Reservoir Dogs

Having hosted a great guest blog by Binder Smiff from Not-On-My-Shift.org a few weeks ago, he kindly gave me the opportunity to share my ramblings over on his blog! He wanted humour and buffoonery as a vague theme, and seeing as being a buffoon is a speciality of mine, it wasn't to hard to find something relevant! Anyway, this was my guest post! Enjoy!

"84 year old male, chest pain"

It was student season. For 4-5 weeks the university students were chucked out from the comfort of their lecture rooms to the unforgiving shift patterns of their respective mentors. It is during this time they home their skills and learn how to take a patient history, diagnose conditions and talk to people. Of course, always under the watchful eyes of one of us! I remember being chucked into the deep end all those years ago. staring blankly at an expectant patient and not having a clue what to say, there were so many awkward silences! It's just part of the learning process. 

We headed off to this particular non-descript chest pain and one route discussed what relevant questions should be asked. Chest pains are a very common call to go to and as such, it is one of the first things that students get well accomplished at doing. However, as today proved, it is often far too easy to get overly focused on one thing, and not looking at the big picture! 

The door to the care home was eventually opened and we headed in! It always amazes just how long it takes them, despite having called 999 and presumably expecting an ambulance to arrive! We followed the carer upstairs and were presented with our patient, who was lying on the floor! To me, it was painfully obvious why we were called. To me, the injury was obvious, as was the fact they had said chest pain just to ensure a quick ambulance. To the student, it was a chest pain lying on the floor and so the history taking began! 

To their credit it was an excellent example of history taking for a patient with chest pain. Unfortunately, they were concentrating so hard on trying to establish the history via the dementia patient's carer and his confused responses that they neglected to focus on what I felt was glaringly obvious. Not wanting to rain on the parade I allowed it to continue for a few moments. I turned to the carer and quietly asked her to get me a few things that I would be needing! (All will be revealed)

"So, from the top, tell me what we have?"

"Frank had an unwitnessed fall, unknown loss of consciousness and now has some discomfort in his chest, not radiating anywhere, says it feels heavy."

"Anything else?"

"Should I do an ECG?"

"Yes, that's probably a good idea. However, perhaps address the fact that his EAR isn't attached to his head first."

The student glanced with horror towards the patients head, and clearly for the first time, realised that lying next to his head in a small pool of blood was his ear. Completely severed. The look I was given was of distraught fear. On cue the carer arrived with 2 sandwich bags, 1 empty and 1 full of ice that I'd asked for.

"Can you pass me the ear please?" I said with a smile on my face. 

I thought it was about to be an ear covered in vomit! Apprehensively the ear was picked up and handed to me. 

So, there I was, standing in a care home, a student kneeling in front of me almost in tears, a patient lying on the floor grinning like the cheshire cat having a whale of a time and I was holding his ear in my hand. I couldn't help but think I was just a cut-throat razor away from Reservoir Dogs! It was most surreal. I popped the ear onto a sterile non stick dressing and put it in a sandwich bag. I then put that in the bag of ice.

"OK, from the top, what's the plan now?!"

"A dressing?"

"Excellent!"

Our patient, who was in no discomfort, was promptly wrapped in a bandage and thoroughly checked for more injuries. I couldn't help but ask the student to check for any more missing body parts to which they just glared at me. The ambulance arrived, an excellent handover was given and we left for a debrief in the car! 

The student felt awful. Part of me felt cruel for allowing it to go on as it did. The other part thoroughly enjoyed it! We have all been there when we were new and naive. It's easy to miss the blindingly obvious when our minds are telling us to look for something else. The first thing that went through my head as I entered the room was "WHY THE F**K IS HIS EAR ON THE FLOOR AND WHY DIDN'T THEY MENTION IT?!". Clearly, the first thing on the students mind as we walked through the door was "Chest pain, chest pain. chest pain!". 

It served as a valuable reminder that looking AT the patient is always a good place to start. Things are rarely as we expect to find them and despite being taught to expect the unexpected, the student fully expected to find a man with chest pain, not a modern day Vincent Van Gogh. I have no doubt, missing body parts will never be overlooked again! 

My iPad's Demise

"32GB iPad, fall from extreme height, multiple injuries"

It is with great sadness and a heavy heart, that I bring you news of the passing of my iPad. On the evening of 12th May at around 23:30 my iPad met a gruesome, tragic end. Despite being surrounded by highly skilled medics at the time, they were unable to save the iPad. The decision was made that due to full body trauma and multiple fractures that surgery was just too risky. 

iPad was only 18 months old and still had many years of loyal service to give when she was cruelly taken away from me. I know accidents happen and if I was in any way responsible that would go some way to helping the healing process. But I wasn't. In a moment of madness 'The Student' picked up the iPad and then proceeded to drop it, from the iPad equivalent of 6 stories, onto a concrete floor. I have been assured that iPad's passing was quick and painless. 

Me and iPad have shared many great moment together. We have enjoyed countless Netflix movies, written many a blog post and wasted many an hour just pissing around on the Internet. These are memories that will stay with me and ones I will look back on fondly. 

I'm sure you will understand that whilst I need time to grieve, what I really need is new iPad. If you have a spare 32GB White iPad 2 with 3G capability just lying round and want to give it to me free of charge I will provide it a good home and solemnly swear to never let a student touch it. In return, I will say thank you and send reports and photos as and when you require. 

There was going to be a full service funeral later this afternoon. Unfortunately, no one from the ambulance service was able to attend because the REAP level is so high and apparently the death of an iPad doesn't entitle anyone to compassionate leave. Also, HEMS were not willing to do a flyby. Therefor I have taken the tough decision to have a private ceremony with just family and close friends. Unfortunately my family prefer Samsung and don't see what the fuss is about and my friends are busy laughing at my iPads demise. To quote a close friend:

'Hahahahahahahaha. Your life is in tatters.'

I'm sure you will understand my need for privacy at this troubling time. I'm still trying to come to terms with the fact I can no longer simply order Dominos from the comfort of my sofa via my Dominos app. There is indeed an app for that. 

Thank you all for your understanding, well wishes, sympathy and suggestions of ways to torture and kill 'the student'. You are a sadistic lot but I love ya! Let me leave you with these (modified) words:

"It is a curious thing, the death of an iPad. We all know that an iPads time in the world is limited, and that eventually all iPads will end up underneath some landfill, never to wake up. And yet it is always a surprise when it happens to an iPad we know. It is like walking up the stairs to your bedroom in the dark, and thinking there is one more stair than there is. Your foot falls down, through the air, and there is a sickly moment of dark surprise as you try and readjust the way you thought of things." 

~Lemony Snicket, Horseradish: Bitter Truths You Can't Avoid 

 

NB: I'd like to add, 'the student' was excellent. He (almost) felt  as bad as I did and was full of apologies and promises to replace. Accidents happen.

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?