Can I Go Down There?

It is with great pleasure that I open the floor to my first Facepalm Friday guest post! This week I welcome the award winning, much revered, mental health guru that is @MentalHealthCop from MentalHealthCop! It occurred to me that all the emergency services interact with the public and therefor, we all come across candidates for the Darwin award on a daily basis! This comedy gem from Inspector Michael Brown is from his earlier days as a police officer. At a guess, it was probably in the late 1870's! ;-) 

"Adult male, wanting to go down there" 

I found the Friday Facepalm idea intriguing! - 999 services see human stupidity on an epic scale and we've all got these stories, but my blog doesn't lend itself easily to letting off the necessary steam around them.  Thanks to Ella, I have offloaded some major stress from my early career.

Well over ten years ago, I was a front-line PC in Birmingham.  My partner and I were called to a gas explosion on a very small traffic island where four approach roads intersected.  A engineer for a telecoms company had been working on underground pipes / cables, on the pavement which rounded the corner of two of those approach roads and had managed to ignite gas by cutting electrical wires.  The subsequent blast singed his hair without causing major injury and sent a thirty foot high flame into the sky.

An early Facepalm! for the engineer - but this is merely incidental to the stupidity that followed.

All three 999 services went down there: Ella's lot were helping the engineer change his underwear whilst Simon and Dennis were using their hoses to put out the fires caused to trees and bushes as the gas plume licked back and forth in the wind, torching anything within it's reach.  The only way to stop the plume of burning gas was to get the gas company to dig up the road around fifty metres away and isolate the supply - this would take hours so we were asked to support cordons on the roads and pavements for public safety.

The fire truck blocked one road, the police car another and the two less frequently used approaches were taped off.  There were two cops and a few fire officers to keep saying "No" to the question that always gets asked on these occasions -

It's been the since human pre-history that when you put a cordon on something, some members of the public will still ask "Can I go down there?"  It's important to understand I'd managed nearly two hours of "Can I go down there?" whilst sweating profusely on a what was already a very hot day, underneath a thirty foot plume of burning gas and we'd had to get another patrol to drop cold drinks up to us because it was quite demanding.  So to say I was a bit tetchy about "Can I go down there?" is to understate things.

The clue is:  my police car is across the road with blue lights flashing, we've taped off the road and you can see highly dangerous flames burning brightly and gently toasting us all.  They're licking backwards and forwards fairly unpredictably and there are fire personnel putting out fires as quickly as they can each time one starts.  You've probably seen other people approaching us who ended up heading back the way they came, so what do you think the odds are that you can "just go down there?"

Then happened one of the most unbelievable things I have ever seen - I will remember this until I die:  on the less often used approach, which was taped off and kept in view, but where no-one was permanently standing, a suddenly saw a young boy approach the tape and lift it in the middle. There was a Mercedes in the road, facing me and the boy looked like he was attempting to allow the car underneath the tape. Hang on: that car is slowly moving FORWARD!!

Stop!! 

*Double Facepalm!*

I ran from the opposite, busier cordon shouting "No!"  The vehicle's bonnet was under the tape, the tape stretching across the windscreen and the boy trying to lift it higher as the car inched slowly forward. There was a hairy arm out of the driver's door also attempting to force the tape higher and flick it over the height of the roof.  "Stop!"  The vehicle was approaching the roundabout on the side where the plume of flames was nearest.  Surely he can see it?!  The fire engine was to the right hand side and he could see it from where his car was and both Simon and Dennis were waving frantically in between planning their second jobs and having a snooze.

"What on earth do think you're doing?" I enquired.  "I live up there." he said, implying outrageous unreasonableness on my part.  The wind blew the flames towards us and I felt the temperature really increase before subsiding as the wind dropped.

"Can't you see the tape, the explosion, the blue lights?" 

"But I live up there!"

"It doesn't matter,  Sir - this road is CLOSED!"

"But I live ... just there!!"

"So find another way around, but this road is closed."

"This is ridiculous - I can just drive on the opposite side of the roundabout.  I'll be home in seconds."

"No you won't - because THIS ROAD - IS CLOSED!"

"You're being obtuse, officer."

"If we're offering viewpoints - I have one about using your son to lift police tape without permission and pushing him into demarked areas of extreme danger.  Shall we talk about that?"

"It can't be that dangerous ... they're letting you move about in it."

"They also let me arrest violent criminals, Sir - I'm guessing you don't want your son doing that either?"

"Fair point."

It took the threat of prosecution to get him to reverse and find another way.  I walked up to his house - it was just fifty yards beyond the opposite cordon and gave the appropriate advice.  I think I had hoped he would have realised the main learning opportunities from this encounter.  It amazed me to find he was still furious for the extra five minutes on his journey.  He informed me of that he would be complaining about my attitude and would like to speak to the duty inspector in respect of the complaints procedure.  Fortunately, Carlsberg do make duty inspectors - a man on whom I've modelled my very own approach to that job.

*Triple Faceplam* - the scale of fail.

Climbing for Little Angels

"28 year old female, climbing a load of mountains"

A few days ago I posted a blog called 'Little Angel'. I wrote it a long while ago but it never seemed the right time to talk about what is a very difficult and distressing subject. 

'Sudden Infant Death’ is the term used to describe the sudden and unexpected death of a baby or toddler that is initially unexplained. The usual medical term is ‘sudden unexpected death in infancy’ (SUDI). Some sudden and unexpected infant deaths can be explained by the post-mortem examination revealing, for example, an unforeseen infection or metabolic disorder. Deaths that remain unexplained after the post mortem are usually registered as ‘sudden infant death syndrome’ (SIDS). 

In February this year I learnt about Matilda Mae, who was the daughter of @Edspire and at the age of just 9 months tragically died due to SIDS. Jennie wrote some brave and heart breaking posts, none more so than 'Dear Matilda Mae: The night we found you sleeping'. Please, please read it to see SIDS from the families perspective. 

In the UK alone, each year there are 300 unexplained infant deaths. It was seeing  this number and seeing the amazing work Jennie, her family and her friends have done to raise money for The Lullaby Trust that made me want to do something. The Lullaby Trust provides specialist support for bereaved families and anyone affected by a sudden infant death, and it is this support which is invaluable to the many families affected by SIDS.

On the 1st August 2013, me and a friend are embarking on a challenge to raise money for The Lullaby Trust. We will be climbing the 4 highest peaks in Great Britain and Northern Ireland over 2 days. Starting in London we will drive to Northern Ireland and start with tackling Slieve Donard (850m). From there we will drive to Scotland and haul ourselves up Ben Nevis (1344m). Once Scotland has been conqured, we will drive to the Lake District where Scaffell Pike (978m) will be awaiting us. After that it's just a case of nipping into Wales, staggering up Mount Snowdon (1085m) and driving home.

Unlike the traditional 3 peak challenges, we have no support team to do the driving while we rest. We will sleep when we can and where we can. There is 1451 miles of driving which will take about 30 hours and about 24 hours of climbing (at best)! We expect to reach the summits of all 4 mountains within a 48 hour time window! 

Please, please, please sponsor me. The petrol costs, ferries and any accommodation will all be self funded. 100% of sponsorship will be going to The Lullaby Trust to help continue their crucial work. It costs them £1.6 million each year to do the work they do so anything that can be raised will help. 

This is my Just Giving page:

http://www.justgiving.com/EllaShawFourPeaks2013

I will of course be showing proof from the top of each mountain so you know I actually went up there! Please dig deep! Anything is better nothing. 

Thank you :-) x

Sync Complete

I should probably start this post with an announcement. I HAVE A NEW LAPTOP! How amazing is that! I've been wanting / needing one a long time! My old one was bought in 2007 and can no longer cope with the simplest of tasks! 2007! It's amazing when you think back THAT far! My son hadn't been born, I was married, I was working Monday to Friday in a tragically dead end job! It is amazing what can change in just six years! Anyway, yesterday when I finished work I wandering into the Apple store and bought my new MacBook Air and totally abused my 'old' student card to blag the discount! I was pretty damn chuffed as I walked out, new toy in hand! I drove home, opened the box and started syncing! What a day!

Then I thought, 'yeah, what a day'. My mood descended somewhat into one of reflection. It's easy to get caught up in a moment. Like I said, it is amazing how much can happen in six years. It's also amazing what can happen in 12 hours. It is also amazing what I'd managed to forget over 12 hours. Maybe not forget, but certainly the prospect of indulging in a new laptop had become top priority in recent hours. So much so, that it wasn't until now, starring at the words 'Sync in progress' that I realized that there were other people, people who I had seen today who weren't enjoying their evenings. 

"09:05 - 57 year old female, cardiac arrest"

I shot off up the road, dropped into 'sport' and started tackling the remains of the rush hour. I knew the road well having walked down it twice a day, to and from school for many years. I knew I would be the first to arrive and wanted to get there as quick as I could. 

Four minutes after someone had dialed 999 I pulled into the street. I screeched to a halt, grabbed all my stuff and rushed inside. I was beckoned up the stairs by the distraught looking husband. Lying on the floor of the bedroom was my patient. There was nothing I could do. She was dead and had been dead for quite a while. Rigor mortis had set in and there was post mortem staining present. I exited the room and closed the door behind me. 

"I'm so sorry, but there is nothing I can do. I'm afraid your wife has passed away."

The man fell forward, wrapping his arms around me and began sobbing. As he cried, their son appeared on the landing in his dressing gown, also sobbing. I managed to escape his grasp and let them cry together. I went and put the kettle on to make some tea and I cancelled all other resources. In situations like this, tea always seems sensible. They came downstairs and sat on the sofa crying. They looked totally lost. No idea where to turn, no idea how they will move forward. 

I waited with them, comforted them as best I could until the police arrived. I left them to deal with their unmeasurable loss. A very tragic start to the day for all involved.

"12:09 - 33 year old male, ? slurred speech, ? stroke"

My initial thoughts on being sent this were skeptical. Come on! 33 years old! Having a stroke! Not likely! It only took me 3 minutes to get on scene and my patient was sat at the roadside waiting for me! He staggered towards me like someone who's been drinking! I kept him at arms distance whilst I spoke to him. Within about 10 seconds it was clear he wasn't drunk. He was having a stroke.....

His speech was slurred and he couldn't find his words. He was limping and had very little power on his left side, hardly any grip at all and he was drooling slightly. He had no risk factors which made it all the more bizarre. I called control to tell them it WAS as given and I needed an ambulance ASAP. 

33! Unbelievable. He was a successful guy, had a lovely house in a lovely area. He was very confused and had been found staggering around the front garden by a neighbor. He was due to get married in a few weeks time to the woman pregnant with his child. Surely his life can't be ruined at 33? Surely he will get a chance to do all the little things with his baby? Surely he can still get married to his childhood sweetheart? So much was suddenly unknown. So much had changed. 

The ambulance arrived and rushed him off to the stroke centre. I phoned his fiancée to give her the news......

"16:01 - 26 year old male, RTC, Car Vs Motorbike, ? unconscious"

Again, I knew the road well. It's a busy, fast, duel carriageway. This guy could be in a serious condition. That ominous sense of urgency engulfed me. As I approached the stretch of road, it was clearly serious enough to cause a complete standstill to all lanes of traffic. I managed to get myself into a bus lane and shot down the inside of the traffic to the incident. Lying on the floor, surrounded by people was the motorcyclist. About 100 meters further down the road was his bike. By all accounts he'd been clipped, flown through the air and then hit by a car. 

The guy was unconscious, he had a pulse but his breathing was extremely slow. Under normal circumstances, you need two trained staff to remove a helmet. It was just me and the ambulance would have a nightmare getting through the traffic. Based on my initial findings I immediately called and requested HEMS. Luckily the helicopter was 'on line'. ETA 8 minutes.

I couldn't wait to take his helmet off. I enlisted the help of a by stander and got it off. I got someone to kneel either of his head and hold it still whilst I started cutting of his leathers. His battered, blooded body was fighting to survive but I got the sense he was deteriorating. I attached him up to the machine to get his blood pressure. It was extremely low. I put in an airway and started ventilating him. I was aware of what was being said by people around me but was trying to ignore it. 

"Red base, this patient is about to go into cardiac arrest. Any other resources near by?"

"Rog, we have a car about two minutes away from you."

As she said that, I heard the sirens. What a relief.....

Too late....his pulse had gone and there was now no respiratory effort. I started CPR. The police and FRU arrived together and now the chopper was circling above. We set about running the resus. Airway, chest decompression, IV access and secondary survey. HEMS landed in the road ahead of us and promptly took over. He was given blood infusions, injuries were treated and eventually his heart started beating again. He was taken off in the chopper to the trauma centre by the HEMS team. 

He was pronounced dead shortly after arrival at the hospital......

"20:12 - 28 year old female, starring at new laptop"

Not such a great day after all. Whilst I sit here enjoying my new laptop there are three families who's lives have been destroyed today. Three families where I have been a huge part of their day. Telling them their wife and mother have died, telling them their husband to be and father to their unborn child is having a stroke and trying in vein to save a husband, brother, father and son. Two lives over, one changed forever. It is too easy to forget about these people. They aren't my family or friends and I have no obligation to mourn their losses and in all honesty, after today I'll most likely forget about them. That doesn't mean they didn't have an impact on me though. They did. 

'Sync complete'

The Elephant In The Room

"33 year old male, bleeding per rectum"

I'm not going to lie. The prospect of visiting a man with a bleeding rectum isn't how I wanted to start the shift. In all honesty when I signed up to this job I didn't know bleeding rectums existed! My issue with them is this. First, there is nothing I can do. Secondly, despite what the patients who are suffering the bleeding rectum think, I will not be examining, visually or otherwise. Finally, when people have a bleeding rectum they invariably find out on the toilet. This then leads to that awkward moment where they want you to visual inspect the content of their toilet bowl. On special occasions, they save used toilet paper in a bowl to look at and more often than not, are insistent that you look! I can promise you, a description of events will usually suffice and no, you need not bend over, spread your cheeks and tell me to look.

Today, I was on the car. Generally any job involving genitals, rectums, embarrassing bodies or anything else that may cause embarrassment, I prefer to be on an ambulance. Maybe it's because I like to share the awkwardness, or maybe because in some situations there should always be a witness! Anyway, sometimes, awkwardness is unavoidable and it's our job to try and not make things worse! 

I rang the buzzer of the flat and was met at the door by the patient who immediately darted back up the stair case. I reached the landing of the flats and headed into the open door. The patient seemed very nervous and anxious. He was breathing very fast and sweating profusely. I spent the first 5 minutes or so just calming him down! His blood pressure was through the roof but I put it largely down to his nerves and fear of being seriously ill. 

He explained what was wrong, and offered for me to look at the blood in the toilet. He told me it was bright red and there were no clots so I didn't feel the need to cast my antique-roadshow-esque eyes over his toilet bowl contents! The reason for the bleeding was somewhat of an enigma, so I just carried on with my questioning hoping that some kind of cause would become apparent. This is what can be awkward. There is me and the patient, alone, and no ambulance to be seen and I have to fill the time with asking questions about his rectum and toilet activities. You can see why it was a little cringe!

I asked about any medication he was on. He started trying to recall them, with little success so I asked if he had a prescription. The patient was sat on the end of the bed, I'd grabbed one of his chairs and sat opposite him. Next to us was another chair with his coat sitting on it. He reached forward, grabbed the coat and pulled it towards him. As he did so, in slow motion, something fell from the chair.....

As it fell, it rotated. I think I saw it slightly before he did. My eyes fixed on the moving target, as he realised what was happened. He lunged his hand out to try and catch it but missed. As it hit the floor it bounced slightly and began rolling towards me. It was like watching it on a super slow-motion camera. I knew it was going to hit my foot but I couldn't move to stop it. Contact was inevitable. Then it hit, wobbled and stopped. Motionless it laid there. Looking at me. A panicked swipe by the patient scooped it off the floor and back under his coat. Now there was a Mexican stand-off of sorts. Who was going to mention it first? Or would we both pretend that nothing had happened and that I'd seen nothing?! Maybe he was hoping I hadn't seen anything?!

I didn't know where to look. I didn't know what to do. There was an elephant in the room. My face stayed emotionless. Behind the cool exterior there was utter panic! My mind was screaming at me......

"THAT WAS A DILDO. A MASSIVE DILDO. A RIDICULOUSLY MASSIVE DILDO. HIS DILDO JUST HIT MY FOOT!! MY FOOT!! HIS DILDO!! HIS MASSIVE DILDO!"

"IT LOOKS LIKE IT WAS MOULDED ON AN ELEPHANT! DILDO DILDO DILDO DILDO DILDO!"

"DON'T......SAY......A......WORD. You'll just make it more awkward. BUT IT WAS A DILDO! A FRICKIN' DILDO. And it's HUGE. And it hit my foot. HIS DILDO HIT MY FOOT."

Whilst my inner monologue continued, the patient was shuffling through his jacket pocket 'trying to find the prescription'. I imagine he knew exactly where it was but his mind was probably busy screaming....

"THAT WAS MY DILDO. MY MASSIVE DILDO. MY RIDICULOUSLY MASSIVE DILDO. MY DILDO JUST HIT HER FOOT!! HER FOOT!! MY DILDO!! MY MASSIVE DILDO!"

"DON'T......SAY......A......WORD. You'll just make it more awkward. BUT IT WAS MY DILDO! MY FRICKIN' DILDO. And it's HUGE. And it hit her foot. MY DILDO HIT HER FOOT."

I think both of us wanted the ground to open up and swallow us whole. Where was the bloody ambulance. This situation was now 'time critical' because I WAS GOING TO DIE! Despite my trusted inner sanctum telling me to keep my mouth shut I had to be the one to discuss the 'elephant'.

"Have you....errrr....could that have....errrr....do you think that....errrr.....it's the cause of the bleeding?"

*Awaits answer* CRINGE!!

"Yes, I think so, sorry"

Before I could respond there was a knock at the door! The ambulance! I shot off down the corridor to let them in. I gave them as sensitive a handover as I could. I managed to avoid blurting out 'THE DILDO HIT MY FOOT'. I said goodbye to the patient (we shared 'a look') and I hurried back to my car. I got in, turned the engine on and laughed out loud!

HIS DILDO HIT MY FOOT! HIS DILDO!

DILDO!

Little Angel

WARNING: Some may find this post extremely distressing. It's on the subject of Sudden Infant Death Syndrome and contains some very upsetting descriptions. 

I remember when I first started training, being told about all sorts of things that we will see. Some rare, some common and some unheard of. The prospect of the sheer volume of things I would see scared me  but having never seen anything, it was all a big unknown. I didn't know how I'd cope with the shifts, the people and the emotions of what is commonly touted as 'A job like no other'. I was assured that when the time came I'd be with a 'grown up' and all the training would come flooding back. I could only hope.....

It soon became apparent that the training did come flooding back, time and time again. As the weeks, months and years went by more and more things became second nature. My body got used to the shifts (kind of), I got use to the people (kind of) and on the whole my emotions were kept in check. You do get an emotional attachment to some patients from time to time. Some faces stay with you. Some are gone within seconds of leaving them. There is a constant emotional tight rope with me thinking that I'm either dead inside or too fragile to do the job. I suppose that balance is what has kept me grounded most of the time.

We'd been having a pretty non-descript shift. I couldn't begin to tell you the patients I had seen or what was wrong with them. That would be the 'at arms length' approach to ambulance life. The first real detail I remember of this day was my index finger reaching out and pressing 'Green Mobile'. Within a couple of seconds the job appeared on the screen.

"4 months old male, cardiac arrest, CPR in progress"

I felt the blood rush away from my face, my hands became cold and my heart rate doubled. I started imagining everything that could happen next. I pictured the child in his cot, his parents frantic. The only image of the room he was in that I could conjure was that of my own son's room. The thought choked me. Surely, this can't be. It must be an error. He must just be asleep. It must be a false alarm. I don't know why, but this felt different to all false alarms that have come before. This had a strange reality. I knew this was real. Then the radio started ringing.....

"Guys, I believe this is as given, we have another truck and an FRU on way but you are currently nearest. I have also requested the police."

My heart genuinely sank. I couldn't for the life of me remember the resus protocol. I knew it, but I convinced myself I didn't. I was the clinical lead. My crew mate was a student and was equally terrified. I tipped my bag upside down and started flicking through pages of A4 paper with recent clinical updates. I had about 0.3 miles to refresh my memory and then it was all on us. 

We screeched into the road, the familiar waving met us at the kerb. This time it was all the more frantic. All the more desperate. All the more real. The child's dad, consumed with grief, overcome with fear was begging us to do something before I'd taken my seatbelt off. I jumped out, grabbed some bags and ran into the house while trying to find out what had happened. A woman, who I assume was the grandmother was stood in the hallway clutching on to two young children. Tears were pouring down their faces. A shiver ran the length of my body.  This is as real as it will ever get. As I neared the top of the stairs I saw the mum. She was kneeling on the floor, desperately trying to breathe for her beloved baby boy. 

"Please, do something!!" she cried at me. 

Her voice alone broke my heart. I'd never experienced such pain and hurting. I could imagine the desperation and her thought process but without living through it, imagination won't ever come close to reality. 

I looked down at the boy. He laid there lifeless, peaceful, like he was sleeping. He was dead. His short life had come to a tragic end and I knew there was nothing I could do. There was nothing anyone could do.  

"Do something, please!" she wept. "My beautiful baby boy. I'm so sorry, I'm so so sorry."

In that split second I made a decision that I have questioned over and over, ever since. I held the mask to his face, filled his lungs with oxygen and started CPR. I lifted his lifeless body off the floor. With him lying on my forearm and using just two fingers I continued the chest compressions down to the ambulance. My crew mate followed with the bags. The FRU had arrived by now. He saw me rushing out of the house with the baby, and opened the back doors for me. The mum and dad got on board and we left. We had been on scene no more than 2 minutes. I looked at the guy on the FRU and just shook my head slightly. 

As we drove through the streets all I could do was go through the routine of CPR and ventilation. I felt in that moment it was what the parents needed to see. They needed to see us do something. Anything. I struggle with the morality of giving false hope though. Was I prolonging their pain? Who am I doing it for? Was it me who felt the need to do something? 

"I'm so sorry my baby boy, I'm so so sorry I wasn't there when you needed me, I'm so sorry my little angel."

Despite my best efforts, tears started trickling down my cheek. I couldn't help but see my son lying there, imagining what I would do in this unimaginable situation. 

The doors swung open, I picked him up and ran into resus. A small team was waiting. They'd been warned by control we were coming with a patient who was deceased and all our efforts were for the benefit of the family. I handed over the brief history I had. He was put to bed at 6pm. At 9pm, mum went to check on him and he wasn't breathing. Here we are now. 

The doctor told them he had gone. He tried to do so in the most compassionate way he could. Maybe that's why I started CPR. Because I couldn't have that conversation. I couldn't be the one to break that news. News they most likely already knew. Maybe I fell into the trap of having to do something. I don't know. To be honest, I didn't know anything. I couldn't process what was happening. 

I left. It wasn't until I got back to the ambulance that I realised we were all crying. We sat there in silence for a good ten minutes. What could we say? What could we discuss? There is no job more distressing, more tragic and more emotional. What we were feeling however, pales into insignificance in comparison to what the family were going through. The more I thought about it, the less I was able to comprehend the impact this event would have on a family. It literally didn't bear thinking about.

The police arrived and asked us some questions, and then one of our officers arrived. We were told once we were finished at the hospital we could go home if we needed to. We all did. I didn't come in for another week. I couldn't. We were offered support and counselling if we wanted it but I turned it down. I suppose the last thing I wanted was to talk about it. I didn't want to think about it. I wanted another job. I couldn't do this again. Ever.

I did come back. I still don't think I could go through that again. I know there is a chance I will and that will have to be dealt with if and when the time comes. Those parents have to not only come to terms with the loss of their child but somehow be strong for their other young children. The least I can do is carry on offering that false hope where it's needed. It would be selfish to walk away.

You cannot quantify events like these. Saying 'these things happen' doesn't do the loss any justice. I felt like a fraud moping around, feeling sorry for myself. This will be with that family for the rest of their lives. There are no answers that can be given. No meaningful explanations as to why. Nothing will make it better. The words 'I'm so sorry my baby boy' will forever be with me. I will always remember their little angel. I know she did nothing wrong, the doctors know she did nothing wrong, but I also know she will probably take a feeling of blame with her to her grave. I imagine all parents would. I know I would.