A Beautiful Death

"97 year old female, DIB, terminally ill"

There is always a sense of appreciation when you are sent to someone so elderly. So many years of experience and knowledge. It's hard to comprehend being alive in 1915. George V was king, Herbert Asquith was Prime Minister and the world was at war. It's an era most of us are lucky not to have been a part of but similarly it's an era and generation where respect is embedded. We arrived relatively quickly, despite the weather and the traffic and were met at the door by the patient's son-in-law. A welcoming smile greeted us and we were thanked for coming. It may sound silly but we a rarely thanked for coming, it's not that I look for thanks or notice when it's not given, but I do notice when it is given and appreciate the gesture. We followed him through the house and up to the bedroom of the annex. 

Our patient was laying in a cot-bed with her daughter at her side. She looked very frail, very pale and exhausted. Her respiratory rate was about 50 and you could hear the bubbling on her lungs as you entered the room. Her oxygen levels were extremely low so we started her on full flow oxygen. She was suffering an acute episode of heart failure. Basically, the heart wasn't pumping properly and fluid was backing up on her lungs. She needed hospital and she needed it quickly. I started to set up the chair in preparation for moving her while my crew mate did her blood pressure.

"We don't want her to go to hospital. She has said she doesn't want to go."

Unfortunately, she was now in such a bad way she was unable to talk, her eyes fixated on the ceiling, breathing was taking every bit of her being. There was no DNR (Do Not Resuscitate) order in place or any palliative care program despite her late stage kidney disease and heart failure. She had been seen by her GP a few weeks previous, who had stopped all of her medication and recommended palliative care but as yet nothing official was in place. This put us in a the very grey area of capacity and our duty of care to act in the patients best interest. We knew that if we left her at home she would die and if we took our oxygen away she would die, but we also knew that with no DNR in place, if she was to die in front of us now, we would have a very difficult job to justify not starting a resus. As horrible and futile that would be on a 97 year old we have to start unless a DNR is in place.

We explained all this and the family were very understanding of our predicament but also quite rightly adamant that they wanted what was best for her and her wishes.

"She wants to die at home, with us and not in a hospital, we are scared that if you take her she won't come home."

She was right, she probably wouldn't. Our thoughts were, that this episode of illness was terminal and it was going to be a matter of hours not days. We needed a plan B and we needed it pretty quickly! We called our local out of hours GP service and explained the situation. After much much debate and various phone calls later, the GP said he'd be with us within the hour and would be able to provide a DNR for us and some medication for the patient. That was a great relief to the family. It was now not about taking her to hospital but about what we could do to make her comfortable. We spent the hour monitoring her and talking to her daughter and son-in-law. Despite the obvious emotion of the situation they showed great interest in us. We talked about the job, what we did before the job, our families and health care. All the while our patient was lying in between us all, fighting hard. Nothing we had done had improved her breathing, it was as bad as it was when we arrived and that was hard to watch. 

Before long the GP arrived. His professionalism and bedside manor was excellent. He engaged with us in everything he was doing and we assisted him drawing up various drugs. He explained everything he was doing to the family and explained he was making her as comfortable as possible. The DNR was openly discussed, written and signed. Everything was in place now for her to die on her own terms. 

We had been on scene for just over two hours before her breathing started to settle down. Her blood pressure was gradually dropping, 102/68, 93/52, 77/44, 63/38. My crew mate was outside the room with the GP and the son-in-law whilst I stood with the daughter, who was holding her mums hand tightly. 

"Is she going to die tonight?"

I knew the answer but didn't know how to respond. Partly because I was choked up and holding back the tears but also because telling someone that their mum is about to die isn't something that is said easily.

"Stay holding her hand, she knows you're there."

She knew what I was saying and asked us to remove all of the monitoring equipment. I left her by the bedside. She told her mum how much she loved her, how much she has inspired her and how much her grandchildren loved her. I ushered the son-in-law back into the room and we stood in the doorway as they said their final goodbyes. The time was now. She wasn't afraid of death and neither was her daughter. Her respiration rate slowly dropped and dropped until she drew her final breath. Very slowly her eyes closed and she let go. There was a peaceful smile on her face It was in that moment her daughter turned to me with a look of fear and desperation and said:

"No, Has she gone?" with tears pouring down her face.

It was as if as much as she knew it, and had made peace with it, but in the moment of death a fear of death had gripped her. I just nodded my head. I walked over and removed the oxygen mask, unable to hold back the tears trickling down my face. We shared a look, one I'll never forget. A look full of appreciation that our inaction had been the greatest gift we could have given their family. It was one of the most heart breaking and distressing things I've ever witnessed yet beautiful at the same time. To be there with someone who isn't afraid of dying and is ready to die, and share that with the family is a humbling experience and one I will never forget. I was so thankful that we avoided a resus because it would have seemed such a tragic way to end what had been a wonderful lifetime.

We went downstairs and in a very British way made them a cup of tea. That is, after all, the done thing in such circumstances. After saying their final goodbyes they came downstairs, teary eyed yet almost relieved. Relieved that they had been able to fulfil her final wish. Death in any circumstances is difficult, but ultimately it's the sacrifice we must all pay for living.

'To die proudly when it is no longer possible to live proudly. Death of ones own free choice, death at the proper time, with a clear head and with joyfulness, consummated in the midst of children and witnesses: so that an actual leave-taking is possible while he who is leaving is still there.'

                Friedrich Nietzsche

Please Please Please

"Signature Needed NOW"

The purpose of this post is simple! I want you and everyone you know, to sign this e-petition as soon as possible. I want the link to it emailed and re-tweeted as much as possible. The e-petition was set up by the Oliver King foundation and was set up after his death at the age of 12. He died from Sudden Arrhythmic Death Syndrome (SADS).

Their aim is to try and raise awareness about the medical condition SADS which commonly affects people aged between 12 and 35 years of age.

By doing this through their fundraising events and major PR drives, their aim is to boost the awareness about SADS enabling them to take the first steps towards preventative steps being made freely available.

They are currently based in Liverpool, UK and are striving to ensure that schools primarily get the equipment they need to help any young people who are affected by this condition. This is namely defibrillators. They need your help to get the government to listen, as until now the only response they have had has been to refuse to help and pass the buck to the ambulance service. 

"From February 2007, responsibility for continuing the legacy of the National Defibrillator Programme was devolved to ambulance trusts. Most of the ambulance trusts across the UK have community resuscitation departments or similar, which work to place defibrillators in the community, and in areas of need."

What they mean is they won't pay for it! What they also don't tell you, is that the ambulance service places defibrillators in places only where the owners pay for them. We do provide HeartStart training in basic life support and defibrillation free of charge to anyone that wants it but this training is provided by willing staff, unpaid, and in their own time. I myself am a trainer. It is something I believe passionately about and it was of such a surprise to me that defibrillators were not in schools by legal requirement. 

The cardiac arrest survival rate in London is around 32%. That figure is much higher than the rest of the country but it also much lower than other cities in the world. Seattle has the highest survival rate in the world at 55%. The reasons for the huge gulf is simple. Basic Life Support is taught as part of the national curriculum from the age of 6. Everyone knows how to use a defibrillator and there is one on every street, in every school and in every public building. That is the survival rate that is possible but that is what the government are unwilling to do. £650 for a defibrillator is more than a 12 year olds life is worth apparently. They even refused to meet The Oliver King Foundation, yet weeks later 16 defibrillators were installing in Westminster and government buildings! If it's good enough for them, it's good enough for you and your children!

Please please please have your say. We have the chance to make a real difference so lets put our weight behind it. 

SIGN THE PETITION NOW!

For more information on the Oliver King foundation please visit  http://www.theoliverkingfoundation.co.uk/ or see them on twitter at @TheOKFoundation.

It's all about the money

"82 year old male, Cardiac arrest"

I can feel my heartbeat almost double in speed when I accept the job. There is always a different attitude in the cab, a sense of urgency, an appreciation of the gravity of the situation and an understanding and acceptance of what was about to happen. For someone not in the know, a resus is not a pleasant affair. For starters, lying between whatever ambulance crews are there is a dead body. During attempts to get the heart started again there will be the cracking of ribs, the jolts of electricity, incontinence, vomit in the airway, gargling and a cocktail of smells. It is what it is. If you were to believe what Ann Widdecombe in my recent post then you will be off the opinion that "the service exists for the benefit of those who staff it rather than those who need it". Well, there is a man lying on floor who needs us now and she would have you think that we are in it for the money. Are we?!

15:52 Dispatched - £0 earned

15:55 Arrived on scene - £0.51 earned

15:56 Start CPR - £0.68 earned

From what we could gather he had woken in the morning and had felt fine. He had been sitting in his arm chair reading the paper when he suddenly felt hot. He then fell to the floor and we were called. Unfortunately, there was only the two of us. We were told that there were no other resources available and I can all but guarantee that none of the other crews were on a rest break at the time! There are simply not enough ambulance for the number of calls and even if there were, there is not enough staff to man them. 

15:59 1st shock given - £1.19 earned

Between the two of us we went through the resus protocol. We put in an airway and ventilated the patient, we gained IV access to give drugs and fluids, all the while doing CPR. A lot to do with just 4 hands! We were giving adrenaline every 5 minutes and shocking every 2 minutes

16:14 8th Shock given - £3.74 earned

His heart started beating, albeit slowly. His blood pressure was low so we raised his legs and started running more fluids in an attempt to raise it. While my crewmate monitored him and attached ECG leads while I went to get the scoop and the bed. Luckily the bed was able to be brought into the house. We packaged him up and got him onto the bed and on to the ambulance.

16:27 Start CPR - £5.95 earned

Unfortunately his heart stopped again so we were back to beating his heart and breathing for him. More drugs were given as were subsequent shocks. With only two of us we were in no position to drive to hospital, there was simply not enough hands to do CPR, ventilate, push through drugs and drive. We asked if there was any other vehicle on route. Any ambulance, an car, any manager, any community responder. Nothing available. There was a car on their way but they were 13 miles away. 

16:33 11th Shock given - £6.97 earned

His heart started beating again, all the monitoring was still attached so we took our blood pressures etc and decided now was our chance to leave. The ECG showed he had suffered a heart attack so we put in a blue call to the heart attack centre where the blockage in his heart could be fixed within minutes of arrival.

16:36 Left scene for hospital - £7.48 earned

16:45 Arrived at hospital - £9.01 earned 

16:48 Transferred patient to the surgical table - £9.52 earned

16:49 Gave full handover to cardiologist - £9.69 earned

16:51 Left the department to do the next job - £10.03 earned

The procedure was a success. The blockage in his heart was cleared and when he was taken up to ITU 40 minutes later his heart was beating well, he was breathing on his own and his outlook was much more positive. They are no guarantees, his brain my have suffered damage due to lack of oxygen before we arrived but he had been given the best chance possible.

I think you'll agree, we are all in it for the money. It's all we think about throughout the day. For every two minutes CPR I do, all I can do is think about how I will spent my 34p. It's all money money money with us. We don't deserve any more either. According to the Health Secretary with are just 'ambulance drivers'. It's not as if any of us have put in years and years of work to get Honours degrees, foundation degrees, BTEC qualification etc to qualify as a registered Paramedic. Oh no. We are just drivers and as such we should be paid as such. Besides, we think that the service exists for our own benefit don't we?! It's all about working out when can next eat isn't? We use the service to our benefit time and time again. We wangle it so we can work bank holidays, work on Christmas eve, Christmas day, boxing day, new years eve, new years day, our birthday & our children's birthday. And you know what?! We selfishly make sure we do most of them on a night shift too.......for our own benefit, obviously.

Just for the record, to Ms Ann Widdecombe, Mr Richard Madeley, Mr Jeremy Hunt, Mr Andrew Lansley and any other member of the government or press that actually believe what they preach.....this cardiac arrest I am talking about, where there were not enough ambulances to meet demand, was done on the back of another cardiac arrest. It was done having been at work for 10 hours, without a break. The shift itself was started only 8 hours after the previous 15 hour shift finished. It was done on a weekend. It was also done on a shift which was the 11th in 12 days. That's 12 days I have been unable to spent time with my child and I have another 3 to go before I can rest. But who cares, us 'ambulance drivers' are the ones who  'have sunk Britain to new depths' and are just in the job to line our greedy pockets. Right?!

The Three Stooges

“43  year old female, chest pains”

This job set the tone for what would turn at to be a very familiar night shift. I exhaled in frustration when I saw the address. It was one of the many regulars on our patch. She was a wine-drinking alcoholic; she always called for chest pains, always went to hospital and was always rude and obnoxious. Tonight would prove to be no different to the norm. We stomped up the concrete stairwell, navigating our way past the vomit on the stairs. Lush! Her door was wide open like it always is. We walked down the landing to her bedroom like we always do and found her lying on her bed smoking a fag like we always do. Then followed a very familiar conversation.

“Hello again”

“Alright luv”

“What’s the problem tonight?”

“I got chest pain”

“Same as before?”

“Yeah”

“Can we do an ECG?”

“Yeah, go on then”

We do the ECG and all her obs. They are all normal like always. 

“Shall we pop you up to hospital?”

“Yeah, I need to see a doctor.”

"Still got the pain?"

"Nah, but it should be checked out."

So, without any fuss he all walked (she staggered) arm in arm to the ambulance. We drove to the same hospital as we always do, where I gave the same handover as I always do. On to the next!

“37 year old female, suicidal, taken an overdose, police on scene”

We all say that the first job sets the tone and shifts have a theme but they really really do and I don’t know why! This address was also well known to us. It was the residence of the most abusive drunk in our area. I say abusive, she abuses the police and most ambulance crews but for some unknown reason she loves me! We pulled up next to the police car, which seems to be a permanent fixture outside her flat. In the hallway outside was one of the coppers.

“Good luck, she kicks off every time I go inside”

Sitting there in her underwear and dressing gown, she swigged vodka while smoking a roll-up. Her face lit up as soon as she saw me.

“Heya babe, tell the pigs they can go and you don’t need them”

As much as calling the police 'pigs' wasn’t acceptable, in all honesty, their presence was only going to make things worse and I knew they’d be only to happy to leave.

“I’m happy to deal with this, I know her well, she’ll be fine with me”

They were only too happy to leave and were gone near enough before I'd finished the sentence! It was the same story, drinking vodka to excess, self harmed her forearms, refused hospital and then there was a 45-minute battle to convince her to go. Sometimes she wins and sometimes I win. Tonight I won. Hospital was the plan and all we had to do first was go through the charade of collection her ‘valuables’ (vodka) and hiding them so they can’t be stolen. After completing this ritual we headed off and handed her over to the less than enthusiastic nurse. 

We left the hospital to go and get fuel and hopefully a Wild Bean coffee and a pre-packed sandwich. It really is 'gourmet on the go'! Well actually it wasn't because we never made it. We were flagged down by a member of the public for what appeared to be an unconscious man in the street.

“u/k male, unconscious, running call”

We called it in and were sent down a CAD number. It shouldn’t have surprised me that he was well known to us. I had picked him up yesterday about 200 yards down the road. In fact, he was being picked up 3-4 times a day, each time by an ambulance and each time taken to hospital. The problem is, each time, the hospital sober him up enough to be able to walk and then either sit him in the waiting room until he walks out or discharges him. He walks up the hill to the shops, buys more booze, drinks said booze and passes out again. The hospital are not willing or able to invest time in fixing the problem & we have no ability to anything else with an unconscious drunk person other than take them to hospital. The cycle will continue until he stops drinking or dies. The latter seemed most likely. 

Tonight, he was lying at the bus stop next to his empty bottle of scotch. He was face down and had wet himself. I often wonder what he was like before this. What kind of life did he lead? What family does he have? What friends did he have? Now there appears to be no one. The only people around him are the members of the public who call 999, the ambulance crews that take him to hospital and the nurses that kick him out. What can we do?! We scooped him up off the floor and onto our bed. We did the usual obs and then drove the half-mile to hospital. We got the usual looks of distain from the nurse and rolled him onto the bed. To be fair to the nurse, we had just brought in three abusive alcoholics in as many hours, but still……not our fault!

Alcohol is something that the NHS does not do well, a bit like obesity. We only treat in the short term when it is too late. Very little is done when warning signs are there. Accessing services is far to difficult and it is a lot easier to just give a bag of fluids and let them go than find out the cause and refer to the appropriate places. It’s a shame, if they invested in prevention rather than cure, the long term saving could be huge. Shame no manager or politician is ever that long sighted.

Off we went for fuel, this time we made it. The sandwich was rank and the coffee was a poor substitute to Costa but beggars can’t be choosers! After the start to the shift we had had it was a necessity! We went off and did a few more jobs to a different hospital and at about 2am came back to our area. We handed over our drunken teen to the staff and booked them in. I walked through the busy waiting room and what did I see?! All my regulars sat in a line on the bench together! The Three Stooges! That image summed up how the NHS treats alcohol and mental health. A sad sight but one that amused me! 

“Evening all!”

Elementary, Dear Right Honourable Ann Widdecombe

I may be late to the party but I felt it was time to come out of hiding to have a good old fashioned rant!

So, Richard Madeley of Richard and Judy fame managed to get the backs up of every single ambulance worker in the country with his badly written, badly researched tripe of an editorial about a crew who finished their break before going to the aid of a critically ill child. For those not aware the original story can still be found here. It should have come as no surprise when the article vanished, but it didn't take long for more of the gutter press to spread lies and mis-information and make slanderous, biased attacks on ambulance services and their staff. Why let the truth get in the way of a perfectly good story eh?! It seems to serve no other purpose other than to blacken our name and tarnish the public perception of the NHS as a whole and only goes to make a hard and volatile job just that little bit harder. This time we have The Right Honourable Ann Widdecombe to thank for providing us with one of the worst examples of 'journalism' I have ever seen.

"A BABY of eight weeks is facing possible disability for life as a result of an ambulance crew finishing its break before going on a 999 call."

Belittling the work of the ambulance, police and fire is a right giggle.....

I agree with what she starts with, 'I can think of few more genuine emergencies than a baby having a 'heart attack'. Neither can I. Unfortunately the cardiac arrest the poor child suffered is not the same as a heart attack; never has been, never will be, but that really is beside the point. The child was critically ill and should have had an ambulance quicker than 41 minutes. Why though was West Midlands Ambulance service solely reliant on a crew who was on a rest break? Obviously Mrs Widdecombe couldn't possibly blame the Tory cuts, must tow the party line after all (even when you've retired from office). We can't for a minute blame the lack of funding, not enough staff, not enough ambulances and too many calls for the delay can we?! Oh no... blame the greedy paramedics stuffing their faces ignoring cries for help from a dying baby.

She goes onto draw parallels between staff having the right to a rest break with babies having the right to live. In all seriousness, what does she expect?! Is this the Conservative ideal?! Ambulance crews working 12 hour shifts without the possibility of a break? What happens when we have finished our shift? Does she expect us to answer calls then too? What about before? Do we sign on when we wake up in the morning and offer to answer calls in our own cars? I'm sure she was never advised to starve herself for 12 hours at a time whilst on Celebrity Fit Club....

One of my favourite parts of the article was when she led with 'Members of that crew had better pray that if they ever need to call out the emergency services they don’t find themselves in a clash with a copper’s cuppa or a fire fighter’s elevenses.' It would have only taken asking one member of an ambulance crew to find out how rest breaks work. We have no idea what jobs are going on around us. We are dispatched by a computer (that computer's sole purpose is to assist us meet the government targets), and on the rare occasion we get a break at all, that computer makes us unavailable for that period and we cannot be sent a call. Does she really think that a crew would knowingly sit down and eat in the knowledge that a baby was in cardiac arrest around the corner? I think its disgusting to level such an unfounded accusation at a crew. As for interrupting elevenses, we all know that Trumpton are always at rest!!

As if that wasn't enough she went on.......

"It is bad enough when public servants worry more about their own safety than that of the public and refuse to enter 2ft of water or to hop on a bicycle without a helmet but when it comes to putting sandwiches before a dying baby and then defending such action as reasonable, Britain has sunk to a new depth."

Look at them all! Scum! Every single one of them in it for themselves....

I don't remember 'can expect to take regular abuse and beatings' as part of the job description of Paramedic, maybe I missed it. I was probably too busy stuffing my face while watching this model citizen use her public standing to earn a few extra quid prancing around on Strictly Come Dancing. Silly me! For the record Ann, yes, we do worry about our safety but that doesn't stop us doing our job. We just wear stab vests so it hurts less. I was recently at an award ceremony for my service where staff were given the Chief Ambulance Officers Commendation for bravery. There was a crew who were beaten with a fence post and still went on to treat their attacker despite numerous broken bones. A crew who continued to do CPR whilst being repeatedly stung by wasps. A crew who disarmed a man with a gun. A policeman who sat next to a burning motorbike to protect the man lying in the road. Crews who day in day out put their lives on the line and for what? For the appreciation of our wonderful politicians?! If Britain has sunk to a new depth it's because of people like you. People so deluded and out of touch, that they label the little people their servants. Ms Widdecombe is not alone. Only today Tory MP Christopher Chope refer to the House of Commons catering staff as his servants. It's YOU who is out of touch, YOU who should be defending actions and YOU who should be answering accusations of sinking Britain to new depths.

I don't recall her or any Tory writing an article about the members of the emergency services who have sustained serious, life changing injuries in the course of duty as one of their 'servants'. Then again when she has the opinion that 'the service exists for the benefit of those who staff it rather than those who need it' it's of no surprise that these articles are not forthcoming.

'The purpose of education is teaching the young, not keeping bad teachers in their jobs, the purpose of the National Health Service is to make people well, not to give doctors evenings and weekends off and the purpose of the emergency services is to protect the public, not the staff’s nosh. Elementary, Dear West Midlands Ambulance Service.'

The purpose of education is teaching the young, so stop moving the goalposts and start supporting your teachers. The purpose of the National Health Service is to make people well, so stop privatising it, cutting funds, cutting staff to line your pockets. The purpose of the emergency services is to protect the public, so stop trying to turn the public against us, stop cutting ambulance funding, stop cutting police numbers, stop reducing wages, stop taking away our pensions, stop expecting us to work for 12 hours with no breaks and stop lying. Elementary, Dear Right Honourable Ann Widdecombe.

Oh and just for the record, you of all people should know that we the ambulance services are NOT emergency services. We are essential services. School girl error there! And I thought you were an educated woman, how on earth did you land the role of questionmaster in Cleverdicks?! They certainly didn't teach you the art of investigative journalism in your time at Birmingham University or Oxford! (See what I did there? Researched! You should try it some time.) You simply cannot put an article making sweeping statements into such a public forum, full of conjecture based on inaccurate information. It is nothing short of negligent, especially from someone with your social standing.

Like Ann, I also rage against the society we have become and when I heard about Thomas Passant it was indeed upsetting and heart wrenching. As a parent I know only too well what I would be feeling in that situation but putting food before the life of a child is not what we have become, not what we have ever been nor will ever be. We will always, always always try everything in our power to help anyone who needs it whether or not we have eaten, whether or not we have had a break, whether or not we have been at work for 14 hours already and whether or not we may get hurt along the way. We certainly don't work 80 hour weeks, 12 hour shifts, long nights, take abuse, receive violence and take repeated public attacks from washed out politicians for the money! £10.12 an hour is only tolerated because it's a job we love. If I wanted money and an easy life I'd work in McDonalds or go into politics. I reckon I'd be rather good at fiddling expenses and reality TV! Maybe that's what I'll do!

Perhaps Ann Widdecombe would like to come for a 12 hour night shift on a Friday (Or Richard Madeley). Would she be happy to face her adoring public in their time of need? Would she like to explain the real cause of the delays? Would she be happy to interrupt her rest break for a 43 year old male bleeding from the wrists, holding a knife and threatening to stab the first person through the door? Come on Ann! It'll be fun! I'll bring the nosh! Or maybe you'd like to find somewhere safe and warm, paid for by your servants, and write about it instead.

'Nero fiddling while Rome burned is the image which comes to mind.' Indeed.