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!"

Sleep

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

"Sure there is."

"Was it a bad crash or something?"

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

"Such as?"

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

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

"Yes. I've seen it."

"How did you cope?"

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

"And then what?"

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

"And that's it?!"

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

Purple

The streets are lined with market stalls, selling flags, scarves, team-branded items of all sorts. Blues to the right, Reds to the left. Home team advantage to the Blues, but it's a local derby, so feelings are running high, the tension in the air is palpable and threatens to erupt at any moment.

Thousands of fans on the streets walk, talk, shout and sing their way to the match. Some are sucked in by the stall-holders, but most have come prepared. The seasoned professionals in this game are the supporters, not the players. Years, even generations of loyal, unwavering support. The traditions remain strong, even when the reasons behind them can no longer be recalled. The sea of people converge on the ground, Reds from the left, Blues from the right, meeting to create a purple haze as they mingle at the gates.

It's a daunting sight, all the more so if you're trying to find one needle-like patient in a haystack of raucous colour. At least we know he's a Red. Eventually, thanks to the police, stewards and several drunken antics, he's found. Lying face down on a bench, his scarf loosely dangling from around his neck, the back of his shirt proudly displaying the coveted number 10.

Around us are more stalls, this time each plying their trade with an added bonus of advertising by aroma. Food and drink on sale at extortionate prices, yet being bought by hundreds of fans, each allowing themselves one more luxury to complete the day. All the while, there's an added smell in the mix, lavender-like, seemingly, almost impossibly, coming from the comatose patient.

Under the bench we see the can. Lavender air freshener. An officer picks it up and with one shake announces that it's empty. He hands us the can as he reads the warning printed boldly, menacingly on the back.

"Solvent abuse can kill instantly".

A Red fan amongst his own, away at the home of the Blues, gone in a self-inflicted haze of purple.

Eating Habits

The famous adage, "You learn something new every day", is especially true if you have kids, or spend any length of time with them. Kids have a way of saying things, seeing things, questioning things, that we as adults seem to lose. It's a kind of honesty and direct approach that where an adult would think twice about the ramifications of what they are about to say, children just want to know. Their inquisitive nature is their no-holds-barred method to a greater understanding of the world around them.

This week, one of my kids found out that in a previous life I used to be a soldier. It's not a fact I hide, neither is it something I'm ashamed of. It's just never come up in conversation. She found a photo of me in greens, carrying a semi-automatic, and looking every part the soldier. She looked, digested, dissected, and then came out with the question that I could clearly see was troubling her 6-year-old mind.

"Did you kill anyone?"

Woah.

I didn't see that one coming. I thought about it for a minute, and told her about people not joining the army to kill people. Soldiers are in the army to care for other people. To secure their land. To safeguard their way of life. Forget the politics. Six-year-olds don't care about it. If she did, she'd have asked about the legal ramifications for the Iraq War, the troops being in Afghanistan, and what the new coalition government plans to do about it all. Clearly not very likely.

She wanted to know about her dad, and I answered her intended question.

All my kids know what I do now. Obviously. They're proud to say that their dad's a paramedic, and if you were to ask any of them what my job description is, they'd each tell you, in their own inimitable style, that I save people's lives, or I go and help the sick and injured, or something along the same sorts of lines. Sometimes, if I come home looking particularly harassed, said 6-year-old will ask if I saved anybody at work, or how many people did I look after, but she has never yet asked me if anybody died. Her question about the army taught me a little about how the little people around us perceive the confusing world around them. To my six-year-old, the following is her view of the world:

Soldiers kill, Paramedics save.

As adults, on the other hand, we look at the world through completely different eyes. Our vision is blurred by stereotype, cynicism, media portrayal, politics, and a small dose of reality. After the "army question", I was left thinking about perception in general, and of the ambulance service in particular. I sent out a tweet to my followers asking a very simple question: "What is the first question/reaction you get as a paramedic/EMT when being introduced to someone new?" A simple question, but the answer to which is probably reduced to a bare half-dozen similar answers.

"Wow, that's interesting", or "How cool", or "You must see some horrible things".

Of course there are the silly ones, like "Do you drive on lights and sirens just to get back for a cup of coffee?" I'd love to say yes to that one, but no. Unfortunately not.

I find that there's one more. Often not the first question or reaction, but is asked on a very frequent basis.

"What's the worst thing you've ever seen?"

I refuse to answer that one honestly. The adult in me forbids it. Anyone asking that question doesn't really want to hear what the worst things are to see, and I know they don't. I know because once upon a time when I was much newer, I'd answer with the truth. Except that after the first three words they'd cover their ears and yell for me to stop. "Stop! No more! I can't understand how you do it!" Now my answer tends to be about the latest delivery I assisted with, and the mess all over the place. It's enough for most.

There's an element in all of us that wants to hear the gory story, to hear about the trauma. It's what makes any person driving past the scene of an accident drive slower in order to take a look, but drive much quicker if there's any risk of actually finding out. The childlike curiosity that is in all of us often makes way for the cynicism of an adult's view of the universe. We really want to know, but not at any cost.

Children have a thirst for knowledge that we as adults have quenched by reality.

Children are on a quest, a treasure-hunt searching for understanding, whilst we as adults we want to rest at the starting line, ignoring all the clues and helpful hints.

As adults we always have much to learn, but not always the hunger to do so. We'd do well to look at the children around us, and learn a little from their hunger. And from their eating habits.

That's what helps them grow.

Bus Stop

Fate sometimes has a strange way of playing with your mind.

After yesterday's post about rarely discovering the outcome of patients, and how it can be the most frustrating part of our job, I had a little closure on one patient.

The last time I saw her, many months ago, she was on a trolley in the resus room.

Unconscious, post resuscitation.

Given a 10% chance to survive the night.

This morning, on my way home, I drove past her address just in time to see her locking her front door, shopping bags slung over her shoulder, and walking to the bus stop just outside her house.

I'll take part of the blame for her shopping bill.

The Best

We all do it. We try desperately to avoid it, but in our line of work, it's an occupational hazard. And over the last couple of days, two of my fellow bloggers have, in one way or another, written about it.

JustMe in her blog reflects on what seemed a routine call that gives her no peace.

FishMedic in his blog reflects on all the What Ifs, where he'll never know.

Go read their blogs, and see how sometimes the knowledge that we'll never discover the outcome, is the toughest part of this job.

Ninety-nine times out of every hundred, we'll not know what happens to our patients once they've left our care.

Once in every hundred, or maybe thousand, or even more, that fact will bother us.

I don't think any of us can answer the questions that they're left with.

But we can all offer them a shoulder to lean on and our support, and leave our colleagues in no doubt that we all experience the same, we all have our own questions, we all sometimes have sleepless nights. Whether we are brand new to this job, or seasoned old-hands, sometimes we'll also need that shoulder.

Last night, I think I missed a trick too, on something we don't see very often. As soon as we'd delivered our patient to the A&E department, I kicked myself for not thinking about it, and hoped that the staff at the hospital would be a little quicker on the uptake than I was. I'll never know.

Questioning is good. Reflecting is good. We need it to ensure that our patients always get the best treatment, and that we are always striving to be the best we can.

Even if we don't always have the best answers.

Rude

An ambulance, parked in the middle of the road, sometimes obstructs the traffic. We apologise, but if there's nowhere else to park, there's nowhere else to park.

An ambulance, parked up, doors shut, but lights on, probably has some dedicated staff inside tending to a needy patient.

That dedicated staff, it may surprise you to know, is not only dedicated, but skilled.

And that patient, despite the indignity of being in an ambulance that may be obstructing the traffic, is still entitled to privacy.

On the outside of the ambulance, on each of the doors into the treatment area, there is a notice. "Please knock and wait. Patient treatment in progress". It's printed in large red letters.

When a doctor is seeing a patient, in their own surgery, the door is shut. For privacy reasons. People knock before they enter, and wait to be invited in.

So why, Doctor, did you feel it was your right to swing the doors of the ambulance open whilst we were treating the patient?

"I'm a doctor!", you sneered. No knock, and no wait. "Do you need my help?" you asked.

"I'm important!", is what we heard. "And can you please get out of my way?", you must have added.

"I don't remember inviting you in", was answered. "And you certainly didn't knock", was added.

We don't barge in on your patients when you're treating them. Don't you dare presume that you're allowed to do it to us.

Rudeness and oneupmanship will guarantee you one thing, doctor. And it most certainly isn't that we'll clear the road any quicker for you.

Noise

Opening the door of the ambulance, there's a noise.

An almost feral scream.

Entering the house, there's a noise.

An accusatory shout, querying the delay.

As the kit is prepared, there's a noise.

A low groan, panting, pushing.

As it's being born, there's a noise.

A parent's question, checking the baby's welfare.

Once the baby makes a full appearance, there's no noise.

No noise at all.

As it arrives, it's blue, lifeless. Silent.

We warm it, dry it, breathe for it.

After a few forced breaths, there's a noise.

The noise of a newborn's cry.

As the lungs open up and greet the world, there's a noise.

A loud, high-pitched, life-saving noise.

The most beautiful noise in the world.

Something

Last night I met one of the HEMS team that was on a recent call I attended.

The one where I performed my first needle-thoracocentesis.

It kept the lungs breathing.

It kept the heart pumping.

It kept the patient alive.

I knew at the time that the patient's chances of survival were very slim.

At last night's chance meeting my fears were confirmed.

The patient died about two days later.

Stabbing them in the chest didn't save their life.

But it did give the family the chance to come and say a final farewell.

And I guess that's something.

Cutbacks

Cuts need to be made. We knew they were coming. The NHS, like all other government departments, is facing some major changes to help it through these financially unstable times. Ambulance Driver is using this piece of news to the tunes of "I told you so" in reference to the changes being proposed over in the States - the so-called "ObamaCare".

So whilst over the other side of the pond they're trying to change public health care to be a little more like the UK, we over here are travelling in the opposite direction. Surely there must be some sort of middle ground, although I'm not sure where it is. A socialist health system in a capitalist society are always going to clash.

I don't profess, or pretend for that matter, to understand all the ins and outs of the NHS, but I do know a little about the very tiny corner of it that I occupy. The NHS, to a certain degree, has been a victim of its own success.

People live longer, healthier lives. That costs money.

Chronic conditions are better treated than ever before. Sometimes they are cured, other times merely managed long-term. That costs money.

Some prescriptions, at least in England and Wales, have a minimum charge. The rest of the cost is covered by the state. That costs money.

Trauma victims have a better chance of survival. Then they need rehab. That costs money.

Operations cost money.

Drugs cost money.

Staffing the NHS costs money.

Everything costs money. And slowly but surely, we're running out of it. The promise that there would be no front line cutbacks is proving to be another of the broken promises that has become the norm for any political party seeking to seize or retain power at general elections.

Read that linked article at the top, and have a glance through the threatened cuts. One in particular caught my eye. The one that has most relevance to my little corner. They want to reduce the number of people using Accident and Emergency departments, whether through GP referrals, or at a guess, also by self-admission. Only having the newspaper article to go on, I can't be certain what that means for the ambulance world. I'd love there to have been something in there about reducing the number of inappropriate ambulance calls.

Sometimes, to save money, like the NHS needs to, there's a need to spend some money. Money spent on education, for starters.

Education on when to use the NHS. Can you manage your symptoms at home? Does your child really need to go to the doctor? Do you really need to go to A&E at 3am for something that has been bugging you for a fortnight?

Education on how to use the NHS. How do you access the most appropriate care? How do you ensure that you get the follow up you need? How do you call an ambulance, and what for?

As ambulance staff, we are front-line providers. And also have the chance to be front-line advisors and educators. But to do this effectively, we need back up. From the state, from our employers, from the system. Even from our colleagues. There are too many who opt either for one extreme or the other.

Too many who turn up to calls that are a totally inappropriate use of the NHS in general and the ambulance service in particular, and yet do nothing but transport to A&E. It's an opportunity missed.

Then there are too many who get so angry about that same call, that all they do is rant and rave at the patient. The chances of said patient paying attention to a telling off are slim to none.

We trialled a system of not sending ambulances, but unless the pressure on the ambulance service is so severe that it is on the verge, or possibly past the point of collapse, it's not utilised. So for now, we need to take it down one level, and give that responsibility to the crews on scene. If only we could devise a system where we can legally refuse to transport someone to A&E, and at the same time use our skills and knowledge to educate them about all the things I've mentioned. As things stand, we're not allowed to refuse to send an ambulance, and we're not allowed to refuse to convey to A&E. And that's money we could be saving.

Instead of employing managers at astronomical salaries who are paid for nothing more than concentrating on fictitious targets, spend that money on educating both the public and the front-line staff. There seems to be a culture shift in the ambulance service at the moment of taking decision-making and skills away from the staff, leaving those decisions to faceless, albeit trained, phone operators. There seems to be a train of thought that cost-cutting can only be done by employing lower grade staff for the front-line on lower wages, whilst maintaining staff on high wages just to hold clip boards and tick boxes.

Cost cutting within the NHS has to be brutal, but it has to be honest too.

It cannot be that the top few percent hold on to their precious jobs, whether necessary or not, whilst those at the coal-face have their jobs threatened.

It cannot be that those who most rely on the NHS, bear the full brunt of its savings.

At the same time, the general population must accept that they need to help the system, if they still want the system to be there to help them.

Fiancé

On the steps of the town hall she sits, staring out at the world, looking for something she knows, someone she recognises. The stairs look familiar, but in an unfamiliar world. The pigeons crowd around her, hoping for food, but she harbours nothing but good intentions and lost thoughts.

"Hello! What's your name?"

"Marjorie."

"What are you doing here? You waiting for someone?"

"I'm just having a rest. My legs seem to be tired today. My fiancé should be here somewhere."

The word 'fiancé' catches us off guard. Marjorie must be at least eighty years old.

"Where do you live?"

"Only up the road. Not far at all. I just couldn't seem to make it today."

As we stand there, he turns up, his lungs out of breath and face full of panic.

"Marje! What are you doing here?"

The sound of her own name startles her, and she shies away a little.

"Just having a rest for a few minutes, waiting for my fiancé." The words hit him hard.

"Your fiancé? But we've been married for nearly 50 years!"

We watch through his eyes how his heart breaks, and he explains. He tells of Marjorie's dementia, how she sometimes forgets where she is, where she's going, what she's doing.

But she's never forgotten who he is.

We check to make sure she's not had a fall, we talk to witnesses, to the person who called for the ambulance. Physically she's fine, but lost in a haze of time and memories that she can't quite fit together. She's comforted, reassured, and slowly accepts a muddled reality.

And then she walks off, hand-in-hand, with her fiancé of fifty years.

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?

Nosey Neighbours

"40 West St, East Area, Baby crying constantly for last hour".

It's a call that's come directly from the police.

That's an emergency? That's what I spent all that time training for? You need parenting classes, not an emergency ambulance! Nevertheless, it's off to the address to see what's probably a teething baby and convey it needlessly to hospital. One of the residents of number 40 is standing on the doorstep, and we head over towards them. It's about one in the morning, the street's quiet, and other than our voices, there are no other sounds. Not even a crying baby.

"You managed to calm the baby down then?"

"No, the baby's still crying. Follow me please."

We walk up a flight of stairs, and I still don't hear any crying. We're shown into a back room, and finally, a faint cry can be heard. Except that there's no baby in the room, and it's almost as though, judging by the direction of the noise, that the baby's been hidden in the cupboard.

"Where's the baby?"

"We think it's next door. There are no babies in this house, and it's been crying for nearly two hours now."

"If the baby's next door, why did you bring us here?" I can't help thinking that this is a case of nosey-neighbouritis.

"We've tried knocking on the door, ringing the doorbell, and nothing. No-one's answering. They're a really nice couple. He works some weird hours, think he's a copper or detective or something, and she's always home with the little one. Only seems to go out for shopping."

We go back out the house and try to look through the front door and windows. There's a light shining through from the back of the house, and some flickering that suggests the television is on too. Someone's definitely home. An adult. Just like the neighbours, we try the doorbell, we try banging on the door and the windows. When there's still no response, we ask the police to turn up. Just to tug a little harder on the heartstrings in the police control room, and hopefully ensure a more swift response, we tell them that there's possibly an infant in danger.

It works. Less than five minutes later there are two units on scene.

One of the officers goes back into number 40, into the back garden, and scales the fence to see if he can find anyone or anything. A few seconds later, there's a yell.

"She's here, on the ground. The doors are locked, someone get the enforcer!"

The enforcer is affectionately known as the big red door key. It's a single-operator battering ram, made of metal and painted red, weighing several kilos. It opens most front doors with just a few well-placed blows. Hence the key reference. It's not carried in all police vehicles, and sometimes has to be specially requested to scene.

Whilst we wait, and feeling a little more athletic than normal, I decide to scale the fence myself to have a look.

She's lying on the floor of the kitchen, face down and looking away from the door. The only movement is her slow, rhythmical breathing. The television is showing some shopping channel, trying to sell an item for thousands that is probably only worth its weight in paper. As I'm standing next to the police officer, his radio blares back that the enforcer is on its way, but it'll take 15 minutes or so to get there. At a rough estimate, and looking from a distance through the patio door, our patient was breathing no more than 6 times a minute, barely enough to sustain life for any length of time. Back over the fence and through the neighbours' front door, I call out to Kim.

"I need the oxygen bag and a blanket!" My crew mate looks at me confused.

"Have you found a way in?"

"Not yet, but we're about to!"

I take the items round the back of the house, and grab another pair of hands in the form of a tall police officer. The officers take one top corner each of the blanket, and place it over the double-glazed door.

"Wish me luck!" The first tentative strike at the glass meets with stubborn resistance.

The second is more successful. The shattered glass cascades downwards like a shower of hail, the blanket protecting the officers and me from getting covered. The patient is far enough from the door not to be at any risk.

One step into the house and the smell gives away its secret. One officer goes to the front door and opens it. He yells to everyone not to touch any light switches.

I go to the unconscious patient and using a bag and mask, help to pump oxygen into her starved lungs.

The second officer goes straight to the gas hob and turns off the ring that had blown out.

Kim runs upstairs and grabs a baby, no more than six months old.

A torrent of instructions are yelled in all directions, from needing more oxygen and opening all the windows, to getting the carry chair, alerting the fire-brigade, the need to get us all out and both mother and baby to hospital in a hurry. No other crew is available, so we're taking them both. with a 2 metre tall policeman playing nursemaid to the baby, she looks like a miniature doll in his arms.

At hospital, when they're no longer our patients, it's a little easier to reflect. To ask all the what ifs.

What if we'd have been a little longer?

What if the baby hadn't cried so loudly?

What, despite my initial cynicism, if the neighbours hadn't been so nosey?

Luckily, we never found out.

A Conversation

On the 100 metre walk to where the patient lay in the middle of the makeshift football pitch:

"I've put a bandage on his leg".

"Great. What happened?"

"He was playing football, stepped on the ball, and fell over. There was a wicked crack."

"Have you moved him?"

"No. I just put a bandage on his leg."

"Is there lots of bleeding?"

"Well, no. Not really. The bone is sticking out of his leg, but not a lot of blood."

"Hm. Sounds broken to me".

"Don't think it's broken. The bone's sticking out, but there wasn't a lot of blood, so it can't be. Yeah. Pretty sure it isn't broken."

"..................."

Tug of War

Cigarettes litter the hallway.

The floors filthy with the wanton abandon of morals, respect and self esteem.

Walls are stained by smoke, the floors covered in grime.

The room is filled with it all, smothered by the air of neglect.

She's there, In the midst of it all, there, her eyes open, staring.

Empty. Void of joy, of life.

Her last will and testament to the world stuck up with gum.

"You won't even know I'm gone".

The ceiling fights against gravity, the rope torn between the two.

A tug of war.

Of Life.

Of Death.

At Home

And so, with no pomp or circumstance whatsoever, it came to an end. A mundane call just before six o'clock in the morning, a simple handover to the crew, and a slightly solemn and very lonely drive back to station. I don't know what I was expecting or hoping for.

Almost five years ago, I started it for the first time. It lasted 6 months, and I hated almost every minute of it. I stuck at it because it was challenging and different, but I still couldn't stand it. At the end of the allocated half-dozen moons, you couldn't see me for dust in my haste to get away. Maybe I was just too young and inexperienced, maybe I was just lacking in confidence. Whatever it was, I was pleased it was over.

Almost two years ago, through lack of choice and with fear and trepidation, I went back to it. Last week it came to a halt, again through no choice of my own. My time on the FRU, the single-manned (personed) Fast Response Unit, has ended. All the things I hated about it the first time round, I loved this time, and I will sorely miss. I guess I'd grown up a little in the interim, and eventually started to feel at home in the FRU.

The most appealing is the challenge of having to think on your own, often for extended periods of time, and sometimes with very ill patients.

Starting a resus on your own and having to carry it out with no back-up for quarter of an hour.

Managing the asthmatic patient who's deteriorating before your very eyes.

Relieving the pain in the elderly patient who's fallen and fractured their hip.

And being unable to transport any of them.

Delivering a baby and praying for it to take its first breath.

Supporting the dislocated shoulder of a brave kid and watching them get drunk on entonox.

Sticking a plaster, or a band-aid, depending on where you are, on an adult who's behaving like a spoilt child.

And telling him so.

Being the first at the scene of a suicide attempt, working hard to save a life, only to see the patient whisked off in the ambulance or the helicopter, and staying at the scene filling in paperwork.

Being the first at the scene of a fatal accident, and having to call it before anyone else even turns up.

Being the first at the scene of a cardiac arrest, a terminally ill cancer patient, and grieving with the family.

And being left alone with your thoughts and a cup of coffee.

Travelling with a crew and them hating you for pulling rank.

Travelling with a crew and them loving you for pulling rank.

Travelling with a crew and the patient thanking you all. Together.

And having to justify it all. To control, to the crew, to the patient, to yourself.

Now, it's back to a mix of real ambulances and a few FRU shifts, but it won't be my car.

It'll be nice to have someone to share with, someone who I can look at over my shoulder when I'm unsure, and hopefully vice versa, someone to sing along to the radio with between and on the way to calls.

They say, whoever they are, that a change is as good as a holiday. Truth is, I could really do with one right now. It's just that I'll miss being at home.

Who'd have thought it?

Polar Bears

I'm sure you've already noticed the new banner at the top of the blog.

Cool, huh? The sleepy ambulance person in particular...

I thought so too!

So thanks to Polar Web Development for designing it for me!

A permanent link to their website is now on the right hand side.

Toilet Humour

So I know that it wasn't Jeramedic who started this meme (I had to learn what a meme was too...), but as he tagged me, I'm blaming him for it. He wanted to know, and now you'll all find out...

I'm not normally one to partake of these 21st century chain letters, but as I know that the whole subject is one of constant irritation to MrsInsomniacMedic, I couldn't really resist.

This whole idea was started by Lissa. Nope, I've no idea who that is either - but as she's started the whole thing, I guess she gets the credit too.

And now, whether you wanted to or not, you'll find out what sits on the bookshelf in the bathroom. OK, it's the window sill, and not yet a bookshelf, but still.

1) There are the books that are there permanently. Probably my favourite cartoon strip of all times. Because of the sleeping issue. Because of the coffee issue. Because of the wicked sense of humour issue.

I. Love. Garfield.

So I have two books of the comic strip in there.

2) There is the book that I'm currently reading. My taste in novels ranges from the sublime to the ridiculous, from new to old, from Harry Potter to To Kill a Mockingbird, but at the moment it's Enigma by Robert Harris, on the Enigma machines used by the Nazi regime to send coded messages, and the attempts at breaking that code.

3) Then, of course, is my favourite book ever. The book which this blog was originally named after, and to which there are many references, some subtle and some not so, throughout. It is, of course, The Hitchhikers Guide to the Galaxy. I started reading this book (and the other four of the increasingly inaccurately named trilogy) on the train to school. I'd giggle quietly to myself and get some funny looks, which then became stares of embarrassment and even concern when the giggles turned to roaring laughter. Today, it's my insomnia partner. When, once again, I can't sleep, I pick it up out of the bathroom and read it in bed, knowing lots of it almost off by heart. And still roaring with laughter. I guess you could call it toilet humour...

So now, who do I tag? I think I'll try to send this round the world.

I guess I'll have to pick on Fishmedic to start with as our European representative, despite the recent football score.

For someone in the UK, but outside of the medical field, I'm going to tag The Buffoon, as his blog has much the same effect on me as Hitchhikers.

And last but not least, all the way on the other side of the world, Flobach is invited to share his readings too!

*****

Happy Reading!

999medic

What a sad time. Due to various reasons listed on his blog, Mark's had to shut his blog down. He of 999medic and Chronicles of EMS, a voice of courage and conviction, has decided that he has to put his job and his family first. Understandable it may be, but the reasons behind it are worrying.

Read his final blogpost, along with all the comments below. They pay tribute much better than I could to his ability and vision to make the world of EMS what it has the strong potential to be.

And for the meantime, this blog remains anonymous (although possibly one of the world's worst kept secrets), for exactly the reasons that Mark has had to walk away.

It's a sad indictment of the lack of vision of others that holds us back, as a service, as EMS providers, and especially as bloggers. It's all the more upsetting that one of the trailblazers in the field, is the one to get caught up in the fear. A fear of the unknown shouldn't mean instant disapproval. It should be a challenge to those who hold on to that fear to come and face it. Come and see that those who blog do so, at least in the vast majority, because they love their jobs. Because they want to cast it in a better light. Because they want to improve both themselves and their environment.

Hopefully, some day, the vision will overpower the fear, and not, like today, the other way round.

Guide Dog

A woman was flying from Seattle to San Francisco. Unexpectedly, the plane was diverted to Sacramento along the way. The flight attendant explained that there would be a delay, and if the passengers wanted to get off the aircraft the plane would re-board in 50 minutes. Everybody got off the plane except one lady who was blind.

The man had noticed her as he walked by and could tell the lady was blind because her guide- dog lay quietly underneath the seats in front of her throughout the entire flight. He could also tell she had flown this very flight before because the pilot approached her, and calling her by name, said, 'Kathy, we are in Sacramento for almost an hour. Would you like to get off and stretch your legs?' The blind lady replied, 'No thanks, but maybe Buddy would like to stretch his legs.'

The pilot took the dog with him off the plane so they could both spend a few minutes out of the cramped environment.

*

Picture this: All the people in the gate area came to a complete standstill when they looked up and saw the pilot walk off the plane with a guide-dog!

The pilot was even wearing sunglasses.

People scattered. They not only tried to change planes, but they were trying to change airlines!

*****

Another call to a man, almost incoherent to the call taker, stating that he's in a park but doesn't know where. I can almost hear the call.

"I'm by the big tree, near the lake."

Not very helpful. The lake has a three mile circumference and there must be thousands of trees along those miles. I drive in circles around the park, trying to get updates, clues, general directions so that this lost man can be found. Not even sure I want to find him. He's probably one of the local NFAs. A person of No Fixed Abode. Probably drunk. Probably filthy. Probably very unpleasant in his appearance, manner and demeanor. In fact, chances are that the only thing more filthy than his attire will be his language. It's not a call that leaves me wanting for more of the same.

I drive in circles, following instructions from control, who in turn were getting directions from what may as well have been the Sahara desert. "Take the third sand-dune on the left and keep going for three days. You'll see a sand-dune. Turn right there, and just in front of you will be a row of sand-dunes. I'll be there".

Sand-dunes in a desert. Trees in a forest. Same thing really. This is slowly becoming a futile task for one car and its driver. It's pointless driving round in circles with no idea of where to look. Instead, I stick the blue lights back on to see if that attracts the attention of the caller, or at least gives him a point of reference.

Clearly not. That'd be too easy.

"I'm walking to the edge of the tree-line", he tells the call-taker, "and I'll just sit down. If they find me - good. If they don't - well, whatever".

I'm about to give it up as a lost cause. Maybe even a hoax call. It's the dead of night, what chance is there that he couldn't see, even if it was at a distance, dozens of flashing blue LEDs? Driving over the brow of a small hill, and round one final corner. Been there already, and there's plenty of light there to be able to complete the pointless paperwork.

Pulling up under the beam of a street light, I suddenly see an outline of a man in a pool of darkness, sitting by the edge of the road, swaying back and forth as if trying to shake the weight of the world off his shoulders.

"Control, believe it or not, I've found him".

As I get out the car, my initial fears are realised. The smell hits me as I open the car door. Even the clear night air seems suddenly infected. His clothes are grimy and in parts torn. His hands and face the colour of a cloudy sky, his entire worldly possessions scrunched up into a couple of plastic bags. Two things are missing from the picture. Two things that are out of place for the normal, run-of-the-mill homeless drunk.

He has no half-empty alcoholic beverage containers.

And he's crying.

Not the drunken cry of the teenager who's overstepped his boundaries and is trying to save face by claiming that his drink must have been spiked.

Not the hysterical cry of the girl who's gone to drown her sorrows after her 3-week-long relationship has gone sour and who's world suddenly and irreversibly seems too dark to cope with.

This was the cry of a grown man. A stone-cold sober man, a man who at one time had everything, and then lost it all.

He told me his story, and left me feeling powerless to help. He's an educated man sent to this country by his company to continue his work and expand the company's reach. Until the company folded. He'd lost his job, his family are overseas, he can't get back there, and he has no other support here. The flat he lived in was rented by the company, and it disappeared along with his wages. The park had eventually become his home. He'd tried all avenues for help, but received none. "You'll get a job", they'd tell him. "Just be patient". Initially he'd sneak into hotels to shower, then the lake sufficed. After a while and multiple rejections from work interviews and social-care agencies, he'd just stopped. Didn't see the point any more.

At first he could afford the calls back home, or plead and beg with someone at one of the interviews to let him make just one phone call. Now even that infrequent contact was lost. It had been several weeks since he'd spoken to them.

I had no idea what to say to this man. No idea how to help him. I just put a blanket around his shoulders.

The call-taker in control said he was incomprehensible. He wasn't. He was inconsolable.

I'd assumed he'd be another regular, drunk, unpleasant, NFA. He wasn't. He was sober, and pleasant. But he was a man who'd lost everything, including hope.

The ambulance arrived, and as the man sat on the edge of the road, wrapped in both our blanket and his grief, I told the crew his story. They invited him into the ambulance, and after a few minutes drove him away.

I sat back in the car and just for a couple of minutes reflected on what had just happened. On how I'd assumed everything and got it all wrong. On how I'd jumped to a conclusion before even setting eyes on the man.

On how sometimes a man with a guide-dog isn't blind at all, and how sometimes people with eyes wide open, have their minds tightly shut.