Choices

There is a recurring conversation that I have with people when talking about my job. It normally starts with a "I couldn't do your job..." with infills of "I don't know how you do it..." and "don't you get scared..." or "how do you sleep at night?" etc etc. My stock answer is something like "Ha! It's fine, things don't really effect me..." with side notes of "I disassociate myself from the patients..." and "I get into a zone and don't really think about it..." etc etc. You see the pattern!

The fact is, most of what I say is true. At the end of most shifts I've completely forgotten about the patients at the start. If someone has a horrific injury, a do what I have to do to it, cover it and move on. If I'm faced with a combustible situation where I might be vulnerable I tend not to think about the what ifs. Instead I focus keeping everything calm. These situations are no place for fear. That said I am by no means immune to feelings of fear, dread, guilt and nausea! We all are, everyone who works for the ambulance service has those jobs which have effected them, or those situations they fear being part of. They differ from person to person and we each react differently when faced with them.

For me, I don't like to see sick, dying or dead children, and it's fair to say that that is across the board, the same for everyone. My greatest is fear in this job is watching someone die and being powerless to stop it. I know it happens but it is an isolated, helpless feeling, especially when you're on your own. Finally, a situation I would have been happy to avoid my entire career, was being the person who has to make a decision between who lives and who dies, when faced with that choice. You can imagine what kind of day I was having, when all three of my fears came to fruition in one job.

"30 year old female, in labour, contractions 1 minute apart."

Not an ideal start to the shift if I'm honest. Early jobs tend to have longer waits for ambulances due to shift change over time, and the prospect of having to deliver a baby on my own is not one I cherish If I'm honest! It is what it is though, I'd have to suck it up and see! 

I grabbed EVERYTHING I could possibly need and headed in through the open door. The patient was on all fours, mid contraction. I started with some history taking and started making a note of times. With women in labour you have to work out if it will be a home birth or hospital birth. At all costs, you want to avoid delivering on an ambulance! They are cold, impractical and dirty! It became apparent pretty quickly, that without an ambulance and the quick fire contractions, that I would be taking on the role of midwife imminently. Balls!!!

I quickly set up a baby resuscitation area just in case! It's something I was taught by a very wise paramedic a long time ago, and I have stuck with it. If things go south, I don't want to be scrambling to find kit, so everything that I would possibly be needed was laid out, opened and ready! Then there was mum! I made a snap decision to cannulate her prior to delivery. I don't know why, it's not something I normally do, but again, with no ambulance I wanted to cover all bases, just in case! 

Anyway, cannula in, everything set up, examination complete and we were ready. She started crowning about five minutes later! I just about had time to update control that birth was imminent and I would require an ambulance as quick as possible, before the head appeared. My relief at seeing the head was short lived. It quickly became apparent that something was wrong. Very bloody wrong. The cord was wrapped around the babies neck. Shivers ran down my spine and I'm sure that all the blood trained from my face. Inside I was panicking. I had never delivered a baby with a cord around it's neck and I wasn't entirely convinced I knew what to do. Well, I knew I had to get cord off the neck, but we were limited in what we were taught on our two days maternity training! She carried on pushing during contractions and after what seemed like an eternity (probably 1 minute) we made enough progress that I could loosen the cord and finish the delivery. 

With baby out and mum overjoyed I started drying and rubbing the little boy. I just wanted him to make that first cry. The first 10 seconds or so are pretty relaxed, the next 10 are a little anxious and by 30 seconds I'm starting to get a little desperate.

"Why isn't he crying, is something wrong?"

Her joy quickly led to desperation. I clamped and cut the cord and moved him over to where all the equipment was waiting. I laid him down on blanket and started ventilating him. This was my worst nightmare. Or so I thought....

"Some thing's wrong, I'm bleeding." she said.

I turned my head slightly and my heart sank. She was having a huge post-partum hemorrhage. It was literally like a bucket of blood had just been poured on the floor and it just kept coming. If I didn't stop the bleeding, she would die, plain and simple. If I didn't work on the baby and get him breathing, he would die, plain and simple. How do you make the choice? It's one I had to make on my own and I could see no way out of this mess. 

I tried to advise mum of what she could do whilst I ventilated the baby. She wouldn't listen, her only concern was why her baby wasn't crying and that kind of made my decision for me. I started listening to heart sounds and when I heard them it was a huge weight off my shoulder. In my head I was screaming 'breathe' over and over again. I managed to hold down the button on my radio long enough to shout exactly what was happening. I couldn't begin to tell you what the reply was because after a slight wriggle, this tiny little boy let out the most amazing cry! 

I turned to the mum, and saw the relief of her pale face, just as she begun to lose consciousness. I wrapped the baby in a towel, left him on the blanket and started a uterine massage on mum. Again, i'd been told what to do years ago but I'd never actually done it! I was kneeling in what felt like a swimming pool of blood. I grabbed my drugs and started drawing up the Syntometrine to stop the bleeding when I heard the door go and a 'Hello?!' in the corridor.

"In here!" I shouted.

Just like London Buses, two crews arrived at once! Thank god! The face of them when they walked in was an absolute treat. Then again, I'm sure my face told a fairly good story. A crying baby on a towel next to resus equipment, an unconscious naked woman in a huge pool of blood and me on my knees amongst it all presumably looking like crap. A hive of activity ensued, fluids were drawn up, drugs given, baby cleaned, wrapped and looked after and we got mum out to the ambulance. 

There was no time to take stock of what the hell was going on. We put in our pre-alert and all headed off in convoy to the nearest maternity unit. The bleeding had stopped but she had lost A LOT of blood. In truth the second I heard the crying of the baby it didn't really get another thought from me. It's easy to compartmentalise patients into fixed and not fixed. Through jobs like this, priorities change. I couldn't stop thinking about whether the mum would ever get to hold her baby. I found myself daydreaming about the 'what ifs' that I don't normally entertain. I also, quite predictably started asking myself if I had made the correct decision. Did I ignore the bleeding too long? Did I chose right? Only time would tell. In situations like this are there ever correct decisions? 

We got to the hospital and handed over. The midwife looked me up and down. 

"Well done, now go get yourself a tea!"

I don't even really like tea, but it's the done thing when chaos ensues. I sat in the blood bath of that ambulance and just starred at the wall. I could feel my hands shaking as the adrenaline continued to rush through my body. What a start to the day! Only 10 hours to go until home time.....

"It's fine, things don't really effect me, I disassociate myself from the patients and I get into a zone and don't really think about it."

Well, we all have very effective barriers we use from time to time.

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Two days later I found out that despite losing half of her blood volume, mum survived and baby was absolutely fine. And THAT is how I can do my job. There is no better feeling than finding out news like that. At least now I 'know' what to do! Ish!

Afro Circus

"3 year old female, crying"

Crying. The child is crying. It doesn't exactly fulfil the 'THIS is an emergency' campaign that's plastered on the side of most ambulances but hey, I'm not there. She might be crying for any number of reasons! All will be revealed!

To the chorus of sirens and the lighting extravaganza of blue lights, we rushed through the busy traffic on route to this seemingly life threatening call. I do often wonder, as the cars dive out of our way, what these drivers would think if they knew we were on our way to a crying child! Hardly the guts and glory Holby City would have you believe! Just before we arrived it updated to say that the child wasn't fully alert. Hmmmmmm!

We pulled up in the car park of the flats and unceremoniously abandoned our ambulance, blocking in all and sundry in the process. It is an emergency after all! We were greeted at the door my the patients mum. She rolled her eyes and kind of laughed as she led the way to the little girl. There was no sign of any crying so that was a good sign....

Sure enough, standing in front of a HUGE TV was our patient, dancing and singing to Afro Circus from Madagascar 3. I kid you not! I recognise the screeching of Chris Rock doing the Zebra's version of I Like To Move It because my son is also obsessed with that song! 

"What's the problem today? She doesn't seem to be crying now!" I exclaimed.

"Ahhhh don't! She's been a nightmare. She's been throwing tantrums all afternoon and it's driving me crazy!"

"Tantrums? What have you called 999 for?"

"Well she wouldn't stop crying, there must be something wrong with her."

"But she's singing, she doesn't seem too distressed."

"But she is singing more than normal."

"That maybe the case, the singing and dancing doesn't suggest an illness to be honest."

"Yeah, but look, it's uncoordinated dancing."

To be honest, it was no Sylvie Guilem but equally, she was a 3 year old mimicking the dance moves of a cartoon Zebra, I wouldn't expect miracles. 

"So just to be clear, your main concerns are crying, tantrums, excess singing and uncoordinated dancing?"

"Well.....yes, but honestly she wouldn't stop crying."

"I'll be honest with you, it doesn't look like there is anything wrong with her, and this isn't something you should be calling 999 for."

"Well I didn't know what else to do, it's not normal."

I wanted to tell her it wasn't normal to call 999 because your 3 year old is being out-danced by a Zebra but it wasn't worth it! I gave my 'inappropriate use of an emergency service' speech and left it at that. Blimey, if uncoordinated dancing as a determinate for an ambulance I'd be carted off every time I went near a dance floor! 

Despite the obvious frustrations, this job amused me greatly!

"Ra da da da da da da da circus

 Da da da da da da da da afro

 Circus afro, circus afro, 

 polka dot polka dot polka dot afro!"

Blue Coats

From time to time I get opportunities to work at sporting and music events. I have worked for a few private companies over the years but now limit myself to just the one! It's the only company, other than my main employer that I will work for, and that is simply down to the people that run it, the people that work for them and the working atmosphere that's created by the above combination! It's a far cry from the endless decreasing morale and target driven pressures of every NHS ambulance service! For that reason, every opportunity that presents itself, I grab with both hands! 

I recently did a weekends work at sporting event for children. It was a great opportunity to have a nice change of scenery and also to learn! It's not often you get to have an abundance of paediatric patients with minor injuries and I think it's important to get this exposure from time to time! I had a great weekend and for the first time in a while, thoroughly enjoyed being at work, and thoroughly enjoyed the company of all of my patients! For two nights, we stayed at the local Pontins, where all the participating kids and their families were also staying. I've never done a review as such, nor a sponsored post, and this is neither. However, it was an eye opening experience which I should be shared and discussed!

The 1970's hay day of Butlins and Pontins has long since gone. I first went to a Butlins in the 1980s when the Red Coats vs Blue Coats battle was in full swing. To be honest, I don't have the fondest memories of my stays there but they were what they were. Basically, a cheap family holiday, entertainment for the kids, a cabaret and somewhere safe for the parents to get drunk, guilt free! Move forwards 20+ years and I arrive at Pontins for my Blue Coat experience! I really can't complain. This was free accommodation during a paid weekends work. A bed was all I needed in reality! 

I drove along the promenade of the sea side resort and it was literally like driving through the 1980s! The amusement arcades, crazy golf courses, fairground rides, flashing neon signs in abundance and candy floss stands, where as garish as you'd expect. The huge Pontins sign welcoming me to the resort was the cue to stop and park. I met my friends outside the clubhouse and in we went for a welcoming drink! We walked through the arcade and into the bar area where I was greeted by Tony Christies 'Amerillo' being utterly murdered by a cabaret artist! It was quite the entrance! We didn't stay long as it was late, so I made my way to my 'Chalet'.

After arguing with the rusted lock for a number of minutes I made it inside. The damp smell of rot hit me first as I entered. I turned the light on and scoured the room, taking in its magnificence! Initially my eyes were drawn to the sprawling mould across the living room wall, but there were so many more delights to find! The electric heater in the living room was condemned with a 'Faulty' sticker on it, so chances of warming the room up to get rid of the damp was slim to none! There was a spill of magnolia paint on the floor and brush marks across the skirting boards, spiders web in the 'bathroom' and a murky puddle on the floor. I wasn't sure if it was a leak or old urine. Either way, it was somewhat off-putting! The bath itself was a half size bath, suitable only for standing in, unless you were a fully fledged Umpa-Lumpa. The bathroom mirror had hand prints on it and the toilet, when flushed, sounded exactly like Rolf Harris playing a saw! The kitchen area was clean enough. It even had a welcome pack containing a tea bag and an open sachet of sugar! The electric meter was down to £3.10 so I kept the lights off! Moving into the bedroom, there were two single beds about a foot off the floor. They appeared however to be clean and there was a bin bag of fresh bedding ready for me to make my own bed. The pillows were stained so I opted to double up on the pillow cases. Finally, I turned the bedroom heater on to be greeted by a turgid smell and smoke, so I left it off and went to sleep. Oh, and I was woken by the sun at 05:45 because there were no blinds and the curtain was missing on one side! Despite all the above, I slept like the dead and had a thoroughly good nights sleep, so in that respect, Pontins had served its purpose!

I went for my morning shower to realise that there were no towels provided, so I had to use the spare bed sheet to dry myself! I went off for my days work, all ready for another night in the unique Pontins paradise! 

It may sound like I have put a downer on the place but I'd yet to experience the cabaret in all its glory! That evening, after a long days work and a hearty meal at a local restaurant, all the medics gathered for a few drinks in the clubhouse to watch the evening entertainment. On stage, were a 3 piece 'band'. Two female singers, one about 25, one about 45 and a middle aged man on a keyboard. Occasionally, one of the woman would pretend to play a guitar but in the main they just sung. They spent about an hour destroying disco classics from the 80's and 90's. It was so bad, it was funny! 

I looked around and at times the dance floor was pretty full. The kids were having a whale of a time. There was a girl in a wheelchair being spun around by her friends and the joy on her face was palpable. Parents were all getting involved too. Most were in fancy dress and making a fool of themselves and the kids were thriving on that. Alcohol was consumed by all and we sat around laughing at everything going on around us!

Then it hit me. The room might well be the worst I have ever stayed in. The beer might be the most watered down I've ever tasted. The performers may be the worst I have ever seen. The surroundings may be 30 years out of date. But, and it is a big but, everyone here was having a good time. Everyone was laughing, and most were with their children. It made me realise, that in 2014, there aren't many things that families do together where they can all be silly. It may be dated and badly managed, and one of the only places left in the country that operated all its shops and bars on a cash-only basis, but it is still, all these decades later, bringing families together to have fun. Despite its inadequacies this should be celebrated. Would I book myself into Pontins by choice? Probably not. However, there experience has made me more determined to let my son see me make a fool of myself from time to time!  

The next morning, I listened to a very serious looking father lecture his son about the previous days performance. 

"If you come off that pitch like you did yesterday thinking you could have done better, then you could have done better and you could have tried harder. You go out there and do better than yesterday, don't leave anything on the tough line, do you understand?"

It was a far cry from the Macarena the night before. In the modern day child's life of pushy parents, sporting prowess, SATs, GCSEs & A Levels, perhaps everyone should take a Pontins break to remember what being a child is like. They don't care about the rooms, the singing or the beer. They just want to have fun. And that, is why I keep coming back to work for this company, every time I get a chance, because it is always fun, and in the modern day adults life of long hours, school runs, rent, bills, housework, MOTs and weekend DIY it is often the fun that get's forgotten. 

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AWOL

"30 year old female, stepping away from the madness"

Right, cards on the table! I haven't been publishing much of late as many of you have noticed! It isn't because I have nothing to write about. I have a list of almost 100 posts to write up. It isn't really in issue of time. I have plenty of it if I'm honest. It isn't that I don't enjoy writing. I do. This job is funny at times. Months can pass as if nothing has happened but equally, a day can pass and it can feel like everything has happened. I use this blog to share my experiences, vent my frustrations and in many ways, use it as a self help therapy to get some of the bad stuff off my chest. Sometimes though, you can share too much. 

The last few months have dealt me some pretty horrendous jobs and as much as I could write about them in detail, some of them I just don't want to re-live through. As someone who likes to reflect on everything that happens to me, it puts me between a rock and a hard place! I want to write about them, but I don't. When I try to write about other things, they don't seem as compelling as the things in the back of my head! So, the result is I don't post anything and just have fun for a while! 

I've finished work each day and not given work a moments thought until my alarm goes off the next day! My rest days have been filled with non-work related stuff, no blogging, and trips away! I celebrated my 30th birthday with friends and family and now feel thoroughly recharged. I always said from the start that this blog was for me, and I would write for as long as I enjoyed it. Well, I wrote a post yesterday and thoroughly enjoyed it! 

A prolonged break from time to time is what has kept me blogging for three years, so hopefully, all things considered I should be back posting with regularity! There are plenty of posts coming up, there is the matter of the MAD Blog Awards 2014 in September and as of last week, I found out I've been short listed for a Brilliance In Blogging Award for Best Health Blog! 

Talking of the BiB's, I NEED VOTES! Please go and vote for me! I'm one of 16 shortlisted and would love to be a finalist for the first time! 

VOTE NOW! 

Anyway, that's the begging out the way! Thank you for all your continued support! 

Much love

Ella xx

Memories

"74 year old male, back pain, feeling dizzy and weak"

I've met 1000's and 1000's of people through my job, some good, some bad, some made me happy, some made me sad. To be honest, as harsh as it sounds, most don't get a second thought. That isn't to say I don't care, but if I take the thoughts and feelings of every job home with me I'd be a jibbering wreck! Doing this job however, it is inevitable some things you see will stay with you forever. It's an unavoidable part of the job. That said, delivering twins is a memory I'm fond of, as is meeting a man whose life I saved, or seeing the child start breathing again who had been choking. These are memories that I will cherish. The flip side, is there are people, faces and events that I can't un-see or forget about. There are people who you share moments with who have a profound effect on you, who stay in your thoughts when you'd rather they wouldn't. 

I was called to this guy with back pain and dizziness. At one point I thought that I'd be cancelled as it wasn't a high priority call, but due to my proximity to the address and the fact the service was busier than normal I was on scene before a cancellation appeared. The door to the flat was unlocked so after knocking, I let myself in. 

Lying on the bed was my patient. He was smiled at me and I introduced myself. He was white as a sheep and pouring with sweat though didn't look in too much discomfort. He spoke very quietly to me, so much so, that I could hardly hear him. He had had back pain throughout the day which he scored at around 5/10. He was feeling very light headed and felt especially dizzy with blurred vision when he sat up. He had no other symptoms to mention but was understandably anxious. I set about doing his observations, already thinking that I'd probably want an ambulance sooner rather than later. 

His blood pressure was in his boots. In fact, it was one of the lowest, conscious blood pressures I'd ever seen. I raised his legs with cushions and then nipped back to the car to get my paramedic bag. I also used the opportunity to request an ambulance ASAP, without having to worry the patient.

By the time I returned, his breathing was notably faster, but he wasn't complaining of feeling short of breath. It was still just the back pain causing him concern. Due to the extremely low blood pressure, finding a vein was a pig! Eventually I found one and got some fluids running. Despite his protests that he was feeling okay, as far as I was concerned, he was deteriorating and I myself begun to get anxious about not having an ambulance. It is one of the perils of working on a car. Sometimes you get stuck in a waiting game and it is a pretty helpless feeling. Luckily, the ambulance arrived a few moments later so my anxiety was put to rest for now!

I was aware that the guy's abdomen was somewhat distended, more so than when I arrived. There was  still no pain but I was pretty confident in my suspected diagnoses. I had a horrible feeling that he was having an Abdominal Aortic Aneurysm (AAA) and that it was at risk of rupture. A ruptured AAA outside of hospital means death. A person can bleed out into their abdomen and die within minutes. We were all well aware that he needed surgery immediately if it was what we suspected. We also had to make sure of minimal movement and a very smooth, yet fast blue light run to hospital. 

We get the bed into the flat and carefully transferred him to the bed. Without any delay we left,  driving off almost the instant the door was shut. We put a blue call in to the local hospital on route. By now the patients breathing was visibly strained. His oxygen levels that had been 100% dropped rapidly so we put him on high flow o2. We were at the hospital within 3-4 minutes, his abdomen now distinctly distended. As we were wheeling him in I knew in my heart of hearts that he was going to die. I still really hope my face didn't show that.

We transferred him to hospital bed in resus and attached him to their monitoring. He turned to us and said:

"Thanks guys, you've been brilliant.......thank you.........."

At that point his eyes closed. 

"Crash call!" shouted the nurse as his breathing stopped.

Within seconds, he was surrounded by nurses, junior doctors, SHOs, registrar's, surgical consultants and us. CPR was started as I handed over to 15 people surrounding him. Five minutes later, he was declared dead.

His medical records will show a 74 year old, male smoker who died of a ruptured AAA. A relatively common cause of death in male smokers aged 65-75. It's life and not something anyone will be too concerned about. He had no family to speak of and lived what a appeared to be a very solitary lifestyle. He is however, one of the patients which will stay in my thoughts. 

There are some patients you create a bond with, not through common interests or friendship, but because you were there when they needed you most. You were the face that appeared when they called 999 for help. You were the person that reassured them when they needed reassuring. Yours was the hand they grabbed when they knew something was wrong. Yours were the eyes they starred into as they drew their final breath. And you were the person they thanked with that final breath. 

I'm not naive enough to think I can save everyone. When he picked up the phone and called 999 he was dead. Nothing was going to save him and I know that. No one is to blame, there are no fingers to be pointed but sometimes that is of no consolation. What I can take solace from is that he didn't die alone, and as much as I don't want to still be thinking about him all these months on, at least someone is. At least he isn't forgotten.

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Thank you!