I, Robot?

I may have mentioned this before. I don't like dentists. No, I mean I REALLY don't like dentists. The last time I went to the dentist, my pulse was still at over 140 an hour later. The time before that I passed out in the chair. I get palpitations if I just phone up to make an appointment. I get chest pain and break out in a sweat if I walk past a dental surgery, even if it's not the one I go to. In fact, as I write these lines, I can feel the dread coming over me in waves. I may have mentioned this before. I don't like dentists.

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The call came in for a man collapsed, unconscious, possible allergic reaction. Easy. I can deal with that. I'm a highly trained, highly skilled, highly motivated paramedic. Most of the time. Then, I look at the address. Dr Payne's Dental Surgery, Filling Road, Phobiatown. Instantly I feel the colour drain from my face, my pulse double. The cold sweat starts on my forehead, and within moments has spread all over me. And I have to drive to the call. I'm on an ambulance, not flying solo in the car, and it's my turn to drive. To be honest, it's probably a good thing, otherwise I'd have panicked even more. At least I had something to concentrate on before we got there.

I hoped that the patient would have had the good grace to collapse in the reception area. Or the waiting room. I prayed that he would be well enough for my crewmate to say that I could wait outside and he'll deal with the emergency. I begged that it would be straightforward, so we'd be in and out in no time.

No such luck. None of my prayers were answered. Well, strictly I guess they were, but the answer was a resounding NO. On our arrival, I scoured the reception area and waiting room. He wasn't there. A frantic looking receptionist sees us and yells directions. "Up the stairs, turn right, turn left, 15th door on the right, spin around and walk in". I'm not sure that the "spin around" bit was actually part of the instructions, but I was doing it anyway. And there probably weren't 15 doors upstairs, but it was starting to look like it. Damned phobia! Concentrate!

We find Phil, a gentleman in his 50's, as if to taunt me he's still sitting in the dentist's chair, and he's not at all well. He'd just been given a local anaesthetic injection, and had reacted badly to it. His body had swelled, he'd come out in a rash and was vomiting heavily. His breathing had started to be affected, soon his blood pressure could plummet too. We'd need to treat him before even thinking of moving him. He needs oxygen, he needs a needle in his arm, he needs drugs. My crewmate checks and double checks everything as I hand him, and keeps a close eye on me at the same time. I'm paler than an ill-looking ghost.

Luckily, one of the driver's duties is to fetch whatever is necessary from the ambulance, including the carry chair. I take the minute or so outside as much needed respite. I regulate my breathing, try to slow down my pulse, and tell myself to stop being so bloody stupid. It's not me at the dentist! Once more I enter the building with the chair, thinking that at least this means we're about to leave.

Phil's improving slightly, but still we have a flight of stairs to negotiate with him on the chair. I take the top end of the chair so that I don't have to go backwards in my state, and we make it down the stairs in one piece. Once we've loaded Phil into the ambulance, I go and sit back in the driver's seat to try and regain my composure. As I look in the mirror I can see my crewmate giggling to himself at my predicament. To top it all off, we had an observer with us that day who got to witness and mock my jelly-like state.

Phil still received the best care possible, and made a full recovery. Hopefully he didn't notice the turmoil that I was going through. Or maybe that he did. Maybe his experience has turned him into a kindred spirit.

As paramedics we face all sorts of unexpected situations and emotions. We're expected to face them all professionally, at times coldly. Most of the time I try to leave my emotions to one side, push them out of my head whilst I'm with the patient and deal with them later if necessary. I have a job to do. I need to focus on the task at hand.

Sometimes, thankfully very rarely, I have to deal with the patient and with what I'm going through at the same time. I'm no robot, no automaton. I think, therefore I am. It's just that sometimes, thinking is what gets me into trouble in the first place. Sometimes, I hate to admit it, but I guess I'm human too.

Skive...

Work's been exceptionally busy recently, and it's not uncommon these days to see upwards of a dozen ambulances sitting outside the hospital at any one time, all waiting to hand the patient over to hospital staff. Probably explains why, being a single responder on a car, I seem to be waiting longer and longer for crews to come to my rescue. Whilst sitting outside the local A&E department the other night, I decided that we needed a name. What we need is an ambulance-related collective noun. Lions parade in prides. Geese gather in gaggles. Bees swarm in a... well...um... swarm.

So what would you have for a group of ambulances? I'll kick off with "A Skive of Ambulances", and hope that it translates ok outside of the UK...

If you need some ideas look here, especially at the bottom of the page for "some that might be" . Look forward to some of your suggestions!

A Bug's Life

The road snakes it's way through suburbia, a three-lane highway practically begging for its speed limit to be ignored. Especially at night. Not at all recommended. The people living by the side of the road are either fed-up with, or immune to, the buzzing of the traffic. It must be like having a swarm of bees constantly inside your head.

The traffic at 1am shouldn't be heavy, but for some reason travels at a snail's pace. Three lanes of solid chaos that I need to worm my way through. Having to use a siren at that time of night can't help the neighbours either, but I have no choice. The bright yellow car and flashing blue lights don't seem to be enough for the other drivers to see. They need to hear the high-pitched wailing too.

In the distance I see what looks like a sea of fire-flies, with all the police cars blocking the road, blue and red lights lighting up the dark night. Eventually fighting my way past the road blocks, I see it. A dead beetle. A big one. One of it's wheels still spinning in a final dance of death, it lies on its roof, shattered. It fought around one of the bends, but lost the fight. At 60mph, the chances of a new driver negotiating this bend are slim. The railings that used to be at the side of the road are now a spider's web that has been brushed away.

By the side of the road sits the driver. He's got out by himself, seems to be miraculously uninjured. The luckiest person I've met for while. I take another look at his car, and with a childish grin think to myself, there's only one thing left to say. But no-one to say it to. Oh well. I'll say it anyway...

PUNCH BUGGY BLUE!

Inspiration

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

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

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

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

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

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

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

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

Who's Law?

In the back of my car is a bag. Only a small bag, with only a few bits in it, just enough for me to provide some sort of basic assistance if I ever come across something. I have a bad habit of doing so. I know if it's there that there's a much better chance that I won't need it.

In the back of my wife's car is no such bag. On the rare occasions that we swap cars (hers has more seats and therefore easier to transport more small, noisy people), I swap the bag over too. I like knowing that it's there. It's my comfort blanket. Today was one of those rare swap occasions. Except that I forgot the bag. About 3 miles from home, car full of large and small people, all noisy, I remembered it. Not being the swearing type (apart from the fact that my kids were in the car so I couldn't even if I wanted to), I muttered lots of gibberish, cursed my stupidity, and repeatedly told myself that I bet I come across something.

Two minutes further up the road there's a traffic jam. I crawl around the blind bend to see the first signs of glass and debris all over the road. Then the police cars. Then the mangled Ford with a large Range Rover shaped dent in it. I KNEW IT! I JUST KNEW IT! The one time I forget the bag, and I'm gonna need it! As there's nowhere safe to stop just yet, I keep crawling with the traffic. I get a little closer, and just there, hidden behind the tall hedge, hidden just well enough and just long enough to scare me, is the ambulance. No need for the bag. Lucky. I get to my destination and breathe a sigh of relief that despite my stupidity, my little bag still wasn't required.

On the way home, very near the scene of the RTA, is a car stopped by the side of the road. In front of it is a bicycle lying at a strange angle, and two women standing comforting each other. Neither is injured, so no need for the bag again. Lucky again.

But next time I swap cars, I'll make sure I remember it, because you-know-who's law only rarely takes a break...

Driven Crazy

The dangers of being a paramedic have been highlighted recently, some for all the wrong reasons. The hazards we face are all too common, from abuse, to threats, to illness to violence. Sometimes, however, the biggest risk we face is before we've even met the patient. It's a risk that is borne out of carelessness, lack of respect, lack of skill, and especially selfishness. It's a threat to every ambulance, be it on six wheels or two, or anything in between. It's the menace of the non-attention-paying other road users. Sometimes it seems that there are certain people who will do all in their power not to let the ambulance through. Take for example the following cases:

1) We were driving down a road with two lanes in each direction, coming up to a cross-road with a set of traffic lights. Ahead of us was a car in each lane, waiting for the lights to change. Lights and sirens on, about 100 metres before we reach the lights, they change to green. The car in lane 1 takes off in a hurry and disappears up the road. The car in lane 2 conveniently moves out the way into lane 1. We look at each other in awe at the fact that there actually seems to be a sensible driver about at last. At that point, my entire life flashes before my eyes, the ambulance rocks from side to side, the brakes scream and both my driving crewmate and I swear loudly. I almost never swear. He never fails to remind me of that fact... The supposedly sensible driver has waited until we are within millimetres of him, and then performs a tyre-shrieking U-turn in front of us. To say that we missed by a hair's-breadth is no exaggeration. Had we have hit that car, I have no doubt that he'd have died. And possibly we would have as well.

2) Again, on lights and sirens, driving down a three-lane highway. I'm in lane 3, the fast lane, there's a car about 200 metres ahead, and almost no-one else on the road. I'm impressed at the fact that he seems to realise relatively early that I'm behind him, as he indicates to move over into lane 2. He indicates, but doesn't move. I'm getting closer, he still looks as though he's going to be helpful, but at the last possible moment he slams on his brakes. Leaving me almost no room for manoeuvre, I end up swerving round him and only just keep control of the vehicle. As I go past I see the reason for him indicating. He's got his phone to his ear, and his elbow resting on what must be the indicator control. He had no idea at all that I was behind him.

I know it can be unnerving having an emergency vehicle suddenly appear in your rear-view mirror. I remember that I had that experience on my very first driving lesson, with a police car behind me, and my very first time driving an ambulance, when two fire-trucks appeared opposite as we both tried to fit through a narrow tunnel. We don't go out of our way to scare or intimidate you. We don't try to run you off the road. We don't abuse the powers that we are given We're here to help the public, not harass them. We just ask for your help and co-operation.

So PLEASE! Think a little.

Pay a little more attention to your surroundings.

Stay off your phone and concentrate.

Turn down the music, just a little.

If there's no safe place for you to pull over, don't panic, keep driving until you can find somewhere safe.

Don't be scared to move into a bus lane, as long as you pull back out again after we've passed.

More than anything else, don't be selfish. It's probably what causes the most accidents.

And while I'm on the subject of driving, please, Please, PLEASE, strap your children in. It's one of the most loving and caring things you can do for them.

I hope that it's not your friend or relative we're on the way to, or are transporting, but just imagine, and act, as if it were. It could be your life-saving, good deed of the day.

Reluctant

It's relatively early in the evening, still much nearer the start of my shift than the end of it. I've just seen two patients in a row with exactly the same, quite rare, cardiac problem that I haven't come across for at least the last three years. Two people from completely different backgrounds, different ages, different life styles. Two people who've never met each other, probably never will, joined by a common thread. Weird coincidence. Makes me wonder what other strange things are going to crop up during the night.

I'm brought back to reality with the computer screen yelling at me that there is a patient with the dreaded Swine Flu who's having trouble breathing. My heart sinks at the thought of another unnecessary ambulance call out. I'm starting to think, somewhat cynically, that this whole pandemic has been magnified in this country just to get the government expenses scandal off the front pages for a while.

This time, however, it's different. I must have seen at least fifty patients who've got, or think that they have, Swine Flu. Or, as I've seen and heard it called, Hamthrax. I can genuinely say that this was the first time any of them really needed an ambulance. This time, I could hear the wheeze before the front door was even opened.

Along with probable Swine Flu, Zohara has asthma. She's had it since she was a little girl, and now she has two little ones of her own to worry about. She's done everything right. Stayed home, called the GP, was prescribed the magic cure, taken paracetamol regularly and used her inhaler. In fact, she's used a whole inhaler in just the last few hours. Usually they last weeks. But Zohara has her kids to worry about. No time to be ill.

She lets me in and collapses back onto the couch. Her breathing is rapid, noisy. She sits leaning forward, using all her chest muscles to try and get her lungs to open up just a little bit more. I don't need a stethoscope to determine that she's in real trouble. I put the probe on her finger that tells me her oxygen levels. They should be, at a bare minimum, 94-95%. The numbers read a dozen percentage points lower. Her pulse is double its normal rate, over 150 a minute. In broken sentences she tells me about her kids, how she'll have to get someone over to babysit. The maternal instinct, once again, over-riding everything else. I suggest that I start treating her first, and then I'll help arrange the baby sitter. A little reluctantly she agrees. The nebuliser, a noisy combination of oxygen flowing forcefully through liquid medication, is only just louder than her breathing. She takes some deep breaths on the misty air that presents itself through the mask, and after a few minutes her oxygen levels start to rise. Just a little.

Zohara's stringing a few more words together, enough to make the phone call and get a local family member to come and look after the kids. Ambulance and baby-sitter arrive simultaneously. Zohara is still trying to give instructions as she's taken to the ambulance, but can't yet manage to concentrate on breathing and talking at the same time. Breathing takes precedence, and she's left with no choice but to trust that all will be taken care of.

As the ambulance drives away, I'm left wondering once again, especially in light of my previous post, why? Why did she wait so long? Why did she think that she could do it all on her own? Why is it that a mother's instinct often doesn't stretch to looking after the mother too?

Most incomprehensible of all, why is it that so often, the people who need us the most, are the ones most reluctant to call us out?

Waiting Time or Wasting Time?

Now THIS has the potential to kick up a storm. £20 to see your GP? In the supposedly free NHS? There's no way to justify it, is there? Personally, I think that there's some logic to it. More so, there's logic to introducing this idea to ambulance calls. I'd like to propose the following as a suggestion, and ask for your views on the idea. On every piece of paperwork we fill out for a patient, there's a box that says "Unnecessary Callout Fee". If it's signed by the paramedic and by a member of hospital staff, it means that both agree that this was a wasted journey for the ambulance, and the patient should be billed. Even if it's a small amount. Just slightly more than the taxi journey would cost.

*****

Here's a list of arguments I've heard against:

1) This is the NHS - it should be free at the point of delivery

2) The people who call are often those who can't afford anything else

3) The decision would be very subjective, and dependent on the mood of the paramedic or triage nurse

4) These call-outs are the ones that keep paramedics in a job

*****

I'm sure there are many others, but in the meantime, some counter-arguments to the above:

*****

1) We already pay for NHS dentists and prescriptions, and the NHS is on the verge of collapse

2) The elderly, children, and those on things like income support would be exempt

3) You need to have a bit more faith in the professionalism of the NHS staff involved

4) Emergencies keep us in a job - that's what we're there for

*****

This needn't be a money-making exercise. The idea would be to reduce the stubbed-toe call-outs, the paper-cut call-outs, the "I've had a pain in my shoulder for three months and decided that 4am on a weekend night is the best time to call" call-outs. In short, to reduce the pressure on the ambulance service, so that ambulances are available more often and more quickly for those calls where they are really needed. "Needed" doesn't necessarily mean life-threatening only. I fully accept that there is a plethora of genuine reasons to call, and agree that sometimes there's just no other answer. That's what we're here for. And no, I wouldn't want to charge you.

We need to get back to ambulances waiting for calls, and not calls waiting for ambulances.

Safety in Numbers

Just as an aside, the "Hit Counter" that was on this blog seemed to be more trouble than it was worth, causing varying types of error messages to appear, as well as several disgruntled messages from people trying to leave comments and being unable to do so. Hopefully the problem is now rectified, but it means I've got to start counting all over again. So apologies to the 8,500 (ok, ok, I know it's probably 4 people lots of times, but still...) who have been erased from the count, but I hope you all come back again!

Proper post to follow soon, but in the meantime, for those cardiac orientated people out there - a treat. I saw this on Medic999's blog a while back and thought it was worth sharing. Enjoy!

Honesty Please

I'd like to ask for some honesty. Many of my readers know who I am, and I hope there are a few more who don't. I'd like to ask both groups of people to follow the link on the left hand side of this page (the one that looks like the one I've stuck next to this post) that says "Rate this Blog". I'm asking that you write a short review, including what you'd like to see more or less of, what you like and don't like, and where you would genuinely rate my rantings on a scale of 1-10. It's anonymous, so please don't be afraid to write what you really think. Just don't ask me to sing and dance. We'd all regret it, believe me...

Skinny-mum

I hate doing it.

It's filled with the possibilities of disaster.

It frightens me half to death.

It's messy and smelly.

I really hate doing it.

So how come, every time I do, I end up grinning like a Cheshire Cat?

________________________________

Maternataxis. That's what we call them. The calls for an ambulance that the mum-to-be has had nine months in which to plan her transport, and at the last minute realises that a free taxi, even if it is bright yellow with blue flashing lights, is the cheapest taxi of all. More often than not, in fact I'd guess that in about 90% of the time, when we are called to a woman in labour, her contractions are still miles apart, and she still has hours to go. She walks on to the ambulance from home, walks off again at the hospital, and on many occasions walks out of the hospital again after a short while for another 24 hours until the baby's actually ready. Most paramedics whinge about these calls not being "proper" ambulance work. I agree to some extent, and sometimes join in the whiny chorus, but then always count my lucky stars that someone else will actually have to do the delivery bit.

This time was different. Dad-to-be was downstairs, outside the block of flats, looking pale as a sheet. "THE BABY'S BORN! THE BABY'S BORN!". Millions of expletives rush through my head as I grab four different bags of equipment and follow the dust trail he's left as he's sprinted at world record speed up to the fourth floor. Why are the proper jobs never, ever, on ground level???

Mum-to-be, Andrea, has had the sense to get in the bath. Not like the last time I went to a delivery to see the white couch and rug totally destroyed. When I say she had the sense, it was really more by luck than judgement. She'd had no contractions, still had a week until the official due-date, and her last labour lasted two whole days. So she had no forewarning as to what was about to happen. Andrea gets in the bath, and has a first contraction. Followed closely by a second. Followed very closely by a third, a push, and then a baby.

As I catch up with Dad and enter the flat, there's yet another flight of stairs until we get to Andrea. Just as I get there, baby is fully delivered, and all I've got to do is get him warmed up, breathing properly and turn him a better colour. I hand Dad the scissors and the honour of cutting the cord. Good thing it doesn't have to be a particularly surgical cut, as his hands are shaking so hard, that he almost cuts in zig-zags.

Babies born in a hurry sometimes struggle to get their breathing regulated. Part of the process of labour is to tell baby's lungs that they're about to start needing to breath air instead of amniotic fluid. If labour's only been 15 minutes, the lungs have a bit of a shock when they're exposed to the totally alien environment that's going to be home for the (un)foreseeable future. So I add a bit of oxygen to the atmosphere, and baby's colour starts to pick (or pink) up. The ambulances turn up as well, and we get ready to transfer Andrea and baby to hospital.

In the process of baby's unexpected arrival, another role has been created. That of The Big Sister. TBS is, understandably, very excited with her new job. She takes to the role like a duck to water. She may only be three years old, but she knows that while mum's gone, she has to look after everything, make sure that dad's ok, remind nan that she has to be there to help, and tell mum that she has to look after the baby during the journey, and come home soon.

Andrea is ready to go, and we head down to ambulance. A mass convoy of ambulance people all grinning like Cheshire Cats, one holding mum, one holding baby, and three holding all the kit that I dragged upstairs.

As we arrive at the ambulance, the newly-installed Big Sister is standing on the balcony, observing the scene like a member of the Royal Family standing at the front of Buckingham Palace. Just as mum's about to disappear into the ambulance, a yell from upstairs halts the procession. "MUUUUUUUUUUMMMMMMMM!!!!!"

"Yes, Big Sister..."

"MU-UM...", there's a long pause as Big Sister thinks about how to phrase it.

Mum's delight amongst the discomfort is evident.

Just in time, several other people appear on their balconies to hear Big Sister make her important announcement.

"MUM, HOPE YOU COME BACK SKINNY!!!!!"

Multi-lingual

I speak two languages. Only one of which is of a great deal of use around where I work, and you're reading it now. I understand enough of a couple of other languages to know when someone is either swearing at me or at least talking about me. And I know the word for pain in about another three. The problem is that the other hundred plus languages that are used regularly in our area are still a complete mystery to me. However, I've now worked out the secret. I can now ask a wide variety of questions in any language I wish. Well, kind of...

______________________________

Mrs Shah claims she's about 90 years old. Nobody knows exactly. Her passport has a made up date on it which may or may not closely resemble her true date of birth. She moved with her family from India many years ago, but never really learnt to speak English. She was spoilt for choice of translators, with her children and grandchildren speaking both their native tongue as well as fluent English. She lives with her son, daughter-in-law and three grandchildren, and is very clearly the matriarch of a very close and tight-knit tribe. She may be elderly, but Mrs Shah is definitely in charge. I feel that we all have a lot to learn from their way of life - especially when it comes to social and family responsibility. Everyone looks after everyone else.

She's had a fall at home, and is still sitting on the floor when I arrive. The look I get clearly says "Who's invited him into my home?". I introduce myself and explain why I'm here as the simultaneous translation is done by a 15 year old, better than any professional. I show off and ask her in her language if she has any pain. The Shah family are in hysterics, and the matriarch eyes me with slightly less suspicion, and even a glint of amusement. Brownie points galore. Excellent. How to win friends and influence people.

I've noticed many times before that translators often throw in English phrases into the conversation, which always amuses me. I laugh, because I do it too. In fact, I do it in both directions. I have words missing in both languages that I steal from the other and just assume that people will understand. My kids are just used to it, and even now do it themselves. I've also noticed how, sometimes, if you say the same word, with a slightly different emphasis or accent, it seems to be understood by the non-English speaking patient.

I ask the translator to inform Mrs S that I need to check her sugar levels, and what sounds like automatic gunfire flies across the room, and she agrees to allow me to steal the tiny drop of blood from her finger. The same when I asked her to check her temperature. By this time, the rapport with the family (more of whom just seemed to appear out of nowhere) is excellent. Mrs Shah sends one of the grandkids into the kitchen with a list of orders. 2 minutes later they return with a cup of tea for her and a tray of drink and biscuits for me, which I politely decline. In the meantime, Mrs Shah has indicated in no uncertain terms that she isn't going to hospital. She's not injured other than a grazed arm, and has an amazing family support network, so I'm happy to agree. But there's just one more thing I need to check before I can complete my paperwork. I need to check her blood pressure. Slightly hesitantly, somewhat bravely, and very cheekily, I put on my best Indian accent (which is rubbish), turn directly to Mrs Shah and say "Blood Pressure Hah?" No offence meant, and none taken. Just my lame attempt at being multi-lingual.

To the amusement of the family she just smiles and presents me her arm.

Safe as Houses

The story of the paramedic who waited outside an address for a considerable amount of time has caused a great deal of outrage amongst the general public. Although the story is a few days old, it has still led to me being asked by several relatives and friends over the weekend what I think about it all. First - three disclaimers:

a) I don't know the whole story, I probably never will.

b) I'm truly sorry for the family of the patient involved, they have lost a loved one, and will never know whether those few minutes made all the difference.

c) The story's not been helped by certain media outlets twisting the facts to suit their own headlines. Truth, apparently, should never be allowed to get in the way of a money making opportunity.

Sometimes, we're stuck between a rock and a hard place. At what point does an open door go from being a welcome sight to being a warning sign? At what point does a normal family home change from a haven of hospitality to a hovel of hostility? At what point does a paramedic say that personal safety comes before patient safety?

The answer to the third question is theoretically easy. Always. Theoretically.

However, we are forever taking calculated risks, especially so, if, like the paramedic in this case (and me), you are a solo responder. We're forever walking into volatile situations. Sometimes with no prior knowledge, sometimes with some sort of forewarning. The mere fact that we are responding to emergency situations means that we're not walking into a normal family surrounding. People react differently when they're under stress, unpredictably so. It's part of our job to accept that, deal with it, and fully expect to be met by a barrage of different emotions. In the vast majority of cases we just get on and do our job, sometimes at great personal risk.

Despite all of the above, if I, or any other paramedic felt that our life was at risk, I would fully expect the patient to take second place. I don't know why the paramedic in our story felt so at risk, but I fully support his decision. After all, if he'd have walked in and disturbed a burglary, then his previous patient may well have been his last one. A life lost is tragic. Two lives lost would have been more so.

Baby Bus II

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

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

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

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

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

Adam was going home.

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

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

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

Baby Bus

There are several types of ambulances out there, from cars to motorbikes, bicycles to a helicopter, emergency ambulances, as well as all the patient transport vehicles. One of the hidden secrets of the London Ambulance Service is BETS, or Baby Emergency Transport Service. It's an ambulance with a difference. It has a crew of one paramedic, one nurse and one doctor. It does what it says on the tin. This is a team of people who travel round London, the South East, and every so often further afield, in order to treat and transport very sick mainly newborn babies. Some are born very prematurely, with all the complications that it can lead to. Some are born full-term with all sorts of illnesses and diseases. The job that BETS has, in the most simplistic of terms, is to stabilise these babies and transfer them to the most appropriate treatment centre for their condition. Sometimes they also take them back to their local hospital once they are well enough. I had the privilege of spending six months with this team of dedicated people, and would love to go back for more. If only they'd move a little nearer...

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Three in the morning, the only noise in the building is the Batman movie that we're watching, the stirring of the cups of coffee, and the mumbled prayers that the phone stays silent now for the rest of the shift. It had been one of those nights. It took me forever to get to work, we'd been busy from the start up until now, having driven 150 miles already, and finally we could have a sit down and watch the movie that someone had kindly left behind. Ten minutes in, 3 pairs of eyes that were fixed on the TV are starting to droop, but the dream world that slowly envelopes the room is abruptly shattered with a shrill ring. In Outtatown Hospital a hundred miles away is a very poorly newborn, and he needs to get to Bigtown Hospital for treatment. There's a chance that he may not survive long enough for us to get there, there's a chance he won't survive long enough for us to stabilise and transport him, there's a chance he won't survive the journey itself, and if he beats the odds and survives all that time, he only has a 50% chance of survival overall.

Hoping against hope, and knowing that we were going to finish our shift very, very late, we set off for Outtatown.

The doctor on board is given constant updates on baby Adam. He suggests treatments to give him the best possible fighting chance. At about 5 o'clock in the morning we arrive, and are met by the local medical team, as well as Adam's parents. They suggest that as I'm doing all the driving that I go and take a nap. I manage 10 minutes, but the tension is palpable, and I feel that I'd be more use being an extra pair of hands. It was an amazing experience for me as a paramedic to be treated as part of a fully fledged medical team, and is one of the things I miss most about BETS.

The parents are, understandably, distraught. Dad is trying to stay composed, but mostly failing. Mum is in a wheelchair, refusing to give her body the chance to recover from the traumatic birth. They want to see everything, know everything, understand everything. Yet they understand nothing. There was no warning, Adam was born on time, all the scans were clear, no sign of the trauma that was to follow his birth.

It's the wrong side of 7am for a night team. Adam is fighting, but transport is a dangerous business, and he has to be completely stable. It takes time, ingenuity, medication and a lot of patience. The day team calls to see if we want relieving, but we work out that by the time they drive 100 miles in daytime traffic, even on blue lights, we'll hopefully be half way back to Bigtown. Adam permitting.

Mum and Dad finally succumb to a fitful sleep in a side room. The efforts continue, the hospital night staff go home to their Outtatown beds, the day team take over where they left off. Slowly but surely Adam's condition is becoming more manageable and he starts to settle. He has episodes where it seems we'll never be able to move him, but finally, at almost 10 in the morning, Adam's loaded into the incubator and onto the Baby Bus.

CONTINUED...

Aerophobia

I quite like flying. Or at least I'm not particularly bothered by it. I do worry, however, that the famous tannoy announcement of "Is there a doctor on board?" will suddenly break the monotony. What do I do then? I could always hide behind the fact that I'm not a doctor, but that's just being pedantic. I could always pretend that I was asleep, but nobody would believe that one.

Except that I know me, and if it did ever happen, I'd be the first to jump up with an offer of assistance. I can't help a good running call. I'm the sort of person who can't be out and about for more than 10 minutes without coming across some sort trouble, so I'm sure one day when I'm flying, it'll happen.

Having said all of that, I think I'd rather hear the request for a doctor on the plane, than a request for an aircraft mechanic...

Second Chances

"Don't you ever get scared, working on your own at night?", asked Nina, the patient's de-facto carer. Fair question I thought. My initial instinct is to be a typical man and say that I'm never really scared. But that's a lie. I think that anyone in this job, whether working on their own or with a crew-mate, has at least one moment where the Fight or Flight mechanism kicks in. There's a fear of the unknown sometimes, there's fear when someone pulls out a weapon and threatens you with it, there's fear being in a situation where you just can't see your way out.

My biggest fear, at work at least, is none of these. It's a fear of doing the wrong thing. I can't help over-analysing my actions sometimes, just to make sure that if, given another chance, I would do things the same way, because in this line of work, there is, at least sometimes, no way back.

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Alan is at the end of his wits. He sits at home with his 80 year old mum, Eve. He's there, waiting for the inevitable. The monotony is broken only by scheduled visits from the district nurse who gives Eve her pain-relieving injections. There is nothing more that can be done for her, beyond palliative care, ensuring that her last days are at least spent in some degree of comfort. Somewhere, however, the system has let them both down. No nurse has been now for 24 hours, when there should be a 4 hourly visit. Eve is in pain, and Alan can do nothing about it. He's tried the GP's surgery, he's tried Social Services, he's tried phoning the nurse directly, but realised that she must be away as the ring tone sounded foreign. In sheer desperation, he calls for an ambulance.

When we arrive, Alan is on the verge of tears. "I know I shouldn't have called you. I know that this isn't what you're here for. But I just need her to have some pain relief. She doesn't want to go. She wants to die at home. She's been crying for hours and I just can't take it any more!" He crumples to the floor, ashamed at admitting defeat. He had promised himself that he would take care of his mum, whatever it took out of him, but couldn't cope anymore.

Eve lies in her bed, unable to care for herself, unable to sit up on her own, barely able to convey what it is she wants or needs. She's frail, grey, and has a look that is almost begging for the end to come. The expression on her face, along with the agonised moan, screams for mercy. It's heartbreaking.

Technically, administering prescribed drugs is out of our remit. Especially the drugs that Eve was on, so we phoned for advice. We spoke to one of the on-call doctors who allowed us to step outside of our normal rules, and slowly give Eve some pain relief. Under their guidance, we watched how the medication took effect. The look of relief in both faces was remarkable. We stayed a while longer, ensuring that the medication did what it was supposed to, and that Eve was settled. Eventually the expression changed from one of mercy to one of grateful thanks. Then we went outside and completed a pile of paperwork.

10 minutes later, I'm still writing. There's a knock on the ambulance window. Alan stands there with tears streaming down his face again.

In a barely audible whisper, he chokes on the words as he says them "I think she's gone".

We rush back in to see that the inevitable has indeed happened.

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This was a couple of years ago. To this day I wonder if I brought about Eve's death, or whether I just made a sad ending a little more comfortable. That's my biggest fear. No second chances.

Comments

Clearly, judging by the comment, I've upset someone with my previous post. I've tried, in the comments section, to rectify what I hope is a misunderstanding. Nevertheless, is there anyone else out there who agrees either with me or with our anonymous friend? Don't be shy... I'm intrigued to hear!

Public Education Message

Amber emergency calls are those that aren't immediately life threatening, but supposedly have the potential to turn nasty. So says the goddess FREDA.

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The Call: 20 something year old female, severe abdominal pains.

The Category: Amber

The Assessment: 20 something year old female, been sick a couple of times.

The Reason for the call: "Well, if she went to the GP, he'd tell her to drink lots of water, take some paracetamol if she has pain, and give it a day or two."

"And what if YOU took her to A&E yourselves, rather than call out an ambulance?" said I.

"Well, we'd sit there for ages, they'd tell her to drink lots of water, take some paracetamol if she has pain, and give it a day or two."

Slightly exasperated, I ask "And what do you think I'm going to tell you?"

One patient, and three supposedly intelligent adult relatives all look slightly sheepish and as if by magic join in the chorus: "Drink lots of water, take some paracetamol if there's any pain, and give it a day or two..."

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This has been a public education message on behalf of frustrated ambulance staff everywhere. Thank you for taking the time to listen.

Tin Can

It's far too hot to be sitting in the back of an ambulance with no air-conditioning, so of course I decided it was time to do a shift on one, rather than stay in my beautifully chilled car. Well, strictly speaking there is air-con, but as it's summer and hot for a change, it doesn't work. Like the heating that refuses to fire on the coldest day of the year. Every patient we had complained about the temperature both inside and out of the truck. Every patient except one.

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Terry is in floods of tears. His 40+ years on earth have taught him only that he's the Chosen One. Chosen for anguish, chosen for torment, chosen for hardship. He's fought all his adult life against it, but just can't tear away from the reins that constantly pull him back into the abyss. He has good days and bad days, sometimes the good days last for weeks, but sometimes the bad days do too.

Today's a bad day. Terry can't control the sobs, can't shake off the panic. He looks at the ambulance and sees it as a means to enforced incarceration. He's not even sure it's a real ambulance and asks for my ID just to make sure that I really am who I say I am. He is shaking with terror, sobbing uncontrollably. All he wants is to feel that he can cope. To stop the voices and visions that have once again taken over his life. Eventually, Terry is able to calm down a little. Just enough for us to coax him into the back of the ambulance without him feeling as though he's being kidnapped. As the back door of the ambulance is opened at the hospital, all the colour drains from his face, and he is overcome with paralysing fear once again. I have to start the process once more. Allaying his fears, controlling those tears, reducing the trepidation that is his every waking thought. Slowly but surely, Terry starts to come round. He knows he needs the help. He knows he wants the help. Reluctantly he agrees to walk in to the monster that may hold the cure.

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As we enter the hospital building, he stops, turns round, and takes one last look at the ambulance. With a great gush of tears he says, "God, it's hot in that Tin Can".