New Years Day

It was New Years Day and the people of our fine city were not feeling well. I spent most of the day observing the pained expressions on people faces as they struggled with the simplest of tasks, like walking. The previous nights celebrations had clearly taken their toll and as per the norm, the ambulance service were left to pick up the pieces! Here is a rundown of what treats the day gave us! Bear in mind, I too was tired. Like everyone else, I had seen the new year in with friends, had a few drinks, mindful I was on an early it was limited to a few! When my alarm went off at 4am I wasn't amused in the slightest but I got on my bike and headed into the night for my 6am start! 

06:05 - '23 year old male, collapsed. He was drunk and asleep.'

Not collapsed. A good Samaritan had called us. They didn't stick around though. Shocker! Taken to A & E to join the heap of drunken delinquents.

07:00 - '21 year old male, collapsed, head injury.' 

He was drunk. In a skate park. He'd fallen over and cut his head. His friends found the whole affair extremely funny and used words like 'wack', 'nang' and 'rad' with worrying frequency. Bandage on head, a large cannula with fluids and trip to A & E.

08:15 - '23 year old female, vomiting blood.' 

She wasn't. She was vomiting red wine. And 'Purple Rain' which I was assured was an 'aggy' cocktail. Her main problem was a hangover. I gave her 2 x Paracetomol, a glass of water, sound medical advise and a few of my best hangover cures. Left in care of friends.

09:06 - '29 year old male, chest pain.'

He did indeed have chest pain. The cause was the copious amount of cocaine, MDMA and skunk that he had taken with alcohol the night before. Due to the fast heart rate and various other things he was given Diazepam to treat his cocaine toxicity. He was promptly taken to the New Years Eve recovery centre for monitoring and further treatment.

10:32 - '30 year old male collapsed.'

He was indeed collapsed. He'd taken an overdose, presumably of heroin.  He was ventilated, filled with Narcan and then once the effects of his high were reversed we were left with an angry, verbally and physically abusive patient who was arrested and conveyed to hospital. 

11:48 - '24 year old male, chest pain.' 

This one was in a police station. He was claiming to pain to avoid being at the police station. Much to his dissatisfaction, once I'd assessed him, done his ECG and spoken to the duty nurse I told him he could stay in the comfort of his room. He called me a cunt. I left.

12:55 - '14 year old female, intoxicated.' 

This one was in a park. She was smashed, well and truly. He blood pressure was in her boots so she got treated to cannula, fluids and a journey to hospital. Because of her age the police had to attend. She vomited all over the ambulance. And my leg.

*change uniform, clean vehicle*

14:10 - '25 year old male, cardiac arrest. '

Sadly, it was as given. He was dead, nothing we could do for him. His friend found him sat on the sofa. He'd been there 2-3 hours. The nights drink and drugs had stolen a young life. A very sobering affair for all involved. Happy New Year eh? 

15:35 - '26 year old male, severe headache, pains in chest.'

He had a hangover. I told him to take his own paracetomol and drink more water. I told him I had just attended a 25 year who had died. I asked him if he felt us being there was a good use of an ambulance. He apologised. We left.

16:20 - '46 year old male, unconscious on bench.' 

He was drunk, on a bench. He told us to fuck off. We did. The caller hadn't stuck around.

16:40 - '19 year old female, feels weak, chest pain, vomiting.' 

She seemed genuinely shocked that her symptoms were caused by lack of sleep, no food, consumption of weed and too much alcohol the night before. I gave her a dose of health promotion and left her with her proud parents. 

17:25 - '40 year old, collapsed in toilet.' 

Clearly the best had been saved until last. We arrived outside a heaving McDonalds and headed inside. A member of staff met us and took us downstairs to the toilets. Hundreds of pairs of eyes stared at us as if they had never seen an ambulance crew, as they chewed their Big Macs. Despite all watching us head into the toilet, within seconds people were trying to come in and seemed utterly shocked that they couldn't use the facilities! Inside was the wonderment that was our patient.

He was a big man, clearly an alcoholic and was locked in the cubicle. His head was slightly protruding from underneath was wall of the cubicle. He was well and truly unconscious. Oh, and his face was lying in a pool of other peoples urine. It appears McDonalds had fallen foul of their hourly toilet cleaning policy, much to the detriment of the patients big ginger beard and open mouth. We requested a chair to look over the top of the cubicle. 

I climbed on top and peered over. There he was in all his glory, trousers around his ankles, and lying in a pool of his own urine and faeces. He had literally keeled over from sitting on the toilet. It really was a wonderful advert for alcohol!

Unfortunately,  despite the treat waiting for us inside, there was the very real problem of how to get him out. I managed to reach down and unlock the door but we could only force the door open slightly, such was his position. My crew mate was slighter than I was so she begrudgingly agreed to be the one to squeeze through the gap and attempt to move him enough to get the door open. Despite her best efforts, the dead weight drunk man could not be moved and in fairness, such was his condition and covering in bodily fluids, she didn't bear hug him with gusto! Luckily for us he started to wake up of his own accord. His personality was every bit as endearing as his appearance. 

"What the fuck are you doing, get out of my cubicle!"

"You collapsed to the floor sir, we are trying to get you out."

"For fucks sake." he mumbled in a thick Scottish accent. 

"Sir, can you move your legs and sit up, we can't get the door open until you do!"

"Yeah.....I know......I'm not fucking stupid you know!"

It's at times like this I like to freeze frame the moment. Ideally I'd like to take a photo on a Polaroid camera and pass it to the patient for them to digest. I was curious as to which part wasn't stupid. Was it the amount he'd drunk? Or the falling off a toilet? Or the double incontinence? Or his face in puddle of strangers urine? All of the above smacked of stupidity, but who am I to judge?! 

Eventually he was up and out. With every passing moment he became more and more abusive and the smell got more and more offencive. After telling us both to, and I paraphrase, 'go away' he headed out back into the restaurant. After attempting to start a number of fights and verbally abusing everyone he passed he staggered up the stairs and out onto the street. During this short journey he only fell over 4 times so that should be looked at as some kind of achievement. He went off into the distance cursing at all he past. I never got his name. What a treat he was!

So, that was New Years Day! Entirely predictable, totally exhausting and all too familiar. Lives wrecked by alcohol and drugs again. When will people learn?! I could sit and reflect on the 25 year old that died but won't. He isn't the first and sadly won't be the last. Perhaps that's cold of me, perhaps it's just self preservation. I'm sure next weekend will bring similar. 

"It's like gambling somehow. You go out for a night of drinking and you don't know where your going to end up the next day. It could work out good or it could be disastrous. It's like the throw of the dice." Jim Morrison

24 - Season 3: Episode 4

continued……

The following takes place between 03:26am and 12:00pm

03:26

Despite that sudden burst of energy that the RTC had yielded, 03:00 in the morning is a friend to no one. As quick as the energy and invigoration arrived, it was gone again, leaving two, very sorry looking individuals left slumped in the cab of an ambulance. I could feel myself slipping into that place between being awake and being asleep, where your dream kind of starts but you eyes are still kind of open. The piercing noise of the MDT soon erred me towards my eyes kind of being open.

03:49

“21 year old female, chest pain. From NHS 111”

“On a scale of 0-10, 10 being central crushing chest pain, pouring with sweat, ashen in appearance and an impending sense of doom, and 0 being……..whatever.”

“ A 1. Panic attack. Fully recovered. Said the words chest pain. Likely car and ambulance.”

Off we went. The conversation wasn’t as bubbly as it had been. We were both staring at the road ahead, struggling to keep our keeps open. I did however summon the energy to make a joke about me not wanting to drive any more! 

When we pulled up on scene, as predicted there was a car there. We took a walk, similar to that of a zombie up the garden path and into the open door. Sitting on the sofa in the living room was our patient. She looked perfectly happy, not in any pain, not hyperventilating. The handover from the FRU went something a little like this……

“Hi guys, this young lady thinks she may have had a panic attack this morning. It has fully resolved now and she has no symptoms. She called NHS111 for advise on medication and they insisted on sending an ambulance because she said that during the panic attack they was tightness in her chest whilst breathing. Because of the ‘chest pain’ they said she had to go to hospital. She told them she didn’t want an ambulance and here we are!”

*little high-5 behind our backs*

Well, this going to be simple! All her OBs were completely fine, as you’d expect them to be and her ECG also resembled the perfect heart of a 21 year old. Needless to say, we did our paperwork and left! 

As you can see, NHS 111 causes a monumental waste of resources on an hourly basis. It’s not the people who work there’s fault. They follow a computer and the computer tells them what to do. When the computer says jump, it also tells them how high. Or in this case, it told them an FRU and an ambulance would be needed to deal with a 21 year old female who had had a panic and din’t want to be seen. 

Just for the record….. 21 YEAR OLD FEMALE DON’T HAVE HEART ATTACKS. OK, so maybe one did once because of having other medical problems and all the risk factors one could have, but surely this doesn’t mean that for ever more any 21 year old with pain in or near their chest, jaw or arms is having a heart attack?! Seriously! 

Anyway, off job time! 

04:27

Luckily a job came down pretty much straight away. Well, I say luckily….I hadn’t the patient yet!

“48 year old male, chest pain, ?intoxicated. At bus stop.”

“On a scale of 0-10, 10 being as blind drunk as they come, vomiting, urinating and requiring carrying, 0 being sober as a judge, how intoxicated is he?”

“6. Drunk, probably an alcoholic, the smell will make your eyes water, but sober enough to answer questions, walk and swear at me.”

My crew mate chuckled. It was knowing chuckle! Mainly because she knew I’d be correct! Social drinkers tend to be drunker and are normally scooped up and hospitalised by 3am. Angry, smelling alcoholics tend to be perms-drunk and therefor somewhat more capable of being encouraged to walk. They are generally much more abusive and tend to sit on benches or at bus stops which are near the 24/7 off-licences! Call me sceptical but this particular bus stop was right outside a 24/7 ‘Food and Wine’! Finally. he was 48. Generally 48 year olds don’t get blind drunk and call themselves ambulances at this time of the morning! The binge drinkers are the young ones, the alcoholics are the old ones. Normally! I may be proved completely wrong. 

I wasn’t. 

Sitting at the bus stop was a regular patient of mine. A vile, abusive drunk who calls an ambulance because he lives near the hospital. I was correct on every single count.

*little high-5 behind our backs*

“What’s the problem today Sir?”

“I’ve got fucking chest pain, I already told ‘em that.”

“Well you hadn’t told me that. How long have you had the pain?”

“Stop asking me fucking questions and just take me to hospital.”

“If you have chest pain, we need to do your ECG and check you over.”

“I don’t want one, just take me to fucking hospital.”

This could work one of two ways. I could say exactly what I was thinking about his abuse of the service for a lift home, probably wind him up further and end up with him being arrested, or I could open the ambulance door, let him on, drive to the hospital and let him run off to his house. There would be no winners for doing the right thing, but at least by giving into his whim, we’d be off on time. You could try and argue the morality or this with me, and tell me it just encourages that behaviour, and you're probably right. But at 5am, I am right. The end!

Off we went, conversation was hardly flowing and all inane questions were responded to with a battery of swearing. Sure enough, the back door opened, he staggered out, and wondered off down the road. Paperwork done, slurp of coffee and we were done. Finito. Fine. Time for bed! 

05:30

Free from the risk of another job we begun driving back to station. I took the opportunity to double check my rota for tonight's shift. Doing so much overtime means it’s easy to forgot where and when you were working. I had booked a late shift somewhere which would mean a relatively short turn around but it was my choice so I couldn’t moan…….

12:00!!! 12:00!!! I had mad the ultimate shift fail! I booked overtime thinking I was in at 18:00 but no! I was due in at 12:00 on a core shift, not overtime! I was due back in work for a 12 hour shift in just over 6 hours! Factor in travel, eating and showering time and I’m left with no more than 3 hours sleep. I felt sick. I had that pitted feeling in my stomach. My crew mate simply laughed, out loud, in my face! What could I do?! It was no ones fault but my own. I couldn’t change or cancel my core shift at short notice because I’d done overtime the night before. I’d just have to suck it up! 

We got back on station and I rushed everything away and headed off on my bike! 

06:20

I finally got into bed. Needless to say I laid away for ages, panicking about having to be up in a few short hours! I set my alarm for the last minute possible but that didn’t alleviate my fears!

10:40

THAT NOISE! Urrrrrgggghhh! I felt like I’d been hit by a bus. Nothing could console me. I was a wreck! I did everything as quick as I could, no time to make lunch and dinner though! Today was going to be a McFried Kingway kind of day! 

11:52

I arrived at work. Here we go again.

*Faceplam*

Russell Athletic

NB: This blog contains very offensive language throughout.

“42 year old female,? Ethonolic, *LOCALITY MATCH* Police required, known violent”

Friday nights are always busy! Without fail! This is partly because of the higher call volume and partly because there are less ambulances. I know it seems strange to have less ambulance when there are more calls but that’s just how it is. Less staff work weekends because of an old fashioned rotaring system and the staff that do only about a 1/3 do nights! That means come the weekend, the service is stretched to bursting point and the people who pay the price are the crews that ARE working! 

There was a job waiting for us the second we officially came on duty. Obviously, we started earlier than that, not being paid, so we could ensure the vehicle had all the kit it needed for a 12 hour shift. Having to do this every shift is a bone of contention amongst staff but we don’t want to be in a situation where a patient needs something and we don’t have it! That argument will probably grumble on for eternity! Anyway, the first few jobs went without incident. Slowly but surely we had been dragged into a grim part of town which was pretty typical of a weekend!

Within 3 seconds of coming up available we were sent the next one. Aaah, nothing like a violent drunk to get the weekend going. When a ‘?’ proceeds ‘ethonolic’ 99/100 it means they ARE indeed drunk. Joy! We headed round to the estate and arrive the same time as the police van. Out climbed 6 of our finest police officers all looking rather miffed to be here. 

“Evening all!”

“You been here before?”

“Nope!”

“You probably won’t be needed, they’ll both be pissed and arguing about something. They usually are!”

“Joy!”

We all stood patiently by the door waiting to be buzzed in. Eventually the intercom was answered and the door opened. As we walked in we heard a muffled ‘Fuck you’ in the background! Here we go! We made out way up to the third floor and along the external corridor. The door was open, but we heard the argument as soon as we made it onto the landing.

“You fuckin’ cunt. Come back ‘ere”

“Pipe down woman”

“You what?”

“Pipe down, I’m gonna go ‘ome now”

“No, no your’e not, I fuckin’ paid for ‘em”

“Sit down and shut up”

“You’re gonna get arrested. Get him arrested”

I looked at her blankly.

“Shut up you old hag”

“Tell ‘im to take that top off, I paid for it”

“Shut up you slag, it’s mine”

“It’s mine and you know it. Gimme my fuckin’ jumper”

“Sod off”

“Officer, arrest him, it’s my fuckin’ jumper”

The officer looked blankly, shaking his head slightly

“I ain’t done anythin’ to be arrested for you nut job”

“You ‘av. You’re wasting the cops time and the paramedics”

“You fuckin’ called em’”

“You won’t gimme my fuckin’ jumper back”

“You owe me a tenner anyway”

“Oh fuck off, gimme my jumper you nonse”

“You what? I’ll clump ya, ya cunt”

“Nonse. Fuckin’ nonse. Dirty little cunt”

“Fuck you”

“No fuck you. Gimme my fuckin’ Russell Athletic jumper and fuck off”

“Officer. She’s unstable. Arrest her. I apologise for her behavior”

“Arrest him, that nonse has my fuckin’ jumper”

“It’s my fuckin’ ju....”

“RIGHT! Both of you, pack it in. We have much more important places to be and i’m sure the ambulance do to. You are both wasting everyones time, now you get out, I don’t care who’s jumper it is. You, stay here, don’t call the police, don’t call the ambulance. It’s the same story every night, how about, for once, you don’t see each other. If I hear a peep from either of you, you’ll both be arrested for a breach of peace, wasting police time and anything else I can think of at the time. Do we both understand?”

“But it’s my fuckin’ jumper.”

“I don’t care.”

“You’re all a bunch of cunts.” *spits at police officer*

*gets bundled to the floor* 

*gets arrested* 

“Told you she was a silly cunt”

“I thought I told you to leave”

*Sticks up middle finger and spits* “Fuck you ya cunt”

*gets bundled to the floor*

*gets arrested*

We never said a word. Just watched and enjoyed the show! Just another friday night in the city! Perhaps when people moan about having to wait for the police or an ambulance they could take a moment to think what we are actually up to?! Right, onto the next one!

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!!

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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!