Cycles

A children's channel shows quietly in the background. A young boy sits in a corner of the entrance hall trying his hardest to keep his eye on the television, as all around him chaos reigns. Dozens of people are in the house, men in one room, women in another. Children wonder between the two, the younger ones chasing each other, playing happily, their childhood seemingly unaffected by the grown-up reality all around them. 

A middle-aged, grey-haired man meets me at the door and guides me towards a side room. The house suddenly becomes silent as they see, hear and sense the intrusion of an unknown guest. Dozens of eyes follow me through the narrow corridor. Another man, of similar age and strikingly similar features to my guide joins us. He puts his hand on the handle, and just before we enter, he stops to explain.

"My name is Deepesh, and this", he says, pointing to the other man, "is my brother. I'm sorry you were called. There is nothing for you to do, but they said this was the only way." 

Deepesh opens the door, and motions me in. Two women are sitting at the other end of the room, their chairs angled gently towards each other. One wipes tears away as the other sits reading prayers from a book. Between them, lying on the floor and covered up to his face in a white sheet, is an elderly man. 

"He died a few hours ago," said Deepesh. "We called the family just before, when we knew he was in his last moments. Many of them have been here since then, many have joined us in the meantime. It is how we help his soul on its way. My sister and aunt, his sister, are the ladies in the room." 

It was the aunt who was crying. 

"We called the doctor to tell him that my father had died, but it was after hours, so they said we had to call for you. All we need is the certificate so we can prepare the funeral."

The call had been dispatched as a cardiac arrest. That would mean at least another three pairs of hands were on the way, possibly even four. I'd left the car and headed for the house with several bags full of kit and ready for a resuscitation. As soon as I had reached the front door, I knew that the equipment was surplus, and that any efforts would be futile. The calm, sad acceptance written on Deepesh's face told me all that I needed to know. As soon as I had seen his father, I called off the reinforcements. Distant sirens fell silent moments later. 

"We knew he was dying. A year ago, he was given three months, but he fought on. He wanted to see his first great grandchild. She was born last week, and he held her yesterday for the first and last time." 

Deepesh called to one of the children, and following an apology to me, asked them something in a language I don't understand. The child, a young girl of six or seven, her long dark hair tied in a plait, looked at him as if he was crazy. He, in turn just confirmed his request with a gentle nod of the head. A minute later she returned holding a digital camera, and handed it to him. He pressed a couple of buttons, and showed me the screen. Sitting there, a broad smile across his face and cuddling a tiny baby, was the same man who lay lifeless on the floor only one day later. 

"He knew it was his time." Deepesh wiped away the hint of a tear and stopped for a few seconds. "Only yesterday he sat holding the baby, and all he kept talking about was the cycle of life." 

Grown up children

It's always good to have helpful family on scene, 

particularly children assisting their parents. 

Sometimes, however, I forget,

that if my patient is 90-something years old, 

the "son on scene", 

or "daughter on scene"

are not going to be kids,

but very likely to be in their seventies... 

Medics are from Mars...

Transcript of a recent conversation with a patient:

"Do you have any chest pain?"

"No. Not pain as such. It just hurts." 

"Have you ever had any heart problems?"

"No. Never. Had a heart attack once, but never any problems." 

"When was the last time you had an ECG?" 

"An ECG? I've never had one. But they did check my heart last month with all those sticky labels on my chest." 

"Have you ever had palpitations?" 

"Never. Every so often I feel like my heart wants to jump out my chest, though." 

"Any other medical conditions?"

"No, no. Take medicine for blood pressure and diabetes, but no medical conditions." 

Patients are from Venus. Well, some of them, anyway. 

Oil Spill

Monday morning. 

Early. 

As the world begins its weekly ritual, a few tired night workers are preparing for their midweek weekend. Empty milk floats head back to their depots, their early morning rounds completed, many a front doorstep adorned with their goods. Autumnal sunrise greets the early risers, the sun shedding plenty of light but not yet enough warmth to clear the dew from the grass and the roads. 

Mike is one of the masses, joining the rat-race and heading into work. In an effort to make his journey easier and quicker, he abandoned his car in favour of two wheels. For months, he'd enjoyed the fact that he could cut through London's standstill rush hour, leave home a little later, arrive back a little earlier, adding a few precious extra minutes with his family every day. 

The call on the screen brings back memories, ones that I'm not keen to relive. Motorcycle under a van, status of patient unknown. When the call comes in, I'd just finished dealing with an acute case of probable paediatric schoolitis, a common childhood ailment, regularly apparent on Monday mornings. There were twenty minutes left of the shift. The call was some five miles away, and would take me straight past the front door of the station, frustratingly close, yet so desperately far. My relief was probably already there drinking coffee and awaiting my return. A few minutes later, Mike and I meet for the first time. 

Unlike the call I'd feared, Mike's head was visible, and he was actually sitting up, helmet off, and talking quite happily. His right leg, however, is wedged between the two back wheels of the van. His bike is lying on its side in front of the van, smashed shards of shimmering glass mingling on the road and glistening in the sunlight. Just in front of that is a small pile of powder covering what we presume is some oil on the road. 

"I don't really remember what happened, I just lost it on the wet road I think. Next thing I know, there's a van on top of me!" 

A quick conversation with the van driver gives us a few more clues and leads us to believe that Mike's had his leg run over by both the front and the first of the back wheels, with the van coming to a halt before the third wheel added insult to injury. 

Unsure of the exact circumstances, Mike's neck is immobilised in a collar and he's laid flat. The fire brigade, having arrived a few minutes later, have secured the van and lifted it high enough for us to get to see Mike's leg. His leathers are intact with only a few scuff marks, but his foot is lying at an unnatural angle, giving away the secret hidden beneath the leathers. As we cut the trouser leg away, the damage is obvious. Several breaks, the worst at the ankle. 

As usual, several things happen at once. A cannula is placed in Mike's arm, giving easy access for some pain relief. A scoop stretcher is placed under him, ready to move as soon as he is secured. Some bandages and a splint are applied to his leg. All while someone else checks for any other injuries, and luckily, finds none.

In the ambulance, once Mike was settled and his pain controlled enough, there are a few moments for a quick conversation.  

"I think you might have slipped on some oil, or diesel. There's a patch already covered up with some gravel, just by where you came off your bike!" 

"You talking about the white grit-like stuff?" 

"Yeah, that's it. Someone must have put it there not long before, it still looked quite clean." 

"Ah. That's not grit or gravel." 

"How do you know that?"

"Well, I work for a pet shop." 

"And?" 

"Well, I was on my way to work with a big bag of cat litter hanging off the handlebar..." 

Double Dutch

For me, being bilingual is more an accident of birth and upbringing than an actual talent. My skill for languages at school was somewhere up there with biology lessons. There are hundreds upon hundreds of different languages and dialects around the world, and, it seems, that there are people all over the place who want to read these ramblings but can't quite cope with my English. 

A few days ago, someone linked to this blog from Google's translation service, and translated the whole thing into Hindi. This is what it looks like. Cool, huh? 

I decided to give it a go, so I did the same into the other language I speak. 

It made for interesting reading. Re-translating it back to English would look a little like this: 

Ss;lfkh5 hds afh nphuIPOHUfaog7  ap7tfih  Toaieh oajef va2oieh a. 

Double Dutch at best. 

Totally, and completely, well, rubbish - Google translate still leaves much to be desired. 

So, my apologies to those of you who want to read these ramblings in any language other than English. I may translate them properly one day, but until then, I'd steer clear of online translations... 

One of Them

It turns out, that after less than a decade in EMS, I have suddenly, practically overnight, become one of them.

When I started, I'd always turn to them, sometimes shy, sometimes fearful, mostly confused, and look for approval, for knowledge, for an explanation.

Over the years I've relied on them less and less, but never forgotten that the basic requirement needed for expertise, is experience itself, and those with more than me will always have something new to teach.

In the last few weeks and months, a few people have left the ambulance service. Some of the service elders have retired, some have moved to different services, some have left to do different things, both ambulance related and otherwise. All of this has made me one of them.

Ambulance work and the world of EMS is changing all the time. Many of the newer recruits are joining through universities, bringing a new atmosphere to the workplace, one where study is a vital component. Up until not very long ago, a paramedic would study for a few weeks, pass a couple of exams and walk away with their qualification. Then every so often, maybe every three years or so, they would be asked to show that they have retained their knowledge and skills in a short refresher course. Now, a paramedic course is merely the basis on which to build.

I have to admit, I've never been a particularly studious type. My school grades were average at best and I was especially useless at sciences. If my biology teacher ever found out what I did for a living, they'd probably need my services almost immediately. My university grades (in a course not in any way related to the medical world) never happened due to the fact that I couldn't keep quiet in a lecture and would often find myself being restrained by friends when a lecturer tried to teach something false as though it was gospel. I lasted less than one semester. Clearly I didn't want to study, I just wanted to learn. Life was going to change direction, despite the fact that I had no idea what that direction was.

The first time I ever passed exams with flying colours, was several years later, when I joined the ambulance service. Finally, I knew what I wanted to do, what I wanted to learn. This time, however, I knew that I had no choice. If I wanted to learn, I had to study. And so I did. But this job can't just be learnt in the class room. There always have been, and always will be, those calls where nothing you learn whilst sitting at a desk will be of any use. Only two things will help: common sense, and often, most importantly, experience. 

In nearly a decade, I've seen a lot, but I haven't seen everything. There are calls that I know of, that I've heard about colleagues who have attended, and that I thank my lucky stars to not have shared the same experience. Yet. Then, there are the calls I attend that my colleagues will think the same of me. However, as time goes on, there are fewer of the former and more of the latter. And with more and more of the new breed of paramedic, the studious type, I'm having to do more and more to keep up. 

At the same time, however, as well as just learning the theory, today's paramedics need to learn from the voice of experience. Suddenly, it seems, practically overnight, I have become one of them. One of the elders of the tribe, who, whilst maintaining they're still young(ish), portray this image of having a wealth of knowledge and information, understanding and experience, just from having been around the block a couple of times. 

I like the fact that people who are only at the start of the ladder of their careers feel they can ask me for my ideas and suggestions. 

I like the fact that sometimes I even have the answers, and sometimes, possibly rarely, I might even be right. 

I like the fact that when I don't have the answers, that I'm now bothered about it enough to go and do some homework. 

I like feeling like I'm suddenly, practically overnight, one of them.

It's just that it scares the crap out of me. 

Counting Sheep

As I lay down my head to sleep,
I start to count a million sheep.
Them sheep, they laugh at me and say
no sleep tonight shall come your way.

I try to argue, beg and plead,
but those damn sheep, they pay no heed.
I press my case, express my sorrow,
Explain my schedule for tomorrow.

I start the count from the beginning,
losing track whilst they are winning.
They laugh and gambol 'cross the field,
Yet heavy eyelids will still not yield.

I change the tactic, skip the sheep,
get out of bed, downstairs I creep.
Try TV or sit and read,
Pray for sleep in time of need.

I fail, and fail, and fail some more,
Insomnia is such a bore.
But then, a glint of hope, of joy,
I've come up with a cunning ploy.

Those teasing, those tormenting sheep,
will now no longer stop my sleep.
They will no more just sit and stare
as I lie still and pull my hair.

My plan involves a plate of meat,
Those sheep's wool coats now not so neat.
My diner now adds to the tab,
as I tuck in to lamb kebab...

Street Lights

The street lights off,

the normal orange glow replaced 

by the flashing blue lights of the police. 

They wave, the officers,

an unnecessary, well-meaning gesture 

to show me the way. 

They turn both their torches downwards

towards the floor,  

and look down, their heads bent 

as if in prayer.

She lies there, a mass of displaced, 

broken bones, 

a mangled, tangled mess, 

limbs misshapen, 

arms and legs scarred,

outstretched. 

She stares, in silence, directly upwards,

past the darkened street lights,

past the trees, 

past the broken, open window, 

past the clouds. 

The sky responds, sheds tears of its own, 

and washes away the blood, the hurt, 

the pain. 

Due Date

"Hello, ambulance service, what's the emergency?"

"Quick, my baby is coming!"

"Is the baby coming now?"

"Yes! Quick!"

A rapid response unit is dispatched from the nearest ambulance station, its driver preparing in his mind to add another delivery to his tally. Arriving no more than three minutes later, and rushing with multiple items to the front door, I am met by the lady in question and stupidly, ask the obvious.

"Is the ambulance for you?"

"Yes! Quick! The baby is coming."

The young lady in question is in no distress, and is having no contractions.

"When's the baby due?"

"NOW!"

The calls to ambulance control are numbered, resetting to call number 1 at midnight. This is call number 3. The call start time is only a few seconds after the witching hour. 

"I understand that you think the baby is coming now, but why do you think that? Are you having contractions? Have your waters broken? Do you feel like you need to push?"

"I don't understand what you're asking me. Talk to him. I just need to get to the hospital!"

"Is he your partner?" 

"No. He's my babyfather." Babyfather. I never get used to hearing that. 

He doesn't utter a word, just hands over the yellow book, it's corners dog-eared and cover stained, and the expected delivery date hand-written in the top corner. He points repeatedly to the date as he shoves the book into my hands. Through gritted teeth and a look of disdain he mutters the only words he would say. 

"The book says it's today, so it's today. Now just take her to the damn hospital." 

"Is this your first baby?"

"Mine, yes. Him, not. He's got four. Well, will have today." 

"You do realise that just because the due date is today, doesn't automatically mean that that's when the baby will be born? It's just an estimated due date!" 

"Really?" 

"Really." 

"Oh. But that's why I waited 'til midnight to call!"

"As it happens, most babies aren't born on their due date at all. You need to go into labour first. You know, contractions and stuff." 

"Oh. But it's the due date. So can you take me to the hospital?" 

Nurse In Charge

The nurse in charge sees us walking Martha into the department. 

"Stop right there!" She shouts. "She's not coming in here unless she's been searched!" 

Back at Martha's house, we had spent an hour negotiating with her, at first through a closed door, and then, finally, face to face after she agreed to let us in. She seemed pleased with her achievements, proudly listing the cocktail of drugs and alcohol that she'd ingested over the previous hour or two. If what she told us was accurate, or even close to it, she would need some serious medical attention, and quickly. 

"Of course she's been searched. The police even stopped her bringing a large kitchen knife with her." 

As we were about to leave, Martha asked if she could go back to the kitchen to get her packet of cigarettes. I waited by the front door as a police officer accompanied her back into the house. Suddenly, he shouted at her to "Put that down!" at which point I saw Martha return a knife to the kitchen drawer. Grinning manically, she put the cigarettes in her hand bag, and we all made our way to the ambulance.

"I don't care. She's not coming in here until she's searched again. Check everything and everywhere. Last time, she'd hidden a knife in her boot." I looked again. She was wearing knee-high boots over a pair of jeans. The two officers who had accompanied us looked at each other, and then at Martha. We all moved into a side room, the eagle-eyed nurse in charge watching every move. 

As she was searched again, Martha started a search of her own. 

"Where's my handbag?" 

I had a quick glance around the room and just outside too. The bag was nowhere to be seen. 

"Must still be in the ambulance. I'll go get it."

The handbag had been in the kitchen, the cigarettes were shoved inside, and Martha had turned her back to us for a second to pick up a lighter too. "No point having ciggies and no fire to light 'em with!" she'd said at the time. "You coppers need to lighten up a little!"


I think that all men struggle to know what to do when asked to hold a lady's handbag. We struggle to look at ease, for fear of looking, too, well, at ease, really. I walked back in to the department, looking and feeling a little uncomfortable, clutching the handbag at the top and letting the handles hang loose by the sides. Stepping back in to the side room, I attempt to hand the bag back to Martha.

"Oh. No. You. Don't... Not. Before. It's searched!" The emphasis of every word, every syllable did the trick, and I gave the bag to the officer. He opened it up, and blue-gloved hands rummaged through the contents. There were dozens of pieces of paper, chocolate wrappers, lipsticks, a packet of cigarettes and lighter. Right at the bottom, hidden by everything that had been thrown on top, was a serrated kitchen knife, with a six inch blade.

"And that, ladies and gentlemen, is why I'm in charge, and Martha isn't."

And to think how close I was to that knife, all the way to hospital...

Ten Years On

I, too, remember where I was, and what I was doing, as I heard the news for the first time. I was a travel agent at the time, and the first I knew of the events of "Nine-Eleven" was when a customer called to say that he'd heard there'd been an accident, a plane crash into one of the Twin Towers, and he wondered if and how it would affect his plans for the night flight to LaGuardia airport.  One half of my brain prayed that, assuming it was true, it had indeed been an accident, whilst the other half, the cynical half, screamed terrorism. Twenty minutes later, the world and I knew for sure. 

Ten years later, ceremonies have taken place all over the world to commemorate the shocking events of the day that changed the world. Ten years later, New York City can stand and watch as the site is rebuilt from the ashes, the Pentagon once again has five walls, and a scarred field in Pennsylvania where heroes came to rest, is once again nothing more than just that. Only one thing remains the same: thousands upon thousands of people are left grieving with nothing but memories of loved ones. 

Three thousand people lost their lives that day. Office workers, airline passengers, members of all the Emergency Services, bystanders watching the world change before their very eyes. America as a nation lost something else that day too: its innocence. The realisation that there are people out there whose very own lives mean less to them than the cause they purportedly stand for was a problem, a distant news item, that, until that day, was safely thousands of miles away in the Middle East and Asia. On that fateful day, mass terror, suicide terror, hit the streets of two of the most famous cities in the world. Four years later it hit the streets of London too.

That terror had a cause, has a cause. They want to change the world. They want a world that adheres to their rules, their beliefs, their dictum. It is a world that our minds cannot comprehend and cannot allow. It is a world that we're fighting against, and must keep doing. 

Since that day, the day the world changed forever, everything has changed, and yet nothing has. This morning, as I thought back to the horrors in America, as the pictures replayed over and over again on television, as one caller after another on the radio recalled where they were and what they were doing, I took one of my children to play football. Yesterday was spent with family and friends, tomorrow the kids go back to school. Life goes on, much as it was before. Airport security may be tighter than ever before, we may all be a little more aware of our surroundings, a little less innocent, but life goes on, much as it was before. 

Since the day that everything changed, nothing's changed. 

And that's our victory. 

Movies

The feet appeared first, his legs skewed apart

mimicking the lines they draw in the movies.

His upper body hidden from view, the suspense building, 

following a plot like the movies.

Climbing over a table to see blood spattered walls,

and a gun lying spent on the floor. 

Finding him there, motionless, lifeless. 

Faceless.

Looking for some way to help. 

Finding none. 

Realising that this isn't the movies. 

And knowing, again, that happily-ever-after 

is often nothing more than a movie, a wish, a dream. 

Teeth

Mrs Symonds collapsed as she sat down in her own home for the first time in over a month. At first, her family thought that she'd just fallen asleep, exhausted by travelling half way across the world. Moments later, the strange noises she was making alerted them that something was wrong. Her head lolled forwards and she started to fall towards the floor. Only the quick thinking of her son prevented her from injury as he helped her gently to the ground. Frantic, he tried to wake her up as his wife called for an ambulance. 

Five minutes later, I was there, and Mrs Symonds was lying on the floor wide awake and wondering what the fuss was all about.

"She just dropped! I caught her and made sure she didn't hit the deck, but I think she had a stroke or something!" 

"What makes you say that?"

"Well, I remember seeing those ads on TV, you know where they show the head on fire, and I think that that's what happened." 

Mrs Symonds didn't seem too impressed. 

"Don't be so ridiculous man, just get me up off the floor!" 

I convinced her to stay where she was at least until I could make sure that her blood pressure was high enough to allow her to sit up again. 

"You've got to watch her," said her son,"she's usually got her wits about her more than all of us put together." 

"Right. Will do." 

It sounded like a simple faint, with the action of laying down on the floor rebooting the systems that so clearly needed a brief rest. However, without further tests, nothing could be ruled out for sure. 

An ECG showed that her heart was probably the one they used for the text book of a normal heart. 

Her baseline observations were all normal. 

Her arms were at full strength. 

Her speech was normal, her mind sharp.

A request for her to smile and show me her teeth, just to test for any facial droop, indeed had her smiling. 

And digging into her handbag for her teeth... 

The Other Leg

Late evening in the city, where another weekend heads to a close as the world prepares to face another Monday morning. There's a definite chill in the air, a disappointing summer fizzling out as the nights begin to draw in, yet all around people are spilling out of pubs and clubs wearing no more than the bare essentials. The street sweepers are out in force, one of them earning a torrent of verbal abuse for daring to complain to yet another youth for throwing an empty cup on the floor.

Rash and his friends walk away laughing, alcohol and bravado fueling yet more antics until, suddenly, he loses his footing on the edge of the kerb. His leg twists, snaps and gives way, and he crumples in a heap on the floor. The street sweeper sees it happen, yells something about karma and walks away to continue his never-ending litter hunt. 

We're dealing with a drunk no more than ten paces away, another victim of just having a good time and she doesn't usually get like this. Each of us, Dean and I, has one eye on our patient making sure we don't get covered in vomit, and another on the altercation, looking for signs of a fight breaking out. When Rash falls, we're close enough that we see his leg change direction and clearly hear the crack in the bone. 

"Stay there!" I shout. "We're coming." Dean calls for help, asking for a second ambulance.

Unable to move even if he wanted to, Rash lies on the ground screaming in pain. Two police officers patrolling the area hear the noise, which even in the bustling surroundings was out of the ordinary, and come to investigate. The bad timing on their part means they get to stay with the vomiting drunk and her overly exuberant friend.

Dean brings the trolley bed and a splint over, the need to see the injury first seeming superfluous having witnessed the noise it made. Nevertheless, a pair of shears always beats a pair of jeans in the trauma version of "rock, paper, scissors" (where the rock or paper are any item of clothing which may be hiding any part of the anatomy that needs to be viewed directly, in a hurry and with a minimum of movement), and seconds later Rash sees his leg for the first time since getting dressed earlier in the evening. He looks down at his ankle, and instantly looks away.

"Do you think it's broken?" It's more of a last gasp attempt at denying what he already knows than a real question.

"Well, I think the fact that your foot is facing the wrong way and there are two bones sticking out of your ankle would probably confirm that." Ten paces away, as if on cue, our drunken patient vomits for the umpteenth time. One of the police officers sends us a grateful stare, all the more grateful now that another ambulance has arrived to deal with her.

We load Rash into the ambulance, dose him up with some pain relief, and straighten his leg out as much as possible before heading to the nearest hospital. The screams of pain as we pull his leg straight subside once his foots faces front again, entonox and morphine leaving him a little dazed. When I ask his date of birth, he hesitates, looking at his friend for guidance. A shrug of the shoulders was the only reply.

"How old are you Rash?"

"Nineteen."

"And what's your date of birth?"

He tells me a day and a month without hesitation, but when it comes to the year, all he could say was "Ummm..."

"OK, so how old are you really?"

"Sixteen. And a half." And a half. Of course. That makes all the difference.

"And why didn't you want us to know that?"

"I didn't want those coppers to arrest me again. You know, for being drunk under age and all that."

"What do you mean arrest you again?"

"Well, I've already been arrested five times before. I was twelve the first time!" He high-fives his friend, seemingly proud of his criminal record.

"Twelve? What were you arrested for at twelve?"

"Fighting!" Another laugh, and another high-five.

"And you were twelve?"

"Yeah man. I've still got the scars now!"

"And you're proud of that?"

"Well, yeah, why not? But not as proud as I am of something else." He shoots his friend a knowing look, and they both smile.

"What's that, Rash?"

He pulls up his other trouser leg and proudly shows off his electronic tag. "Got this last month, didn't I! All my mates want one now, it's, like, so cool!"

"You know that you'll probably get nicked now anyway, out after what I presume is your curfew time?"

"Oh what? Even if I'm in hospital? Pull the other one, yeah?"

"I already did." 

Dark Night

She sits and stares out of the window

Her mind as dark as the night,

her stare as blank as the moonless sky.

I stand at the door, afraid to walk in,

scared of how she'll react to a man, a stranger

getting too close. Again.

Her shirt is ripped, her hair a mess.

Makeup runs down her face,

teary streaks leave a stain as they silently drip

off her cheek and into her lap.

Her mother holds her close,

wiping away some of the tears, whilst

letting some others fall away.

"I swear," her father says, teeth clenched,

fists clenched, eyes troubled,

"If I ever catch him..."

The officer, a young lady, pretty as a picture

and unnaturally calm,

tells him he'll do no such thing, begs him

to let the police do their job,

so that he can concentrate on doing his.

Stepping back into role, he sits with them,

A husband, consoling his wife,

A dad, caring for his little girl.

S'pose

"I know you," he says, his knock on the window jolting me out of my nocturnal daydream. "You picked me up when them cops came to my house! S'pose you don't remember." 

"Craig?" 

"Good memory you've got there." 

"What are you doing here at four in the morning?" 

"Oh, you know. This and that. Just hanging around." 

"Outside a hospital?"

"S'pose this is where I live now. Under section, in the nut house round the back. They just let me out for a smoke, but I ran off to get a better spot." 

Craig was dragged away from home a couple of weeks earlier by the police after destroying every piece of furniture in his house and threatening to set fire to the damaged remains. His mother begged us to let him stay at home, claiming it had never happened before, that he was just drunk, and that she'd look after him now. Two facts prevented that from happening. The first was the fact that it was taking the full force of several police officers to restrain him, and the second was the arterial bleed from his arm. 

Craig went back to sitting on the wall where he must have been perched before scaring the life out of me. It was three storeys up from the ground, with nothing between him and the concrete below. 

"You know, I'm pleased you're here. You can be my witness." 

"Witness for what, Craig?" 

"For me jumping off here. You can tell them that I meant it, that I didn't just fall." 

"Jumping? What do you want to do that for?" I sat there, frantically wracking my brain for a way to get some help without alerting him to the idea, but in the meantime I was happy that he just kept talking. 

He took a crumpled cigarette out of his pocket. "I 'spose you don't smoke, do you?"

"Nope. Never have done. Why?"

"Smoked since I was fourteen. Ten years that is. S'pose I knew then already that I wasn't going to have a long life. Twenty a day normally, sometimes thirty, forty. Even had a hundred once in one day, thought it would kill me there and then, but it didn't. Still here, aren't I? Still need my smokes. Still need some fresh air to smoke 'em. Pollute the air with smoke like they tried to pollute my mind. I know what they were doing to me in there!"

"In where, Craig?"

"There! The nut house!"

Craig pulled a lighter out that was tucked into his watch strap, made himself a little more comfortable on the edge of the wall and after a few attempts finally managed to light the cigarette. Two long drags later, he kept talking.

"I'm gonna finish the pack of twenty that I've got, and then that's it. I'm getting out. I've got this one and one more. That's it. No more smokes, no more police, no more hospitals, no more nothing. Glad you're here, anyway. I already told you that, didn't I?"

"You did. But I might be gone in a minute, if I get a call."

"S'pose I'll wait 'til you get back then."

As if on cue, the computer rang and sent me out into the night, heading in the vague direction of a jumbled set of coordinates on a map. Someone had called in from a mobile phone, and before the exact details are confirmed, the system works out which mast the call is routed through, and starts sending me there. The little red triangle on the map showed a point less than a mile away. Now that I finally had the chance, I called up control and let them know about Craig, where he was sitting, and that they need to send someone, anyone, to stop him from carrying out his threat.

A minute or so down the road, the details of the call finally came through.

Location: Nearby Hospital, by the A&E entrance. 


Details: Male, unknown age, threatening to jump off high wall. Ambulance car was on scene, now left. 


By the time I'd turned round and got back to where I started, two members of staff from the Mental Health unit were talking to Craig, as a police officer helped him off the wall. He looks up at me, perhaps confused by my swift return, perhaps amused by it.

"You know what," he says, as a pair of handcuffs are applied, "I'll do it one day, whether you're there, or anyone's there. Or not. S'pose it's back to the nut house. S'pose I'd better get another packet of smokes, though."

Gossip Monger

It's taken a while to get used to the new radios, not that they've been a bad thing, especially for someone who spends most of their time working solo. Prior to their arrival, the only communication we had with the control room was if we were still in the ambulance or the car. Failing that, we could use our own mobiles or even the patient's phone, sometimes dialling 999 if it was particularly urgent. Summoning police in a hurry often involved one of the crew running back to the ambulance and calling for help whilst leaving their partner facing whatever the danger was. A solo worker was even more isolated. 

There was, however, certainly as the people on the front line, one advantage to the old radios: they were an open channel. As long as you were on that channel, you could hear everything that was going on with all the ambulances in your sector, and therefore it was often the people you knew best. If you heard them calling for extra help, for whatever reason, you could call up and offer that help. Now the channels are blocked. Communications are direct between a radio and the control room. 

The airwaves are silent most of the time, except for the control room sending out "General Broadcasts" advising of calls waiting for ambulances, and other general information. Even these seem to have reduced in number now that they can send messages down the MDTs (mobile data terminals, or, for ease of use, the computer screens on which we get our calls). Communicating to the whole sector is still possible, but is very much frowned upon, except in one instance. If you need help in a hurry. 

On top of the new handsets is an orange button. Press and hold that for a second or two, and everyone else on your channel hears you. No need to push any buttons to talk, your mic is open and hands-free. Everyone else's radios flash bright, and make an alarming sound. In the control room the radio-op has a similar sequence of events and alarm bells sounding. Nine times out of ten, the next words you hear are a crew discussing how upset they are at yet another hospital banning them from the coffee and tea, or some slanderous gossip or rumour, or even someone dealing calmly with a patient. Nine times out of ten, the button has been accidentally pressed, control checks in to make sure that all is well, and nine times out of ten the crew will apologise and spend the next few minutes panicking about what may or may not have been said as the world and his wife were listening. 

A while back, I hit the orange button. On purpose. 

The next words everyone heard were probably a garbled stream, and would have looked good on an old-fashioned Batman TV show: 

"Get off!" "Step back!" THUD "Ow!" SMASH 

"Red Base, I need police on the hurry up!"

"Z751, are you OK?" Control actually sounded a little worried.

"NO!" BANG "I need police! NOW!" "OY, GET OFF!"

I think the magic of the hands-free open-mic only lasts for ten or twenty seconds, so that's probably all they heard. Luckily, probably. Profanities are not welcome across the ether. 

At that point, a crew turned up, not realising what they were about to walk in to, especially as they're on a different radio channel and hadn't heard my calls for help. An innocuous sounding call with little prior information other than the fact that the patient was crying doesn't normally call for any concern. 

The next few seconds, maybe minutes, are a bit hazy. One of the crew waded in trying to help get the patient away from me as the other called again for back-up. Between us we tried to get him down on the floor, both for our safety and his. We failed miserably. In the background I could make out the sounds of several sirens, and a few seconds later half a dozen police officers ran in. 

"Someone call the cavalry?" 

"Er, yes! He's all yours!"

In a blur of arms, legs, handcuffs, swear words, brute force and brilliant technique, the patient, high on illicit drugs and alcohol, was finally subdued and taken into custody. It took all six officers to deal with him, so my pride wasn't too dented by the fact that I couldn't do it on my own. Still, malicious thoughts (often spoken in jest) of using an oxygen cylinder as a weapon came all-too-close to being a reality. 

I drove back to station, covered in my blood and his, uniform ripped and with a sore shoulder and back. On the way back I phoned control to thank them for their prompt assistance and told them that during the events I'd made a new discovery. 

"What's that then?"

"I now know that the orange button isn't just for accidentally spreading gossip!" 

"Well, you say that, but now everyone's talking about you!"

"Oh." 

Important Phone Call

The glucose slowly feeds its way out of the liver and up through the blood stream, finally reaching the brain and bringing Alan back to his senses. Glucagon is one of our miracle drugs, and it's always incredible to watch how a patient transforms from totally unconscious to completely alert within a very short space of time. Once Alan comes round he looks almost embarrassed, the reality dawning on him that it's happened again.

"How low this time?" Alan asks.

"Oh, 0.9. Quite impressive really." It's my third or fourth visit in the past few months, and there had been others too.

"I'm so sorry. I hate to bring you out like this, I know you've got better things to be getting on with."

Alan's daughter stood by the door watching what had become an all-too-common scene in the house, but despite the familiarity she looked nervous and on edge. She held a cordless phone and kept looking at it as if it was burning a hole in her hand.

"You OK?" I asked.

"Yes, thanks. Well, no, not really. I mean, yes, I'm OK. Sorry. A bit stressed. Waiting for a phone call. I'll go make dad a sandwich."

"Great, just what he needs and desperately doesn't want."

Alan gives me an amused look. "You know me well."

"Well, what do you expect if we keep meeting like this?" 

As his daughter heads for the kitchen, the phone rings.

"I'm sorry. I really have to get this. Can I leave you making a sandwich? Help yourself to a tea too if you want." Without waiting for a reply, she answers the phone and disappears upstairs. Finding my way round a strange kitchen, I make Alan the sugary tea that he despises and a jam sandwich that he doesn't mind so much. It's the staple diet of a post-hypoglycaemic diabetic. The emergency sugar stores that we steal from the body need replenishing, and it's the one time where diabetes and sugar are a relatively good combination.

I write as he eats, completing the never-ending paperwork that will end up in the growing pile of similar scrunched up and fading sheets. With a mouthful of food he tells me to write his daughter's name and number as the next-of-kin contact.

"Don't worry," he says, "she's not always on that thing. It's an important call, this one is."

"I don't doubt it." But he saw the look on my face and straight through my doubts. It seemed strange that whilst your dad is being treated, even if it's something you're used to, you'd find it more important to be on the phone.

"Ask her to tell you who it is on the phone when she comes back downstairs."

Alan finishes his food and drink, we chat for a few minutes longer, and I recheck his sugar levels, now a healthy 5.8. Just in time to see me opening the door, his daughter comes downstairs, tears streaming down her face, and I instantly feel guilty without knowing the reason why.

"That really was an important phone call, wasn't it?"

"It was. It really was. It was my husband, it's been almost a month since we've spoken. If I missed that call today, it could have been another two weeks."

"What does he do? Work on an off-shore rig or something?"

"Nearly. He's in Afghanistan."

London's Burning

We're a privileged lot, us ambulance people. We knock on people's doors, people we have never met before and in all likelihood will never see again, and they just let us in. In fact, not only do they allow us in, they invite us into their homes. Any time of the day or night, we knock on the door, strangers in every sense of the word, and step into somebody else's world, usually without any fear. And in these worlds, these homes, we see lives laid bare. Emotion at its most raw, sadness and anger in equal measure, happiness rarely, but for just a brief period we're allowed a quick peek into lives that not only do we not live, but often couldn't imagine. 

From beautiful homes, some bigger than my street, fenced off, gated properties with the rich and sometimes famous, to squalid apartments, crawling with rats and bearing a gut-wrenching smell that needs to be experienced to be understood, we see them all. 

We see happy families, smiling photos beaming down from the walls, and families torn apart by an unknown, unloved past. There are single parents, adopting and adopted families, children who grow up with everything they could wish for, and children who grow up with nothing. 

This country is the same as any other, the people here too. Most of us strive to make the best with what we have, to live our lives to our fullest potential, to be a member who contributes to a society in order to make it more livable, more comfortable for both ourselves and everyone else. These are the basics of human life, of being part of normal society. 

These last few days, starting in London and spreading around the country, have shown another side to our first world society. An ugly side, a threatening side, a destructive side. We've seen society at its worst. 

There's a sense of entitlement that exists amongst too many. It starts with people expecting to have everything handed to them on a plate. People don't want to have to think for themselves any more, so that where once, many years ago, ambulances would only be called in the most dire of circumstances, now a mere six hour old case of sinusitis is cause for a deferment of responsibilities onto somebody else. 

Let someone else tell me what to do, it's too hard to think for myself. 

I'm not a member of society, I'm me. And I'm the most important. 

What I want, I will have. 

The longer it goes on, the more it becomes ingrained as a norm. It's culminated over these past few days by several hundred people deciding that normal society just isn't for them. They don't want to be a part of it, and don't care about any other members of it. 

If I want a television, I'll just go and get one. 

If I want the latest trend in sportswear, I'll just smash my way into a shop and take it. 

That's not my house, or shop, so who cares if I set fire to it? 

This isn't a democratic exhibition of freedom. Freedom isn't expressed by attacking public and private property; homes, cars, even ambulances.

This isn't a political protest, aimed at changing any one of many government strategies or some perceived unfairness. 

This isn't the underprivileged minority, or a certain race, or only young men. The pictures tell a different story altogether. There's a huge mix. The demographics can't be narrowed down in any way, but the thought process can:

What's mine is mine, and what's yours is also mine. 

It starts with disregard for society as a whole and its rules; it's a disregard for private belongings, a disregard for public provisions, and eventually leads to a disregard for human life in general. We can consider ourselves lucky if all we do is count the cost in the number of human lives lost. But that is not all we've lost. People have lost their homes, their businesses, their streets. 

They have lost financially and physically. They have lost their pasts, their presents, their futures. But we, as a society, have lost a great deal more. 

We have lost our dignity. 

Now's the time to fight to get it back, and maybe, just maybe, by showing these criminal thugs and hoodlums that we care, by teaching them that there is another way, they might decide to rejoin society as valued members rather than self-proclaimed outcasts. 

And as I watch London burn, I can only hope. 

The Night After

It was one of those nights. I only saw five patients. 

1) Drunk, fallen asleep in the street. Told me to get lost. Not quite as politely as that, however. Then proceeded to walk straight into a wall.

2) Drunk, fallen over in the street. Told me I need a shave, which I do, and that I speak good English for a Chinaman, which I'm not. Also, I need to go back to China, where I come from, "'cos we don't need no more foreigners in the country." Nice.

3) Drunk, fallen over at home, slightly apologetic. Slightly better natured than the previous two. Things were looking up. But not for long.

4) Drunk, violent and nasty, high on drugs to boot. I got covered in his blood as well as mine as I tried to stop him killing both himself and me, before the police turned up and looked after him. Things were looking grim again. 

5) Drunk, unconscious and very seriously injured after a high speed impact with the road. Definitely grim. Grim for me, as it was pouring with rain, but that's nothing. It's much more grim for him. He's probably going to die, assuming he hasn't already.

I'm back at work in a few hours. The night after the night before. I hope it's a better one. For everyone.