Friday, 25 September 2009

Harry's life

Life changes and specifically the one I was hinting at on my last post are important because they act as reminders (whether positive or not) that life is short and for living – changes occur to expedite movement where there is stagnation. So, two things have taken place that will move the rest of my life further along

At precisely 4.50pm yesterday my wife ended an ordeal of almost 3 hours in which she fought to push our son (her first baby) into the world. He was born at home, in our front room because there was no time to get to hospital and the midwife was on scene. I’d called an ambulance, which I swore I’d never do because normal labour isn’t an emergency and you get plenty of warning, but this was different and I misjudged it. She had been in labour for hours but it had been nothing more than a twinge or two every now and again; we both agreed that we were going to go to hospital by car, as per the original plan and the timing looked good – I was measuring the rate of each contraction and her pain score was low but it changed suddenly as I readied the bags for the trip to Maternity. She made another sound – one I’d never heard her make and it was obvious the pain had intensified. Now she needed to push.

I remained as calm as I could but I now had a problem. I couldn’t take her in the car or a taxi because it looked and sounded like she was imminent and the waves of pain were making her stand still, bend over and rest against whatever she could. I had to call an ambulance and I found myself apologising for the nature of the call. The hospital sent our Community Midwife and a young student and both arrived within thirty seconds of the FRU. The poor medic didn’t get a chance to start – the midwife took over, decided to stay put and sent him away, cancelling the ambulance. My wife was going to have the baby at home after all. Another Midwife was summoned and the five of us prepared for an expected quick delivery.

But our baby got stuck somewhere along the way and almost three hours passed as my wife endured the pain and trauma of pushing to the point of complete exhaustion. The possibility of moving her rapidly to hospital was considered over and over again but she was determined to continue at home and, despite my growing fears for the baby (and her), she braved it out and finally delivered little Harry Gray into the world. During the entire struggle his heart rate remained steady and normal, although my wife’s was spiralling and I could feel that as I sat beside or behind her, depending on which position she was trying, supporting every effort she made.

I cut his cord and forgot to keep the cutters, which still annoys me. The Midwives stayed for a while afterwards (they'd been on scene for fours hours by the time they left) and I cannot praise them highly enough. I work in London and have had, to be honest, poor experiences of some Midwives working there, so this team helped change my mind entirely and I have a great respect for the 'old school' that still love their jobs.

Harry is fine and healthy. He sleeps a lot and has yet to feed properly but that’s okay - he’s alive and well and we are both very happy to have him with us. The night ended with pizza and lots of fluids (water and coke); both of us were dehydrated and starving. My wife hadn’t slept for 24 hours and she had endured her pain without any relief – no analgesics were taken at all; no entonox, no morphine. Our Midwife called her the strongest woman she'd ever met.

My second life change will be my career. I still love my job but I have recognised that, even with the best intentions of Universities and professional bodies around the UK, at present and for the immediate future, there is nowhere to go. There’s no prospect of furthering my career unless I decide to leave the frontline, partially or fully. I had never intended to end my working life as a paramedic and quite frankly, society and the related professions still haven’t been able to recognise us as more than just ambulance drivers – even A&E nurses, with whom we are equally banded, can sometimes treat us as little more than the delivery people for their patients. I don’t blame them because all we ever seem to do is bring in one drunken timewaster after another – my God, we even have ambulances dedicated for that task alone, we call them booze buses!

I have decided to pursue my childhood ambition of becoming a doctor and will apply to study medicine in 2011. I’ll still be doing my job (hopefully) until then and I will continue to write the diary of course but I want to achieve all that I can be – I am no longer happy to settle for less because I think my age will be against me. So, it’s onwards and upwards.

This rest (I am on leave and have paternity leave as well) is doing me good. I am focussing on my novel, which will probably be late now and hope to continue writing in the future. The diary won’t disappear but it may change because I have new things to say – let’s see; it’s early days yet.

As for Harry – well, his arrival and the nature of it has reminded me to confine my opinion on pregnancy and labour and the need (or not) for an ambulance to the reality of another person’s life – their pain, their experiences. I will always have opinions but I want to base them on the balance of truth and reality, not generalisation and frustration.


Sunday, 13 September 2009


If you are a pigeon residing around Traflagar very afraid.

Day shift: Five calls; one treated on scene; one by car and three by ambulance.
Stats: 1 RTC; 1 DOAB; 1 Faint; 1 Unwell adult; 1 Feeling faint.

I’m off for a while and that’s why my posts have me in note form for weeks as I contemplated whether or not to bother when I had so much more to do. I’m preparing for a major life change and it has put me off my routine. I’m also looking very closely at my career and the options that are open to me. In Paramedicine, there are few. In the ambulance service, you move up the ranks if you want (there’s no automatic promotion) but the further up you go, the less frontline you become. It’s a typically military-styled structure, designed to ensure a numerous force of worker bees and I am getting tired of it. So, I am contemplating the rest of my life.

This morning, as I sat in my car on the Strand, ready for the first call, I was approached by a street dweller with grubby skin, yellow teeth and an open hand. I waited for him to approach, knowing that he would certainly paw at my window and ask for money simply because uniforms are easy targets. I wasn’t in the mood, so I prepared my neutral face and ‘go away’ posture at the wheel. But what he did knocked me for six and I drove off after the encounter with a sense of shame and a deeper understanding of what was happening to me as a person. The disheveled man had me wind down the car window. Then he leaned in slightly, beamed broadly at me and simply said ‘Can you just start with a smile?’

Lottie joined me for her last rideout shift before going off to study medicine. I was glad of her company and she has learned a lot about how we function on the frontline and how different it is to be with the patient at the raw end of their experience before cleaning them up for the trip to hospital, where doctors (like the future Lottie) will often assume we just fetch and carry. She promises me she will use her experience to avoid such miscalculated judgment of ambulance personnel.

The first job of the day came quite late on. A 55 year-old man is knocked off his moped by a private taxi that manoeuvres to do a U-turn across a busy road. The man is lying dramatically flat in the middle of the road, helmet off and off-duty nurse at his side. ‘We need to get HEMS’, the nurse says. I’ve spent ten seconds with them and I already know that we don’t need any more drama than we presently have – the man is not badly injured (if at all) and seems to be playing on the concerns shown by the people around him.

It is important to recognize individuals who may have social problems, learning difficulties or mental health issues because their behavior may differ when they are caught up in a situation like this. The man had certainly been knocked off his little scooter but witnesses say he was travelling at about 10mph. The road isn’t fast because it’s always tailed back due to buses and heavy traffic, so I believed what they said. The man initially played the ‘unconscious’ patient but then sparked into life when the ambulance arrived and we began to cut through his clothes to examine him for possible injuries.

We didn’t need HEMS. We had everyone we needed and it took no more than ten minutes to get the man onto a trolley bed and into the back of the ambulance, out of public view. He’d get the same care and attention that every road traffic collision patient got, of course, but he’d spend no more time in hospital than the average walk-in for minor injuries. There wasn’t a mark on him and he functioned perfectly well.

Then a drunkard falls asleep on a bus (DOAB) and, as expected, the report given is ‘unconscious, can’t wake up’, so a 999 call is made and I arrive to shake the Polish man awake and send him on his way. It takes a few seconds to do and the bus driver is bigger than me, so could have done this himself but for some reason the public believe that we are being paid to take risks with potentially violent people, so I am tasked to carry out this completely non-medical act whilst, possibly, some poor patient waits longer for help. Mr. Polish man is not happy with me at all but he refrains from threatening me beyond words because it’s broad daylight and there are dozens of witnesses around – and I can defend myself.

Inside Buckingham Palace, a 19 year-old tourist faints. It’s her third faint in recent weeks, her mother informs me, but she isn’t pregnant and has no medical problems. She has been walking around all day but she’s a teenager, so that shouldn’t be a relative factor. I am quite prepared to take her to hospital in the car because she is fully recovered and the Queen isn’t keen on ambulances turning up because more traffic inside the Palace makes the armed cops nervous, so I cancel the backup. But, in recognition of my authority as a clinician and therefore able to decide what needs ambulatory transport and what doesn’t, an ambulance arrives anyway. This has happened a lot recently. The ‘Amber Car’, which is the daytime FRU that I’m running on, is supposed to convey patients in order to free up ambulances for more serious and deserving calls. Up until a few weeks ago it worked perfectly and my posts over the last six months will have demonstrated that. Someone somewhere is choosing to ignore this and now the Amber Car is reduced to clock-stopping like all the others. It’s a shameful waste of a perfectly useful resource.

As I take the patient to the ambulance, I remind her that things aren’t too bad at all. After all, how many people can go home and brag about how they got ill inside the Queen’s house?

A running call in Trafalgar Square next (and only because I was already sitting there on stand-by) and a tourist group leader – a teacher – asked me to attend a 16 year-old Italian girl who was upset for reasons unknown to anyone but herself (she was probably homesick). She’d told her mates that she was feeling faint and indeed displayed the potential for that event by adopting an ‘I am dizzy and will probably fall down at any moment’ position, mainly for the benefit of her peer group. So the first thing I did was ask them all to leave and this meant she had nobody to worry over her, except two friends and her teacher, who wasn’t worried at all in fact and agreed that the girl was simply emotional.

Nevertheless, I asked the teacher to keep an eye on her, the paperwork was done and advice was given but I didn’t expect to see them again… and I didn’t.

Every now and then, you come across people who seem to have given up on life. Such is the effect on their physical bodies by their psychological attitude that they actually become ill enough to die. I have seen this a few times over the years. My next patient was 86 years-old and she had recently undergone a double-amputation of her legs due to uncontrollable disease. Initially, according to her carers (who cared very much) she was getting back to normal but over the past few weeks she had begun to get depressed. Over the last few days she stopped eating and drinking – refusing to take anything in that was offered and she lay in bed all day and night, not communicating much, if at all.

I was called to this lady because she had suddenly stopped responding altogether and her carers were seriously concerned about her now. My attempts to get her to open her eyes failed and I knew she was deliberately sliding herself into an abyss. She was conscious and she had no immediately significant problems with her vital signs. She was dehydrated and muscularly tense when any attempt was made to move her. Even getting a line into her arm proved difficult as she seemed to resist my efforts. Eventually, she got fluids but I don’t think she cared and she remained completely non-responsive when the crew arrived and we carried her down stairs and into the ambulance.

This lady wanted to die I think. I felt very sorry for her because I put myself in her position and I could empathize. Strong, independent people react very badly to having their lives halted but they pick themselves up and carry on or they do what this lady did– they stop living altogether.

Be safe.

Saturday, 12 September 2009

Another day in paradise

See? The shadows on the wall are more interesting than the people on the plinth!

Day shift: Five calls; one NPC; three by car and only one by ambulance.

Stats: 2 eTOH; 1 ? fracture; 1 Abdo pain; 1 Eye injury.

Ahhh, the old Red1, ‘life status questionable calls’ – they never cease to wake me up and make me smell the roses. I didn’t even make contact with this one (who was, of course too drunk to look alive). The police had found him lying on the pavement, where nobody in their right mind was going to touch him to see if he was alright, so they called us. The cops hadn’t over-reacted and screamed cardiac arrest down the phone but someone else button-pushed their way through a load of stupid questions, designed by and for robots, until the only conclusion they could come to (automatically, remotely and whether they liked it or not) was that the person on the pavement must be dead. A ‘life status questionable’ that actually produces a corpse is as rare as an ‘unconscious on a bus’ being something more than just another sleeping drunk.

‘Where’s my mates?’ asked the drunken fool, according to the police officers who flagged me down and stopped me from becoming part of the circus. I’m also told he then attempted to get up and fell back down, stating ‘I’m so drunk I can’t even stand up’. Honestly, he knew what was happening before we did. I would want to produce a little book of receipts and swipe his credit card for the couple of hundred quid that he had just cost me and my fellow tax-payers; Ka-ching.

Bear in mind folks, that it was still early in the day – morning time in fact.

Moving home for the new University Semester can be stressful. Moreso when, not only have you barely seen your new pad but your parents are visiting to help you settle in and your sister, who is also at uni, is at hand to comfort you during the move. Then you trip and fall off a high kerb outside your new digs, badly spraining your ankle in the process.

I was called to the aid of this 19 year-old woman who now lay in the road with her family around her. She still had her sense of humour and she still had her dignity (wasn’t wailing and crying all over the place) and she did have a possible broken ankle. Moving would have to wait and I took her and her mother up to A&E in the car.

The voluntary services arrived on scene when I was dealing with my next patient, a 33 year-old pregnant woman at 22 weeks who had abdominal pain and the worries of the world about losing her child. I had expected my colleagues to show and was quite prepared to take the lady and her husband to hospital if they didn’t, so I stuck to my guns because (1) I had no idea why the volunteers were there on blue lights and neither did my Control desk, (2) I would have to ride along with my patient in their ambulance because I had no idea what their skill levels were and I was responsible for her and (3) well, let’s just say I didn’t like the look of them to be honest.

I know I will get the usual flak for that comment but even my patient was concerned about being left in their care – one looked far too old to be doing the job and the other may still have been at school; the image was bad and the poor lady in pain had no confidence in them from the start.

She wasn’t bleeding and the pain came and went. Her last scan, which was the day before, was fine, so she was absolutely stable for travelling in the car. In fact, she insisted, so I cancelled the crew down right there, even though I didn’t know in what capacity they had even arrived here and drove the patient and her husband to hospital myself, delivering them to the Obstetric Day Unit within 20 minutes.

I must point out that, regardless of my personal opinion of the crew that arrived, the patient was given the option of travelling in their ambulance because I wanted to make sure I wasn’t the only one with an uncomfortable feeling about it. This is not an attack on the voluntary services, which generally do a great job and without which we’d struggle at times; it is a statement about the image given by certain individuals in their uniforms.

The stupid call of the day was for a 27 year-old man with a 2-week old eye injury (he poked it with his finger) who called an ambulance from a phone box when he got lost on his way to the eye hospital – apparently, he couldn’t see where he was!

He had been attended to at his local hospital but they had referred him to a specialist unit and now he was in Regent Street, nowhere near his destination. His eye couldn’t be to blame for that confusion and misinterpretation; his brain must have played a part.

I found out just how devious (or thick) he was when, after the fuss of myself and an ambulance showing up for him and me offering to drive him almost 4 miles to his destination, he not only asked me to stop at a shop so he could top up his mobile credit but to wait for him so that when he was finished at the hospital, I could take him home... to Acton! I clenched the wheel as I drove, I can tell you.

I deposited him in the waiting area of the eye hospital, where the triage nurse listened to my story and tutted sympathetically for me. Then I drove off in a puff of irate blue smoke and sped into the distance as the mad blind man came running after me, waving his mobile phone in the air with the words on its screen reading ‘battery lo’.

That last bit didn’t actually happen but it could have. I just drove off and left him there. The words ‘battery lo’ were probably flashing in his brain.

We end as we begin, right? As in life, the drunks and wasters get all the duvet, so I was given my last life-saving assignment for the shift at a train station where a Polish man lay ‘unconscious’ on the floor, directly below a little food stand. Police were on scene and by the time I got there, he was awake. He’d never actually been unconscious and he proved his worth by vomiting, without much warning or the good manners to catch it, copiously onto the cleanish, tiled floor underneath that little food stand (which was currently doing no business).

His foul vomiting went on and on. He became aggressive and nasty when the cops held him down for his own sake. He had no medical need of me or anyone in green but we had to do something about him – he was putting the Burger King customers off their meals. So, I asked for an ambulance and hated myself for doing it. The poor crew were dragged, near the end of their shift, all the way from the north to here in the south, just so they could continue the game we had started – ‘babysitting the foreign drunk man’; a game played by thousands of healthcare professionals and police officers around the country and a game which can be variously titled ‘foreign’ or ‘home-grown’, depending on your town and its national diversity.

This game, incidentally, if you are still chortling away, is costing us all money every day. It appeases no-one who pays to suggest that alcoholism is a disease, so ‘leave them alone and don’t be judgmental’. When we run out of money and have to face it all, what will we do with those hard-core individuals then? It would be cheaper to buy an island, drop them off and let them drink as much as they want until they die of it, or sober up and come home to rejoin society. We could use the savings to buy hospital beds for children with cancer or other genuinely ill people.
That would be nice.

This ‘patient’ was the only person I had to call an ambulance for. That says it all I think.

Be safe.

Saturday, 5 September 2009

Bacardiac Arrest

Some people are sober when they behave drunk.

Night shift: Seven calls; all by ambulance.

Stats: 1 Vomiting; 1 Allergic reaction; 1 Drug o/d; 1 eTOH; 1 High temperature; 1 Chest pain.

I’ve decided that most of our Red calls should be dubbed ‘Bacardiac Arrest’, since they are alcohol related anyway.

A single night shift among the leave dates I have booked (you may have noticed the sparse postings of late) and I am running to a 68 year-old woman who is ‘unconscious’. When I almost get on top of the call, I radio Control and ask them if I am still required because it went green as I travelled towards it and I’d decided to keep going until they cancelled me, which is the usual practice. I’m told that I’m no longer required but no reason is given and I don’t ask for one. I turn my tail and head for the West End, where I will haunt the drunks for the night.

Thirty minutes later and the same call, to the same restaurant for the same patient, rings onto my screen. This time it’s red and I get myself on scene as fast as I can because bitter experience has taught me that when these calls are wrongly categorised, patients can suffer and this lady had been unwell since my initial activation.

I arrive and walk into the place to find her vomiting on the clean, posh sofa of a clean, posh restaurant. Her family is with her and they are none too pleased about the delay in getting help to her. She has been in this state for almost an hour, I’m told. An ambulance was called but somewhere along the line, someone had called it off… I suspect the staff at the restaurant had something to do with it; communication gone wrong.

The poor woman was in a real mess; very pale and sweaty, shaking and throwing up. The vomit was acrid and soaked into the light cloth of the restaurant lounge sofa, staining it, probably forever.

She had no history of illness and she and her family suspected that something she ate had triggered this although the onset of food poisoning in such a short time was unlikely unless she'd eaten shellfish. Whatever it was, she should never have been left like this for so long and as soon as the ambulance arrived, she was taken away and out of public view. I went back into the restaurant to help clean up the mess that had been left behind, mindful that customers were trotting in and out of the place, passing the devastated sofa; it wasn’t the best advertisement for eating there and the smell was so powerful, it could be detected outside as you read the menu.

In the narrow road that we’d blocked off with our blue-light flashing vehicles, a couple of drivers had dismounted and walked up to me in a demonstration of anger, as if just by being close enough to show me how annoyed they were, I would disappear and the road would become passable again. I did what I could to move out of the way but the ambulance remained in the middle of the road like a fat dog at rest and there was no way it was going to move until the patient was checked and made comfortable. Whilst I understood the irritation this must cause to drivers with places to go in a hurry, weekend night-time double-parking is to blame. The design of London’s streets is to blame… The Great Fire of London (1666) is to blame. The LAS and the NHS is not to blame. For that reason, would you kindly stop threatening us when we park, without an option, awkwardly in the street for an emergency call and will you also stop yelling at us, swearing and gesticulating your annoyance when our sirens insult your delicate ears?

If you are anaphylactic, you will experience severe, possibly life-threatening signs and symptoms, ranging from swelling of the face and throat to DIB and shock. If you are allergic to things but have no more than a tickly throat and can speak and walk around without any problem… and you are approximately a mile from hospital and metres from the nearest taxi, dialing 999 is a little far-fetched.

I saw my 26 year-old ‘lump in throat and DIB’ patient chatting on the phone and leaning against a wall as I pulled up on scene. She didn’t identify herself and I only know it was her because, after walking around in plain sight for a minute or two, calling in a possible no-trace and chatting to the ambulance crew that arrived after me, she wandered over and let us know she was the one who’d called.

Our walking, talking, normally-breathing patient seemed to have no difficulties whatsoever, except for the disease of panicking and reaching for the three 9’s as if there was a limitless supply of ambulances. She hadn’t identified herself to me because some people simply don’t see the car as an ambulance; it confuses them when I arrive.

No patient contact on the next call. A 28 year-old woman had fallen and a crew was on scene. So, I slinked back onto Trafalgar Square, where I had a long and enlightening conversation with a police officer about made up porn names. We came up with Paddy Spurger, Buster Chamberlain, Stuart Scamp and Mopsie Hucklebridge for the real people we knew. They know who they are!

Then a 30 year-old drug addict overdid it with Heroin at his hostel. He was staggering out with the crew when I arrived and I gave him some Narcan to wake him up a little. It worked well and he remained passive but by the time he got to hospital he’d collapsed again and needed more Naloxone to keep him breathing. Silly man.

This call was followed by a 24 year-old female who’d collapsed, vomiting in the toilet of a club. She too had taken something she shouldn’t have and when she pulled the IV line out, after I’d worked hard to get it in there, it looked as if her vein was spewing blood around like it was an artery – always a worrying thing. In fact, blood had gone up into the tubing and was now pouring back out of it under the influence of the fluid pressure when she dislodged the thing. It made the patient’s brother frown a bit and the floor of the loo was now awash with watery pink stuff.

A 30 year-old Arabic man with a Hickman line fitted lay in his bed with a temperature of 38.8c because the entry site of the line was infected. He was very unwell and, in addition to having cancer, this current acute situation was a kick in the teeth I would imagine. His family was around and they showed great concern for him as he lay there not wanting to move.

In stark contrast the last call was for a 26 year-old man with nothing wrong with him except the inability to grow up and behave. He lay in bed not suffering from cancer, with normal vital signs and generally good health, crying about having ‘chest pain’ that was clearly the result of hyperventilation. His entire family, mostly female, gathered around him as if he was dying. They actually looked like they were rehearsing the mourning bit of their lives. I let the crew deal with him because I had just been to see a man who probably wouldn’t make his 31st birthday and was suffering to the end and I had very little professional medical sympathy for this one as a result. Sorry.

So, to cheer me up, I was entertained in the early hours of the morning by ‘Darth Vader’ as he strutted his stuff and threw his light saber around on the 4th Plinth on Trafalgar Square. I tried to imagine how this grown man’s normal daily life went, what his routine was and whether he still lived with his mum.

Be safe.