in their own way. Some cry, some wail, some are silent and sombre. Some are more stoic, lending shoulders and strength to those who need it most. 

Back upstairs, behind closed doors, a mother and her young children sit stunned as the building in which they reside remains upright but the entire world around them collapses. 

Sandy Hook

Rivers of ink have raged, almost as the rivers of blood that flowed all too freely have now stilled. I don't know when is, or even if there is, a right time to wade in to a discussion on a tragedy as raw as that of Sandy Hook School, where those killed are only now being buried, where their families have not even begun to really grieve. Parents of children are being forced to come to terms with a reality that none of us should ever have to face. Families of adults who died protecting the innocent battle with conflicting emotions; pride in the bravery displayed by their loved ones fighting for space in amongst the utter sadness at their deaths. 

And in the midst of it all, the all-too-familiar rhetoric begins. Pro-gun versus anti-gun is too simplistic. It's like saying that there are those who wish to live in a constant state of war against an enemy and those who want peace with the very same. In reality, everyone wants peace. It's just a question of how to get to that state. Rhetoric alone will not answer the questions that will race around the minds of a nation, particularly a nation in mourning. 

I have only questions, no answers, but feel the need to raise them here, if only as an outlet. I struggle to understand why this happens. Why it happens in America. Why is it that I live in a country where guns are a part of the daily view, yet we have mercifully been spared the awful scenes that have now been shown all over the world. 

I am torn. Torn between believing that weapons should be available so that it is not only the criminals and terrorists who possess them, and believing that they should be almost impossible to come by. Several times in the past, terrorist incidents in Israel have been halted by a passer-by who happened to be there and happened to be armed. Right place, right time. On the other hand, the readily available weapons allow for easier access to those who would use them to harm the innocent. 

However, one cannot walk into a gun shop here and buy an assault rifle "off-the-rack." The number of civilians carrying weapons is actually surprisingly low. Assault rifles are seen in the streets, but they are carried either by members of the armed forces or by members of response teams in the more volatile parts of the land. They can't just be stored at home as yet another item on a list of fixtures and fittings. Licenses are hard to come by and are enforced by strict regulation.

Arguments will appear on every media outlet, on social media, in conversations between neighbours and friends. Both sides will voice their opinion, all too often based on that cyclical rhetoric, bandied about by populace and politician alike. Slogans don't solve the problem, they just accentuate and polarise it. They certainly do not reunite grieving families with those that they have lost. Falling back on rights is as helpful as quoting often irrelevant statistics. It is, however, clear that something has to change, probably on both sides of the great gun divide. 

I don't have the answers. I may not even be in a position to ask the questions. I do know one thing for sure. I never want to see these scenes again. Not as a parent, not as a news reader, and not as a paramedic. Not on my own doorstep, nor on anybody else's. 

Yet another community will have to rebuild itself, brick-by-brick, one family at a time, united in grief for now, but hopefully in strength in the future. And all the while, the answers must be found to prevent anyone else from facing yet another unspeakable tragedy. 

English Lesson

Blotchy eyed and with a tear-stained face, Claire meets us at the door holding a small child in her arms. His chubby face is flushed with colour and steam comes off him where the cold compress is applied to his back. A quick check with the thermometer only confirms the fever and gives it a number: 40.9 degrees Celsius, or 105 and a little bit in old (and American) money. It's the highest I've ever seen.

"I only went out for five minutes, just to get some milk from the shop. I left him with Liana - the nanny."

She whispered the next bit.

"By the time I got back you were already on the way. Sounds like he's had a febrile convulsion. She was terrified, thought she'd done something wrong, and I can't convince her it wasn't her fault - we both ended up crying. Will you have a word with her? It's just that Andy's never had a fit before."

"No problem. Lets deal with little one first. I have to say, you seem quite calm about it all!"

"I'm a paediatric nurse in the A&E down the road, actually due on shift in an hour. Obviously it's a little different when it's your own, but at least I know what I'm dealing with. We've thrown everything at him, he'd only just had paracetamol just before I went out. Poor Liana's completely freaked out by it all."

Quiet, muffled footsteps shuffled towards us, and I could see Liana tentatively head back into the lounge.

"He's OK?" A slight accent gave away her foreign origins, but I couldn't at first place the country.

"He's absolutely fine. He has a fever, and babies sometimes do that when they can't bring the fever down. He needs some medicine, but he should be just fine."

"So I shouldn't called the ambulance?"

"It was good to call the ambulance. If a baby has a fit then he needs help - so don't worry."

"I'm sorry. I don't want you tell me off, I don't want you think I hurt Andy." Her look darted between Claire and me. "I love Andy - he's like my own baby - I never hurting him!"

Claire handed Andy over to me and went to put her arms around Liana. "You did everything right. I know you would never do anything to harm him." Then she turned to me. "Liana's been here for nine months, since he was five months old and I went back to work. She's like gold dust - I don't know how I'd ever manage without her! I'm helping her with English, and she's trying to teach me Greek - although she's a much better student than I'll ever be."

At last, Liana smiled.

"I can hold Andy?" she asked Claire.

"Of course you can."

"Efxaristo!" she said as she took Andy from me and held him tight. 

"I presume that means thank you?" I asked Claire.

"You're a quicker student than I am!"

"But now," laughed Liana, "you have to say it!"

"Forget it. My language-student days are over. I'm sticking to what I know."

As we walked in to the department, Claire was met with some quizzical looks, one in particular from the nurse in charge.

"I know it's a bit rough in here these days, but now you bring your own security detail?"

"Well, you know, these paramedics, they're always hassling us, interrupting our peace and quiet. I thought it was time we hassled them instead."

"Sorry," interrupted Liana, "this word hassle, it means to look after somebody?"

We left them in the department and went to find someone else to hassle.

Can't Cure Stupid

I think, that rather than preventing my kids from leaving the car at the wrong time, I need to child-lock myself in my car sometimes. 

On route to work, I was followed for almost ten minutes by another car with a small child on the front seat. Then on the back seat. Then back to the front. 

In uniform, out of sorts, and stopped at a set of traffic lights, I could bear it no more. 

I got out of my car, knocked on the window, and was about to suggest to driver that an unrestrained child is not only illegal, but it's damned stupid, and that I didn't much fancy the idea of being the medic at the scene of an accident who had to break the news that her child's dead. Because she's stupid.

Stupid wasn't the half of it. 

On the back seat, secured by not one but two seat belts, was a brand new television. 

"Your TV is strapped in, and your child isn't? What's wrong with you?" I didn't mean to yell, but my red-headed temper got the better of me.

As luck would have it, a passing police car saw the altercation and came to tell me off, assuming another road rage incident (they were only partially wrong), only to see the real problem.

I left them to it. 

Teddy

The room was on the third floor, not in an apartment block - but a private home. The driveway was the length of many suburban streets, and the private estate on which the house sits could pass for a royal residence. The country park feel only added to its charm, but at the same time left the scene feeling cold.

"He's just in here. I won't come in with you, because he screams each time I step into the room."

The room is also massive. Floor to ceiling mirrored wardrobe doors only added to the size making it seem twice as big. An en-suite bathroom cleverly hidden in the far corner. In there, huddled in a corner with his knees under his chin, sat the terrified figure of an eight year old boy.

"He's been fine up until the last few days, maybe a couple of weeks I guess. Can't work out what's bothering him. He's slowly stopped talking, hardly eats, hardly sleeps, and has started wetting his bed at night. He won't let me help him get dressed, won't let me check his school bag, hates going to school which he used to love doing and he doesn't want me to step into his room! Now he won't even come out of the bathroom!"

"Alright. I'll try to talk to him. What's his name?"

"Andy. Andrew really, that's what we christened him, but nobody calls him that."

I step into the bathroom and sit down on the floor by the door. Andy tries to scrunch himself up into an even smaller ball, pressing his legs to his chest and shutting his eyes as tightly as he could. I notice a small bruise on his forehead, an almost ever-present mark on any young boy's head.

"Hi Andy. My name's Ben. Your mum tells me your not feeling too good, can you tell me what's wrong?"

Without a sound, he turns himself towards the wall, facing away from me. I kept my distance and pondered my next step. Children are not small adults, they're child-sized, fully-grown children. You can't just talk down to them - you need to look them in the eye and speak at their level. Sitting cross-legged on the floor of the bathroom was starting to get uncomfortable. 

"Andy, is something hurting you?" 

Without looking up he shook his head from side to side. 

"Do you feel sick?"

Same response again. I asked Andy's mother if he had a favourite toy, and without a word she left and returned a moment later with a teddy-bear. 

"Andy, would you prefer to show me what's wrong on the teddy?" 

A shrug of the shoulders was the closest Andy came to cooperating. I handed him the bear and asked him to show me what had happened, but he sat just as still as before. 

"Shall I ask teddy instead?" It felt wrong to be treating an eight-year-old as though he was still a toddler, but it seemed to work. Andy nodded his approval and I addressed teddy instead as he sat hugged tight by his owner. 

"Teddy, does your tummy hurt? Have you bumped your head? Has somebody said something not nice to you?" 

All the questions were met with a tough silence and a shake of the head. 

"Why don't you show me what's happened then? I'll stop guessing, and you can just tell me. Does that sound OK to you?" 

After a few moments, Andy suddenly stood up from under the sink, turned on the tap and stuck teddy's head under the stream of cold water. He then turned the tap off, and started hitting the teddy's head on the sink.

Suddenly, having taken out all his anger, the teddy's arm fell off. 

Andy sank to the floor, curled himself back up in a ball and sobbed uncontrollably. I turned round to see his mother in the same state, tears streaming silently down her cheeks, all the answers she'd been seeking suddenly hitting her like a juggernaut.

"Andy, I think you and teddy need to speak to someone like a doctor. Mum can come too. I can put a bandage on teddy's arm for now if you like. Will that be alright with you?

Andy looked at teddy who turned his head to look back. They both nodded their approval. 

First Steps

A parent's life changes forever on an almost daily basis.

The day a baby's born.

The first smile.

The first tooth.

The first "Mama", "Dada".

The first crawl.

The first steps.

The first fall down an unguarded flight of stairs.

The first broken leg.

The first ambulance.

The first hospital visit.

The first steps again.

Months later.

Birthday Boy

The shift had been relentless:

Two unsuccessful resuscitation attempts, including one young person. 

One serious motorbike accident, unlikely to survive. 

One serious stroke, unlikely to survive.

Two asthma attacks. 

And a twenty year old with tonsillitis somewhere in the middle of the mess.  

There was still an hour left of the shift, and we hadn't stopped once in the previous eleven. I was working with Gary, 50-something in body, still a teenager in spirit. He'd joined a little before I did, his previous job having lost its sparkle, as he looked for a new adventure whilst headed towards the end of his forties. In the short few months we'd worked together, we'd found a rhythm. We each preferred different types of calls, we could tell when the other was off-colour, but would both kick into gear when it was really necessary. Sometimes there was no need for words. Whatever needed doing was just done. 

This time, it was his turn to drive and mine to attend, yet as with most regular crews, it was more a case of who was in charge of the writing, and who of the driving. The actual caring for the patients was done by both of us irrespective of what was on the actual ticket. 

"You OK?" Gary asked, as I rested my head back on the attendant's seat, closing my eyes for a second. 

"Think so," I sighed, "just a bit tired. It's been one of those again, hasn't it?" 

"Well, they can't throw anything else at us now, can they? There can't possibly be anyone really sick left!"

With that, we pushed the green button to let the Brain know we were ready to go. Just one more call, and then it'd be home time. Within seconds, the computer rang, and another call appeared out of the ether. 

Toddler-aged, fallen, bleeding from the ear, unconscious. Address? Two hundred metres from the next hospital down from where we were.

I stared in disbelief at the screen, my head and insides screaming for some sort of respite. This doesn't sound like the sort of call that is going to be an easy, end-of-crazy-shift, non-thinking, walk 'em on, walk 'em off the other end type. 

Gary drove as quickly as the rush-hour traffic would allow, the flashing lights and blaring siren apparently  completely invisible and inaudible to the people rushing home to their families after a long day at the office. The frustrations were building, the anxiety of the unknown trauma caused to the child beginning to play havoc with my already shattered brain and body. Adrenaline was building up and coursing its way through my bloodstream, and was only increased when what seemed like half the street were stood outside and waving frantically to show us the right house. 

As we pulled up outside, I jumped out the door, grabbed the bags from the ambulance, and ran up the stairs following the man who said he was the baby's uncle. 

"What's happened?" I ask the uncle. He either doesn't hear the question, or doesn't understand it. 

"Just come quickly, look, see!" Gary's a step behind me, and equally as anxious. 

We step into a lounge, balloons and streamers are everywhere, and a banner that reads "Happy 2nd Birthday" hangs above a shelf that is covered in cards. There are at least thirty people in the room, some eating cake, some drinking tea or coffee, all chatting amongst themselves. The birthday boy sits in the middle of the floor, surrounded by presents and wrapping paper torn to shreds, beaming from ear to ear. Cake crumbs are strewn all around him, and blue and red icing covers his face, leaving him with an almost clown-like appearance. 

The adrenaline build-up had no practical escape, and I lost it. 

"I thought he fell?" It was more a demand than a question. "I thought he was unconscious? And I thought he was bleeding from his ear?"

"He IS bleeding!" It was a new voice, another male, who identified himself as the father. "Come and look!"

He picked up the toddler, who cried at being dragged away from his new toys, turned him sharply round, and made me gaze at his left ear. There, at the top of his ear, was a pin prick of dried blood. "He scratched it with this toy, and we want you take him to the doctor. I knew if I said he was unconscious, that you'd come quicker. He needs to be back for the rest of his party!"

Through gritted teeth, I started to answer him back. I got two words into my sentence, when there was a hand on my collar, pulling me back. 

"Go out to the ambulance, and get the bandages ready." Softly spoken as ever, Gary prised me away from the situation, and gently threw me out the house. "We'll be down in a minute." 

The parents demanded that their little boy be seen at hospital, and we obliged, but this time Gary stayed in the back, and I drove. I couldn't guarantee that I'd bite my tongue long enough to get us through the two minute journey. Gary took them into the department, and as they walked past the front of the ambulance, I wound down the window and called out to the patient.

"Happy Birthday," I yelled, as I sat and pondered just how close I had come to losing everything I had worked for, if Gary hadn't have stepped in when he did.

The little boy grinned back, and shyly hid his head in his father's shoulder.

"That was some day," Gary sighed as he stepped back into the cab.

"Could've been worse!" I answered, not entirely convinced myself. "Here," I said, handing him the keys to the ambulance. "Drive us home."

It was a silent ten minutes back to station, as we both mulled over the day's events. Back at the station, we gathered our belongings, tidied up the ambulance ready for the next crew, and set about going our separate ways. As Gary was stepping out the back door of the station, I called after him.

"Thanks for today, especially that last one. You probably saved my job!"

"See you tomorrow, we'll do it all again."

"Isn't it your birthday tomorrow?"

"Yup. But I'm not planning on cutting my ear, so I reckon I'm safe."

He laughed, and I threw an empty plastic bottle at him, which dropped a couple of feet short, but made him trip over his own feet as he tried to beat a hasty retreat. It was my turn to laugh.

"See you tomorrow Birthday Boy." 

Hysterics

As I mind my own business walking around the local supermarket someone I've never met starts a conversation. 

"You don't remember me, do you?" 

I get nervous when I hear things like that. She'd walked past me down one of the aisles a few minutes earlier, and gave me a funny look that I just shrugged off. Her daughter, probably three-years-old, was sat in the half-trolley, half-car, trying to grab anything off the shelves that took her fancy. I recognised the constant struggle with a toddler, and was pleased that I no longer have to deal with it. Having said that, bigger kids, sometimes bigger problems.

"Sorry, I don't remember." 

"Well, do you remember my daughter?" 

"Also not. I'm sorry. " I'd put the idea that she could have been a patient out my head, as I live and shop some distance from where I work. 

"Well, really, you should remember her more than me, as you met her first!"

"Pardon?"

"Well," she said, clearly enjoying the exchange as much as I was confused by it, "this is Aleesha, and you and your colleague brought her into the world!" 

A few seconds passed as I regained my composure. 

"Oh! Wow! I've never met anyone I've delivered before!"

"Well, now you have!" She turns to Aleesha, just as the toddler's about to take some chocolate from the shelf.

"What do you say to the nice man?" 

Aleesha quickly hides the chocolate in her car, looks sheepishly down at her feet and mumbles a barely audible word. 

"Sorry..." she says, as mum and a very strange man burst into hysterics. 

Shortlist

It all seemed so simple. We turned up at the house for what appeared to be yet another "maternataxi". An ambulance being called to a woman in early labour for simple transport, where after nine months of preparation, buying clothes, painting nurseries, and building cots, no-one had thought about how to get to the hospital. Either that, or it's just that we're the cheapest option. Taxis cost money, as does parking, so an ambulance that will deliver you (sorry) to the front door and not cost a penny is a very attractive proposition.

Zara had two days to go according to her notes, but babies rarely arrive exactly when expected unless it's by planned Caesarean. Whoever called the ambulance told the call taker that the contractions were two minutes apart, whereas in reality it was nearly five. Her waters hadn't broken, this was her first pregnancy, and she wasn't too troubled by the contractions even when they did occur. Her husband said he'd make his own way in the car. He could have taken Zara too, but probably feared the mess if she delivered on route. Either that or he panicked. I gave him the benefit of the doubt as it was their first baby.

"Which hospital are you booked into?"

"Faraway hospital," she answered. Not the answer we'd hoped for. There were at least five other maternity units that were nearer in all directions, but if that's where she was booked, that's where we were taking her. It was over half an hour away, if the traffic was bad it could be double that, and the only reason she wanted to go there was because she had heard from friends that it was a good place to go. She never quite took into account the fact that she actually had to get there, and possibly in a hurry.

"Lucky you're not booked into Edinburgh hospital!" I commented, only half joking, trying to hide the nervousness I felt at a long trek with a labouring mother-to-be. Zara's husband stuck his head back in and asked if we would take the luggage as well and then he'd follow us to hospital.

"I'll be right behind you. Don't have the baby without me!" I hoped Zara's husband was right. We told him that if the traffic was particularly bad, we'd cheat and use the lights, and he had to make sure that he got there safely, even if it meant a slight delay.

I was fairly new, with only one delivery under my belt, an easy home birth where the midwife turned up less than five minutes too late. I was working with a partner who'd long ago lost interest in treating patients. He was working out the years until his retirement and spent most of his time driving the ambulance, ignoring both patients and crew mates alike.

"She'll be fine," he said, "we'll make it there with enough time for us to grow the coffee beans and still drink them before she has this baby." With that, he shut me and the patient in the back, and started gently trundling to hospital. Half way there, something about the way she was contracting changed. The look on her face was more anguished, the mix of gas-and-air in the bottle with the chipped blue paint no longer worked its magic quite so effectively. I called through to the front and explained what was happening. My crew mate looked up briefly in the mirror, switched on the lights and pushed the engine a little harder. The engine roared a response, but the actual change in speed was barely perceptible. Zara certainly didn't seem to notice the difference. I placed a maternity kit on the trolley, just by her feet, hoping the clear plastic case would remain sealed.

We called ahead to the hospital and asked them to make sure we were met by the front door, as it was notoriously difficult to get into the unit in a hurry. It involved two doors that required remote access, and a lift in between the floors where the doors were located. Waiting at each stage could easily add ten minutes to the journey. The lights and sirens had no real effect on the speed, but at least we could weave a little easier through the daytime traffic. Fifteen minutes and six or seven sets of strengthening contractions later, we pulled up outside the hospital. As expected, despite our prior warning and plea, there was no one there to meet us.

Zara screamed. She yelled about needing to go to the toilet. Desperately. There are two sets of patients who tell us that. One set is those having some sort of cardiac event, who if allowed to go will probably collapse, or worse. The other set is mothers in labour who are about to deliver their babies. As we lowered the trolley out of the ambulance, I was in a way glad of Zara's panic. It was doing a great job of masking mine. We pressed the button and waited for what seemed like an eternity until someone answered. We didn't need to identify ourselves, Zara once again did it for us.

"Get the lift down here, and get these doors open!" yelled my crew mate. It was the first time I'd seen any sense of urgency about the man.

Dragging the trolley up a slight ramp into the building, I prayed for the lift doors to open, and a midwife to be standing inside. Neither happened. I pressed to call the lift, and the square button lit up, its dim red light stopping us from proceeding. As the lift arrived, the light went off and a bell chimed to announce the blindingly obvious. Another chrome button, this time with a large "2" embossed both as a regular numeral and in braille. Once again I cursed hospitals everywhere for not having all maternity units on the ground floor.

We stopped on the first floor, a frightened looking mother and child taking one look inside and deciding to wait for the next time round. Another delay, another contraction, another scream. I frantically looked for the button that closed the doors again, only to find that there wasn't one. Instead I pressed the number 2 again, willing the lift to move. Zara had practically finished the entonox, and I promised her that there was more on the unit. All she had to do was hold on another minute.

I timed it. Forty-five seconds from when we stopped on the first floor, until we starting rising again, another thirty for the doors to open on the second door. As we landed, Zara contracted once again, and begged us not to move until it was over. We stood, waited, and prayed.

"It's coming!" She yelled. "Now!"

My crew mate got out the lift and pressed the buzzer to ask the staff to let us in. A distance of no more than five metres. As he got out and pushed the button, Zara pushed the baby.

There was a gush of water as the amniotic fluid escaped from the sac, and a scream as the baby's head appeared an instant later. The scream was Zara's, but it might as well have been mine. In the meantime, the unit's doors remained firmly shut, the magnets holding them in place still secured by an electrical circuit. Finally, training took over from panic, and I gently held the babies head as it turned. The next contraction didn't move anything, and in between the pains my crew mate resorted to bashing on the ward doors instead of pressing on the buzzer. But it was too late.

One more contraction, and Zara was able to hold her beautiful baby girl.

"Time of delivery - 13:14. Born in a lift."

She seemed, from my limited experience at the time, to be quite a big baby. Thirty seconds after she made an appearance, a midwife finally came to open the doors.

"What gives you the right to make such a noise? We're very busy in there, and if we don't answer the door, you'll just have to wait!" She emphasised each of the last four words through gritted teeth.

"Unfortunately," I said, somewhat cooler than I'd imagined possible given the circumstances, "this young lady couldn't wait any longer." I pointed to Zara and the little bundle she was cuddling, each wrapped in an appropriately sized ambulance issue blanket.

Instantly, the attitude changed. We were led inside, shown into a delivery room, and assisted Zara to move across from our narrow and uncomfortable trolley onto the hospital bed. There was the small issue of the cord and placenta to deal with, of which the midwives now took charge. The baby was taken to be cleaned and weighed, a shout from across the room announcing that what I'd guessed at being 'quite big' turned out to be well over four kilos, some nine-and-a-half pounds.

Zara was given an injection in her thigh, and with that chemical encouragement, the placenta too was delivered. She was free to hold her baby again now she'd been cleaned, and at that point her husband appeared. He was puffing and panting as if he'd been through the labour himself.

"I thought I told you to wait for me!" he gasped, leaning over to kiss both his girls.

"Have you got a name for her yet?" asked the midwife who'd initially let us in, now suddenly full of smiles.

"Not yet," they answered in unison.

"We've got a shortlist," Zara added, "but we hadn't definitely decided. We had a definite name for a boy, but this little one will have to wait a little while."

"How about Ellie?" I ventured. Zara looked offended.

"You mean short for elephant? Just because she's a big baby?"

"Actually, I meant Ellie as in short for elevator. I didn't think about the weight!"

"She was born in the lift?" asked the new dad, his voice an octave higher than it should have been. "How did I miss out on all that action? I can't believe it!" He sank into the armchair next to the bed, gently stroking his little girl's wispy hair. "What do you think Zara?" he added after a few moments. "It's quite a nice name? And what with all the circumstances, it really fits too..."

"I'm too tired to think about it right now." Zara replied. Single tears from each eye took a gentle stroll down both her cheeks as she gazed lovingly at her newborn daughter. "Why don't we just add it to the shortlist?"

A Christmas Tear

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

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

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

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

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

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

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

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

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

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

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

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

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

Orders

By order of InsomniacMedic after last weekend's horrendous shifts:

All parents or soon to be parents of babies and young children must:

1) Undertake a basic paediatric first aid course. And refresh it regularly.

2) Have child-friendly Calpol / Tylenol / Ibuprofen on tap. I mean it. A never ending supply. And know how and when to use it.

3) Be aware that ambulances are for emergencies. We're here for you and your child whenever you need us. But we're not here for common colds.

4) If necessary, take a course in common sense. It's not as common as it should be.

This order has no expiry date.

Starfish Ward

The outside of the building is dark and miserable, much like the early morning itself. We walk in, straight past the lift where I have some mad memories of a call years ago (that story another time), and up a flight of stairs. Hospitals are miserable places. Full of sick people as well as unappreciated and overworked staff. The only place in a hospital that tends to have smiling faces is the maternity unit. Oddly, that's the building we walked into, but only because that's where the paediatric wards are, and we were taking our little one to say goodbye to his troublesome tonsils. Over a dozen episodes of tonsillitis and dozens more "Say Ahh"s in eighteen months do not make for a particularly happy young boy. For a change, the system agreed with us, and the NHS would take the kind donation of a pair of five year old tonsils.

The dark early morning confused the little one into thinking that we'd woken him in the middle of the night. We'd prepared him for the day by explaining as much as we knew. He read a book that he borrowed from a friend who'd faced the same ordeal not long ago and understood a little more, and we had decided up front - no tricks. He knew about the magic (EMLA) cream on his hands, he knew about the needle and that he wouldn't feel it, he knew that he'd be asleep when his tonsils were taken out, and he knew that, more importantly than his parents being there with him, so would his favourite Beddy Bear.

He pressed the button allowing us into the ward, and the instant the door opened, the hospital magically transformed. Starfish Ward is full of colour, the walls covered with sea creatures of all sorts, psychedelic jellyfish dangle from the ceilings, and the theme is continued into the rooms and especially the impressive play area. The first person we met smiled at him and made him instantly feel at ease. Not an easy feat at the end of a night shift. We were shown to a room where he was given a choice: bed by the window or bed by the TV. The view from the window was dull and full of hospital buildings. I'll let you guess which he chose.

After he was booked in he was asked if he wanted to head to the play area. The world land speed record was broken on route. Whilst he was entertained we met the nurse who'd be looking after him, the surgeon, the anaesthetist (add an -easiologist on the end if you're across the pond), and were constantly kept updated by the staff who couldn't do enough for us. MrsInsomniac kept a cool and calm exterior, even as we wheeled him down the long corridors towards theatre, helped in no small part by the staff and their caring attitude. The normal sized hospital bed made him look small and for the first time a little vulnerable as he was taken into the anaesthetic room.

The cannula went into his little hand, twice, without even a flinch. He even watched as they did it, probably making sure they were doing it right and that everything he was told was true. As the propofol went in I watched him fight a losing battle with sleep he gripped ever more tightly onto his bear, I gave him a kiss, and left to wait outside.

An hour later they came to find us.

We went to see him up in the recovery room, where he was just coming round and was a little confused. A bit like I feel most of the time. He tried sitting up in the bed, but his head looked as if it was made of lead and made him lie back down again. MrsI held his hand all the way back to the ward, back through the grey buildings, through a colourful mural painted in one tunnel as we approached our destination, and back into the full vibrancy of Starfish just moments later.

It took him just over an hour before he was back playing in the play area, as if nothing was wrong. Analgesics are wonderful things. He was eating and drinking a little, and the first "Can we go home now?" came after less than two hours. Barely six hours after the operation, we were allowed home. He couldn't wait to get home and show his non-existent tonsils to his big sisters.

The system is what it is. It's beauraucratic, it's cumbersome, sometimes it's slow and irritating. There are gripes, there are moans, there are those who, whatever you do for them, will always complain about the system and those who run it not doing enough. Behind the system, however, stuck in its grinding cogs, are the staff. The real people with real faces.

On Starfish ward they wear brightly coloured uniforms that match their surroundings. The staff we encountered are a credit to their uniforms, and their characters mirror in them. They were helpful, friendly and understanding, and of course highly professional. There were children on that ward who are, unfortunately, regular customers and the staff know them well. We were only temporary dwellers, yet were treated by the staff as if we'd been there every day for a year. They are a credit to their ward, to their hospital and most importantly to themselves. MrsI, JuniorI and I (heh) can't thank them enough. Instead of hanging your "Thank You" card stuck onto a wall or cupboard door somewhere, yours is going global.

Oh. And it was two operations for the price of one. Beddy Bear also had his tonsils out. Starfish looked after him too.

Feeling

Do you ever get that feeling?

You know,

the one where you've done everything possible,

done it to the best of your ability,

brought about a good result,

improved a condition that was rapidly deteriorating,

but nevertheless felt that something was lacking?

Yeah.

That feeling.

I did. Just the other day.

Now,

I just hope the kid's on the mend.

I couldn't have done any more.

The worst thing is,

that I'll never really know

why I had that feeling, or

what I should have done about it.

Loco Parentis

The door is opened by a middle aged woman, cigarette hanging off her lips, her attitude delighting us almost as much as the smoke in our faces.

"You take this bag, and I'll bring her out in a minute!" She dumps a pink hold-all in my surprised arms, and shuts the door almost completely, leaving us in the pouring rain. The inch of artificial light shining between the door and the frame means the gap is just wide enough for us to hear our patient and her cries of pain. Our requests to be allowed in to at least see and start to assess the patient are met with defiance.

"You stay out there. I don't want your muddy boots in my house. I told you she'll be down in a minute."

The tirade changes direction and is re-aimed at the patient.

"Come on already. They're here. And you make sure that you don't have any of that gas stuff they're gonna offer you. You don't need it!"

A minute or so later, Mina appears. 18-years-old and a week overdue with her first baby, she looks just about ready to pop. She has a look about her that's a mix of excitement and anticipation, as well as fear of the unknown.

We invite Mina into the back of the ambulance, and ask her whether she'd be more comfortable sitting on the chair or lying on the trolley. She chooses the chair, and as she sits down, another contraction begins. I write the exact time down on my glove, ready to time the frequency and length of each contraction.

Her pregnancy notes suggest that all has been well for the duration, that the health of mother and baby is satisfactory, and even, from just the day before, that the baby was head down and ready to be born. Her vital signs are normal, and contractions now two minutes apart. She seems to be at the stage of labour that makes most ambulance staff nervous about a BBA, a baby Born Before Arrival at hospital, and start to think about the mess they're going to have to clean up.

I offer Mina some entonox, the magic pain relieving gas. She takes the equipment in her hand, only for her mother to snatch it away.

"I told you, you don't need that rubbish. I never had any when you were born, and you're certainly not going to have any with your baby either!"

Mina looks downtrodden.

"I'm sorry", I say to her mother, "but you're not the patient in this case. If Mina decides she wants the gas, then she is more than welcome to use it".

"You. Are not. Her mother", she spits through gritted teeth, "And you're not going to make the decisions. She's MY daughter, MY responsibility, and it's MY decision!"

"You're absolutely right, it's not my decision. But it's not yours either. It's Mina's. She's old enough to make her own decisions. If she wants to use the entonox she uses it. I understand you're almost as anxious as she is, but right now you're not the patient. Mina, would you like the gas?"

She's terrified, struggling with the conflict between the pain she's in and her mother's overbearing presence. She nods an almost imperceptible "yes", and I hand her the entonox once again, just as another contraction starts.

"Well, if she keeps using the gas, then I'm not going with her to the hospital!"

Shocked looks are exchanged between Mina, her mother, and the crew.

"That's your choice! You decide! Yes gas, no mother!"

Another contraction starts, and I tell them both that we're leaving, as this baby wants to make an entrance, sooner rather than later. Mina screams with the contraction, takes another few lungs-full of entonox, and her mother storms out the back door and back into the house.

"You do it on your own then!" she screams, as she slams the door behind her.

Mina's resolute, and tells us to go, as her partner should be at the hospital within the hour anyway.

The transport is relatively uneventful, other than the contractions strengthening and becoming more frequent, causing us to move Mina onto the trolley. Just in case. We arrive at hospital, and Mina moves across onto the delivery suite's bed. As she does so, her waters break, and a baby's head appears.

"Stay with me", she begs the two of us. We do.

A minute later, her baby boy is born, and in loco parentis we witness her joy.

"Thank you, both of you. And don't worry about my mother. She'll be up here apologising soon enough. Stubborn cow that she is."

We congratulate Mina, refuse to have our photo taken with her and the baby, and head back to the ambulance to pack away the trolley.

As we sit back in the front completing the call, a car races into the car park, its driver rushes straight past us and into the department, begging to be allowed to see her daughter.

Laughing Gas

As the nights draw in, the hours of darkness rise as the temperatures fall, and I find myself longing back to the long, warm, days of summer.

*****

A Sunday evening, towards the end of the school holidays, and the kids are making the best of the last of the late sunlight. The park is full of children, some accompanied, some not, and the sounds of the joys of the summer break fill the air. The park is a large expanse of green with a large play area in the middle, a few trees surround it giving sporadic shade, used mainly by the parents enjoying the respite whilst their children soaked up the freedom.

The sound of playing children is shattered by a scream.

A mother runs to her child.

An ambulance is called.

*****

We're greeted at the park gate by an anxious looking man wildly waving his arms. The air conditioning has failed, so the windows are wound down, and as we draw nearer, the sound of a distressed child can be clearly heard. Even from 200 metres away.

"He came down the slide Superman style", he starts, even before we've opened the doors.

"And then he just screamed. Now he can't move his arms." Suddenly the realisation dawns on him that if he wants us to treat the child, he needs to move away and let us get out.

The scream sounds even louder now we're out of the ambulance.

"Well, at least his airway's OK", says my crew mate, pointing out the obvious.

We grab our equipment and start to make our way to the playground.

Harrison sits on his mother's lap, sobbing and screaming intermittently, his pain seeming to make him shrink in his mother's arms to half the size of his nine years.

The description of the event leads us to check his neck first, then his arms, where we find no injury and no pain.

We hand Harrison the entonox and explain how it works. "This is a special gas to help with the pain. It might make you feel dizzy, and it might even make you laugh. That's why they call it laughing gas!"

I try to hand it to him, but he won't move either arm to reach for it, so we ask mum to hold the nozzle for him. After a few short moments, the anxious, pained look on his face eases a little, and he's able to speak for the first time and tell me where it hurts. I feel one collar-bone, and then the other, and find them both to be probably broken. No wonder then that Harrison won't move his arms.

Superman style, head first down the long slide, his arms out in front clearly meeting their Kryptonite in the form of the solid ground.

Harrison starts on the gas, and after about ten minutes, he's calm and relaxed enough to let us put one arm in a sling, as his mum cradles the other one. I check the gauge on the entonox to see that it has just about moved out of the green zone and into the long, colourless middle area. There's a long way to go before he reaches the nearly empty red section, and I doubt he'll ever get anywhere near it. I've never seen anyone other than a labouring woman come anywhere near to using a full cylinder of entonox.

Slowly and very gently we move him to the ambulance, the hiss of the cylinder punctuated by frequent yelps of pain as one or other arm moves even the smallest amount. Thinking about giving him something stronger for the pain, I ask Harrison's mother about any medical conditions he may have, and medications he takes, and any allergies.

"Yeah. He's allergic to morphine! We found that out two years ago when he fell of a trampoline and broke his leg."

Entonox it is then. The only needle for this kid is going to be the one on the cylinder gauge.

A few minutes into the journey, as Harrison drinks the elixir of pain-relief through an overgrown straw, he suddenly giggles.

"You OK, Harrison?"

"Of course I am!"

"Is the gas helping you then?"

He giggles again, on the verge of laughter, but too scared in case it hurts. "It's much better thank you. Can I go home now?"

Mother and medics laugh instead. "Not right now. You need to go to hospital to see what they're going to do to fix you."

"OK", he says, closes his eyes, and goes back to concentrating on the gas. I fill in the paperwork, explain to Harrison's mum what I think has happened and what will possibly happen after we leave them at hospital, and her husband follows behind in the car, refusing to let us out of his sight.

Harrison is relaxed, pain still evident as we hit the unavoidable pot-hole or two, but he seems a lot more care free about it. The cylinder hits the red zone just as we're pulling into the hospital. It'll leave us just enough to get him into the department.

"This may hurt a little as we get you off the ambulance, but we'll be as gentle we can, OK?"

"OK! Let's go!"

We unhook the trolley from its securing clasp on the floor, and get ready to move.

"Happy, Harrison?"

"Very happy", he says. "Can I ask you a question?"

"Sure!"

"Do you know what to do when you're happy?"

"Errr, clap your hands? But I don't think that'll be a good idea for you right now!"

"I know that", he answers back, with a voice that's a kid's way of saying I'm not stupid, y'know!

And so, drunk on a whole bottle of entonox, he sings his way off the ambulance and into the children's department.

"If you're happy and you know it, clap your feet!"

Laughing gas indeed, except it worked on everyone.

Brick Walls

A short observation:

Children's heads do not do well in collisions with brick walls.

Ask any of the kids I had to treat during my so-called days off...

Real World

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And back to the reality of the real world.

Far Too Young

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

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

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

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

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

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

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

And this time, I was transferring her.

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

A last, lost hope.

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

She'd been diagnosed a week before.

Far too young, at eight years old.

After-Dinner Mint

A midsummer's night, a cool breeze shakes off the last of the day's stifling heat. The trees wave a silent farewell to the day, and usher in the perfect evening. The streets are still aglow in the last moments of the red sunset, and as darkness falls, they step into the restaurant for a quiet birthday dinner. It's still their favourite eatery, the place where they first met, he a waiter in his parents' business, putting his teenage years to good use and saving some money. She was the shy daughter of regular diners. When they married, they took over the business.

They had sold the restaurant several years ago, but it had retained its character under the new ownership, and as it still felt like home, they would always go back for special occasions, and were always treated as royalty each time they did. Her birthday was one of those special occasions.

They sat at their usual table, hidden away in a corner behind a screen. It had been their own private hideaway when they were teenagers, and it remained so well into their adult life. The service was, as always, excellent, the food was top grade, and, most importantly, the company was intimate and loving. They sat and talked about their lives, their jobs, their futures. Their kids, babysat at home by their grandparents, were central to their plans. They talked about school achievements, nursery drawings, friends coming to play, and how they were growing up so fast.

"We have everything we wanted, and everything to live for", he said.

"I know. But if I don't go to the bathroom now, I may explode, and that might ruin our plans!"

They laughed, and as she left the table after their dessert bowls were emptied, she picked up a striped mint sweet and popped it in her mouth.

Less than ten minutes later, there were four of us crowded into that bathroom, as well as her frantic, distraught husband and the restaurant manager looking lost and scared. She lay on the floor, her breathing stopped, her heart firing a useless, chaotic attempt at a rhythm, she was a vision of suspended animation.

Equipment flew in all directions, instructions given, actions undertaken. We would breathe for her, we'd pump her heart for her, forcing the oxygen and the blood to fulfil their duty against their will. The air from the mask was going nowhere. Her lungs wouldn't move, declining the offer of the oxygen that was being forced into them. Something must be sitting in the way and fighting our actions. After another round trying to beat and shock the heart into action, someone took another look at the airway.

It wasn't there the first time we looked, I could swear to it, but now it sat staring innocently back at us, just out of reach. It was the round mint, all along, that had lodged itself in the airway, trying to complete her circle of life, and kill her on her birthday. Five seconds later, a pair of forceps flew across the bathroom and were used to fish the mint out of her throat. We breathed a few more breaths for her, whilst all the while her heart was being operated remotely, from the outside-in.

In the ambulance, it finally happened.

She took a breath.

We all stopped to watch her, to check the monitors, to make sure that our imagination wasn't playing tricks on us.

There were no tricks. She was pulling through.

By the time we reached the hospital, there was nothing left for us to do but hope and pray.

As the adrenaline wore off and the ambulance was being returned to its normal state, I had a weird thought.

Crazily, I wondered what had happened to the mint.

Sleep

"Have you ever seen something at work that you wish you'd never seen, or that you'll never see again?"

"Sure there is."

"Was it a bad crash or something?"

"No, it wasn't. There are much worse things to see than that."

"Such as?"

"Well, if I never ever again see another neglected, abused child, it'll be too soon."

"So you've actually seen it? Bad child abuse I mean?"

"Yes. I've seen it."

"How did you cope?"

"I called the police, looked after the child, took them to hospital, and made sure they were cared for."

"And then what?"

"Then, I saw another dozen patients in the shift, and carried on as normal."

"And that's it?!"

"Nope. Come the morning I went home, hugged my kids, had some breakfast, and cried myself to sleep."