The difficulty with being at the Castle is that you’re always “on”. While you’re in the classroom, you can relax to a degree, but in the public areas you’re under the scrutiny of public guests.

I’ve spoken before about being asked the difference between “The green uniforms and the blue uniforms.” but what gets my goat is the assumption by public guests that we’re somehow an extension of the hotel staff. They tut when we have the audacity to read the newspapers in the lounge, glare at us when we convene in the bar after dinner.

One woman grabbed Kappa and Granny Chan and started describing her indigestion to them!

This week we were having coffee when an older gentleman walked past. He snorted at us.

“Don’t work too hard, now, fellers.”

I maintained a poker face and replied with my best stars-and-stripes-in-soft-focus-as-a-background tones.

“Not paid for what we do, sir. Paid for being ready to do it.”

His companion touched him on the arm.

“That’s so true…”

Midge and Stingray were nice enough to let them go round the corner before we all pissed ourselves laughing.

I could write here about challenging Midge to eat Dortios dipped in hair wax (I lost the bet) or the ascending spiral of practical jokery that is developing within the group. But that could cast us in a bad light.

And we’re Health Care Professionals, don’t you know?

Next week I have my final finals - a paediatric scenario (trauma or medical), an obstetrics scenario, a paeds/obstetrics MCQ and a short written made up of “one paeds question, one obs, one trauma and one ‘other’”

That “other” is scaring the shit out of me.

My textbook is a rainbox of highlighter ink, I’ve copied out screeds of writing, boiling and distilling the data down into a concentrated educational goo.

There is an enormous volume of data to try and cram into my head, I’m feeling a certain affinity with the plastic dummies we use to simulate birth. I’ve got an intra-cranial knowledge baby growing inside me and this week I have to twist its shoulders and head around and squeeze it out onto the page.

I wonder if they’ll give me pain relief in the exam…?

Midwives are no longer allowed to bring placentas into classrooms to show students - I have absolutely no idea why.

Now they bring felted/knitted versions.

They’re really fucking weird, like a vascular Tam O’Shanter.

The midwife who comes in is quite clearly the best lecturer we’ve had all course. The vast majority of the other have been proficient and pleasant, though some have slouched in their chairs and exited the building at such a rate it was hard to convince ourselves that they were in anyway interested in actually teaching.

This lady, however, was fabulous. Energetic, relaxed, funny, knowledgeable and honest. She was also fiercely pro-green suit, bigging us up at every opportunity - “I’m not going to insult you by telling you how to resuscitate people, you’re paramedics”.

The issue of absent midwives on the road raised its head repeatedly. Our lecturer was passionate about giving us the straight dope on pre-hospital obstetrics. Stingray was concerned, as we all were, and asked if, perhaps, the local GP could be called in to assist?

“GP?!” she exploded, “A bloody GP?! Don’t even THINK about it! You are BETTER than GPs at delivering babies.”

Cool.

She mentions a physiological phenomenon that presents just before birth - I’ve always known that a symptom of imminenf birth is “anal pouting” - but this lady introduced us to “anal winking” as well.

If I’d known that my obstetrics training would involve getting the come-on from a stranger’s poopy pipe?

I may have reconsidered.

The lesson is intensive and fast, we all know how to handle a normal, healthy birth, so this is nothing but pathology, a rapid list of terrifying situations and the skills needed to manage them, her handheld slide advancer clicks like a panicked Geiger counter. Children are born backwards, with trailing limbs, toxic liqour in their lungs. Mothers’ organs tear themselves apart, massively increased blood volumes pour into body cavities and down their legs. Our lecturer trips between being a health professional and an expert in the human angle of her skill.

“Women will clean themselves up before calling you, they’ll wipe their legs down, they’ll be embarassed. It won’t look as bad as you might expect - there might not be any blood at all. But look at their toes.
There isn’t a woman on this planet with the mental stability to scrub between her toes when she’s scared she’s bleeding to death.”

We’re taught to push twisted babies around inside the womb, to understand why handling a cord is a bad thing, to appreciate how the simplest gesture (like wiping shit off a baby’s bum as it’s born) can have devastating effects. We are interlopers in the most natural procedure on earth, frighteningly necessary, dramatically redundant.

She hands us a blank maternal record so we can be familiar with its layout, we now know enough to NEED to know the pregnancy’s history. There’s a box at the bottom - “If you have any cultural needs (dress, certain people to be present, ceremonies), please let your midwife know and we will accommodate you.”

See if I was having a baby? I’d be writing in that box - “In my religion, people who are present at births must all be dressed as Imperial Stormtroopers.”

It’s maybe just as well I’m a man…

This week we learned the disadvantage to kids having bendy bones. Little people spend the first six or eight years of their life pouring calcium into their bones, hardening and stiffening them. When kids fall, they bounce, because the bones just don’t break.

We got taught in our trauma lesson that they do break, but that instead of viewing a paediatric break as “Nothing heavy, their bones bend, don’t you know?” we should be thinking “Shit, they’ve suffered enough of an impact to break bones that aren’t meant to.”

Equally, we were taught that a child’s springy, bouncy chest can transfer almost all the forces it suffers to the internal organs, then sproing back into its old position, with minimal visible fractures and bruising.

But underneath? Their hearts and lungs are pummeled and sheared to pieces.

The information we’re being given this week is sobering, but I’m loving every minute of it.

At the end of the day we’re given the Child Protection (NAI) lecture that shook me up so wholeheartedly on my Technician course. I was interested in my response to the same data; with nearly two years ‘road time’ on my hip, I wasn’t nearly as disgusted or horrified as I had been when I first looked at such pictures. My response had changed to one of sadness, resignation and fatalism - bad things happen, we try to fix them when they do, but all too frequently we’re unable to stop them from happening in the first place.

Summer has rocked up early, we hadn’t got a room ready for it so it’s been sleeping on the living room floor on a pile of sofa cushions.

It’s still very welcome.

We schlep our practice dummies and defibs out onto the front lawn and establish ourselves a classroom on the massive ridge that runs above the drive of the Castle. There in the shade of an almight Scots pine we drill each other on paediatric trauma and arrest protocols, while Uzi and Vatican lounge on the bench, laughing at us and making ascerbic comments.

Back in the classroom we puzzle over “Cushing’s syndrome” - is it the same as Cushing’s triad; is it even the same Cushing?

Sensei decides he wants his own syndrome, so invents “Sensei Syndrome” - a gradual onset of lethargy, rambling speech, glucose/caffeine dependence and anti-social behaviour.

The class as a group has already taken on the “unusual blame conception” symptom from the paediatric trauma section of the book. Coupled with our widening waistbands, it adds a certain neurosis to the most unlikely situations.

Like medieval seers we nod sagely as we read difficult sections in our textbooks - “This is complicated because we all had pudding at lunch time…”

If you can’t get a cannula into a kid’s vein, it can be just as effective to drive that big black-headed mother fucker into the softened walls of their bones and inject fluids and drugs into the wee one’s bone marrow.

You’ve still got to twist the IO needle into the middle of the tibia.

It goes “kchunk”.

We don’t carry these kits, though we have to be competent in the procedure to graduate.

Apparently the kits cost pennies.

But they’re not on our vehicles.

I hope I never need one….

To alert you to this:

I sat in the cinema watching the trailer last night, the title wasn’t presented until the last moment.

I laughed so hard I almost shat.

Surely SOMEONE must have pointed it out?

At the end of this course I will have learned a number of things. IV cannulation, chest decompression, needle cric, thrombolytic therapy.

And the ability not to drown.

Because up until now I’ve considered the concept of being underwater absolutely horrific. Underwater is where dead people are found. Dead, blue, bloated people.

Me? I’ll stay pink and fat and dry. Thanks.

But the fact is that I WANT to be able to swim properly, I hate swimming “Like your granny” as someone once put it, my head and face arching out of the water. It’s knackering and inefficient and makes going to the pool a bloody chore.

So this week, I decided I was going to conquer it.

Thanks to Stingray and Sensei who’ve taught me to breathe out through my nose when I submerge, who’ve shown me how long I CAN stay down there for and have taught me ways to build my confidence without sitting on the bottom of the pool watching the second hand tick by on my watch.

Everything culminated on Thursday night when Midge and Stingray showed me how to hang my feet on the side of the pool and hang upside down in the water. Pinching my nose tight to ensure I didn’t irrigate my sinuses with chlorine, I sunk down slowly under the surface and stared around at this alien, wavy, underwater world.

I was fine. Not panicking, quite chilled in fact and highly entertained by how easy everything was.

And that’s when I laughed.

See if you’re trying not to drown?

Don’t laugh underwater.

-

Those of you who read my Twitter posts will know that my practical exam results came through and were just fine and dandy, thanks awfully.

So that’s nice, too.

I have no angst for you, guys. Move right on along.

Our trauma MCQ is…atraumatic. The mocks that we’ve been given beforehand have armed us well, gaps in knowledge have been identified and plugged, foibles of the IHCD’s questioning techniques are noticed and artfully sidestepped.

Our running order for the practical final exams are posted in the classroom, we gather around like high school students.

My name is second last.

That’s going to be a long wait.

We drink coffee and slide headphones into our ears. There is nothing to be gained by questioning each other, chatting about possibilities, or dissecting each others’ experiences. Music shuts it out and as long as we’re ALL listening to music, nobody feels abandoned.

We all listen to music.

Kappa is called in for her first practical and returns after 14 minutes (yes, I’m sure, we record the times).

“Piece of piss.”

Kappa is not the most confident student in the class. This is something of a revelation.

“For real?”

“For real. He never even asked me any theory, I was all ready to talk him through different presentations of shock and stuff when he went “Right, there’s the boy there, it’s a stabbing.”"

An electric thrill zips through us all; no theory? A simple stabbing? Fantastic! ‘Mon the schoosh.

We’ve been told to only return to classroom to collect our books once we’ve been assessed, so our numbers gradually dwindle. Midge, Stingray and I practice quietly in the corner while others read. I start making stupid mistakes, forgetting to perform the most basic checks, over complicating my treatment, getting ahead of myself.

Granny Chan pulls my shoulder away from the dummy andsets me straight.

“You’re over practicing. Stop it. Chill out.”

Headphones back in, Fratellis on. I stare out the window at the rabbits on the front lawn, my shoulders and head popping up and down. Holiday makers stare up at the window, bemused by the jigging ambulanceman.

Pumped up and ready, one of our tutors calls me through.

“The consultant’s having a wee break, so I’ll be running this one.”

Even better news! This tutor has winkingly mentioned that he “Doesn’t fuck about.” with his scenarios.

“Nae drama, right?”

I nod.

Into the exam room, a plastic dummy on the deck, our instructing consultant sits at the top table. He was friendly and chatty and receptive on Monday, so I flash him a smile and greet him warmly.

He nods stiffly, returning to his paperwork.

Oh.

Exam mode, then.

“Right Kal, you’re called to a firearms incident - I’m an ARU copper.”

I get him to explain what’s happened, a simple enough situation on the face of it, an eighteen year old male shot in the chest. Police don’t have any further information, but are out looking for the gunman.

The patient is supine, not moving but making gurgling moaning noises . I clamp both hands over his ears to protect his C-spine and in the same breath get a cop (disguised as my tutor) to take over for me. I’m buggered if I’m spending the entire scene holding the punter’s head still. The airway’s full of blood, but it’s nothing a little suction doesn’t clear and I teach the cop to perform a jaw thrust on the patient. The gurgling stops and I’m able to move onto the breathing assessment.

Central trachea, distended jugular veins, 40BPM, shallow and irregular; far too fast to inflate his lungs properly and supply oxygen to his lungs. I shove a mask over his face and squeeze oxygen into him.

But now I really AM buggered.

Looking up at my tutor and the consultant, I shrug -
“I can’t go beyond breathing. I need back-up to transport him and without another medic on site there’s little I can do beyond here.”

My tutor disagrees.

“What else can you do?”

I’m staring down at our four hands on the patient’s head and face.

“I suppose I could teach this cop how to bag the patient…”

“Or you could find another way of immobilising him.”

“Ummm…yeah, I suppose.”

There’s a beat while they wait for me to speak, my instructor takes pity on me.

“What’s the most definitive C-Spine care?”

“Board, collar, head huggers and straps. But we can’t do that with two people, we need a whole crew.”

“Right. Ok. Let’s say you’ve done that and he’s on the board.”

Eh? I’m not sure how the patient has magically levitated onto a spinal board, but I’m not about to look a gift horse in the airway.

“Cool. I’ll teach this cop how to bag the patient and move on.”

As I strip the patient’s chest there’s a small entry wound over his left nipple which is bleeding a little, but he’s otherwise unscathed. I push his ribs and sternum together to no effect, but when I listen to his air entry there’s nothing but dull sounds and gurgles in his left lung.

His chest is filling up with blood.

There’s nothing I can do in the field to deal with a haemothorax, so my next step is circulation. The bloke’s pale and sweaty, with a radial pulse at 140bpm. Too fast, but still producing enough pressure to perfuse his brain and kidneys. I prod and flex his belly, pelvis and long bones and confirm once more that there’s no massive blood loss onto the floor.

The tutor shakes his head - “Nothing to note…but his crotch is wet.”

Right, maybe he’s bleeding from his genitals, or his arse, maybe he’s been shot in the gut and is bleeding out through an orifice. Maybe I’ve missed a wound.

Or maybe….

“Blood, or urine?”

My tutor laughs.

“Looks like urine, smells like urine…”

“Probably urine then, huh? Well…he’s 18 and he’s just been shot…I’d say that’s an appropriate response.”

There’s a snort of laughter from the consultant.

“Right. So he’s got a diminished GCS, his airway’s safe, his breathing’s supported by the BVM, he’s got a developing haemothorax but is otherwise stable. I’m going to reassess him from the top while I wait for my transport.”

I do so, finding nothing. I’m beginning to run out of things to say.

“Let’s have bilateral wide bore cannulae, just in case he loses his pressure…”

They both just stare at me.

“And…ummm…since I’m waiting for my transport, I’ll get my Lifepak out and get a full set of obs. ECG, BP, SpO2, BM.”

“His ECG is sinus tach at 148, his BP is 70/40, SpO2’s 97% and his BM’s 4.3″

“BP’s down to 70/40?”

“Yup.”

Right. I’m fully expecting him to have lost radial pulses, but still assess him starting at “response”, working my way down.

He still has a feathery pulse at both wrists.

Shit.

Our aim in giving IV fluids in trauma is to maintain a systolic BP of 90mmHg. Below that your radial pulses vanish and as such we use this as a quick way to assess a patient’s circulatory capacity.

This patient has a crap BP, but present pulses.

Yesterday I over infused a patient because I cocked up my assessment.

I’m terrified of doing the same thing today. Just for something to do while I think, I confirm a carotid pulse as well. My tutor just stares at me, I’m sure it’s only his professionalism that stops him sticking his tongue into his lower lip.

Fuck it. He’s losing blood, as I ausculate his left lung its now completely dull, all gurgles are gone. He’s pissed a good couple of litres into his chest.

All or nothing time, I squeeze saline into his veins, 250ml at a time. A litre of fluids later he’s still not responding. His BP still crap.

“You did say he wasn’t lying in a pool of blood, right?”

“Yup.”

This is weird, so I strip the patient right down, confirming that I’ve not missed any other injuries.

My tutor cuts in.

“The police say they’ve found a 9mm casing on scene. What does that tell you about the type of weapon he was using? A rifle?”

All I can think about is Schwarzenegger talking about uzis. They’re not rifles, are they? Are they?

“That would be a smaller weapon, a pistol, or revolver?”

“Uh-huh. And if the patient was shot at a range of 15 metres with that weapon, what size of exit wound would you expect to find?”

What? *I* don’t know! What am I, a fucking siege engineer now?

I plump for honesty.

“I don’t know enough about ballistics to answer that question, I’m sorry.”

He shrugs.

“Fair enough.”

The scenario ends and I hand over to the consultant, summarising the patient’s condition and my treatment before arriving at hospital. I try my best to gauge their responses to what I’ve done, but there’s none. Just blank faces and a dismissive “thankyou”.

I stomp off around the garden before having my lunch, double and triple guessing what I did against what i think i should have done.

Chan and I are cursing our instructor at the lunch table (she had a similarly grim scenario to face) when he wanders up, slaps us on the shoulder and grins.

“Did you guys enjoy that lot, then?”

Our responses are not recorded, but he shall be known from here on in as…”Uzi”.

The morning begins with mock MCQs and Practicals. They warned us that the week would creep up on us and suddenly we’re twenty four hours away from our finals.

Shit.

My mock practical does not run well. Airway and breathing in my assault victim are easily stabilised, but when he loses his radial pulse I batter fluids into his arm far too fast.

Without checking for a carotid pulse.

Two litres of saline later I realise I’ve been merrily pouring IV fluids into a dead dude who probably could do with some tips towards a healthier lifestyle, like, you know, five pieces of fruit and veg a day, or 20 minutes brisk exercise…or a pulse.

Benito laughs at me as I slink from the room.

The afternoon is largely empty. No more lectures and (despite the crashing and burning motif of my mock) Benito seems to think we’re all doing alright. I do a little reading in my room, watch some day time TV and head down for dinner.

That evening I’m lying on my bed when Midge wanders in, we’re both claustrophobic and bored and frazzled.

I decide I need M&Ms, Midge decides she’s coming along too.

Halfway down the drive we find a snowy white lamb running up and down the fence. He’s something of a independent wee thinker, because every OTHER sheep is on the OTHER side of the fence.

We can’t leave him out there. It wouldn’t be right. He’d end up inside a fox come dark.

I turn to Midge.

“You grew up on a farm, right?”

“I grew up in a farm-HOUSE.”

“Oh. Ok. Well, we go one on each side and when he runs past, you grab him, k?”

“K.”

I start off running up the hill to head the lamb off and slowly herd it back towards Midge.

It is at this point that I learn some important lessons about Midge.

1. Midge has greatly underestimated how fast lambs can run.

2. Midge has greatly overestimated the intelligence of the average sheep.

I watch, dumbfounded, as Midge lifts the bottom of the loose fence up and points at the gap. The lamb looks at her as though she’s mental, and tries to ram itself through a square in the fence four inches across.

Midge walks towards the lamb, the lamb runs like fuck.

I run back around the lamb and herd it back towards Midge; trying not to be that guy who goes “No! Like *this*!”

The lamb bolts past me. I fail to catch it.

I run back around the lamb and herd it back towrads Midge, wondering to myself how come it’s me that’s doing all the running up and down the hill.

Midge is laughing at me.

We slowly corral the lamb into one wee corner and I’m just about to grab him when he tries to run past me a second time. Realising that I’m going to get him, he does that “leap in the air without bending your knees” thing that lambs can do.

And headbutts me firmly in the eye.

I’m not sure who was more taken aback by the experience, myself or my wooly assailant. I do know that only one of us said “Ooohya little fucker.”

Thankfully our meeting of minds stuns the little bugger sufficiently for me to catch him by the front legs and swing him over the fence. I’m just lowering him into the grass when Midge pops a hand under his back legs.

“I’ve got him,” she says “He’s fine.”

Thanks mate. Pleased you’re here.

We fail to find M&Ms in Peebles and so undertake the 36 mile round trip to Galashiels, ostensibly in search of chocolate in candy shells. In reality, it’s just nice to be out of the Castle for a bit.

Roaming around Tescos, we buy supplies for our classmates and pop in on the Nerf family for a cup of tea. Back at the Castle later that night we make Party Bags for everyone else in the class, little fiddly plastic games, sweeties, energy drinks and ascerbic notes. Last week everyone fiddled and stressed while waiting for their practicals.

At least this week they can play mini pinball in between times.