War and EMS

This is a post I have written, deleted and rewritten several times. It is a risky post, as it has the

potential to delve into political wranglings that I do not wish to enter. Nevertheless, I want to write about a side to EMS that very few have seen.

Those of you who have followed this blog for any time, will know that just over two years ago, I left the relatively safe shores of the UK and headed to continue my life and my career in Israel. Just the name of this country evokes images in people's minds that I cannot control. Some for better, some for worse. Living here is a complex mix of normality and insanity, of the usual and the unusual, of war and peace. Few places in the world stir up as much feeling as Israel does. There are lovers and haters, there are the passionate and reserved, but there are very few who have no feelings one way or the other when it comes to Israel. That, despite the fact that too few could point it out on a map or describe its size. (Look on a world map for the eastern edge of the Mediterranean Sea in between Egypt, Jordan, Syria and Lebanon for a dot about the size of Wales, or New Jersey...)

The national ambulance service is called Magen David Adom - Red Shield of David - (follow them on Twitter here) and is an affiliate of the international Red Cross. It serves a population of some eight million people in times of peace and war. It has in the past sent crews to disaster zones such as the Philippines, Haiti and Turkey. It has dealt with mass casualty incidents from which the world has come to learn. It is, however, or at least tries to be when circumstances allow, just an ambulance service treating its population for all manner of illness and injury as is seen in any normal (for want of a better word) part of the world. 

The last two weeks have been a little unusual, to say the very least. Treating patients has taken on a different sort of urgency, when the decision making process doesn't only include what the best treatment options are, but also where is the nearest point of safety for when the air-raid siren sounds. Each ambulance now carries ballistic vests and helmets. Enough for each crew member plus one patient. 

However, what if there is more than one patient? What if someone is accompanying our patient? If the siren sounds, do we stop and seek shelter, taking time to help our patient out of the ambulance and into hiding and increasing the risk for all of us, or do we keep going to the hospital and hope that the inbound missile heads elsewhere? 

We have been sat on station when the siren has sounded. At the same time, a call comes in. The rules dictate that after any siren, we need to take shelter for ten minutes, giving time for the threat to disappear, for any shell fragments to stop falling, for the Iron Dome anti-missile system to do its job and destroy the inbound terror. Do we wait for those ten minutes? Do we follow the rules, or do we break them, heading out for whatever that call is that has just come in? What if the call is for someone having a heart attack? Or someone having a baby? Or for someone who has stopped breathing? 

At times when seconds count, can we afford the luxury of minutes? 

I'm fairly lucky. I'm not near where most of the missiles are landing. Parts of Israel, particularly the southern region near the Gaza border, are facing dozens of missiles every single day. Paramedics there are making these decisions call by call, minute by minute, whereas I've only had to think about it on a few occasions. 

It is somewhat of an understatement to say that these are very strange days and this is a very strange place to be part of the world of EMS. However, it is times like this that the significance of this choice of career is suddenly very much in evidence. 

I look forwards to calmer days, where my decision making process goes back to the best treatment and the most appropriate hospital for my patient, and that the list of decisions and thought processes don't include where all the available bomb shelters are on my route from station to patient to hospital. 

Stories and Poppies

Rarely, very rarely, my grandfather will tell some stories. Usually, they're the funny ones, the ones that many in the family have heard over and over again, the ones I will never tire of hearing. 

Stories of chasing a barge full of watermelons down the river through Baghdad. Or playing tank football in north Africa. Or running around the streets of Paris with a necklace made of onions.

Sometimes, when it's just me and him, he trusts the soldier in me with a little more. I'll hear a little more of the battles, of manoeuvres, of his comrades. He never tells me who fell and who came home, but some names are harder for him to mention than others. Some raise a smile, some cause the hint of a tear. But just a hint. Some manage to raise both emotions at the same time. 

And me? I just listen, and wait in hope for the day when he trusts me with a little more. In between, once a year, I wear a poppy and stop to remember. It isn't much, but I know it means the world to him and to his comrades. 

Those who came home, those who didn't, and those who are still doing it today. 

Overheard

"It's my ninety-ninth birthday today!" Said the gentleman at the polling booth this morning. He walked unaided, no stick, no frame, and looked the picture of good health. 

One of the officials in the hall showed her amazement. "You look incredible for seventy, leave alone ninety-nine!" 

"I don't take medicines, and I've never seen a doctor or been to hospital, either." 

"What, never?" 

"Well, except once. That was after I fell out the sky after being shot down over France during the war. Broke my leg then, but was back flying six weeks later." 

The four ladies monitoring the voting all stood up and applauded, and everyone else in the hall joined in. One of them, having put down her newspaper and pencil, asked him what his secret to a long life was. 

"Very simple!" He said. "Just make sure you wake up every single morning for a very long time!"

Survivor

Today is International Holocaust Memorial Day. This repost is my attempt at keeping one story alive, honouring one memory, and teaching just one extra person, in the hope that if we remember our history and learn from it, we are unlikely to repeat it. 
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Like a herd of elephants, we charge into the sanctuary that has been their home for the last forty years, maybe more. Eyes withered with age and a hand crippled by arthritis, a tattooed number just visible below the three-quarter length sleeve, pointed us in the direction of the upstairs rear bedroom. She lay there, exactly as she had done for probably several hours, a peaceful look on her immobile face. There was nothing left for us to do. Back downstairs, waiting for confirmation of the inevitable, was the person who had lived with her and cared for her for the best part of seventy years. 

As soon as we broke the news, the lifelong protector broke down in tears, and after a minute or two, composed herself, and began a breathtaking monologue.

"She's my baby sister, younger than me by three years. She was five years old when our parents were dragged out of our house, along with our six other siblings, and machine-gunned. I saw it, couldn't help but watch in warped and terrified fascination, through a darkened window in the cellar of a neighbour's house. Eva was still hiding in a drain when they marched off. To this day I don't know how she ended up there."

Rosa's perfect English is betrayed every so often by a Germanic twang to some of her words, labeling her for all eternity with a past she'd rather forget.

"When it was all done, they were dumped into large wheelbarrows, taken just past the tree line not fifty paces away, and thrown into a mass grave. As a parting gesture, the soldiers fired on them again, silencing the few voices still calling for help. Or praying for the end. Whichever would cease their suffering quicker.

"After they disappeared to look for more fun, I ran out of my hiding place and went to find Eva. We had seen death around us, heard it, tasted it, but this was the first time it hit us directly, and we knew we had no-one left. For a few days we hid where we could, and once a day I left Eva and went to steal any food I could. One day, when we heard more soldiers coming, we ran into the woods, and never looked back. 

"For over a year that forest was our home. We even hid in the graves, where we learnt to play dead if we heard anyone coming. Bodies were dumped on top of us, and we'd have to dig our way out. We slept in barns when we could sneak in, found abandoned houses where they at least had a roof, even if no windows. We stole food, ate dead animals that we found, every so often a friendly home owner would give us something small, but they'd never let us stay. The fear in their heads ruled the compassion in their hearts. 

"About two years later, we were finally caught. It was a blessing in disguise. We were taken to a camp and forced into different jobs. The Kommandant's wife took a liking to Eva, and decided she'd take her in as a maid. It saved her life. All other children her age were taken away, often literally snatched out of the arms of screaming mothers, and never seen again. I was put to work in the camp itself, anything from scrubbing floors to sewing uniforms and repairing soldiers' socks. Beatings were a regular part of life, but so was a daily slice of bread and clear soup. No more fighting for food, or stealing it. I saw Eva every few days, when one or other of us managed to sneak across the camp.

"We survived so much that others didn't. We were the lucky ones. At the end of the war, after we were liberated, we eventually found our way to London. I was fourteen, and Eva eleven, but our life up until that point gave us a look of several years older. We were taken in by a children's charity and cared for until we decided we'd never again trust anyone else. We worked hard, saved some money, with it we bought our own home, and have lived here ever since.  I don't know how I'll live without her here."

Once again, the tears flowed. Rosa's mainly, but we weren't doing a great job of hiding ours either. I sat, pen and paper in hand to fill in the necessary forms, but as Rosa's sobs ended her story, I found that I'd not written a single word.

"I'm sorry", she said, wiping her face dry. "I have more than sixty years worth of crying to do. This is the first time since."

At her request, we contacted a friend who arrived within minutes of our call. We left the room to allow them to talk and grieve together. To comfort each other. To shed those reluctant tears. Whilst they did, we reloaded the ambulance with our equipment, sat in silence as I completed the paperwork that I'd struggled to fill in while in the house, and fought to comprehend all that we'd heard. After writing the empty words that described all that had clinically occurred, we returned to the house one last time to explain to Rosa what would now be happening.

Once we'd finished and offered our condolences, Rosa got up and saw us to the door.

"Don't worry about me", she started. "I've got my friends and neighbours. They'll help look after me".

And as we stepped back out over the threshold, as a farewell comfort from her to us, she called us back again.

"I'll be fine", she said. "I'm a survivor".

I know she is. I just hope I've done her story justice.

Worldwide Alert

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

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

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

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

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

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

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

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

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

Canada doesn't have any alert levels.

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

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

Remembrance Day

A rainy day in London, as though the heavens themselves cry for those who made the ultimate sacrifice for their country and country folk. 

People have been sporting poppies on their clothing for the last couple of weeks, and many will have made a donation to the charity supporting not only families of those who never came back, but also helping those soldiers who did. They too face a daily struggle to rebuild their lives, recovering from both the physical and mental scars of the horrors of war.

We in the UK feel safe in the knowledge that the war is a million miles away. Out of sight, out of mind. It's almost as if there is no war. For some, however, even those who have returned, war is a constant figure in their lives. A constant fear too.

I wrote about just one of the many a while back. An ex-soldier named Sim.

Just as they have a duty in service, we have a duty to them too.

A duty to remember, a duty to help, a duty to thank.

Wear your poppies not only with pride, but also with gratitude and at least a moment's thought.

Shut. Up. Den!

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

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

"Shut up, Den!"

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

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

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

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

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

I try to hide the smile.

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

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

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

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

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

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

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

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

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

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

"Feeling better?"

"Much better. Thank you."

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

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

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

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

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

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

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

"Oh, do shut up Den!"

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

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

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

No Answers

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

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

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

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

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

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

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

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

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

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

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

Smokers with emphysema? Charge.

Footballers with broken legs? Charge.

Diabetics with high blood-sugars? Charge.

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

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

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

I just wish I had some decent answers.

What do you think?

Hero

I met a true hero the other day.
Not a celebrity. A hero.
Here was a man, who after surviving the horrors of one war, went back to fight another.
Voluntarily.
Not because he wanted to, not because he was made to.
Because he felt he had to.
A very public war.
He went to defend his Country, his People.
His Way of Life.
Now he was fighting his own, private war.
Three wars in one lifetime may be just one war too many.
Still, once a hero, always a hero.