The Best

As we march quickly into the resuscitation room, wading through the sea of people currently waiting for their turn in triage, one face looks directly at us. Most mumble amongst themselves, wondering what trauma had befallen our patient with his face a mangled, bloody mess, made all the more grotesque by the tube sticking out of his mouth. People stare. Human nature seems to render all those around unable to look away from the macabre scene. All except for her. Her gaze held for just long enough. Enough for me to realise that she recognised me, remembered me from some event in the past. Whether that past was recent or not was beyond me and in all honesty I was too busy with the patient we had right now. 

The chaos in the resus room was as organised as usual. Doctors waiting for a handover, nurses anxious to begin treatment, paramedics eager to deliver their patient to the next link in the chain fighting for his survival. His chances were slim - we knew that. Falling, perhaps jumping off a bridge onto the road below should have been lethal. Being hit by the car after he fell should have sealed his fate. Somehow, however, against all the odds, he was still alive when we reached him. Somewhere, the stars combined. The calls came in fast, we were nearby, the hospital was only a few minutes away. We treated him on the move, leaving us on scene for as short a time as possible. We had done our best. 

We spent some time cleaning our equipment in the resus room, keeping out of the way while trying to stay in the loop. As always, we knew that as soon as we left the department, chances were high that we would never know what happened next, so we took our time to grab more snippets of information. Anything from the results of an x-ray to the positing of a professor who happened to be in the area. Eventually, however, we had no choice but to head back out into the heat of the day, through the throng of people still hovering around the waiting room. Still, she sat there, a bandage wound round her head, with a small patch of blood showing through just above her left eye. 

Outside, by the ambulance that looked inside as though full-scale war had just taken place, we started to take stock of what we had seen and done just as one of the nurses who was in the resus room came out, cigarette in one hand and a lighter in the other. 

"They've done their best, but they've called the organ donations team," he said, as he flicked the lighter into life. I couldn't help but grimly wonder if one day he too would need a new set of lungs. 

We tidied up in silence, clearing the floor of the bags of fluids, of the empty wrappers from the kit we'd used, of the blood. The next link in the chain of survival meant that he wouldn't survive, but perhaps others would. It would be a tough call to make. They needed to find his family fast, give them the impossible task to make an impossible decision in an impossible situation - to do what's best. 

Suddenly, she stepped into the sunlight, bandage still in place with its crimson spot and walked straight over to us, stopping only very briefly. "You don't remember me, do you?" 

"No. I'm sorry, I don't." 

"I'm glad. It's probably for the best." 

Sad or Depressed?

It's so easy to overlook, to underestimate. "Cheer up, it might never happen." It's easy to say. Often easy to do, too. Sometimes, however, suggesting that a smile will cure all ills, only shows a lack of understanding. Sometimes it takes a big name, a celebrity, a high-flying politician to be affected enough by something that whatever that something is, suddenly hits the news. 

Gary Speed, a well known footballer and football manager, took his own life. The news only broke today so one can only assume, at this very early stage, that Gary was trying to cope with some unenviable hardship. He was a man who seemingly had everything to live for, a loving family, a place in the history books of both national and international football, a career and direction in life envied by many. And yet, somewhere in the deep recesses of his mind and soul, a dark, endless depression loomed. 

It's a tough one, depression. I see patients practically daily on anti-depression medications. Depression is the only illness named and described with the same word. Diabetes is an illness where a person's sugars are out of control. Hypertension is when blood pressure is too high. Asthma is when the lungs aren't working properly. 

Depression is when a person is depressed. 

The other problem is that depression is a word that is bandied about all too freely. People are depressed when they miss out on a good night out, they're depressed when their boss tells them off, they're depressed when their football team loses. But depression isn't sadness or upset. It's a state of mind caused by one of many factors and triggers, some physical, some chemical, some emotional, where a person can appear happy and content with their lives, and yet not be able to cope with all that is happening around them. 

Often, in the depths of these depressions there is only one viable option, and that's the option that Gary Speed seems to have taken. Some will claim that this is a selfish option, but to be honest, my uneducated mind tells me that for something to be selfish, there needs to be conscious and coherent thought. Depression allows for neither. The mind's inability to cope, to rationalise, to comprehend, leads the body down a path of self-destruction. 

It's also not something that we can solve in a twenty minute meeting in the back of an ambulance. Sometimes, however, just being able to spot the first signs, may be the trigger that leads a patient to treatment and save them and their families heartbreak in the long term. Most of the knowledge I have about depression isn't from books or classrooms, it's from witnessing it first hand. It's not something we're taught as paramedics to really deal with, because most of the time we're dealing with the consequences, not the disease itself. 

We can bandage wounds, or we can pronounce death. Understanding that there's a stage before this, a stage that we should be able to spot, may be the most life-saving action we can perform out on the front line.