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......

Right or Wrong?

"40 year old female, won't get off the floor"

Doing the kind of work I do brings with it some fantastic opportunities. I work for a number of different companies doing various event work ranging from sports events to concerts and festivals. This weekend I was lucky enough to be able to work at the Red Hot Chilli Peppers concert in Knebworth. For most of the day I was working on the cycle response unit but occasionally I was required in 'the pit'. The pit is the area between the stage and the crowd. When crowd surfers or people who can't stand the crush get to the front they are escorted back into the crowd by security. The reason I was there was in case anyone came 'over the top' injured. I have done a lot of festivals and you would be amazing what medical problems come flying over the top into the waiting arms of security; unconscious people, seizures, open fractures, neck injuries, crush injuries and 6 year olds! Nothing surprises me anymore! Being up front for the headlining act is a sought after place and people literally wait there all day and night! Saturday was no different. As soon as the gates opened people ran to the front to wait! One of the eager few was a woman in a wheel chair. 

She had arrived early, sat in the rain, queued like everyone else and had wheeled herself to the front and sat there all day. She was told as soon as she arrived at the front by security that she probably would not be allowed to stay there but she wouldn't move. The issues surrounding her being there are down to 'health and safety'. I can hear some of you groan already but in this instance I'm with the H & S bods (To a point!). A crowd, 80,000 strong, all crushing up to the barrier causes injury in itself. Stick a woman in an electric wheelchair in there and not only is there a danger to her but to others too. As the day went by the 'wheelchair in the pit' situation was monitored and despite every effort by security to get her to move to the disabled viewing platform she wouldn't. About an hour before the Chilli Peppers were due on stage the decision was made by the event organiser that for her own safety she had to be removed along with her very heavy chair. Against her will, she was lifted over the barrier, followed by her chair and moved out of sight of the crowd whilst a plan of where she could go was made. From here things took a turn for the worse. She refused to get back into her chair. Instead, she threw herself on the wet floor.

There she sat, refusing to be lifted, refusing to move and getting further soaked by the rain. She quoted legal legislation to prevent anyone from touching her and although, technically they could have moved her as she was causing an obstruction to an emergency route, they opted for diplomacy instead. This approach however was futile. She was livid that she had been moved and part of me understood why. That part was my heart understanding her frustration. My head however felt she shouldn't have put herself in that position and should have just gone to one of the three disabled viewing platforms. This was offered but she wasn't interested. Again, I get why, I can only imagine being on a platform would make her feel like a spectacle. She just wanted to be in the crowd, soak up the atmosphere like everyone else. After an hour she agreed to be taken into our field hospital to warm up. This happened just as the Chilli Peppers were starting. The event organisers offered for her to sit on her chair in 'the pit'. She would have had a perfectly good view, better than what she would have had stuck behind a barrier, but she wasn't interested. She turned down all viewing platforms and every offer that was put to her. Now, she was simply cutting of her nose to spite her face. Again, I get why! It had been a horrible, embarrassing experience and to be fair, I would probably have acted the same. She sat on the hospital bed for all of the concert and once it had finished refused to leave the hospital until she was given a refund for the entire concert. The problem was at 11pm on a Saturday night the security staff and the hospital have no power to issue a refund and the event organisers are busy! Sadly, she was taken away punching and screaming by police.

Should it have come to that? No. Could it have been avoided? I don't think so. I am all for disabled people doing everything they can to have a normal life; I have close friends in wheelchairs. Unfortunately, no matter how much will they have, there are some things people's injuries or illnesses will not permit them to do. That is life. No it's not fair but life isn't. A wheelchair has no place in a mosh pit. I'm sorry but it doesn't. Event organisers have to think about everyone there and to accommodate wheelchair users there are viewing platforms with an unrestricted view, toilets and clear pathways. The fact is, rules are rules, right or wrong. The argument over whether the organisers should or shouldn't allow wheelchairs in the crush is another debate. If a wheelchair user pays for a full price ticket then surely she has the right to go where she wants. Unfortunately, she can't, and was told so from the outset and as horrible as it was watching it unfold the ones taking the action did not make the rule. I felt guilty looking at her on the hospital bed, she looked like a drowned rat. I know being in a wheel chair was not her choice and she is trying to lead a normal life and do things that everyone else does, but in this instance I feel she was playing on her disability to make a point. She wasn't removed from the crowd out of spite or malice, it was done with her best interests in mind and I agree with that decision. Were they wrong? Were they mean? Should she have been allowed to stay? Please tell me because I am split on this one!