Clean up on aisle 3

"72 year old female, generally unwell, at GP surgery, chair required"

A pretty standard job for a Monday morning. Mondays are a funny day. GP's tend not to work weekends,  so on a Monday morning everyone who is everyone flocks to the GP surgery like migrating buffalo and sits there waiting for their various ailments to be examined. As a result GP's phone a lot of ambulance to alleviate their strain. This particular patient was sitting in the waiting room with a wicked grin on her face. She was basically doing a stand up routine to all the ill and needy that Al Murray would have been proud of! Every one around her was smiling!

"Last time I was here I went up to the receptionist and said there's something wrong with my vagina"

"You shouldn't come into a crowded waiting room and say things like that." 


"Why not? You asked me what was wrong and I told you," 


"Now you've caused some embarrassment in this room full of people. You should have said there is something wrong with your ear or something"


"I walked out the door and came straight back in and said I've got something wrong with my ear. The receptionist nodded approvingly"

"And what is wrong with your ear, madam?" 


"I can't piss out of it,"  


The waiting room erupted in laughter. What a character! I'd heard the joke before but she delivered it so well. We explained we had a chair for her. As we assisted her to standing she let rip! And I mean with gusto!

"Sorry about that, had egg and beans for breakfast"

Whilst trying to maintain some form of professionalism my crew mate managed to do the British thing of 'Keep Calm and Carry On'! Me? Not a chance, I couldn't stop laughing. She just farted! It's funny! Fact! We wheeled her to the ambulance, transferred her to bed but in doing so, she let rip again but this time we were in a metal tin.

"Sorry, how un-ladylike, that's not going to be pleasant"

I was beyond help, I was supposed to be treating her but I couldn't control the laughter. I was shaking! Verging on a seizure. With a raised eyebrow the keys were past to me and my pen confiscated. It was a sign I was to remove myself from the situation. As I stepped over my crew mates legs to get out, in the most ungainly of fashions, she did it again. This time though her tone changed, she had 'that look' on her face and the sudden smell told us all we needed to know, but she put it so well.

"Oh dear, clean up on aisle 3"

This is the kind of humour you'd expect from a drunk 20 year old but a sober 72 year old who is apparently ill? Amazing! It made our day to meet such a lovely, funny, albeit smelly woman. This is why our job is the best job in the world! You'd pay good money for that calibre of entertainment yet we get paid to watch it first hand! I didn't stop laughing for a very long time. Even writing this blog I can't help but giggle! Everyone hates monday mornings, that will never change but a little laughter goes a long way to improving ones mood!

To Blue or Not to Blue?

"30 year old male, unconscious"

Can I just say, before I rant, I like nurses. Most, who I come into contact with are very nice indeed. Some are a bit moody, some are a bit snappish, some epitomise the 'matron' we all fear but generally I won't have a bad word to say about them. Generally.

We arrived on scene and soon realised it was the same guy we picked up yesterday. An alcoholic. He was a young guy, about 30, well dressed, but clearly fallen on bad times. He was lying at the bus stop, on the floor, empty bottle of vodka next to him. A picture paints 1000 words. Attending so many alcohol related calls can and does become frustrating and it's easy to become complacent and lazy. I try not too. You never know when complacency will bite you in the arse. Due to my over caution and paranoia this 'drunk' got assessed and treated the same as everyone else.

A quick primary survey told me his airway was slightly compromised, his respiratory rate was low, around 8 breaths a minute, and he a weak radial pulse, probably due to low blood pressure. We loaded him on to the bed, I inserted an oropharangeal (OP) airway and my cremate 'bagged' him while I put some fluids up. We also raised his legs to try and raise the profound hypotension. At the end of the day, this guy may be drunk, but left to his own devices, was in real risk of dying through positional asphyxia or aspiration, not to mention the long term effects of alcohol abuse. Alcohol damages almost every organ in the body, including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both medical and psychiatric problems.

I only ever pre-alert the hospital if I genuinely believe the patient is severely ill, at risk of rapid deterioration or there is airway compromise. The fact this guy was tolerating an airway, was unresponsive to fluids or any pain stimulus I deemed that he warranted a blue call. The fact his condition is self inflicted has no bearing on the clinical decision making process.

We arrived at our local hospital. Every crew likes their local. They know the staff, the staff know them and it generally makes for a more pleasant experience. We went straight into resus, transferred patient to bed and began a handover to the waiting Dr. During my handover, the nurse in charge came marching over.

"I knew it would be him, he certainly doesn't warrant a blue call, you should know better"

"He's GCS 3, tolerating an airway and not responding to treatment, that's airway compromise. Blue call"

"No, it's a waste of my bloody time. I'm just gonna stick in 2 grey cannula's, give him a litre of fluids until he wakes up then let him stagger out"

"And there lies the problem"

"What would you know, I spend all day every day in this department and you clogging up my resus with pissheads doesn't help"

On that note, I walked out rather than get embroiled in an argument I wasn't going to win. She had a chip on her shoulder the size of Peru and views ambulance staff as untrained stretcher monkeys who bring her work. She was rude, dismissive and in many ways, adding to the problem. Professional courtesy is a big thing for us. We are treated like the pond life of the NHS food chain by GP's, some nurses and our own management and without good cause. They may not have faith in our abilities and that's fine, but there is no need to be rude and condescending. Like nurses, we work long hours, are treated like crap by peers and patients alike but at the end of the day we are doing a job. We are working for the same team. If someone phones an ambulance, they get one. If that person wants to go to hospital, we have to take them, and if that person is unconscious we will take them. That's how it works. What does she want us to do? Leave him in the street? Dump him in the waiting room? Has she not heard of the duty of care or is it only something that applies if she deems the patient to be deserving enough of her oh so valuable time. I for one will continue to do what I do, treat how I treat and 'Blue in' who the hell I want to regardless of her issues and PMT. The funny thing is, if we hadn't blued him in and gone to triage with a patient with an OP airway being bagged not only would we have been sent to resus but would have more than likely got a complaint!

This job also highlighted one of the major problems with the NHS. As the nurse said, she was basically going to wake him up and push him out the door. Yet she seems surprised that he is back the next day. And the next and the day after. What he needed was help. I spoke to his family. He is a good guy. He had a good job and wife he adored. She died. And so will he unless he gets help. For too long the NHS has been throwing money at 'cure'. Perhaps if that same money was thrown at 'prevention'  in the long term maybe those cut backs may not need to be so severe. 

Unions, Strikes and Scabs

I ummed and arred over writing this blog but like most things I ponder over, I end up doing them anyway. I pondered because as is often the case my views are not popular but hey ho, they are my views and I don't try and encourage anyone to agree!

The ambulance service is a very unionised institution. Staff are actively encouraged to join one during their training or once they are posted to a station. I am with Unison. I am with them because they are the only union represented at my station and because unions in general are very good if you need representation with any issues at work. They also try to act in the best interest of their members when it comes to government policy and changes to working conditions. They are however biased and i believe anti-democratic. They are very closely aligned to one political party and dictate everything from policy to leaders. That is where a high percentage of our monthly fees go. As their affiliated party is not currently the party chosen by the people, I think its fair to say, that that is their motivation behind persistent strike threats. 

As most of you are aware, the government have been making some very radical and drastic cut backs to reduce the national deficit. One of the main things to effect us and all public sector workers is changes to our pensions. They want us to pay more, work longer and receive less. Obviously, we don't want this. Why would we? We work hard enough and long enough as it is and quite frankly, we feel we are being treated like crap. After much deliberation, Unison decided to ballot its 1.1 million member on strike action. The result was a 78 per cent majority, with 245,358 in favour and 70,253 against, on a turnout of only 29 per cent of the members balloted. Whilst I don’t agree with the length to which the government are going I also don’t believe the unions are being realistic in their demands. This country and Europe in general are financially up shit creek, and without drastic measures, further financial misery is inevitable. Yes, it wasn’t our doing, it was the greedy bankers but everyone has too pay the price. It’s just how it is.

I for one won't be striking for a number of reasons, and its not because I'm happy with what is happening, I'm not. Firstly, I don't agree with striking. I don't believe that what is essentially blackmail, is the correct way to make a case for what you want. Secondly, I joined the job to help people. It wouldn't sit well with me to stand on the picket line knowing that people would die or suffer because of our action, and they would. I assure you of that. There may well be a skeleton staff running but not all the holes will be plugged. People wont phone 999 because we are on strike and that is not what the ambulance service stands for. Finally, from a selfish point of view, I can't afford to lose a days pay! If I have to work on the 30th November, I will. I will make no apologies for it  and if that means I have to relinquish my union membership, get called a scab and take flack in the mess room then so be it. I've never been one to suffer fools gladly and I wont start now. Everyone has the right to do what they believe in, but I feel union culture removes that. The 'us vs them' attitude puts walls up with can't be easily removed. 

As well as my personal reasons for not striking I believe there will be much greater consequences should the strike go ahead. Public opinion and trust in the ambulance service will be damaged and it's not David Cameron or Nick Clegg who will bare the brunt of that, it's us. As per the riots, public frustrations against the government will be aimed directly and the people on the front line. The strikes of 1989 had great public support but today, the public are in the same boat as us. Everyone is being pinched financially and I don't think they will accept us putting lives at risk for money at a time where they are become increasingly sympathetic towards the governments cause. The government itself wont tolerate it either. Striking is becoming more and more frequent and at such unstable economic times, the government will not be held to ransom. As unions repeatedly push with strikes and threats of strikes based on low turnout they are making the case for legislative reform even more compelling and much harder to resist. Having striking made unlawful will mean the end of any positive dialogue and that will not be in the best interest of its members. 

For what has been billed as 'the strike of the century' turn out was poor, very poor indeed! It doesn't convey the showing of strength that was promised nor does it show that members have any confidence in their unions.  If the strike goes ahead, it will do so on the say so of less than 25% of it's members and although it may be enough to legally go on strike I don't think that it conveys the right message. It smacks of desperation, a final roll of the dice that if unsuccessful may end any hope of protecting our pensions and working conditions. It also poses the question of whether we need unions any more. Unions were founded when workers had no rights but times have changed. All workers are protected by law to such a great extent now that the need for union representation could just as easily be filled by any solicitor, most of which can be obtained free of charge. The unions clearly don’t have a majority of support from their members, through either frustration, disillusionment or apathy, and without full backing and confident of it's members the once booming voice of strength is now nothing more than a polite whisper.

I'm all for taking the fight to the government, whether it be pensions, working conditions or wages but it needs to be done in the right way without compromising what the ambulance service stands for and without bias from political agenda. We are there to help the public at their greatest times of need (yes we moan about the drunks etc but still....) and that principle must not be lost in the fight for our working rights.

Dr Shaw: Open all hours?

What do you do when your kid is ill? We all have different approaches, some of us are lenient, some of us are strict. Me? I'm strict, I can see through the 'I have a tummy ache' and 'I don't feel well' and have no doubt that as he gets older his fake illnesses to avoid school will be common place. On the occasions where he is sick I used to do what everyone does! Freak out! What if it's something really bad?! I would give Calpol and cuddles, it cures most things after all! Failing that, i'd call NHS direct or call the GP and make an appointment. One thing I didn't do this......

"35 year old female, her daughter doesn't feel well"

I recently moved house. After a prolonged absence I came back to my home town. It was a stressful yet exciting time. I moved in on a Friday and was unpacking solidly until work on Sunday afternoon. I finished this particular shift at 3am. I crawled into my bed, knowing that there was no need to set an alarm. I had 4 days off so catching up on sleep was top of my priority list! Therefore, you can imagine my displeasure at being woken at 7:30 by a ring on my doorbell. Who in god's name is that? The postman? I don't care, it can't be that important. Apparently it was, the bell rang again. Begrudgingly I got up, chucked some clothes on and staggered down stairs. Looking like a wild banshee I opened the door. A 35 ish year old woman was standing there, well dressed, well kept, with a 6-7 year old girl standing by her side looking miserable. That makes two of us.....

"Hello there, my name is Joanne, I live a few doors up"

Failing to see her point I croaked a vaguely audible hello back, making my displeasure at being woken perfectly clear with the cunning use facial disgust and body language!

"I saw you leave for work yesterday and couldn't help but notice you were a paramedic"

I knew where this conversation was heading. Things started to make sense now, she was being strangely friendly because she wanted something and the child was looking suitably unhappy to suggest she wasn't well. Begrudgingly I replied 'yes, I am' in a tone that conveyed annoyance, displeasure, frustration and anger all at the same time.

"I was wondering if you could help me, Chloe here isn't feeling well, she is really hot and flushed as you can see and says her throat is very sore. She has hardly slept all night and has a terrible cough. I didn't want to go through the palaver of dragging her up to the GP, you know how it is. Would you be able to check her over?"

Firstly, I had to check over my shoulder to see if there was anyone behind me who gave a crap. Nope, no one there, she is actually talking to me. Secondly, I had to decide how to play this one. Do I......

a) assess the child like the consummate professional and provide the necessary health advise to appease this anxious mother.

b) rant, tell her exactly what I'm currently thinking, tell her what I'd really like to do with people like her.

c) stare blankly for 3 seconds, turn slowly and slam the door as i staggered back up the stairs.

Well, A was never going to happen, I was too annoyed and too tired. B, tempting, do I risk upsetting a neighbour after 2 days and C, again, bit risky. After a brief moment of consideration, I went with B. A rant. 

"I don't mean to be rude, but I didn't get home until gone 3am. This is my rest day and now I'm up. I'm not a GP, I can't prescribe medication, I can't even take her temperature. I'm not telling you how to suck eggs but surely, if a kid is hot and coughing, they have a cold. Calpol will probably do the trick but what you expect me to be able to do I don't know. And, to be perfectly honest I think it's a bit off for you to come here, first thing in the morning based on seeing me leave in my uniform yesterday. If you are worried take her to the GP."

"Sorry, I should have thought, I'll let you get back to sleep, sorry"

Admittedly, I got a card through the door to apologise again which I appreciated but still! What a bloody cheek! The audacity, to knock on my door because she couldn't be arsed to go to the GP.  Is she for real? And, someone she has never met before! I was speechless! It doesn't say 'Dr Shaw: Open all hours' above my door. In fact, if I did have a sign above my door it would say 'Jog on!' I get it, people worry about their kids, but a kid with a cold? She is 6 years old. That means she has had 6 years at managing and treating a cold! Surely, knocking on a strangers door isn't top of her list of things to do? How dare she?! Needless to say, I vented, ranted, stomped and shouted for the rest of the morning.  

I'm not a miserable git, honest, and if someone was in need I'd always be there and have been. I've helped out with cardiac arrests and RTC's when off duty but interrupting my sleep for a cold is not, and will not, ever be acceptable. Ever. 

Ever.

Fat people, stairs and backs.......(the follow up)

Following the posting of my last blog it appears I offended some people. Let me make this very clear. I don't care, however, in the interest of rousing debate and gathering public opinion i'm going to make the conversation I had public. These are my opinions and mine alone. Some people will agree with me and some will disagree. Everyone is entitled to an opinion. Oh, and her name wasn't really Carol!

Carol: "How dare you chastise people who are suffering. Your job is to help people and berating them is nothing short of negligent"

Me: "They are my opinions, I base them solely on experience and fact. You clearly have an agenda for your dislike of my posting"

Carol: "Its not an agenda, I am obese and also the full time carer for my husband. He is 42 stone and isn't able to work. He is ill and to think that if he needs an ambulance someone as biased and bigoted as you may show up is horrible. You are a fucking disgrace to your profession. Fat hater"

Me: "My opinions have NEVER compromised my patient care, nor my treatment to a patient. I didn't say morbidly obese patients didn't deserve care, I merely said throwing money at bigger equipment is not the answer. If you dragged yourself away from the donuts and read my blog properly you would understand that. Also, if you want to berate me, have the balls to do it publicly where I can defend your baseless accusations"

Carol: "Fuck off"

Me: "Good response"

Carol: "Yeah it was, I don't like the way his illness is singled out"

This whole blog is a pot calling the kettle black
moment so while i'm on a roll !!

Me: "Again, read read read. I quote my blog 'I know that morbid obesity is an illness, like alcoholism, but they are both avoidable & they are both lifestyle choices'. I havnt singled morbid obesity out, i've said it his an illness through lifestyle choice. That is fact"

Carol: "You are despicable. You are going to hell"

Me: "I don't care what you think, not one iota. If you'd voiced your opinion i'd engage in discussion with you but abuse is not welcome. Whine to someone who gives a damn"

Carol: "Fuck you"

(blocked)

Ok, the donut comment was a cheap shot but I don't write my blog to appease the masses or make friends. It's my way of venting frustrations, voicing opinions and sharing funny experiences. I try to educate and amuse in my own little way. I don't go out of my way to offend but if i do, I won't make any apologies for it. 99% of people who have read my blog take it how it is meant. I'm not a nasty person and am sympathetic to anyone who is ill. That is why I do this job. That doesn't mean I can't moan and suggest ways to right the wrongs in society. Sticking my head in the sand and saying everything is ok is naive to say the least. Thank you to everyone who has agreed and disagreed. I'm always open to discussion, just not an onslaught of abuse. Over and out!