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.
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.
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."
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."
"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."
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..."
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.
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.
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.
(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.
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!"
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.
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.
It's only a weekend, but it's hopefully long enough.
I'm taking some time away from anything ambulance related, including this blog. It's been a tough few days, what with strikes and some recent calls that are playing (preying?) on my mind a little too much.
So no posts for this weekend, just some time away.
I'm taking the advice of someone with vast amounts of experience more than me, and I'm sure he's right.