Monday, 27 December 2010

A Christmas Tear

This is a guest post by the person known on Twitter as @MadMedic1, and I thank them for it.
A drizzly morning outside. Much like any other December morning of late. Inside, carols and banter filled the air in the warm mess room. Christmas greetings were being exchanged. It was, after all, Christmas Day.

Hoping for an easy start to the shift, we were treated to an hour or so on station to enjoy our little slice of Christmas before the world went mad and started to demand ambulances for the usual run of the mill calls such as abdo pains, chest pains and injuries sustained by adults testing kids toys/power tools/ drinking too much. One by one the crews left station, probably not to return till the end of shift, to go home and be with their loved ones.

Our turn was next. We were ready to face the day having had sustenance in the form of tea and shed loads of chocolate – surely the norm on Christmas Day? The phone rings, obscenely loud in the now almost empty mess room. No pleasantries exchanged from control. Never a good sign, especially given the day. Two words. “Cardiac Arrest”. Oh… Followed by another three words I certainly wasn’t expecting. “6 years old”.

My face must have said a thousand words. The colour felt like it had drained. My crew mate, now out of his seat as I repeated those words as I put the phone down and began to head for the garage doors, at a run. I almost never run. I’m built for comfort not speed, but I run. I run for jobs like this. Jobs where every second counts.

Soon we are flying or so it seems. Willing the ambulance to go faster. Thankfully, the roads are clear. Thankfully, my crew mate got new lead boots for Christmas, or so it seemed! Thoughts of this call being not as given run through my head. My crew mate for the day and I barely say two words to each other, which is unusual. Normally the mickey taking flows. Not now. We remain focused and hoping. Hoping this call is a mistake. We arrive on scene to find an FRU already stranded in the road outside the address. Abandoned quickly. Door not quite shut, left ajar in haste.

I grab my paramedic bag and run for the house. The front door is already open. I knock and go straight in. The scene of festive cheer in front of me immediately throws me. 4 children. Laughing. Playing. Shouting. Enjoying their day. Wrapping paper strewn within a 15 foot fall out zone that is the norm on Christmas day. For a split second I think the job’s not as given after all. Then a sudden realisation. Where is the FRU person? Where are the Parents? Remaining as calm as possible and with as much happiness as I can muster I ask the children where our colleague has gone and they point me upstairs without so much as looking up from their festivities.

Leaving behind the raucous laughter and happiness I make my way upstairs. Mary’s Boy Child by Boney M is playing softly alongside muffled and calm voices as I walk towards the bedroom door. Hung on the door, in anticipation of a morning of rejoice and celebration, a suit. Jacket, waistcoat and trousers. Festive red bow tie and crisp white shirt. All in miniature size. A size to fit a child. My heart lurches and I push the door open. Inside, the FRU paramedic is stooped slightly with her back to the door. In front of her is a bunk bed. Sat on the lower bed is a woman, rocking gently back and forth, quietly talking. The FRU paramedic straightens up and turns to me, drops her eyes and sadly shakes her head. As the FRU para moves out of the way I see that the woman is holding a small child in her arms. Gently kissing his head. His tiny body motionless apart from the rocking prompted by his mother. Dressed in pyjamas he looked asleep. Peaceful. Safe.

Mum looks up from her child and thanks me for coming, a wan smile on her face she also wishes me Merry Christmas. I nod, my gaze now dropped to the floor and I shift my feet from side to side, not knowing how to respond appropriately. Mum continues to talk to her child for a few moments more then becomes quiet, her eyes now shut. A single, fat tear rolls down her cheek. An awkward silence envelopes the room broken only when a man then joins us. Tall with a commanding presence he says hello and he too thanks us for coming. His gaze glassy but full of emotion. He is a larger version of the boy in Mum’s arms. This must be Dad. Numb with sadness and seeing that the FRU paramedic is now struggling with emotions I say that we’ll give them some time with their son but we’ll have to do some checks in a short while and we leave the room.

Stood on the landing we all have a moment lost in our own thoughts. Some tears shed, all silently wishing this wasn’t happening. Not today. Not at all. Not ever. Police and a duty officer are called to scene – formalities for situations like this. Still downstairs are the siblings. Blissfully unaware. Composure and strength regained we knock on the bedroom door. Certain procedures needed to be done. The parents leave us to do the formal part of our job and we continue in hushed tones and a great, overwhelming sense of sadness.

He had died some time during the night. He looked peaceful. Apparently, he always liked a lie in. Liked his sleep. But he had Cystic Fibrosis. A mild form that was being managed and wasn’t giving him much trouble of late. He had been well and very excited before going to bed last night. Ready for Father Christmas. His stocking hung on his bed ready…

We called the parents back into the room and left them once again. Paperwork to be completed. Such empty formalities but formalities just the same.

There was nothing left for us to do. The police had arrived and were downstairs talking to the children. Our time to leave had come. Unsure as to what to say we made our apologies and went to leave. Once more we were thanked. Thanked for coming. Thanked for giving them the time they needed. Thanked for doing the wonderful job we do.

As we left the house, all in quiet reflection, we were thankful that child had the most wonderful, loving family in his life. Bitter that his life was too short. That the outcome was so very wrong…

Thursday, 23 December 2010


The instant the doorbell rings, a sharp bark pierces through the biting wind, a pitter-patter of paws runs towards the front door and starts trying to scratch its way out.

"Hold on one minute," calls a male voice, "I'll just put the dog away." Just above the sign warning would-be intruders of the presence of a menacing dog is another, more welcoming sign - Patterson Plaza. We wait outside as we hear the barks fade, and at the sound of a door shutting somewhere in the house, they turn into a distant, sad whimper.

Eventually he returns and opens the door to let us in. "She's in the back room, is Ada. You'd better go ahead of me, I'm a bit slow on the old pegs! Second door on the right. But just be careful, she's right behind the door!"

We peek round to see Ada propped up against a wall, using a glass-fronted unit for support. One of the glass panels is shattered, shards covering the floor and sparkling in the dull amber light. A wound in the back of her head has left her silvery hair tinged with a streak of red.

"I bet I look a right sight!" Ada looks up from her precarious seat on the floor to see two 6-foot plus green aliens in her lounge. The look is almost child-like, a stare upwards that slowly keeps going until reaching the top of the view.

"You look fine Ada, us red-heads must stick together, so we'll make a good job of looking after you." She laughs. "Not much left of your red hair, is there?"

"You noticed, huh?" I kneel down beside her. Apart from the impoliteness of standing bearing over a patient, it also means she no longer has to crane her neck just to speak to us. "Let's get you patched up shall we?"

The shuffling footsteps that had followed us down the corridor finally approached, and Ada's husband joined us in the room. "Mind the luggage, Mr Patterson, it's taken over your lounge a little."

"Oh, I'm alright. And call me Derek! None of this Mr Patterson stuff - you're not my bank manager!" Stern, but friendly and sincere. We check Ada for other injuries and find that she's probably fractured her hip. Derek's warned us that she has a habit of falling, as she uses a zimmer frame to get around, but sometimes gets too frustrated and leaves it behind. When she does, she often tumbles to the floor.

"I've told her she has to use the frame, but will she listen to me? Of course not!" After giving her a glare, he rattles off her list of medications, tells us what each one is for, and how many of each she takes and at what time of the day. "I'll just go get the box and show them all to you, make sure I haven't forgotten any." Derek walks off in the direction of the kitchen.

"He's been looking after me like this for years, ever since the arthritis has stopped me getting around easily," Ada whispers, "but I know he can't go on like this. We're both getting too old. We've been looking into moving into a home together. It's not as simple as it sounds." In the time we've taken to bandage her head and stop it leaking, Derek has returned. Ada stops talking, perhaps not wanting to upset him.

"Right," says Derek, pointing out each of the medications in the box, "this is the one for blood pressure, this one for her heart, this one for the pain from her arthritis, and the big box is full of calcium tablets."

"Thank you, Derek." In the background, the sound of paws clawing away at a door are a constant reminder of the caged animal.

"What dog have you got?" I ask. My knowledge of dogs is limited. I know they have tails, four legs, and bark. And I know that I don't like them particularly. Owners' assurances that "Oh, he's the friendliest dog in the world, you don't need to worry about him," are often followed by a nip on the hand and a now apologetic owner sheepishly mumbling "Well, he's never done that before!" I'd rather not take the risk.

"He's a beautiful Labrador. Wouldn't hurt a fly." At least I know what a Labrador is.

"And who walks him?"

"Mostly I do," Derek answers, a little insulted I fear. "Sometimes, when our son's in town, he'll come and do it for us. But normally I take him to the shops once a day, you know, when I get the paper and a few odds and ends, and he's happy with that." Knowing the area, I realise that the shops are a good quarter of a mile away. "Helps keep me fit, too!"

In the meantime, we've given Ada some pain relief and prepared to move her onto our chair and out to the ambulance. I'd have preferred to keep her laying flat and not moving her hip, but it was an impossible idea, the tiny corridor and curved walls not allowing for a stretcher of any kind. The morphine would hopefully work its magic and prevent her from feeling any more pain.

"She'll want her dressing gown, if that's all right with you? I'll just go get it from upstairs."

"Why don't you give me directions, and I'll go for you. Don't need you running up and down for no reason."

"Right. Well it's up the stairs, first door, right in front of you. It's the light blue one, hanging on the back of the door. The dark blue one's mine, so don't bring that one, or I'll never hear the end of it. But just so you know, it's the room where I put the dog."

Just for once, I decide to be brave. "Don't worry, Derek. I'm sure he won't bite me just for taking a dressing gown. It's probably not his colour anyway!"

"Fine, then. I'll just make sure everything's locked up and switched off downstairs, then I'll join you in the ambulance."

We wheel Ada out wrapped in the ambulance-standard red blanket to keep her warm as well as safe. "Matches my hair now, doesn't it," she muses as she looks down at the crimson cover. Once she's safely on board and as comfortable as possible, I go back into the house, and up the stairs to retrieve the dressing gown. Not before a plea from Ada.

"Make sure you help Derek out when you come back, won't you? He's not so good outside without the dog."

"Of course I will. Don't you worry about anything. That's what we're here for." She relaxes back on the trolley and allows my crew mate to check her blood pressure again.

As I open the bedroom door, the dog is lying on the floor and looks up at me with what seem to be almost contemptuous eyes. "Sorry," I mumble, "we have to look after Ada first." I can't quite believe I'm apologising to a dog. I take the dressing gown, fold it in half over my arm and leave the room with the door slightly ajar. Hopefully if I show the dog a small sign of trust, he'll understand my intentions are only good ones.

I meet Derek at the bottom of the stairs. "Got it!" I tell him.

"You sure it's the light blue one, aren't you?" His question confuses me.

"As you can see, sir, it is indeed! And I got it without being eaten alive!" I try to put on a show of pride.

"Actually, I can't see it. I forget to tell people sometimes, sorry. It's been twenty-five years now." It's then that I see the dog's reins, reflective strips on the straps and bars, and a white cane sitting by the door. I think back to everything he's done. Clear descriptions and directions, knowledge of exactly where everything is, drugs in perfect order, looking after the dog, looking after us, looking after Ada.

And all in darkness.

"Come on Derek, let's get you out to the ambulance. There's a young lady in there asking after you."

His hand holds onto the crook of my arm, and we walk out together, leaving the dog to watch from the top of the stairs.

Tuesday, 21 December 2010


By order of InsomniacMedic after last weekend's horrendous shifts:

All parents or soon to be parents of babies and young children must:

1) Undertake a basic paediatric first aid course. And refresh it regularly.

2) Have child-friendly Calpol / Tylenol / Ibuprofen on tap. I mean it. A never ending supply. And know how and when to use it.

3) Be aware that ambulances are for emergencies. We're here for you and your child whenever you need us. But we're not here for common colds.

4) If necessary, take a course in common sense. It's not as common as it should be.

This order has no expiry date.

Thursday, 16 December 2010

Social Networking

Courtesy of a good friend of mine over at Jumblerant - I've been directed to another discussion regarding the use of social media in the workplace in general, and EMS in particular. Admittedly this was an infraction that harmed no-one else but the person involved, and no patients or their confidentiality were compromised, but nevertheless the discussion points are there.

Is there an argument for total freedom of speech in and about the workplace, or should there be some limitations? Is chatting to a friend in private any different from posting a rant on Facebook or Twitter?

To my mind, and the rule I've tried to follow whilst writing this blog is that biting the hand that feeds you isn't particularly wise. So, say what you think, but think about how you say it!

What do you think?

Comments welcomed!

Tuesday, 14 December 2010

Starfish Ward

The outside of the building is dark and miserable, much like the early morning itself. We walk in, straight past the lift where I have some mad memories of a call years ago (that story another time), and up a flight of stairs. Hospitals are miserable places. Full of sick people as well as unappreciated and overworked staff. The only place in a hospital that tends to have smiling faces is the maternity unit. Oddly, that's the building we walked into, but only because that's where the paediatric wards are, and we were taking our little one to say goodbye to his troublesome tonsils. Over a dozen episodes of tonsillitis and dozens more "Say Ahh"s in eighteen months do not make for a particularly happy young boy. For a change, the system agreed with us, and the NHS would take the kind donation of a pair of five year old tonsils.

The dark early morning confused the little one into thinking that we'd woken him in the middle of the night. We'd prepared him for the day by explaining as much as we knew. He read a book that he borrowed from a friend who'd faced the same ordeal not long ago and understood a little more, and we had decided up front - no tricks. He knew about the magic (EMLA) cream on his hands, he knew about the needle and that he wouldn't feel it, he knew that he'd be asleep when his tonsils were taken out, and he knew that, more importantly than his parents being there with him, so would his favourite Beddy Bear.

He pressed the button allowing us into the ward, and the instant the door opened, the hospital magically transformed. Starfish Ward is full of colour, the walls covered with sea creatures of all sorts, psychedelic jellyfish dangle from the ceilings, and the theme is continued into the rooms and especially the impressive play area. The first person we met smiled at him and made him instantly feel at ease. Not an easy feat at the end of a night shift. We were shown to a room where he was given a choice: bed by the window or bed by the TV. The view from the window was dull and full of hospital buildings. I'll let you guess which he chose.

After he was booked in he was asked if he wanted to head to the play area. The world land speed record was broken on route. Whilst he was entertained we met the nurse who'd be looking after him, the surgeon, the anaesthetist (add an -easiologist on the end if you're across the pond), and were constantly kept updated by the staff who couldn't do enough for us. MrsInsomniac kept a cool and calm exterior, even as we wheeled him down the long corridors towards theatre, helped in no small part by the staff and their caring attitude. The normal sized hospital bed made him look small and for the first time a little vulnerable as he was taken into the anaesthetic room.

The cannula went into his little hand, twice, without even a flinch. He even watched as they did it, probably making sure they were doing it right and that everything he was told was true. As the propofol went in I watched him fight a losing battle with sleep he gripped ever more tightly onto his bear, I gave him a kiss, and left to wait outside.

An hour later they came to find us.

We went to see him up in the recovery room, where he was just coming round and was a little confused. A bit like I feel most of the time. He tried sitting up in the bed, but his head looked as if it was made of lead and made him lie back down again. MrsI held his hand all the way back to the ward, back through the grey buildings, through a colourful mural painted in one tunnel as we approached our destination, and back into the full vibrancy of Starfish just moments later.

It took him just over an hour before he was back playing in the play area, as if nothing was wrong. Analgesics are wonderful things. He was eating and drinking a little, and the first "Can we go home now?" came after less than two hours. Barely six hours after the operation, we were allowed home. He couldn't wait to get home and show his non-existent tonsils to his big sisters.

The system is what it is. It's beauraucratic, it's cumbersome, sometimes it's slow and irritating. There are gripes, there are moans, there are those who, whatever you do for them, will always complain about the system and those who run it not doing enough. Behind the system, however, stuck in its grinding cogs, are the staff. The real people with real faces.

On Starfish ward they wear brightly coloured uniforms that match their surroundings. The staff we encountered are a credit to their uniforms, and their characters mirror in them. They were helpful, friendly and understanding, and of course highly professional. There were children on that ward who are, unfortunately, regular customers and the staff know them well. We were only temporary dwellers, yet were treated by the staff as if we'd been there every day for a year. They are a credit to their ward, to their hospital and most importantly to themselves. MrsI, JuniorI and I (heh) can't thank them enough. Instead of hanging your "Thank You" card stuck onto a wall or cupboard door somewhere, yours is going global.

Oh. And it was two operations for the price of one. Beddy Bear also had his tonsils out. Starfish looked after him too.

Saturday, 11 December 2010

Early Christmas Present

Deciduous trees stand barren in the biting breeze, their branches, undefended from the airborne frost, wave a muted welcome as I drive gently down the road. It's a long dual carriageway, leading from one built up area to the next but a large section in between is sparsely built and poorly illuminated. The blue, strobing lights do more to show the way ahead than the dull orange street lamps intended for the purpose. My chances of finding the reported faller were reduced further by the fact that the caller was too vague to give an accurate location, and too much in a hurry to hang around and wait for the ambulance to arrive and show us the particular hedge in question. The only helpful detail they managed to convey was that the patient was wearing a red top.

Driving on roads that were more sheets of ice than tarmac delayed my arrival as I chose safety over speed. The rapid response unit that night would be more response than rapid, a case of better to be late than The Late. Having no exact address meant that I crawled the length of the hedgerows, bright search lights showing up the left side of the car. If I couldn't find the patient on the first run, it was a two mile run until I could turn round, check the other side and come back again. The first northbound trawl was unsuccessful. At the roundabout at the top I came across a lone officer in a police car, advised him of the call, and he joined the search. One of us would search the hedges, whilst the other would look in the central reservation.

We headed southbound, matching speeds and each blocking a lane, we drove with one eye on the road and the other looking out for our prey. During the day our slow march would have caused traffic chaos, but in the dead of night there was only one unlucky driver stuck behind us. Seasonal spirit prevailed and I slowed enough for a gap to open, and the driver, a confused look evident on his face, took his chance and snuck through the temporary opening.

I caught back up and signalled to the policeman to wind down his window.

"Does this count as heading south for the winter?", I yelled across the lanes.

"Doesn't seem to have warmed up much!", he called back and pressed a button next to him. The electric window smoothly wound its way up and cocooned the officer back in the warmth. I quickly followed suit.

The southbound drive was equally as unproductive, and the officer received another call and was forced to abandon the search. I stopped at the side of the road and asked the control room to give the original caller a ring back to try to extract at least a snippet of information that might help me in my search. A couple of minutes later they advised me that the patient was definitely on the northbound carriageway, and near the northern end of it, supposedly lying at the base of a hedge. I didn't really expect them to be lying at the top of it. But the latest update did mean skating the entire length of the ice-rink of a road. Again. Two hundred metres from the end, having almost driven straight past them, I finally found the patient.

As promised, a red top.

As promised, at the bottom of a hedge.

A sleeve and the bottom of what looked from the car to be a thick woolly jumper peered out from the hedge, and I presumed the rest of the patient was hidden in the bushes. I stopped the car by the kerb, still a good fifty metres from the hedge, called out to the patient to "Hang on, I'll be there in a second", and went to grab my kit out the boot. Still talking out loud, I finally approached and prepared for the worst. The temperature was well below freezing, they had been there for at least an hour from the original call, and were wearing nothing more than just a jumper. And just to worry me a little more, they made no attempt to move or call back.

Carrying the two bags of kit, more for balance than anything else, I slipped and skated my way across to the hedge, eventually arriving at the side of the patient. I knelt down beside them, moved to shake their arm at the top of the sleeve, only to find that the whole red arm was unoccupied.

I'd been searching for a discarded, unloved and unwanted jumper.

The shop tag was still attached to the collar.

As I was just about to call control and ask them to cancel the crew, their blue lights appeared behind me and they pulled up to help. The odds on a white Christmas were shortening as the frozen weather continued with only days to go, so I decided to let them stay in the warm comfort of their ambulance.

"We'll need the stretcher", I said, "but I'll bring the patient to you. That way you don't have to get out of the truck. They're not that heavy!"

I slid across, holding the patient gently in my arms, and presented it to the crew. It was just too dark for them to see exactly what I was holding until I was right beside them.

"Merry Christmas!" I grinned as I handed the patient over. "It's the early Christmas present you've always wanted!"

Thursday, 9 December 2010


I have a serious problem. I don't deny it, and I don't plan on resolving it.

My problem is that I can't stand a scruffy uniform.

Your uniform represents who you are, the care you take and even the pride you have in who you are and what you do. An untucked uniform shirt is a sure way to say that you just don't give a damn.

And I can't stand unpolished boots. Those who know me will bear witness as they read and smirk at this post.
A clean, tidy uniform and a pair of shiny boots do a lot more than just look good. They portray an all important sense of professionalism which is sadly sometimes lacking in the world of EMS.
Slowly, one boot at a time, I'd love to be able to change that.
In the meantime, my students, as well as my kids, will just have to put up with my problem.

Sunday, 5 December 2010


Do you ever get that feeling?

You know,

the one where you've done everything possible,

done it to the best of your ability,

brought about a good result,

improved a condition that was rapidly deteriorating,

but nevertheless felt that something was lacking?


That feeling.

I did. Just the other day.


I just hope the kid's on the mend.

I couldn't have done any more.

The worst thing is,

that I'll never really know

why I had that feeling, or

what I should have done about it.

Saturday, 4 December 2010


Did you hear the one about the snowman? No?

Well, it's not really surprising.

He's been stolen...

I have only one word to describe the person in this story.


Thursday, 2 December 2010


The patient we'd just dropped off at the hospital only became a patient when the police turned up. Far from being police brutality, it seems that they just seem to have an overwhelming effect on some people. Paulo had driven home from the pre-Christmas office drink, a warm up for the main event that was scheduled for mid-December. It was only supposed to be the planning meeting, but he decided to sample some of the drinks to help him decide what to make available for everyone else. Then he drove home. Well, about half way, before he met the kerb, burst a tyre and was stopped by a grass verge. A good Samaritan witnessed the incident, and as he drove past and kept going, he called for an ambulance. Paulo was uninjured, the crash and his escape a dichotomous result of his drunken state. The police turned up a few minutes later, and as soon as they said the magic words informing him of his arrest, Paulo collapsed.

Paulo fell to the ground, making sure he found somewhere soft to drop. His eyelids held tightly shut and hands making tight fists, he failed every test for unconsciousness known to any paramedic worth their salt. However, he still refused to open his eyes or speak, and therefore won the first round. The police had no choice but to send him to hospital, although rather than being let off by them, Paulo was accompanied all the way, and would be watched until he recovered from his mysterious ailment. Round two would be won by the police as soon as he woke up. Far from being sent home, Paulo would spend hours in A&E, and then more hours in a police cell. Round three would be up to the judge.

Having transported an officer and their quarry, we were then free to go back out on the road. We left the hospital, and half way back to station, saw a car veering across lanes, bouncing off the pavement, and showing a general disregard for any rules of the road. We called control and let them know that there was probably another drunk driver on the road and asked for police to attend before anyone was injured or worse. Following the car, we were given permission to use lights and sirens to see if that would help stop the driver, but both were completely ignored.

The car seemed to be accelerating away from us, and was heading directly for a line of traffic waiting at a set of lights. Assuming that our presence might be making the driver act more erratically and dangerously, we turned off the lights and sirens and slowed down. We waited for it to skirt around the line of cars, jump through the red light and across a busy junction. That wasn't even close to what happened.

The car didn't even brake. It slammed into the car at the back of the line and stopped dead, steam pouring out the hood seconds after impact. We pulled up behind the car, radioed in to let control know what had happened and requested another ambulance, as we'd probably have at least two patients. 

The blue van that had been stationary was shunted forwards a good distance right into the middle of the junction. Luckily the lights had changed, so there was no cross traffic and the car in front had already moved off, missing an impact by the thinnest of margins. The driver got out, and looking a little dazed, walked over to us cradling one arm in the other. Even from a distance we could see that he'd fractured his wrist. The police turned up at that point, and were tasked with babysitting him until we could assess the other driver.

The front of her car was half the size it should have been. She hadn't moved since the impact, and as we approached we could see that she was conscious, breathing, and seemingly uninjured. The expected smell of alcohol didn't materialise when we opened the door, although her speech was slurred, she was confused and her behaviour was erratic. Sure drunken signs, but lacking evidence, we carried out further checks. Within under a minute, we had the answer. As a police officer looked for physical clues, we searched for medical ones. A blood sugar check was all it took. Her sugar level had dropped to less than one (or eighteen for you Stateside persons). Most people I've seen with that level have been totally unconscious, and nowhere near a steering wheel. A few hundred drops of sugary water directly into her blood stream were enough to bring her back to reality, although not the one she remembered.

"What happened?"

"Well, you've had a hypo, and crashed your car. It seems that you've come out of it OK."

She took a moment to digest the information. A look of horror suddenly crossed her face. "What about the person I hit? Are they hurt?"

"Don't worry. They're on the way to hospital for a check-up." I didn't have the heart to tell her about the broken arm. "What's the last thing you remember?"

"I was having a meeting with some guy. I run an inn, and we were planning their Christmas do. He had a couple of drinks, maybe more than a couple, and I told him he probably shouldn't drive, but he went anyway. I hope he made it home in one piece! Maybe I should've taken my own advice too..." 

We asked about her medical history, whether she'd been eating regularly, all the other relevant questions for a diabetic whose blood sugar levels have dropped so low. She'd been doing everything right, so the reason remained unclear. There was still one thing we wanted to quiz her about.

"Do you remember the name of the person you met?" I couldn't believe the coincidence, and I didn't expect the answer. 

"Yeah. It was a foreign sounding name. Pablo I think." 

"Pablo? You sure?" 

She sat looking thoughtfully into the distance. "Oh. No it wasn't. It was Paulo. Not Pablo. Definitely Paulo." 

Two ambulance crew stared at each other in total silence, barely accepting the answer we'd just heard.

She broke the silence after a few seconds. 

"Instead of telling him to get a cab, maybe I should have asked him to drive me! It would probably have been much safer..."