InsomniacMedic

Greg

2012-01-28T20:42:00.000Z

"GREG?"

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

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

Greg will have to find help elsewhere.

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

Missing

2012-01-25T17:25:00.001Z

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

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

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

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

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

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

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

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

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

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

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

"GREG?"

DVT Confusion

2012-01-20T14:09:00.000Z

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

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

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

Medic: "Any medications?"

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

Medic: "Why is he on warfarin?"

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

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

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

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

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

Medic: "Nope. Still confused."

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

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

Familiar Arms

2012-01-17T21:06:00.000Z

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

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

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

"Only some painkillers when she needs them."

"Do you have the packet?"

"I'll go and find it."

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

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

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

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

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

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

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

"Where's your boy?"

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

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

"You're sure, yes?"

"I'm sure."

"Can I come with you?"

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

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

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

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

"Indeed."

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

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

"Has he ever hit you?"

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

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

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

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

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

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

NHS

2012-01-13T15:47:00.000Z

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

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

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

Any other ideas?

Transcript

2012-01-10T12:25:00.000Z

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

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

*RING RING* *RING RING*

IM: Unintelligible... "Hello?"

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

IM: "Who's this?"

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

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

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

IM: "And what service might that be?"

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

IM: "Which loan would that be?"

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

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

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

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

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

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

CC: "Correct."

IM: "Is this a free service?"

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

IM: "So you are selling something then?"

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

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

CC: "Why do you ask?"

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

CC: "The CEO is Mr Khan."

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

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

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

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

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

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

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

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

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

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

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

CC: "Yes, that's right."

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

CC: "Umm... Err..." Click, Beeeep

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

Tick Tock

2012-01-08T13:48:00.000Z

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

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

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

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

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

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

They want to go to hospital.

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

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

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

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

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

Edna and Eddie

2012-01-05T15:20:00.002Z

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

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

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

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

"I'm fine, I tell you."

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

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

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

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

"Eddie, do you have a pacemaker?"

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

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

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

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

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

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

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

Last Light of Day

2012-01-02T16:02:00.000Z

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

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

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

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

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

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

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

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

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

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

"Cool. How old are they?"

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

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

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

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

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

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

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

"Are the kids' uniforms ready?"

"Yes."

"Their lunches?"

"Yes!"

"You set the alarm for the morning?"

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

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

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

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

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

The A to Z of 2011

2011-12-29T18:18:00.000Z

Abuse on some staff, and Booze bus galore,

car crashes, drugs deaths of children and more.

Some eavesdropping stories and unhelpful friends,

girlfriends who cry when their boys make amends.

Hysterical children, invisible men.

Jokes on the nurses, knives out again.

Lives are saved and more memories learned,

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

Police under threat, questions ignored,

Riots in London and strikes 'cross the board.

Teddies tell stories that children can't share,

Uniforms and vests can't hide that we care.

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

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

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

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

Responding

2011-12-28T13:38:00.000Z

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

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

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

Welcome Home

2011-12-27T12:33:00.000Z

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

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

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

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

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

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

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

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

"Good work!"

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

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

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

"You think it works?"

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

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

"You're kidding, aren't you?"

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

"Today?"

"No."

"This week?"

"No. First ambulance ever."

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

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

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

"Who are you?"

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

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

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

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

"When did you move here?"

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

"So what took you so long?"

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

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

"Well, gently moved in a positive direction."

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

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

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

"Well, that's no surprise, is it?"

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

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

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

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

Nero's Virus

2011-12-20T20:03:00.001Z

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

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

"That'll be norovirus."

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

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

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

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

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

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

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

"Do I really need to go?"

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

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

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

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

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

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

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

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

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

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

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

"Still, I'd really rather have it."

"OK, where is it?"

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

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

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

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

"A fiddle? Why do I need a fiddle?"

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

The Secret of Medicine

2011-12-18T19:23:00.000Z

Ah, the joys of plagiarism.

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

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

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

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

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

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

Threatened

2011-12-15T17:18:00.000Z

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

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

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

Either you leave the house.

Or I do.

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

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

"I'll kill you if you leave!"

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

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

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

"Good choice, son."

Picture on the Wall

2011-12-13T18:05:00.000Z

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

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

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

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

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

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

play havoc in my dreams.

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

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

Bragging Rights

2011-12-11T10:15:00.000Z

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

and think back to my biology teacher. And laugh.

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

Sometimes, I look at the blog I write,

and think back to my English teacher. And laugh.

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

Sometimes, I look at the job I do,

and think back to my careers adviser. And laugh.

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

I laugh at how wrong they were.

I laugh at how I believed everything they said.

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

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

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

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

More Drunken Logic

2011-12-09T14:00:00.000Z

Drunks.

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

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

Medic: "Who's your next of kin?"

Drunk: "What's that then?"

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

Drunk: "Oh! That's you then!"

Once again, another case of infallible drunken logic.

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

Silence

2011-12-06T15:18:00.001Z

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

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

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

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

"I'd guess so."

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

"Something like that, yeah."

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

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

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

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

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

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

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

"No. He's not OK. He's dead."

Suddenly, silence engulfs the ambulance.

Images

2011-12-05T17:46:00.000Z

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.

Time Off

2011-12-01T17:32:00.000Z

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.

Hope you understand.

Politics, Strikes and Goodwill

2011-11-29T15:52:00.000Z

Those of you who read my ramblings on a regular basis, will know that 99% of the time, I try to avoid any of the politics involved in this job, and concentrate on real people and real events. This time, however, the politics are a little bit too big to ignore.

In under nine hours time, a huge strike by some two million public-sector workers will begin. I wrote about my feelings on this strike in a post at the beginning of the month, and I still stand by what I said then. In fact, I resigned my membership of the union last week, so as not to be in a position where I had to decide at the last minute where my allegiances lay, or leave me any room for second thoughts.

Over the past few days I have spoken to many of my colleagues, all with differing views on the strike. Some are supporting it wholeheartedly and will down tools, some who are still torn between the patients and the greater cause, some who agree with me that this is the wrong way to go about things. The unions and the ambulance service have been in negotiations as to what sort of cover will be provided, and the agreement that has been reached is that the vast majority of calls that we normally attend will still have an ambulance arrive. At times the response may be slower, but the most serious calls will still hopefully receive the normal fast response.

This agreement, whilst seen by many as turning the strike into a something of a damp squib rather than a strong statement, did something positive for those who were unsure as to the best course of action. Many, many paramedics (and nurses) felt very uncomfortable with the idea of striking and leaving their patients in need. There was a general uneasiness, something that I think the government (or Government) relied on a little too much, amongst many public servants, particularly those with direct and immediate public contact. An uneasiness that leaving our jobs for a day would impact badly on people who, through no fault of their own, are some of the most vulnerable in our society.

The uneasiness felt by many, certainly in the health service sector, took yet another battering this afternoon. Just a few hours ago, the Chancellor announced that at the end of the two year public-sector pay freeze, a fiscal policy that still has some time to run, there will now be another two year period of only 1% pay rises. With an annual rate of inflation somewhere around the 5% mark, that pay-cap, in real terms, means a pay cut over four years in the region of some twenty percent. At the same time, tens of thousands of people on benefits, some genuinely, some whose claims range from dubious to outright fraudulent, will enjoy a rise in line with that rate of inflation. I'm no economist, but surely, the best way to get the economy jump-started is to encourage more work, not less.

Many of those who were left confused and unsure about a strike, and who were going to work through it, are now left battered and bruised by another swipe taken at their goodwill and desire to serve the public. There's a limit to how many times a person can be beaten and bounce back. There's a limit to how much goodwill can be stretched. Every person has their breaking point, even the most public spirited of us.

I'll be working through the strike, but with a little more personal turmoil than I had anticipated. I will try to tweet throughout tonight and tomorrow night, bringing a selection of sights, sounds and thoughts from the front line. Who knows what lays the other side of the picket lines.

Sad or Depressed?

2011-11-27T17:58:00.001Z

It's so easy to overlook, to underestimate. "Cheer up, it might never happen." It's easy to say. Often easy to do, too. Sometimes, however, suggesting that a smile will cure all ills, only shows a lack of understanding. Sometimes it takes a big name, a celebrity, a high-flying politician to be affected enough by something that whatever that something is, suddenly hits the news.

Gary Speed, a well known footballer and football manager, took his own life. The news only broke today so one can only assume, at this very early stage, that Gary was trying to cope with some unenviable hardship. He was a man who seemingly had everything to live for, a loving family, a place in the history books of both national and international football, a career and direction in life envied by many. And yet, somewhere in the deep recesses of his mind and soul, a dark, endless depression loomed.

It's a tough one, depression. I see patients practically daily on anti-depression medications. Depression is the only illness named and described with the same word. Diabetes is an illness where a person's sugars are out of control. Hypertension is when blood pressure is too high. Asthma is when the lungs aren't working properly.

Depression is when a person is depressed.

The other problem is that depression is a word that is bandied about all too freely. People are depressed when they miss out on a good night out, they're depressed when their boss tells them off, they're depressed when their football team loses. But depression isn't sadness or upset. It's a state of mind caused by one of many factors and triggers, some physical, some chemical, some emotional, where a person can appear happy and content with their lives, and yet not be able to cope with all that is happening around them.

Often, in the depths of these depressions there is only one viable option, and that's the option that Gary Speed seems to have taken. Some will claim that this is a selfish option, but to be honest, my uneducated mind tells me that for something to be selfish, there needs to be conscious and coherent thought. Depression allows for neither. The mind's inability to cope, to rationalise, to comprehend, leads the body down a path of self-destruction.

It's also not something that we can solve in a twenty minute meeting in the back of an ambulance. Sometimes, however, just being able to spot the first signs, may be the trigger that leads a patient to treatment and save them and their families heartbreak in the long term. Most of the knowledge I have about depression isn't from books or classrooms, it's from witnessing it first hand. It's not something we're taught as paramedics to really deal with, because most of the time we're dealing with the consequences, not the disease itself.

We can bandage wounds, or we can pronounce death. Understanding that there's a stage before this, a stage that we should be able to spot, may be the most life-saving action we can perform out on the front line.

Bother vs Bovvered

2011-11-25T14:08:00.000Z

Rule number one of EMS:

The likelihood of a patient apologising for calling the ambulance,

is diametrically opposed

to the patient's actual need to apologise

for calling the ambulance in the first place.

Examples from a recent shift:

The patient who was practically blue,

wheezing and gasping for breath,

who uses one of those precious breaths

to utter the words

"I'm sorry to bother you."

Or, the patient who, without a second thought

having had a sore throat for an hour

decides that they need to see a doctor now,

whatever the time of day,

and when asked if he realises that he's called

an emergency ambulance,

shrugs his shoulders,

looks down his nose,

and grunts: "Bovvered?"

Meant To Be

2011-11-23T17:38:00.000Z

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

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

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

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

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

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

Just a Thought

2011-11-21T16:11:00.000Z

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

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

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

Putting Their Lives on the Line

2011-11-20T02:04:00.000Z

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

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

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

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

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

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

Thursdays

2011-11-18T12:30:00.000Z

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

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

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

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

"How long have you been out here?"

"Don't know, what time is it?"

"About eleven o'clock."

"At night?"

"It's dark, isn't it?"

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

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

"Do you know what day it is?"

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

Traffic Stop

2011-11-15T17:50:00.000Z

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Patch Adams

2011-11-13T17:59:00.000Z

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

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

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

Stories and Poppies

2011-11-12T19:19:00.000Z

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

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

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

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

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

Care?

2011-11-11T08:42:00.000Z

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

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

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

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

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

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

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

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

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

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

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

White Van

2011-11-10T15:55:00.001Z

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

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

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

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

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

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

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

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

"What's your name, sir?"

"Mani."

"How old are you?"

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

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

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

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

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

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

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

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

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

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

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

"Oh yeah? What's that then?"

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

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

Crisis

2011-11-07T15:15:00.000Z

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

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

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

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

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

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

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

Without a word, Donovan turns to find the footwear.

"And I'll need my keys."

"Keys, right."

"And don't forget my handbag."

"Handbag too."

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

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

"Did you find everything?" Violet quizzes him.

"It's all in there!"

"Keys, money, tablets, phone?"

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

"Slippers?"

"They're on your feet, Mum."

"Oh yes. So they are."

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

"Yes, Mum. Off, and locked."

"Oh, and what about my hairbrush?"

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

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

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

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

Are you sure?

2011-11-06T08:41:00.000Z

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

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

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

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

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

"Do you know what she might have taken?"

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

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

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

A nod of the head.

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

A shake of the head.

"OK, how many have you taken?"

Clara holds up four fingers.

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

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

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

Clara went back to nodding her head.

"Can I see it?"

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

"You took four of these?"

A nod.

"And nothing else?"

A shake.

"I think you'll be fine."

"Are you sure?"

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

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

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

"Are you SURE?"

"I'm sure."

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

"If that's what you want? Sure."

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

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

"Sure."

Unison on Strike

2011-11-03T20:25:00.000Z

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

_____________________________________

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

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

However,

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

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

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

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

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

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

Red Rags and Suits

2011-11-03T11:22:00.000Z

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

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

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

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

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

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

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

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

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

"Oh. Then I think we're quits."

"You what?"

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

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

"Ah well. There goes the dignity."

Simple

2011-10-30T19:23:00.000Z

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

What makes a good medic?

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

Here's the test:

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

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

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

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

Simple.

Lives

2011-10-28T14:02:00.000+01:00

Some, over the years, have been badly hurt.

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

I guess they're the lucky ones.

Assuming it's lucky to be stabbed.

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

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

with a stitch or two and a warning.

Some, bravado and ego getting the better of them,

refused any treatment at all and ran off.

Two died. In front of me.

When there was nothing I could do.

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

Drop the damned knives, people.

Stop destroying lives, people.

Go live your lives, people,

and stop tearing those lives apart.

Experts and Law Suits

2011-10-25T19:27:00.000+01:00

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

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

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

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

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

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

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

Windows

2011-10-23T17:19:00.001+01:00

Tiny drops trickle down, zigzagging along

the inside of the steamy window,

leaving streaks,

like tears,

on a pockmarked face.

Inside, they lie,

side by side.

He watches her, holds her,

caresses her lifeless, cooling hand,

begs her to stay, despite knowing,

knowing she's gone.

We step inside and take one look.

Inside, the image in the window is mirrored,

as tears stream down his gentle, pockmarked face.

Animal Farm

2011-10-19T10:43:00.002+01:00

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

"Is that dog locked away?"

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

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

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

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

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

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

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

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

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

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

"Does he have any allergies?"

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

"A what?"

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

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

"Don't you like snakes?"

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

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

"Aha! So we meet again."

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

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

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

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

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

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

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

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

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

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

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

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

"You don't eat fish?"

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

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

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

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

"Are you asleep yet?"

"Yes!"

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

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

"Where is he?"

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

"Which shop?"

"The one next to the bank."

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

"Um, your favourite."

"My favourite? What's my favourite?"

"Umm, the fishmongers."

At least Jill and Rachel wouldn't find out.

The Keys to the Asylum

2011-10-16T22:33:00.000+01:00

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

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

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

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

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

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

"How'd you do that then?"

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

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

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

"Do you fall often?"

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

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

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

"Any other medical problems?"

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

"How'd that happen?"

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

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

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

"Why, what do you do?"

"I'm a mixologist."

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

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

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

"You bet. Does it get any better?"

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

Cars

2011-10-12T04:35:00.000+01:00

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

I know that they need fuel, oil and water.

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

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

I can, if needed, change a tyre.

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

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

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

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

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

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

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

Not a good thing at all.

Cycles

2011-10-09T23:19:00.000+01:00

A children's channel shows quietly in the background. A young boy sits in a corner of the entrance hall trying his hardest to keep his eye on the television, as all around him chaos reigns. Dozens of people are in the house, men in one room, women in another. Children wonder between the two, the younger ones chasing each other, playing happily, their childhood seemingly unaffected by the grown-up reality all around them.

A middle-aged, grey-haired man meets me at the door and guides me towards a side room. The house suddenly becomes silent as they see, hear and sense the intrusion of an unknown guest. Dozens of eyes follow me through the narrow corridor. Another man, of similar age and strikingly similar features to my guide joins us. He puts his hand on the handle, and just before we enter, he stops to explain.

"My name is Deepesh, and this", he says, pointing to the other man, "is my brother. I'm sorry you were called. There is nothing for you to do, but they said this was the only way."

Deepesh opens the door, and motions me in. Two women are sitting at the other end of the room, their chairs angled gently towards each other. One wipes tears away as the other sits reading prayers from a book. Between them, lying on the floor and covered up to his face in a white sheet, is an elderly man.

"He died a few hours ago," said Deepesh. "We called the family just before, when we knew he was in his last moments. Many of them have been here since then, many have joined us in the meantime. It is how we help his soul on its way. My sister and aunt, his sister, are the ladies in the room."

It was the aunt who was crying.

"We called the doctor to tell him that my father had died, but it was after hours, so they said we had to call for you. All we need is the certificate so we can prepare the funeral."

The call had been dispatched as a cardiac arrest. That would mean at least another three pairs of hands were on the way, possibly even four. I'd left the car and headed for the house with several bags full of kit and ready for a resuscitation. As soon as I had reached the front door, I knew that the equipment was surplus, and that any efforts would be futile. The calm, sad acceptance written on Deepesh's face told me all that I needed to know. As soon as I had seen his father, I called off the reinforcements. Distant sirens fell silent moments later.

"We knew he was dying. A year ago, he was given three months, but he fought on. He wanted to see his first great grandchild. She was born last week, and he held her yesterday for the first and last time."

Deepesh called to one of the children, and following an apology to me, asked them something in a language I don't understand. The child, a young girl of six or seven, her long dark hair tied in a plait, looked at him as if he was crazy. He, in turn just confirmed his request with a gentle nod of the head. A minute later she returned holding a digital camera, and handed it to him. He pressed a couple of buttons, and showed me the screen. Sitting there, a broad smile across his face and cuddling a tiny baby, was the same man who lay lifeless on the floor only one day later.

"He knew it was his time." Deepesh wiped away the hint of a tear and stopped for a few seconds. "Only yesterday he sat holding the baby, and all he kept talking about was the cycle of life."

Grown up children

2011-10-07T15:43:00.000+01:00

It's always good to have helpful family on scene,

particularly children assisting their parents.

Sometimes, however, I forget,

that if my patient is 90-something years old,

the "son on scene",

or "daughter on scene"

are not going to be kids,

but very likely to be in their seventies...

Medics are from Mars...

2011-10-04T17:20:00.000+01:00

Transcript of a recent conversation with a patient:

"Do you have any chest pain?"

"No. Not pain as such. It just hurts."

"Have you ever had any heart problems?"

"No. Never. Had a heart attack once, but never any problems."

"When was the last time you had an ECG?"

"An ECG? I've never had one. But they did check my heart last month with all those sticky labels on my chest."

"Have you ever had palpitations?"

"Never. Every so often I feel like my heart wants to jump out my chest, though."

"Any other medical conditions?"

"No, no. Take medicine for blood pressure and diabetes, but no medical conditions."

Patients are from Venus. Well, some of them, anyway.

Oil Spill

2011-10-03T12:40:00.001+01:00

Monday morning.

Early.

As the world begins its weekly ritual, a few tired night workers are preparing for their midweek weekend. Empty milk floats head back to their depots, their early morning rounds completed, many a front doorstep adorned with their goods. Autumnal sunrise greets the early risers, the sun shedding plenty of light but not yet enough warmth to clear the dew from the grass and the roads.

Mike is one of the masses, joining the rat-race and heading into work. In an effort to make his journey easier and quicker, he abandoned his car in favour of two wheels. For months, he'd enjoyed the fact that he could cut through London's standstill rush hour, leave home a little later, arrive back a little earlier, adding a few precious extra minutes with his family every day.

The call on the screen brings back memories, ones that I'm not keen to relive. Motorcycle under a van, status of patient unknown. When the call comes in, I'd just finished dealing with an acute case of probable paediatric schoolitis, a common childhood ailment, regularly apparent on Monday mornings. There were twenty minutes left of the shift. The call was some five miles away, and would take me straight past the front door of the station, frustratingly close, yet so desperately far. My relief was probably already there drinking coffee and awaiting my return. A few minutes later, Mike and I meet for the first time.

Unlike the call I'd feared, Mike's head was visible, and he was actually sitting up, helmet off, and talking quite happily. His right leg, however, is wedged between the two back wheels of the van. His bike is lying on its side in front of the van, smashed shards of shimmering glass mingling on the road and glistening in the sunlight. Just in front of that is a small pile of powder covering what we presume is some oil on the road.

"I don't really remember what happened, I just lost it on the wet road I think. Next thing I know, there's a van on top of me!"

A quick conversation with the van driver gives us a few more clues and leads us to believe that Mike's had his leg run over by both the front and the first of the back wheels, with the van coming to a halt before the third wheel added insult to injury.

Unsure of the exact circumstances, Mike's neck is immobilised in a collar and he's laid flat. The fire brigade, having arrived a few minutes later, have secured the van and lifted it high enough for us to get to see Mike's leg. His leathers are intact with only a few scuff marks, but his foot is lying at an unnatural angle, giving away the secret hidden beneath the leathers. As we cut the trouser leg away, the damage is obvious. Several breaks, the worst at the ankle.

As usual, several things happen at once. A cannula is placed in Mike's arm, giving easy access for some pain relief. A scoop stretcher is placed under him, ready to move as soon as he is secured. Some bandages and a splint are applied to his leg. All while someone else checks for any other injuries, and luckily, finds none.

In the ambulance, once Mike was settled and his pain controlled enough, there are a few moments for a quick conversation.

"I think you might have slipped on some oil, or diesel. There's a patch already covered up with some gravel, just by where you came off your bike!"

"You talking about the white grit-like stuff?"

"Yeah, that's it. Someone must have put it there not long before, it still looked quite clean."

"Ah. That's not grit or gravel."

"How do you know that?"

"Well, I work for a pet shop."

"And?"

"Well, I was on my way to work with a big bag of cat litter hanging off the handlebar..."

Double Dutch

2011-09-28T16:24:00.000+01:00

For me, being bilingual is more an accident of birth and upbringing than an actual talent. My skill for languages at school was somewhere up there with biology lessons. There are hundreds upon hundreds of different languages and dialects around the world, and, it seems, that there are people all over the place who want to read these ramblings but can't quite cope with my English.

A few days ago, someone linked to this blog from Google's translation service, and translated the whole thing into Hindi. This is what it looks like. Cool, huh?

I decided to give it a go, so I did the same into the other language I speak.

It made for interesting reading. Re-translating it back to English would look a little like this:

Ss;lfkh5 hds afh nphuIPOHUfaog7 ap7tfih Toaieh oajef va2oieh a.

Double Dutch at best.

Totally, and completely, well, rubbish - Google translate still leaves much to be desired.

So, my apologies to those of you who want to read these ramblings in any language other than English. I may translate them properly one day, but until then, I'd steer clear of online translations...

One of Them

2011-09-26T21:12:00.000+01:00

It turns out, that after less than a decade in EMS, I have suddenly, practically overnight, become one of them.

When I started, I'd always turn to them, sometimes shy, sometimes fearful, mostly confused, and look for approval, for knowledge, for an explanation.

Over the years I've relied on them less and less, but never forgotten that the basic requirement needed for expertise, is experience itself, and those with more than me will always have something new to teach.

In the last few weeks and months, a few people have left the ambulance service. Some of the service elders have retired, some have moved to different services, some have left to do different things, both ambulance related and otherwise. All of this has made me one of them.

Ambulance work and the world of EMS is changing all the time. Many of the newer recruits are joining through universities, bringing a new atmosphere to the workplace, one where study is a vital component. Up until not very long ago, a paramedic would study for a few weeks, pass a couple of exams and walk away with their qualification. Then every so often, maybe every three years or so, they would be asked to show that they have retained their knowledge and skills in a short refresher course. Now, a paramedic course is merely the basis on which to build.

I have to admit, I've never been a particularly studious type. My school grades were average at best and I was especially useless at sciences. If my biology teacher ever found out what I did for a living, they'd probably need my services almost immediately. My university grades (in a course not in any way related to the medical world) never happened due to the fact that I couldn't keep quiet in a lecture and would often find myself being restrained by friends when a lecturer tried to teach something false as though it was gospel. I lasted less than one semester. Clearly I didn't want to study, I just wanted to learn. Life was going to change direction, despite the fact that I had no idea what that direction was.

The first time I ever passed exams with flying colours, was several years later, when I joined the ambulance service. Finally, I knew what I wanted to do, what I wanted to learn. This time, however, I knew that I had no choice. If I wanted to learn, I had to study. And so I did. But this job can't just be learnt in the class room. There always have been, and always will be, those calls where nothing you learn whilst sitting at a desk will be of any use. Only two things will help: common sense, and often, most importantly, experience.

In nearly a decade, I've seen a lot, but I haven't seen everything. There are calls that I know of, that I've heard about colleagues who have attended, and that I thank my lucky stars to not have shared the same experience. Yet. Then, there are the calls I attend that my colleagues will think the same of me. However, as time goes on, there are fewer of the former and more of the latter. And with more and more of the new breed of paramedic, the studious type, I'm having to do more and more to keep up.

At the same time, however, as well as just learning the theory, today's paramedics need to learn from the voice of experience. Suddenly, it seems, practically overnight, I have become one of them. One of the elders of the tribe, who, whilst maintaining they're still young(ish), portray this image of having a wealth of knowledge and information, understanding and experience, just from having been around the block a couple of times.

I like the fact that people who are only at the start of the ladder of their careers feel they can ask me for my ideas and suggestions.

I like the fact that sometimes I even have the answers, and sometimes, possibly rarely, I might even be right.

I like the fact that when I don't have the answers, that I'm now bothered about it enough to go and do some homework.

I like feeling like I'm suddenly, practically overnight, one of them.

It's just that it scares the crap out of me.

Counting Sheep

2011-09-20T18:24:00.000+01:00

As I lay down my head to sleep,
I start to count a million sheep.
Them sheep, they laugh at me and say
no sleep tonight shall come your way.

I try to argue, beg and plead,
but those damn sheep, they pay no heed.
I press my case, express my sorrow,
Explain my schedule for tomorrow.

I start the count from the beginning,
losing track whilst they are winning.
They laugh and gambol 'cross the field,
Yet heavy eyelids will still not yield.

I change the tactic, skip the sheep,
get out of bed, downstairs I creep.
Try TV or sit and read,
Pray for sleep in time of need.

I fail, and fail, and fail some more,
Insomnia is such a bore.
But then, a glint of hope, of joy,
I've come up with a cunning ploy.

Those teasing, those tormenting sheep,
will now no longer stop my sleep.
They will no more just sit and stare
as I lie still and pull my hair.

My plan involves a plate of meat,
Those sheep's wool coats now not so neat.
My diner now adds to the tab,
as I tuck in to lamb kebab...

Street Lights

2011-09-18T20:01:00.000+01:00

The street lights off,

the normal orange glow replaced

by the flashing blue lights of the police.

They wave, the officers,

an unnecessary, well-meaning gesture

to show me the way.

They turn both their torches downwards

towards the floor,

and look down, their heads bent

as if in prayer.

She lies there, a mass of displaced,

broken bones,

a mangled, tangled mess,

limbs misshapen,

arms and legs scarred,

outstretched.

She stares, in silence, directly upwards,

past the darkened street lights,

past the trees,

past the broken, open window,

past the clouds.

The sky responds, sheds tears of its own,

and washes away the blood, the hurt,

the pain.

Due Date

2011-09-16T14:44:00.000+01:00

"Hello, ambulance service, what's the emergency?"

"Quick, my baby is coming!"

"Is the baby coming now?"

"Yes! Quick!"

A rapid response unit is dispatched from the nearest ambulance station, its driver preparing in his mind to add another delivery to his tally. Arriving no more than three minutes later, and rushing with multiple items to the front door, I am met by the lady in question and stupidly, ask the obvious.

"Is the ambulance for you?"

"Yes! Quick! The baby is coming."

The young lady in question is in no distress, and is having no contractions.

"When's the baby due?"

"NOW!"

The calls to ambulance control are numbered, resetting to call number 1 at midnight. This is call number 3. The call start time is only a few seconds after the witching hour.

"I understand that you think the baby is coming now, but why do you think that? Are you having contractions? Have your waters broken? Do you feel like you need to push?"

"I don't understand what you're asking me. Talk to him. I just need to get to the hospital!"

"Is he your partner?"

"No. He's my babyfather." Babyfather. I never get used to hearing that.

He doesn't utter a word, just hands over the yellow book, it's corners dog-eared and cover stained, and the expected delivery date hand-written in the top corner. He points repeatedly to the date as he shoves the book into my hands. Through gritted teeth and a look of disdain he mutters the only words he would say.

"The book says it's today, so it's today. Now just take her to the damn hospital."

"Is this your first baby?"

"Mine, yes. Him, not. He's got four. Well, will have today."

"You do realise that just because the due date is today, doesn't automatically mean that that's when the baby will be born? It's just an estimated due date!"

"Really?"

"Really."

"Oh. But that's why I waited 'til midnight to call!"

"As it happens, most babies aren't born on their due date at all. You need to go into labour first. You know, contractions and stuff."

"Oh. But it's the due date. So can you take me to the hospital?"

Nurse In Charge

2011-09-13T22:29:00.000+01:00

The nurse in charge sees us walking Martha into the department.

"Stop right there!" She shouts. "She's not coming in here unless she's been searched!"

Back at Martha's house, we had spent an hour negotiating with her, at first through a closed door, and then, finally, face to face after she agreed to let us in. She seemed pleased with her achievements, proudly listing the cocktail of drugs and alcohol that she'd ingested over the previous hour or two. If what she told us was accurate, or even close to it, she would need some serious medical attention, and quickly.

"Of course she's been searched. The police even stopped her bringing a large kitchen knife with her."

As we were about to leave, Martha asked if she could go back to the kitchen to get her packet of cigarettes. I waited by the front door as a police officer accompanied her back into the house. Suddenly, he shouted at her to "Put that down!" at which point I saw Martha return a knife to the kitchen drawer. Grinning manically, she put the cigarettes in her hand bag, and we all made our way to the ambulance.

"I don't care. She's not coming in here until she's searched again. Check everything and everywhere. Last time, she'd hidden a knife in her boot." I looked again. She was wearing knee-high boots over a pair of jeans. The two officers who had accompanied us looked at each other, and then at Martha. We all moved into a side room, the eagle-eyed nurse in charge watching every move.

As she was searched again, Martha started a search of her own.

"Where's my handbag?"

I had a quick glance around the room and just outside too. The bag was nowhere to be seen.

"Must still be in the ambulance. I'll go get it."

The handbag had been in the kitchen, the cigarettes were shoved inside, and Martha had turned her back to us for a second to pick up a lighter too. "No point having ciggies and no fire to light 'em with!" she'd said at the time. "You coppers need to lighten up a little!"

I think that all men struggle to know what to do when asked to hold a lady's handbag. We struggle to look at ease, for fear of looking, too, well, at ease, really. I walked back in to the department, looking and feeling a little uncomfortable, clutching the handbag at the top and letting the handles hang loose by the sides. Stepping back in to the side room, I attempt to hand the bag back to Martha.

"Oh. No. You. Don't... Not. Before. It's searched!" The emphasis of every word, every syllable did the trick, and I gave the bag to the officer. He opened it up, and blue-gloved hands rummaged through the contents. There were dozens of pieces of paper, chocolate wrappers, lipsticks, a packet of cigarettes and lighter. Right at the bottom, hidden by everything that had been thrown on top, was a serrated kitchen knife, with a six inch blade.

"And that, ladies and gentlemen, is why I'm in charge, and Martha isn't."

And to think how close I was to that knife, all the way to hospital...

Ten Years On

2011-09-11T21:42:00.000+01:00

I, too, remember where I was, and what I was doing, as I heard the news for the first time. I was a travel agent at the time, and the first I knew of the events of "Nine-Eleven" was when a customer called to say that he'd heard there'd been an accident, a plane crash into one of the Twin Towers, and he wondered if and how it would affect his plans for the night flight to LaGuardia airport. One half of my brain prayed that, assuming it was true, it had indeed been an accident, whilst the other half, the cynical half, screamed terrorism. Twenty minutes later, the world and I knew for sure.

Ten years later, ceremonies have taken place all over the world to commemorate the shocking events of the day that changed the world. Ten years later, New York City can stand and watch as the site is rebuilt from the ashes, the Pentagon once again has five walls, and a scarred field in Pennsylvania where heroes came to rest, is once again nothing more than just that. Only one thing remains the same: thousands upon thousands of people are left grieving with nothing but memories of loved ones.

Three thousand people lost their lives that day. Office workers, airline passengers, members of all the Emergency Services, bystanders watching the world change before their very eyes. America as a nation lost something else that day too: its innocence. The realisation that there are people out there whose very own lives mean less to them than the cause they purportedly stand for was a problem, a distant news item, that, until that day, was safely thousands of miles away in the Middle East and Asia. On that fateful day, mass terror, suicide terror, hit the streets of two of the most famous cities in the world. Four years later it hit the streets of London too.

That terror had a cause, has a cause. They want to change the world. They want a world that adheres to their rules, their beliefs, their dictum. It is a world that our minds cannot comprehend and cannot allow. It is a world that we're fighting against, and must keep doing.

Since that day, the day the world changed forever, everything has changed, and yet nothing has. This morning, as I thought back to the horrors in America, as the pictures replayed over and over again on television, as one caller after another on the radio recalled where they were and what they were doing, I took one of my children to play football. Yesterday was spent with family and friends, tomorrow the kids go back to school. Life goes on, much as it was before. Airport security may be tighter than ever before, we may all be a little more aware of our surroundings, a little less innocent, but life goes on, much as it was before.

Since the day that everything changed, nothing's changed.

And that's our victory.

Movies

2011-09-09T11:58:00.001+01:00

The feet appeared first, his legs skewed apart

mimicking the lines they draw in the movies.

His upper body hidden from view, the suspense building,

following a plot like the movies.

Climbing over a table to see blood spattered walls,

and a gun lying spent on the floor.

Finding him there, motionless, lifeless.

Faceless.

Looking for some way to help.

Finding none.

Realising that this isn't the movies.

And knowing, again, that happily-ever-after

is often nothing more than a movie, a wish, a dream.

Teeth

2011-09-07T15:04:00.000+01:00

Mrs Symonds collapsed as she sat down in her own home for the first time in over a month. At first, her family thought that she'd just fallen asleep, exhausted by travelling half way across the world. Moments later, the strange noises she was making alerted them that something was wrong. Her head lolled forwards and she started to fall towards the floor. Only the quick thinking of her son prevented her from injury as he helped her gently to the ground. Frantic, he tried to wake her up as his wife called for an ambulance.

Five minutes later, I was there, and Mrs Symonds was lying on the floor wide awake and wondering what the fuss was all about.

"She just dropped! I caught her and made sure she didn't hit the deck, but I think she had a stroke or something!"

"What makes you say that?"

"Well, I remember seeing those ads on TV, you know where they show the head on fire, and I think that that's what happened."

Mrs Symonds didn't seem too impressed.

"Don't be so ridiculous man, just get me up off the floor!"

I convinced her to stay where she was at least until I could make sure that her blood pressure was high enough to allow her to sit up again.

"You've got to watch her," said her son,"she's usually got her wits about her more than all of us put together."

"Right. Will do."

It sounded like a simple faint, with the action of laying down on the floor rebooting the systems that so clearly needed a brief rest. However, without further tests, nothing could be ruled out for sure.

An ECG showed that her heart was probably the one they used for the text book of a normal heart.

Her baseline observations were all normal.

Her arms were at full strength.

Her speech was normal, her mind sharp.

A request for her to smile and show me her teeth, just to test for any facial droop, indeed had her smiling.

And digging into her handbag for her teeth...

The Other Leg

2011-09-01T15:38:00.000+01:00

Late evening in the city, where another weekend heads to a close as the world prepares to face another Monday morning. There's a definite chill in the air, a disappointing summer fizzling out as the nights begin to draw in, yet all around people are spilling out of pubs and clubs wearing no more than the bare essentials. The street sweepers are out in force, one of them earning a torrent of verbal abuse for daring to complain to yet another youth for throwing an empty cup on the floor.

Rash and his friends walk away laughing, alcohol and bravado fueling yet more antics until, suddenly, he loses his footing on the edge of the kerb. His leg twists, snaps and gives way, and he crumples in a heap on the floor. The street sweeper sees it happen, yells something about karma and walks away to continue his never-ending litter hunt.

We're dealing with a drunk no more than ten paces away, another victim of just having a good time and she doesn't usually get like this. Each of us, Dean and I, has one eye on our patient making sure we don't get covered in vomit, and another on the altercation, looking for signs of a fight breaking out. When Rash falls, we're close enough that we see his leg change direction and clearly hear the crack in the bone.

"Stay there!" I shout. "We're coming." Dean calls for help, asking for a second ambulance.

Unable to move even if he wanted to, Rash lies on the ground screaming in pain. Two police officers patrolling the area hear the noise, which even in the bustling surroundings was out of the ordinary, and come to investigate. The bad timing on their part means they get to stay with the vomiting drunk and her overly exuberant friend.

Dean brings the trolley bed and a splint over, the need to see the injury first seeming superfluous having witnessed the noise it made. Nevertheless, a pair of shears always beats a pair of jeans in the trauma version of "rock, paper, scissors" (where the rock or paper are any item of clothing which may be hiding any part of the anatomy that needs to be viewed directly, in a hurry and with a minimum of movement), and seconds later Rash sees his leg for the first time since getting dressed earlier in the evening. He looks down at his ankle, and instantly looks away.

"Do you think it's broken?" It's more of a last gasp attempt at denying what he already knows than a real question.

"Well, I think the fact that your foot is facing the wrong way and there are two bones sticking out of your ankle would probably confirm that." Ten paces away, as if on cue, our drunken patient vomits for the umpteenth time. One of the police officers sends us a grateful stare, all the more grateful now that another ambulance has arrived to deal with her.

We load Rash into the ambulance, dose him up with some pain relief, and straighten his leg out as much as possible before heading to the nearest hospital. The screams of pain as we pull his leg straight subside once his foots faces front again, entonox and morphine leaving him a little dazed. When I ask his date of birth, he hesitates, looking at his friend for guidance. A shrug of the shoulders was the only reply.

"How old are you Rash?"

"Nineteen."

"And what's your date of birth?"

He tells me a day and a month without hesitation, but when it comes to the year, all he could say was "Ummm..."

"OK, so how old are you really?"

"Sixteen. And a half." And a half. Of course. That makes all the difference.

"And why didn't you want us to know that?"

"I didn't want those coppers to arrest me again. You know, for being drunk under age and all that."

"What do you mean arrest you again?"

"Well, I've already been arrested five times before. I was twelve the first time!" He high-fives his friend, seemingly proud of his criminal record.

"Twelve? What were you arrested for at twelve?"

"Fighting!" Another laugh, and another high-five.

"And you were twelve?"

"Yeah man. I've still got the scars now!"

"And you're proud of that?"

"Well, yeah, why not? But not as proud as I am of something else." He shoots his friend a knowing look, and they both smile.

"What's that, Rash?"

He pulls up his other trouser leg and proudly shows off his electronic tag. "Got this last month, didn't I! All my mates want one now, it's, like, so cool!"

"You know that you'll probably get nicked now anyway, out after what I presume is your curfew time?"

"Oh what? Even if I'm in hospital? Pull the other one, yeah?"

"I already did."

Dark Night

2011-08-26T13:55:00.000+01:00

She sits and stares out of the window

Her mind as dark as the night,

her stare as blank as the moonless sky.

I stand at the door, afraid to walk in,

scared of how she'll react to a man, a stranger

getting too close. Again.

Her shirt is ripped, her hair a mess.

Makeup runs down her face,

teary streaks leave a stain as they silently drip

off her cheek and into her lap.

Her mother holds her close,

wiping away some of the tears, whilst

letting some others fall away.

"I swear," her father says, teeth clenched,

fists clenched, eyes troubled,

"If I ever catch him..."

The officer, a young lady, pretty as a picture

and unnaturally calm,

tells him he'll do no such thing, begs him

to let the police do their job,

so that he can concentrate on doing his.

Stepping back into role, he sits with them,

A husband, consoling his wife,

A dad, caring for his little girl.

S'pose

2011-08-24T19:53:00.001+01:00

"I know you," he says, his knock on the window jolting me out of my nocturnal daydream. "You picked me up when them cops came to my house! S'pose you don't remember."

"Craig?"

"Good memory you've got there."

"What are you doing here at four in the morning?"

"Oh, you know. This and that. Just hanging around."

"Outside a hospital?"

"S'pose this is where I live now. Under section, in the nut house round the back. They just let me out for a smoke, but I ran off to get a better spot."

Craig was dragged away from home a couple of weeks earlier by the police after destroying every piece of furniture in his house and threatening to set fire to the damaged remains. His mother begged us to let him stay at home, claiming it had never happened before, that he was just drunk, and that she'd look after him now. Two facts prevented that from happening. The first was the fact that it was taking the full force of several police officers to restrain him, and the second was the arterial bleed from his arm.

Craig went back to sitting on the wall where he must have been perched before scaring the life out of me. It was three storeys up from the ground, with nothing between him and the concrete below.

"You know, I'm pleased you're here. You can be my witness."

"Witness for what, Craig?"

"For me jumping off here. You can tell them that I meant it, that I didn't just fall."

"Jumping? What do you want to do that for?" I sat there, frantically wracking my brain for a way to get some help without alerting him to the idea, but in the meantime I was happy that he just kept talking.

He took a crumpled cigarette out of his pocket. "I 'spose you don't smoke, do you?"

"Nope. Never have done. Why?"

"Smoked since I was fourteen. Ten years that is. S'pose I knew then already that I wasn't going to have a long life. Twenty a day normally, sometimes thirty, forty. Even had a hundred once in one day, thought it would kill me there and then, but it didn't. Still here, aren't I? Still need my smokes. Still need some fresh air to smoke 'em. Pollute the air with smoke like they tried to pollute my mind. I know what they were doing to me in there!"

"In where, Craig?"

"There! The nut house!"

Craig pulled a lighter out that was tucked into his watch strap, made himself a little more comfortable on the edge of the wall and after a few attempts finally managed to light the cigarette. Two long drags later, he kept talking.

"I'm gonna finish the pack of twenty that I've got, and then that's it. I'm getting out. I've got this one and one more. That's it. No more smokes, no more police, no more hospitals, no more nothing. Glad you're here, anyway. I already told you that, didn't I?"

"You did. But I might be gone in a minute, if I get a call."

"S'pose I'll wait 'til you get back then."

As if on cue, the computer rang and sent me out into the night, heading in the vague direction of a jumbled set of coordinates on a map. Someone had called in from a mobile phone, and before the exact details are confirmed, the system works out which mast the call is routed through, and starts sending me there. The little red triangle on the map showed a point less than a mile away. Now that I finally had the chance, I called up control and let them know about Craig, where he was sitting, and that they need to send someone, anyone, to stop him from carrying out his threat.

A minute or so down the road, the details of the call finally came through.

Location: Nearby Hospital, by the A&E entrance.

Details: Male, unknown age, threatening to jump off high wall. Ambulance car was on scene, now left.

By the time I'd turned round and got back to where I started, two members of staff from the Mental Health unit were talking to Craig, as a police officer helped him off the wall. He looks up at me, perhaps confused by my swift return, perhaps amused by it.

"You know what," he says, as a pair of handcuffs are applied, "I'll do it one day, whether you're there, or anyone's there. Or not. S'pose it's back to the nut house. S'pose I'd better get another packet of smokes, though."

Gossip Monger

2011-08-19T10:47:00.000+01:00

It's taken a while to get used to the new radios, not that they've been a bad thing, especially for someone who spends most of their time working solo. Prior to their arrival, the only communication we had with the control room was if we were still in the ambulance or the car. Failing that, we could use our own mobiles or even the patient's phone, sometimes dialling 999 if it was particularly urgent. Summoning police in a hurry often involved one of the crew running back to the ambulance and calling for help whilst leaving their partner facing whatever the danger was. A solo worker was even more isolated.

There was, however, certainly as the people on the front line, one advantage to the old radios: they were an open channel. As long as you were on that channel, you could hear everything that was going on with all the ambulances in your sector, and therefore it was often the people you knew best. If you heard them calling for extra help, for whatever reason, you could call up and offer that help. Now the channels are blocked. Communications are direct between a radio and the control room.

The airwaves are silent most of the time, except for the control room sending out "General Broadcasts" advising of calls waiting for ambulances, and other general information. Even these seem to have reduced in number now that they can send messages down the MDTs (mobile data terminals, or, for ease of use, the computer screens on which we get our calls). Communicating to the whole sector is still possible, but is very much frowned upon, except in one instance. If you need help in a hurry.

On top of the new handsets is an orange button. Press and hold that for a second or two, and everyone else on your channel hears you. No need to push any buttons to talk, your mic is open and hands-free. Everyone else's radios flash bright, and make an alarming sound. In the control room the radio-op has a similar sequence of events and alarm bells sounding. Nine times out of ten, the next words you hear are a crew discussing how upset they are at yet another hospital banning them from the coffee and tea, or some slanderous gossip or rumour, or even someone dealing calmly with a patient. Nine times out of ten, the button has been accidentally pressed, control checks in to make sure that all is well, and nine times out of ten the crew will apologise and spend the next few minutes panicking about what may or may not have been said as the world and his wife were listening.

A while back, I hit the orange button. On purpose.

The next words everyone heard were probably a garbled stream, and would have looked good on an old-fashioned Batman TV show:

"Get off!" "Step back!" THUD "Ow!" SMASH

"Red Base, I need police on the hurry up!"

"Z751, are you OK?" Control actually sounded a little worried.

"NO!" BANG "I need police! NOW!" "OY, GET OFF!"

I think the magic of the hands-free open-mic only lasts for ten or twenty seconds, so that's probably all they heard. Luckily, probably. Profanities are not welcome across the ether.

At that point, a crew turned up, not realising what they were about to walk in to, especially as they're on a different radio channel and hadn't heard my calls for help. An innocuous sounding call with little prior information other than the fact that the patient was crying doesn't normally call for any concern.

The next few seconds, maybe minutes, are a bit hazy. One of the crew waded in trying to help get the patient away from me as the other called again for back-up. Between us we tried to get him down on the floor, both for our safety and his. We failed miserably. In the background I could make out the sounds of several sirens, and a few seconds later half a dozen police officers ran in.

"Someone call the cavalry?"

"Er, yes! He's all yours!"

In a blur of arms, legs, handcuffs, swear words, brute force and brilliant technique, the patient, high on illicit drugs and alcohol, was finally subdued and taken into custody. It took all six officers to deal with him, so my pride wasn't too dented by the fact that I couldn't do it on my own. Still, malicious thoughts (often spoken in jest) of using an oxygen cylinder as a weapon came all-too-close to being a reality.

I drove back to station, covered in my blood and his, uniform ripped and with a sore shoulder and back. On the way back I phoned control to thank them for their prompt assistance and told them that during the events I'd made a new discovery.

"What's that then?"

"I now know that the orange button isn't just for accidentally spreading gossip!"

"Well, you say that, but now everyone's talking about you!"

"Oh."

Important Phone Call

2011-08-12T18:03:00.002+01:00

The glucose slowly feeds its way out of the liver and up through the blood stream, finally reaching the brain and bringing Alan back to his senses. Glucagon is one of our miracle drugs, and it's always incredible to watch how a patient transforms from totally unconscious to completely alert within a very short space of time. Once Alan comes round he looks almost embarrassed, the reality dawning on him that it's happened again.

"How low this time?" Alan asks.

"Oh, 0.9. Quite impressive really." It's my third or fourth visit in the past few months, and there had been others too.

"I'm so sorry. I hate to bring you out like this, I know you've got better things to be getting on with."

Alan's daughter stood by the door watching what had become an all-too-common scene in the house, but despite the familiarity she looked nervous and on edge. She held a cordless phone and kept looking at it as if it was burning a hole in her hand.

"You OK?" I asked.

"Yes, thanks. Well, no, not really. I mean, yes, I'm OK. Sorry. A bit stressed. Waiting for a phone call. I'll go make dad a sandwich."

"Great, just what he needs and desperately doesn't want."

Alan gives me an amused look. "You know me well."

"Well, what do you expect if we keep meeting like this?"

As his daughter heads for the kitchen, the phone rings.

"I'm sorry. I really have to get this. Can I leave you making a sandwich? Help yourself to a tea too if you want." Without waiting for a reply, she answers the phone and disappears upstairs. Finding my way round a strange kitchen, I make Alan the sugary tea that he despises and a jam sandwich that he doesn't mind so much. It's the staple diet of a post-hypoglycaemic diabetic. The emergency sugar stores that we steal from the body need replenishing, and it's the one time where diabetes and sugar are a relatively good combination.

I write as he eats, completing the never-ending paperwork that will end up in the growing pile of similar scrunched up and fading sheets. With a mouthful of food he tells me to write his daughter's name and number as the next-of-kin contact.

"Don't worry," he says, "she's not always on that thing. It's an important call, this one is."

"I don't doubt it." But he saw the look on my face and straight through my doubts. It seemed strange that whilst your dad is being treated, even if it's something you're used to, you'd find it more important to be on the phone.

"Ask her to tell you who it is on the phone when she comes back downstairs."

Alan finishes his food and drink, we chat for a few minutes longer, and I recheck his sugar levels, now a healthy 5.8. Just in time to see me opening the door, his daughter comes downstairs, tears streaming down her face, and I instantly feel guilty without knowing the reason why.

"That really was an important phone call, wasn't it?"

"It was. It really was. It was my husband, it's been almost a month since we've spoken. If I missed that call today, it could have been another two weeks."

"What does he do? Work on an off-shore rig or something?"

"Nearly. He's in Afghanistan."

London's Burning

2011-08-10T16:59:00.000+01:00

We're a privileged lot, us ambulance people. We knock on people's doors, people we have never met before and in all likelihood will never see again, and they just let us in. In fact, not only do they allow us in, they invite us into their homes. Any time of the day or night, we knock on the door, strangers in every sense of the word, and step into somebody else's world, usually without any fear. And in these worlds, these homes, we see lives laid bare. Emotion at its most raw, sadness and anger in equal measure, happiness rarely, but for just a brief period we're allowed a quick peek into lives that not only do we not live, but often couldn't imagine.

From beautiful homes, some bigger than my street, fenced off, gated properties with the rich and sometimes famous, to squalid apartments, crawling with rats and bearing a gut-wrenching smell that needs to be experienced to be understood, we see them all.

We see happy families, smiling photos beaming down from the walls, and families torn apart by an unknown, unloved past. There are single parents, adopting and adopted families, children who grow up with everything they could wish for, and children who grow up with nothing.

This country is the same as any other, the people here too. Most of us strive to make the best with what we have, to live our lives to our fullest potential, to be a member who contributes to a society in order to make it more livable, more comfortable for both ourselves and everyone else. These are the basics of human life, of being part of normal society.

These last few days, starting in London and spreading around the country, have shown another side to our first world society. An ugly side, a threatening side, a destructive side. We've seen society at its worst.

There's a sense of entitlement that exists amongst too many. It starts with people expecting to have everything handed to them on a plate. People don't want to have to think for themselves any more, so that where once, many years ago, ambulances would only be called in the most dire of circumstances, now a mere six hour old case of sinusitis is cause for a deferment of responsibilities onto somebody else.

Let someone else tell me what to do, it's too hard to think for myself.

I'm not a member of society, I'm me. And I'm the most important.

What I want, I will have.

The longer it goes on, the more it becomes ingrained as a norm. It's culminated over these past few days by several hundred people deciding that normal society just isn't for them. They don't want to be a part of it, and don't care about any other members of it.

If I want a television, I'll just go and get one.

If I want the latest trend in sportswear, I'll just smash my way into a shop and take it.

That's not my house, or shop, so who cares if I set fire to it?

This isn't a democratic exhibition of freedom. Freedom isn't expressed by attacking public and private property; homes, cars, even ambulances.

This isn't a political protest, aimed at changing any one of many government strategies or some perceived unfairness.

This isn't the underprivileged minority, or a certain race, or only young men. The pictures tell a different story altogether. There's a huge mix. The demographics can't be narrowed down in any way, but the thought process can:

What's mine is mine, and what's yours is also mine.

It starts with disregard for society as a whole and its rules; it's a disregard for private belongings, a disregard for public provisions, and eventually leads to a disregard for human life in general. We can consider ourselves lucky if all we do is count the cost in the number of human lives lost. But that is not all we've lost. People have lost their homes, their businesses, their streets.

They have lost financially and physically. They have lost their pasts, their presents, their futures. But we, as a society, have lost a great deal more.

We have lost our dignity.

Now's the time to fight to get it back, and maybe, just maybe, by showing these criminal thugs and hoodlums that we care, by teaching them that there is another way, they might decide to rejoin society as valued members rather than self-proclaimed outcasts.

And as I watch London burn, I can only hope.

The Night After

2011-08-04T12:59:00.000+01:00

It was one of those nights. I only saw five patients.

1) Drunk, fallen asleep in the street. Told me to get lost. Not quite as politely as that, however. Then proceeded to walk straight into a wall.

2) Drunk, fallen over in the street. Told me I need a shave, which I do, and that I speak good English for a Chinaman, which I'm not. Also, I need to go back to China, where I come from, "'cos we don't need no more foreigners in the country." Nice.

3) Drunk, fallen over at home, slightly apologetic. Slightly better natured than the previous two. Things were looking up. But not for long.

4) Drunk, violent and nasty, high on drugs to boot. I got covered in his blood as well as mine as I tried to stop him killing both himself and me, before the police turned up and looked after him. Things were looking grim again.

5) Drunk, unconscious and very seriously injured after a high speed impact with the road. Definitely grim. Grim for me, as it was pouring with rain, but that's nothing. It's much more grim for him. He's probably going to die, assuming he hasn't already.

I'm back at work in a few hours. The night after the night before. I hope it's a better one. For everyone.

It's Time

2011-07-29T13:49:00.000+01:00

Sitting at the side of the road at one of my normal standby points, book in hand but completely failing to read any of it, it's obvious that the school holidays are finally in full swing. Children have been let off the leash, running around playing outside until much later in the evening than usual. Some ride up and down the pavement on their scooter, others play with a ball, whilst a few more chase each other screaming, shouting and laughing with the innocence of youth. Eventually, one comes over and taps on the window.

"Are you an ambulance?"

Some days earlier, our neighbour of several years moved out. It's unusual these days to know your neighbours well, and we were very lucky that not once did we have any problems between us. The day after she left, new people moved in; a family with young children. Them and my kids hit it off straight away, and became best friends within minutes. The first night shift I was due to work since they moved in was last night. It was the first time they saw me in uniform. As I was getting into the car, one of their kids came over.

"Are you a, errr... an, ummm... an ambulance?"

Regularly, at least several times a shift, as I pull up outside an address, someone will open the door, turn their head back towards the house, and announce my arrival.

"The ambulance is here!"

The last time I checked, I was not a vehicle; I did not have flashing lights on my head (although the bald patch reflecting in the moonlight might give that impression); and I definitely did not eat diesel as one of my five-a-day fruits and vegetables. So why is it that nobody seems to know who we are, what our title is, or, quite often, what we do?

A child seeing a police officer in uniform knows that they are a policeman. Or woman. They know that those working on a fire-engine are firemen. Or women. They know that the people walking around the hospitals with stethoscopes round their necks, whether or not they can pronounce stethoscope, are doctors, and that those in uniform who do most of the doctors' work in every department are nurses. So why is it that children rarely know who we are? A teacher is a teacher, not a school. An out-of-hours doctor on a home visit doesn't suddenly become a Ford Fiesta just by virtue of the fact that that's the car that carried him.

Partially, it's probably our own fault. We don't get out there enough, meeting the public who, until they desperately need us, are happy to forget that such things as ambulances, and those who man them, exist. We're not as cool as the fire-brigade or the police, we don't give off a sense of pride like doctors or nurses.

When was the last time you heard a child say they want to be a paramedic when they grow up? Except my youngest, that is, and he's slightly biased. A few weeks ago I went into my children's primary school and spoke to the top class as part of a "Careers Day". This group of ten and eleven-year-olds were shocked and amazed by who we are and what we do, some even expressed an interest in hearing and learning more about it. For them, it's early days. It took me until I was a lot older than ten to decide on my career path, but as a child the thought of being "an ambulance" was never one of the options. Now, for them, being a paramedic is another possibility to think about, another point on a list.

It's time we started promoting who we are and what we do. It's time we were proud of who we are, of what we do, of what our title is. It's time that our public relations included more than announcing facts and figures in the news, of smiling when we hit targets and hiding in shame when we don't. It's time that our knowledge and skills spoke for themselves, that our care and compassion are the name that walks before us. It's time for our job to be recognised for what it is, for us to be recognised for our job, and not for the vehicle that carries us.

At least, in the meantime, a group of holidaying kids, a bunch of my children's school friends and some new neighbours now know.

Mug

2011-07-25T17:21:00.000+01:00

It's nothing fancy, the end of year gift, just a simple mug. If teachers are anything like paramedics, and I think there's a lot in common, they need their cup of coffee refilling regularly. On the back of the mug there's a short inscription:

A teacher preserves the past,

reveals the present

and creates the future.

Simple, but true.

I can only regret the fact that I never, in my entire school career, had a teacher like the one this mug was bought for. Someone who has left such a positive impression, has been so inspiring, so enthusiastic over the few years he has taught my child. Some things are written in pencil, but it seems that his mark has been left in indelible ink.

As paramedics, we only have a very brief period of time to make our impressions. Often it's a once in a lifetime experience for patients and their families, and often, even if they remember nothing else, they recall how they were treated not only as a patient, but as a person.

It's left me wondering what a similar mug would read, if instead of teachers, it were dedicated to paramedics.

Convoys II

2011-07-20T15:23:00.000+01:00

...
We were given a police radio, instructed in its use and told just to listen and not talk, unless we found ourselves in immediate danger. Out of hearing range from the scene, we were the only ones who didn't need an earpiece for the radio, so all four of us could listen in. We heard as orders were given, roadblocks inserted, a sterile area set up and snipers took up their positions. Further instructions were repeated and confirmed by the officers, and as each group arrived at its starting point, the radio traffic stopped and a tense silence filled the air.

Suddenly, an order is barked across the airwaves.

"GO! GO! GO!"

I knew exactly what was about to happen, and couldn't help thinking back again to the days when I would have been a part of the action. There's nothing quite like the feeling of adrenaline coursing through the body, that mix of anxiety, fear, anticipation and knowledge that you were doing a dangerous job that had to be done. The feeling that you were looking out for others, and that they were doing the same for you. Trusting someone with your life loses its cliche status when you have to do it for real.

Information was shouted back and forth, much of it in pre-agreed codes, some of which I could remember, others not. We couldn't see or hear the actual raid, but each radio message gave us another snippet of information as to how it was progressing. After a short few minutes, even before the information had been relayed by radio, we knew it was all over.

In the distance, a police motorbike had switched its blue lights back on, and several other of the vehicles followed suit. No more than thirty seconds passed, when the call came for us.

"Ambulance crews come forwards. Scene is secure."

Being told that the scene was secure gave us no clues as to what we would see when we pulled up. The senior officer met us outside, and gave us a brief overview. The fact that he was speaking to us at all calmed us down and left us with the feeling that there were certainly no officers hurt, and that there were no serious injuries at all.

"They're in two rooms down in the basement. We've got no idea how long they've been there, but it must be some time."

The tip-off note had told the police of one or two hostages, and as he spoke in plural, we presumed it was the latter. The narrow concrete stairs were lit by the dull green glow of an emergency exit sign at the top, whilst a small glint of light appeared down at the bottom from behind a wooden door. Several voices wafted their way towards us, some talking, some moaning, some crying. Nothing could have prepared us for what we saw.

Wearing nothing but underwear, nearly twenty men, aged from their teens to their sixties, were having their hands and feet untied by countless police officers. Several still had masking tape across their mouths that they were now trying to remove as gently as possible. Some didn't care about the pain, ripping the tape off in a swift motion, relieved to be finally freed of their shackles. A few could do nothing but hang on to the police officers who were the first into the room. The sight of scarcely clothed, emaciated men clinging tearfully to heavily armed and armoured police was one which would not leave my visions for some time.

They had been in that basement for anything up to a year, having been smuggled out of their home country by various means. On a promise of a better life, they were told they were headed for jobs that would keep them housed and cared for, and their families financed and fed. In reality, they'd been held as servants and slaves. They were beaten regularly, and tied up in the basement every night. A few of them had obvious fractures that had healed badly, arms and legs at unnatural angles. All were bruised, dehydrated and malnourished, like a picture from a prisoner-of-war camp.

One by one, they were either assisted or carried up the stairs, the most seriously injured or ill to waiting ambulances that had been requested the second we walked in, the rest were helped into a police minibus. At the same time, the handful of people who'd held their own captives turned into prisoners themselves. Handcuffs firmly in place, each guarded by at least two officers, they were placed in prison vans and driven away in a line of flashing blue lights.

In the opposite direction, guarded front and back by police bikes, a convoy of ambulances carrying a fragile but relieved cargo, gently snaked its way to hospital.