Thursday, 17 July 2014

War and EMS

This is a post I have written, deleted and rewritten several times. It is a risky post, as it has the
potential to delve into political wranglings that I do not wish to enter. Nevertheless, I want to write about a side to EMS that very few have seen.

Those of you who have followed this blog for any time, will know that just over two years ago, I left the relatively safe shores of the UK and headed to continue my life and my career in Israel. Just the name of this country evokes images in people's minds that I cannot control. Some for better, some for worse. Living here is a complex mix of normality and insanity, of the usual and the unusual, of war and peace. Few places in the world stir up as much feeling as Israel does. There are lovers and haters, there are the passionate and reserved, but there are very few who have no feelings one way or the other when it comes to Israel. That, despite the fact that too few could point it out on a map or describe its size. (Look on a world map for the eastern edge of the Mediterranean Sea in between Egypt, Jordan, Syria and Lebanon for a dot about the size of Wales, or New Jersey...)

The national ambulance service is called Magen David Adom - Red Shield of David - (follow them on Twitter here) and is an affiliate of the international Red Cross. It serves a population of some eight million people in times of peace and war. It has in the past sent crews to disaster zones such as the Philippines, Haiti and Turkey. It has dealt with mass casualty incidents from which the world has come to learn. It is, however, or at least tries to be when circumstances allow, just an ambulance service treating its population for all manner of illness and injury as is seen in any normal (for want of a better word) part of the world. 

The last two weeks have been a little unusual, to say the very least. Treating patients has taken on a different sort of urgency, when the decision making process doesn't only include what the best treatment options are, but also where is the nearest point of safety for when the air-raid siren sounds. Each ambulance now carries ballistic vests and helmets. Enough for each crew member plus one patient. 

However, what if there is more than one patient? What if someone is accompanying our patient? If the siren sounds, do we stop and seek shelter, taking time to help our patient out of the ambulance and into hiding and increasing the risk for all of us, or do we keep going to the hospital and hope that the inbound missile heads elsewhere? 

We have been sat on station when the siren has sounded. At the same time, a call comes in. The rules dictate that after any siren, we need to take shelter for ten minutes, giving time for the threat to disappear, for any shell fragments to stop falling, for the Iron Dome anti-missile system to do its job and destroy the inbound terror. Do we wait for those ten minutes? Do we follow the rules, or do we break them, heading out for whatever that call is that has just come in? What if the call is for someone having a heart attack? Or someone having a baby? Or for someone who has stopped breathing? 

At times when seconds count, can we afford the luxury of minutes? 

I'm fairly lucky. I'm not near where most of the missiles are landing. Parts of Israel, particularly the southern region near the Gaza border, are facing dozens of missiles every single day. Paramedics there are making these decisions call by call, minute by minute, whereas I've only had to think about it on a few occasions. 

It is somewhat of an understatement to say that these are very strange days and this is a very strange place to be part of the world of EMS. However, it is times like this that the significance of this choice of career is suddenly very much in evidence. 

I look forwards to calmer days, where my decision making process goes back to the best treatment and the most appropriate hospital for my patient, and that the list of decisions and thought processes don't include where all the available bomb shelters are on my route from station to patient to hospital. 

Monday, 7 July 2014

Nine Years Ago Today

London, 7/7/2005.

I remember, 9 years ago today, that it was my first day off after thirteen shifts in a row. 

I remember, 9 years ago today, driving my car to the garage for its annual MOT test. 

I remember, 9 years ago today, walking the mile or so home to be greeted by a yell from upstairs telling me that there'd been "Some sort of power surge on the London Underground." 

I remember, 9 years ago today, of a shiver going down my spine and me yelling back "That's no power surge, that's terrorism. Just wait ten minutes for the official news." 

I remember, 9 years ago today, of running upstairs, putting on the uniform and boots that I'd thought were going to have a day's rest. 

I remember, 9 years ago today, of calling the garage, explaining, apologising, telling them I need the car back and that I'd rebook the test. 

I remember, 9 years ago today, running back to the garage, finding that they'd done the test, refused to charge me for it, and the manager saying "I hope it really is just a power surge." 

I remember, 9 years ago today, that London was taken back to darker days. To days of fear and terror and explosions and loss of life. 

I remember, 9 years ago today, that I was one of the lucky ones. I went to work, but wasn't in any way directly involved in the rescue operation around the bombings. I sat on station as backup in case it was needed. Friends and colleagues of mine were first on scene; some climbed into the bowels of the Underground to help survivors; some climbed through wreckage of twisted metal and twisted bodies. Many showed bravery above and beyond the call of duty.

I remember, 9 years ago today, driving to work through eerily quiet streets, watching the horror unfold on screen, and wait and wait and wait for a call to come in, to be able to be a part of something, to be able to feel useful. For me, it was probably the quietest shift I ever had in London. For too many, it was a shift they'll never forget. 

Perhaps, next year, when the tenth anniversary comes around, there will be a more public acknowledgement of this day. For now, quiet reminders and private memorials will take place. The news outlets will remain resolutely silent, and the only people who will pause to reflect are those who were there - the injured, the families of those killed, the rescuers who raced into the inferno rather than run the other way. 

Thursday, 5 June 2014

Trust

There are several posts, in fact dozens of them, sitting in the drafts folder, waiting to see the light of day. At times, I sit at the keyboard and, just like the ad for Yellow Pages used to say, let my fingers do the walking. Or, as in this case, talking. I wrote most of this post over two years ago, but wasn't ready to share it. Everything within it is still true today. 

There are times where I don't write the posts, don't compose the stories, they just magic themselves from memory to fingertips, skipping out any thought processes along the way. Sometimes, the opposite is true. There is a tale I wish to tell, if only I could find the way; if only confidentiality issues, or lack of descriptive skill, or plain and simple fear weren't preventing me from doing so. For me, writing is often a type of therapy, giving voice to the sights and sounds that sometimes torment or trouble or even tickle my thoughts.

I've never been one to talk about how I feel. I find it uncomfortable and always worry that the skeletons I keep hidden behind lock and key will be too much of a burden to anyone else, be they family, friends or total strangers. It takes a certain amount of bravery to open up and bare one's soul. Over the years, I've watched colleagues who seem to take everything in their stride, who never appear to be bothered or upset by even the most gruesome of scenes. I've wondered if perhaps I am the odd one out. 

Perhaps I'm the only one who's affected by the horrors of the scenes we see. Perhaps I just had an overload of them. If you've read my writings for any length of time, you'll know that I tend to attract more of the serious calls than would be a fair average. My colleagues look at me and wonder if the black cloud that follows me will be blown away on the winds, leaving a clear sky, or whether it's planning on raining down with a particularly torrential downpour. I've never asked or prayed for that to change. All I can do is face up to the challenges as and when they present themselves and hope that I deal with them to the best of my ability. 

This blog has been, and continues to be, a revelation to me. Despite the fact that I'd kept an old-fashioned (and now destroyed) diary for years before starting to write here, the realisation that there was someone, anyone, out there who would want to read about my thoughts and experiences was astonishing. As I head towards half a million readers, that realisation is all the more powerful. It is also daunting in the extreme.

MrsInsomniac has spent years trying to get me to open up, to be less afraid to trust others. Trust someone enough to reveal what I'm really going through. To talk. Not the babbling gibberish and hyperactive nonsense that I talk most of the time, but really talk. Express what I was going through. Describe the scenes, the experiences, the thoughts, the fears, the triumphs and tribulations. 

On the one hand, to talk about what it feels like when all I want is not to feel anything. To talk about what it feels like when despite all the knowledge, despite all the learning, despite all the experience, to turn up to a scene and realise with cool composure that there is nothing left to do. 

On the other hand, to talk about the scene that is so chaotic and confused and unusual when we arrive, with instructions and treatments and decisions flying in all directions, yet by the time we leave, all is much calmer, and there is warmth and a smile and appreciation and thanks.  

And in both of these possibilities, when we have either done good or when we have done nothing, is it right that sometimes I feel something when I shouldn't, yet at other times I feel nothing at all when perhaps I really should?

Monday, 2 June 2014

Honour

There is no honour in a so-called "honour killing." 

These horrendous pieces of news reach our eyes and ears all too often, streaming in from media the world over, yet for as many of these horrendous news items that make it to the front pages, there are so many others stories that never see the light of day. The trauma affects only those closely connected to the victim and the world can't share the pain, even if only for a brief, fleeting moment of reading a hastily clicked-away internet screen. 

I know these cases exist. I have seen them, or at least their results. A woman lies dead in the street. A man she chose to live her life with was found not far away. Their families, disapproving of their relationship, made an unholy union in order to sever theirs. Calm is restored. At least until the next victim in the cycle finds themselves at the wrong end of a knife or gun or blunt instrument; harbingers of doom; revokers of life; restorers of so-called honour. 

The cycle continued. One death led to another, each family seeking the upper hand, the glory. There would be news of a shooting, or a stabbing, or an inexplicable car accident. Then there would be quiet. Sometimes days, sometimes weeks or longer, but still the air was filled with the constant threat of the next retaliation. 

We were traveling through one of the tougher parts of town. The roads have more holes and fewer rules, housing is a mish-mash of prefabricated buildings and run-down apartment blocks, street signs and street lights are almost non-existent and the numbering system no better than guesswork. 

Only a few days had passed since the last honour killing. The latest in the neverending cycle of deaths that proved nothing except that yet another gun had tried to restore its owner's pride, yet at the same time now made him, or those closest to him, the next likely target. In the darkness, we could see the hazard lights of a car parked a few hundred metres ahead. The driver's door and the rear door directly behind it were both open, and all we could see was a pair of legs sticking out. As he heard us approach, he jumped out. 

He was wearing nothing but a pair of boxer shorts. No shoes, no trousers, no shirt, nothing. As we pulled up behind the car, the first thing we noticed was that he was covered in blood. 

"She's in here! I don't know if she's breathing!" It seemed as though the latest victim of honour was in the back of an almost-naked man's car. 

We jumped out of the ambulance, grabbed the bed so that we could at least move her into the ambulance and be able to see to start treating whatever gruesome injury was about to reveal itself to us. The man who greeted us jumped over the clots of blood that were lying on the floor by the passenger door and looked as though he was about to faint. He sat back down in the driver's seat with his head between his knees and his hands on his face. 

"Just help her. Please. Just help her." 

Two steps later, we could see that our victim was no victim at all, sitting as she was, cradling the baby boy that she had just delivered. 

Monday, 19 May 2014

Evidence

She's wearing a long black coat, fake fur around the collar, like she's wearing a fox for a necklace. And although the sun has already set, sunglasses rest on her head; gaudy, silvery arms that hold on to giant darkened lenses. One of the lenses is shattered but still intact, as though a spider had built its web all the way across. Her handbag, with its plaited rope handle still loosely around her arm, has spilled its contents across the pavement. Lipstick, coins, old receipts and chewing gum are sprawled across the ground much like their fallen owner. 

On the outskirts of the scene, it's like trying to empty flood-waters out of a sinking ship with a teaspoon. Two police officers fight back the threatening crowd, as a third attempts to tie the blue and white tape across the only access that doesn't involve climbing a fence. Each time he ties one end, someone tears down the other. It takes the threat of a taser before the massed mob take a hesitant step back and as they do, back-up arrives, giving the police more of a chance.

We're in the middle. Surrounded on all sides of the open ground by people who could be friends or foe of our patient. They could be idle bystanders too. Some may be able to tell a story, to give us some facts, some history. But none could tell the story as well as the obvious evidence on the ground.  

We walk up to her, through the mob, through the strategically placed line of officers, through the spilled contents of her bag, through the pools of blood and golden, gleaming bullet cases, through the torrent of screams and curses and cries for us to do something. 

As the mob takes a step closer and holds its collective breath, one look tells us that the evidence - the handbag, the glasses, the bullets and blood and broken skin - is overwhelming. Even the mob knows: there is nothing more to be done. 

Sunday, 11 May 2014

The Best

As we march quickly into the resuscitation room, wading through the sea of people currently waiting for their turn in triage, one face looks directly at us. Most mumble amongst themselves, wondering what trauma had befallen our patient with his face a mangled, bloody mess, made all the more grotesque by the tube sticking out of his mouth. People stare. Human nature seems to render all those around unable to look away from the macabre scene. All except for her. Her gaze held for just long enough. Enough for me to realise that she recognised me, remembered me from some event in the past. Whether that past was recent or not was beyond me and in all honesty I was too busy with the patient we had right now. 

The chaos in the resus room was as organised as usual. Doctors waiting for a handover, nurses anxious to begin treatment, paramedics eager to deliver their patient to the next link in the chain fighting for his survival. His chances were slim - we knew that. Falling, perhaps jumping off a bridge onto the road below should have been lethal. Being hit by the car after he fell should have sealed his fate. Somehow, however, against all the odds, he was still alive when we reached him. Somewhere, the stars combined. The calls came in fast, we were nearby, the hospital was only a few minutes away. We treated him on the move, leaving us on scene for as short a time as possible. We had done our best. 

We spent some time cleaning our equipment in the resus room, keeping out of the way while trying to stay in the loop. As always, we knew that as soon as we left the department, chances were high that we would never know what happened next, so we took our time to grab more snippets of information. Anything from the results of an x-ray to the positing of a professor who happened to be in the area. Eventually, however, we had no choice but to head back out into the heat of the day, through the throng of people still hovering around the waiting room. Still, she sat there, a bandage wound round her head, with a small patch of blood showing through just above her left eye. 

Outside, by the ambulance that looked inside as though full-scale war had just taken place, we started to take stock of what we had seen and done just as one of the nurses who was in the resus room came out, cigarette in one hand and a lighter in the other. 

"They've done their best, but they've called the organ donations team," he said, as he flicked the lighter into life. I couldn't help but grimly wonder if one day he too would need a new set of lungs. 

We tidied up in silence, clearing the floor of the bags of fluids, of the empty wrappers from the kit we'd used, of the blood. The next link in the chain of survival meant that he wouldn't survive, but perhaps others would. It would be a tough call to make. They needed to find his family fast, give them the impossible task to make an impossible decision in an impossible situation - to do what's best. 

Suddenly, she stepped into the sunlight, bandage still in place with its crimson spot and walked straight over to us, stopping only very briefly. "You don't remember me, do you?" 

"No. I'm sorry, I don't." 

"I'm glad. It's probably for the best." 

Saturday, 3 May 2014

Sounds of Life

We arrive at the hospital gates
mere seconds apart.
Two ambulances with lights flashing,
Sirens trailing off as we pull up
At the kerb.

They open their doors first,
Exposing their patient to nosey bystanders.
Some look shocked.
Some smile.
Some look away.
Pretend they don't see.
Or hear.
The hiss of the oxygen,
The ping of the monitor,
The instructions of the crew,
All the Sounds of a Life
being saved.

They turn right and disappear,
and as they do,
We turn left.

Our patient is bursting with life, albeit
In pain.
She's Expectant,
Ready,
Anxious.
Scared and excited all at once.
All of a sudden, she screams.
She screams and curses and yells and cries.
And then another noise. A sigh.
And a second cry.
All the Sounds of a Life
being born.

Sunday, 27 April 2014

Mood Swings

The gesture is so unexpected, coming from someone clearly suffering as much as Leah is. Lying in her makeshift bed as she has been for two days, a look of pain etched on her face, silently spelling out the words that she refuses to say. Instead, all she does is smile and tell us that everything is alright. 

"It's just a little painful when I move," Leah tells us, except that she can't move at all. The tell-tale sign of one leg appearing shorter than the other leads us to the quick conclusion that she probably has a broken hip - fractured NOF - or neck of femur. I remember wondering in the very early days of my career what a "nekkafeema" was, only summoning up the courage to ask after I could no longer hide my embarrassment at not understanding yet another medical term. 

Leah's son, a tall, sickly looking man of fifty, appears almost as old as his mother and at first I mistook him for her husband. He tells us that she had fallen almost a week ago. Since then, the pain has gradually increased, her mobility slowly becoming more and more limited until eventually she could move no more. 

"It's taken us days to convince her that she needs help!" Leah's son explains. "Every time I've picked up the phone to call you, she screams at me that she'll die if she goes to hospital." 

The smile on Leah's face cracks a little, like an ice-cube in a glass of water, still present but a little changed, and the polished facade she has paraded for her family and initially for us no longer holds strong. "It does hurt, but not too bad. Are you sure I need to go to hospital?" I explain that there may be, in fact probably is, a fracture, but the only way to tell for sure is to have an X-ray done. The old, well-worn joke that I left my X-ray glasses in the other ambulance rejuvenates her smile a little. 

We're lucky. Leah is lying on a strong sheet that we can use to manoeuvre her. She has cushions for support all around and we use all of these to help move her as gently as possible onto the trolley bed. The first couple of attempts catch her off guard, despite my warning that she would feel a little pain when we helped her across. It makes her grab hold of the bed railing and prevents us from carrying her from her bed to ours. On the third attempt, I make her promise that she keeps her hands still and if necessary grabs hold of my arms. That way, at least we'll still be able to keep moving in the right direction. It's a successful move. We're grateful for the lift that means we only have to transfer her once, rather than into a chair and only then on to the bed. Fewer moves means less pain. 

At the hospital, Leah withdraws a little, showing the apprehension that her son had warned us about. "Are you leaving me here now?" 

"As soon as we make sure that you're as comfortable as possible on a hospital bed, then yes. It's the hospital's turn to take care of you." She doesn't seem too keen on the idea, but resigns herself to it nonetheless.

"I have to tell you something," she says once she's calmly lying on the hospital bed. She motions me to stand a little closer, as if she has some state secret to sell. Suddenly, Leah grabs my face and gives me a kiss on the cheek, loud enough for what seemed like the entire department to hear. My crewmate laughs hysterically, sensing and seeing my embarrassment as my face glows a warm shade of red. 

As the first call of the morning, I feel that that one moment sets me up for the day and set off out of the emergency department with a smile firmly planted on my face. 

On our second call, a man dies in front of us with his family all around, and there's nothing we can do. 

Thursday, 6 March 2014

Birthdays


Five o'clock in the morning and for the first time all night, we finally arrive back on station. Within seconds, before the engine has had the chance to cool, or the water in the kettle given the chance to boil, the phone rings again, sending us out on our next call. It had been one of those shifts. Job to job, patient to patient, hospital to hospital. With barely the chance for a bite to eat, we had inhaled cups of coffee throughout the night to keep our energies, as well as our hopes, alive and kicking.

Five minutes later we arrive at the address, still with no real details of what awaited us on the second floor of the dilapidated building. The only information we knew was that an elderly lady had pressed an emergency button and there had been no contact with her since then. The three of us grabbed the four bags of equipment and a carry chair between us and started the march up the stairs. Any hopes of there being a lift in the building were dashed the second we pulled up outside and saw its age. 

A tired, but determined voice answered our first knock. "I'm almost there, just give me a minute!" We waited, each silently praying for the clock to tick a little faster, for the end of the shift to arrive, for the calls to end so we could go home. As we did so, a shuffling sound from indoors became louder, like a dog scratching on a door trying to get out. Eventually we heard a key turn and the door opened just enough for us to peer in. 

"You'll have to push the door to get in, I've got no more energy left." Gently we did as were asked, guessing that she was leaning against the door, when after a moment we were able to squeeze in through the gap that had opened. The smile that greeted us was like that of a child seeing its very first snow. Pure delight shone from Eva's face, as if she had stored up ninety years of smiles for just this one freeze-frame. 

"I'm fine, really I am. I just need help to get up off the floor. I've been here for a little while, thought I could manage to get up on my own. Looks like I was wrong." 

"How long have you been there?" 

"Since nine o'clock last night." All three of us do the mental maths. Eight hours on the floor. Eight hours trying to solve the problem by herself that we would now solve in thirty seconds. We checked Eva for any injuries and found that, other than a small graze on her elbow, she seemed to escape unscathed. "I need two things from you please," she asked, almost pleaded. "First, I need you to make sure I'm steady enough to get to and from the bathroom. Eight hours stuck leaves a lady just a little in need of refreshment." 

She smiled her child-like smile again. 

"Second, and more importantly, I'd like five more minutes of your time. Just to have a look at something for me." Presumably a medical issue had been bothering her and now that she had readily available access, she would use the opportunity. 

"We're not going anywhere. Get yourself settled and I'll make you a drink first whilst you do." Once Eva was up on her feet, it took only seconds before she regained her balance, walking around the flat in a manner almost as spritely as a  teenager rather than a nonagenarian. 

"Just a few minutes. I promise. No more." 

When Eva returned, she asked us to follow her into the lounge, where we were greeted to a picture gallery of immense proportions. Every wall was covered, every bookcase had pictures on the shelves, every picture frame hid several pictures within it. Hundreds upon hundreds of pictures, each with smiling faces that crossed ages, generations, and eras.  

"These are my children. And my grandchildren. And my great grandchildren. I should have lost count by now, but I know. I know all their names, I know all their birthdays. Sometimes I might need a small reminder, just that the date is coming up, not that it's their birthday." She stopped just long enough to look once all the way around the room. "It's a birthday today, too, so I'm glad I'm up in time to go and celebrate." 

"Whose birthday? Which generation?" 

"Mine," she said with a wicked grin. "And," as she pulled out a hidden envelope with an old photograph of a young couple at their wedding, "my husband's too." 

I'd had a quick look around when I looked for the kitchen to make her a drink. There was no-one else there. Just Eva and now an ambulance crew. Definitely no husband. 

"Where is he? Your husband?" 

"He's in a home, just a few minutes walk, not far away. When his mind started to wander, his body sometimes followed and he would end up lost, so about five years ago we decided it would be safer to have him move into a home. I see him every day except Tuesdays. That's when I meet with friends for a coffee. Every other day, I always leave the house at six in the morning to get to the home in time to make his coffee and have breakfast with him." 

All three of us looked at our watches. Almost six o'clock. 

"I'm presuming you don't want to go to hospital and get yourself checked after your eventful night on the floor?" 

"Don't be ridiculous. Spend my birthday, my Izzy's birthday in hospital? No way. The only place I'm going is to visit him. And if you people are as kind as you look, you'll help me get down these stairs." 

"We'll carry you down if you like!" 

"Most definitely not. I've still got legs that work, haven't I?" None of us dared argue.

With one of us either side, we slowly walked Eva down the flights of stairs to the entrance of the building. She refused any further offers of help, from us accompanying her on foot, to the offer of a lift in the ambulance. 

"It's only five minutes away, I'll get there the same way I do every day." 

"Happy birthday," the three of us called after her as she started to walk away. 

She stopped, turned around and smiled that smile once more. "Thank you for making it so." 

Friday, 24 January 2014

Thoughts on a Difficult Week

Each Friday, I post a poem, a rhyme, some silliness, to my family and friends on Facebook. Each week I look back, think of the events we have had as a family and as a way of keeping in touch with people, I share a little of what we have experienced. Some weeks it'll take me a dozen attempts to post something I like, even if it really is only a little moment of daftness. This week, the words just flowed, and I thought I'd share them with you too. 

Stay safe and have a good weekend. 

Thoughts on a Difficult Week

What happened this week? What passed us all by? 
Who did we see? Did we laugh? Did we cry? 
Where did we go? Was it slow or quite fast? 
Why did we do it? Will the memories last? 

Did we take some time out with our families and friends? 
Did we need to say sorry, to perhaps, make amends? 
Did we travel a little, did we smile a lot? 
Did we help someone whose needs they'd felt were long forgot? 

Some shifts make me look with a new pair of eyes,
As sun rises each day, or sets in the skies.
Some shifts leave me cursing at cruelty unbound,
Yet counting my blessings at the goodness all round.

As a change, just for once, from the silly and daft,
I thought I'd make you think back to the last time you laughed.
Spend time this weekend, with those who make you smile,
And carry those smiles through the week for a while. 

Monday, 30 December 2013

Angels

Some days I feel like the Angel of Death's right hand man. It's almost as if he's sitting on my shoulder, bidding me to do his work, waiting for me to feed him another soul.

The shift starts with a family member or a carer discovering that their relative or ward has died peacefully during the night. We march in, carrying equipment that we know will be totally redundant. Oxygen, where the tap will remain unopened. A box full of drugs that will number the same when we leave as they did when we entered. A monitor that will do nothing but paint a long, straight, lifeless line on a strip of paper, telling us and the family what we already know. All too often we are still there as the reality of loss strikes home. Sometimes slowly, gently creeping into the minds of those around; sometimes it hits with the full force of a tsunami wave. Before we leave, we comfort the bereaved, we mutter words, platitudes, practicalities, and then go back into the world outside that just carries on as if nothing has happened - unlike the four walls that we have just left, within which the world has suddenly stopped. The Angel has won.

Then there's a call for someone who's dizzy.

Yet another for someone in pain.

And we treat them with care, give them attention, tend to their needs, transport them to the hospital. In the short time it takes me to walk back from the emergency department to the ambulance, all too often I have forgotten their basic details, like a name, or age, or chief complaint. By the end of the day I barely remember these calls at all. And the Angel lurks bored in the background.

And then again there's a call: to someone who has stopped breathing. But this time, someone was watching as they took their last breath. We drive fast, arrive into the confusion and chaos and panic and fright. This time we have a chance. We open the oxygen, we give them the drugs, we beat hard on their chest, we breathe for them, pump blood around the body for them. Try our damndest for them as all around people are crying or screaming or praying or silent. But after a while, twenty minutes, forty minutes, an hour, we are defeated. Death has beaten life, as if the Angel is ironing out the last of the ups and downs on the monitor, leaving that long, flat, lifeless line again.

Then there's a call for someone short of breath. They have nothing more than a cold.

Then there's a call for someone whose blood sugar has fallen so low that they're unconscious, or confused, or violent. We fill their blood stream with dextrose which brings them out of their stupor. All too often they are embarrassed and apologetic. Nine times out of ten we leave on the best of terms, but every so often we need to force a trip to the hospital. All the while, the Angel slumbers.

Then there's a call for someone who's fallen and can't get up. We help them up, dust them down, sometimes make them a tea or coffee. We look at pictures of their grandchildren, or take an interest in their books, or listen to an abridged life story. Often we leave with a smile and a smirk at the Angel. Sometimes, that smile fades in the blink of an eye.

There's a baby turning blue. Can't breathe. Floppy. And we're miles away.

These sorts of journeys happen in an eerie sort of silence. No words are spoken, no thoughts-out-loud. Only the wail of the siren permeates the air, helping us push through traffic as fast as we can, but it never seems quite fast enough. Yet, when we arrive, with the Angel looking over our shoulders, we take hold of the baby.

She's breathing. Shallow, struggling breaths, her shoulders and ribs working twice as hard as they should be, trying to expand her lungs and feed them the oxygen they crave. And the Angel stares, prepares, dares us as he heats his iron, yet all the while we beat him back. We feed her oxygen, drugs, put up defensible borders, give her a fighting chance. We carve our way through the traffic again, to hospital, hand her over to the staff and breathe a sigh of relief when we hear a beautiful noise.

She's crying.

We clear up, tidy the back of the ambulance and prepare it for the next call, and finish the paperwork. Just before we leave, we go back to check on the baby, whose cries have subsided as she finally catches her breath and her face slowly breaks into a wary smile. As we step into the room, her mother finally sees us, as if for the first time, even though she was with us all along. 

"Do you know what you people are?" she asks, as she gently strokes her baby's face. "You're angels. Nothing short of angels."

I look over my shoulder, see no-one there,  and smile. 

Thursday, 12 September 2013

Footprints

Bright red footprints, like they'd been painted in a playground, appeared on the steps that we were hurriedly climbing. Not every step, only some. Every second or third stair was marked by a print hastily left by whomever it was that had either caused this horror or, at the very least, discovered it. We would never know whose prints they were, but a clue had been left for the police to use in their hunt. Each mark, no more than half the sole of a shoe or a boot, was as red as the next, each as incriminating as the next, each as foreboding as the next. As we ascended three flights of stairs, the footprints descended at speed. 

The floor and the walls are awash with red; pools and clots and smears and streaks. And footprints. And in the middle of it all, she lies, barely breathing, barely conscious, barely alive. Two police officers search the house as we start to treat her. The scene is no better in the tiny bedroom or bathroom. She had tried to escape and was cornered, prevented from fleeing by the force of a knife, and by her lifeblood draining away. Eventually, she fell by the front door and there she lay, waiting, in a motionless race against time. 

It took time to get her out, as we stepped out of the sea of red, time she didn't have. We couldn't bandage each wound; they were too many, and the minutes too few. We could barely stem the bleeding, although, ominously, it seemed to be slowing of its own accord. Four pairs of hands carried her on the backboard down the stairs, following the footprints and leaving some more, but this time each step was marked. Prints of different sizes, different shapes, but each dipped in the same red paint. 

At the hospital, they're ready for her. Bags of fluids and blood hang at the ready the instant we set foot in the resuscitation room. Oxygen can already be heard hissing out of the tap. Nurses and doctors take over the treatment. Orders are barked, instructions carried out, messages relayed. She's still breathing, still conscious, still alive. 

Outside, as we start to clean up, the police are waiting for us. They want the prints from all our boots. One by one, each police officer who had entered the scene, each paramedic who took part in the call, steps somberly on and off shoe-shaped pieces of card. Each leaving a pair of gruesome footprints - the imprints that would rule them out of the investigation - but would leave a mark in their minds. 

Inside, in the meantime, as the footprints dry, she dies.  

Wednesday, 14 August 2013

An Insomniac's Guide to the Theatre

If I had to sum up the last week, it can be done in just one word. A word that I have repeated so many times over these past few days, that I'm a little nervous to utter it again. However, there is no better place to start. The word? 

Surreal. 

It all began with a throwaway idea by a friend who asked how I would feel about turning this blog
into a play that would appear at London's Camden Fringe. The throwaway idea began taking shape, delayed not a little by the tough decision of permanently shedding my cloak of anonymity. Take one playwright ready to bare all to anyone who will listen (I mean that in the nicest, most artistically possible way!) and one paramedic who has spent a lifetime building barriers to his innermost thoughts, and you have a potential recipe for disaster. 

Instead of disaster, however, we had a hit on our hands. Hundreds of people from all walks of life - ambulance crews, medical staff, other actors, general members of the public and even a blogger or two - came to see the play, to experience a little of what goes on in our insular world. "An Insomniac's Guide to Ambulances" draws on both my experiences as well as those of writer / producer / director / general dogsbody /chief cook and bottlewasher Rachel Creeger, who in a previous life tackled the world of social work. 

It is a mix of the hideous and hilarious, of the terrific and the terrorising, of the dangerous and the dignified, of the sublime to the (dare I say it again?) surreal. Conflicting emotions battle for room on the stage, work life impacts unintentionally on home life, idealism fights reality, insomnia wards off sleep. All of these are portrayed thanks to Rachel's excellent writing and some fantastic acting by people who, by their own admission, had had little to no contact with the ambulance world prior to taking part in this play. 

Back to where I started - what made it surreal? Well, if you mean something other than the fact that I travelled a round trip of 5,000 miles, just to see a play, the surrealism began by hearing my own words, my own thoughts spoken in somebody else's voice. I had read the script a hundred times, but I was used to seeing words written down. After all, I had written at least some of them. However, hearing them, seeing how they are portrayed, sensing them spoken with an outsider's emotion, was an experience that left me with a chill down my spine, as well as proud and not a little humbled. 

This blog started as nothing more than a figurative notepad for me to voice my thoughts, to tell some stories, to open a porthole into my world, even if no-one else was interested. The fact that it has taken on a life of its own and opened up to a whole new style of audience has left me with a renewed sense not only of pride in my job, but responsibility in its portrayal. 

As for the play itself - it still has two more days (14th/15th August) to run. You can book tickets here if you're quick! The audience feedback has been incredible and the giggles and knowing murmurings I heard from some of my old colleagues must mean that the nail has been well and truly hit on the head. 

I owe my thanks to Rachel and the cast - Dimitri Shaw, Josh Burdett, Stacey Evans, Alex Hall, Buchan Lennon and Laila Pyne - for bringing it all to life. 

Sunday, 21 July 2013

Five-a-Day

Progress report: Situation normal.

Well, as normal as it can get in the world of EMS. Several months into my new adventure, treating patients from right to left, filling in electronic patient reports instead of paper ones, on a system that is a combination of awkward, clever, helpful and frustrating all at once, and generally getting back into the swing of things, I have discovered that even if the systems are totally different, the end result is the same. 

The patients don't change. 

There are calls for all the same reasons, some genuine, some not. 

There are drunks. There are assaults. 

There are those who are dying to live and those who are living to die. 

And there is everything in between.

I have been working at a number of different stations, in different towns, separated by distances that in London are probably the equivalent of boroughs and in Australia or the USA I guess it would be just popping by to the neighbours. Still, the people are all the same. 

The arrival of a new baby still brings joy to the parents. 

The passing of an elderly relative brings sadness, grief; sometimes relief. 

The feeling of impending doom of a critically ill cardiac patient is just the same, whatever language may be used to express that feeling. Often, words aren't required; the mere look in the eyes conveys the message all too clearly. 
***
Just a few short years ago, In her early thirties, Leah had a cardiac arrest. She was one of the lucky ones. The stars aligned and she collapsed whilst visiting a relative in hospital. The ward staff reached her in seconds and she was resuscitated, waking up in unfamiliar surrounding a few days later. She heard talk of her heart stopping. She heard talk of having a funny rhythm and could think of nothing but a set of drums, but then talk of electricity in the heart confused her even more. Nothing made sense. 

She heard something about a defibrillator to shock her heart each time it happened. Something about it being there for the rest of her life. A life that had been taken away, returned, and now seemed once again to be slipping through her fingers. 

Leah's deathly pale, beads of sweat covering her face and arms. The fear in her eyes, as if we couldn't see it, was reflecting in her voice, in her pleading. 

"Don't let me die. Not here. Not with my children in the next room." 

The voices of cartoon characters fill the background, muffled by a doorway that separates the innocence of childhood and the harsh reality of life. That reality was monitors, needles, drugs. A battle against time and an unruly heart, beating to its own chaotic rhythm, rather than the regular spike on a screen and the audible lub-dub in the stethoscope. 

A few tense minutes later, Leah's face eases a little. As drugs course through her veins, sending orders to the heart to regroup, we see the rhythm take on a semblance of order. Finally steady enough to move, we carry her down the four flights of stairs to the ambulance and start to head to hospital. A few minutes into the journey, she lifts the oxygen mask from her face and asks a simple question. 

"Do you think it would help if I stopped smoking?"  

"I'm sure you've been told several times prior to today to stop." 

"But I only smoke about five a day." 

"Even those five aren't helping your heart, are they?" 

Leah didn't answer, choosing to sit in silence for the rest of the journey. We wheel her in to the hospital, to be met by an all-hands-on-deck medical team. Leah is transferred to the hospital bed, a nurse detaches our cables so that she could reattach theirs, as all the while Leah appeared deep in thought. 

"They'll take good care of you now," I said as I started to walk away, "just make sure that you do the same."  

Leah called after me. 

"Wait. Just wait a second. I have something for you." She reaches into her handbag, pulls out a box of cigarettes and a lighter, and places them firmly in my hands. 

"Take them. Throw them away. I never want to see them again."

Thursday, 20 June 2013

Fringe Benefits

First, there was a diary. Yes, I'm serious. I kept a diary for years. I was still intermittently writing in it well into my twenties. 

Then, in an attempt to join the 21st century, there were a series of blogs. This very blog that you are presently reading is the latest and most successful. It was a natural progression from a hand-written, and now very much destroyed, diary. Anyone who wants to add "of a wimpy kid" to the end of the previous sentence won't be far wrong. 

Now, in a totally unforeseen, unplanned and somewhat unbelievable development, there is a stage play. Yes, you read that right. InsomniacMedic is coming to the stage. Not me personally, for that would be nothing short of foolish, frightening and entirely forgettable, but this blog has become the basis for a play that is to appear for two weeks at this year's Camden Fringe festival. 

That's Camden, London, UK. Not Camden, New Jersey; or Camden, New South Wales. Sorry to disappoint any of you who may be inconvenienced by the distances involved. 

Written by fellow insomniac and long-term friend Rachel Creeger of Time2Shine Productions, "An Insomniac's Guide to Ambulances" was borne out of many late night Facebook chats about our past experiences, mine as a paramedic and hers working with vulnerable families. InsomniacMedic was the starting point for this immersive piece which blends fiction and fact from both our real working lives, much like the blog itself. 

As an added bonus, certainly for me, anyway, despite being several thousands of miles away from London these days, I plan on attending a few of the nights, including one where a Q&A session will follow the play. For all the details, head to the Camden Fringe website, and search for one of two theatres where the play will be showing: Upstairs at the Gatehouse from the 5th-8th of August, or at the LJCC from the 11th-15th of August. The Q&A is on the 12th. 

I, for one, am honoured that this is even happening. I'd be even more so if you came and showed your support. At the very least, I could thank you in person for being a reader of this blog, and by that mere fact alone, making this entire project remotely feasible. 

See you there, but no breaking any legs please. I'm supposed to be on holiday! 

Friday, 31 May 2013

The week that's been

We see things. 

We see things that otherwise are seen only in movies, 

or in overactive imaginations. 

We see things that should never be seen 

and that cannot be unseen. 

We see the amusing, we see the frightening. 

We see things that others can only wish to see,

and that we are privileged to share. 

We see the sublime, the ridiculous, 

and everything in between. 

We see magic at its very best, 

and life at its very worst. 

We see trust and betrayal, belief, 

and the loss of all hope. 

We see acceptance of fate, we see denial. 

We see life end and life begin, 

first breaths and last. 

All in the space of a week. 

Thursday, 9 May 2013

Unwritten Rules

The first clue was the fact that the apartment was on the fourth floor. It's the internationally recognised, first unwritten rule of ambulance work that the higher up the patient is in the building, particularly if there's no lift, the more likely they are to need carrying down. A voice hollers out of the window, through the security bars that seem totally unnecessary on a window so high up. 

"Bring some bandages, you're going to need them!" 

We're already carrying a supply, along with oxygen, a defibrillator, a carry chair and all other manner of equipment that we may or may not need. Unwritten rule number two is that whatever piece of kit you leave behind, is exactly the one you're going to need for the patient, so often we carry too much, rather than be stuck with too little. 

The trail of blood that greets us at the front door leads us to Berhanu, an ancient looking Ethiopian man, surrounded by concerned family. Three people start talking to us at once. 

"It happened yesterday too!" 

"He's on all these tablets!" 

"We tried to stop it, but it keeps filling up again!" 

Eventually, we calm the scene and reach Berhanu, finding him chirpy and unconcerned, unwritten rule number three proving yet again that often the family panics a great deal more than the patient. He was sporting a self-made blood collecting device around his foot, proudly showing off the handiwork that we were just about to dismantle. First, we remove the plastic bag, within which must have been a couple of hundred millilitres of blood. Next, we gently removed the DIY bandage that was held in place by sellotape and electrical tape, and that was made up of blood-soaked tissues, cotton wool and torn up pieces of newspaper. Finally we could see the ruptured vein just above the ankle. It was pouring out his blood as though someone had left a tap running. The tourniquet that he'd fashioned out of several elastic bands was doing nothing other than leave nasty marks further up his leg.

Within seconds, we applied a new bandage, lots of pressure and raised his leg, all in an attempt to stem the flow. It took some time, but eventually it slowed to just a trickle and then all but stopped, meaning it was stable enough for us to move Berhanu to hospital. 

"I'll walk!" he says, watching me open the carry chair. 

"I think it's better if you don't. We don't want that to start bleeding again." 

"I have walked every day of my life for the last eighty-five years, and up and down those flights of stairs for the last ten. You're not carrying me!" 

We pleaded with him. His family suggested, begged, shouted, instructed and cried at him. Nothing would convince Berhanu to sit in the carry chair. As a final attempt, my crew mate told him that the rules said that anyone who was bleeding, even a little, had to be carried. 

"Where does it say that?" 

"In my rulebook!" 

"Show me." 

"I don't have it with me. But believe me, it's there." 

"I don't believe you, and I won't be carried. Rules or no rules." 

He stands up, refusing all offers of assistance and takes a step towards the front door. All of a sudden, a trickle of blood appears below the bandage and within seconds it's dripping onto the floor at an ever-increasing rate. Defeated, he sits down again, allowing us to start the process all over; redress the wound, raise the leg and wait until the pressure and some gravity do the job again. 

When we're ready, Berhanu looks up at us and motions towards to the carry chair. 

"Good choice, we don't want to go through that again." 

"It's not really in the rulebook, is it, carrying bleeding people?" 

"Well, not specifically, no." 

"Unwritten rules, I guess. I suppose you have to have them too." 

Sunday, 5 May 2013

Then and Now

At a Remembrance Day parade, several hundred war veterans, many of them well into their eighties and nineties, marched past an equal number of supporters who lined the streets of Whitehall, me amongst them. As long as I was in the country, I had attended every single parade for as many years as I could remember, supporting my grandfather, my great-uncle as well as all the other veterans. As they reached the Cenotaph, the cold, grey war memorial reflected the overhead skies. A fine drizzle had fallen all morning, coating the roads and pavements, but in an apparent show of respect had stopped falling as the veterans started to march. The Royal Air Force band escorted the veterans, the mix of young and old stark, but reassuring. A continuation of the generations, a knowledge that freedoms had been bought at huge cost, but that there were still those who would go on paying the price. It is both encouraging and tragic all at once, the knowledge that there are those who will continue to fight, alongside the reality that the need still exists. 

At the sound of the bugle, the flags are lowered and heads are bowed. An air of solemnity replaces the noise as a minute's silence begins, a silence crudely broken by the crackle of a police radio nearby and the words "Possible cardiac arrest on parade, St John Ambulance staff on way." 

When I look up from my place in the crowd, I can see the first shuffling of feet, clearing a path for the medical team and I approach the police officer to offer my help. He immediately pulls the gate aside and allows me through. I arrive at the same time as the team, explain who I am, and they gratefully welcome an extra pair of hands.  

The normal frenzied actions of a full resuscitation attempt are underway, but there is an acute awareness of the moment. Instructions are whispered, actions carried out in silence, even the ambulance arrives with blue lights flashing but the siren mute. The only loud instructions come from the defibrillator, as it advises to all who care to hear "Shock advised! Stand clear!" The orange button lights up and I press the button, wishing that there was another button to be pressed that would silence the instructions too. 

I never found out my patient's name, and the last I saw of him was in the back of the ambulance as he was taken to hospital, his chances of survival in single percentage figures. 

Against the odds, a few months later I found out through the grapevine that he had survived, and at the following year's parade, my grandfather pointed him out as he stood proudly alongside his comrades once more. 

Over a decade has passed since that day. Since then, I have left London, moved countries, and started on a new EMS path with a new organisation. The system may be different, but the patients are the same. They call when they are at a loss for any other options, sometimes they really need us, sometimes they just don't know where else to turn and hope for someone to share the burden and hopefully offload it.

Outside of work, we have made our home in a welcoming community, have made new friends as well as reconnecting with friends from days of yore, have moved nearer to some family whilst leaving others further away than ever. The number of expats is also fairly large, and so there are frequent visitors from overseas. Yesterday, I was introduced to one of the visitors, a friend's mother.

"Oh, so you're the paramedic?"

I'm not sure why I still find that question a little ominous.

"That's me."

"Did my son ever tell you about our story with ambulances?"

"Don't think so!"

"Well, about ten or eleven years ago, my dad was on a Remembrance Day parade and collapsed. St John Ambulance were there, they started doing CPR and they got his heart started again, and..."

I finished the sentence for her.

"And he was on parade the following year."

We both stopped in our tracks; the coincidence incomprehensible. She went on to tell me that her father lived another seven years after that day, long enough to meet his great-grandchildren, to see how the family continued to grow.

It is an occupational hazard, the knowledge that we almost never find out what happens to our patients once they are conveyed to hospital. But every so often, even if it takes a decade, we hear of remarkable stories such as this one.

My first successful resuscitation was on a gentleman whose grandson, years later, became my friend.