Greg

"GREG?" 

The man looks up, raises an eyebrow, shrugs his shoulders and finally shakes his head. 

As for us, there's still a child with an asthma attack waiting for our attention. 

Greg will have to find help elsewhere. 

Thinking back to the crash, maybe he's already receiving it. 

Missing

We spread out and search a room each. The police broke the door down, leaving the splintered remains of the frame lying all over the carpet, like a giant wooden pile of pick-up-sticks. Greg's worried neighbour had called the police having not seen him all day and seeing that his morning newspaper was still sticking half way out of the letter box. 

"He often goes out for the day, but he's never this late back and never leaves before reading the paper first." He stands behind us as we step into the house, brave and afraid in equal measure. "I just hope he's alright." 

Each door is opened slowly as the fear of what may be found behind it gnaws away at the back of all our minds. The kitchen and main dining room are empty, as are the other two downstairs rooms. One of them looks as if it had been locked in a time-warp for fifty years, with piles of newspapers tidily stored all around the room. 

Some houses give more of an eerie feeling than others and this is one of them. Only half the lights seem to be working, the doors creak and floorboards whine as the small army of police, ambulance staff and worried neighbours walks around fearing the worst, but hoping for the best. The search continues upstairs and follows a similar pattern. A gentle opening of the doors, initial relief at finding nothing and then a move to the next room. A more thorough search of each room, behind beds, in hidden corners, in the toilets and bathrooms reveals nothing. Greg isn't at home. 

Initial relief is soon followed by concern. The police start to take a more detailed report from Greg's neighbours, knocking on a few doors up and down the street to see if anyone could remember the last time they'd seen him, the latest time being the previous afternoon. The lady next door tells us that she's known Greg for over twenty years. 

"He has family, but they all live somewhere in the north of England. Come down for Christmas and his birthdays, but that's about it. He's fiercely independent and very stubborn. Never asks for help or anything. Loves his days out, goes everywhere by bus." 

We ask our control to contact the local hospitals, wondering if Greg had been taken ill in the middle of the night or whilst out and about on one of his gallivants. As they contacted each hospital they called us back to let us know the answer. No hospital within a ten-mile radius was looking after Greg and concern for his welfare was building. The police had called his relatives just to make sure that he hadn't headed north without telling anyone, but he hadn't contacted them either. 

As we were about to leave, a white van pulls into the road, the two men on board had come to fix Greg's front door and make sure the house was safe and secure. "We'd have been here sooner," said the driver as he stepped out of the cab, "but we got stuck behind a crash. Some old bloke knocked over about a mile down the road. They've only just let us through!" 

The coincidence isn't lost on anyone and worried looks cross a number of faces. Yet again, one of the officers gets on the radio and tries to find out the name of the victim of the crash. We all hear the reply. 

"No details yet. He didn't have any ID on him." 

We have no choice other than to leave the scene and leave the police and neighbours to deal with the missing Greg. As we drive up the steep hill towards the main road, we're given another call. A child somewhere is having an asthma attack. It puts an end to our mystery call. We turn left at the top just in time to see an older man walking in the opposite direction. Shopping bags in each hand, he strolls without a care in the world. On a whim, I wind down the window and shout. 

"GREG?" 

DVT Confusion

When is a DVT, or deep-vein thrombosis, more dangerous to an ambulance crew than it is to the patient who's had one? Consider the following conversation:

Medic: "Does your husband have any medical conditions?"

WifeOfPatient: "Yes, he's diabetic and has high blood pressure."

Medic: "Any medications?"

WOP: "Oh, lots, I'll show you the list." A list is promptly produced. On there, alongside medications for the ailments already mentioned, is warfarin.

Medic: "Why is he on warfarin?"

WOP: "Oh, that's to thin the blood."

Medic: "Yes, well we know that bit. But why does he need his blood thinned?"

WOP: "Oh, he's got that thing, you know, the thing that's like a video or television thing."

Medic: "Pardon? What's TV got to do with blood thinners?"

WOP: "You know, that new-fangled thing they use to watch films now!"

Medic: "Nope. Still confused."

WOP: "Oh! I remember now. It's that thing in his leg. A DVD! Told you it was like a telly..."

Just so you know, it's a little difficult to treat your patient when you and your crew mate are having fits of the giggles...

Familiar Arms

Wrapped in blankets almost up to her eyes, Liana's barely visible. Naz, her husband, met us at the door with a roll of the eyes, as if to say here we go again. It takes a few minutes before we coax the first words out of her and longer still until we could calm her breathing enough to be able to have a conversation. A little boy of about three, a mix of Middle Eastern features and Eastern European pallor, runs around the house without a care in the world. Every few minutes he would come back in to check on what was happening and satisfied that there was nothing untoward, would go back to playing.

Naz never left the room for more than a few seconds at a time. He stood by the door, watching our every move, listening to every word. 

"Is Liana on any medication?" I ask him. 

"Only some painkillers when she needs them." 

"Do you have the packet?"

"I'll go and find it." 

The moment he leaves, Liana moves the blankets a little away from her face. 

"Liana, do you want to tell us what's wrong? What's got you so upset?" 

She shakes her head so violently that the straight-flowing tears suddenly zigzag their way down her cheeks. But she can't bring herself to say it. She just looks in the direction of the door and a shiver runs through her. When Naz comes back, I suggest that we need to do some more checks in the ambulance.

"I'll come with you." It's a demand rather than a request.

"Why don't you stay here with the little one, we'll just be a few minutes, do a few checks, then we can decide what the best plan is." 

Reluctantly, he agrees, but tells us he would just get their son ready and then he would be down too. In the time it takes him to find coats and shoes, we've already got half a story and realise that we need to get Liana away from home. She told us a little of the terror she faces at home every day, how she's not allowed friends, how her family have been kept away, how the threats of harming their child make sure she's kept on a short leash. Before she can tell us any more, the door to the ambulance swings open and Liana jumps in fear.

"Well, what are you doing with her? She doesn't need hospital, you know. She just needs to get back home and calm down. She's always doing this." 

"Where's your boy?" 

He shuffles slightly aside to show us a frightened shell of a child, totally different from the one we met upstairs. 

"I think we need to take Liana to hospital. Her pulse and blood pressure are a little concerning, so we want a doctor to look at her." It's a white lie, one we hoped was real enough for him to accept. 

"You're sure, yes?" 

"I'm sure." 

"Can I come with you?" 

"Why don't you come in your car, then you've got a way of coming home?" 

"Fine. But I don't want this child crying all the way there. You can take him too." 

"Not a problem. We'll look after them both. We're only going to the nearest hospital."

"I'll be a few minutes behind you. I go to the emergency department?" 

"Indeed." 

For the few minutes in the ambulance, Liana was silent. Her little boy had calmed down a little, a combination of glove balloons and a bottle of bubbles easing his fears. He even managed a laugh when one of the bubbles flew up to the roof of the ambulance, drifted slowly down and suddenly popped on his nose. As we arrive at the hospital, an all too familiar queue appears in front of us, with two other crews and their patients waiting for triage. It gives us some more time to talk, but Liana chooses to keep quiet. 

As we reach the front of the line, I have one final chance. 

"Has he ever hit you?" 

A single tear escapes and rolls down her face, as a confused little boy wipes it away for her. She leans forward, kisses him on the head and lifts the back of her shirt. She's black and blue from top to bottom. Belt marks, cigarette burns and crude, jagged cuts cover her entire back. 

"Please don't tell anyone. Please!" Her plea is barely audible, no more than a tormented whisper.

"Liana, I don't have a choice. Some of these wounds need treatment. I have to tell the nurse."

After more tears and pleads, once we promise that both she and her little boy will be looked after, she finally agrees. Having waited almost half an hour, we hand over just as Naz walks into the department and immediately all the eyes turn on him. 

"You told them, didn't you? I told you what would happen if you told anyone!" His screams make every other person in the department turn around and make me clutch on to the little boy. "What are you all looking at? She deserved it!" 

A security guard hurries over and after a bit of a struggle promptly removes Naz from the department, all the while calling for police over the radio. Liana breathes a sigh of relief and holds on tightly to her little boy who I've handed back into familiar arms.

NHS

"I know what NHS stands for!" announced mini-Insomniac as he visited his mum in hospital. "It's Natural History Science!"

I can only presume he's alluding to his two favourite London museums. And it beats "No Help Service" that I've heard bandied about in the past... 

The best I could come up with in a hurry? "Not Healthy? Sick!"

Any other ideas? 

Transcript

The following is an almost word by word transcript of a phone conversation I had not long ago. It has nothing to do with EMS, ambulances or anything such like, except for the fact that the conversation took place when I was woken up by the phone ringing less than an hour after going to bed after a night shift. 

It was a conversation between ColdCaller (CC) and a slightly disgruntled, but surprisingly ever calm InsomniacMedic (IM). For the purposes of this conversation, IM lives at 123 High Street, Neartown, Z99 9ZZ. 

*RING RING* *RING RING*

IM: Unintelligible... "Hello?" 

CC: Overseas call pause and click... "Is this Mr IM?" 

IM: "Who's this?" 

CC: "This is Bill from PPI International. I'm calling you to help save you money."

IM: "Whatever you're selling, I'm not buying." 

CC: "I'm not selling anything sir. I'm offering you a service."

IM: "And what service might that be?" 

CC: "Like I said, I'm calling to help you save money, by claiming back payments on a loan that you shouldn't have made."

IM: "Which loan would that be?" 

CC: "You know the one, the loan you took out some time ago." 

IM: "Hedging your bets there, aren't you?" 

CC: "I'm sorry, I don't understand."

IM: "Never mind. Can you tell me the name of your company again please and where you're based?" 

CC: "PPI International, and our headquarters are in Karachi." 

IM: "And you're not selling anything, just offering a service, right?" 

CC: "Correct." 

IM: "Is this a free service?" 

CC: "Well, no, it is not free, we charge a fee." 

IM: "So you are selling something then?"

CC: "It is not selling, it is providing a service for a fee." 

IM: "Right. OK then. And who's the CEO of your company?" 

CC: "Why do you ask?" 

IM: "I like to know about any company which randomly calls and offers to help me. I just want to do some research and make sure that you are who you say you are." 

CC: "The CEO is Mr Khan." 

IM: "You say that your HQ is in Karachi. Where exactly is your office?" 

CC: "You want to know where my office is?" 

IM: "Exactly. Where do you go every day to make these phone calls?"

CC: "I'm not sure of the exact address." 

IM: "You don't know where you go to work every day?" 

CC: "I know where I go, I just don't know the address." 

IM: "I'll ask you one more time, and if you can't answer the question, I'm hanging up. Where do you go to work every day?" 

CC: Short pause. "OK, I don't normally give out my work address, but it is 123 High Street, Neartown."

IM: "Pardon? Can you repeat that? And tell me the postcode too please." 

CC: "My work address is 123 High Street, Neartown, Z99 9ZZ." 

IM: "You're sure? That's your work address? That's where you start and finish every working day?" 

CC: "Yes, that's right." 

IM: "Well then, how do you like your coffee???" 

CC: "Umm... Err..." Click, Beeeep

Moral of the story? Never, never, wake up an already sleep-deprived insomniac. 

Tick Tock

Times, they are a-changin'. Or so said Bob Dylan. Personally, I'd reverse the lyrics. Over the past few months I've had the opportunity to work with several student paramedics, either as a working crew, or when they're out on vehicles and I'm on the car. Some are good, some less so. Some who are too young, whilst others are either mature students or have maturity beyond their years. All, however, seem to have arrived bamboozled by the power of the clock. 

I'm going to be honest. I don't give a damn about the time limits we're given, particularly when it comes to turn-around times at hospital. It's probably best that I don't give a damn, because I suspect that my turn-around times are probably giving my management team nightmares. I do, however, give a damn about my patients, so I get to the call as quickly as I safely can, I treat them as best I can. We have fifteen minutes in which to hand our patient over to hospital staff, clean the ambulance, restock the missing bits of kit (if possible - sometimes it's a bit of a challenge to do anything short of reallocating resources from either hospital or another ambulance), use the bathroom if required, grab a quick drink and sometimes a bite to eat, and, of course, complete the paperwork. 

Admittedly, the fifteen minutes on which we're currently assessed don't start until our patient is on a hospital trolley or in the waiting room, so the three hours(!) I waited the other day with a patient on our trolley bed won't count against me. I do realise that we don't have to have a coffee or use the facilities after every call, but the pressure of this quarter-of-an-hour time limit has led to what, at least in my eyes, is an ugly new trend, particularly amongst these new paramedics and students. 

The trend? Completing the paperwork before we've even left the scene of the call. Not just the basic details, but every last bit of paperwork.

I hate it. The patient is in the back of the ambulance, a history has been taken indoors, observations checked and rechecked (after all, every patient must have two sets of obs - yet another box-ticking nonsense in many cases), the patient has received treatment if appropriate and/or required, all whilst the family are standing outside wondering what's happening. Often, the patient is wondering the same thing too. 

The patient is in the back of the ambulance for one reason and one reason only. You've made the decision that they need to go to hospital. Well, either that, or the patient has made that decision themselves and aren't going to be persuaded otherwise. In either case, the reason is the same. That patient is going to hospital. They don't want to be sitting on their own doorstep for an extra fifteen minutes with the blood pressure cuff aimlessly inflating automatically at five minute intervals. They don't want their family standing outside the ambulance concerned that something terrible has happened. They certainly don't want to be ignored for the time it takes to complete the scribbled account of everything that they've just told you. 

They want to go to hospital. 

Many (most?) of our patients need no treatment on route to hospital other than a smile and some friendly, calming banter. Talk about the weather, talk about their children and grandchildren, talk about their wartime experiences, talk about the football or last night's garbage television. Talk, and write. And if you can't do both, then just talk. If your patient isn't interested in conversation, then you can just write, but be on the move. And if, by the time you get to hospital you haven't completed your paperwork, do what I do, and take whatever time it takes. 

Paperwork, as well as being the bane of the life of any paramedic, is a legal document. If it's not written down, it didn't happen. Standing in front of a coroner and claiming that you provided treatment but failed to document it will leave the coroner with no choice but to accuse you of lying, so you do need to make sure that everything is written down. It is, of course, helpful to write down the patient's details as they tell you their name and date of birth. But as far as the story, the history and the symptoms are concerned, just listen, make mental notes or even quickly scribbled ones on a notepad and then write them down properly later, once your patient is no longer yours. If you can do it in the allocated time, all well and good. If you can't, if you need to pay extra attention to detail, if you need to ignore the clock, just do it. 

Concentrate on your patient, not on the clock. It takes a while to learn the knack of writing and talking at the same time as being on the move across the pot-holed London streets, but it's a skill worth learning. But if you can't manage it, then just wait. Arguing that completing the turn-around in the allocated time is beneficial to other patients by being back in service quicker, is no more than complete nonsense. If you've taken exactly the same time to complete the call by standing outside the patient's house for those precious minutes, then you're not back in service any quicker. 

Concentrate on your patient, not on the clock. It takes a while to develop a system that ensures that everything that needs to be written down actually makes it from thoughts onto paper, but it's a system that's worth having. If you can't manage it within the precious time allotted to you at hospital, then just take a little longer. Each patient is worthy of your personal attention. That tick-tocking noise in the back of your mind should come a distant second. 

A little more of the personal touch and a little less of the clock-watching paranoia can turn a good paramedic student into a great one. Try it. You may be surprised at the results. 

Edna and Eddie

Surrounded by his wife, children and grandchildren, Eddie sits in an armchair so huge that it seems to almost swallow him up. 

"I'm alright," he says. "Don't know what all the fuss is about!" 

His face is pale and the sweat is pouring off him, whilst his arms hang down lethargically by the side of the chair. He denies any pain but does admit to feeling a little dizzy. 

"He's had heart trouble for years," says Edna, his wife of almost sixty years. "Never makes a fuss. Always ignores any problems until they get really too much." This time, he'd passed out for a few minutes, giving the family enough time to call for the ambulance before he came round enough to object. 

"I'm fine, I tell you." 

"Let's have a look at you and we can see what's going on. It'll only take a few minutes." 

"Oh. Do what you have to do. But I tell you there's nothing wrong that a drink down the pub with a couple of young ladies wouldn't sort." 

Edna shakes her head and rolls her eyes. "Oh, do stop messing around Eddie. You frightened the life out of the children you know. And me for that matter!" 

It takes only for me to feel for a pulse at his wrist to tell me what the problem is, or at least part of it. 

"Eddie, do you have a pacemaker?" 

"Not yet. They were talking of giving me one a while back when I kept getting dizzy spells, but whatever the problem was went away so they didn't think it was necessary." 

"Ah. I think they might have to think again. Your pulse is less than half what it should be!" Attaching him to the monitor, I hit the alarm silencing button before the irritating whine even has the chance to tell me what I already know. The number 28 appears in a bold yellow highlighted box at the top left of the screen and the flicker of a heartbeat flashes across the monitor only every other second. At least his blood pressure was behaving itself. "You're definitely going to need to pop up to the hospital. Can't have your heart only doing part time labour for full time pay." 

Moments later, the rumble of a diesel engine struggling up the steeply inclined street tells us of the ambulance's arrival. Tanya and Michelle step into the house, bringing a carry chair with them and a smile to Eddie's face. I introduce them to Eddie, explain the situation and tell them what I'd found so far. 

"He says that a drink down the pub with two young ladies should sort the problem." 

"Well," says Tanya, "it doesn't seem to be working so far. We've turned up, and your heart rate still hasn't picked up!" 

"Oh," Eddie replies, "well it might not be beating any faster, but, I can tell you, since you two walked in, it's certainly beating much stronger." 

Edna, for what must be the millionth time in their marriage, shakes her head and rolls her eyes.

Last Light of Day

The first I saw of Mel was a late summer's evening, when we were called to her house for a very simple transport. Arriving ten minutes earlier than the scheduled pick-up time and understanding the significance of the call, we waited outside in the ambulance for those few minutes. As the clock struck on the hour, we knocked on the front door and waited. 

"Oh, you're here! Sorry, we're running a few minutes late." Rob looked tired and hassled as he moved a small suitcase out of the way so that we could get in.  "I've never been a good one for time keeping, that's always been Mel's job. Speaking of which, you'd better come in and meet her." 

Rob shows us to their bedroom, as Andy and I size up the corridors and turns to see which will be the easiest route out again - on a wheelchair or the trolley bed - but the last corner is too tight for the latter. Mel's eyes are closed as we walk in, but she still manages to welcome us. 

"Hi guys. Let me guess, he's running late, right?" 

"Well, yes, but take your time. We're in no hurry. We're either here in your lovely home, or out there fighting with drunks. I know which I'd prefer." 

"Has he offered you tea yet?" Mel gives Rob a look of resignation, as if all the lessons she's been trying to teach him have failed to register. 

"No. We're good thanks. Too much tea is an occupational hazard we need to avoid. Not enough toilet stops, you see." 

Mel manages a smile as Rob steps out to finish packing. All around her are cards and flowers, messages of support cover the bedside table and windowsill. A single picture in a frame sits in the middle of all the cards. A photograph of two young children, one boy, one girl, both in school uniform, lazing on a wooden bench in the shadow of an enormous tree. 

"Twins?" Andy asks, pointing to the picture. 

"Twins. But born a day apart. Well, ten minutes really, but one each either side of midnight. I'd always heard stories like that, but never thought it would happen to me!" 

"Cool. How old are they?" 

"Eleven. That picture was taken two days after I was diagnosed, three years ago, so I guess they must have been eight then. I'm sure they'll be down in a second." 

Rob comes back into the room with a glass of water for each of us and behind him, as if on cue, are the twins. 

"Ah, maybe I have taught him something after all!" 

"Oy, be nice! Or I'll tell 'em to drive you over every pot hole from here to the hospice!"

"You wouldn't make my last ambulance ride a bumpy one, would you guys?" 

"We wouldn't dare! Well, not unless the money was good enough!" 

Last minute logistical arrangements meant that the twins would come with us in the ambulance, whilst Rob would drive his car, leaving them with transport to get home again. As we wrapped Mel in a blanket on our wheelchair, she remembered to check a few things with Rob. 

"Are the kids' uniforms ready?" 

"Yes." 

"Their lunches?" 

"Yes!" 

"You set the alarm for the morning?" 

"For heavens' sake, Mel. YES! Have some faith, won't you? Now, I'll be back in a second, just going to lock the back door." 

We wheeled Mel to the front door and waited for Rob. The twins stood just outside, half staring into the back of the open ambulance, its tail lift sitting on the floor waiting to swallow its precious cargo. 

"Shall I switch the hall light off?" Andy asks Rob. 

"Actually," says Mel, "do you mind if I do it?" 

We lift Mel just high enough in the wheelchair so she can reach the switch, and as the sun sets through the clouds outside, the hall is engulfed in the orange glow of the last light of day. 

The A to Z of 2011

Abuse on some staff, and Booze bus galore,

car crashes, drugs deaths of children and more.

Some eavesdropping stories and unhelpful friends,

girlfriends who cry when their boys make amends.

Hysterical children, invisible men.

Jokes on the nurses, knives out again.

Lives are saved and more memories learned,

Nero's a hero, a man's overheard.

Police under threat, questions ignored,

Riots in London and strikes 'cross the board.

Teddies tell stories that children can't share,

Uniforms and vests can't hide that we care.

Visions that haunt me, the writer's block time,

Arms that need X-rays, and yawning in rhyme.

And now as we near year's end, and this verse, 

I'm still lacking Zzz's, the Insomniac's curse. 

Responding

Lt Michael Morse writes one of the best EMS blogs out there - Rescuing Providence, and has the guts to put his real name to it! If you've never read it, you need to fix that now. Three years ago, he published his first book by the same name. 

Now there's a second book, called: Responding. 

I'll be honest, I've yet to read the book, but it's on order. If it's anything like his blog, it'll be well worth every penny. The fact that yours truly has a small mention on the acknowledgments page is nothing short of an honour and privilege. 

Welcome Home

A grand old house, maybe a century old, maybe even older, stands at the top of the long, dark road. Balloons and a Welcome Home sign hang over the front door, but once inside, more traditional decorations greet visitors walking into what looked from the outside like a stately manor, but inside was yet another nursing home. A tree in the corner, tinsel around the door handles and frames, cards strung from one side of the dining room to the other. The staff were all in a jovial mood, some wearing festive hats, many wearing badges and gimmicky trinkets on their uniforms. Even the dozen or so residents seemed to be enjoying themselves.

A carer meets us by the door and shows us to Mr Hella's room.

"He is unconscious. He's diabetic and his sugar is low. We've tried to give him glucose tablets and that gel stuff, but nothing is working, so we've had to call you."

"No problem. That's what we're here for." We notice the spotless carpets, the freshly painted walls and the furniture that looked either brand new or just very well cared for. "Nice to see a home where people actually take time to look after the place! Have you had it done up just for Christmas?"

"Something like that. We're trying to keep it that way and hopefully it will last." He points to the room at the end of the corridor and tells us that the nurse is there to help us further.

"Oh, good. You're here. We've tried everything to bring him round, but nothing's working. Hope this isn't a waste of your time."

Mr Hella's blood sugar has dropped so far, that the machine won't even give us a reading. A digital "LO" flashes up on the screen, although we didn't really need to check it. All the classic signs were there. A thready, rapid pulse, sweat pouring off him in buckets and an odd sounding snore when he breathed.

"We've only known him three days, he's a lovely chap and nearly ninety, but this is the second time he's done this to us in two days. Last time we managed to bring him round. He's not on insulin, just tablets, but they must be too strong for him."

"Good work!"

As we find a vein and draw up some glucose to feed his blood with some much needed sugar, we have time to talk to the nurse, complimenting her and the staff again for keeping the care home so clean, making the effort, and especially for being helpful to ambulance crews. Too often when we're called to care homes we're met more by apathy and resignation than by helpful, knowledgeable staff. Assuming, that is, that we're met at all. Sometimes we have to guess which of the rooms is hiding our patient, often having stood outside the building for some time before anyone let us in. 

This place was a timely reminder that not all care homes are the same. 

"Good to see that you seem to have a system that works well when you call an ambulance." 

"You think it works?" 

"Well, we were met at the front door, given a brief idea of what's going on, shown the way to our patient, and had a handover from someone who knows the patient and their condition. I'd say that's a pretty good system." 

"Isn't it the same in all these places?" 

"You're kidding, aren't you?" 

"Well, I'm glad you think it works. You're our first ambulance." 

"Today?" 

"No." 

"This week?" 

"No. First ambulance ever." 

"What? You've never had to call an ambulance before?" 

"No. Never." An amazingly rare feat for any care home, and a record to be proud of.

Mr Hella starts to come round, the sugary water coursing through his blood and up into his brain. 

"Who are you?" 

"Ambulance service, sir. It seems you gave these people a bit of a fright." 

"Oh, I'm so sorry. Did my sugar level drop again?" It seems that he's more used to his condition than the staff who are looking after him. 

"Just a little. They seem to take good care of you here." 

"They are truly amazing. I only wish I could have moved here sooner." 

"When did you move here?" 

"Three days ago. My family have been trying to convince me either to move in with one of them or move into a home ever since my wife died. I needed someone to care for me when I pulled these sorts of tricks." 

"So what took you so long?" 

"First, I'm a stubborn old fool, and proud of it. Secondly, all the places I looked at were awful. Or worse. But I had a look around here when they were just putting it together and when they opened, I jumped at the chance!" 

"Jumped?" asked the nurse with an amused grin.

"Well, gently moved in a positive direction." 

We all laughed. "I think, since this is your second attempt at being difficult in as many days, we should probably get you checked at hospital. Just to make sure you're going to behave." 

"Hospital already? I've only been here five minutes!" 

"But," said the nurse, "you do have the distinct honour of being our first ever ambulance patient." 

"Well, that's no surprise, is it?" 

Confused, I had to ask the obvious question. "Why isn't that surprising?" 

"Well, they've only been open for three days. I was their first ever customer!" 

No amount of pleading would convince him to take a seat on our wheelchair out to the ambulance. "I'll walk, thanks. Just get me my frame. I might be old, but I'm not that elderly. And you," he said, looking back to the nurse, "make sure you look after the place until I get back. Can't have my new home going to ruin whilst I'm away." 

"Don't worry. We'll keep the sign up just for you, Mr Hella." 

Nero's Virus

Clouds are building, the forecast downpour seems just minutes away. Set against the dark background is an unassuming row of terraced housing, the exact same kind that's seen in every part of town. One house, however, stands out from the rest. The brickwork is painted a glorious yellow, the window frames green, the colours complementing each other and brightening up a boring row of houses. The front door, its paintwork matching the windows, is opened by a character just as colourful.

"Oh good, you're here!" Burgundy trousers, black shirt and multicoloured waistcoat with matching bow-tie on a man who can only be described as a pantomime giant. "She's just upstairs. Think she's got that horrible winter bug. What do they call it? Nero's Virus? Not that I know what a Roman emperor's got to do with viruses."

"That'll be norovirus."

"I prefer my version. Got more class to it."

"To be honest, I do too. I think we'll use that from now on."

As is always the case when patients are sick, she's in the bedroom on the top floor of the townhouse, two flights of stairs up. Vera is John's total opposite. Dressed in dark pyjamas and wrapped in a plain dressing gown, her dress sense and tiny body are completely out of character with her house and incongruous with her theatrical husband.

"It's been three days now," John tells us. "She can't keep anything down. It just comes out almost instantly, one way or the other. Even water."

"I'm sorry we had to call you gentlemen." Vera talks in between attempts to empty any remaining contents of her stomach. "We just didn't know what else to do. We've tried all the over-the-counter stuff. Nothing works. Every time I try to stand up, I feel like I'm going to keel over."

We check her vital signs and find that her blood pressure is low, which explains why she feels faint whenever she stands up.

"Lets get some fluids into you before we move, then we'll get you on a chair and up to the hospital."

"Do I really need to go?"

"I think it's probably for the best. You can't keep going with the blood pressure of a five-year-old."

She sighs. "I've never had to go to hospital in my life. And when you're as old as I am, that's a long time!"

"Well, if that's the case, it's about time you saw what all the fuss is about. I'm sure they'll look after you."

"Alright then. Do what you need to do."

We give Vera some medication to help stop the nausea and she gets some fluids too, enough to make sure her blood pressure is a little more settled before we start moving her down two flights of stairs. Once we're ready, she takes a seat on the folding chair, we wrap her in a blanket and secure her with the bright yellow strap. Half way down the first flight of stairs, the lights go out, and the house is left in complete darkness. I manage to fish the pen-torch out of my top pocket whilst balancing the chair with one hand and with the aid of my belt, bite the torch between my teeth, and we manage to get down the last few stairs. There was another flight to go and dim light wasn't quite enough, so we stopped on the landing. 

"Hang on a minute," says John, "I think I remember seeing a candle in the draw upstairs. Lend me that torch and I'll go find it." A minute of darkness later, he comes back with the candle. "Only one problem," he says. "The matches are downstairs in the kitchen." 

"Don't worry," laughs my crew mate, "I've got a lighter." 

"Well, how about that then! Haven't had a powercut in these parts for years! It's a miracle I still had that one candle. Left over from her birthday cake, the one the kids brought over last month." 

A combination of candlelight and torchlight saw us the rest of the way, until we reached the street that was lit up by the flashing blue lights. As we were about to step out of the house, Vera remembered the one thing she wanted. 

"Will you bring my walking stick with you? I can't go anywhere without it."

"Are you sure you want it? We've strapped you in to the chair, it's on wheels, and you're going on a trolley bed. You're not exactly walking anywhere."

"Still, I'd really rather have it." 

"OK, where is it?" 

She hesitates, almost scared to answer the question. "It's in the bedroom." 

Vera smiles as I tut theatrically and roll my eyes. "Let's get you comfortable in the ambulance, then I'll go and get it. But you're sure you want it? Walking sticks have a habit of going for walks without their owners in hospitals." 

"And the way I feel, it could probably walk a darn sight quicker!" As we helped her across to the bed, she vomited once more, and we got a bowl to her just in time. 

"Wouldn't want to get your pyjamas in a mess, would we?" We covered Vera in the blanket that had kept her safe as we carried her downstairs and tightened the strap around her legs, telling her it was just to make sure she didn't run off. "By the way, you don't own a fiddle by any chance, do you?" 

"A fiddle? Why do I need a fiddle?" 

"Oh, you know, it'll give Nero and his virus something to do..." 

The Secret of Medicine

Ah, the joys of plagiarism. 

"Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better. The human body is exquisitely talented at healing.  If bodies didn’t heal by themselves, we’d be up the creek. Even in an Intensive Care Unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you gave it plenty of gas, oil and brake fluid, and then expect the transmission to  fix itself."

What a fabulous paragraph, even if the article is a couple of years old. Click on the quote above to read the rest of the article by Dr. Thomas A. Doyle. No, I don't know who he is or anything about him either, except for the bit of blurb at the end of the article. But he has some very interesting things to say, don't you think? 

Change "America" for "UK", or anywhere else in the developed world, and I suspect that the same problems are present all over. 

So what do you think? Does he have a point? Are we really a nation of wimps? More to the point, does the medical system here just pander to too much? 

Case in point, particularly after the weekend just gone - The Booze Bus. Look at the photo. A transport ambulance, with a fully trained paramedic crew, loaded with three (that I can see, anyway) people who have nothing wrong with them other than an under-developed sense of responsibility and self-awareness. Should the health system really be paying for what is no more than a babysitting service for people who, a few years ago, would have spent the night in a police cell and woken up to a hangover, a steel door, a charge of drunk and incapable, and a large fine? Nothing's changed since then, except for the fear of litigation, and that in itself is well on its way to bankrupting our health system. 

I know the arguments for and against the concept of the Booze Bus (or, Alternative Response Vehicle, to give it its official title). I understand both sides, and I know that had it have been available last night around where I was working, I would have had four fewer patients. Or at least different ones. But I still feel that society as a whole needs to realise that the days of personal responsibility need to return, that the pot of money is not unlimited, and that sooner or later, whether we like it or not, charges will have to be made on certain categories of patients. I just think that the Booze Bus is as good a place as any to start. 

Threatened

I'm not entirely certain what I'd done to offend you, other than come in to help save your mother's life (which would be the last on my list of things to get ticked off about), but as it seems clear that I have upset you in some way, allow me to offer you a little bit of advice. 

If you're going to threaten, in a language other than English, to kill me and my family, maybe you should check one thing first - check that I don't understand what you're saying. 

Otherwise, you will be left with only one of two options: 

Either you leave the house. 

Or I do. 

Seeing as I'm the one with the knowledge, skills and equipment to actually help your ailing relative, I would suggest the first option as the more prudent of the two. Acting all innocent and pretending that you didn't say what I heard, or didn't mean what you said, or, more likely, didn't mean for me to hear and understand it, is all a little bit too late. 

A moment passes, you stand your ground, shout at all those around you. Even your family know you're in the wrong, that you've been rumbled. They want you out as much as I do, but you refuse to leave, or at the very least, apologise. As I stand up to leave, having made sure to leave the oxygen with the patient so that she suffers a little less, you block my path, holding a fist up to my face. 

"I'll kill you if you leave!" 

"A second ago you were threatening to kill me if I stayed. Now make your mind up. Either get out of my way, let me out of the house and you can deal with the consequences, or you can leave and let me treat your mother. Your choice, but the longer we stand here, the worse things get for her." 

You shout some more, a mix of languages. You push your brother out the way, storm out to the street and slam the door behind you. 

After you leave, several sighs of relief can be heard, and amongst them one voice, quiet and muffled by a plastic oxygen mask. 

"Good choice, son." 

Picture on the Wall

A smiling face adorns the walls,
in frames all shapes and sizes,
Holding trophies, hugging dad,
bringing home surprises.

A quick look round the house again,
whilst clearing up the mess,
Certificates of excellence,
no signs of any stress.

Yet here we are, police are too,
looking at the rope.
That piece of ragged, torn up towel
that's stolen all your hope.

Your smiling face, a child so proud,
watched us as we tried.
Tried to save your dying dad,
'Til that silent face then cried.

I never met you, little one,
but know one thing for sure.
We tried our hardest, tried it all,
until there was no more.

All that pride there in your eyes,
as you stand with your team.
Your face will stay there, in my mind,

play havoc in my dreams.

I'd hate to see those eyes go dim,
I'd hate to see those tears.
Just to imagine your heart break,
brings out my deepest fears.

Your smiling face adorns the walls,
despite the sight so grim.
I'm sorry we weren't good enough,
to give you back to him.

Bragging Rights

Sometimes, I look at the career I've chosen,

and think back to my biology teacher. And laugh.

(No more than the most basic grasp of the subject.)

Sometimes, I look at the blog I write,

and think back to my English teacher. And laugh.

(Poor writing style, no imagination, little effort.)

Sometimes, I look at the job I do,

and think back to my careers adviser. And laugh. 

(Back-office job, contact with the public ill-advised.)

I laugh at how wrong they were. 

I laugh at how I believed everything they said. 

I laugh at how, despite the fact that I believed them at the time, I proved them all wrong. 

A very good friend of mine recently told me that he used to read my blog, but stopped because it was too self-centred, sounded too much like a self-portrait of a hero in the making. Initially, I was a little troubled by his comments, well, actually, more than just a little troubled. I didn't perceive that this is what this blog is all about. However, thinking about it, I guess he was at least partially right. It is very self-centred. But that's only because I can only write what I feel. I can't express the feelings of the people I meet, although I can often have a good guess. And for anyone who's known me for any length of time knows, expressing what I feel is a very new (and exceptionally frightening) concept that I still fail at doing in a face-to-face situation. It's precisely why I took to writing. 

As for heroics? Pah. Anyone who does the same job I do is as much a hero as I am, although I am almost totally certain that none of us looks inwards and sees anything suchlike. We see a person who may have a special skill, maybe even a special connection with people we've never met before and may never meet again. We may even be opportunists who are presented with a statistically skewed number of chances to help preserve a human life. But heroes? Soldiers who save their comrades whilst under heavy fire are heroes. Random members of the public who jump into a raging sea to save a drowning child are heroes. We have a job to do, a special job maybe, but we wear uniforms, not capes. 

All of that doesn't mean that I'm not proud of who I am and what I do - alongside my colleagues. I may have recently had some second thoughts, well, more of a crisis of confidence really, but hopefully I'm back to  what passes as almost normal. I'm still pleased that I chose the path I did, even if it did take me some time to realise what that path should be. And if that comes across in this blog as being too self-centred - well, good. Because, whether my friend likes it or not (and yes, we're still friends), I've still got much to brag about. Even if it is self-centred. 

More Drunken Logic

Drunks. 

Love 'em or hate 'em, they're always there. Some obnoxious, some difficult, some driving when they really shouldn't be, risking their own lives as well as the lives of all around them. 

Every so often, we come across a gem, the entertainment value often carrying us through the rest of the shift. Recently, a friend of mine, previously nicknamed "Little" told me of the following conversation:

Medic: "Who's your next of kin?" 

Drunk: "What's that then?"

Medic: "You know, someone you'd want to contact in an emergency!"

Drunk: "Oh! That's you then!" 

Once again, another case of infallible drunken logic. 

Enjoy your weekend, go out, have a drink, have a good time. Just stay safe. 

Silence

Two faces in the dead of night, staring out of the front windscreen of a destroyed car. One's talking to me,  bragging, apologising, part regaling in their achievements, part regretting their actions. He tells me of their drink fuelled night, how they argued over who would drive, how they agreed that they'd have one go each at making the car fly over the bridge. His friend is quiet, eyes staring into the distance.

They succeeded. The police estimated that they must have been driving at over a hundred miles an hour when they hit the brow of the hill. The car's front was unrecognisable, make and model only clear from the back, airbags deployed all around. As we strap him down to a board, hoping to prevent any further injury, he tells us that once they'd left the road, the car just seemed to fly sideways instead of straight, and there was nothing they could do. In the meantime, the police dealt with his friend.

He kept saying that he wasn't brave enough to drive that fast, and when they failed the first time, they turned around, lined up again, changed seats, and had another go. He talked to us all the way to hospital, barely noticing any checks we did, any treatments we provided, just boasting about their tricks, about how impressed he was with his friend, the one we'd left on scene.

"Car's a write-off, isn't it?"

"I'd guess so."

"How come you guys got me out first? Is it because I was making so much noise?"

"Something like that, yeah."

"Well, my leg is smashed, isn't it?" It was. 

"Guess my mate's OK then, he didn't seem too hurt, just sitting back like that in his chair." 

A police officer travelling with us shuffles uncomfortably in his seat, and gives me a quick look. He makes a few more notes in his pocket book, checks once more for our call sign, and asks the passenger again what happened. He goes through the stories again, tells how they took a longer run up the second time round, makes sure that we know that he wasn't driving, that his friend was.

"I was in the driver's seat first time, but we didn't take off. So he took over. Called me all sorts of things for chickening out. But he did it! It was so cool! Shame we hit that fence though, won't be able to do it in that car again!"

It wasn't the fence that was the problem. It was the street light after the fence, the one that had smashed through the roof and the windscreen of the car. On the driver's side. The passenger, our patient, notices the looks, senses the unease. 

"Is my friend OK? Is there another ambulance looking after him? How come you didn't get him out too?" His world crashes in around him as the reality dawns, and he shouts. "I asked you, is he OK?"

I look across at the officer, who gives me an almost imperceptible nod of the head. 

"No. He's not OK. He's dead." 

Suddenly, silence engulfs the ambulance. 

Images

When insomnia seems a blessing rather than a curse, I know that it's time to take a break. When sleeping leads to dreams, nightmares, that wake me up, sometimes it's better just to stay awake. It's then that I know that I need to step away, albeit briefly. For some reason, working the day (well, two nights) of the strike last week, led me to exactly that point.

Working those shifts led to a torrent of emotions, from fear to pride, from anxiety to hatred, from fulfilment to total despair. Finishing my shift on the morning after, I got home and was ready to throw my uniform away for good. I was exhausted and frustrated, and calls that I would normally deal with on a regular basis, and that would have no lasting effects on me, suddenly turned into difficult calls. I heard of other calls that night, calls that I thank my lucky stars that I didn't attend but that colleagues, friends of mine did, because I think that having to deal with those calls as well, would have left me a broken shell. It seems that the world was going all out to make it as difficult as possible to do our job. Fewer ambulances, more calls, more serious calls. 

And I left work that night with the image of a smiling child burnt into my mind. A picture that was hanging on a wall. A child, no older than my youngest, with a grin like a Cheshire cat, holding a trophy, beaming with pride.  That child was about to have their world crumble all around them, as soon as the police had done their job - a job I didn't envy one little bit. 

It all conspired to leave me wondering whether it was all worth it, with what the police officer in the blog I've linked to refers to as an involuntary slide show. The politics, the trauma, the arguments, the abuse, the emotions. I had to step away, just for a few days. Not read any blogs or write them, not think about the ambulance service, not talk about it, not consider the possibility of working some overtime. I had to spend some time with friends and family, some time not seeing things in perspective, but seeing them through slightly rose-tinted glasses. 

The image of that child will, I'm sure, stay with me, even though I never met them in person. One day, I might write about the call itself, but not yet. For now, I'm ready to go back to work, if a little anxious. The tensions of the strike are no longer there, everyone is just there to do what we do best: saving people's lives. Or at the very least, improving them.