Meant To Be

It's so easy to be dismissive, so easy to drive along, thinking that this is just going to be yet another one of those calls. A young girl, in her twenties, complaining of the ambulance service's number one call. Abdo pain. Another twenty-something, self-entitled, all-deserving, all-demanding twenty-something who can't be bothered to take any pain killers and like most people, wait for the pain to go away. 

It's so easy just to assume another late night out, another curry gone bad, another Chinese take-away with more after-effects than the alcohol it was meant to be soaking up, another case of food-poisoning victim seeking a non-existent magic cure. 

But with only half a story, it's so easy to be wrong. 

The tear-stained face, the look of real pain, the blood-soaked trousers, the shocked and saddened eyes, tell the other half of the story. 

A story, a history, of broken hearts and shattered dreams, of hopes raised and dashed time and time again. Through sobs and tears, she looks at him, she shrugs, she says We'll try again, neither of them really knowing if they have the strength.

Twenty two weeks, the furthest she'd ever got. But once again, for the fifth time in as many years, it just wasn't meant to be.

Experts and Law Suits

This post over at Rogue Medic reminded me of the day our youngest child was born. Being as stubborn as his older siblings, it was decided that two weeks after his scheduled arrival, it would be a good idea to serve him notice and have him evicted. Bags were packed, plans made, babysitters arranged, and a fortune was spent in the hospital car park. 

As we headed towards the main entrance, a scene so familiar to me, yet alien to a heavily-pregnant-about-to-be-induced MrsIM, played itself out in front of us. A group of people were stood in an almost perfect circle looking down at the ground, as a middle aged lady lay on the floor crying in pain. Much like Rogue Medic's story, the lady probably had a fractured hip. The crowd were a mixed group. Some visitors to the hospital, and several staff, including a few doctors, at least one of whom I knew and several nurses who looked familiar. All told, a group of about twenty people, standing, talking, gesticulating. 

A bed had been wheeled from a nearby ward and stood next to the patient as a discussion took place on the best method of getting the patient from the floor to the trolley. As we neared the actual scene at the rate of a nine-plus-month-pregnant-waddle, I could see six pairs of hands trying to move the patient up to the height of the trolley in a tangled mess that would have any back-injury specialist cringe and cry for their mother.

The upshot of it all was that none of them, not the visitors, or the nurses, or the doctors could work out how to do what comes to any EMT or paramedic as second nature. Having admitted to being a paramedic, I offered my help, and after a couple of "What do you know that the doctors don't?" type questions (from certain nursing staff no less), and using only two pairs of hands, the lady was moved gently, safely and with minimal pain from the floor to the bed.  

I don't claim to know what doctors know, I don't claim to have the skills to nurse a patient either. I do, however, claim to be an expert at what I do for a living. I've said it before - we need to have pride in our profession. We need to know that our skills and expertise are exactly that. We need to know that we are the specialists in our field, and that any doctor or nurse worth their salt would do well to understand and respect that. My remit may end at the entrance to the A&E or ED, but up until that point, the patient is my responsibility. That responsibility extends past mere transport - it can also include extrication, removal from scene, treatment, resuscitation and stabilisation. And just simple pick-ups from the floor.

I would love, one day, to hear news presenters, career advisers and general Joe Bloggs speak about paramedics in the same respectful tone as they do about doctors and nurses. Actually, first of all, I'd like to hear paramedics speak about paramedics in that same respectful tone, instead of doing ourselves a disservice by constantly saying things like "Well, I'm no doctor..."

Whilst the USofA as a whole needs to learn a little more about caring for others, as opposed to staving off law suits (not that the UK is all that much better), paramedics the world over need to learn that we are no less experts than the doctors and nurses to whom we're compared, often in such an unfair light. We need to show that we don't do things just in order to avoid yet another American-style law suit, or just to cover our over-exposed behinds. We do things because they are the right things to do, the expert thing to do, and are in the best interests of our patients. 

Due Date

"Hello, ambulance service, what's the emergency?"

"Quick, my baby is coming!"

"Is the baby coming now?"

"Yes! Quick!"

A rapid response unit is dispatched from the nearest ambulance station, its driver preparing in his mind to add another delivery to his tally. Arriving no more than three minutes later, and rushing with multiple items to the front door, I am met by the lady in question and stupidly, ask the obvious.

"Is the ambulance for you?"

"Yes! Quick! The baby is coming."

The young lady in question is in no distress, and is having no contractions.

"When's the baby due?"

"NOW!"

The calls to ambulance control are numbered, resetting to call number 1 at midnight. This is call number 3. The call start time is only a few seconds after the witching hour. 

"I understand that you think the baby is coming now, but why do you think that? Are you having contractions? Have your waters broken? Do you feel like you need to push?"

"I don't understand what you're asking me. Talk to him. I just need to get to the hospital!"

"Is he your partner?" 

"No. He's my babyfather." Babyfather. I never get used to hearing that. 

He doesn't utter a word, just hands over the yellow book, it's corners dog-eared and cover stained, and the expected delivery date hand-written in the top corner. He points repeatedly to the date as he shoves the book into my hands. Through gritted teeth and a look of disdain he mutters the only words he would say. 

"The book says it's today, so it's today. Now just take her to the damn hospital." 

"Is this your first baby?"

"Mine, yes. Him, not. He's got four. Well, will have today." 

"You do realise that just because the due date is today, doesn't automatically mean that that's when the baby will be born? It's just an estimated due date!" 

"Really?" 

"Really." 

"Oh. But that's why I waited 'til midnight to call!"

"As it happens, most babies aren't born on their due date at all. You need to go into labour first. You know, contractions and stuff." 

"Oh. But it's the due date. So can you take me to the hospital?" 

Sleeping Partner

The bed is covered in blood. The floor is too. Apparently there's loads of the stuff in the bathroom as well.

"We left it there, unflushed, just in case you wanted to see it!" I'd seen enough already, without having to go snooping in someone else's toilet bowl.

Another one of my return customers, Greg and I had met on a previous similar occasion, and probably about a year had passed since then. Maybe eighteen months. The alcohol he'd taken on board over years, slowly destroying him from the inside out. He looked pale, gray even, and was sweating as though he'd just run a marathon in the Sahara Desert.

"I'm gonna die, aren't I?" Greg asks. The fear in his voice is only too real. "Not in my ambulance you're not". I think it, but don't say it. Patients who genuinely fear it, and voice that fear, often know.

"No, Greg, you're not. We're going to get you up to the hospital as quick as we can, and get you sorted."

"We? You're the only one here!" And he's right.

"Another ambulance is on its way. They'll be here soon enough!" I hope my prediction is a self-fulfilling one. I need them in a hurry. In the meantime, I start getting some fluids into him. It's another case of salty water replacing blood, but at least it gives the heart something to work with until we can get him the real stuff he needs. The blood that's left inside him will have to work extra hard to pump round the oxygen that's free-flowing into him through the mask on his face. At least he's stopped vomiting for a while. I don't know how much he's lost internally, but just from what I can see in front of me, he must have expelled a third of his blood volume. By the time the crew arrive, he's had about a litre of fluid back in through a thankfully large vein in his arm.

I hear them downstairs and yell: "Bring a chair up with you!" Often crews backing up first responders will come in to see what's going on, and only then decide what extra things they'll need. Usually it works just fine. Luckily the crew recognised my voice, and the urgency in it, to know not to ask questions.

"Last time I needed surgery. And they gave me nearly twenty bags of blood apparently. But I don't really remember anything. They told me if it happened again, if I didn't stop drinking, that I'd probably kill myself."

He started sobbing.

"I have, haven't I? I've killed myself! And now, two days before my son's due to be born!"

A neighbour was with Greg the whole time we were there, but no-one pregnant.

"Where is she Greg? Where's your partner?" I thought that a friendly face might help calm him a little.

"She went up to her mum's last night, up north somewhere. I've got her mobile number, but I don't want to call her now. It's too early!" Barely in control of his own body, he was still worried enough about his partner and unborn child. "I didn't mean to drink so much. I shouldn't have had anything at all. It's the first time in months!"

We moved Greg to the ambulance, a creaking flight of wooden steps leading down to the front door and out into the cold night's air. Dawn was breaking across the horizon, and the traffic was just starting to build as normal people started another working day. Leaving my car on scene, I travelled with Greg, an extra pair of hands always helpful with a particularly ill patient. The siren blared its way, ensuring the cars cleared the way for us to make a smooth but rapid journey to hospital.

"I don't want to hear the sirens! I don't..." He wept again. "I just want to hear my baby cry..."

We arrived at the hospital, a team ready to meet us was standing round the designated bed.

A doctor listened to the handover and asked for some blood almost immediately, as a student nurse hooked him up to the machines. A nurse thanked his luck for finding a decent vein and put a second needle in the arm I'd left alone.

Greg's tears flowed, and he was barely able to catch his breath between sobs. "Just help me see my baby! Just once! Please... Please..."
Another nurse left the cubicle without a word, and hurried to wake his partner.

Two Hours

Jen's been a little overweight almost all of her life, enough to give the kids at junior school the excuse to tease and bully her, but never really badly enough for her to want to do something drastic about it. Sure, she'd tried diets, fads, exercise, everything, but always ended up back where she'd started. Her parents had, maybe a little tactlessly, nick-named her YoYo thanks to her eternally fluctuating weight. Eventually, at almost 18 years old, she'd learnt to accept who she was and what she looked like and live her life the best way she knew how. She went to a good school, had friends, many of whom had been her tormentors in earlier years, and now saw Jen for who she really was, rather than how she appeared. And she had a boyfriend, Ian, a childhood sweetheart who'd been her partner now for almost four years.

It was Ian who'd called the ambulance. An 18 year old female with abdo pain doesn't fill any ambulance crew with the joys of spring. It's another routine, mundane call, often leading to mutterings of "waste of time", "taxi run", and "bet they haven't taken any pain-killers". Nevertheless, the way the call comes in, we have to run on lights-and-sirens.

As we walk in, Jen looks a little embarrassed, apologises for calling us out, and says that the pain has passed. "He panicked a bit", she starts, "the pain was really bad, and it came back a couple of times, but it's gone now. Really, guys, I don't need an ambulance. I'm sorry".

She's pleasant enough, too nice to be mad at, and clearly concerned as to how ridiculous she seems.

"We'll just do a couple of quick checks, make sure you're really ok, then we'll leave you alone. But if the pain was as bad as Ian described it, maybe you should come with us anyway, just to be on the safe side".

Abdo pain is such a minefield. It can be everything and nothing. Anything from uncomfortable food poisoning from last night's drunken take-away, all the way to a deadly ruptured aorta, the body's trunk-route for blood distribution.

She sat comfortably on the couch, hand on her lower abdomen, the memory of the pain still there, the brain trying to do its usual trick of erasing it. We check her basic observations, her pulse is a little quick, her blood pressure normal. We take her temperature, placing the tympanic thermometer in her ear - a quick and painless way of doing what used to take 3 minutes of sitting still with a piece of glass stuck under your tongue.

Jen suddenly screams. A piercing, terrifying scream that made me jump back, wondering how I could have inflicted such pain by just taking a temperature. She arches her back, holds on to the couch as though she was clutching at life. The pain lasts for no more than 30 seconds, and is gone as if nothing had happened. She looks down at the floor, suddenly refusing to make eye-contact and mutters, barely audibly, "I think I've wet myself".

A minute later, the pain returns again, and it finally dawns on us.

"Jen, how many months pregnant are you?"

"I'M NOT PREGNANT! WHAT ARE YOU TALKING ABOUT?"

"Jen, these pains are contractions. You're about to have a baby! How many months are you?"

Ian and Jen stare at each other.

"I can't be pregnant! I'd know if I was! I've only put on a bit of weight. I'm NOT PREGNANT"

Much as she tried, much as she wanted to, there was no denying it. Jen was in labour. Her waters had just broken, she was having contractions every minute. The baby was about to be born. We asked for a midwife, and another crew, and started preparing for the birth. We have no idea how developed the baby will be, so have to prepare for every eventuality, from a normal delivery to the horrendous thought of having to resuscitate a tiny newborn. There was hardly the time to think.

The baby's head appeared in the very next contraction, and by the one after that, a newborn baby's cry filled the room. The baby girl seemed a good size, a good colour, and there was clearly nothing wrong with her lungs as her voice made her surprise appearance clear to all. We cut the umbilical cord, cleaned her up, and I handed her to the new mum.

"Here she is! Your beautiful baby girl!"

Jen looked away, kept her arms folded, and through stifled tears whispered "I don't want it".

"It", she said. not "her". I was shocked and saddened, trying to understand the turmoil that Jen was going through. An hour ago she had some tummy ache, now she had a daughter. I couldn't get my head round it any more than she could. She couldn't, wouldn't, accept that this baby was hers. To her, the little girl was an "it".

The second crew turned up just after she was born. The midwife was still miles away. We decided to send mother and baby to hospital in separate ambulances, and not wait in the midst of the anger, the confusion and the rejection. Jen came with us, a few minutes after her baby had gone. A few minutes to gather her belongings, gather her lost dignity, and gather her muddled thoughts.

At the hospital, we're shown into a room, and as we walk in, Jen having refused to travel on the trolley bed. There's a small cot already there, and in it a sleeping baby, swaddled in a pink blanket. Jen gets onto the bed and says nothing. One of the midwives asks us for the story, we take her aside and explain all that has happened. Slowly and quietly, the cot is moved nearer and nearer to Jen's bed as she has her blood pressure checked and a midwife reels off a seemingly never-ending list of questions.

Absentmindedly, as she answers the queries about her health, about the pregnancy she never knew she had, and about her personal life, Jen's hand moves to the cot. She sits there, a tiny smile slowly creeping onto her face, as she strokes her daughter's soft, downy hair.

"I want her". As the words escape her lips, she grins, then bursts into tears. "I want to keep her. I want her to be mine".

She seems hardly to believe her own thoughts, as if someone else had spoken them. But she was exceptionally proud of them.

"She is yours, Jen", says one of the midwives. "And there's nothing you can do about it".

She just sits there, uncomfortable on the ancient hospital bed, the initial shock on her face and sadness in her eyes, turned now to relief and happiness like she has never experienced.
Two hours earlier, it had all been so very different.

Icing

Recently I've written a couple of posts reflecting disappointment and frustration at the system that guides the job that I do. I love my job, I'd just like to be able to get on and do it. Sometimes I need a reminder that when all else fails, there's someone somewhere, not very far away, who will call on us and we will make all the difference. They'll be relieved, appreciative, sometimes thankful, even if they don't necessarily show it at the time.

Often all it takes is one call. One short-lasting event to remind me why it is I do what I do. Sometimes it's an entire shift. One of the things I most enjoy about my job is the fact that not only are no two days ever the same, but that the huge variety of calls we receive keeps me constantly on my toes. Every time I get just a little too laid back, something jumps out at me and reminds me that there's always something out there that I know nothing about, have never seen, and will really have to think about how to deal with.

Mostly I feel that it's the variety that keeps me here, but sometimes, when the variety is only of the unnecessary sort, the multiple gear changes leave a burnt out clutch.
Sometimes that clutch just needs changing, and all is back to (ab)normal.

And just when I needed it, the clutch that needed fixing was sent the mechanic that it needed. A recent shift, and being in the right place at the right time, brought the following:

I went from dealing with a child who's been on antibiotics for 2 hours and hasn't yet miraculously recovered from their sore throat, to comforting the relatives of a cancer patient who had just succumbed to their illness.

Then from a mild allergic reaction caused probably by new medication, to extricating two people trapped in the mangled remains of the family car.

And last job of the night, I was called to a patient threateningly at death's door, danger lurking both for her and her unborn twins. I was, along with the crew, still in the maternity unit finishing the paperwork as we heard those same babies, abruptly c-sectioned from their mother, cry for the very first time.

I wasn't all that far behind.

I went home that morning once again knowing why I do this job, and why I love it.

That night, I came back to work to be met by one of our managers.

"Do you remember a call you attended a few weeks back?" He went on to describe a call of which I had a vague recollection. It was routine. An unconscious diabetic, hypoglycaemic, sugars too low. We reversed it, he recovered, and stayed at home to be cared for by his family. I feared a complaint coming my way, although I couldn't figure out why. I told the manager that I remembered it, bizarrely more because I remembered the house, than the patient.

At that point, he opened up the back of his car and handed me a box.

"Here. These are from them for you. They gave me 12 bottles of wine, 4 for each of you that were there!"

Very much taken aback, I took my share of the box and, not being much of a wine drinker, later donated the wine to a worthy cause.

This isn't even close to the reason I do what I do.

But after the night before, it was just the icing on the cake.

Except

Came in to find that all the shifts are changing, and not for the better. Would love to stay doing what I'm doing after they change.

Except I can't. So onwards and upwards.

*

Well, at least the vehicle works. It stinks of cigarettes, but at least it works.

Except it doesn't - not to the extent I need it to.

*

It starts OK, but the flashing lights and computer screens on it don't. But at least I can get it to the people who can supposedly fix it.

Except they can't.

*

So I then spend the next five hours being told to drive from pillar to post to find a working car. Apparently you have the supposedly "bigger picture".

Except you don't. You have a severe case of LeftHandRightHandItis.

*

After driving from pillar number 4 to post number 5, you then phone me up, tell me off for not being back at point number 1, and that I'm shirking my duties.

Except I'm not. I'm doing anything but.

*

So I arrive at work almost an hour early, try to solve the problems, follow your instructions to the letter, and still get told off.

Except that you don't do it yourself - you send someone else to tell me off. Cowards.

*

Finally, despite risking being sectioned and put away for temporary insanity by screaming out loud, I have a working vehicle. I can do my job.

And just as an aside, I'm sure you felt good about getting the vehicle on the road. I'm sure you felt good about bullying one of your loyal members of staff. I'm sure you felt good that all the numbers tallied up.

Except that, despite your best efforts, I win.

*

How many of you up there went home knowing that they'd come to work and helped a mum deliver her baby? No hands up?

Oh well.

I know that I did.

Taxi!

Normal thought process:

Pregnant.

9 months.

Got a twinge.

I know.

I'll call an ambulance.

*****

Really?

Had a strange experience recently. Someone I know very well was pregnant. Overdue even. She's young, never been pregnant before, except for the last nine months, so didn't really know what to expect.

She did the strangest thing. She asked her family, several of whom have been through the same thing over the past few years for help, advice, guidance, tips. Anything that may assist her in this weird new world.

Then, finally, what seemed like 2 months late, she went into labour. She wasn't sure it was labour, so she called her family again. They said it sounded very much like she was in labour. So she called the hospital. They said she should come in. It was time.

Except that she has no car.

So she did something even stranger. In the middle of the night, she phoned her nearest relative and asked for a ride to the hospital. She didn't call an ambulance! Can you believe it? What sort of odd behaviour is that?

Said relative took her and remarkably calm hubby to hospital, dropped them off, and waited for news.

Several hours later, still in the middle of the night, the news arrived. As had the baby. And all was well.

And not a maternataxi ambulance in sight!

Amazing.

Who knew???

PS - Congratulations!

Training School

I was new at the time. Very new. Not even two months out of training school. It was a time when I was keen, eager, and very very scared. I arrived at the station at least half an hour before the shift, which I still do to this day, just to make sure everything that I may need for the shift is available and ready for use on the ambulance. Obviously still keen and eager.

Ten minutes later my crew mate for the day arrived. I introduced myself and told her that I was new, and would need all the help I could get. She asked if there was anything in particular that I was nervous about, anything that I really wanted to see, that she'd see what she could arrange. I didn't really believe it, but I did mention that I'd not yet been to a cardiac arrest call. I'd practised the scenario endlessly in training school. Everyone seemed to die there. All the scenarios seemed to end in cardiac arrest.

Asthma attack scenario? Cardiac arrest.

RTA scenario? Traumatic cardiac arrest.

Pregnancy/Labour scenario? Double cardiac arrest.

Drug overdose scenario? Self inflicted cardiac arrest.

And the scenarios would always be as difficult and unlikely as possible. "Worst Case Scenario" the trainers would call it. We all took it with a pinch of salt, they were just so far-fetched.

In a broken down lift.

A crane at full height.

Stuck behind a toilet.

In the middle of a muddy building site.

On and on it went. Weeks of "people dying". If that was the real world, I wasn't so sure I was ready for it. The real world, however, was anything but constant cardiac arrest calls. Six weeks on the road, and I hadn't seen it or had to deal with it once. So I told Anne about it. She laughed and told me that the chances were slim. It was a day shift, and people tended to die at night.

Those were the days before we had computer dispatch on the ambulances. The calls would come off a printer, and the Control Room would call the station to find out who was to be the next crew out. I can still hear the distinctive whirr of that printer and find that if I ever hear it anywhere else, I instinctively expect to hear a phone ring.

We'd been out on a couple of calls and had managed to get back to station. There was nothing to challenge my knowledge yet. But now, we were the next crew out. I sat anxiously waiting for something to happen. Eventually, the blue piece of paper appeared at the top of the printer, and the phone made me jump half out my skin. This was it. My turn. And for some reason I had butterflies in my stomach. I looked at the piece of paper and saw that we were on our way to a man in his 40s with difficulty breathing. In the special instructions section there was a line about the patient being in a "hard hat" area on a building site. Could be interesting.

Half way there, we get a call on the radio: "ETA request from the scene. Patient deteriorating".

"We're approx 5 minutes away."

"Thanks, we'll let them know."

Anne presses the accelerator a little closer to the floor, the engine screams in response, but the ambulance doesn't seem to move any quicker. Two minutes later, the radio operator calls over the noise of the engine. "Update from the scene. They're on the 3rd floor of a building site. Stairs still unsafe. Ladders in use. Patient turning blue." Leave the important bit until last, why don't you?

"ETA two minutes. Thanks."

Accelerating makes no difference other than the noise, so we will the ambulance to go a little faster.

As we're no more than half a mile away, the radio chirps in once more. "Patient now in cardiac arrest!" I expected panic to set in, for the shakes to take over, for my brain to freeze. None of that happened. It was as if I'd been programmed for just this moment. The adrenaline rush was incredible. In my head I'd made a detailed list of what equipment to take, how we'd get to the patient, how we'd get him down again, and what else needed doing. All this before I'd even got out of the ambulance.

We arrived to find that our patient, had been carried down one floor by the other builders. Now at least we only had stairs to contend with, and no ladders. Two of the builders had started CPR whilst the others looked on anxiously. Anne and I took over and with the oxygen we were giving him his colour started to improve. The defibrillator looked at the chaotic heart rhythm and decided that it needed to be shocked back to life. Shocks, CPR, Shocks, CPR. We were in hard hats, covered up to our knees in mud, on the second floor of a building site, surrounded by exposed beams and electrical cables, with a 100kg patient. A real "worst case scenario".

Moving him to the ambulance was much easier than expected, thanks to several pairs of builders hands helping us carry him. The ambulance visibly sank by several inches and audibly groaned its complaint as the group of 4 ambulance staff, 6 builders and one patient either climbed in or were loaded into the back.

We continued our attempts all the way to hospital where the staff took over. They knew Anne and the other crew, but I was a new face. I overheard one of them ask Anne who the "new guy" was.

"Oh" she said. "He's a bit like this job. Come straight out of Training School."

Mother & Baby

Throughout her/our pregnancies, my wife complained on numerous occasions that I had no idea what it's like being pregnant. Now, whilst I can't refute that (and if I could, I'd be earning a fortune), I did constantly remind her that she had no idea of what it's like to be living with someone who's pregnant. The mood swings, the cravings, the going shopping for mango sorbet at 3 in the morning, the vomit all over my clothes on the way to friends' weddings, and a multitude of other sins. Admittedly it's a lame argument, but it's an argument nonetheless. And it's the best I could come up with. All I can say for sure is that babies clearly start causing trouble well before they're even born.

*****

Helene was on her third pregnancy, but she was a little out of practice as her 2 kids were already teenagers. She felt almost like it was the first time all over again. She'd almost forgotten about the twinges, the kicks, the nausea. She'd tried not to remember the sleepless nights, the discomfort and the anxieties that were caused by growing a small person inside you. Over the 38 weeks all her memories flooded back and she knew she could cope with them all.

*****

Until she woke up one morning and thought her world was about to end. The meaning of having your breath taken away had never had such relevance, or filled her with so much fear. Helene had the sensation that she'd been stabbed in the chest and just couldn't take in enough air. She'd had a strange sensation the day before like a muscle cramp in the back of her leg, but put it down to another one of those pregnancy things. "Only 2 weeks to go," she thought, "then it'll all be worth it." At three in the morning she'd woken up and thought she was going to die.

*****

Patients should most definitely not be blue. Unless they're smurfs, and I've never had one of those yet. Helene was blue. Her lips were blue, her finger tips were blue. It was as if she was being lit by an ultraviolet light. No need for an oxygen saturation reading before applying oxygen. It's low. Probably dangerously so. I place a 100% oxygen mask on her and then start checking observations. Pulse rapid, at about 140, oxygen levels unreadable at the moment, air entry greatly reduced, especially on one side. Blood pressure low and dropping. Helene is very poorly. My initial assessment leads me to think that it's a Pulmonary Embolism, or PE, a blood clot in the lungs. Pregnancy is one of the known causes of a PE, where it's either due to the fact that the blood's clotting is increased, or sometimes due to amniotic fluid escaping into the blood stream.

*****

I start to hope that the ambulance is nearby, as there's not much more that can be done pre-hospital for a PE. Luckily they turn up only a few minutes after I complete my set of observations. We wheel Helene into the ambulance and she is whisked to hospital with due haste, while I'm left alone in my car with the paperwork, wondering if I was right or wrong, and what would happen to her now. I have no idea what happened after that. All I know is that, in pregnancy, if the mother's ill, the baby's ill too. So if you treat the mother, you treat the baby. If all's gone well since, the baby should be a few months old by now. I hope that's indeed the case.