Snap out of it

“27 year old female, feeling unwell, tired"

Just another day, another dollar. The usual routine; wake up, shower, get dressed, make lunch, drive to work, get crap out of locker, chuck it on a truck, check the bags, check the cupboards, drive off for 12 hours of the usual. Job to job to job; the same old patients, the same frustrations and no thanks for it. It really does get you down sometimes! As for the patient, man up springs to mind!

She lived in a nice area, her flat was a nice size, clean and tidy, nothing out of place and she was well dressed and well presented. She was well spoken and very polite. What could possibly be wrong? She didn’t seem in any pain, she had a smile on her face and cracked jokes. She couldn’t really explain what the problem was and knew it was nothing she needed an ambulance for, but she didn’t want to go back to the GP. The last time she did she was fobbed off with a prescription and told to diet and exercise.  She was just... feeling unwell. So here we are. What is the problem?!

She took a deep breath... “OK, from the beginning...

...I suppose it started during my teenage years to a point; broken family etc blah blah blah, always a brave face but I suppose it took its toll. Self esteem was low, confidence was low but I suppose you just cope don’t you? A marriage painted over the cracks, 6 years of happiness and distractions and a lovely child to add to the mix made everything seem OK. After the marriage ended there was a rebound relationship that painted over more cracks. I suppose that wasted year gradually chipped away at any remaining confidence there was and after being left a shell, rock bottom was reached. All the while though, a well painted exterior left no one the wiser. Even my closest allies were unaware. Panic attacks began, intrusive thoughts plagued me and sleep became an issue. 3 months of 2-3 hours sleep a night took its toll. Bags under eyes is not a good look on me!


Despite the self-inflicted isolation and a full box of prescribed anti-depressants that I refused to touch, I found a way out. I suppose being as low as can be makes improvement all the more possible. I climbed out of the swamp of self pity and changed my lifestyle. The fake smile was more sincere and I felt good again. This lasted for 6 months. I found ways to deal with my insecurities and achieved a lot of personal goals. I had a good relationship with my ex which my son benefited from, I was fit, active, had a close group of loyal friends, I got this lovely flat in a lovely area, my family is caring and supportive, I live comfortably, I eat well, I could do what I want when I want. What is there to be miserable about? Nothing!


Not so. Despite my new found ‘happiness’ there was also an inherent loneliness. A void that was not being filled. A cloud I was unable to see through. A cloud that engulfed me. The unspoken D was looming again, threatening to rear its ugly head. No one could spot the signs as no one knew it had been there in the first place. For 4 months now I have not been sleeping. I don’t mean the odd night of broken sleep, I mean not sleeping. My job is demanding and exhausting; after an 84 hour week I should be tired enough to sleep but I can’t. I can’t switch off. I lie awake for hours on end. 1am, 2am, 3am, 4am, 5am, now it’s time for an hours kip, 6am, hours kip, 7am, wide awake. The next day I am back to work. The annoying thing is it was work that triggered my current demise. There was an incident in which I was hospitalised which caused a long spell on my sofa. A long time to think, take stock and over think. I couldn't exercise, I couldn't really socialise and it felt like all the positive changes I had made were being undone. It was like I was watching it happen but unable to stop it snowballing. It knocked my confidence and left me resentment about the job I loved. Once back to work the damage was done,and I was left feeling like I was existing, not living, yet all the while the smile is still there. 


I hear people talking of depression and saying ‘why don’t they just snap out of it’. I want to. I can’t. It isn’t a choice. If I had a choice between a physical illness or a mental one I’d choose the former. Instead I get both. Maybe that is the problem. If it's not one it's the other. I don’t know. Looking in from the outside I have nothing to stress about. I have more than most people. I have a lovely, happy, healthy son who lights up my world. Surely that is enough? I have a job that pays well compared to a lot of people. I am not isolated from friends or family even though I feel it and isolate myself. I have a roof over my head. Seriously, surely I can just snap out of it?


It’s a cycle. You lie awake not able to sleep. Because you are awake your mind is at work. 5 hours awake in the dark gives you time to over think everything. You confuse yourself. You upset yourself. You feel alone. You wake up exhausted. You feel like you have been hit by a bus. Every day it becomes more and more of a struggle to leave the house. Your motivation is completely gone. The simplest of tasks become a chore. You feel lazy but there is no willingness to be pro-active. You feel horrible about yourself because you are so tired you are snappish. You start to snap at the people who are close to you but they just think ‘someone woke up on the wrong side of the bed’. You feel guilty and obsess over everything you are doing or saying. Tired and weary you get back into bed. Now you are stressed about your behaviour and your relationships in your life and can’t sleep or switch of. 1am, 2am, 3am, 4am, 5am, now it’s time for an hours kip, 6am, hours kip, 7am wide awake. It eats away your confidence and your self esteem. You feel like a shell.

Work doesn't help. I see things every day that add to my problems. I do have forums to vent and talk it out but I would be lying if I said things don't get to me. They do. I'm haunted by a lot. I struggle to deal with what life throws at people. A lot of the time I am fed up with hearing everyone else's problems. What about mine?! I can't avoid my work, I have to drag myself in every single day knowing that there is a high chance I'll be lying in bed later thinking about it. 

When does it stop? I don’t want to be that medicated patient. I don’t want to list antidepressants to the ambulance crew. I don’t want the big D on my medical record. I don’t want to talk to my GP about it; I won’t talk to best friend about it so the GP doesn’t stand a chance! Maybe I’ll just carry on smiling. No one will know. I don’t know. I think I’ll just stay here.” 

She didn't need hospital and didn't go, she just needed to talk it out, but it does raise questions. It’s a very common job, a very common problem. It’s probably more common that the stats suggest. How many people are suffering in silence? It isn’t an emergency and doesn’t warrant an ambulance but it does need addressing. Like all mental health, there is a stigma around it, a perception of weakness and misery that is not true. The fact that it can go so well hidden is testament to that. You can't just snap out of it. There is help out there, it just takes the courage to admit and find it. Unfortunately, until it is accepted as a genuine illness people will hide from it, deny it and do nothing about it. Luckily, she isn't hiding from it, denying it and is doing something about it.

The she is me.

If you are struggling with any of the issues raised in this post I highly recommend The Blurt Foundation. They are great to talk to, in total confidence, anonymously and online. 

Breakfast

"A giggle of ambulance folk talking shop"

I pulled into the car park at 06:45 and struggled to find a space. We don't have the biggest of ambulance stations and parking is often tight but this time of day is often the worst. You have all the 6am and 7am crews who are starting, the early turn FRUs, the team leaders are in, as are the duty station officers and training officers. On top of that there are the night crews, the night FRU's and any night officers, all finishing at 7am. I dragged my weary arse out of my car and headed over to the fire door in the hope someone would be in the mess room to let me in! There was, 'Morning' 'Morning' 'Morning' 'Morning' 'Morning'. The usual pleasantries were exchanged and then I went to see if there was a truck for me. Nope! Result! Back to the mess room I went! A few friends were in there, eating breakfast, drinking coffee and checking emails. 

"How's it going?"

"Yeah not bad, wish I wasn't still here but can't complain!"

"Yep, sounds about right! Good night?"

"It was mental, non stop"

"Get a break?"

"Hah, good one!"

"Any good jobs?"

"Actually we did, makes a bloody change! Had a cardiac arrest in the street!"

"Nice! How old?"

"60 odd, proper dead though"

"Dead dead?"

"Yeah, classic dead face, did 20 minutes ALS and ROLE'd it, backs killing me now!"

"I bet!"

"Had one you would've loved, this geezer was rat arsed and tripped over, head butting a wall on the way down. A proper flap of skin, skull showing and all sorts! Seriously, it was a mess, he'd done a proper number on himself!"

"Awesome! Trauma center?"

"Yeah, massive pain in the arse though, spent most of the night down"

"At least it was a decent job!

"Thing is it wasn't, he was rude and gobby, giving it all the big'un and had pissed himself. We had already been dragged down that way so the trauma center was actually the nearest."

"You made it back though!"

"Yeah some old dear chucked up everywhere, just been mopping out. It was literally everywhere, cupboard door, the bins, the bed, the runners, it was trickling towards our bags, I had to chuck everything in the front. Nightmare!"

"Grim, I had a good job yesterday, pretty horrible though. Lovely old guy with tongue cancer, we were pulling clots the size of golf balls out of his mouth. They just wouldn't stop coming, I felt a little queazy afterwards!"

"Ah mate, I had one of those before, it's rotten! Was he alright?"

"Don't know, it was our off job so we never made it back to check on him"

"Right, that's me done, bed time! Have a good one!"

"You too, have a good sleep!"

"Yeah right!"

That is a normal morning conversation! Piss, blood, vomit and dead people over breakfast! Like I have said before, there is a lot of gallows humour in this job, there has to be. It is no different to any other colleagues in any other job talking shop before and after work. The only difference is the setting. We wouldn't bat an eyelid at talking about dismemberment over a slap up meal because that is what we know. We wouldn't do the job if it grossed us out! When I read the conversation back in black and white I suppose it looks a bit cold. Talking about the dead in a passing comment, 'dead dead', 'dead face', they are just ways we talk about jobs. Dead people do have a dead face, it is unmistakable. Mouth open, eyes looking up and glazed over, it is just a look we have come to know. Normally you know within a minute of hearing the history and looking at the patient if they are going to make it. If they are not, you quickly detach yourself from it. Maybe we are sick in the head? We certainly all have a screw loose! Someone's bad day can make ours a good day. It is simply different perspectives! 

One tape fixes all

"9 year old ambulance, not feeling well"

When we all buy cars we want something that won't break down. We look at the body work, the interior  and the mileage. Low mileage is always a selling point! When we insure the car the insurance company ask your annual mileage and it varies from person to person depending on the commute. Now take an ambulance; many of them are 24 hour vehicles, 07:00 to 19:00, then a crew change to the night turn on 19:00 to 07:00. This is repeated every day, 7 days a week, 52 weeks a year and only gets a rest when it breaks down. The driving that it puts up with isn't your average drive either. It is driven at speed, at high revs, it's swung around corners, there is repeated heavy breaking and it is pushed to its limits every day. We have a team of fitters who try their best to keep them working but invariably they break, and break often. There are so many vehicles breaking down that they are left doing quick fix after quick fix, and it is not just the mechanical side of things that go wrong. There are cupboards, trolley beds, carry chairs, blue lights, reversing cameras, 2 sets of steps, signage, clocks, Sat Navs, MDT screens, radios and tail lifts; all which get used and abused. 

The other day I was working on a 9 year old Mercedes Sprinter. It had 248,000 miles on the clock and, to be honest, had seen better days. There was a hole where the radio once was, the sat nav was hanging off, all the air con vents were missing, the air con wasn't working, there were no lids for the bins, a cupboard door was missing, there were holes in the seats covered with gaffa tape and the oxygen mounting was held on with micropore tape.

Micropore! The entire ambulance service, infact the entire NHS, is held together with micropore. It is used for everything. It has become a running joke that if something breaks, it's nothing that micropore tape cannot fix. You would struggle to find an ambulance in service that doesn't have micropore tape holding something together. The same applies to the newest vehicles. As with everything in the NHS our vehicles are provided by the lowest bidder and as such the quality of workmanship and materials used is poor. There are 100s of vehicles less than 3 years old and a quick look through their defect books will reveal just how much has gone wrong with them in such a short space of time! It can be embarrassing when a patient gets on board and you see them looking around at the bodge-job of a truck they are in!

About 3 hours into our shift, we were called to an unconscious male in the street. We pulled up to the bus stop to find him lying face down on the floor. Once we were within 6 feet of him it was clear he was an alcoholic; the smell was awful, his clothes were dirty, his hands filthy, his face was flushed and he had the drinkers nose. A quick shake and he was mumbling and groaning away. Unfortunately for our backs he was in no state to stand and stagger without assistance. We opened the tail-lift to get the bed out but it wouldn't open. Nothing we did would make it budge. Bugger! Back to the pre-tail lift way of doing things. We picked him up off the floor, onto our chair, and then lifted him up the steps and onto the bed. We took him to hospital and did the same at the other end. Job done! We then informed control that our vehicle was broken and were told to wait where we were for an engineer to come to us. An hour later he arrived. He looked at the tail lift, opened it as far as we had been able to and then said:

"You got any micropore?"

Micropore in action! 'Now get back to work'

I laughed and handed him the roll of tape attached to my trousers. Sure enough, he had seen the issue and binding the loose switch with tape would fix the problem. Taping complete the tail lift was working like a dream! Off we went to the next job. 14 miles away through traffic, engine screaming, heavy breaking and taking corners at speed. I could hear the vehicle crying in pain.

I guarantee everyone, in any ambulance service, all over the world has used or seen micropore used for something other than what it was intended! It really is the glue that holds everything together! Without it there would be no ambulances on the road! I know in an ideal world broken parts would be replaced, things would be fixed properly, and vehicles would be replaced after a certain amount of years served. Sadly, our government won't allow that. I shudder to think how many ambulances could have been bought with the fines for missed targets. Services are left with making the best of a bad situation. I just wonder how David Cameron would feel if it was his loved one in cardiac arrest in the back of an ambulance and there is a delay getting them into hospital because the micropore on the tail lift has come off?! Hmmmm... maybe taking the money and resources away from the emergency services wasn't such a good idea after all!

We all make do, we all carry our micropore and, in general, make it work for us.

The Panic

Hands up who has panicked when their kid has fallen over? Tentatively I'm sure, but I bet every parents hand is raising as you read this! It's a natural reaction. We run over, there are screams, tears, but normally it's just the indignant shock of face planting the floor when they least expected it. Hugs, kisses and TLC (and sweets) tend to make everything OK. Hands up if after 5 minutes it is as if the fall / accident never happened! I reckon hands are shooting into the air! Kids bounce! It's a fact! For a toddler to seriously injure themselves something pretty awful must have happened. Generally, it's a bump and bruise or a graze and everything is OK. That doesn't mean we stop panicking every time it happens, but we know what to do when it does. Mums are probably better than dads in general, mainly because they see it happen and deal with it more; that is no slight on the dads whatsoever! This 'panic' in this post is two-fold and you'll see why. Now, something for all the mums to remember before you read this post. Think back to when your first born was very young. Do you remember the first time you went out and left them with dad?! Dads, do you remember being left alone with them for the first time?! A scary time for all involved! Did anything like this happen?!

"18 month old male, fall, arm injury"

We were absolutely miles away. For a city, 14 miles is a long time to travel, especially on a Saturday afternoon. Apparently we were the nearest available ambulance so begrudgingly, off we went to my least favourite area. The job was a very low category, so low we didn't even need to travel on lights. As call volume was high, the lower categories of call have to wait longer for an ambulance, and by the time we got it the call was well over an hour old. Off we trundled, having to sit in every traffic jam and at every red light. After 25 minutes we still had 9 miles to go. Then the call upgraded to the highest priority of call, a Red 1.

"18 month old male, fall, arm injury, patient now unconscious"

Unconscious draws the same dispatch response as a cardiac arrest so it was unlikely we would be first on scene. We lit up the roof and flicked on the sirens and off we went! Bye bye traffic jams, bye bye traffic lights! See ya! It was still 15 minutes on lights and sirens but we made it and we were indeed 4th on scene. There was already a response car, another ambulance and a community first responder. Neighbours were out of their houses, curtains were being twitched and for the cul-de-sac we were in, it was the event of the century! Everyone loves a bit of drama!

We piled into the house and entered the sea of green that was the living room. The child was sat on the sofa, awake, not crying, a little grouchy but are you surprised? I too would be livid if two ambulance and two responders woke me up from my AFTERNOON NAP!!! Yes, you've guessed it; the boy wasn't unconscious, he was asleep. The trauma of falling off the large bean bag had been too much to handle and all the crying had worn him out. It was also 4pm so well past his nap time, of course he would be tired! Amazingly, today was the first time the dad had been left alone with his son! 18 months! He was beside himself with worry and despite 4 paramedics, a technician and a community responder telling him his son was fine, he wouldn't have it, he wanted to go to hospital incase there was a fracture! He really was beside himself with worry, it was quite funny! He disappeared upstairs to grab the 'red book' and a change of clothes like we'd asked. At that moment I saw through the net curtains a woman running at full speed down the garden path!

"Oh my god, oh my god, what's happened?!"

Mum was home! Imagine her panic? She has left for 2 hours to get her hair done. She walks home and outside her house are 2 ambulances, a car and a community responder, most with blue lights still flashing. She then enters her house to see 7 ambulance staff in her living room! I think i'd be terrified! We explained what had happened as hubby came back into the room looking sheepish:

"2 hours! I left you for 2 hours, most of which he should have been asleep! What is wrong with you?! I'm sorry about this, he doesn't need to go to hospital does he?"

"No, he's fine"

"See! He's fine, what the hell were you thinking?"

She went to town on him! Poor guy! We all piled out leaving them to 'discuss' parenting techniques! What can you say though? Surely after 18 months he should know what a sleeping child looks like?! I have learned over the years never to presume a thing!

There isn't really any advice I can give. I can't even be angry or wound up! OK, I can! I was livid to be sent so many miles for that. I was annoyed at being in the area and available for another call. We ended up being 2 hours late off because we were so far away from our station, but I can't be annoyed with the dad. It was genuine concern and an emergency to him. The only advice I could give him was to "Keep Calm and Carry On"! Kids are resilient. Falling off a beanbag will very rarely result in anything other than crocodile tears. If you are worried though, call us. Maybe ring mum first though, she might have some wise words to save the embarrassment of having us all pile in, then out of your house and watching you get schooled by the Mrs! 

Back to the waiting room!

"25 year old female, head injury, nausea, vomiting, blurred vision"

For various reasons I have found myself sat in a hospital waiting room a number of times in recent years! I first blogged about it in 'Musings from a Waiting Room' after I was a patient! Within 6 months I was there again, it provided me with yet more musings and grumbles that inspired 'More Musings from Another Waiting Room'. Well today, I was back! This time with an injured sister and 4 hours of people-watching! Having blogged twice about it before I walked into the A & E with my observation head on and boy, I had plenty to look at and amuse me!

As the two sets of sliding doors open, the sea of people, 39 to be precise, all turned their heads or looked up to see who and what was entering the queue. It is always an awkward moment! We headed over to the reception desk where we were 'greeted' by a witch. I'll get on to her general behaviour shortly, but she specifically annoyed me with my sister's GP details. My sister hasn't been to the GP for about 8 or 9 years. When she did, she was at university so didn't know her current details. I offered to go and find out and let her know shortly; 'It'll be too late by then, I can't add it later' was the reply! Liar! The funny thing was she didn't recognise me out of uniform but I see and speak to her most days and she was talking nonsense! We finished booking in and went to take our... nope, there are no seats, we'll stand. It took a good 5 minutes for one of the non-sick relatives to offer my sister a seat despite the pained look on her face and the concerned one on mine. Some people! Pah!

The Foot Injuries - I don't know what they had been doing on this particular morning but there were at least four young females with ankle injuries; none of them older than 30 and they were all there with their partners. Each time their name was called, out came the exaggerated hobble, with the half-caring/ half-embarrassed partner walking beside them with a semi-caring arm on the shoulder. After 10 minutes behind 'the doors' they all walked out with a tubi-grip round their sprain able to walk much better. A few even cracked a joke with the other sprainees saying 'it's only a sprain hahahahahaha'. Idiots. Yes, it's only a sprain, that's why your attention seeking hobble and wincing was so embarrassing to watch. Man up!

The Receptionist - She got my back up the minute I walked through the door. I know she is probably weary with the hoards of pathetic illnesses that walk through the door, the rudeness she gets from most, and the complaints about waiting times, but I also see my fair share of these people. The fact is, like how I represent the ambulance service, she is representing the hospital and the NHS. There is no need to be rude, and given that we were polite, said 'good morning', and smiled, there is no need to bark. Then there is the patient confidentiality thing that really irks me. I could have written down ever name, every address, every GP, every next of kin and every medical ailment of everyone who walked in. She repeated everything, loudly, most of the time said 'pardon', and made what is already a horrible experience an embarrassing one for anyone who had to join the crowd. Before I left I reminded her that I work here every day and I little bit of common courtesy would not go a miss. 

The Door - When it is your time, a door opens and a nurse calls your name, normally it is mispronounced and then everyone looks as the ill or injured patient slowly makes their way to the door. Then they disappear off into the unseen heart of the hospital. 5 minutes later they return and from where I was sitting I could see their approach to the door. I say door, but they were double doors, one of which was locked. The one that wasn't locked had a button that required pressing before the magnetic lock was released. I watched on in amusement as every single person walked into the locked door which didn't budge, followed by confusion over why the other door would not open. It was hilarious! Some would end up with their face squashed against the glass as the exuberance to open it ended in an epic fail! I know a simple sign would change things, but where is the fun in that?!

The Vending Machines - Every hospital waiting room has them. This one has three! A hot drinks machine, a cold drinks machine and one stuffed with crisps, sweets and chocolate. None of them were working, yet despite numerous complaints to 'the receptionist' no 'out of order' signs were put up. I watched on from the opposite side of the room as countless people put their money in and heard the ominous drop as the coins unceremoniously dropped through the machine. They would try again and again, scrapping the coins on the side of the machine, putting them in slowly or pushing them in as fast as possible, each time with the same result. Frustration! What amused me more than anything is that no one who had tried, failed, complained and re-took their seat told any other unsuspecting customer! Aren't people great?! They probably did so because they were getting as much enjoyment from watching people fail as I was!

The Cure - One thing I found amazing was the vast number of people who didn't wait for their name to be called, or didn't wait to see the doctor and finish the treatment they had been waiting hours for. It was as if having to wait cured their illness or injury. With a sudden huff and puff and a snide comment about the hospital being a joke, they would up and leave. Every now and again a name would be called, the heads would turn and then all look back at the waiting nurse. She would say the name again and then disappear back behind 'the door'. It does beg the question why come to hospital in the first place?! Did they need to be here?! Why wait 3 hours but not 4?! Have those 3 hours removed the pain?! It seems a bizarre way to waste a day! Perhaps people should have a long hard think; How ill am I?! Do I want to wait 4 hours? Will I wait 4 hours? Can I get treatment without having to sit in a hospital waiting room?! I reckon as high as 80% of people in a hospital waiting room at any one time don't need to be there!

The Silent Button - SERIOUSLY. Does no one know where it is? Can no one put their bloody phone on silent? It's annoying enough hearing everyone's phone conversation consisting of:

"Hello mate!"

".......alright mate, what you up to? (I'm guessing)"

"Yeah I'm ok, just in hospital at the moment"

"...........really?! are you ok?! (I'm guessing)"

"Yeah I'm fine....blah blah blah"

Well if you are fine, bugger off. And if you won't and are intent on sitting here, turn your phone on silent and take your calls outside. Text message tones, ridiculous ring tones, notification alerts, email tones, games and keypad tones. TURN THEM ON SILENT! 

This was just another bad experience to add to my long list. On top of all the above there was the usual crying babies, badly behaved kids, drunk people, mental health patients starring at you and people being just rude and obnoxious. I won't miss it, but I'm sure I'll be back at some point for the fourth instalment. God I hate hospitals!