Head Injury

Barely a cupboard under the stairs, the tiny top-floor room in the residential care home had no more than a bed, a two-door bedside cabinet and a tiny sink. The floor space was almost entirely taken up by Jasmine, and she was no bigger than a ten-year-old. As I walked in through the door, the sloped ceiling made me tilt my head to the right a little, just to make sure I walked in unscathed. 

From the look of her, Jasmine looked like she weighed no more than a wet tea-bag, and even then after the water had been squeezed out. Her skin was dry and fragile, veins spidering up arms so thin they seemed as though they would snap like sun-dried twigs. The red tinge to her thinning white hair gave away a secret, as yet unseen, cut to her head. She lay there confused and a little disorientated, but a winning smile crossed her face. 

"I'm not too sure how I ended up here, but I think I'm alright. Just get me up and I'll get right back on that gin that must have floored me in the first place!" 

"Now, Jasmine, if you'd have said whisky, I'm your man, but not gin. Might have to leave you on the floor until you can choose a proper drink."

The care home staff looked horrified, but Jasmine saw the funny side. 

"You'll do as you're told, young man! Now get me up so I can see exactly who I'm telling off." 

With the help of one of the carers, Jasmine was lifted off the floor and helped to a chair. It was the first we saw of the damage she'd done to her head. 

"You're going to need a trip up the hospital, I'm afraid. That's quite a nasty cut you've got on your head." 

"I'm not going anywhere, but back to bed." 

"Jasmine, your scalp looks like you've put a cat-flap in it - it needs sticking back together again. It's that impressive, that I can almost read your thoughts!" 

"I'm NOT going to hospital!" 

"See! I knew you were going to say that!" Jasmine eyed me suspiciously, a small, half-smile giving away her amusement. 

I tried to replace the flap of skin back in place and hold it all together with some bandaging. The carer who helped me lift Jasmine off the floor started to feel faint at the sight of the injury, so I sent him to get something completely irrelevant, allowing him to get some fresh air and maintain some dignity. 

As he left, the ambulance crew arrived, the two-wheeled carry-chair in hand. Having spent a few minutes explaining, cajoling and joking with Jasmine about her injury and the need to have it treated, she finally agreed. We helped her into the wheelchair, wrapped her in a blanket and secured her with the belt.

"At least I managed to arrange a blanket that matches your new hair colour. Anyway, I'll leave you with the  friendly ambulance crew, I'm sure they'll be nicer to you than I was." 

As they turned the chair around, Jasmine said a polite "Thank you", and I turned back to sort out all my bags. 

"I'll check on you a bit later at the hospital if I get the chance, make sure you're behaving yourself." 

"You do that. I look forward to it. And make sure you don't forget that gin!" 

"Whisky!"

"Oh. Alright then. Make it a whisky." 

With that, Jasmine was wheeled into the lift and taken down to the ambulance for the short journey to the hospital. I tidied up the mess of packaging, wrapped some of the blood-stained bandages in an inside-out glove, picked up all my luggage, turned to leave the room, and without looking up properly, walked head-first into the low sloped ceiling.

Milk Bottle

Two bottles of milk by the front door,

A neighbour sensed something was wrong.

"She has one bottle delivered each and every day!"

A light was on,

The television flickered through a sliver of open curtain,

But there was no answer to our calls.

A kick, another kick, and the door splintered open.

In the kitchen, by the table and an upturned chair,

She lay where she fell.

A bowl of dry cereal sat waiting,

For an unopened bottle of milk.

Sppel Chekking

I admit, I'm a pedant. I don't claim to be perfect at it, but to me, spelling matters. 

I have an editor and a sub-editor for this blog who regularly pick up on mistakes I make, as well as using the sppel chekking fasility, because grammatical errors aren't picked up. 

So, in a begging open letter to our call takers, I ask you to please check your spelling. 

I know that if the message on the screen tells me the patient has "palpertayshuns", I can understand what it means. 

I know that if the patient apparently has narrowed "artoreys", he's at risk of heart problems, and not, as would seem at first glance, that he's a high-risk attorney. 

Vomiting. It has one 'T'. Lots of carrots and a dreadful smell, but - Only. One. T. 

Assmah. Really? Or are you just sending coded messages as to what you think of me? 

Stares. As in "The patient fell down the stares." Into my deep, dark, bloodshot eyes? 

And many, many others. Some amusing, some confusing. 

So please, dear call takers. I know it all happens in a hurry, I know the callers aren't always calm, clear and concise. And believe me, I know, that for all the tea in China, I couldn't do your job. But I beg of you; please, please, check your spelling before sending it down the computer to the often baffled crew... 

Anyone else out there got some good ones to share? Feel free to add your comments!

Scriptwriting

Just as I'd started to get over the trauma of the call itself, a reminder arrived through the internal mail. 

The Coroner was requesting a report. 

As I sat for the next two hours typing out everything as I remembered it, or as a copy of my paperwork reminded me, I wondered how much I would have changed given the chance to press a delete button and rewrite the script just as I was doing to ensure the accuracy of my report. 

Thinking back to the call, I wouldn't have changed a thing. The team worked well, the skills were flawless, the professionalism without blemish. 

But as I typed out the last line of the conclusion, I realised that there was one thing that needed to be crossed out and rewritten, one thing, that if given the chance I'd never have sent in to the editors for printing. 

The final page of the script. 

Sometimes we don't write the scripts. Sometimes we're merely characters within it. 

Teddy

The room was on the third floor, not in an apartment block - but a private home. The driveway was the length of many suburban streets, and the private estate on which the house sits could pass for a royal residence. The country park feel only added to its charm, but at the same time left the scene feeling cold.

"He's just in here. I won't come in with you, because he screams each time I step into the room."

The room is also massive. Floor to ceiling mirrored wardrobe doors only added to the size making it seem twice as big. An en-suite bathroom cleverly hidden in the far corner. In there, huddled in a corner with his knees under his chin, sat the terrified figure of an eight year old boy.

"He's been fine up until the last few days, maybe a couple of weeks I guess. Can't work out what's bothering him. He's slowly stopped talking, hardly eats, hardly sleeps, and has started wetting his bed at night. He won't let me help him get dressed, won't let me check his school bag, hates going to school which he used to love doing and he doesn't want me to step into his room! Now he won't even come out of the bathroom!"

"Alright. I'll try to talk to him. What's his name?"

"Andy. Andrew really, that's what we christened him, but nobody calls him that."

I step into the bathroom and sit down on the floor by the door. Andy tries to scrunch himself up into an even smaller ball, pressing his legs to his chest and shutting his eyes as tightly as he could. I notice a small bruise on his forehead, an almost ever-present mark on any young boy's head.

"Hi Andy. My name's Ben. Your mum tells me your not feeling too good, can you tell me what's wrong?"

Without a sound, he turns himself towards the wall, facing away from me. I kept my distance and pondered my next step. Children are not small adults, they're child-sized, fully-grown children. You can't just talk down to them - you need to look them in the eye and speak at their level. Sitting cross-legged on the floor of the bathroom was starting to get uncomfortable. 

"Andy, is something hurting you?" 

Without looking up he shook his head from side to side. 

"Do you feel sick?"

Same response again. I asked Andy's mother if he had a favourite toy, and without a word she left and returned a moment later with a teddy-bear. 

"Andy, would you prefer to show me what's wrong on the teddy?" 

A shrug of the shoulders was the closest Andy came to cooperating. I handed him the bear and asked him to show me what had happened, but he sat just as still as before. 

"Shall I ask teddy instead?" It felt wrong to be treating an eight-year-old as though he was still a toddler, but it seemed to work. Andy nodded his approval and I addressed teddy instead as he sat hugged tight by his owner. 

"Teddy, does your tummy hurt? Have you bumped your head? Has somebody said something not nice to you?" 

All the questions were met with a tough silence and a shake of the head. 

"Why don't you show me what's happened then? I'll stop guessing, and you can just tell me. Does that sound OK to you?" 

After a few moments, Andy suddenly stood up from under the sink, turned on the tap and stuck teddy's head under the stream of cold water. He then turned the tap off, and started hitting the teddy's head on the sink.

Suddenly, having taken out all his anger, the teddy's arm fell off. 

Andy sank to the floor, curled himself back up in a ball and sobbed uncontrollably. I turned round to see his mother in the same state, tears streaming silently down her cheeks, all the answers she'd been seeking suddenly hitting her like a juggernaut.

"Andy, I think you and teddy need to speak to someone like a doctor. Mum can come too. I can put a bandage on teddy's arm for now if you like. Will that be alright with you?

Andy looked at teddy who turned his head to look back. They both nodded their approval. 

English for Americans

It's multiculturalism at its best. London's a melting pot of people, of languages, of cultures. 

My Hindi is coming along nicely, I understand a few Polish sentences, and I still remember some Japanese I learnt in school. 

Arabic is on the tip of my tongue, Spanish is a rare necessity, and I can count to ten in a variety of others.

Thanks to a very good friend I even understand and speak a slice of Dutch. 

Gouda. 

See? 

French still eludes me, but I can always ask any passing school kid. 

However, there's one language that I still cannot understand. There seem to be no online translators for it either. Which language? 

Americanish. 

I gather that the Americans feel the same about English. 

So, in the spirit of co-operation, and with many thanks to Jumblerant (a compilation blog with regular posts of genius), I present the English for Americans poster. 

Clear as mud, right? Now if only we could get the ambulance service equivalent... 

Being Human

We wheeled her husband to the ambulance, even though he wasn't all that ill, but he definitely needed to be in hospital. We made sure he had everything he needed, and even some things that he probably didn't, but would make him feel more at ease. A dressing gown, a pair of slippers, his favourite walking stick and his green-framed reading glasses.

"Can I get you all a drink?" asked his wife.

"No thanks. We'll get a coffee at the hospital."

"Are you sure? It's really no trouble. You've been so kind!"

"Sure. You don't need to trouble yourself."

She looked almost disappointed at our refusal, so we softened the blow by explaining that the quicker we get her husband up there, the more chance we had of beating the drunken rush of a Saturday night. At the age of eighty-several, they both looked after each other, rarely asking for help from anyone else. As we wheeled him into the ambulance, she wanted to check that he was comfortable.

"Can I just make sure that he's OK in there?"

"Of course you can."

The ambulance was about fifty metres away, and she gladly accepted a helping hand, holding my arm by the elbow to steady her gait. She looked in, checked on her husband, dismissed his assurances that everything was as it should be, and made sure to remind us to look after him. Still holding on to my arm, we walked back to the house, and made sure that she was safely behind the glass doors.

"Thank you. You've been most kind to us."

"A pleasure. We'll take good care of him, just make sure that you take good care of yourself."

"Don't worry about me. I'm fine."

I turned and headed back to the ambulance, and took a final look back to their front door. She was still standing there, keeping a close eye on proceedings. Just before I stepped out of sight, I waved.

She waved in return, made sure to lock her door, wiped a tear, and then blew us all a kiss.

Sometimes it's not about the latest kit, the newest ambulance or the fastest treatment.

Sometimes it's just about being a human being.

Fines

BBC News amongst others is reporting the new idea of on the spot fines for dangerous driving. I'm sure we've all seen examples such as the ones in the video, and worse. 

The plan for an £80 fine and three points on a licence is a start, but nothing more. 

It seems like nothing more than a political stunt when you consider that you can get fined £1,000 for throwing a piece of chewing gum in the street.

Surely, driving dangerously and threatening the safety of others should have a much higher penalty than than littering? 

What do you think? 

Two Seats

A pair of expensive-looking trainers adorned the feet that stuck out from behind the bush. It was the only part of Jacek that was visible from the street. A concerned member of the public walking home late at night called the ambulance when he thought someone must be lying dead. It's a good thing he waited, because we'd never have spotted the shoes from the road.

"He's in there. Not sure if he's breathing or not, didn't want to get too close."

At five in the morning I had to ask what he was doing walking around the streets.

"I was on my way home from work. I do funny hours too."

"Oh really? What do you do?"

"I'm a nightclub bouncer."

I should have guessed really. Six feet four in every direction, close cropped hair, and a badly fitting suit - a perfect stereotype. The fact that someone who intimidates people for a living was a little nervous about approaching a pair of shoes, or at least whatever or whoever was attached to them, seemed a little ironic. I shook the patient's legs and one of the shoes fell off, making our bouncer friend visibly recoil.

A groggy mumble of "Go away!" from deep inside the bush only added to his discomfort.

"Do you still need me here, or am I alright to go home?"

"Yeah, sure. We're OK here. Thanks for your help."

He practically ran away from the scene.

After a few more attempts at waking up our patient, he finally relented and climbed out of the branches, hampered slightly by the thorns of a lone yellow rose. His face appeared last bearing a five o'clock shadow, but at the wrong five o'clock.

"Go away! I'm sleeping!"

There's gratitude for you.

"You can't sleep here. People will think you're dead and call ambulances!"

"Go away! I'm sleeping!"

"Where do you live?"

"I live here. Go away."

His clothes, other than the odd branch and a few green leaves, were clean, maybe even new. Not exactly the attire of a long-term homeless man. 

"Do you have any family in the area?" 

"No. They not live here." I guessed by his accent that he must have left his family in Eastern Europe somewhere. 

"And friends?" 

"My friend he is here." 

"Where's here?"

He turned round and looked back into the bushes.

"Here!" He points aggressively at the broken branches. "Don't you speak English good?" 

I looked at him, looked at my crewmate, shrugged my shoulders, and climbed half way into the bushes looking for a drunk friend. 

"Jacek, There's no-one in here!" 

"He is there! You not see him!"

I look again.

"There's definitely no-one here!" 

"He is there! Only I see him. You no see him!" 

I climb back out of the greenery, and look much the same as our patient with leaves and bits of broken branch all over me. 

"You mean to say I've gone looking for an invisible man?" 

My crewmate takes one look at me and tries to stifle a giggle. We help Jacek into the ambulance and as I'm about to take my seat, he suddenly shouts. 

"You not sit there! Friend - he is there!"

All of a sudden, the trolley seems a much better choice of seat. At the hospital, the waiting room is busy, and I take a minute to look around.

"What are you waiting for?" asks my crewmate.

"Just trying to find two seats together." 

Overheard

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

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

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

"What, never?" 

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

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

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

Apologies

This is an open letter to the driver of the car behind me earlier this morning: Stand by for a rant.

Dear Driver of the BMW X5 that was behind me in traffic,

I hope you read this - I gather I owe you an apology.

I'm sorry I stopped in front of you at an inconvenient moment.

I'm sorry I blocked your lane, (even though the other one was clear).

I'm sorry I stopped to help the elderly gent who fell right in front of us.

I'm sorry I took a few minutes to help him and make sure he was OK.

I'm sorry you may have been a little late to your coffee morning or other meaningless task.

But if I ever see you, your car, or the horn you beeped at me repeatedly,

You selfish, arrogant, ignorant, rude and insensitive person,

I may not be responsible for my actions.

Oh, and as for your apology, I shan't hold my breath.

Central Locking

Before the old ambulances could be completely replaced, we were treated to a smattering of new vehicles. Shiny yellow, with a trendy battenberg design all the way round, and as an extra confusion, diesel engines rather than the lawn-mower type petrol ones. Many a medic would be caught out in the first few months by feeding the engines with the wrong fuel.

They were hardly loved, those old LDV's. Nothing more than vans that had been given blue flashing lights for the roof and the front grill. Meat wagons. Loud, growling engines that would wake an entire street at three in the morning, but which you had no choice sometimes but to leave running, just to make sure that you still had some battery power by the time the patient had been recovered from the scene and placed on board. The three battery lights on the front would give the cab a disco feeling as they would all start off a tired red, change through slumbering amber and on their way to eager green, each individually, each moving backwards and forwards through the sequences depending on what the driver tried to get out of the engine.

At least the temperature control was reliable. The heating would completely fail in the winter, and work whether you liked it or not on the hottest days of summer. The air-conditioning never worked - there simply wasn't any. Anything that broke, fell apart or went missing was fixed with tape, a staple of any medic's armoury, along with all the medical stuff, and in fact probably higher on the priority list than most of the real kit.

In their final days, as they sensed the day of judgement and their own demise, they mounted a rebellion. They had a knack for trying to poison the occupants by filling the cab with noxious gases that would leave crews needing oxygen therapy themselves. Finally, not so long ago, and at least five years past their best, the last of the old fleet were mothballed.

In the early days of the new Mercedes ambulances there would be fights as to which crew would have the privilege of owning it for the shift. Those on the longest shift thought they were entitled to it, or those who were taking the longest transfer. The lure of the softer suspension, gentler ride, and most importantly the ability to control the internal temperature were cause for more than one disagreement. Yet, as the younger members of staff would argue over the newest, shiniest ambulances, the old guard would reminisce about the wondrous days of sliding doors, scoop-and-run, and were often mocked about their memories of the horse-and-cart. Finally, after several weeks of watching others enjoy the pleasures of the new arrival, it was my turn, and as I tried to climb in the passenger side door, I discovered one more novelty that the old trucks lacked - central locking.

Dean took the keys and control of the vehicle for the day, I never even got a look-in, not that I minded particularly. Even from the earliest days in this job I've preferred to attend rather than drive. Dean, however, was like a kid in a sweet shop who'd been given free run of the shelves, and loved every minute of finally driving a vehicle that responded as an emergency ambulance should. After a few routine calls, we were tasked to a call given as a man with a serious laceration to his arm caused by broken glass.

Arriving at the call a few minutes later, we took out the normal bags, as well as an extra bag of bandages. A trail of blood stretched across the pavement by where we'd parked, down the paved driveway and into the house that was about thirty metres away. Dean locked the ambulance. We started to walk towards the house and as we opened the porch door, a figure started to run towards us and stopped us in our tracks. As he came nearer, we saw that he wasn't alone, but carrying what looked to be a knife behind his back. We could just see the handle and a glint of metal, but that was enough. 

We stepped back out, backpedalling at speed, and Dean had the presence of mind to slide the porch door shut in a hurry. Still carrying all our kit, we ran back to the ambulance, and tried to climb back in, only to find that the doors, for the first time ever, were locked. Our "patient" had almost caught up with us, and now all I saw was the knife, which turned out to be a samurai sword being waved menacingly above his head and coming ever closer. I dropped the bags.

"Open the doors!" I screamed to Dean. 

"I can't! The bloody things won't open!"

"IT'S THE CENTRAL LOCKING!!! USE THE KEY!!!" 

Dean fumbled in his pocket for the unfamiliar key, whilst we both ran round and round the ambulance trying to avoid being sliced in half. Dean yelled to a neighbour to call the police, as this was before the days when we had personal radios, and our only means of communication were, like our safe haven, locked inside the ambulance. Eventually there was a standoff, where we stood at 180 degrees to each other - us on one side - and a sword wielding maniac on the other, but all three of us standing by doors. If we unlocked the ambulance, he could get inside just as quickly as we could. We worked out a plan where we could hold him away from an access for just long enough to unlock the doors, climb inside and re-lock the ambulance before he'd climb in. Another couple of circuits of the ambulance and we'd finally positioned ourselves as per the plan, and miraculously managed to pull it off. 

"Control, this is Z321, we need urgent police assistance!"

"Z321, received. Can you tell us what's happening?" 

As I tried to catch my breath, I told them in half sentences what had happened and they promised to arrange for the police to attend. Our sword-swinging friend had finally realised he couldn't get in, and instead took to trying to smash the windscreen, which thankfully held fast. Any interested bystanders had quickly seen sense and fled back into the safety of their own homes, and as he turned away to pick up one of our discarded pieces of kit, we had just enough time for Dean to beat a hasty retreat, far enough to be safe, but close enough to still see the scene. Ninety seconds later, the first of the police units arrived, closely followed by several more. 

We watched from afar as our patient was quickly bundled to the ground by half a dozen officers, the sword wrenched from his grip, and he was placed in the back of a police car. Not without a struggle, but it wasn't a very long one. Slowly, Dean turned the ambulance round and we headed back to the scene, safe in the knowledge that neither assailant nor weapon were now of any threat. Stopping alongside one of the officers, I wound down the window and briefly explained again what had happened. 

"We'll need a full statement," said the officer, "we can do it here or back at the nick." 

"Might as well do it here. At least we've got air-conditioning." I climbed through the door between the cab and the back of the ambulance as the officer tried to open the back door from the outside. 

"Can't open it!" he said, "Must be jammed!" 

"Oh. Yeah. That'll be the central locking..." 

Dean pressed the button that magically unlocked every door to the ambulance. 

"Must remember not to lock these in future, especially on samurai-sword calls. Too bloody dangerous!" 

Signs of Life

A thin sliver of sky turned from dark to dawn as a new day started to break over the horizon. Birds hidden in the leafy trees sang their chorus as two ambulances arrived simultaneously, shattering the peace. A police officer stood banging on the front window trying to raise the occupant's attention. As we joined him, a neighbour approached. 

"She hasn't moved from that chair for days. I reckon she's dead by now!"

"And what made you call us this morning, instead of days ago?" 

"Not sure. I was just about to go to work, I'm a tube driver, y'know, that's why I start early and thought that this is ridiculous. So anyway, I called the Old Bill. Why don't they just smash the door in?" Six sentences all at once left me wondering which to deal with first. 

"I think they need to make sure that that's absolutely necessary before they take drastic measures. Believe me, if they think that they need to, they will." 

I stood alongside the officer at the window, and could see now why they weren't breaking the door down. Despite the occupant being somewhat obscured by a television and some other household furniture, we could clearly see the rhythmic movements of someone breathing regularly. 

"She's deaf y'know!" We all turned to look at the neighbour. "Last fifteen years she can't hear a bloody thing if she ain't got 'er aids in! I think she leaves 'em out on purpose sometimes!"

"You didn't think to tell us that ten minutes ago when we started waking the neighbourhood?" 

"Errr... Sorry." 

"How old is she, anyway?"

"Dunno. 'Bout eigh'y, nine'y I guess." 

A police van turned up carrying the duty sergeant who was quickly brought up to date on the story so far. I shot him a mocking look, knowing that it's rare for stripes to come out when it's dark. 

"Slow night." He shrugged and smiled. "Fancied some action!" 

He suggested using the van's search light as a last attempt at waking the probably slumbering lady before having no option and breaking in through the front door. All we needed was a sign of coherent life, and we could leave her alone. 

The van was moved onto the vacant driveway. Apparently she "gave up driving when she gave up listening." 

"Well," said the sarge, "if this doesn't wake her up, we'll have to use a heavy boot. Just make sure that if she does wake up you turn the beam off straight away. Either that or she'll be blind as well as deaf!" 

The light was switched on, and the beam hit the target straight in the face. She stirred after a few seconds, and the searchlight was turned back off again, as ordered. As we all breathed a sigh of relief, she opened her eyes, picked up one of her hearing aids from the coffee table next to her and marched towards the window. She fumbled with a small key, unlocked the double glazed window, opened it only a few millimetres and turned her ear towards it. 

"Sorry to wake you ma'am," starts the sergeant, "we were worried something was wrong, and had to make sure you weren't injured or ill." 

"Thank you officer. As you can see, I'm fine. No need for anyone to worry." 

"We have the ambulance here too, if you'd like to let them in. They can just make sure." 

"I don't think that's necessary, thank you." 

"Are you sure?" 

"I'm sure. Don't worry... Actually," she said having paused for a few seconds, possibly debating the idea of a home-visit check-up, "there's just one thing you could do for me, if you don't mind?"

"Sure. What's that?" 

"Just F*** OFF AND LET ME SLEEP!"

She slammed the window shut, locked it, and made a point of showing us all that she was once again removing the hearing aid. As she sat back down in her armchair, she looked round the television that obscured our view, raised her arm, and as a final wave goodbye, stuck up her middle finger.

"That'll do!" I said. "I reckon that's enough signs of life for me!"

Crosswords

Mrs Vine and I could easily be on first name terms by now, except that she's very much old-school. I learnt that very quickly the first time we met on what was supposedly a "Breathing Problems" call. Control called me on the radio and let me know that she'd already called half a dozen times in the past few hours, each time claiming to have a serious problem, each turning out to be nothing of the sort. 

With the key to her front door locked away in a coded key-safe, she never had to leave her room to let anyone in. She would just tell the control room the number we need to crack the safe, and they send it down the computer screen in the car. I'd hardly set foot in the house and was looking for somewhere to put the key so I wouldn't forget to replace it, when a shrill yell cascaded down the stairs. 

"Close that bloody door already! I'm getting cold up here!" An ominous start.

Her voice reflected the night - cold and miserable. I tried to be a little more cheerful. 

"Good morning, Miss. What's made you call the ambulance out tonight?"

"Don't call me Miss. I have a name!" 

I didn't expect to have to ask the question, having been already chastised, but as she seemed to be waiting for it, I obliged. 

"And what is your name?" 

"My name is Mrs Margaret Vine and as we're not related, I'll expect you to address me as Mrs Vine." 

"Right then, Mrs Vine. I understand you've been having some problems with your breathing?" 

"There's nothing wrong with my breathing. It's just what I told that woman on the phone, because she kept banging on with these stupid questions and I just wanted to make sure that I got one of you here." The contempt in her voice almost made me want to leave, or at least explain the reasons behind all the so called stupid questions, but in the end I decided that both plans were futile. In the first instance she'd call again, and in the second, any explanation would probably go in one ear and straight out the other. 

"So how can I help you?"

"Well, first of all, my carer's left me." She was still shouting as if I was stood downstairs by the front door, despite the fact that there was no more than a metre between us. I'm a little ashamed to admit that the idea of her home help abandoning her didn't surprise me in the least. "And then, the cleaners don't come when they're meant to, and my doctor's completely useless and won't do what I tell him to!" 

"I see." I wasn't sure that I did, but I was trying. "And how can I help?" 

"You can pass me the newspaper and a pen, and sort these pillows out for me.Then I'll be able to do the crossword and hopefully fall asleep!"

"You called an ambulance to pass you your newspaper?"

"Yes. And to sort out these pillows. I shan't ask again." 

"And then you're going to sleep?" 

"As soon as I finish the crossword." 

"Fine then." 

As I found the paper and the pen, and fixed the pillows, I thought about offering to help with the missing crossword clues just to hurry the process along, but decided to leave her to it. I found the key, and as I stepped out across the threshold, Mrs Vine's voice once again filled the night air. 

"Close that bloody door already! I'm getting cold up here." 

I left the house and hoped she finished the crossword before I finished my shift.

Everything and Nothing

The email arrived last week, subject matter - "Appreciation." 

"Please see attached letter." 

The attachment was dated well over a year ago. 

"I'd like to thank the crews who attended our house on what was a very distressing day for us. If it wasn't for them, their professionalism and skill, their dedication and especially their kindness, our father would have died. Please convey our heartfelt thanks and appreciation to them all."

For us, it was just another call. So much so, that I don't actually remember the call at all. 

To the patient, and to his family, it was everything. 

Coping

Eyes glazed and bloodshot, he stands in a corner at the side of the building trying to hide his tears, but to no avail. His colleagues avoid his eyes, fearing that they'll make things worse. Last time him and I met on a call, it was after a man had been shot in the head. He sat holding a bandage over the bleeding wound whilst we worked to save the man's life, none of us fazed by the scene or its consequences. 

"It's never the big things that get you. It's always the ones you least expect!" A word at a time, sobbing through a simple sentence, he managed to verbalise what we all felt. 

His police uniform, bullet-proof vest and all might shield his exterior, but his insides were in turmoil. We all were. He was just brave enough to show it, even with his colleagues and superiors around. I'm not that brave.

At the scene, blood trailed around the house. 

There were no screams. 

No shouts. 

No reaction at all. 

And just for once, I wish there were. It might have made things seem less surreal, and maybe we'd have had less time to think. 

When it was all over, the scene was cleared, the ambulance had taken the patient away, and I was left with my car and a dozen police officers. I tidied up outside and went to talk to him, trying to rationalise the medical side of what we'd just seen. 

But a dead baby can't be explained. 

It can't be rationalised. 

It can't be forgotten. 

Our uniform makes people think that we can deal with anything, sometimes we think the same too. Sometimes we believe that we can see anything and just go home at the end of the day as if we've had just another day at the office.

But we're as human as a bank clerk, a teacher, a garbage collector. Each of us finds a way to cope, because we have to, just so we can go back to work each day and do it all again. 

And for now, at least for me, coping means that I travel to and from work using a different route, just so I don't drive past the scene every day and see those vacant eyes. The eyes that stared back at me from the blood-soaked crib. 

Natural Wastage

We're in the media... for all the wrong reasons.

The news has hit the mainstream news outlets shortly after we heard about it internally.

Almost nine-hundred jobs are to go at the London Ambulance Service.

Two thirds of them will be front-line.

There are tough times ahead.

Possibly tougher for our patients than for the staff, if the "natural wastage" policy is adhered to.

I just hope I'm wrong.

Monday Mornings

Monday morning. A curse for many, a blessing for some. The day breaks on the horizon as I head towards what will almost certainly be the last call of the weekend, with the car sounding almost as tired as I am. Thirty six hours over three night shifts, almost seventy activations, with over thirty patients attended. It's been a busy weekend. 

Henry, well into his eighties, is woken by a crushing pain in his chest and his jaw. 

"Call an ambulance, love. I think my heart's playing up again." He tries to stay calm, putting on a facade for Lena's benefit, but after more than fifty years together, she sees straight through it. Once she's called the ambulance, she wakes up her neighbours and asks them to come in. 

"Just to help me keep an eye on him. You don't mind, do you?" 

Their neighbours are young, and always willing to help. I meet them first as I pull up outside, barely five minutes after the call has started. 

"Thanks for coming so quick. I've hardly even put the phone down! Henry's upstairs." Lena's calm exterior  as she watches me climb the stairs does little to hide her anxiety, and as I step in to the room, I ask her to take a seat next to her husband so she can see and hear everything that's going on. 

Craig, the neighbour, gives me a quick rundown of Henry's history, a heart attack nearly twenty years ago leading to a series of another four over the years. 

"I think I'm running out of lives!" Henry says, only half joking. "I guess I'm lucky to get this far. I think it's Lena's fault that I'm still going. Who else is she going to nag to take out the rubbish?" 

She glares at him and tells him to keep quiet. 

Henry's pulse is irregular, a rate of anything from the low thirties up to nearly one hundred. The ECG shows that the heart's struggling, not getting enough oxygen to where it needs to be. Another heart attack seems just around the corner, and as the second ECG strip prints, I hear the crew arrive. 

"Bring a carry-chair up with you please!" I call down. One set of footsteps keeps heading up the stairs whilst the other heads back out to the truck to get the chair. 

"Meet Henry," I say to the attendant. "He's eighty-five years young, and has a habit of causing Lena stress by having had five heart attacks in the last few years, and his heart isn't particularly happy at the moment." I show the attendant the ECG strip, and he concurs. 

The pain had eased a little since I'd given Henry a lemon-flavoured aspirin and spray of GTN under his tongue. That should help open up the blood vessels that feed the heart, easing the problem at least temporarily, if not solving it altogether. The ECG remained unchanged after we had loaded Henry into the ambulance. His heart was sick, and so was he. Lena wasn't far behind, worrying about her husband. 

Once we had reassessed Henry, cannulated him, taken some of his blood, and given him some more medications, I stepped out of the back of the ambulance and headed back to my car, closely followed out of the treatment area of the ambulance by one of the crew. As she was about take her seat behind the wheel, Craig approached her. 

"Make sure you take good care of both of them, won't you?" 

Loading the luggage into the boot of my car, and with my back to them both, I couldn't believe as I overheard her answer. 

"I'll do what I can. But it's late, it's Monday morning, I've worked all weekend, I'm tired, and I just want to go home." She got in the cab, and within seconds was driving away. 

I left half my kit on the road, and went back to speak to Craig. I don't know why I felt the need to apologise for somebody else's behaviour, but I just felt it was inexcusable. 

"I'm sorry about that. I don't really know what to say!" 

"Don't worry about it. It's not you who needs to say anything. Anyway, thanks for your help. I hope Henry'll be OK." 

"They're taking him to the best hospital in the area for cardiac care, and I'm sure they'll do all they can for him.  If you wait an hour or so and then give them a call, the hospital might be able to give you some details on how he's doing." 

"Hope so. I suppose I'd better go get ready for work now. Back into the real world again after the weekend." 

"Ah. Yes. Forgot about that. It's Monday morning for you normal people." 

"Yup. For normal people and grumpy ambulance drivers." 

*****

We meet dozens of people every week, be they patients, relatives, friends, or neighbours. They all blur into one after a while. For us, these calls become routine, emotions become dull, and we feel disconnected. For us, it's a coping mechanism. There's no way we could feel what they all feel, and still be able to do our job.

The patients, however, their friends and family too, may only ever meet one ambulance crew. If the impression they're left with is one of "grumpy ambulance drivers", somewhere along the line, not only do they fail their patient, but we all do.

In amongst all the skills we use, and the knowledge we possess, showing that we care, even if sometimes we struggle to do so, may be the most important thing that we do.

Especially on Monday mornings. 

The Vow

With her head in her hands, Lea sat on the torn green seat at the back of the ambulance. Perched on the edge in total silence, trapped in a world of fear, as the shuddering of her shoulders told a tale all of their own. I remembered meeting her once before when she told me of her dream to move from her job as a health care assistant to that of a paramedic. 

I was packing my kit back into the car as the ambulance took off in a hurry with a badly injured cyclist. The driver of a car parked at the side of the road didn't look before opening their door, and the cyclist had no way of avoiding the collision. Riding downhill at high speed meant that his injuries were severe, and a doctor was called to scene to help stabilise him for travel. The doctor traveled with the crew, leaving me to tidy up the carnage.

Lea was the first one on the scene, having seen the accident from her bedroom window, and when I arrived I was glad of her help. Initially I left her holding the patient's head, and then, when pairs of more experienced hands arrived, she kept running backwards and forwards getting whatever piece of equipment we needed. 

When the action was over, she came over to help me pack up. 

"I'd love to be out on the road, on the front line, but they told me I needed a driver's license." 

"Very difficult to drive an ambulance without one!" 

"Well I hoped they'd just let me do all the other stuff, you know, the real fun bits!"

"Oh, you mean like talking to people who can't cope with a bit of a sniffle, you mean?" 

A look of mock horror crossed Lea's face. 

"You mean it's not all trauma like this?" 

"'Fraid not. It's one percent trauma and ninety-nine percent routine. Sorry to shatter your illusions!" 

"You haven't really. I know it's not always like this. I did my homework, you know! Now all I've got to do is learn to drive."

"For what it's worth, I love this job, even with the sniffly people. You come to work, ignore the nonsense, ignore the politics, and try to make a difference in just one person's life. It's that one call in a hundred that makes it all worthwhile. And it doesn't have to be a trauma job, either. It could be just talking to a ninety-year-old war veteran." 

I cleared what was left on the road of the mess that we'd created, and got ready to leave the scene. Lea approached the car window again. 

"Thanks for letting me help. Now I'm even more determined to get in!"

"Well, you were more than helpful. Good luck. I really hope you make it!" 

Our second meeting was a year, maybe even two years later. Now she sat, a broken woman in desperate need of help, and not knowing where to look. There were bruises down both her arms, a palm print on her cheek and a deep cut to her forehead. Tiny shards of broken glass reflected the light as they sat on her face and clothes. A police woman sat next to her, held her hand and told her that she could talk whenever she was ready. Two other officers had removed her partner from the house. He put up no fight, showing his cowardice for all it was. 

"Lea," my voice as gentle as possible, "we'll need to take you to hospital. You'll probably need some stitches, but you'll be fine. Is that OK with you?"

She nodded. 

"They've got him, so he can't do you any harm, and this police lady will be with you the whole time, alright?"

Again, with the tiniest movement, she nodded her approval, and we set off for hospital in an impenetrable silence. As we arrived, she finally spoke.

"You know what this was all about?" Now she was practically shouting. "He didn't want me to go to out to work. He didn't want me to ever leave the house. All he'd do is scream 'What do you want to go to work for?' or 'What do you think you can do that's any good?'"

She dried her eyes, summoning up the courage to speak out.

"I told him I wanted to do what you guys do. I told him that I was learning to drive so that I could work on an ambulance. Do you know what he did? He slapped me round the face and threw the glass at me! Told me that now I've got a reason to be on an ambulance." She stopped and took a deep breath.

"I'll show him!" She said. "I'll prove to him that I don't need him, or his approval. And while he sits in jail, I swear I'll be the best damned paramedic there is!"

From what I've heard, she's kept her vow. 

Simple

As road-staff, we regularly have to contend with doctors and nurses complaining about our choice of whether or not to cannulate a patient, which vein we use, or why we didn't bother at all sometimes. 

Trying to explain at hospital that the patient was trapped in a car that was upside down and on fire, surrounded by a herd of elephants that were corralled by a pride of ravenous lions, which in turn were being shot at by hunters, doesn't seem to hold much water. 

Strangely, therefore, sticking lines in people out in the field isn't always quite as simple as dealing with a patient in the relatively sane (I said relatively) of the hospital. Some IV's are easier than others, but until now, there has been no actual scale on which to compare and contrast the complex nature of one of the most basic aspects of our job. 

However, a while back, The Happy Medic came up with one. 

So as a weekend treat, I hereby attach a link to a "difficulty scale" for sticking needles in people. 

It includes bonus points if the lighting is less than ideal, if you're hanging upside down, and various other "normal" variants to the tricks we must employ to do what in theory is a very simple task. 

Simple, if your patient is four feet off the ground and horizontal in a well-lit hospital bed, and with several pairs of hands to do everything else, that is.