That's a Wrap

"26 year old male, stabbed in the stomach"

When you first come out on the road, it's quite daunting working with lots of different people; people with different experiences, different personalities, different genders, different ages, different attitudes and different ways of doing things. I've probably worked with at least 300 different people over a 4 year period, most have been great, some haven't been, but on the whole it's been good. 12 hours is a long time to spend with someone in a confined, high stress environment and getting on makes it a whole lot easier. As I've said before, working the relief rota is tough. You don't know who you will be working with, your shift patterns and shift times change daily and you could be working anywhere. The long term goal of all staff is to be given a permanent line on a rota with a permanent crew mate. Sadly, I am not there yet and probably have a number of years until I am, but in the meantime there are occasional opportunities to ghost a line. For the best part of a year that is what I've been doing. 

Due to the fact that you are with that person day in day out, 12 hours a day & up to 5 times a week you have to be able to get on. You spend more time with them than your friends and family. As such, as much as I get on with near enough everyone I work with, there are not many I would be happy to work with all the time. I was lucky enough to get the opportunity to work with one of the few and what a blast it has been. It has by far been the best months of my career; not just because I was at my local station, on a regular pattern, with plenty of weekends off and fewer nights; but because I had such a good time doing it. I learned a lot from him and take a lot away from the experience. Obviously I had to put up with his verbal abuse and constant stream of insults, but that's him! What he also did was get me blogging. It was his idea. Maybe he suggested it in the hope that I'd moan somewhere else! Well that didn't happen! We work in a very similar way, we have the same ethos and the same views on health care. A large proportion of my posts have been inspired by his rants so it'll be interesting to see if the tone changes after we are finished! We often moan about the stuff we go to. The 'good jobs' seemed very few and far between yet the LOB seemed to be constant. It seemed to be a running theme!

After months of laughs, good music, crap food and smutty jokes, the dream team drew to a close. @diagnosisLOB & @secondonscene were no more! We have shared a lot together and as a crew have been in some pretty hairy situations. Coming into work knowing that I can rely on him to have my back in the face of violence and abuse is comforting. I trust him implicitly and that makes the rest of the job easy. Although he was the paramedic, all decisions were discussed as a crew. He respected my opinion as I did his. There was no rank pulling or worry about the level of patient care being given. The most important thing with a crew mate is having someone who is not going to lose you your job. That's what it comes down to. That is a security you don't have as a relief.

We arrived at work for our last shift together in what was a rather sombre affair. We are not the types to cry and hug, but we both knew there would not be as many laughs in the months to come. We managed to get a vehicle with a CD player and off we went. It was  a hugely uneventful shift, the dream of a traumatic cardiac arrest to sign off on was fading fast. We managed our statutory McDonalds dinner at about midnight and then the dross continued. We finished up at hospital, cleared down the back of the truck and started heading back to station. We were reminiscing about the good times, the bad times and some of the utter crap we had been to. We debated what had been the best job, the worst job and the best shift. There were a lot, but what sticks in my mind was a job from a previous blog 'She's Gonna Blow'. We still laugh about it 6 months on! Half way through our nostalgic 'remember when' conversation the radio went off.

"General Broadcast, all units, ambulance required for 26 year old male, stabbed once in stomach, please press green mobile or priority to assist"

We had finished work but no discussion was needed. We were 1/2 mile away from the job, we would be the first there, HEMS were on route, as were police, this was our time to shine. This was the one we wanted.

"Red base, we'll take that, we are just round the corner"

Details were given, stab vests donned and we headed round. We were first on scene, shortly followed by an officer and 3 police cars. We knocked on the door. No answer. We knocked again. No answer. On the third knock the door opened. An angry looking middle aged woman was stood in her dressing gown. Clearly the address was wrong. We made our apologies and scuttled off. We called in for a location update. As we did the HEMS car arrived, as did 3 more police cars and another ambulance. They were all on another job; a bottling further up the high street. A bit of investigation from the police showed it was the same phone number that had called them in. They got an updated address further up the road so the 5 police cars, the HEMS car, the officer and the 2 ambulances drove to the new location. The house was in darkness; again there was no answer. This was just another Saturday night hoax. The caller was probably watching us all chasing our tales and laughing. We had to laugh! Not because a hoax is funny but it summed up our time together. We got back in the truck and let Frank Sinatra's That's Life blare out one last time. We sat and listened as we drove back to station enjoying the moment. That was our theme song and its sentiment is mirrored in our outlook on the job. 

We put our crap in our lockers, signed all the drugs back in and signed out. We touched fists and walked to our cars. He turned to me and said:

"It's been emotional"

And it has been. Without wanting to give him a big head, I've enjoyed every minute we've been together and I will miss working with him. This is the point he'd normally look me up and down, snarl slightly and call me pathetic! That's a wrap! 

Nice Try

"25 year old female, a tad disillusioned but fighting back and feeling generous"

It's been the best part of a week since I last blogged, which as my regular readers will know, is a long time. This isn't because I have nothing to say or write about, I do, but a few things happened which led me to step back and ponder. When I started blogging, I did so as an outlet; an outlet for pent up feelings which I wanted to get out. Some were frustrations, some celebrations and some simply anecdotal but most importantly it was for me. I said from the outset that I have always been the type of person that questions right and wrong. Be it politics at local level to government policy, or patient behaviour to staff attitudes I will always ask questions. That is just my nature. I don't care if people don't agree and I don't care if people don't like what I have to say, or how I say it.  All I wanted to do was vent frustrations, share experiences, provoke debate, and educate people as to what life is really like on the road AS I SEE IT. That is what a blog is. It's personal.

As far as I was concerned, and to a point still am, the blog is going well. A lot of posts have indeed created debate, shown some home truths and rubbed a few up the wrong way. Last month, in what was the highlight of my newly found world of blogging; I received nominations for EMS Blog of the Year. For the first time in a long time I was proud of myself. I felt I had achieved something from nothing. Not an accolade but recognition from people who read my ramblings and it was touching to say the least. I had no expectations to be shortlisted and no expectations whatsoever to win. It was just nice to have my blog mentioned with some very well known, established blogs. Unfortunately, this public recognition brought the detractors out of the woodwork. I received nasty messages about my blog and was basically told I have no place in the 'blogging community'. As the competition went on I began hearing whispers via Twitter that a number of people were talking about me behind by back. As childish and playground like this may seem it was true. I was sent copies of messages, screen shots of conversations, the content of which was bringing my professionalism into dispute. Accusations of breaching patient confidentiality were mentioned, and as untrue as it was, it had the desired effect. 

I spent a number of days trying to write posts, but as I did, rather than writing for myself like I had always done, I found myself writing to please others. I started second guessing everything I wrote and my posts felt forced. I began to resent my blog. It was doing the complete opposite of what I had intended it to be. The added anxiety I was feeling about possible repercussions of these accusations caused my already sleepless nights to become pure insomnia. For that reason I closed my laptop and gave twitter a wide birth. I always said I'd blog for as long as I enjoy it. Well, certain people took that enjoyment away. I didn't know if I would come back to it. It kind of felt a bit tarnished. That was until a very close friend gave me a good old fashioned telling off. She told me in no uncertain terms that I cannot let these idiots win. I cannot walk away from something I've worked so hard at and what means so much to me. 


There will always be bullies; there will always be people who don't like me, no matter what I do. I can't change that, but so what? If you don't like my blog, don't read it; if you don't like me, unfollow/block me; if you have an issue with what I have said then say it to my face. Failing all that; be a coward, bitch about me to others, leave anonymous comments and messages, I don't care. I'm going to carry on writing for me and anyone who wants to read it. Don't like it, jog on!

I think this is also a great opportunity to thank all my readers for the support you have shown me over the past 6 months. It's so nice to hear the positive feedback I get and this compels me to do more. As a token of my appreciation I'm giving away 5 x Diagnosis: LOB mugs.

To enter the competition all you have to do is:

1. Click the 'Join this site' button on the right of this page and do just that.
2. 'Like' my Facebook page (if you have Facebook)
3. Tweet the following if you have Twitter. 

'I've just entered @diagnosislob March competition. Have you?! If not, get involved. You've got to be in it to win it! http://www.diagnosislob.com/2012/03/nice-try.html'

Once you've done the above, leave a comment on this post to tell me you've done so with your name, email address or twitter name. Each entry will be given a number and then the winners will be picked out by a random number generator on 4th April.

Thanks again for all the kind messages of support, all the nominations I received and all the votes I was given. It meant a lot. Good luck and happy hunting!

Ella x

Lost in Translation

"69 year old male, chest pain"

There is a lot of inter-service banter between ambulance and police. We mock them for repeatedly asking us for our call sign and they mock us for requesting police back up because in 1974 someone at the address swore at a crew! We roll our eyes when they call us for the most pathetic of injuries and likewise, they get fed up at our constant requests for help the second the words mental health or assault are mentioned. It is a constant source of amusement and one which will not go away. The problem is, we will never stop asking for help if an address is flagged or there is a hint of danger and similarly, the police will never stop asking for an ambulance when someone is ill or injured. This is simply because no one wants to take the risk! The one time they don't call us, there will be an unexpected death in custody and the time we don't call them, we will get a beating. Things will continue to frustrate and amuse, but what can you do?! This job today had a lot to do with the flagging of addresses. When ambulance or police go to a property if the occupant is violent, abusive, used weapons etc. that information is linked to that address. Through CADLink the information is shared between the services so when either of us are called to an address we know what we could potentially be walking into. 

It was about 11pm when we got the job. On the CAD information was *LOCALITY MATCH*. We phoned in for further details and were told not to approach. This address is known for firearms and we were to wait at the RVP for police. This is was exactly what we did! We waited, and waited, and waited some more. An hour went by and nothing. The police and no units to send. Unless we are in imminent danger police response can be varied. Waiting 2 hours a few hundred yards from a patients address isn't uncommon. I think a lot of it has to do with the amount of time we have to call them. Just like Peter crying Wolf so many times, the response to ambulance requests can often become diluted. I'm not saying we are calling them unnecessarily but we are not a priority if we are sat safely on the side of the road eating a cold McDonalds! After about an hour and a half a car turned. The two officers called in to get more information on the address and the occupant was known to be violent and have a string of firearm offences. I don't blame them for requesting SO19 back up! Eventually one of our officers arrived with ballistic vests. We shoehorned ourselves into them and continued to wait.

"What's your call sign?" one of the coppers asked!

After a little while the whole team was assembled. 2 x cars of firearms officers, 1 x car of police officers, 1 x incident officer, 1 x DSO and 1 x Ambulance. In a glorious convoy of blue lights we headed round to the address. I love moments like this, this is what I live for! We pulled up and the police sprang into action. I was unable to see the entrance to the property but I could here lots of shouting. After about a minute a copper came wondering over. 

"All clear" he said with a look of amusement and dejection.

Loaded up like pack-horses we bundled into the house. Sat in the living was a rather bemused, shocked looking elderly couple. Audrey and William had been enjoying their evening when William got chest pain. 2 hours after calling an ambulance the armed police burst in. Not exactly what they ordered! Luckily he wasn't having a heart attack either. We took him to hospital as a precaution apologising profusely for the mix-up. Needless to say it was our turn to gloat today. There was some head scratching going on amongst the 5-0! Something, somewhere had got lost in translation and never in their 50 years of marriage had either of them been gun toting reprobates! They saw the funny side! We all did!

Baby Blues?

"4 month old baby, crying, mother not on scene"

To be honest, it seemed like a rather bizarre call to get. A crying baby is hardly a medical emergency now is it! We had no other information other than that to go by so mind open we headed round. We arrived at a block of flats and waited an eternity to be let in. Eventually, as someone was leaving we bundled in and headed up the stairwell. I could hear the babies crying as we entered the corridor, so just followed the noise. The door to the apartment was ajar so we knocked and entered. Standing in the living room was a guy with his hands in his pockets. On the floor, in a car seat, was the baby crying.

"What's the problem today?"

"The mum gave me the baby and said she can't do it anymore"

"How do you know her?"

"She's my neighbour, she hasn't been right"

I started checking over the baby, he seemed well. I opened that bag that he was left with and found some milk. It worked a treat, we could now start to try and unravel what has happened. 

We called the police and requested social services. While waiting we managed to track down a friend on the phone. It turns out that the baby's mother may have been suffering Postnatal Depression. She had been crying a lot, been very irritable and had been losing her temper with the baby. Apparently there had been weight loss through not eating and a distinct lack of sleep. She hadn't received any help either which I found strange. PND can often bring feelings of denial to services because new mums fear their child may be taken away, but in this case it appears she had fallen through the cracks in the system. Not speaking fluent English maybe she didn't know what services she was entitled to or maybe her symptoms had simple gone unnoticed by those she came into contact with. What we did know was there was a vulnerable adult missing and no one seemed to know where she might be.

Postnatal depression is very common, yet too often new mothers are left to suffer in silence, struggling alone with the pressures of parenthood without any diagnosis. Giving birth brings with it a range of emotions from pure happiness to anxiety and mild depression. The mixed emotions and tearfulness are often put down to 'baby blues' by GPs and other services alike and are fully expected to clear up on their own.  When it doesn't and the depression gets worse the PND occurs. It usually happens when the child is between 4 and 6 months old and effects 1 on 10 new mothers. It can be a gradual or sudden onset and can be mild to extremely hard hitting. Clearly in this case it reached the extreme of abandonment. With no father around and an apparent lack of access to services she had left the baby and run; that to her seemed the only logical option. Obviously for an outsider looking in it isn't a rational thing to do but not being in the mindset of a mother in such difficulty it's hard to comprehend what she is going through.

The signs and symptoms of PND are extensive and varied and I think it's important that anyone close to a new mother is aware of them. New mothers may go through one or more of the following experiences, although it's extremely unlikely that they will go through all of them:

• feeling very low or despondent, thinking that nothing is any good
• feeling tired and very lethargic, or even quite numb
• not wanting to do anything or take an interest in the outside world
• a sense of inadequacy; feeling unable to cope
• feeling guilty about not coping, or about not loving the baby enough
• being unusually irritable, which makes the guilt worse
• wanting to cry
• losing your appetite, which may go with feeling hungry all the time, but being unable to eat
• difficulty sleeping: either not getting to sleep, waking early, or having vivid nightmares
• being hostile or indifferent to your husband or partner
• being hostile or indifferent to your baby
• losing interest in sex
• having panic attacks
• an overpowering anxiety
• difficulty in concentrating or making decisions
• physical symptoms, such as stomach pains, headaches and blurred vision
• obsessive fears about the baby's health or well being
• thoughts about death

It is the latter that was concerning us today. Intrusive thoughts about death can be frightening and make the person fell they are losing control. Clearly it had got to the point where the mother could no longer cope alone and desertion seemed the best thing to do. It was imperative she was found for her own well being so she could receive treatment and prevent her son going into the care system.

Under normal circumstances PND is assessed by health visitors who use a tool called the Edinburgh Postnatal Depression Scale. When originally designed it was meant for British women and its usefulness and effectiveness on women from ethnic minority communities has been brought into question. Perhaps this job was a case in point. Maybe her poor grasp of the English language had caused her to continue without diagnosis. Like with most things with the ambulance service, we are limited to what we can do. We have an hour window to diagnose, treat, refer or convey so even if she had been in contact it isn't necessarily likely that we could have helped. New mothers need to rely on friends and family and the health care professionals they come into contact with to get a diagnosis. 

Clearly the system failed on this occasion. We were left with an innocent baby whose mother was missing. It was impossible to imagine her mindset and frustratingly we never find out the outcomes. It's one of the most annoying parts of the job we do. All we can do is try and understand the causes and symptoms in the hope we are able to spot and prevent similar in the future. What this job highlights is the fragility many new mothers face despite apparent well being. If they become isolated a vicious cycle of denial can occur leading us to the situation we found ourselves in. It was this point that gave me the idea of combining my thoughts on the issue with that of someone who has suffered from postnatal depression. It is with great pleasure I introduce a fellow blogger and friend BookwormMummy. Gem shares her thoughts and personal experience with PND in an attempt to show the vicious circle and mindset of the patients we often come into contact with and how their feelings are often marginalised as 'Baby Blues'.

"Perhaps the majority of you reading the above felt a mixture of concern and disgust. I read it and felt a mixture of relief and hopefulness. Relief that the mother had walked away leaving her baby safe with someone who did the right thing, and hopefulness that by doing so it allowed her to find the help she desperately needed. I hope that she was found to be well and reunited with her baby with the proper support in place, which is the outcome everyone would hope for. I also secretly wish I had done something so bold to indicate that everything actually wasn’t OK. 

I have never been medically diagnosed with postnatal depression; I am not truly sure what my medical records must say about the three visits I made over a 3 year period to discuss my mood swings, irritability, anger, anxiety, night terrors, exhaustion and tearfulness. I do know that I have a phone number somewhere from my first GP for a local counselling group I could never get an answer from. I know the same GP told me on my second visit that I was perfectly normal and would be fine, that perhaps a diary where I recorded all my feelings and moments that made me happy each day would help give me a boost. I have that diary still; the few entries I made do not make happy reading. I know that from the third visit, to a different GP (that I burst in to tears in front of which rarely happens!) I have a leaflet about contraception. I know from the list above I had almost all of the experiences listed. I know no one ever really asked me the right questions, probably falsely assuming the smile I painted on my face every day meant everything was OK, and that joking about sleep deprivation and comparing myself to a milk machine at the baby clinic meant I was fine. I wasn’t fine, I was unable to make any decision or even speak properly when my baby would cry, my skin would itch with tension and my heart would race. I know I gave up on explaining myself properly to a GP and decided it was probably ordinary and I was just tired. I know that I felt isolated, alone and inadequate, even when surrounded by family, friends and my children that were hard work yes but thriving. I know that I am lucky to have made my way through it. I’m not entirely sure I am through it.

What probably made a huge difference to me was having good friends and a supportive family around me who picked up the slack on days I ran away, who helped the best they could to get me to rest, and who provided me with enough encouragement and reassurance I was doing OK that I believed them. Another godsend was having somewhere I could feel in touch with people also having a bad time. The Internet makes it easier to seek solace and support even when you’re too anxious or exhausted to leave your front door; it is also fairly anonymous or at least I don’t have to look someone in the eye when I type “I am struggling” or “I’m not sure I can do this anymore”. I wasn’t really aware of any support groups or charities that I could approach; I felt they were for the really ill ones, or people that didn’t have anyone there helping them, I didn’t think I deserved to be a bother or would get treated with the same vague shrug and a hug I got from my GP. I should really have realised I needed to reach out, but until I emerged from the really ugly fog I didn’t actually realise how immersed I was. That is the difficulty with depression, it isn’t a choice or a state you trip up in to suddenly; it creeps up, masked usually by other events like illness, or sleep deprivation, or a bad turn of events; then before you comprehend it you’re stuck in the fog unable to think clearly or find your way home."

This was a very valuable exercise from a patient care point of view and one I intend to use more often. As health care professionals we are often far too focused on our own job and those of the services we interact with. The patients voice is often lost amongst all the hypocrisy but if we can start to understand the mindset of the people we are trying to help then perhaps the level of care they receive will be greatly improved. 

If you are suffering with PND, or know someone who is or might be, then contact Mind for advice. Don't allow it to go unchecked.

Mind infoline 0300 123 3393

or email to info@mind.org.uk

I'm Lovin' it!

"41 year old female, collapsed"

Sometimes there are those days where everything goes wrong. Sometimes there are those days where everything goes right. Sometimes there are days where everyone is rude. Sometimes there are days where everyone is bizarre! Today was one of those days. I can't quite put my finger on what it was about most people I saw, but it was just odd. The locations were all weird, the circumstances for illness or injury were abnormal to say the least, the dress sense of people were extrovert and the patient's behaviour in general was well.....just bizarre!

We headed through the lunchtime traffic and pulled up outside McDonald's. This is where our patient was supposed to have collapsed. This is where she was supposed to be unconscious. We headed in with all our kit to be greeted by a member of staff. 

"She's over there" he pointed rather sheepishly....

"There?! The one sitting at the table eating?!"

"Yes"

We wandered over slightly bemused as to why we were there and why she was showing no signs of collapse or indeed any signs of illness.

"Hello there, did you phone for an ambulance?"

"Do you mind? I'm eating"

"OK but you have phoned for an ambulance so we want to make sure you're OK."

With that she took another bite out of her Fillet-O-Fish and began chewing whilst starring directly at me.

"Can you stop eating please so we can find out what the problem is?"

(Whilst chewing) "I'm not going to ask you again, I'm having my lunch, I'll come out and talk to you when I've finished, now stop pestering me"

I made another few attempts to reason with her but, alas, they were in vane. We took the kit back to the truck and waited, watching her through the window. I wasn't happy leaving until we had checked her over in case she had been unwell. After watching her eat her second Fillet-O-Fish she got up and walked over to the ambulance. I went and met her at the side door and she climbed on board.

"So what is the problem today, why have you called an ambulance?"

"I'm feeling better now, can you just drop me off at my hairdressers, I have an appointment at 2pm"

Now it was my turn to stare. My jaw dropped to the floor and I'm sure one eyebrow raised itself independently to my hairline. 

"Pardon?!"

"The hairdressers. I have an appointment."

"I'm afraid we don't offer that. If you are ill we can take you too hospital. If you don't want to go to hospital I can refer you on to your GP, but if you are not ill I am certainly not taking you to your hairdressers. That is a totally inappropriate use of an ambulance."

She just looked at me, nostrils flared and a real look of disgust on her face. She picked up her bag, swung the door open and walked out. It took a moment to take stock of what had happened. I wasn't even angry! I just shook my head and laughed! What can you do?! Like I said, it was one of those days!