7.9 miles

First job of the shift was nothing to write home about. It was just another job that made me despair. I questioned why we were even dispatched, why no one made the decision that the patient didn't need an ambulance for a 'blocked nose'. Yes, a 20 year DID call an ambulance for THAT and they DID get an ambulance. I know! Move on; I am... ish! In what was a rarity, after leaving hospital we actually made it back to our ambulance station. We even managed to park the vehicle! Those who work in ambulance services will know only too well, it is one thing to get back to station but managing to get out of the vehicle without getting another job is an achievement! Today we made it to the mess room. Another crew was sat there on their break. I sat in the armchair. No sooner as I had relaxed back into the pit of the chair the radio started screaming and vibrating. When we get a job, a message is sent to the handset with the details. We started walking towards the ambulance as I had a look at the radio: 

"Red 1, Cardiac Arrest, 10 year old male"

I read it out loud and our slow walk significantly increased into an 'ambulance run'. It's kind of a fast walk, but not a walk... but it's not a run either. We never run (except away!), but the fastest we ever go is for sick kids. As I 'ran' I hit the garage door button and jumped into the driving seat. We accepted the job and sat for what seemed like an age for the garage door to slowly bimble open. We edged out to the road, blue lights already flashing and the traffic stopped in both directions. This was a little awkward as the sat nav hadn't kicked in and I didn't know whether to turn left or right! Luckily it was only a few seconds delay and off we headed. My crew mate called control to see if there were any other vehicles en route due to our distance; there were. We were also told that CPR was in progress. There it was... the adrenaline rush!

7.9 miles 

It was dark outside, the roads were wet and the traffic was still quite heavy. You are driving to the vehicle's limit and your own. There is silence in the cab. Your crew mate runs through the paediatric guidelines for resus and the drug dosages while you are trying to get there as quickly and safely as possible. That is a fine balance! On the way to a resus you form a plan in your head of what you will do on arrival. You have worked together for a long time and don't need to discuss it. You know what your crew mate will pick up; you will grab the rest and follow in shortly after. You know the role each of you will play when you walk through those doors. Every emotion runs through you on the way to a job like this. Sick kids are everyone's worst nightmare. 

6.5 miles

You think of all the outcomes; you think how you will feel in each of them. The thought of it is quite distressing and emotionally draining. You think of similarities to your own family. You think of how the family will be when you arrive. You think of how you will hold your emotions together in the face of the horrors that may lie ahead. You think of what you will do, where you will go. You hope it's not as reported. You hope you are second on scene. You are basically hoping that a child's life doesn't rest in your hands. You are hoping you will not have to do CPR on a dead child. 

5.2 miles

While all these thought are running through your mind, ahead of you is the road. Your eyes are wide open; your senses are all heightened. Your heart is pounding as you weave through the traffic at high speed. The volume of the siren changes as you pass under bridges; you rotate through the different tones with every change in road condition. The blue lights are reflecting off everything, lighting up the roads like a Christmas tree. You are aware of everything. The revs are screaming, you are planning your path hundreds of yards ahead, planning for the unpredictable movements of people, pets, car, vans, lorries, buses, bikes, cyclists and the police. I say police because when you have sirens on, you can't here other sirens and the police go faster than us. Slamming the anchors on as you round a corner because the police are overtaking a learner isn't a new thing! 

3.8 miles

You find yourself glaring at every junction waiting for confirmation everyone has seen you and everything has stopped. You take a racing line, accelerating out of every corner. The rush of the drive with the rush of the job means you are very emotionally charged.  You are getting closer and closer. Every minute that passes makes the job all the more real. This is what you have trained for. This is the extreme of what you have trained for. It doesn't get more real or more serious than this. 

1.8 miles

A feeling of apprehension and nervous energy begins to filter in. The truck swings left and then right around corners; the engine is screaming and you can smell the breaks burning. You are aware that you are both jolting up and down with every deviation in the road surface, your bodies lurch from side to side, eyes permanently fixated on the road in front of you. Your mind is working overtime; processing the road ahead, processing everything that could be, processing everything that will be. You are as alert as you will ever be.

0.4 miles

'Cancelled, no longer required'

A Calling

"26 year old female, made a change, found her calling"

On the 22nd of May EMS Week 2012 begins and EMS1.com is running another competition. It is all about informing people of why we do the job we do. They ask the simple question: 'When did you know EMS was your calling?' It's a very good question and one that I'm sat here thinking about at 4am on a rather horrendous night shift. Here I am, exhausted, standing in the back of a cold ambulance, listening to rain crash onto the windscreen whilst I clean vomit off the floor. Is this what I had chosen to be? Is this what I had chosen to do? Yes it was! And I would do it over and over again. Some will raise an eyebrow and say...'really?!' Let me explain why...

About 5 years ago I came home from another day at work. It was 'just a job'. It paid the bills but it wasn't fulfilling at all; I had ended up doing it through a number of poor choices and various inactions. Today was no different to the end of any other day. I  sat down on the sofa, puffed my cheeks out and exhaled deliberately. There was nothing to say really. It was just... just the way it was. Was this really what I would do forever? I hoped not but I couldn't see any way out of it; my training and qualifications only really allowed me to do work in a very particular area, and it wasn't one I savoured. That night, things changed. I flicked through the newspaper's job pages with the usual air of resignation and chanced upon an advert; 'Student Paramedic'. Hmmmm! I read on. It described a great opportunity where I could become a paramedic in just 3 years. All the training would be provided, I would be paid whilst training and it was a career that offered progression and a pension which was something my current job lacked. I applied on a whim not expecting to get an interview. To my surprise 4 months later I received a letter inviting me to an assessment day. To cut a long story short I was assessed, I went for an interview, I had a driving assessment and a medical, and got offered the job. I was made up! Could this be the job, the career, the life I had been looking for?!

Training began. It was a tough six months, a lot of home study, multiple exams and assessments and a large proportion of it was done without any knowledge of what it was like to work on an ambulance. It was a little scary to be honest; I was putting in all of this work with no real idea if I would truly like the job. Then I had my first placement. It was the first time I indeed entered the world of EMS. Dressed in my brand new uniform, polished boots, company branded rucksack and a hi-vis jacket you could eat your dinner off, I arrived for my first ever shift. Due to the fact I was at training school I was 'third manning'; there were three of us on the vehicle: a paramedic, a technician and me. It being my first day I was observing and helping out with obs etc. It was the first time I had done a 12 hour shift and 6am is not a good look on me. At 6:01am we got our first job. Sat in the back, looking through the bulkhead door as we drove through the dark streets, blue lights flickering off every window and road sign, sirens blaring, I was so excited! What a rush! I soon got to see what a Materni-taxi was but I didn't care! When you're new every job is a good job. I suppose I was just so happy to be there. The shift passed by very quickly. We saw a variety of patients; chest pains, drunks, an overdose, an elderly faller, a pyrexic baby. I remember every job from that day, none more so than our off job:

"64 year old male. DIB. COPD patient. On home o2"

It was about 4pm and already dark, it was raining and we were flying through the city streets with all the drama I had imagined; I was loving it! My neck was hurting from peering through to the front for the last 10 hours but I wasn't going to miss a second! We arrived at the address and all piled in. 


The first thing that hit me was the smell of stale smoke. Our patient was sat in his armchair, clearly in trouble. To this day I still haven't seen anyone so blue; not alive anyway. He was surrounded by empty bottles of vodka and it was a sad case of a life of excess laid out in front of me. He was given oxygen and my mentor's sense of urgency was evident. We got him onto the chair and out to the truck. We didn't hang around and before I knew it we were driving; and then I saw why we had been rushing. My mentor said, 'Shit, he's gone on us, start CPR', and so I did. I was very task focused and did what I was told. Whilst the ambulance was swinging from left to right I was doing a concoction of CPR and bagging. It was a surreal out of body experience. I remember it as if I am some fourth person, looking on at me working; I don't see it from my eyes. We arrived at hospital and wheeled the bed out onto the tail lift. There I was bouncing up and down on this guy's chest, being lowered on to the tarmac. We entered the hospital through its double doors. About 100ft away, at the end of the corridor, was resus. The doors to resus were open and inside were the awaiting crash team. We sped down the corridor towards them, continuing CPR as we went. My heart was pounding, shivers ran the length of my spine and I could feel the hairs on the back of my neck stand up. This moment was when I knew that EMS was my calling. This was what I had chosen to be. This was what I had chosen to do. This, I will remember for the rest of my life.

I soon found out that it isn't all like that, far from it. I quickly learnt that there are time-wasters, hoaxes, violence, vomit and abuse. Many of the people we go to don't need a hospital. We work long, arduous, unsociable hours, and get little or no thanks, and little or no breaks, but we take the bad with the good. There will always be that one job which makes everything worth it. 

I am left now cleaning vomit off a floor. Vomit from someone who drank too much. Vomit from someone who was rude to me. This is my calling and I love it!

Once You've Popped, You Can't Stop

"33 year old female, burn to stomach"

This job never fails to amuse. Very rarely do you go through an entire shift where you don't see some form of sheer stupidity, or a bizarre injury, or a faker, or something that makes you question people's right to reproduce. I mean seriously, some people just don't get it! It's an emergency ambulance service predominantly meant for emergencies. OK, a lot of what we do isn't an emergency or even urgent but it is often necessary and that is fine. The term emergency is subjective and a trivial complaint to one person is an emergency to someone else; I get that, I really do. But, sometimes I really do wonder the thought process behind what some people do. Were they really brought up with such a little amount of common sense? Do they have no perspective on what constitutes an emergency? In the past month alone I have been to people with: a cold, a stubbed toe, a cut finger, a headache, a 'vomited once', a stiff back and a bad dream. Surely these things have happened to everyone?! Unfortunately, time and time again, valuable resources are being wasted because we are too scared of litigation to say no! 

Today, I didn't say no either. I treated what I discovered, I was polite but firm, and although I didn't and wouldn't ever refuse hospital, I did strongly advise against it and instead offered three other alternatives. It was a weekday morning and we were in the queue in Costa grabbing our daily fix; on this occasion our fix would have to wait! Our radios started blaring so off we went in haste! If only you could hear our moans and groans on seeing what we were going to. To be fair there was a fair bit of laughter too, but it was a frustrated 'is she serious?' laugh. Above is the abridged version of what the call was given as, this is what we were sent to:

"33 year old female, burn to stomach, let off party popper on stomach"

I can safely say this was my first Party Popper related injury. We headed round to the address and gave 3 slow knocks on the door. We were greeted by a young woman who seemed perfectly calm and not at all flustered or injured. 

"Hello there, who are we here to see?"

"Me" she replied as she walked off into the living room.

I asked what had happened and she explained she had been fiddling with a party popper and it had gone off and hit her stomach. She lifted her top up to reveal a small pink area the size of a 2p coin. It wasn't burnt; she was fully dressed at the time... I KNOW!! Why call an ambulance? Don't get me wrong, I know there are dangers around party poppers. The pulled string ignites 16mg of explosive charge which when combined with air pressure causes the popper to launch a small rocket of joy. Avoid the face; don't aim it at  aperson, especially from close range, blah blah blah. Let's be honest though, if you are hit by one on your torso it isn't life and death!

"Are you in any pain at the moment?"

"No"

"What would you like us to do?!"

"Take me to hospital for a check-up." 

The hot head inside me wanted to scream and rant at her! The girl in green said:

"What are you worried about? I don't think you need to go to hospital to be honest."

"Because people don't always have pain when they have internal bleeding do they, so it's better to be safe than sorry isn't it?"

I spend 25 minutes trying my best to alleviate her fears. I did all her obs and explained if she had internal bleeding there would be signs and symptoms. I also did a full abdominal examination to put her mind at rest. Alas, my offers of: staying in the comfort of her own home, referring her to her GP or taking her to the walk-in centre, were all declined. Sadly, we cannot refuse hospital so as futile as it appeared off we went. My handover at hospital consisted of:

"The lady sat over there has been hit in the stomach by a party popper. There is no injury. All her obs are fine. There is no bruising or swelling. See has no pain. She declined to stay at home, see a GP or go to the WIC. We are here because she fears she has internal bleeding"

"Waiting room"

Gone Fishing

"59 year old male. Abdo pain, shortness of breath"

Every now and again, you get a job you are literally right on top of. Our radios went off and the sat nav started directing us where to go. My crew mate suddenly swerved violently in to the road on the left and stopped. We were there already; dispatch time to on-scene time was 13 seconds. Someone in control was now grinning like a Cheshire cat, patting themselves on the back for a job well done! It was about 12:30 in the afternoon on a sunny spring day. As we had arrived so quickly, the call was still in progress so we waited back a few doors down in case it updated that our patient had a large kitchen knife and wasn't afraid to use it! (see 'Retreat') After a minute or so we got the update that the patient was short of breath with abdominal pain. The call had come from a GP surgery and had been booked as an 'Urgent within an hour'. We grabbed our bags, walked up the path and pressed the buzzer for flat A. 

I heard the bell ring and echo through the hallway. No answer. I rang again, this time hammering the brass knocker 4 times. No answer. I peered through the old Victorian sash windows and could make out the living room / diner but no sign of life. My crew mate shouted through the letter box a number of times but there was no response. We called control and asked them to do a ring back. After a minute or so they got back to us:


"We tried the number where the call originated from but it was the GP surgery. There was a recorded message saying they were closed for lunch. We'll try the number listed to the address. Standby."


We waited at the door, knocking, ringing and shouting. No response at all. We then heard the phone ringing. It rang and rang. No sooner as it stopped, our radios started ringing again.


"No answer at the patient's address, we'll have to treat it as a collapsed behind closed doors. Standby for police"


I gave the door a shove but there was little movement, so I decided not to make a fool out of myself and wait for the big red key to arrive! There is nothing worse than trying to kick a door in, only to bounce off with a sore knee! The fact I was considering putting the door in shows the concern I had for this patient; short of breath and with abdominal pain followed by being incommunicado in a matter of minutes was a concern. 


After 5 minutes of frustrated waiting, the police came screeching into the road. They made short work of the front door! One well-placed hit and the door came crashing open. As it did, I heard the following voice:


"What the hell are you doing?"


Standing at the end of the path was a man of about 60, wearing a shirt and trousers with a tweed trilby hat on. We all just stared at him for a moment. He was breathing very heavily and didn't look too good. 


"Do you live here?!"


"Yes!" he said in an astonished, confused tone.


"An ambulance was called for you and there was no answer, we thought you had collapsed. Where have you been?"


"Walking back from the GP surgery. I was told to go home and wait for an ambulance as the surgery was closing. They said you wouldn't be here for an hour!" 


He was very breathless. We assured him his door would be fixed and we got him on the truck. His oxygen levels were very low indeed. We put him on oxygen and started checking him over. His heart was racing and his blood pressure was a little low. Having walked nearly a mile, in pain and struggling to catch his breath, the findings were of no surprise. We took him into hospital and left the police to sort out the mess of the front door.

The likelihood is that he would be absolutely fine; there would be various tests done and his symptoms would be treated, but why on earth was he made to walk home?! Surely, if someone is ill enough that the GP feels an ambulance is necessary then walking a mile when already short of breath probably isn't appropriate? Especially as it was only being done so the surgery can be shut for lunch! This isn't a GP issue; it's a general issue of professional conduct. This patient was unwell and needed treatment, not a walk. If we are on a cardiac arrest we don't all stop and say 'sorry, gotta go, our shift has finished'.  You don't arrive at an A & E department to find a sign on the sliding doors saying 'Gone Fishing'. Sacrifices sometimes have to be made. It's part of the medical profession; you miss breaks, eat at crap times, do long hours and finish late. If a lunch break is more important than a patient's well-being then you're in the wrong job. I bet the GP in question a) disagrees & b) doesn't get charged for the broken door. Why would you not tell the call taker that the patient isn't actually at the address in question? 'Within an hour' doesn't mean 'In an hour'. Just sayin'!

Huffing and Puffing

"71 year old male, intermittent chest pain, in GP surgery"

I have recently had a few pops at GPs, in fairness with good reason, but in the interest of equality it is only right that I highlight the other side of the coin: How GPs sometimes view the ambulance service. 


After my recent blog 'GPs: Take Note' some of my sweeping statements were highlighted. I often make them without much thought and with little investigation! That's the 'hot head' inside of me. I think of something and write it and that is where it stays! Obviously GPs don't all work 9am to 5pm. I was reliably informed that in fact it's near 8:30am to 6:30pm which I promptly corrected! I was also asked how many extra hours on top of their 50 hour weeks they should be expected to do 'out of hours'?! Good point! I didn't really have an answer other than a sarcastic '80+ hours?!' In all honesty, it is easy for everyone to point the finger and say 'do more' and 'work more nights' but I'll be honest, I wouldn't. Despite my stupid hours I still average 37.5 hours a week over the year and anything over and above that I am paid overtime for. I suppose everyone just wants a GP whenever it suits them. Sure, they could all start working from 6:30pm to 8:30am but then we would moan there were no GPs during the day. It's a lose lose situation for everyone. It is how it is, but I'll still have a dig for my own satisfaction as and when the opportunity presents itself!

To that end, I was sent a link to a blog by Dr John Crippen, author of the now archived The Crippen Diary (2008) to look at my GP surgery moans from the other perspective. We are guilty of groaning when we see a 'chest pain' at a GP surgery pop up on our screen, but likewise, this post highlights the groan when a GP has to call an ambulance! It thoroughly amused me and I felt it warranted sharing. To be fair, he makes some excellent points! Enjoy!

"Once again, the best and worst of the modern NHS.

Last Thursday I arrived for work at about twenty to eight, to find Andrew and his wife, Mary, already waiting. Andrew is 71, retired, in good general health though he has (well controlled) hypertension and (well controlled) hypercholesterolaemia.

He looked well, and smiled as he sat down. He gave a history of three attacks of severe indigestion, two during the night and one whilst having breakfast this morning. Andrew is an intelligent man. He knew this was not indigestion. The history was the kind of text book angina that makes one want to run out and find a medical student and say “listen to this.” Andrew was now free of pain, with a normal heart rate and blood pressure. He is already on aspirin and had indeed taken it that morning with his BP pill.

This was classical unstable or crescendo angina and Andrew needed to go into hospital. He was not surprised. Mary was, but started fumbling for her car keys. The local hospital is three miles away. Now one of those taxing general practice moments which we all dread.

“I will get an ambulance” I said

Mary looked shocked and panicky. “But we have just driven down here and have been sitting in the car park for fifteen minutes”

I know, I know, it seems melodramatic, but I can’t take the risk that Andrew might have another attack on the dual carriageway. So I call the ambulance service. A very friendly operator answers on the second ring. I give all my details, my code number, then all Andrew’s details, his address, date of birth and then I am asked "the question". The same glorious I am always asked, read, as always, from the protocol.

“Is there a medical need for an ambulance?”

I resist the temptation to say “WTF do you think I am phoning” and merely say, “Yes.”

Even now, I know that there is about to be a problem. What is your provisional diagnosis? The word "provisional" is irritatingly gratuitous. “Unstable angina”. Silence. Operator switches to a different protocol. Do you want an immediate ambulance? Well, I certainly do not want to wait two hours, but this was not dire enough for me to have dialled 999. “Yes, please, but you don’t need to arrive with sirens and flashing blue lights”.

There is no such option on the protocol sheet and so my request is ignored I am switched to the 999 “pathway”. I am told that the ambulance is on the way but I have to answer some more questions.

"Are you with the patient?" Of course I am. “Is the patient conscious?”. Yes, of course he is, if he was not, I would have dialled 999. In fact, he is sitting in front of me smiling. “Is he breathing.” “Has he changed colour.” And so it goes on. These are the 999 protocol questions for the layman. They are not questions for experienced doctors but they are always asked and have to be answered. By the time I get to the end of the ludicrous questionnaire I can hear the siren and soon I see the flashing blue lights through the window.

I go out to meet the paramedics. Two very keen young men. I give the history to them, and tell them the important things. Andrew is pain free, stable, in sinus rhythm, with a normal blood pressure. Then we have to play the ECG game.

“Have you done an ECG, doctor.”

“No”.

“Do you have an ECG in your practice?”

Tempting to say mind your own business, or ask if they have oxygen in their ambulance. We have both an ECG machine and a defibrillator but neither has been needed, thank God. It is not possible to make paramedics understand that it is not necessary nor even helpful in this situation to do an ECG.

“Why on earth would I want to do an ECG?” I ask

The paramedics look at each other and back at me. “To see if he has had a heart attack, and to see what rhythm he is in.”

I know what heart rhythm he is in (well, OK, he could be in steady atrial fibrillation or even compete heart block but it is not likely) and you cannot exclude a heart attack at this stage by doing an ECG so, whatever it shows, he needs to be in hospital. Might as well just take him. We are not on Dartmoor. The paramedics do not carry clot busting drugs. The hospital is only a few minutes away.

The paramedics huff and puff.

Andrew refuses to get on a trolley and insists on walking to the ambulance. The paramedics do not like this and huff an puff some more. I keep a straight face. Not a sign of schadenfreude from me.

The ambulance then sits in the car park for eleven minutes (just over). I timed it. Stay and play. Do an ECG. Follow the ritual. The ambulance service insisted on sending a blue-light ambulance which, all power to them had it been needed, arrived in less than five minutes. They then waste eleven minutes doing unnecessary tests. Stay and play probably killed Princess Diana. Fortunately it did not kill Andrew.

He arrived at the local cardiac unit a few minutes later, alive and well, and still pain free. By mid afternoon he had been fully investigated, ECG, blood tests, angiogram and stent. He was discharged home the following day.

Andrew has almost certainly been saved from a full blown heart attack or worse. He appeared at the Health Centre at 7.40 am and thirty six hours later was back at home, well, stented and pain free. Whatever one may think of protocols and government targets, this is an excellent outcome.

Criticisms? Well, a few.

Andrew was in and out of hospital so quickly that he did not really take it all in. I had to spend half an hour translating all the medical jargon on the discharge summary and explaining the medication to him. Mary was still frightened and wanted to rap him up in cotton wool. And I hate doctors who are too frightened to use their own name. The “cardiology team” is not a consultant.

But, all in all, a good result. I wish they would treat psychiatric emergencies in the same way, but hearts are glamorous. The mentally ill, apart of course from Stephen Fry, are not."

We do huff and puff! A lot! As a service we are obsessed with ECGs and with good reason. I think we often lose sight of the point of them though. The problem is, like Dr Crippen alluded to, we have protocols. Shit loads of them! On top of that we are judged on our paperwork, and if the words 'chest pain' appear anywhere on our paperwork there has to be an ECG! Why? Because we are told too and as a result some people do them at inappropriate times. It does often seem pointless in some patients and personally I wouldn't have done one on this guy unless it was going to change my plan.  In this case it wouldn't have. He was already going to a cardiac unit. Doing an ECG on someone not in pain was not going to change a thing in this instance. If he wasn't booked to the cardiac unit, even if the ECG shows some kind of cardiac event he would still go to an A & E because the criteria for going straight to a cardiac unit is central chest pain for more than 15 minutes with some exceptions, none of which he fits into. We also do an ECG if a patient's blood sugar is above 10mmol/L. Not 9.9, oh no, 10.1 makes all the difference! In reality it is a number. I will do an ECG if  I think it's indicated or if a patient will benefit from the investigation, not because of a difference in 0.1! Some people will see a BM of 10.1 and just do an ECG but why?! It's all relevant to history. If a non insulin dependant diabetic who's BM sits between 10 and 14 normally has called for a back injury doing an ECG won't change much! Some of the things we do are over the top and it doesn't surprise me in the slightest the GPs get annoyed with us but they are over top for a reason. History has taught us to be over cautious for a reason. They have years and years of training and we are certainly not placed to second guess a diagnosis or decision, but can ignore and make our own ones! Obviously we can share an opinion about leaving ill patients alone in a waiting room with a letter in their hand, but we certainly shouldn't be questioning whether or not an ECG has been done. If we think one should be done, we'll dam right do on!

It all comes down to the age old problem with the NHS. Services not working together! There is not a big enough understanding between job roles and policies in different areas of the NHS. Yes, a GP should be able to say 'I need an ambulance, don't worry about lights, but as soon as possible would be great' without having to answer pointless questions! Likewise the GPs need to understand why we have to do ECGs and wait around for 11 minutes when it appears we are simply delaying definitive treatment. We don't delay for fun and it isn't simply a box ticking exercise. We do it because we have the knowledge and equipment to be able to form a more comprehensie history and picture of a patients health and in 'staying and playing' can benefit a patient in the short and long term. I doubt it will ever change, everyone has their arses to cover and everyone thinks their job role is more important than others. That's just how it is. We will all continue to love to hate each other and engage in professional banter wherever possible! 

Full article: The Crippen Diary - 2008 : January (2) | Trusted.MD Network http://trusted.md/feed/items/system/2008/01/15/the_crippen_diary_2008_january_2#ixzz1uNIWHPXm
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NB: I have made some edits to this post following comments which showed the point I was trying to make had been lost. I am not making editing notes. This is not a scholarly article, a journal or anything other than a personal blog. Just be aware that most of the comments were made before my edit which were merely the re-wording of a couple of sentences. I stand by what I say, like always.