Experience

"28 year old female, lacking experience....."

Right! Rant time! This post was inspired by a twitter conversation with @butwhymummywhy about being judged as being too young! (see her musing on the same subject here) Tell me, who here has been told they were too young to do something? Which mothers have faced criticism for being to young to have a baby? I'm not talking the 13 and 14 year olds, they ARE too young. I'm not even talking about the '16 and pregnant' ones. I'm talking those in the low 20's. At what age is the 'right age'? Who has not been trusted at work because of their age? Who's opinions have been discounted because they were 'too young' or 'inexperienced'? Personally, I've been on the receiving end of a number of comments about being 'too young' throughout my relatively short life. Being a parent at 23?! What was I thinking! Far too young! Right?! Let me put this too you....

Let's say I went to university, graduated at 21, got a job, worked for 4 years, had a committed relationship and then had a baby at 27. Is that acceptable? Yes it is! How about leaving school at 16, working for 3 years, buying my own house, had a committed relationship, worked for another 4 years and had a baby at 23. I was earning more than most of the 23 year olds with degrees. I owned a house and had 7 years working and living as an adult under my belt. Am I any less qualified? Apparently so! Surely my degree from the University of Life counts for something?! It really pisses me off when age is used to undermine, with nothing to back it up other than a date of birth. 

Now take the work place. My work place. The ambulance service is a very strange working environment. There is a bizarre mentality amongst many that the more years of service you have done, the better you are. There is a culture of looking after the 'long timers' and the 'newbies' can deal with it. The relief rota is a case in point. Working 7/10 weekends indefinitely just because you are new if fine for a few years but 3? 4? 5? 6 years? When are you experienced enough to not have to do the shifts that the experienced staff don't want to?!

"68 year old female, chest pain"

I was working with a guy who had done 25 years on ambulances. The shift had been painful. He didn't have the time of day for me because I was a student. At no point did he bother to ask where in my training I was. He opened the days conversation with 'are you one of jumped up Uni medics or one of the Playmobil Paras?'. There is a lot of ambiguity in the service about university students. They are seen as stuck up 'know it alls'. OK, some are but similarly there are 'old hands' or 'dinosaurs' who swagger around with just as much self importance. It's not the training, it's the personality. Difference is I wouldn't call them a derogatory name to their face! This guy was giving me one of two labels regardless of what kind of clinician I was. For the record I was a 'Playmobil Para'. I get this label because my route to becoming a paramedic had a different name for the final exam than what used to be done. Therefor it stands to reason that I will be incompetent, useless, untrustworthy, unknowledgeable and a clinical liability. Right?

The hours past with stories about 'back in the day' and instructions not to do too many jobs in the shift etc. I was mocked for being thorough and told my extensive paperwork was a waste of time. I ignored it. It was the expected treatment for a relatively new student. By relatively new, I mean only 2 years. At 4 shifts a week, 10 jobs a shift, that equates to roughly 4,160 patients. In that time I had done 2 ECG recognition courses, a course in Trauma, plenty of home study, clinical updates, reflective practice and some other work related stuff. Yes I was new, yes I was still keen (still am) and no I didn't tell him what I'd done in my spare time.

We arrived on scene at the patients house and as the 'newbie' I carried all the bags while he followed with his hands in his pockets. The patient looked like crap. Pale, sweating and complaining of central chest pain radiating to her jaw. I did the ECG, looked at it and KNEW it was heart attack. I passed it to my crew mate of 25 years experience.

"Nah, it's just high take off."

A) Normal B) Heart Attack (NOT High Take Off!)

For those not down with ECG terminology, we look for ST segment elevation. I know that means nothing to most of you but all you need to know is high take off and elevation can look similar but are not the same. I explained my reasons why it wasn't high take off and the response I got was:

"You can use all the long words you like, that's high take off."

The reason this was a sticking point was, if it WAS a heart attack, we would be travelling a long way to a Heart Attack Centre and would be late off. It is wasn't, and was just high take off, we'd be going to the nearest A & E and would be off on time. 

"I've been doing this job for 25 years, you're a student, trust me, it's high take off."

"It's elevation, we are going to the HAC, you can call clinical support if you like. The history matches the ECG."

He muttered something under his breath about 'know it alls' with 'no experience' and stomped off to the cab. We drove to the HAC, the waiting cardiologist looked at the ECG and confirmed it was indeed ST elevation and she was indeed having a heart attack. 

Student 1 - 0 25 Years Experience

It made for an awkward journey home. I didn't gloat. I didn't say 'I told you so' but I didn't need to. He just ignored me. The silence was golden. My point isn't that I was great. On a day to day basic his wealth of experience would help him and me in many ways but just because I'm young and new doesn't mean I don't know what I'm doing. He hadn't done any training for years, no continual professional development. Therefor, is 25 years experience just 1 years experience repeated 25 times? I have uppermost respect for people who have done the job for so long but respect still has to be earned. Treating my like an idiot only earned my crewmate disdain. I don't know everything, far far far from it. I'm still learning. I'll always still be learning. The time I don't feel the need to learn more is the time I stop gaining experience.

People should be judged on ability not experience. People should be judged on how how well their children are brought up, not how old the parents are. Experience is relative. It's well known that discriminating against sex, race, religion and sexuality is not acceptable in today's society. Well, age isn't a reason to belittle / dismiss / ignore someone either. To label someone as too young to do something or to have done something, smacks to me as criticism to justify their own choices in life. There is no point in having experience if you've done sod all with it.

Rant over! 

Do I have enough experience ranting to call myself a well rounded ranter or am I too young?

Silence Hides Violence

"33 year old female, chest pain"

NB: This post is about Domestic Abuse, so for anyone who has been a victim or knows someone who has, reading may cause distress and provoke painful memories.

We were trundling back to station towards the end of our shift when we got sent the job. We were only a couple of minutes away so were on scene quickly. The address was given as 'above the shops'. Flats above shops can often be very difficult to access, mainly because the entrance is nowhere near the corresponding shop number. This particular flat was accessed via the rear of the shop from an alley way. After a few minutes of looking we found it, but had walked a considerable distance from where we had left the truck. I went in to see our patient whilst my crew mate went to move the vehicle closer. I was greeted at the door by our patient's husband. He was a polite guy and gave me a very full handover of what had occurred. She suffers with anxiety and had a panic attack, but had some residual chest pain. Which seemed reasonable. I entered the bedroom and Claire was sitting on the bed. It was obvious she had been crying and appeared very timid. Her voice was quiet and shaky. I started asking my usual questions about the chest pain whilst trying to get her to slow her breathing down. She said the same as what I had already been told but wasn't giving me very clear answers about her symptoms or cause of her anxiety. I became aware that before and after everything she said she was looking over my shoulder. Her husband was standing in the door way and it was obvious to me she was holding back. 

A couple of moments later there was a knock on the door. My crew mate had returned. Claire's husband went to let him in and I turned to her and said:

"Do you want me to get you out of here?"

She simply nodded and the expression on her face said it all. She was desperate to get out of the flat. She was terrified. I offered to take her to hospital and her husband was very quick to interject.

"She doesn't want to go to hospital, it was just a panic attack"

"That may be but she still has some chest pain and at the very least we need to do an ECG"

"Then do it here, she doesn't need to go to hospital, she needs to rest. The last crew did the ECG here"

(Lying through my teeth) "I'm afraid we can't do it in here, we have no batteries so it needs to remained plugged into the ambulance"

His tone had changed, it was rather intimidating. He was a big guy and clearly objected to my suggestions and started acting in a very aggressive manner saying she didn't need to go anywhere, and that we were no longer needed.

"Look, she has chest pain, she needs an ECG, and that's what we are going to do. One of the best cures for a panic attack is leaving the environment in which it occurred. In this case, stepping outside for 10 minutes could do her the world of good."

With that, I basically ushered her out of the room and out of the flat. He began acting rather frantically and marched out after us.  We got Claire on board and he tried to push his way on. We managed to close the door on him and lock the truck. My crew mate clambered through to the front and started driving off out of the alley way. Her husband was screaming and shouting, punching the back door. I called for urgent police and we drove off down the road and out of harm's way.

Claire burst into tears. While we waited for police she disclosed years of abuse. She showed me the bruises, strangulation marks & scratches. She had suffered since the day after their wedding 6 years previous. He was controlling, possessive, she had no freedom at all. He used to take her to work and pick her up afterwards but had stopped her working 2 years ago. If she did anything he didn't like he would beat her. If he got drunk, he would beat her. If she answered back he would beat her. She feared for her life but was too scared to walk away. He had threatened to kill her should she leave him. She had no friends and no family in the country and not a single soul knew of her suffering. She wasn't allowed to socialise, she wasn't allowed any money. She was basically his prisoner. She had suffered physical, emotional and sexual abuse on a daily basis for her entire marriage. It was gut wrenching to hear. How can anyone cause so much pain and suffering to another? How can anyone be that cowardly to torment and abuse someone who is so powerless to stop them? How can a man do that to his wife? She had attempted suicide on a number of occasions as it seemed the only way out. Each failed attempt came with it a beating and more threats. As she sat there pouring out everything she had been bottling up, I could see what a relief being able to do so was. She was still terrified but had finally found the strength to put an end to it. Her suffering would end here, although it would be a long journey of psychological recovery ahead. 

Domestic abuse is far too common. I see it on a number of different levels at work, be it emotional, physical, economical or sexual abuse. It is horrible to see and often very challenging to deal with. That said, the emotions I feel when seeing the consequences of it, pale in significance when I think about what the victim has suffered. So often the abuse is painfully obvious but denied by the victim through love or a continuing sense of loyalty. This particular job was some time ago. It was one of the first instances of abuse I had seen and it wasn't until I decided to write about this topic that I found out exactly how common it is and what effects it has, not only on the victims, but also on the NHS too: 

• Domestic violence accounts for between 16% and one quarter of all recorded violent crime. 
• One incident is reported to the police every minute. 
• In any one year there are 13 million separate incidents of physical violence or threats of violence against women from partners or former partners. 
• Women are much more likely than men to be the victim of multiple incidents of abuse, and of sexual violence.
• 54% of UK rapes are committed by a woman’s current or former partner. 
• On average 2 women a week are killed by a male partner or former partner: this constitutes around one-third of all female homicide victims. 
• The cost of treating physical health of victims of domestic violence, (including hospital, GP, ambulance, prescriptions) is £1.2 billion, 3% of the total NHS budget. 
• Between 50% and 60% of female mental health service users have experienced domestic violence, and up to 20% will be experiencing current abuse.
• Domestic violence and other abuse is the most prevalent cause of depression and other mental health difficulties in women.
• Domestic violence commonly results in self-harm and attempted suicide: one-third of women attending emergency departments for self-harm were domestic violence survivors; abused women are five times more likely to attempt suicide; and one third of all female suicide attempts can be attributed to current or past experience of domestic violence.

The statistics alone speak volumes but seeing it first-hand makes me extremely angry. Any kind of bullying is disgusting and seeing someone so gripped by fear emotes all sorts of feelings. Sadly, it is prevalent in all walks of life, across all age groups, and can take a number of different forms including emotional, verbal and physical abuse. As the world develops so does bullying and with the ever growing world of social media it is becoming more and more prevalent; be it subtle digs and intimidation online or physical violence in person, the lasting effect on the victims are the same and domestic abuse is merely bullying within an intimate relationship. It is picking on someone and making their life a misery for personal satisfaction. Intimidating someone to the point where they put up with it, through fear of repercussions, is what these thugs rely on. I don't know the outcome of his arrest, but the police were confident that he wouldn't get away with it. What also concerns me is the reliance these women (and men) have on the NHS, especially that of the already under resourced mental health services. I shudder to think what effect the inevitable NHS Bill and subsequent privatisation will have on the accessibility and affordability to these services. Only time will tell. There was an interesting article in the Guardian regarding the impact the government cuts will have on the help that is available to victims (click to view). The suffering of many will not stop though. It will continue behind closed doors and will continue to go unreported, often until it is too late. That is the tragic reality of the world we live in. All I can do, and all anyone can do, is encourage victims to come forward as and when we become aware of it.

If you, or anyone you know, is suffering or has suffered domestic violence or abuse please please please contact the 24 National Domestic Violence Helpline either by phone or on line.

National Domestic Violence Helpline

0808 2000 247