Well, no flashing lights.

Saying that, no chuffing air conditioning either which is less than ideal when it’s over thirty degrees outside and you’re already bricking it.

Monday morning we’re allocated vehicles and I find myself behind the wheel of a wee Renault Scenic. Sadly, the space between the middle of the gas pedal and the right edge of the brake pedal turns out to be *slightly* smaller than the breadth of the huge safety boots I’m wearing. As such, my car control is a little shonky. We make our way up to the show ground opposite Edinburgh airport and screech up and down through the gravel, practice parallel parking a bloody great ambulance and reverse through a slalom of cones. If I ever find myself attending an emergency a hundred yards behind me and theres nothing but a long line of wee orange Nazis in the way, I won’t have a thing to be worried about.

Tuesday we’re out in a “Driver Training Unit” - That’s a crew-cab transit with seats and a whiteboard in the back, to you and me.
Come the end of the afternoon the I’m taught an important lesson as I cock up. My instructor picks me up on a few points and they rattle me, I sit and stew about them, stop concentrating on the road and make further cock ups. After 20 minutes I’m all over the place and he pulls me over. “So, are you as pissed off as you look?”

He then spends 15 minutes telling me that I hold onto my mistakes, that I let them interfere with my performance and that I need to find a way around this.
Sadly, this is something that I’ve been doing to myself since I was 5 years old. I’ve had 20 years experience of beating myself up for my cockups, I’m rather good at it by now.
What I REALLY needed was someone to teach me how to get around this.

I return to the college, stomping headache, feeling miserable. The farmer who owns the fields behind the college has sprayed slurry over the grass, so every corner of the premises, inside and out stinks of shit. I peel my uniform off and jump in the shower to find the boiler is broken, providing no hot water. After a cold shower I dry myself off, spray my pits with deodorant and haul a black t-shirt over my head. A mirror check shows me that I’ve rubbed white stripes all over the back of my shirt.
I shout a very rude word very loudly and stomp down to dinner where I eat through my grin and insist to my colleagues that everything is ‘fine’.

That night I catch up with my course director, a gem of a bloke who sets me straight on a number of things. He teaches me how to put my mistakes behind me and move on, he asks if I’m enjoying the course and when I answer in the negative teaches me how to enjoy it…

“You’ve got to get behind the wheel every day and say “Fuck you, I’m going to show you exactly how well I can do this.”
“Yeah, but Dougie, I don’t KNOW that I can do this.”
“We’ll teach you everything, you’ll be the best driver you’ve ever been once we’re finished with you. You WILL get enthusiastic.”
“I can’t see it happening, I’m just not excited by it.”
“You told me at the start of this course that you wanted to be the best you can be, right? So do you want to be an emergency driver, or do you want to be another hazard to be overtaken?”

I stare at the table, lip twisting, look him in the eye.
“I didn’t work to get here for three years to become a fucking speed-bump.”

On Wednesday we whizz about the Borders in one of the officers 4×4s,, nip across into the North of England, laugh at the coach tours standing right on the border listening to a piper playing “In The Mood” and “Rock Around The Clock” (”In The Mood”, on a set of fucking pipes. In The Fucking Mood!).

We stop at a reservoir….somewhere. Pile out, have a pee and a cup of tea, munch on some biscuits and leap back into the car. My colleague Yorkie (bizarrely, not the Yorkie who’s started commenting here!) comments as we pull out “Do we all have horns or something? Everyone was staring at us.”

I explain that they might have been a little taken aback by the image of a family car rolling up to a beauty spot and four members of ambulance personnel doing traditionally family-road-trip-esque activities.

We have a standing joke in the course “D’you wanna be the Mummy or the Daddy?” after a joke that was told in the first week - A white collar worker is sent down for fraud and is asked the above question by his cell-mate on the first night. He demurely refuses, he’ll justclimb on his bed and leave him in peace. His cell-mate insists and he reluctantly acquiesces, thinking he’ll err on the side of caution and says “I’ll be the Daddy.”
“Excellent” says the con “Come here Daddy and suck Mummy’s cock.”

Thursday morning was skid-pan training, hammering about a wet car-park in Ford Granadas, throwing out the back end and correcting it, learning cadence braking and cackling as the ex-traffic cop who was putting us through our paces yelled “Gas! Gas! Go go go!”. Aside from the sheer exuberant fun of it all, it was a refreshing change from the cautious driving style we’ve had hammered into us all week.

Friday we covered box overtaking and by lunchtime I was home. At the moment I’m blogging from Len and Amber’s kibbutz in Lanarkshire, there’s a possibility I might be working a night-shift with SMM tonight in Leith and then it’s back to college for my last week. My uniform all arrived yesterday, so I played dress-up for half an hour, but at least I’ll have a set of greens to pass-out in on Friday afternoon, all things going well, that is.

It’s been a long course, intense and wearing at times, but the thing I’m most looking forward to about the end of it is not having to write these posts. It’s great to be able to keep everyone up to speed, but I’m bored witless of this “What I done this week” format. I want to get back into my abstracts and metaphors, arguments and angles. It’s coming back, guys, watch this space.

to catch up on and two more to go. The end of the road is getting close and it’s getting scary.

For those of you who really aren’t interested in the minutia of my college life, I’ll cut to the chase, bow my head, look up through my eyelashes at you, draw circles in the dust with my toe, pull my lips over my teeth in a shy dog grin and mention, casually like, that I might have sort of passed my Ambulance Aid finals.

And more to the point, I might have, sort of passed them with colours that might, sort of be described in a sort of aerobatic type way.

That it’s entirely possible that I missed one point on the multi-choice and two on the essay questions, giving myself final marks of 95 and 96 per cent respectively.

A bit.

But there’s more story here, infinitely more story.

I need to tell you about how I went out observing with SMM and TechnicianL a fortnight ago, responding to two diabetic crises in the early hours of the morning. I can tell you how I shat myself when L casually shouted through to the back, over the scream of the siren “If we’re jagging them, you’re giving the drugs.”, how I scrambled for my JRCALC and learned the indications, contra-indications, route and dosage for Glucagon in three minutes flat. How my hand shook when I pushed a needle into another person for the first time, the trembling ache in my thumb muscle as I pushed the plunger, as my brain said “I’m going to put these chemicals into your bloodstream, they’re going to radically change your body chemistry and make you better.”

It strikes me that clinicians throughout the ages must have all felt this way at one point, a nagging fear at the top of your neck that you’re playing God with these people’s metabolisms and all that holds you back from crashing them to the floor is your expertise. My gut rolls at the thought, but the smiles on the faces of the family as that woman dragged her eyes open and blearily apologised for bothering us is emotional antacid.

For all my nervousness, my bravado was equally bolstered the following day, as I sat in a lecture on diabetic crisis and administration of glucagon.

I should tell you the story of our emergency maternity lecture, where the midwife painted a beatific picture of childbirth as a natural, forgiving process where we, the health care professionals, played a background role, hovering in the wings, lights off, ready to step in if anything went awry. We broke for coffee, loved up and glowing, ready to bask in the warmth of life emerging from life.

Returning, our lecturer lifted a clinical waste bucket from behind her desk, lay out a sterile sheet on a desk and poured a freshly delivered placenta onto the table-top. Some of my colleagues paled, held the back of their hands to their mouths and turned away, but I was transfixed. Strangely, I was reminded of helping my mum butcher animals in my childhood, staring and prodding with wonder at kidneys, hearts, stomachs, lungs. It was just another lump of flesh, blood clots and vessels, silky amniotic memranes to lift away from the dark red tissue, to poke fingers through and test their statement “If the baby’s face is covered with membrane, rip it away.”

Rip it away my arse, it’s as tough as a flannel sheet, they make it sound as though you could seperate it like gossamer.

We pulled lumps from the placenta to test the consistency of the flesh and understand what an incompletely delivered example will look like, juggled cubes of meat between each other, marvelling as just how close to steak it really was.

By the end we were bloodied and grinning like jackals, the healers becoming hunters, intimately involved in the bodies that we’ll strive to save.

We retired for lunch and skipped back up the stairs where the screen was emblazoned with the word “Complications”.

We covered buttock breechs, footling breaches, miscarriages, ante and post partum haemhorrage, perineal tearing, shoulder dystocia and a host of other conditions too ghastly to discuss.

And again we returned to animal basics, no longer were we waiting with towels and boiled water, shafts of morning sunlight keeking through the curtains, depending on millions of years’ worth of women giving birth in our abscence. Suddenly it had all gone wrong and we were slammed by the lapels into the simple truth that when it goes well, birth goes very well, but out on the road, parked in a layby or kneeling on some unfortunate’s living room floor? Then, when it goes wrong, it goes very, very wrong.

We were taught to deliver babies backwards, to classify newborns into “Pink, blue or white” on birth and resuscitate them as necessary and to ram our fists into the upper pelvic region to force tiny trapped shoulders under the pelvis and out into the world. This was barbaric, a simple physics lesson and a shoulder-shaking realisation that you’re trying to force a big peg through a small hole. Our lecturer looked us in the eye and said “As you push the shoulders down you may feel the collar-bone snap. Don’t try to do it, but be prepared for it to happen.”

The session ended and 16 sober faced student technicians slid quietly to their rooms to revise.

There are more stories, the story of how I flunked my first practical final, trying to fandango a bent-in-the-middle patient onto a straight rigid metal stretcher. I sat glumly through my debrief, realising with despair that the word “Paramedic” on my instructer’s chest was an anagram of “A Crap Diem”.
He caught up with me on the stairs as I headed to my room to bawl my eyes out.

“You’re not on the third floor, are you? You look like you could jump.”
A wan smile from me, “Trust me, I’d be up a tree if I was jumping. Not that I’d trust myself to find the ground, the way I’m doing today.”
He clapped my shoulder, gave me a smile.
“It wasn’t that bad, son, it really wasn’t.”

I should tell you the story of how I passed my final practical, despite the fact that there was an explosion in the middle of it that killed myself, my partner, the patient and a fire officer.
We were treating an engineer who’d had a face full of burning gases from a boiler, sitting in the boiler room we treated his smoke inhalation, cooled the burns, gave him analgesia. The instructor wandered back from where he’d been waiting “I’m the fire officer, the gases are building up dangerously. If this patient can’t walk, you leave him. You have two minutes to ignition.”
“No way.” We responded. “Give us the two minutes and we’ll lift him out onto a chair.”
My partner had recently been a casualty for a similar burns incident where the crew were slated for walking her out and exacerbating her breathing difficulties and shock, I took my cue from her and ran for a carry chair to haul our punter up the stairs.

We humped him onto the chair and rocked him backwards.
“Fifteen seconds to ignition. Leave him and run. Now.”
“No!” I shouted “Ready. Brace. Lift!”

We had the wheels just off the ground when a voice said “Bang. Congratulations. We’re all dead. Fuck off and write up your patient forms and meet for debrief in five minutes.”

We grumbed our way through the paperwork - “Don’t see why we’re writing the fucking form, we’re fucking dead, can’t fucking write if you’re fucking DEAD…” - and met our trainer in the coffee lounge.

He clattered through the debrief, ticking “satisfactory” for each box until he got to “Manual handling and extrication.” (Which, if you’ll remember, is what we failed on previously.”

“Right. Extrication.”
We stared at our boots.
“We know, we know, can we resit tomorrow?”
“Hang on, don’t be so hasty. It was crap, right? If a fire officer tells you to run, what do you do?”
“We run?”
“Damn right you do. Has learning taken place?”
We sadly nodded, prepared to sign our failure forms and retreat to the classroom.
“On the other hand…” he butted in “You haven’t been trained in major incident work, OR working with other agencies…and I’m not allowed to fail you for something I haven’t taught you…so that’s a pass guys. Well done.”

I caught up with him later on.
“Can you really pass us, even though we blew everyone up?”
“Of course I can. I only threw in the explosion because you were doing so well. Everything was textbook, I just wanted to see what would happen if I chucked a spanner in.”

The week ended with a team run around the grounds, running with a dummy on the stretcher, stopping every minute to do a round of CPR on the ground. We staggered back into the venue, caked in sweat and dust, past the other class who were in their first week, their eyes wide with apprehension at what lay before them.

Sunday morning I sloped off to Len and Ambers’. They’re all well, sitting in the sunshine and building houses, wonderful to have them here, must visit more.

This past week has been a funny one, they’ve been packing in all the bits and bobs that they didn’t manage to fit in over the past six weeks, so we’ve covered light rescue, which was lots of fun, arrived at a local beauty spot in a convoy of six ambulances, scared the sunbathing familes shitless, then entertained them by running up and down hills with people in stretchers. They didn’t seem so impressed when we all bought ice-creams from the nearby van and lay in the grass though. Ahhh well, they forgave us when we dunked our last patients, strapped firmly to stretchers, into the river we were meant to cross.
The next day we looked at major incidents and the special operations team (where we learned to run like fuck if the fire officer says so).

Then Thursday morning was finals, a multi-choice/true or false paper and then an essay paper, Thursday afternoon was “Mental Health First Aid” where we nodded at symptoms lists such as “Feels negative, cynical, thoughts of suicide, feelings of worthlessness.”

We received the nod from an instructor “I’m not allowed to tell you you’ve all passed until tomorrow morning.” and retreated to the bar for a night of drunken revelry.

And once again I find myself at Sunday evening, preparing to drive back down the road to college. There’s only another fortnight to go and I’ll be spending most of it in ambulances learning to drive. It’s going to be brutal, I’ve been warned, but it sounds fun to me.

Hey, I’m back again. Those of you prone to travel sickness (like me, I had to stop watching) might want to sit this one out but someone has uploaded a video of the world’s shortest flight (Westray to Papa Westray in Orkney) on YouTube. Probably worth having an explore of the other Orkney videos as well.

Via Silversprite.

When you read guides to Orkney you get pretty excited by the idea of all the wildlife you might see: seals, porpoises, puffins, eagles, all sorts.

As an adult, and having lived away from the islands for 19 years, I get pretty excited at what I might see when I go back up. A couple of years ago a friend took me out in their boat around the harbour and a seal followed us for a while. Of course I hadn’t taken my camera. Durr.

As a child, and when I did live there, I was too busy wanting Barbie dolls and going for adventures in the field next door (sh, don’t tell my mum). However, I did see some pretty good wildlife. Standing at the windows of my classroom at Stromness Primary, waiting for the teacher, I saw some porpoises in the harbour. How often do you get to see porpoises, and from your classroom window at that?

There was also the whale. I don’t know how old I was, four or five probably. I’m not sure how, but a dead whale had ended up at the foot of the Pier Head in Stromness (where we lived). It may have been stranded or beached, I don’t know (that’s the trouble with experiencing these things when you’re five, you don’t know and/or don’t remember the details). The news spread round the town and people went down to look at it. I remember imagining that it would be a lovely big blue whale and almost being glad it was dead because that meant that it couldn’t eat me or anyone I knew.

My mum took me down to have a look and of course it wasn’t a lovely big blue whale. It was pale, a death white-grey with it’s bloodied mouth wide open. Even though I didn’t want it to be enormous (because that would have meant we might have been in danger if it had been alive according to my pre-school logic) I remember being surprised at how small it was. Whales didn’t have to be huge and have the ability to eat half a village in one go. God I had a lot of fears at that age.

Anyway, that’s all from me. Hope you’re feeling better Kal, can’t believe how quickly the time is going.

Worth of catching up to do.

Well, it’s not going to be that difficult, really. The week before this one (week four at the college, if you’re counting) was pretty grim, I went to bed on Tuesday night feeling a little under the weather and by Wednesday morning was shivering, sweating and shitting like there was no tomorrow. Everything hurt, every joint and muscle, and my eyes felt like two stones in my head.

Thankfully, week four (introduction to trauma and head injuries/neurological disorders) wasn’t wildly different from most of the trauma stuff I’ve done with BRC. There were changes, I’ll grant you, and new bits of kit that I needed to get my head round, but considering that one of the lessons I run with first aid volunteers is “What’s the difference between concussion and cerebral compression?” I didn’t feel too challenged when it came up in lectures.

This is all just as well, as I spent most of the week sitting very, very still, or lying in bed moaning.

Vast kudos to SMM, who arrived on Wednesday night with a SAS fleece “It’s uniform, they can’t shout at you for wearing it.” and a bag full of goodies, including a big bottle of cranberry juice.
Imagine my surprise then, while waking up to find my mouth dry and my body screaming of dehydration when I cracked the aforementioned bottle open and took a swig, only to realise that is was concentrated diluting juice, rather than fresh.
Blech.

We finished early on Wednesday afternoon and G, our Invernesian instructor said “Right, I’ve got some trauma slides here, let’s look at mechanism of injury.”
There then followed slide after slide of people who can best be described as “a bit mushy.”

My stomach sent a telegram “Feeling grimSTOPStop looking at gross stuffSTOPLeave class.”
I duly excused myself.

Thursday morning I joined in on our “Management of aggression” course, learning lots of “Breakaway” moves, which on ONE hand allow you to retract your lapel, wrist, neck etc from an attacker’s grasp. The thinking being that once you’ve locked their wrist, elbow and shoulder into an immovable position, you should be able to just shove them backwards. A later conversation with my lovely friend Sarah uncovered the fact that a lot of the arm locks we’d been taught can be converted into methods for dropping people to the ground/wall with just a little extra pressure.

It’s a difficult subject to teach, emotive in that attacks on emergency workers are on the increase and we have to be *so* careful in dealing with patients. Sure, he was verbally aggressive and he swung at you, but was he pissed and violent, or hypoglycaemic? Is that guy really intent on stabbing you with the machete by the front door, or is there a voice at the back of his head telling him what to do?

We sought some guidance from the lecturer, as our books stipulate that “Appropriate and proportional force can be used in case of attack.” To that end, it would seem that having disarmed our assailants, or escaped their clutches, nobody is going to mind if you accidentally skelp them round the chops as you run away, though rather perversely, we are supposed to record any violence we apply to patients on their paperwork.

“35YOM, c/o abdo pain, has been drinking, vomitted x 2 in ambulance, vitals normal, verbally abusive, assaulted crew, police escort.
53%O2 via Duo Mask, swift application of size 12 x1 to right shin/foot.”

Went to bed immediately after lectures, slept fitfully, interrupted by wonderful classmates who gingerly tapped on my door and checked on me. One of them even came up and asked if I was feeling nervous about the wedding on Saturday.

I did tell you about the wedding, right?

I was my mate’s best man and yes, I was shitting myself about it, but I’m confident that the nerves weren’t what was making me feel so grim.

Thankfully I managed to shake off most of the grimness in time for Saturday morning, though I was teetotal for the whole day. On two occasions I tried alcohol (champagne at the reception, red wine with dinner) and both times my entire nervous system jangled, my brain sending me a clear message - “You’re vertical, nothing hurts desperately, I haven’t made you throw up once. Don’t push your luck, sonny.”

Still, my speech seemed to go well and it was lovely to catch up with lots of people who I’ve not had much of a chance to see while I’m at college. And yes, as DigitalKatie pointed out, Adam and Esther were there, with tiny tiny baby Finlay. And yes, Druss and I fought all night over who got to cuddle him.
And Druss won.
Asshole.

Back to college for last week at Sunday, a whole week of trauma, including RTA extrication work. Flunked my practical assessment on Thursday (mis-prescribed a drug *again*) but aced my written exams (93% multi-choice, 97% essay), tutorials read “Kal obviously has a high level of theoretical understanding, but needs to work on patient management plan and physical assessment skills for a successful course outcome.”
Which, though I’m paraphrasing, seems to mean “If you don’t get better, pal, yer tea’s oot.”
Hmmm.

A colleague was teaching me to Cha-Cha on the lawn in between written exams when my DTO walked up.
“Kal? What are you doing?”
What can you say, but
“The cha-cha.”
“Why?”
“It’s either that, or we dissect the last paper, which does nobody any good.”
“Carry on.”

We presented our research project to the lecturers (You remember, “Infectious diseases…as presented by Jim Henson’s Sesame Street”). I introduced it and one of the lecturers gave me a look of death, opened his mouth to object. I cut in.

“You said we could do anything we wanted, as long as it was about infectious diseases and as long as it was NEW. That was your remit, you asked for something you’ve never seen before. I’m 99% certain you’ve never seen this before.”
He grinned “Fair enough, carry on.”

Saturday was spent with friends from up north who needed somewhere to stay, H (11) woke me up by bouncing on my bed with both knees at 0730, so we got up and went and bought breakfast for his mum and sister. Good times, good pancakes.

Then a Saturday night-shift with SMM and colleague L. Busy night, though nothing particularly serious and more than a few patients who were obviously ‘at it’.

Advice to a certain patient - Trying to kill yourself by ODing on anti-depressants is not wise. You feel sad, you take lots of pills, they kick in, you feel happy, but are now pumped full of a lethal dose of prescription only drugs.
D’oh.

Seeya soon

K

Sick as a dog all week; best man at friend’s wedding on Saturday; boring week anyway; will tell you about it on Sunday.

Kal