Meant To Be

It's so easy to be dismissive, so easy to drive along, thinking that this is just going to be yet another one of those calls. A young girl, in her twenties, complaining of the ambulance service's number one call. Abdo pain. Another twenty-something, self-entitled, all-deserving, all-demanding twenty-something who can't be bothered to take any pain killers and like most people, wait for the pain to go away. 

It's so easy just to assume another late night out, another curry gone bad, another Chinese take-away with more after-effects than the alcohol it was meant to be soaking up, another case of food-poisoning victim seeking a non-existent magic cure. 

But with only half a story, it's so easy to be wrong. 

The tear-stained face, the look of real pain, the blood-soaked trousers, the shocked and saddened eyes, tell the other half of the story. 

A story, a history, of broken hearts and shattered dreams, of hopes raised and dashed time and time again. Through sobs and tears, she looks at him, she shrugs, she says We'll try again, neither of them really knowing if they have the strength.

Twenty two weeks, the furthest she'd ever got. But once again, for the fifth time in as many years, it just wasn't meant to be.

Just a Thought

A blog post so short, that it probably should have just been a tweet, but I felt it was more important. 

Remember - you're not just treating a patient. You're treating a person.

There you go, just a quick thought for the day. 

Putting Their Lives on the Line

I was at home enjoying some family time when it happened. But just hours after the horrendous incident in north-west London that left four police officers with serious injuries after being stabbed, I was back on duty, and this time, not a million miles away from the scene.

At a totally unrelated call, an RTC, the police had to block the road for a few minutes so that we could treat our patient safely. A driver caught up in the traffic approached one of the officers, stood toe-to-toe, and through gritted teeth and a with a horrible snarl commented: "It's no wonder you lot get stabbed."

I'm not sure I would have been as restrained as this officer was.

The police have to put up with a lot more abuse than we do, and take greater risks too. If there's a call that sounds a little suspect, we'll ask for police attendance and hide around the corner until we know it's safe. Yesterday's incident proves once again how big that risk often is. I have a great deal of respect and admiration for the police, what they do, and what they sometimes have to put up with, especially as they've saved me from a serious pounding on numerous occasions.

I hope and pray that those injured make a full and speedy recovery, both of body and soul. They deserve it.

And as far as the idiot driver who had been inconvenienced for a few minutes, well, I can't really tell you what I hope and pray for him. But I'm sure you can well imagine.

Thursdays

Lying on the pavement in a puddle which I hope is just rain, but fear that it probably isn't, Val starts cursing the second he sees me approach. 

"Now, now, there's no need for that! We should be best friends by now!"

"Oh! I'm sorry." Val says. "I didn't know it was you. I thought it was the old bill again."

Somehow his clothes are filthy, even though I remember for certain that they're not the ones he was wearing the day before. He's a regular, but as regulars go, normally a fairly friendly one just looking for somewhere warm to spend the night. The truth is, it's rarely Val that calls us, but some unsuspecting member of the public worried that they're looking at a dead body in the street. So far, he's never been dead. I fear for the day when he really is, it'll probably be the one time that nobody bothers to call. Along with the rest of the usual observations, I check his temperature which shows that he's hypothermic, four degrees below the normal body temperature. 

"How long have you been out here?"

"Don't know, what time is it?" 

"About eleven o'clock." 

"At night?"

"It's dark, isn't it?" 

"True, but it could have just been cloudy." I raised an eyebrow, and he saw the flaw in his own logic. "Anyway, if it's eleven, it's probably been about eight hours. I got thrown out the pub at about seven." 

"That would make it only four hours, Val." Unsure as to whether it's alcohol or hypothermia that's causing his confusion, I decide on another line of questioning. He wasn't sure where he was or which pub he'd been in, but knew his date of birth and even where he was born, or at least claimed to have been. With time for one final question as the ambulance pulled into view, I decided on an easy one. 

"Do you know what day it is?" 

"Pass me the bag will you?" Val takes the plastic bag, pulls out the large bottle of cider, turns the label towards him to read the name and proudly announces: "It's Thursday. I always drink this one on Thursdays." 

Traffic Stop

Knowing that police are on scene and knowing that the scene is safe are two very different things. Once we know that the latter is true, we approach at speed. 

A bystander runs up to us and practically pushes me off my feet. 

"What the hell took you so long? The police have been here for ages." 

I push him off, lift the police tape that marks the outer cordon, and head into the neutralised area.

One of the officers signals to us to head towards the idling car, the headlights of a police van on full beam illuminating our approach. Sitting in the front passenger seat of the car is yet another officer, looking pale and wearing a blood-soaked shirt. A crowd stand around the cordon, some hurling abuse at the police, some at us, some at each other. The atmosphere is on a knife-edge, teetering on the brink of an all-out riot. In the driver's seat, unconscious and bloodied, sits London's latest gun-crime statistic. 

Two holes through the windscreen, almost perfect circles, the rest of the glass undisturbed. 

To the police, he's a victim; to us, a patient. The work we do could mean the difference between attempted and actual murder, between a life-threatening injury and a fatal one, between life and death. We move him out of the car, looking for injuries, and finding them too. 

Two holes in his chest, almost perfect circles, the rest of his body untouched. 

Entry wounds only, leading to only one conclusion: the bullets are still lodged within him. The visible damage is only a small part of the story. It's impossible to know what damage was caused after those tiny projectiles entered the body, where they veered off to, what organs they hit, what arteries they missed, how much blood has been lost. 

"Are you gonna just sit there looking at him all day?" 

The call comes from one of the irate crowd, someone who doesn't understand that just moving the patient could be the wrong thing to do. We need to have an idea of what we're dealing with, whether his lungs will hold out for long enough, whether we think his heart's been hit, whether there's anything we could possibly do to give him a better chance. 

There's no one else to send to help us out so we package him up into the ambulance, give a report over the radio and head to the trauma unit. Luckily, for a change, we're not too far away. On route to the hospital his breathing becomes more noisy, more erratic, and then silent. His heart changes from a rapid beat to a slow beat, to no beat at all.

The officer in the bloodied shirt meets us at the hospital and asks how the victim is doing. We tell him. 

"Damn. I only pulled him over because he had no headlights on, I had no idea that anyone else was watching him too." He shakes his head. "Can I go and see him?" 

We walk with him in the direction of the resuscitation room, and he knocks gently on the door. A nurse peeks through to see who's disturbing their work, sees the blood on his shirt and lets him in immediately. It takes a minute for him to convince her that he's not injured, that he just wants to see the victim. 

The third cubicle along has the curtains drawn. Monitors all around ping with electronic bells, whine with wavering warnings, but the monitor in cubicle three is silent. The officer steps in, the nurse follows and we stand by the curtains. The victim's face is already covered, and the nurse slowly, gently, mournfully pulls the cover back. The officer takes one final look, shakes his head again and turns to leave. 

"A traffic stop. Just a simple, damned traffic stop." 

Patch Adams

"Our job is improving the quality of life, not just delaying death." It's like everything I keep trying to say, but just said so much better.

Two things have come out of a friend of mine sending me the link to this: The first, considering how much I like Robin Williams, is how have I never heard of this film?

The second? I think I may have found my new career, should I ever decide to change.

Stories and Poppies

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

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

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

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

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

Care?

If you're a carer in a care home, your job is to care, and all that your caring entails. 

If you're a nurse in a nursing home, your job is to nurse, and all that your nursing carries with it. 

Don't you dare tell me you've only known one of your residents for only a few weeks, or a few days, or even a few hours, as an excuse for your inaction and lack of care. 

I only get to know my patients for seconds, literally seconds, before I have to decide and act on their needs, and be able to do so with care and compassion.

You may only be temporary staff, but your nursing diploma stretches as far as giving a patient oxygen when they need it, whether you know them well, or not. 

You may be new to this particular establishment, but your nursing experience should tell you how unwell your patient truly is, and that now's the time to act. Now's not the time to lean over the bed with your hands in your pockets and your head in the sand.  

Don't you dare excuse your mistreatment by claiming to not know the resident well enough - abuse and neglect can never be excused. 

I know my patient for only moments, and I still treat them like human beings, not like bed-filling, revenue-raising, income-generating pieces of unimportant meat. 

Damn you for making me care so much as to make me hate you and your actions - or lack of them. 

Damn you for being so blasé about the desperate needs of those in your care. 

Damn you for choosing a caring profession, when clearly you just don't care. 

White Van

Downtime is a rare commodity on the ambulances these days. Socialising with colleagues is limited to snatched moments in between handing over patients at the hospital and the next call. Rarely is that time more than a few brief minutes. More often than not, the second a crew is ready to go, there's a call already waiting for them. The same is true from shift's start to shift's end. I try to arrive for my shift about half an hour before the official start time. It gives me a chance to get all my equipment ready and catch up on the news, whilst not having the stress of having to go out on call the second the clock ticks over at the start of my shift. 

The evenings are getting cooler, and darkness seems to fall in the middle of the afternoon. Standing out the front of the station, I start to get the car ready for my shift. Checking the stock, changing the oxygen cylinders and making sure that all the lights are working, whilst at the same time catching up with the oncoming night shift crew. One of them is a brand new trainee, in only their second week on the road, the other with only a year's worth of experience, having a new probationer to look after for the first time. 

"You guys make sure you hurry to my rescue tonight, won't you?" I know that at night, sometimes waiting for the ambulance to back me up can take some time. 

"More like you're going to rescue us!"

The chit-chat continues, some along professional lines, some less so. A bit of good, off-the-record banter can work wonders sometimes, giving the time to replay calls that we're unsure of, seeking backup for good decisions, learning from others about things we don't know or understand. With ten minutes to go, we all finish our checks, the crew head inside and I'm only a step behind, hoping for a quick cup of coffee. Just then, a white van pulls up outside the station and the driver steps out.

"Excuse me, I don't feel very well."

He looked pale, and the sweat was dripping off him. He walked up to the car and as he came within touching distance, collapsed to the floor. Practically tasting their coffee, the crew turned round and came straight back outside. Within a few seconds of hitting the floor, our unnamed patient started to come round.

"Stay there a second," I tell him, as he tries to get up. "We'll get you in the ambulance and check you out." A check of his blood pressure confirmed our suspicions - it was so low that it was barely readable and his pulse was much slower than it should be, at less than forty beats a minute. We get the trolley from the back of the ambulance, and lift him gently from the floor,.

"What's your name, sir?"

"Mani."

"How old are you?"

"Thirty." One of the crew, the new probationer, looks shocked. Mani looked probably double the age he claimed to be, but confirmed his date of birth without having to stop and think about it. The maths adds up. He really is as young as he says. As usual, several things need to happen at once. Observations, an ECG, cannulating a vein ready for any drugs he may need. It's always a good indication of the seriousness of an illness when a patient's reaction to the threat of being stabbed in the arm with a large needle is almost no reaction at all. He managed to give us various other details, including his home address, only one street away from the ambulance station. He'd decided when he started feeling unwell that it was quicker for him to drive to us, rather than the other way round. By the end of the call, we would all realise that he was lucky to drive that far.

Despite raising Mani's legs on the stretcher, giving him drugs and some fluids, his blood pressure fails to rise. We have difficulty attaching the sticky dots to his chest because he's so clammy, but eventually we succeed and the machine complies, printing out the tracing of his heart. His heart was sick.

At thirty years old, Mani was having a heart attack, the part of the heart that affects his pulse and blood pressure blocked and dying. It was no wonder that he wasn't responding to any treatment we were giving him. I abandon my car at the station before I'd even had the chance to turn the wheel, and travel with Mani and the crew to hospital, hoping to get there before his heart gave up altogether. With a twenty-five minute journey, there were no guarantees, and there was little more we could do to help improve the odds.

Mani listened anxiously as we explained what was happening, but accepted it. His greatest worry after his health was getting a parking ticket on his van. or worse, having it towed, having left it in front of the ambulance station with the keys still in the ignition. I promised to do what I could to make sure that wouldn't happen.

He was lucky. Still conscious when we got him to hospital, and amazingly calm as the team did their work. As we stood watching what is effectively a plumbing procedure on the heart, the response was almost instantaneous. Blood began to flow back around his heart, feeding oxygen to the parts of it that had been starved for some time. His pulse improved, as did his blood pressure, and the hospital team seemed pleased with their work and Mani's response.

"We'll keep him here for a few days," the consultant tells us through the lead-lined window, "then if all's well, he'll be sent home to restart his life. Good work guys!"

"Don't forget my van, will you?"

"Don't worry, Mani. We'll sort it out for you. You concentrate on getting better. I'll leave a message with the hospital when we work out what to do."

"Thank you. Thank you for everything." He waved at us, a relieved smile on his face, and then rested his head back on the trolley that had been brought to wheel him to the ward.

Having tidied up the ambulance, we drove all the way back to station, and I discussed with control what would be the best plan for Mani's van. Having made all the arrangements and received agreement from on high, I called the hospital and asked them to let Mani know that his van was parked outside his house, and the keys had been put through the letter box.

"You know," said one of the crew as I walked back into station, "you've got a new career ahead of you if you give up on ambulance work!"

"Oh yeah? What's that then?"

"Well, the world always needs more white-van men..."

"Yeah, thanks for that guys. Should we start our shifts now?"  

Crisis

The front door is ajar and as I knock and enter, a voice from upstairs directs me to the drama. Two people are in the room; one frantic, one calm. Violet, lying on the floor with a weeping head wound is relaxed and resigned to her fate. Her son, Donovan, tries to sit still and move out of the way all at the same time, causing him to trip and almost fall on top of his mother.

"I'm sorry," he says, "I'll just... Well, I'm... Oh, I'm not much use in a crisis. I'll get out your way now."

"Donovan!" calls his mother. "Will you settle already. I'm alright. They'll look after me now!" The gentle sing-song of her West Indian accent finally seems to have an effect, and he's able to step out of the way and relax a little.

Distraction tactics at the ready, I ask him to find me his mother's medications, write down a few basic details and generally try to keep him out of the way for long enough to assess some basic observations and wrap a bandage round Violet's head.

"Oh, that's better!" he says, returning to the room once some of the mess had been cleaned up and the bandage hid the injury. "Did I mention that I'm not much good in a crisis?" 

"Don't worry. I'd fret too if it was my family." Turning back to Violet, I gently break the news, worried that I was about to have a fight on my hands. "Now, miss, we need to get you off to hospital. There's a hole in your head that needs some proper fixing." 

"I knew you were going to say that. Can you just get me my slippers?" 

Without a word, Donovan turns to find the footwear. 

"And I'll need my keys." 

"Keys, right." 

"And don't forget my handbag."

"Handbag too."

By the time he's half way down the stairs, the list has grown to almost a dozen items, each call from Violet repeated with a resigned sigh from Donovan and an amused smile from the ambulance crew and me. Whilst he runs around the house turning off lights, checking doors and gathering medications, we get Violet as comfortable as possible in the carry chair and move her downstairs and into the ambulance, the crew carrying Violet as I carried the bags. 

After a few minutes, Donovan knocks on the back door of the ambulance and hands a bag through. 

"Did you find everything?" Violet quizzes him.

"It's all in there!"

"Keys, money, tablets, phone?" 

"Yes Mum. Keys, money, tablets, phone."

"Slippers?" 

"They're on your feet, Mum." 

"Oh yes. So they are." 

"What about the lights? Are they off? Did you check the back door's locked?

"Yes, Mum. Off, and locked." 

"Oh, and what about my hairbrush?"

"Hairbrush? What do you need a hairbrush for? You're going to hospital, not a fashion show!"

"Donovan, don't argue with your mother. A woman always needs a hairbrush in her handbag, no matter where she's going!" 

As he runs inside to retrieve the hairbrush, muttering the whole way there and back again, Violet relaxes back on the trolley bed, and allows herself a smile. 

"Kids, you know what they're like, don't you? Even when they're grown up they're hard work sometimes. I mean, look at all of this. Just a simple trip, and he falls to pieces. But he's a good boy really, always looking after his mum. He's just not very good in a crisis." 

Are you sure?

Lights and sirens help us part the traffic a little like the Red Sea would have done, walls of cars forming on both sides of the road, just slower and with greater apathy. A few stray waves decide to make a stand and not get out of the way, one racing to see if he could beat the ambulance, only to have his plan ruined by a red traffic light. Another just stops dead right in front of us, clearly having more faith in our brakes than we did. A tug on the steering wheel, a slam on the anchors and a few choice words had the desired effect, and we avoided the back of their car by an air particle or two. 

Emergencies come in three broad categories: Life-threatening, possibly life-threatening, and not life-threatening. This call was the former. An unconscious twenty-year-old girl, believed to have taken some sort of drugs, the quantity and type as yet unknown. 

"It's my girlfriend, Clara," says the panic-stricken gentleman who greets us in the car park, barely giving us a chance to open the ambulance doors. "I think she's tried to kill herself!" 

"Is she breathing?" We talk as we walk towards the patient. 

"Yes, but she won't talk, won't open her eyes. I think she's unconscious." 

"Do you know what she might have taken?"

"She's lying on top of the box, so I can't see it. They told me on the phone not to move her." 

Having climbed the two flights of stairs, we find Clara lying on the floor of the lounge. Flickering eyelids tell us all we immediately need to know - she's not unconscious. Some gentle persuasion and asking Dean to leave at the realisation that as her boyfriend, he was possibly the catalyst to the drama, finally convinced Clara to open her eyes. 

"Dean seems to think you might have taken some tablets. Is he right?" 

A nod of the head. 

"Can you tell us what they're called?" 

A shake of the head. 

"OK, how many have you taken?" 

Clara holds up four fingers. 

I decided to end the game of charades, and ask a question that would require a spoken answer. "Were they prescription tablets, or something you bought by yourself?" 

"Bought them from a friend." She looked down at the floor, thought for a second and then went on. "They're not going to kill me, are they?" 

"Do you still have the box they came in?"

Clara went back to nodding her head. 

"Can I see it?" 

Slowly, she moves to remove the box from the pockets of her pink hoodie, and hands it to me. 

"You took four of these?" 

A nod. 

"And nothing else?"

A shake. 

"I think you'll be fine."

"Are you sure?" 

"I'm sure. Four Strepsils have never killed anyone." 

"But I didn't have a sore throat, so isn't that dangerous?" 

"No it's not. Not sensible, possibly, and might give you a bit of belly ache, but it's not dangerous." 

"Are you SURE?" 

"I'm sure." 

"Can you take me to hospital, just to be sure?" 

"If that's what you want? Sure." 

"Yes please. Y'know, just to be sure." 

My persuasive skills that managed to bring her back from unconsciousness were no match for her concerns about four throat lozenges. 

"Sure." 

Unison on Strike

This is a rare political post. Ignore if you so wish. 

_____________________________________

So, it seems that Unison, the union to which I belong, having decided to ballot all its members for a strike, has got the majority it wanted. 70% voted in favour. However, fewer than 30% of the members bothered to vote in what has been billed by union chiefs as the public sector fightback of the century. Several things have become obvious over the past few months: 

1) Many public sector workers are indeed feeling particularly unfairly treated, and often with good reason. 

However, 

2) Very few trust their own union (also, I believe, with good reason), and 

3) Very few, in relative numbers at least, believe that as public workers, striking is the correct course of action. 

I voted against the strike. Not because I think there's nothing wrong, because there is plenty. I voted against because it goes against each and every one of my principles as a public sector worker in general, and as a paramedic in particular. We are all entitled to our rights and privileges, and must indeed sometimes fight for them. Turning off the engines on all the ambulances, however, seems the wrong thing to do. 

The government won't suffer if we down tools. Our patients will. These patients won't turn their anger at the government either, they'll aim it squarely between the eyes of the ambulance service, and at the very next paramedic they meet. 

Time will tell if this strike will eventually go ahead, but I, for one, won't be striking. If that means resigning my membership of this particular union, so be it. If my maths is any good, it would seem that a mere 23% of members of one single union are holding an entire country to ransom. That, in and of itself, is wrong. If the majority of the majority voted in favour, then that might be something different. But to have two-thirds apathetic to the point of not voting, and then going out on strike based on the majority of a small minority, will always, in my eyes, be wrong. 

Fight the fight, but don't lose sight of who we really are, what we really do, and who we are really here to help. 

Red Rags and Suits

To a non-suit wearer, all suits look expensive, and there were several suits sitting around the table. 

"We're sorry to call you," said one of his friends. "We think he's just had too much." 

As I approached the table where he and his colleagues had hidden in the corner of the pub, the patient looked up and stared. His eyes were glazed and his look wavered as he probably tried to stop the room from moving. 

"Oh. Good. You're here. What took you so long?" The fact that it had taken less than four minutes from the call coming in had no bearing on his skewed sense of time. "I pay your wages, you know!" 

Oh. That one again. Red rags don't normally set me off, but this one did. 

"You do? How's that then?" One of these days, I'm going to come across a patient who actually works for our payroll department. Then, at least, they'd have a point to that claim. 

"Yeah, I do. My taxes pay for your job. So now, you can just do your job." 

"I'm doing my job sir," I said, as I started to check some basic observations. "And what, may I ask, is your job, sir?" 

"I'm a city banker!" He even told me the name of the bank, just for good measure. I guess I was right about the suit. 

"Oh. Then I think we're quits." 

"You what?" 

"Your taxes may pay for my job, but my taxes saved your bank and your job. And right now, sir, I'm trying to save your dignity." 

Just in time, I recognised the signs of a drunk about to eject the contents of his stomach, and side-stepped the impending eruption. Seconds later, his suit didn't look quite so expensive. 

"Ah well. There goes the dignity." 

Simple

It's a question I get asked on a fairly regular basis:

What makes a good medic?

In my simple mind, it's a simple answer.

Here's the test:

Would I be happy with you treating a member of my family?

If the answer's no, then in my eyes, you've some work to do.

If the answer's yes, then in my eyes, you're a good medic.

The test works when I look at myself in the mirror and check on how I treat my patients too.

Simple.

Lives

Some, over the years, have been badly hurt. 

Some, over the years, have been only lightly grazed. 

I guess they're the lucky ones. 

Assuming it's lucky to be stabbed.

Some had a wound so deep, they needed surgery right away. 

Some had a wound so shallow, the hospital sent them straight home, 

with a stitch or two and a warning. 

Some, bravado and ego getting the better of them, 

refused any treatment at all and ran off.

Two died. In front of me. 

When there was nothing I could do.

Others may have died later, but I'll never know.

Drop the damned knives, people. 

Stop destroying lives, people. 

Go live your lives, people, 

and stop tearing those lives apart. 

Experts and Law Suits

This post over at Rogue Medic reminded me of the day our youngest child was born. Being as stubborn as his older siblings, it was decided that two weeks after his scheduled arrival, it would be a good idea to serve him notice and have him evicted. Bags were packed, plans made, babysitters arranged, and a fortune was spent in the hospital car park. 

As we headed towards the main entrance, a scene so familiar to me, yet alien to a heavily-pregnant-about-to-be-induced MrsIM, played itself out in front of us. A group of people were stood in an almost perfect circle looking down at the ground, as a middle aged lady lay on the floor crying in pain. Much like Rogue Medic's story, the lady probably had a fractured hip. The crowd were a mixed group. Some visitors to the hospital, and several staff, including a few doctors, at least one of whom I knew and several nurses who looked familiar. All told, a group of about twenty people, standing, talking, gesticulating. 

A bed had been wheeled from a nearby ward and stood next to the patient as a discussion took place on the best method of getting the patient from the floor to the trolley. As we neared the actual scene at the rate of a nine-plus-month-pregnant-waddle, I could see six pairs of hands trying to move the patient up to the height of the trolley in a tangled mess that would have any back-injury specialist cringe and cry for their mother.

The upshot of it all was that none of them, not the visitors, or the nurses, or the doctors could work out how to do what comes to any EMT or paramedic as second nature. Having admitted to being a paramedic, I offered my help, and after a couple of "What do you know that the doctors don't?" type questions (from certain nursing staff no less), and using only two pairs of hands, the lady was moved gently, safely and with minimal pain from the floor to the bed.  

I don't claim to know what doctors know, I don't claim to have the skills to nurse a patient either. I do, however, claim to be an expert at what I do for a living. I've said it before - we need to have pride in our profession. We need to know that our skills and expertise are exactly that. We need to know that we are the specialists in our field, and that any doctor or nurse worth their salt would do well to understand and respect that. My remit may end at the entrance to the A&E or ED, but up until that point, the patient is my responsibility. That responsibility extends past mere transport - it can also include extrication, removal from scene, treatment, resuscitation and stabilisation. And just simple pick-ups from the floor.

I would love, one day, to hear news presenters, career advisers and general Joe Bloggs speak about paramedics in the same respectful tone as they do about doctors and nurses. Actually, first of all, I'd like to hear paramedics speak about paramedics in that same respectful tone, instead of doing ourselves a disservice by constantly saying things like "Well, I'm no doctor..."

Whilst the USofA as a whole needs to learn a little more about caring for others, as opposed to staving off law suits (not that the UK is all that much better), paramedics the world over need to learn that we are no less experts than the doctors and nurses to whom we're compared, often in such an unfair light. We need to show that we don't do things just in order to avoid yet another American-style law suit, or just to cover our over-exposed behinds. We do things because they are the right things to do, the expert thing to do, and are in the best interests of our patients. 

Windows

Tiny drops trickle down, zigzagging along

the inside of the steamy window, 

leaving streaks,

like tears, 

on a pockmarked face. 

Inside, they lie, 

side by side. 

He watches her, holds her, 

caresses her lifeless, cooling hand,

begs her to stay, despite knowing,

knowing she's gone. 

We step inside and take one look. 

Inside, the image in the window is mirrored, 

as tears stream down his gentle, pockmarked face. 

Animal Farm

Towering over me, with arms as big as a normal person's torso and wearing a vest that showed off tattoos from his shoulders to finger tips, Tom struck an imposing figure. As he opened the front door to let me in, I could hear barking from somewhere else in the house. 

"Is that dog locked away?" 

"Are you kidding me? He won't do you no harm! He's only a little thing."

"Yeah, the last person to say that to me then suddenly had to apologise and explain that Ooh, he's never done that before!"

"OK," Tom said, a mischievous grin crossing his face, "I'll go get him and lock him in the garden. Mum's in the back room with him, so you can follow me." Tom led the way, making sure to grab the dog as he went. "This is what makes you nervous? And I don't?" Every word dripped with sarcasm, and he had a point. The dog was probably no bigger than a child's football, and looked even smaller in the arms of his giant owner.

"Yes, and no. I can read people, they don't often bite, and I can usually run faster than they do. Dogs on the other hand, I can't read, often bite, and have four legs that are quicker and better than my two." 

Tom was still laughing at me when the crew arrived to take his mum to the hospital, but he did shake my hand and thank me for my help. He took great pleasure in telling the crew, Jill and Rachel, of my nerves, and they joined in the laughter at my expense, Rachel even going as far as asking him to get the dog so they can meet it. 

One-nil to the crew, but revenge is a dish best served cold.

An hour later and another call. This time the only noise I can hear at the front door is the wheeze coming from the lounge. A girl of mid to late teens opens the door. She looks frightened and worried, and practically drags me through the door to see her eight year old brother who's sitting on the couch struggling for breath. I kneel down next to him to start reassuring him and begin his treatment.

"He's got really bad asthma, and his inhalers aren't working. Mum and Dad let me babysit him for the first time tonight, and I didn't know what else to do." 

"You've done just fine, you did absolutely the right thing, so don't worry." Sometimes part of the treatment is treating the family too. "We'll have him sorted in no time at all, but you'll have to go with him to the hospital in the ambulance. Just give your mum a call and let her know what's happening." 

Mum instantly asks to speak to me, and I did all I could to calm her down. I apologised for disturbing their evening out and tried to ascertain a few more details.

"Does he have any allergies?" 

"Well, not to any medicines, but he's allergic to furry animals. You know, cats, dogs, guinea pigs, that sort of thing." I was relieved by that bit. "That's why we eventually let him get a snake." 

"A what?" 

"A snake. It's still quite small, only about five feet long, and he normally leaves it in the tank under the couch." 

Slowly, I lower my head and peek under the couch. There, staring at me from a glass fronted box, is the snake. It makes me jump a little, which probably had more of a therapeutic effect on the little man than any medicine I was throwing at him, making him laugh at my fright. 

"Don't you like snakes?" 

"Don't mind them too much, just didn't expect to be sitting next to one for so long without realising it." 

The room lights up in flashing blue as the ambulance pulls up outside, and two familiar voices are shown into the house.

"Aha! So we meet again." 

"No dogs for you to be afraid of this time then?"

"Well, as it happens, there is. He's terrified of me this time, and won't come out from under the couch. Maybe he knows I don't like animals much." 

They both crumbled at the thought of another tiny dog worrying me, so both knelt down to see if they could entice him out. I gave the brother and sister a quick signal to keep quiet. In an instant, there was a scream in stereo. Jill and Rachel both glared at me as I served up my revenge. 

One-one. And the dish wasn't even cold yet. 

As dawn approached, Jill, Rachel and I met on our third call of the night. We both arrived at the same time, and still just about had the energy to tease each other. 

"I'll tell you what," I said, "we'll make a deal. I'll make sure there are no snakes, if you take care of any dogs." 

"Deal," they replied in unison, as we walked up to the front door. 

A mother introduces us to the patient, her six month old baby, and immediately apologises. She talks in hushed tones, explaining that two other children are sleeping upstairs.

"You'd think I'd know better by now, after three kids, but I think I panicked a bit. She just coughed up a bit of her feed, and couldn't catch her breath for a few seconds. I'm sure she's fine." 

As Rachel checks the baby, Jill and I spot a huge fish tank, an aquarium that was more part of the wall, separating between two rooms. Dozens of beautiful fish swam around, adding colour and calm to the room. 

"Finally," says Jill, "an animal we can all agree not to be nervous of!"

"Well," I said, and Jill looked gleefully forward to me admitting another irrational fear, "I don't mind them if they're swimming, as long as I don't have to eat them!" 

"You don't eat fish?" 

"Can't stand the stuff. Can't eat it, smell it, look at it, or be within a mile radius of the stuff without feeling ill." 

"But you're not actually scared of them then?" 

"No. Not scared. It's just that I'd rather meet a live shark than a fillet of salmon or tuna steak."

At shift's end, I pack up and head for the animal-free sanctuary that is home. No dogs, cats, snakes, fish, or other creatures. Just as I was about to go to bed there's a yell from downstairs.

"Are you asleep yet?"

"Yes!"

"Good. Get up. My dad's had a fall in the high street and is a bit of mess. Can you go get him and see if he needs hospital?"

A grump, stomp and re-clothing later, I was back downstairs and ready to go out.

"Where is he?"

"He was helped up by some people but he didn't want an ambulance, so they helped him into some shop."

"Which shop?"

"The one next to the bank."

"There are two. One each side. Which. One?"

"Um, your favourite."

"My favourite? What's my favourite?"

"Umm, the fishmongers."

At least Jill and Rachel wouldn't find out.

The Keys to the Asylum

The council estate is a maze of rat-runs, dead end roads and multi-storey buildings. There's no logic to the numbering, and most of the buildings are unnamed, just to make it all that more exciting. The computer must know something I don't, as I turn into yet another alley and a disembodied voice from the sat-nav announces You have arrived. I drive around in circles, zooming in on the digital map trying to locate the tiny alleyway that was given as the address I was looking for, and try to find the man with the broken leg.

With no luck at finding the patient, I leave the blue lights flashing and give a couple of blasts on the siren. It's not too late at night, but still late enough that some of the neighbours, particularly children, may have been tucked up for the night. A few minutes later the crew follows me in to the multi-tentacled cul-de-sac. 

"No idea where this alley is, and no-one's come to find me." 

"We went up the other way first, no sign there either." 

After a few more minutes of searching up and down the same tiny roads, a figure appears at the top of a fire escape. "Oy! He's up here! Come on! Hurry up! What took you so long?" 

Not lying half dead in an alleyway then, and three flights of stairs up, probably not nursing a broken leg either. Nevertheless, between the three of us, we take all the kit we might need in case the call really is all it was stated to be, including a carry chair. As we reach the top of the stairs, Neil is sitting on a picnic box, his legs intact but his left arm bowed right in the middle of where it should be straight.

"How'd you do that then?"

His first words engulfed us all in a haze of alcoholic breath.

"Fell over, didn't I? Down that stupid alley. I told 'em someone was gonna get hurt, didn' think it'd be me now, did I?!"

We stabilised his arm in a splint and cleaned up a wound that he'd opened up on his eyebrow. It looked like it was an old scab that had opened up again.

"Do you fall often?"

"Nah, not really. Just a bit unlucky the last couple of weeks."

"How much have you had to drink tonight, Neil?"

"Oh, not much. Two, three pints maybe."

"Any other medical problems?"

"Yeah. My liver's knackered. They might have to replace it soon. 'Swhat the docs said, anyway."

"How'd that happen?"

"Well, I used to be an alcoholic. Not any more now though. Now I only have a couple of drinks a night, you know, when I'm at work."

"You used to be an alcoholic, but you're still drinking?" Then it hit me. "Hang on a minute. You drink at work?"

"Yeah. Course! There's got to be some perks to my job."

"Why, what do you do?"

"I'm a mixologist."

Oh. He's got an ology. "A what?"

"A mixologist. I mix all the cocktails at the bar."

"You're an alcoholic, and you work in a bar?"

"You bet. Does it get any better?"

"Well, your arm says it could probably get a lot worse." 

Cars

I don't know a great deal about cars, whether they have "Ambulance" plastered all across them or otherwise. 

I know that they need fuel, oil and water.

I know that you turn the ignition to start them, and turn the key the other way to turn them off.

I know what most of the controls do - which pedal does what and how far to turn the steering wheel.

I can, if needed, change a tyre.

Recently, I even ventured as far as changing a headlight bulb. If you own the same car I do, you would understand my sense of achievement.

But when it comes to cars going mechanically wrong, I have no idea where to start.

I have no idea what a cam belt looks like, or how many extra holes it would need if the car lost weight.

I have no idea what a clutch looks like. Then again, most Americans don't actually know what a clutch is.

I'd be too scared to change a battery or replace a spark plug. Do cars even have spark plugs?

However, I do know one thing for sure about cars.

If, when you start the engine and are about to head out on yet another call in the middle of the night, there is a loud THWUNK type of noise, and then, all of a sudden, sitting two metres in front of the car is a large, round metal piece of the engine, I know absolutely for certain that this is not a good thing.

Not a good thing at all.