Me, Myself and Ambulances

"27 year old female, bored, hacked off, fed up and tired"

This is my blog. I have have been writing it for about 15 months and it has helped me no end. It gives me focus at work, it has made me a better clinician and has helped my health in a number of ways. I may be opinionated, I may be judgemental and I may be hot headed but that is my way of venting about what I see. This blog isn't real life. Look on it as a work of fiction if you will loosely based on real events. 

I'm bored of having to tell a select few people that I AM NOT breaching patient confidentiality when I write. I'm not stupid. I would never write anything which could be linked back to specific person. 

I'm fed up with people leaving insults and threats because they disagree with me. If you have a different opinion, share it. Ask me a question. Don't spit feathers at me, don't climb on a high horse and get all your mates to leave similar comments and don't patronise me.

I'm hacked off with having to write this post to explain myself AGAIN. I have never received a complaint letter. I have received plenty of thank you letters. I have received commendations. I act professionally at ALL times and treat ALL others how I'd like to be treated.

I'm tired of losing sleep because of trolls, bullies, intimidators and those that threaten me. No more. Until now I have never blocked anyone on twitter and I have never deleted a comment on my blog. That ends today. I'm not taking crap from a tiny, tiny minority. It may only be about 5 people who have moaned out of the 70,000 who have viewed by blog this month but it's those 5 that have ruined various days and various much needed sleeps. 

So, to everyone who is unclear and thinks I'm full of hatred, classist, unprofessional, discriminatory and whatever other term of endearment you can come up with, this is ME from the 'about me' page on my blog. Read it, absorb it and if you don't like me, or my blog please please please go away and don't come back. 

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My name is Ella Shaw. I work on ambulances somewhere between Lands End & John O'Groats and in my spare time, own a 5 year old boy. 

Ambulances: I didn't always want to do this. I'm not going to lie and say it was something I dreamt of, in fact, until I saw the advert in 2008 the thought hadn't crossed my mind. I suppose I applied on a whim; just looking for something to get me out of the dead end 9-5 I'd been in. To my amazement I got the job. I completed my training and off I went into the big wide world of ambulances, and I haven't looked back since. It was by far the best decision I have ever made.

I have always been the type of person that questions right and wrong and in this job you experience a lot of both: politics at local level, government policy, patient behaviour, staff attitudes, life or death and everything in the middle, and I find myself asking questions. Invariably that involves an indignant rant and grumble but that's me. I'm a full time cynic, part time pessimist and a conspiracy theorist at weekends. I love a good moan but I can't stand moaners. That's my right. Deal with it.

The Boy: The boy means everything to me, part of why I wanted this job was to have a career to support him, the security of a job that will always be needed and the regular salary and pension to provide for him. I am immensely proud of him, he is funny, intelligent and happy. He has also sleeps through the night which has helped with shift work! He is a huge part of my life and when you ask him what I do he replies

"My mummy is a paramedic, she works on the ambulances and looks after the ouch. And if someone falls of their bike you call 999 and my mum comes. And looks after the ouch."

Need I say anymore!

The Blog: I’m writing this blog to vent frustrations, share experiences, provoke debate and educate people as to what life is really like on the road as I see it. I don't have the wealth of experience that many do but I don't think you need that so much to form opinions. I may have only been on the road for 4 years or so but in that time I've seen and learnt more than my entire life before that. I’m lucky enough to have a great job; I work with great people and strive to be the best I possibly can be for my patients. Some patients were sent to test me, some were sent to amuse me and some just baffle me, and despite my ramblings I generally look forward to work each day. I love my job. 

All my blogs are loosely BASED on real experiences and feelings, though I do use poetic license to protect the identity of my patients, their families and my colleagues. All names, ages, nationalities and locations have been changed as to uphold their anonymity. Please do not read a post and think that I am talking about an actual patient. I use my experiences to create a post to express how I felt at the time or how I feel about a certain topic. It's my way of dealing with what I see. All opinions shared are mine and mine alone. I hope you enjoy reading and welcome any comments and opinions. That said, there is a big difference between offering a different opinion and having a debate, to trolling, bullying and threatening me. That WILL NOT be tolerated. I am not representing any particular ambulance service (I work for 3) or any professional body. 

You can also follow me on Twitter @diagnosisLOB or join me on my Facebook page. If you don't like what I have to say, don't read it. I will make no apologies for my opinions. Though I welcome all comments, good and bad, if you over step the line, insult, patronise or get all high and mighty on me, your comment will be deleted. I write this blog for me and the people who enjoy it. It's that simple!

Thanks for taking the time to read,

Ella x

Oh to be Bi-Lingual

"9 year old female, fever, DIB"

I know I seem to start most posts with 'it was the middle of the night' but in all seriousness, it normally is! People don't generally call ambulances at school finishing time, dinner, time, prime-time TV and bed time! They call when nothing else is happening and they are left alone with their own thoughts and fears! Take this job for example. A 9 year old girls with a fever! No biggie! Girl says 'I don't feel well' when she gets home from private tutoring. Mum thinks 'you'll be fine'. Serves dinner. Girl eats dinner and forgets she's under the weather. After dinner, child is pre-occupied with playing and watching TV. Then it's bath time and bed time. All goes according to plan. Because the child is slightly unwell she sleeps restlessly. When she wakes she wants mummy. 'Mummy, I don't feel well'. Now it's 1am. There is nothing to distract her, no TV, no food, no entertainment. Mum's comforting doesn't work. 'Mummy, I don't feel well'. Mummy phones 999.

Now, this apartment was in an very expensive part of town. Probably the most expensive there is! The family were eastern european but spoke excellent english and were very polite. Our patient, the 9 year old had an americanised accent and from what we were told they moved around a lot around the dad's job. In the flat was our patient, her mother and a neighbour / friend. We managed to obtain a history from our patient and it appeared she may have had the start of a chest infection. She had been given Calpol earlier on and was due another dose. We asked about referring her on to her GP but her mum didn't understand. 

Her friend stepped forward. 

"Let me translate for you, what do you want to know?"

"Can you ask her if they are registered with a GP in this country and if she is, would she be happy for us to refer her daughter onto the GP?"

"OK, no worries."

He turned to the mother and to my surprise, annoyance and embarrassment said the following in English..........slowly.

"Do...you...have...GP...or Doctor? Can...ambulance...driver...call...them...for...you?"

Are you serious?! That is your translation?! In that case I can speak fluently in every bloody language! I can say 'Hello' in Russian. By his linguistics I can speak the language! It's just a vocabulary issue! And don't even get me started on "Ambulance Driver"!I decided to bypass him and speak to the mother again. She understood the GP bit, just not the referral! I asked the daughter to help! She spoke fluently in Russian to the mum, who then answered in English to me! She was registered with a GP but it was a private medical centre. A quick phone call and I was assured that a GP would be at the house within half an hour! It's amazing what money gets you!

We left the mother and daughter with their 'translator' to it with advise to call back if needed. It was a bit of a waste of time call but I got the impression she had called 999 for advise but despite her good grasp of the english language, being prompted about difficulty in breathing etc had ended up with an ambulance arriving. I don't mind these calls so much when there is an outcome other than hospital. In this case we assessed and referred on with only half an hour of time used. If we'd had to go to hospital that would be an hour + of ambulance time then 4 hours minimum at a hospital. Luckily my grasp of 'slow english' was enough to make this possible! 

This job also highlighted just how embarrassingly awful we are in this country at second languages! We really do need to buck our ideas up!

A Real Emergency

Let me paint you a little a picture. We had just taken a 97 year old to hospital. This 97 year old had just fallen down 17 stairs from top to bottom. She had a head injury, she had a broken wrist and she had broken ribs. She didn't want to go to hospital. She didn't want to call an ambulance. She did, because she couldn't get herself up. She apologised 12 times whilst in our presence for getting us out and wasting our time when we could be dealing with REAL emergencies. It took a lot of convincing to get her to agree to hospital and despite the pain she was in she felt she was burden. She had lived through 2 world wars. She had been employed full time from the age of 14 to 75. That's 61 years of taxes and national insurance since its inception. She has no carers at all and still does her own shopping. She costs the country her Freedom Pass and her medication which consisted of a daily Aspirin. She really was an inspiration. We left her at hospital to go and do a REAL emergency.

"25 year old female, pain in back after carrying baby and changing nappy"

What is there to say? I could rant about this for 10, 000 for even needing a breath, but I won't. I will not pass judgment, I will not share my thought. I was just explain what happened, what was said and what we did. Then, I will open it to the floor!

We arrived on scene at the patients flat. It was a council flat. 3 bedrooms. Nice kitchen. HUGE TV in the living room. Ashtray on the coffee table full of fag buts. Childs dummy 6" away. We had let ourselves in as the door was ajar. Sitting on the reclining black leather sofa was our patient. She had a pain'd expression across her face. Jeremy Kyle was on the TV (I'm being serious).

"Hello my dear, what's the problem today?"

"My back hurts."

"Where about?"

"Right here" she said, rubbing her lower back.

"When did it start?"

"About half an hour ago?"

"And what were you doing when it came on?"

"I'd been carrying me baby round and then put her down to change her and as I leaned down it started hurting real bad."

"Do you suffer with back problems?"

"Nah"

"Have you taken any painkillers?"

"Nah"

"It sounds muscular, you may have strained it slightly, what would you like to do today?"

"Go up hospital to get it checked out."

"I don't think hospital is necessary. You can probably treat it at home with pain killers and rest. Hospitals aren't the best place for babies, especially as they will probably tell you what i'm suggesting."

"Nah, i'd sooner go up there and get it checked out."

So that's what we did. She got all her stuff together and we headed out to the ambulance. As we were walking down the stairs her boyfriend / partner arrived. He followed us up to hospital in his car. It was a 2011 BMW with a personalised number plate. He lived at the same address. 

In the ambulance I established she was normally fit and well. No medical history to speak of. No allergies. She smokes 20-30 a day. She is unemployed. Her partner is also unemployed. We arrived at hospital, handed over to the nurse and were promptly sent to the waiting room.

So, for a change I will refrain from saying too much and leave it there!  That is for YOU, my readers to do! Thoughts on a postcard please! 

Black Wednesday

“77 year old female, everything is fine.....no wait.....she’s dead”

The first wednesday in August each year is known as Black Wednesday and so begins the ‘killing season’. It is the day that junior doctors start working in a hospital. It is also when a lot of other doctors change job role and as such, this day results in a significant increase in mortality of emergency patients. It is fair to say that Black Wednesday and the two days that follow are the worst days to fall gravely ill in the NHS. Saying that, is there ever a good one?! Up to 7000 graduates enter the halls of their respective hospitals and with it, the sudden burden of responsibility of the lives of their patients. The death rate in these three days each year rises by 6%. 

I don’t blame the newbies for this, they are thrown in at the deep end, they are made to do operations and procedures on patients way beyond their capabilities. On top of that they end up working the graveyard shifts when there are little or no senior staff around. They are in charge of wards, departments and health and wellbeing of all patients inside them. Someone who has just passed their driving test drives off and starts learning how to drive, someone who passes their law exams then goes off to learn how to be a lawyer. These kids, and they are kids, have spent years with their heads buried in text books. Their only patient contact and bedside manner has been learnt from corpses so it’s no wonder the proverbial shit hits the fan. 

I’m all for a steep learning curve. In those situations you learn a lot. In most walks of life, when you are learning, the mistakes that are made, end up costing time and money. In health care, the mistakes that are made, end up costing lives. It was daunting the first time I was in an ambulance as a crew of two! I didn’t really have a clue what I was doing. I always had a safety net. Firstly, I was never alone, secondly I was always with someone better trained than me and finally, if the shit really did hit the fan we were never more than a short drive to a hospital where the grown up could take over! Junior doctors don’t always have that safety net. The buck stops with them and that added pressure probably has a lot to do with labeling of ‘killing season’.

Personality has a lot to do with it to. Becoming a doctor is very competitive and as such there are egos at play. When we have dealing with a junior doctor there are generally three types that we me. 

• The Flapper: These newbies are terrified. They know their stuff but don’t show it! The pressure is all to much. They look around to everyone else for the answers and are yet to have any confidence in their abilities. They drop things and actually look scared. Their patients will likely die from their inaction.

• The Ego: These ones think they have made it. They know all there is to know. They walk around looking the part, walking the walk and talking the talk. They won’t ask for help because let’s be honest, they don’t need it. They talk down to nurses and ambulance staff because they are a DOCTOR. They try to do to much over and above their ability. Then patients die. They are ignored by all and they slowly realise they are not god.

• The Awkward: These guys have all the social skills of grizzly bear. They know their stuff, they were probably top of every class they have ever been in. The problem is, they have absolutely no people skills and no bedside manner. They will not spot a sick person because they won’t look at their patients. They will not talk to their patients because they don’t know how to. They just look at numbers.

All three will learn and all three will improve, however once an arrogant arse, always an arrogant arse in my experience. 

This year during Black Wednesday week the A & E was absolute chaos. We were coming and going every hour on the friday night with another puzzle for the newbies to solve, as was every other ambulance in the area. Although they didn’t take the handover I could see them looking as the double doors swung open, hopeful there was nothing majorly wrong with them. At about 3am, we’d handed over our patient to the nurse, my crewmate was booking them in and I was changing the sheet on the bed. Suddenly, in a cubicle a few feet away there was a commotion. A junior doctor was in there with a patient and her son. 

“What do you mean she’s dead?”

“Sorry”

“You said 3 hours ago that she was fine.”

“I know”

“You said she was asleep.”

“I know”

“How can you not know she was dead?”

“...................”

*awkward*

I left the department so as to avoid the furore. Ah.....Killing Season, and so it begins with a key lesson......check your patient is breathing at regular intervals and ensure the monitoring equipment you have connected them to is switched on!

Feeling Sick

“48 year old male, nausea”

Yes, you read correctly, nausea, nothing else; no other symptoms, or at least no other symptoms that we were privy to. I hoped there was something else; surely nausea was not something worthy of an EMERGENCY ambulance. After waiting 5 minutes for the recycling lorry to edge down the road we were trying to access, we pulled up outside the house. The garden was overgrown; an old sofa, upside-down, was protruding from the hedge, and various pieces of broken wood and piles of rubbish were scattered up the crazy-paved path. The flaking paint around the rotten doorframe told us all we needed to know about what the house was like inside. There was a porch stopping us from accessing the front door so we rang the bell. Then we rang it again. And again. Eventually our patient, sporting a lovely string vest and trousers held high up his mid-drift, appeared. Using a tissue he opened the door, and then dropped said tissue on the floor. I looked down, carefully stepping over the sea of clean tissues and into the hallway. 

The smell was grim! It was kind of stale with a hint of ammonia and rotten food; nothing new to my senses but unpleasant all the same. Clearly there were social issues at play here as well as medical. We went into the living where our patient had wondered off.

“Take a seat”

I looked around… "I’m OK thank you, been sat down for ages” (massive lie!)

“So, what’s the problem today?”

“I feel really sick”

“How long have you felt sick?”

“Since I woke up”

“And how long ago was that?”

“About an hour ago”

“Have you phoned your GP?” (my tone was already quite short and frustrated!)

“Yes”

"And…"

“There was a queue on the phone so I couldn’t get through”

“So what do you want us to do?”

“I don’t know”

Well if he didn’t know why he called an ambulance, what the hell do we know?! There was no way I was going to take him to hospital. Despite me asking about every symptom I could think of he had none. No vomiting, no pain, no dizziness, no headache, no urinary symptoms, nothing! I saw an old PRF on the sideboard.

“You had an ambulance last night?”

“Yes”

“Why?” I asked whilst I was reading.

“I felt sick”

I decided to phone the GP, there was indeed a queue to talk, and I was 16^th in line. There was no way I was going to wait. 

“OK then sir, let's go to the ambulance and we’ll pop you round to the GP, grab your shoes and your keys”

I started scribbling my paperwork to hand to the Doc as we drove off down the road. 100 yards and we turned left, 50 yards and we stopped. Yep… journey time to the GP by ambulance was 42 seconds. It would have taken a whole 2 minutes to walk... Just sayin’.

I sat him in the waiting room and went for chat with the receptionist. After a slight battle to let me see a GP rather than divulge his entire medical history to her, she buzzed me through. I told the Doc that the string vest in the waiting room was feeling sick and had had 2 ambulances because there was no answer on the phone. He rolled his eyes and said a sarcastic thank you! We bid farewell to our time-waster and went grumbling back to our truck.

Seriously… TRIAGE. I know it’s a French word but surely that call could have been downgraded to ‘make your own way’. As much as I want to scream at the people who pick up the phone, dial 999 and say ‘I feel sick’, I equally want to scream at the person who says ‘sure thing, an ambulance is on the way’. What is the problem with saying ‘No’?! This guy didn’t need an ambulance; he didn’t even need the GP. He said what was wrong, he felt sick. So what! We are humans, we feel sick from time to time.  We live in far too much of a nanny-state where the fear of something going wrong far outweighs common sense. One of the drawbacks of a totally free health care system is that it is vulnerable to abuse, and abuse it gets. I think the ambulance service in general needs a new PR department. The Fire Service got it right with their various fire safety campaigns. We need to follow suit with educating people what is and isn’t an emergency.