Little Angel

WARNING: Some may find this post extremely distressing. It's on the subject of Sudden Infant Death Syndrome and contains some very upsetting descriptions. 

I remember when I first started training, being told about all sorts of things that we will see. Some rare, some common and some unheard of. The prospect of the sheer volume of things I would see scared me  but having never seen anything, it was all a big unknown. I didn't know how I'd cope with the shifts, the people and the emotions of what is commonly touted as 'A job like no other'. I was assured that when the time came I'd be with a 'grown up' and all the training would come flooding back. I could only hope.....

It soon became apparent that the training did come flooding back, time and time again. As the weeks, months and years went by more and more things became second nature. My body got used to the shifts (kind of), I got use to the people (kind of) and on the whole my emotions were kept in check. You do get an emotional attachment to some patients from time to time. Some faces stay with you. Some are gone within seconds of leaving them. There is a constant emotional tight rope with me thinking that I'm either dead inside or too fragile to do the job. I suppose that balance is what has kept me grounded most of the time.

We'd been having a pretty non-descript shift. I couldn't begin to tell you the patients I had seen or what was wrong with them. That would be the 'at arms length' approach to ambulance life. The first real detail I remember of this day was my index finger reaching out and pressing 'Green Mobile'. Within a couple of seconds the job appeared on the screen.

"4 months old male, cardiac arrest, CPR in progress"

I felt the blood rush away from my face, my hands became cold and my heart rate doubled. I started imagining everything that could happen next. I pictured the child in his cot, his parents frantic. The only image of the room he was in that I could conjure was that of my own son's room. The thought choked me. Surely, this can't be. It must be an error. He must just be asleep. It must be a false alarm. I don't know why, but this felt different to all false alarms that have come before. This had a strange reality. I knew this was real. Then the radio started ringing.....

"Guys, I believe this is as given, we have another truck and an FRU on way but you are currently nearest. I have also requested the police."

My heart genuinely sank. I couldn't for the life of me remember the resus protocol. I knew it, but I convinced myself I didn't. I was the clinical lead. My crew mate was a student and was equally terrified. I tipped my bag upside down and started flicking through pages of A4 paper with recent clinical updates. I had about 0.3 miles to refresh my memory and then it was all on us. 

We screeched into the road, the familiar waving met us at the kerb. This time it was all the more frantic. All the more desperate. All the more real. The child's dad, consumed with grief, overcome with fear was begging us to do something before I'd taken my seatbelt off. I jumped out, grabbed some bags and ran into the house while trying to find out what had happened. A woman, who I assume was the grandmother was stood in the hallway clutching on to two young children. Tears were pouring down their faces. A shiver ran the length of my body.  This is as real as it will ever get. As I neared the top of the stairs I saw the mum. She was kneeling on the floor, desperately trying to breathe for her beloved baby boy. 

"Please, do something!!" she cried at me. 

Her voice alone broke my heart. I'd never experienced such pain and hurting. I could imagine the desperation and her thought process but without living through it, imagination won't ever come close to reality. 

I looked down at the boy. He laid there lifeless, peaceful, like he was sleeping. He was dead. His short life had come to a tragic end and I knew there was nothing I could do. There was nothing anyone could do.  

"Do something, please!" she wept. "My beautiful baby boy. I'm so sorry, I'm so so sorry."

In that split second I made a decision that I have questioned over and over, ever since. I held the mask to his face, filled his lungs with oxygen and started CPR. I lifted his lifeless body off the floor. With him lying on my forearm and using just two fingers I continued the chest compressions down to the ambulance. My crew mate followed with the bags. The FRU had arrived by now. He saw me rushing out of the house with the baby, and opened the back doors for me. The mum and dad got on board and we left. We had been on scene no more than 2 minutes. I looked at the guy on the FRU and just shook my head slightly. 

As we drove through the streets all I could do was go through the routine of CPR and ventilation. I felt in that moment it was what the parents needed to see. They needed to see us do something. Anything. I struggle with the morality of giving false hope though. Was I prolonging their pain? Who am I doing it for? Was it me who felt the need to do something? 

"I'm so sorry my baby boy, I'm so so sorry I wasn't there when you needed me, I'm so sorry my little angel."

Despite my best efforts, tears started trickling down my cheek. I couldn't help but see my son lying there, imagining what I would do in this unimaginable situation. 

The doors swung open, I picked him up and ran into resus. A small team was waiting. They'd been warned by control we were coming with a patient who was deceased and all our efforts were for the benefit of the family. I handed over the brief history I had. He was put to bed at 6pm. At 9pm, mum went to check on him and he wasn't breathing. Here we are now. 

The doctor told them he had gone. He tried to do so in the most compassionate way he could. Maybe that's why I started CPR. Because I couldn't have that conversation. I couldn't be the one to break that news. News they most likely already knew. Maybe I fell into the trap of having to do something. I don't know. To be honest, I didn't know anything. I couldn't process what was happening. 

I left. It wasn't until I got back to the ambulance that I realised we were all crying. We sat there in silence for a good ten minutes. What could we say? What could we discuss? There is no job more distressing, more tragic and more emotional. What we were feeling however, pales into insignificance in comparison to what the family were going through. The more I thought about it, the less I was able to comprehend the impact this event would have on a family. It literally didn't bear thinking about.

The police arrived and asked us some questions, and then one of our officers arrived. We were told once we were finished at the hospital we could go home if we needed to. We all did. I didn't come in for another week. I couldn't. We were offered support and counselling if we wanted it but I turned it down. I suppose the last thing I wanted was to talk about it. I didn't want to think about it. I wanted another job. I couldn't do this again. Ever.

I did come back. I still don't think I could go through that again. I know there is a chance I will and that will have to be dealt with if and when the time comes. Those parents have to not only come to terms with the loss of their child but somehow be strong for their other young children. The least I can do is carry on offering that false hope where it's needed. It would be selfish to walk away.

You cannot quantify events like these. Saying 'these things happen' doesn't do the loss any justice. I felt like a fraud moping around, feeling sorry for myself. This will be with that family for the rest of their lives. There are no answers that can be given. No meaningful explanations as to why. Nothing will make it better. The words 'I'm so sorry my baby boy' will forever be with me. I will always remember their little angel. I know she did nothing wrong, the doctors know she did nothing wrong, but I also know she will probably take a feeling of blame with her to her grave. I imagine all parents would. I know I would.

Elementary, Dear Right Honourable Ann Widdecombe

I may be late to the party but I felt it was time to come out of hiding to have a good old fashioned rant!

So, Richard Madeley of Richard and Judy fame managed to get the backs up of every single ambulance worker in the country with his badly written, badly researched tripe of an editorial about a crew who finished their break before going to the aid of a critically ill child. For those not aware the original story can still be found here. It should have come as no surprise when the article vanished, but it didn't take long for more of the gutter press to spread lies and mis-information and make slanderous, biased attacks on ambulance services and their staff. Why let the truth get in the way of a perfectly good story eh?! It seems to serve no other purpose other than to blacken our name and tarnish the public perception of the NHS as a whole and only goes to make a hard and volatile job just that little bit harder. This time we have The Right Honourable Ann Widdecombe to thank for providing us with one of the worst examples of 'journalism' I have ever seen.

"A BABY of eight weeks is facing possible disability for life as a result of an ambulance crew finishing its break before going on a 999 call."

Belittling the work of the ambulance, police and fire is a right giggle.....

I agree with what she starts with, 'I can think of few more genuine emergencies than a baby having a 'heart attack'. Neither can I. Unfortunately the cardiac arrest the poor child suffered is not the same as a heart attack; never has been, never will be, but that really is beside the point. The child was critically ill and should have had an ambulance quicker than 41 minutes. Why though was West Midlands Ambulance service solely reliant on a crew who was on a rest break? Obviously Mrs Widdecombe couldn't possibly blame the Tory cuts, must tow the party line after all (even when you've retired from office). We can't for a minute blame the lack of funding, not enough staff, not enough ambulances and too many calls for the delay can we?! Oh no... blame the greedy paramedics stuffing their faces ignoring cries for help from a dying baby.

She goes onto draw parallels between staff having the right to a rest break with babies having the right to live. In all seriousness, what does she expect?! Is this the Conservative ideal?! Ambulance crews working 12 hour shifts without the possibility of a break? What happens when we have finished our shift? Does she expect us to answer calls then too? What about before? Do we sign on when we wake up in the morning and offer to answer calls in our own cars? I'm sure she was never advised to starve herself for 12 hours at a time whilst on Celebrity Fit Club....

One of my favourite parts of the article was when she led with 'Members of that crew had better pray that if they ever need to call out the emergency services they don’t find themselves in a clash with a copper’s cuppa or a fire fighter’s elevenses.' It would have only taken asking one member of an ambulance crew to find out how rest breaks work. We have no idea what jobs are going on around us. We are dispatched by a computer (that computer's sole purpose is to assist us meet the government targets), and on the rare occasion we get a break at all, that computer makes us unavailable for that period and we cannot be sent a call. Does she really think that a crew would knowingly sit down and eat in the knowledge that a baby was in cardiac arrest around the corner? I think its disgusting to level such an unfounded accusation at a crew. As for interrupting elevenses, we all know that Trumpton are always at rest!!

As if that wasn't enough she went on.......

"It is bad enough when public servants worry more about their own safety than that of the public and refuse to enter 2ft of water or to hop on a bicycle without a helmet but when it comes to putting sandwiches before a dying baby and then defending such action as reasonable, Britain has sunk to a new depth."

Look at them all! Scum! Every single one of them in it for themselves....

I don't remember 'can expect to take regular abuse and beatings' as part of the job description of Paramedic, maybe I missed it. I was probably too busy stuffing my face while watching this model citizen use her public standing to earn a few extra quid prancing around on Strictly Come Dancing. Silly me! For the record Ann, yes, we do worry about our safety but that doesn't stop us doing our job. We just wear stab vests so it hurts less. I was recently at an award ceremony for my service where staff were given the Chief Ambulance Officers Commendation for bravery. There was a crew who were beaten with a fence post and still went on to treat their attacker despite numerous broken bones. A crew who continued to do CPR whilst being repeatedly stung by wasps. A crew who disarmed a man with a gun. A policeman who sat next to a burning motorbike to protect the man lying in the road. Crews who day in day out put their lives on the line and for what? For the appreciation of our wonderful politicians?! If Britain has sunk to a new depth it's because of people like you. People so deluded and out of touch, that they label the little people their servants. Ms Widdecombe is not alone. Only today Tory MP Christopher Chope refer to the House of Commons catering staff as his servants. It's YOU who is out of touch, YOU who should be defending actions and YOU who should be answering accusations of sinking Britain to new depths.

I don't recall her or any Tory writing an article about the members of the emergency services who have sustained serious, life changing injuries in the course of duty as one of their 'servants'. Then again when she has the opinion that 'the service exists for the benefit of those who staff it rather than those who need it' it's of no surprise that these articles are not forthcoming.

'The purpose of education is teaching the young, not keeping bad teachers in their jobs, the purpose of the National Health Service is to make people well, not to give doctors evenings and weekends off and the purpose of the emergency services is to protect the public, not the staff’s nosh. Elementary, Dear West Midlands Ambulance Service.'

The purpose of education is teaching the young, so stop moving the goalposts and start supporting your teachers. The purpose of the National Health Service is to make people well, so stop privatising it, cutting funds, cutting staff to line your pockets. The purpose of the emergency services is to protect the public, so stop trying to turn the public against us, stop cutting ambulance funding, stop cutting police numbers, stop reducing wages, stop taking away our pensions, stop expecting us to work for 12 hours with no breaks and stop lying. Elementary, Dear Right Honourable Ann Widdecombe.

Oh and just for the record, you of all people should know that we the ambulance services are NOT emergency services. We are essential services. School girl error there! And I thought you were an educated woman, how on earth did you land the role of questionmaster in Cleverdicks?! They certainly didn't teach you the art of investigative journalism in your time at Birmingham University or Oxford! (See what I did there? Researched! You should try it some time.) You simply cannot put an article making sweeping statements into such a public forum, full of conjecture based on inaccurate information. It is nothing short of negligent, especially from someone with your social standing.

Like Ann, I also rage against the society we have become and when I heard about Thomas Passant it was indeed upsetting and heart wrenching. As a parent I know only too well what I would be feeling in that situation but putting food before the life of a child is not what we have become, not what we have ever been nor will ever be. We will always, always always try everything in our power to help anyone who needs it whether or not we have eaten, whether or not we have had a break, whether or not we have been at work for 14 hours already and whether or not we may get hurt along the way. We certainly don't work 80 hour weeks, 12 hour shifts, long nights, take abuse, receive violence and take repeated public attacks from washed out politicians for the money! £10.12 an hour is only tolerated because it's a job we love. If I wanted money and an easy life I'd work in McDonalds or go into politics. I reckon I'd be rather good at fiddling expenses and reality TV! Maybe that's what I'll do!

Perhaps Ann Widdecombe would like to come for a 12 hour night shift on a Friday (Or Richard Madeley). Would she be happy to face her adoring public in their time of need? Would she like to explain the real cause of the delays? Would she be happy to interrupt her rest break for a 43 year old male bleeding from the wrists, holding a knife and threatening to stab the first person through the door? Come on Ann! It'll be fun! I'll bring the nosh! Or maybe you'd like to find somewhere safe and warm, paid for by your servants, and write about it instead.

'Nero fiddling while Rome burned is the image which comes to mind.' Indeed.

24 - Part 3

continued.......


The following takes place between 2am and 7am (ish)

02:01

"6 month old male, crying, difficulty in breathing"

The fatigue had well and truly kicked in. Unfortunately we had agreed to swap over half way through the shift so at my most tired, I was now behind the wheel of a 3.5 tonne ambulance. Awkward! Within 3 seconds of greening up for the next job, we got the next job! Off we went; the roads now were pretty empty, which although makes the drive easier,  means there are less distractions to keep you awake. I opened the window, turned the volume up and sat bolt upright whilst I drove. My eyes were fixed on the road ahead, but I could feel my rate of blinking increasing. Focusing became harder and my eyes were feeling so heavy. Pleased to still be in one piece, but with no memory of the journey, we pulled up outside a rather lavish property. 

Inside was our patient, crying. No difficulty in breathing, just crying. He had been crying for an hour apparently. He also had a cold. He had had calpol. He was just crying. It wasn't a teary crying, just a grouchy wimper. It was more the noise that I make when I'm awake and don't want to be or I'm hungry. Now I was driving, I didn't really have to talk to people, which was a good thing as I was suffering from 'grumpy driver syndrome'!

'Grumpy Driver Syndrome: A condition that effects the driver of an ambulance. Symptoms include increased irritability, decrease in levels of patience and overwhelming feelings that no patient deserves an ambulance. In severe cases the driver is best to be left well alone and avoid eye contact'

All that was going though my head was IT'S A BABY. IT CRIES. DEAL WITH IT AND DON'T CALL 999. Rules are rules though and all under 2's go to hospital. The dad followed us to hospital in the CAR! The car by the way, was a Porsche Cayenne. Why that is important, I don't know, it just added to my annoyance. The drive to hospital was no better than the journey to the job. My eyes were getting heavier and heavier, this was the most tired I had ever been. Not  a nice feeling.

03:12

"68 year old male, chest pain"

Having dropped the 'cryer' and the doting parents to A & E we sat there sipping the watered down Maxwell House hospital coffee. It wasn't pleasant but I needed caffeine to snap me out of the 3am lull. I even took some ProPlus in the hope I'd get some energy. Nope. Not a chance. In the 7 minutes spare we had, I dozed off, woken only by the screeching of the MDT sending us off on yet another magical mystery tour. My eyes were bloodshot and the thought of having to drive 3.4 miles filled me with dread. Yet again, we made it! I think the concentration I was having to use to stay awake was making me more tired, but I had no choice. At least we were greeted by the sight of an FRU as we pulled into the road. We headed in, I was a good 4 or 5 steps behind as I didn't have the energy to lift my weary feet off the floor. 

What I didn't need was that smell of urine again. It hit me as I walked through the door and I gagged. The patient was in the kitchen chatting away to the FRU. He was basically a lonely old man and just wanted someone to talk to. He was complaining of a 6 month history of intermittent chest pain but 3am seemed like the pefect time to call us. If it was 2pm and I was attending I would have been full of the joys of spring. I love talking to old people and listening to their stories but now, at 03:31, all I could think about was a) how tired I was and b) how the hell I was going to wake up enough to drive to hospital. We were on scene for ages, the guy kept changing his mind about whether or not to go and once it was decided he was going, there was the task of collecting everything he wanted to take with him. I sat in the front, starring through the windscreen watching the first rays of light fill the air, waiting to be told that my crew mate was ready to go.

04:26

"Ready when you are!"

Off we went. This 2 mile drive would bother me for hours and days to come. It made me evaluate what exactly I was doing. Was all this worth it? Was this the job for me? As I drove I could feel my eyes shutting. I was fighting it so hard. I started hallucinating; seeing buses and lorries that were not there, seeing things that would make me brake but when I re-focused they were nowhere to be seen. It terrified me, but what could I do? Call control and say, 'sorry I'm too tired for this'. Would this count as going off sick? Would I be reprimanded for it? Probably. If I had a crash it would be my fault. Yes! I am the driver, it is my responsibility. It doesn't matter if I have been awake for almost 22 hours. It doesn't matter that I have been working 9 and a half hours without a break. That's the job. Isn't it? Maybe if the advert had read:

'Work up to 80 hours a week on a night heavy, debilitating shift pattern with no rest breaks & late finishes which causes you physical and mental ill heath, crippling insomnia and fatigue beyond your wildest dreams for less money than a bin man. On successful completion of your training you will be rewarded with a divorce and have no relationships with anyone outside of work and no social life. You'll ferry people around while getting verbally abused, kicked, punched and spat at. Not allowed to go off sick.'

I would have thought twice about it. Please please please remind me why I love my job?!

We got to hospital and I headed straight for the toilet, I splashed cold water on my face and then drank 2 more cups of coffee. By the time I emerged back outside it was light again. I could feel the glaze over my eyes. One more job. One more job. One more job. The finish line was in sight!

05:17

"45 year old female, kidney pain"

Luckily the address given was only half a mile away. Even I could do that drive without too much hassle. We pulled onto the estate and hunted for the block. Unsurprisingly it was the only block without the block name on it and we only found it by matters of deduction. Inside was our patient, lying on the sofa, 6 or 7 family members flocking around her. She didn't speak any english. 

"What's the problem?"

"She has bad pain in her kidneys" her son replied. 

"How long for?"

"3 days"

"Has she seen the GP?"

"No"

"Has she taken any pain killers?"

"No"

The questioning continued like this for a few minutes. I did her OB's while my crew mate played the translation game. Basically, in summation, she had been ill for a few days, not done anything about it and now her first port of call was an ambulance. We would play taxi and take her to hospital where she would be given antibiotics and sent back home. And that is exactly what we did. 

06:03

Having arrived at hospital and handed over the patient we now had 27 minutes to wait until we could go back to station. As we hadn't been given a break, we basically take it at the end of our shift and leave 'early'. I cleaned up the back of the ambulance, got all the bags ready at the back door and then waited until 06:30 and drove back.

07:04

Having battled through the rush hour traffic we made it back on station. I was slightly more awake but not much. My crew mate drove back for me as I didn't feel safe to do so. I signed the drugs back in, put my stuff back in my locker and signed out at 07:15. 45 minutes late off.

07:31 

Clamber into bed. Another day, another dollar; done.

OK, so that was a random day as it happened. I still had 4 more night shifts to come. As a member of the public, how happy would you be knowing that I could have been driving your loved one at 4am? I wouldn't be happy but what would you suggest? I am not alone, every single night there are crews fighting fatigue and exhaustion and they do so under the guise of 'it's the job'. The fatigue aside, this shift highlighted so many problems this country has. It showed the uphill battle the NHS is facing and the consequences the cuts are having. We go from patient to patient all night, forget and move onto the next. We move from one problem to the other having just passed it on to someone else. If I hadn't written down every job I had done, by the time I had woken up the following morning I would have forgotten most of the people I had met and most of the problems I came across. Even writing this now, I can't recall any of their names, not even the mother of the dead baby I held at 19:00. I bet that as you are reading this now, you had forgotten about that too.

24 - Part 2

continued......

The following takes place between 10pm and 2am

22:00

"76 year old male, fall, lying on floor, confused"

The yawning had begun. Not a good sign so early on! After a couple of cancellations we were dispatched to this job, another night, another fall. The sheer amount of jobs likes this highlights the ever increasing difficulty with caring for the elderly and what a social problem providing the necessary care is becoming. We pulled up outside and our patient's wife was waiting at the door. The usual unnecessary apologies for wasting our time were offered, as were the usual assurances that there was nothing to be sorry for. The smell of urine was so so strong. The house was filthy; our patient was filthy. The smell of a UTI is extremely distinctive, the smell of a UTI with the heating on is enough to make you gag. The smell of a UTI with the heating on and infected leg ulcers is where we were at! It's the kind of smell that gets in your throat and makes your eyes water. It is so difficult to ignore it but I don't like to show  how physically sick I feel. 

Our patient had slipped off his chair onto the floor. His ulcers were dressed in thick dressings and he was unable to sit up, let alone stand. There were no injuries so we helped him up to standing, then back into his chair. Unsurprisingly, he refused hospital but due do his confusion, inability to cope and numerous infections we entered into the grey area of capacity. After a frank conversation with him and his wife I deemed him not to have capacity to refuse but was taking him to hospital against his will the best option? Probably not. The pathways available to us look at what is the least restrictive option and it is a battle between what you want to happen, what the patient wants to happen and what is best for the patient. In this instance a referral to the GP and a home visit was the best we could do. He had a hospital appointment the following day for which transport was arranged so I was happy to pass him into the care of the GP. Yes, it's partly an arse covering exercise but when patients don't heed our advice we have to. 

It is very sad to see our elderly generation living in these conditions. They owned their own home, so as such were not entitled to free care. Despite both paying taxes for 50 years they were left to pay for their own care. Because of this they didn't have any. No carers, no cleaners, nothing. I'd love David Cameron to have been with us on this shift. See how he would deal with a dead baby, a mental health patient with no treatment and a pensioner living in squalor. Would he still think the NHS cuts are a good thing? We are left sat in the truck at 11pm filling out a vulnerable adult form for social services eternally frustrated at seeing our ageing population chucked on the scrap head.

23:07

"40 year old female, chest pain"

The second I pressed the button we got another job. The call was 45 minutes old which for a chest pain means the service is being run ragged already. When we entered the house of the last job it was still light. Now it was pitch black outside; the glare of headlights, break lights and street lights was going to be the view for the next 6 hours or so. The job was 9 miles away which at this time of night is about a 15 minute drive. Driving on blue lights has its dangers; you are often going faster than the speed limit, on the wrong side of the road, through red lights  and doing lots of overtaking. You also have to factor in the erratic behaviour of other motorists. A long drive can be quite stressful and there is nothing more frustrating to arrive on scene after a long drive through traffic to find it's been a complete waste of time. Eventually we pulled up outside the address. The smell of burning brakes was lush (that's the petrol head talking)! I grabbed the bags and headed up to the front door. Knock knock. Nothing. Knock knock. Nothing. Knock knock. A light comes on. A guy opens the door:

"You're late"

"Sorry, it's very busy tonight, we only just got the job"

"It's not good enough, she has gone to hospital in a taxi"

"OK, did you tell the ambulance service you no longer needed an ambulance?"

"Nope, it's not my job"

"Well we have just driven a long way to get here, we could have been going to someone else who needs us"

"That's not my fucking problem, you should have come when we called"

With that he slammed the door in my face. Joy! Another happy customer. I detest the ignorance and attitudes of people like that. They think their little problems are more important than anyone else's. 'Gone before arrival' on the paperwork and off to the next one.

23:41

"38 year old male, unknown problem" 

With no other information to go on we headed back to the area we had just come from 9 miles away. It's controls game of ambulance dot to dot. I'd love to see what our shifts journey looks like on a map. It's probably the outline of a middle finger! Half way to the address we got an update:

'38 year old male, uncertain of what is going on and feels very angry and violent, history of schizophrenia, calm now but could kick off at any time, NHSD believes patient needs to be in a safe environment, wait for police before entering premises'

Interesting! We were no clearer about what exactly is wrong and what exactly we are supposed to do. It is the middle of the night, as far as mental health services are concerned it's A & E or nothing. This should be fun. We parked up at the top of the road and waited for police. After 20 minutes we got a message from the police. 

'No units to send'

So we waited, and waited, and waited some more.

01:03

'Unit assigned, ETA 15 minutes, please ensure your unit is on scene as we are very busy' 

Eventually the police arrived and en mass we knocked on the door. The patient's mother let us in and pointed us in the direction of the living room. Our patient was sat on the sofa, calm as anything.

"What's the problem today?"

"I don't want to go to work"

"What do you mean?"

"They say that I have to go to Jobcentre Plus tomorrow to get a job"

"And why don't you want to do that?"

"Because I shouldn't have to work? I've been on benefits for 20 years and now they say I'm well enough to work so won't give me my benefits what I'm entitled to. They can't just make me work like that"

"What have you called an ambulance for? What do you expect us to do?"

"Tell them I can't work"

"We can't do that. That is between you, your GP and the Jobcentre"

At this point the wound up copper took over. She lectured him about the inappropriate use of emergency services, told him not to call again and told him that we were not all here to help him get out of working. If only we could get away with lecturing people like that. We all bundled out again, exchanged call signs and they left us doing paperwork. 

I hate people who abuse the benefits system. Benefits are there for people who physically CAN'T work or who have fallen on bad times. They are NOT there to live a life on without making the slightest effort or earning an honest living. It is people like this who have put the country in the mess it is in. This guy had mental health problems, there is no doubt about that, but has had treatment for that and deemed able to work. He is no longer medicated, he no longer attends any therapy and is not physically incapable of work. He doesn't want to work. THAT is the crux of the matter, and why doesn't he? Because he has never had to work before. He's lived his entire life on the taxpayer's money. Newsflash sunshine, I don't WANT to work. I do because I HAVE to, to pay bills, support my child and do what I want to do. GET A JOB!!

click to continue......

24

What is a typical day? What is a typical night? I suppose there is no 'typical' but I thought rather than write about one job, or list the jobs I did in a day, or even talk about how I was feeling at a particular time of day, or what my feelings were on a particular issue, I would attempt to blog a day of my life. Write the entire day from eyes open to eyes shut with everything in the middle. I chose the first night shift of a run of 4.

The following takes place between the hours of 7am and 10pm

07:00

Precisely 3 hours and 54 minutes after getting into bed, I'm awake again. I glare at my clock with utter disgust. Why am I awake so early before my night shift starts?! It's the same every time, I'm now going to be awake for at least 24 hours and that is not a happy thought. The day drifts by, most of it spent procrastinating and promising myself I will do tomorrow what I couldn't be bothered to do today. It's the same promise I make to myself everyday, yet I am forever lacking the motivation to do the simplest of tasks! Before I know it the impending night shift is looming and I have to start getting ready.

16:00

Shower, iron uniform, eat dinner and pack the leftovers away to eat in the middle of the night. This pre-night routine is all too familiar and I know that the middle of the night will come and I will not want to eat the leftovers. At 18:15 I get dressed and leave the house for the short drive to work.

18:30

I pull into the car park, switch off the engine and sit there, in my car for about 30 seconds. Do I really have to go and do this?! I enter the garage, I check my pigeon-hole, I sign in, I get my bags out of my locker and throw them on an ambulance. Time for the first coffee! No sign of a crew mate so I take my 'too hot to drink coffee' onto the ambulance and start checking it over. I check the response bags, cupboards, gases, make the bed, refold the blankets and start the paperwork. Still no sign of crew mate! I check the headlights, break lights, blue lights and tyres, then I sign my drugs out.

18:59 

Crew mate arrives, I have never met them before, but I am unimpressed they have arrived so 'late'. OK, they were not late but it is poor ambulance etiquette. Everyone comes in early so as to get the vehicle ready for the imminent job the second your shift starts. Sure enough...

19:00

"38 year old female, 18/40 pregnant, abdo pain, bleeding PV"

This could go one of two ways, it could be just a bit of abdo pain and a trip to hospital or it could be horrific and a trip to hospital. Being the first job of the shift, most of the journey was consumed with me filling in various forms and getting the PRF started for the job we were on. We had a real struggle finding the address; it was a new build on a new road so the sat nav nor the map book was showing where it was. We called control and asked for them to get more location information. Eventually a teenager came running out of a side road up ahead waving frantically. He waved and beckoned until we had parked. He then came running over and told us to hurry as 'it's an emergency'. Emergency or not, we do not like being told to hurry up, though given the presenting complaint and his age, I let him off and followed behind.

We were ushered through to the bedroom where our patient was lying alone on the bed. She looked understandably worried and there was an ominous amount of blood on the sheets. She was 17+5 weeks pregnant and had suffered a sudden onset of abdominal pain which was coming and going. 17 weeks is sadly not considered a 'viable' pregnancy (there is that word again) so consequently this involves a trip to A & E for her, not maternity. Her OBs were fine and she wanted to walk, so after grabbing her bag we started moving to the ambulance. She stopped suddenly, bracing herself on the wall: 

"The pain is back, I feel like I need to push"

My crew mate ran off for the maternity pack while I ushered her into the bathroom. She sat on the edge of the bath, crying:

"I need to push"

She slid to the floor and pushed. Through groans of pain and floods of tears, and whilst holding my hand, she delivered.


I placed the foetus in one of our vomit bowls and wrapped the bowl in an incontinence pad. How horrible does that sound? It was all we have. I couldn't leave a 6 inch foetus on the floor, it just seemed like the right thing to do. We got the trolley bed inside the house and got the Mum onto it. She answered my questions with nodding and shaking her head. She was consumed with grief. I didn't know what to say. We drove to hospital; myself on one chair, her on the bed and the small bowl on the chair next to me. We arrived at A & E, transferred her over and I wandered off to book her in. My crew mate cleaned the bed, made the bed and made the coffees. 

It is these jobs I struggle with; it is one of the sights I struggle to get out of my head, and the rush of negative emotions are hard to deal with. Working with someone you have never met before makes it harder to talk though these jobs, instead it just sits with you for the rest of the shift. Sadly, I can't dwell; time to press the button for the next job. My 15 minutes are up.

20:37

"34 year old male, thinks he is about to have a fit"

We get quite a lot of these jobs. Epileptic patients often know when they are going to have a seizure and call us first. More often than not there is no seizure and we just take them to hospital; occasionally there is a seizure. Today, there was no epilepsy! We pulled up outside the address to the welcome sight of the FRU! Inside the building the medic on scene came and met us in the corridor.

"This is just plain weird. He's crying at the moment but doesn't know why. He says he thinks he has epilepsy and diabetes but has never had a seizure or seen a GP about it. He also says he had a heart attack three weeks ago but has no medication. There are clearly some mental health problems but he says he has amnesia. It's all a bit odd to be honest"

We entered the flat, the smell of alcohol hit us. Our patient was lying on the bed, kind of crying but not. He was very hard to engage with and just reeled of symptom after symptom. He had a headache, nausea, back pain, chest pain, abdo pain, leg pain and shortness of breath. In fact, he had everything we asked him about from urinary symptoms to photophobia. His pain was 10/10 yet when we suggested coming to the ambulance he just got up and walked with no obvious discomfort or reduced mobility. Once on the ambulance there was no change; he declined any pain relief and didn't want an ECG. It transpired he had already had an ambulance earlier in the day. He had been taken to hospital and had self-discharged from the waiting room after an hour of waiting. I don't know what he expected would be different this time around, but all we could do was convey and hope he stayed.

At the hospital a handover was given to the nurse who yet again, sent him to the waiting room. I booked him in and returned to the cab. Within 5 minutes, he emerged from the main entrance of the hospital and wandered off up the road. Another worthwhile use of an ambulance. It's so frustrating to see. There is nothing you can do or say. I know the hospital are busy, but surely a guy who has already absconded and who is clearly suffering mental health problems should be seen before being chucked back to the waiting room. I have no doubt he'll be back in another ambulance very soon. Anyway, no time to worry about the inevitable drain on resources. More lives to save......

click to continue......

The Circle of Life

Life is a funny old thing and if this job has shown me anything it is that. The general public of this fine country never fail to disappoint. I see incredible strength and incredible weakness, absolute joy and crushing sadness. Stupidity is rife, common sense is sparse and everyone loves a good drama. I get to see a snap-shot into people's lives, I get to see inside their homes, inside their bedrooms; see their photos, their prime and their squalor. The difference in people is truly amazing but the basics are the same. You are born; you are helpless and rely on everyone for everything. You grow up; work, live a life and occasionally get so drunk that you regress to the behaviour of an infant. You then grow out of it; retire, get old and eventually you are back to square one. You are helpless and rely on everyone for everything again. It is the circle of life. It is only ever going to start and finish in exactly the same way. It's how you act in the middle that defines you.

This night shift was no different to any other in terms of the length of shift, the crew mate and the type of jobs we did, but there were three jobs that stuck out, that got me thinking:

"1 month old male, crying, DIB"

Not the most exciting of headlines really! We headed round to the address expecting the usual 'walk on, walk off' type of job. They are our bread and butter jobs; no lifting required, from start to finish it would take an hour, the patient probably not that ill but a trip to hospital regardless. We arrived and headed inside. The doting parents were stressing, the baby was indeed crying. He way lying on his back, massively distressed about something. What? No one knows; they can't communicate and it's a case of 'best guess wins'. Try cuddles, try music, try food, try toys, try Calpol. Clearly in this case it was then 'try ambulance'. Unlike most other mammals, human babies are helpless. For years they can't really do anything for themselves. They need their nappies changed, they need to be fed, they can't explain what they are thinking; their frustration must be immense. This is how it all begins. Ahead are years of learning, years of making mistakes and years of paying obscene taxes, working for the best part of 50 years and if they are lucky having a reasonable retirement. We checked him over, walked to the ambulance and off we went to hospital. I love the innocence of them. Yes it's annoying that this is a complete waste of time, an arse covering exercise if you will, but babies go to hospital. I'm not risking it! I also remember how I felt the first night I came home with my son. I just stared. 'Has he stopped breathing?', 'Is he ok?', 'Why is he crying?' The fact is I was still learning and so are they! Handover complete, I ran to the shop to buy my nutritious dinner of a BLT and a coffee; a pretty standard diet. Next!

"26 year male, lying on pavement,  intoxicated"

This is the regression I mentioned. Having had 2 bites out of my pre-packed BLT sandwich and a few slurps of coffee, we arrived on scene outside a pub in the heart of the city. Lying on the floor in what appeared to be a very expensive suit was our patient. He was conscious but plastered. Apparently he had been drinking all night with friends and something went array after the last Jaeger-train & Sambuca chaser. Binge drinking seems to be the hobby of choice for most 16 - 30 year olds. They can never handle it; loose all sense of decency and end up lying in a pool of  their own vomit in front of the group of girls they had been trying to impress with their power-drinking prowess. Oh how the mighty have fallen. We got him on to the bed and onto the ambulance. His friends were very well spoken. Apparently he was a hedge-fund manager, whatever that is. Rich people investing in hedges? I genuinely have no idea. I can barely afford a tea fund. Job title regardless, he was now back to being helpless, just like he was 25 years ago. He needed positioning so he didn't suffocate, his face needed wiping and at hospital he would need undressing and dressing again. I have no doubt that once fixed he'll be mortified and full of regret. En route to hospital the regression was more than evident. Remember boys when they are born? Remember the nappy change horror? The arch of pee?! Yes... Half way to hospital this guy whacked out his crown jewels and did his best impression of being back on the changing table. It's amazing what 25 years, a degree and a bottle of Jaegermeister does to one's sense of decency. True to form, my solution was simple; chuck patient's Hugo Boss suit jacket over his crotch and swiftly avoid the golden river heading towards me. We dropped him off, cleaned out the vehicle and I got back to my BLT. Next!

"93 year old female, fall, can't get up"

The address was a care home. The word 'care' is meant to be ironic or sarcastic I think because, despite an army of 8 carers on scene, they left her without blankets until we arrived.  Obviously, for health and safety reasons they cannot help their patient, a patient in their care, off of the floor. Silly me. Unless there is an injury we are not supposed to be called, but in all fairness due to her advanced dementia she was unable to tell them. This is where life reaches full circle. Ok, so I don't imagine that in 1944 she was binge drinking her 20's away, things were different then, but I'm sure in her own way she had a raunchy dinner and dance or two. She has lived her life, a good life if her photos were anything to go by, and was now back at square one. Lying on the floor unable to do anything then herself; she needs her nappy changed, she needs to be fed, and can't explain what she is thinking or feeling. The frustration must be immense. This is how it all ends. Depressing?! Kind of. I don't want to end up like that, I want better care and more dignity but we cannot change the inevitable. We will end how we started. We checked her over and put her back to bed. There were no injuries or anything untoward going on. It was another bread and butter job, a pick up and put back to bed. I knelt down beside her. I felt something strange. A weird sensation; one I have felt before but one I promised myself I wouldn't feel again. It was the all too familiar feeling of urine seeping through my trousers and onto my knees. Joy! Next!

The Temperature

Temperatures. We all have them, we all deal with them, kids especially. Until the age of 5 children cannot control their core temperature as well as adults so are prone to high temperatures when fighting any major or minor infections. To that end, we give Calpol and do so because it contains Paracetamol. Paracetamol is an 'anti-pyretic' and will bring the temperature down. If the temperature isn't controlled there is a risk of a febrile convulsion which can be scary to see for a new parent. Generally, it is common sense though. Before I started this job and had any medical training I was a parent. I didn't have a clue what I was doing but I knew when my son was ill and knew that when he had a temperature I was to keep him cool and give Calpol &/or Nurofen. Apparently, I was one of the lucky ones though! Lucky because I was given this closely guarded secret and extremely useful knowledge.

"2 year old male, fever"

Wednesday lunch time. We had done the usual mix of slips, trips, falls and chest pains when this job came down. My first thought was 'So?!' That was the only information we had to go on which was reflected in its low priority category. We arrived at the tower block and rung on the bell. The piercing buzz of the locking mechanism echoed down the corridor towards the 'not so welcoming' looking lift. We risked it anyway as 16 floors was not about to be walked! The smell of urine and graffiti on the wall told us all we needed to know really. We arrived at the flat, the door was open, so we wondered in. Sitting in the living room were both parents and the child. Our patient was lying on the sofa, dummy in mouth, looking around inquisitively whilst wrapped in about 20 layers of clothes and various blankets!

"What's the problem today?"

"He's gotta tempricher"

"OK, how long for?"

"I reckon bout an hour ago or summit"

"And have you given any Calpol?"

"Nah"

"Have you got any?"

"Nah"

I got out our Calpol whilst shaking my head a tad. He did have a temperature but not that high. I removed most of the clothing whilst reminding them that dressing a hot baby as an eskimo will not lower the temperature! 

"Has he been unwell at all? Any cough or cold symptoms?"

"Nah"

"Any vomiting or diarrhoea or pain you are aware of?"

"Nah"

"So what made you worried enough to call an ambulance?"

"He's gotta tempricher"

SO WHAT?! She didn't get where I was trying to go with this conversation. I tried my best to explain that kids get temperatures and that doesn't mean they necessarily need an ambulance. The kid was happy as anything! Perhaps if the temperature lasted a number of days and he wasn't well and didn't respond to treatment, then perhaps a GP would be a good idea, but a 1 hour history?! Hmmmm. Sadly my words of wisdom were lost on her! Hospital it was!

2 hours later.........

"4 year old female, fever and shaking"

It was clearly going to be one of those days. We'd spend half the shift picking people up off the floor and now the latter was being spent taking temperatures and administering Calpol! In stark contract to the first job we were now driving towards a very affluent road. We pulled up outside this grand detached house with a huge double garage as separate outhouse. Parked outside the garage was a Porsche 4 x 4 and a branch new Range Rover. I couldn't help a sarcastic 'Oh...so they do have cars' comment as I ventured up the path to the huge front door. As I learnt towards the doorbell, the door opened. A very well spoken woman in her 30's opened the door. As we walked towards one of the living roomS I couldn't help but think that given a house like this I'd do a better job! Sitting in a high chair was the kid. He had a flushed face and looked tired and grumpy. I'm not surprised. He had a whopping temperature! 40.9 to be precise! I'd be grumpy if I was that hot!

"What's the history? What's been going on?"

"Well, it started about 3 or 4 days ago. He's generally been under the weather and not himself but I thought it would pass but it hasn't"

"So what has changed today?"

"He had a convulsion about an hour ago and has since been really groggy, I'm getting a bit worried now"

"And have you spoken to his GP at all?"

"Oh no, I didn't think of that!" she said with a jovial tone. Haha.....

"What time did he last have Calpol?"

"He hasn't, we don't do Calpol, we don't agree with it"

"Well it's what is going to bring his temperature down. That's what the hospital will most likely want to give"

"Well as parents we decided not to use unnecessary drugs"

I skipped on. I was never going to win. I wasn't educated. She was. I have no money. She was rich. She was talking down to me. I wanted to be done with this job. We took her and her kid to hospital & I left the department grinning, as the nurse schooled her on the benefits of temperature control, whilst sad next to our previous patient! I wear smug very well indeed!

Seriously though, when did the concept of giving kids Calpol get forgotten. These are by no means isolated jobs. Most kids we see with temperatures have not had Calpol. That is probably partly because the ones who have had Calpol don't need an ambulance. See, there is a clue! Temperatures need treating, they don't need ambulances. Kids with temperates also still fit into their own car seats......just a thought! A temperature on its own is also not a medical emergency. It is simply the bodies way of fighting off an infection. Let it do it's thing! Also, please please please don't wrap them up in every piece of fabric you can find. I really did think that people knew this when I started the job. It's just common sense. As for wanting to go to hospital, 4-6 hours sat on a metal chair in a waiting room will probably make things worse for all involved. Giving your child Calpol when they are unwell is basic parenting and personally, refusing to give it 'on principle' is negligent. If the kid grows up and decides he or she doesn't want to take it then fine, but to risk a child's health and comfort because of a warped principle is wrong. 


I'm not saying don't call an ambulance, I'm simply saying do the basic things to reduce a temperature first. If they are unwell and showing signs of serious illness, have a rash or go floppy the do not hesitate but a one hour history of a moderate temperature is not an emergency. That is all!




For tips on treating a fever see the NHS Choices website.