…are you fucking kidding me?

Over the 48 hours of my Christmas Eve/Christmas Day nightshifts:

*Countless assaults.

*Panic attack over present wrapping angst.

*Bottling.

*Glassing.

*Chased by lynch mob in housing estate, who were, in turn being chased by a police car.

*”Road-blocked” in same housing estate by group of blokes strung across road marching towards us.

*Pally and I marching around back alleys with our big red Maglites (”Medic’s Truncheons”) looking for a “?collapse” call.

*The two of us driving around the city singing along to Wizzards “I wish it could be Christmas”, using said Maglites as microphones.

*Called to this woman’s house in the early hours. Dissuaded her from travelling to hospital, wished her pish-soaked husband a Merry Christmas and left her to it.

*Chocolate eating competition with Evilontheinside.

*Emergency transport for a man with a textbook Sense Of Impending Doom and subsequent ST Elevation.

*”I’ve got chest pain, well, throat pain really.” “Uh-huh, how long have you had this?” “For about a year.” “And you waited until Christmas Morning to have something done about it?” “Well, I won’t see a GP, will I? Not today.”

*”I’ve got a chesty cough, can you give me anything for it?” - “No, take Benylin, I see you’ve got a bottle there.” “Can you take me to hospital?” “I can do, but what do you expect them to do?” “Give me a cough bottle.” “But you have one right there.” “Yes, but I want one from the hospital.”

Thanks all for the best wishes on the exam. I’m pleased to announce that after day’s written papers and scenarios i got a pat on the head and released back into the community.

As for the lurkers, i’m stunned! I had no idea you were all out there!

I feel like a kid at the zoo who’s been marching past all the enclosures, only paying attention to the immediately visible animals.

Turns out there was a whole collection of little brown furry beasties in the undergrowth that i only saw when i stopped to look.

Still, Saturday night found me once again dressing up and kitting out, bag on shoulder, strolling into the station for a night shift with Pally (Hi, Pally!)

After some paperwork and a trip to the vending machines, we “fived” the radio (punched *05#, sends a message to the automated computer making us available for further jobs) and were sent towards the West of town for an GP’s non-emergency call, 84 year old man with persistent D&V.

We were on the bypass, cruising along, sipping from our cans when the radio boodley-booped. The message on the screen changed.

“1 mof, choking.”
That’s Month Old Female, for those of you who want the translation.
“Jesus, Pally, choking baby, mate. Give me your Coke.”
He didn’t argue.

Maddeningly my map didn’t have the street name we were looking for, it was a new build on the South side of the city, predating my map’s publishing date. I didn’t fuck around, hit the red “Priority” button on the radio. Normally when we call Control it works like a phone conversation, we put a call in and they either phone us back, or we listen to it ringing before the controllers pick up. The “Priority” button is reserved for moments when you need to talk to someone *now*.
They didn’t disappoint.
“Kal’s vehicle, pass your priority.”
“Control, our map doesn’t have this address, can you assist?”
With some discussion we were able to pinpoint our target, thankfully we were less than a mile away, just approaching the exit on the bypass that we needed and already rolling at 70mph.

A man was standing outside the front door, waving. I raised my hand in response to let him know we’d seen him and turned to Pally.
“I’m just going to jump, mate, bring the gear, yeah?”
The pavement under our wheels hadn’t come to a complete halt as I opened the door of the cab, I hopped to the ground and ran into the lobby of the house.

Two women, one in her twenties, one in her fifties and a tiny, tiny baby in someone’s arms. I can’t remember who was holding her, but I do remember someone saying “Thank fuck you’re here.” and thrusting the child into my hands.

She was pink, which was a good sign, and floppy, which wasn’t. Pink, wriggly babies are what we look for, pink and floppy is indicative of being well on the way to blue and floppy which is well on the way to, well, you get the idea.

I juggled her round so she was lying on her front along my left fore-arm, her head hanging down, my thumb and little finger supporting her head and thumped her with the heel of my right hand. I thumped her hard, once, twice and on the third she lurched, vomited, spluttering a fat bolus of phlegm, vomit and milk onto my boot. A sudden, screeching breath later and she was right as rain, firm muscles wriggling against my arm, previously closed eyes blearily blinking at me. It was staggeringly close to swinging newborn lambs by their rear legs as a kid in Orkney.

My instructors from College spoke in my ear - “You have an infant with an airway problem, do the bare minimum and run like fuck.”

I grabbed a blanket from the chair in the lobby, laid it over her,said to Mum and Granny “We’re going to hospital, are you coming?” and walked out of the house and into the ambulance; whereupon I realised that it was just me, babyP (for that was her name) and Pally. I cradled her against me for a minute, checked her over again, took a breath. Pally ripped open a maternity pack and, using a manual mucus extractor, we gently and tentatively excavated the strings on phlegm from her mouth and throat.

Onto the trolley with her, tiny cardiac monitor pads, tiny SpO2 probe, tiny oxygen mask. Wrapp her in layers of blanket and strap her to the bed, radio call to nearest paediatric unit, chat to Dad “We’re going to move fast, don’t try and keep up, don’t tailgate me and don’t run red lights. We’ll see you at the hospital, don’t worry, we’ll look after her.”

10 minutes later we were in paeds resus, the team wrinkling their brows at our story.
“You gave her backslaps?”
“Yup.”
“You?”
“Yes, is that a problem?”
“Well, it’s just, you’re very big…and she’s very small.”
Pally stepped up to the plate for me.
“She wasn’t breathing on our arrival, Kal’s treatment cleared her airway and it did it fast.”
There was nothing more said. Cheers mate.

Standing in the background of the resus room while the team checked her over, found her well and handed her back to Mum and Dad, I felt the unmistakeable feeling of adrenaline come-down. I crossed my ankles, hugged my arms to my shoulders, literally and emotionally holding it together.

We left, Mum and Dad’s thanks in our ears and, once behind the curtain seperating the room from the corridor I slumped back against the wall.
“Are you ok?”
A staff nurse, standing at the corridor’s foot, looking at me cautiously.
“Yeah, yeah, just a funny job.”
“Bad job?”
“No, no, that’s the stupid thing, it’s a great job, patient’s fine, I’m just feeling a bit…”
She nodded.
“The staff room’s on the left, help yourself.”

We sat, the three of us, with instant coffee and chocolate biscuits, I’d called Control and told them that we were taking a break.

It wasn’t the fear of her death that rattled me, it wasn’t the fact that she was a baby, or that it was Christmas (though, granted, they both played a big part in my response), it was that “Thank fuck” moment when they passed me her. That moment of “This is my kid’s life. Fix it.”
Total trust, total expectation.
I did my job and I did it well, but I’m going to have to do some soul searching to get round my first paediatric death, when it happens.

That’ll be a post and a half, I can tell you.

Dear all.
Sorry for the apparent silence on the blog, I have my four month assessment on Thursd…shit, tomorrow morning and have been revising frantically. Wish me all the best, won’t you? Because nothing says Christmas more than sitting an exam.
Also, I KNOW that some of you are lurking, some are anonymous and that’s all fine, but if you’re a lurker who reads and never comments, just say Hi for me? Just once is all I ask, it would just be nice to stock-take and get an idea of how many of you there are reading this.

Cheers darlings, posts coming up about:

Poo
Christmas
Medical Students
and Left Ventricular Failure

Wooooo!

August 06 - His Mum had collapsed at the bus-stop, she was concious when we got there, but still groggy. He was holding it together, only looking concerned when a ‘helpful’ passer-by said “Anything you need me to do? D’you want me to look after the wee boy?”
His eyes widened and he side-stepped smartly to stand in the triangle formed by myself, my partner and his Mum on the floor, nodding fervently as I refused her offer - “No thanks, you’ll be alright with us, won’t you buddy?”

The three of us chatted on the trip in, she wasn’t seriously ill, just wobbly from an unknown source. He was full of questions, about the ambulance, the equipment, the ‘worst thing you’ve ever seen’, he assured me he watched Casualty, wanted to know how he could be a Paramedic when he grew up, which subjects he should work on at school. I booked his Mum in at hospital and wandered back to find him sitting forlornly in the waiting room; family members usually face half an hour of kicking their heels while their sick relatives are processed before they’re allowed to sit with them, not usually a problem, unless you’re a worried, solo eleven year old.

I stood him a Coke, filled the processing time with a more in-depth tour of the vehicle, let him take an ECG of his heart, printed out his BP, pulse and SpO2 levels, loaned him my steth so he could listen to his heart, lungs and guts. I suggested he look into learning some first aid as an introduction to the job. Satisfied, he hopped down from the tail gate and headed in to sit with his Mum.

December 06 - I’m helping at SMM’s first aid group as an impartial casualty, assisting with his first-aid students’ assessments when a familiar face strolls by. We lock eyes, he knows me, I know him and neither of us can place each other. I ask his name and on hearing it can place him instantly, a worried young face at a city centre bus-stop, I re-introduce myself as “the ambulance man”. We chat, his Mum’s fine, he’ll pass on my best wishes to her, he’s started studying first aid as one of SMM’s cadets.

I couldn’t be more pleased.

There aren’t many of them around anymore, but occasionally I like shrugging on the coat and trying to do a bit of community goodness.
We get kids coming up to the vehicle all the time. All. The. Time. Often they’ll run at you down the street bellowing at the top of their lungs “What happened? Who’s hurt? Is someone dead?”

Depending on how polite they seem (from the merely young and mee-maw fascinated, through the wide-eyed chancers right up to the malicious little scrotes who’ll try and nick your gear from the back of the motor) they’ll either get a “Oh nothing’s wrong, everything’s fine, off you go,” a sterner “Don’t be nosy,” or sometimes a blunt “Never you mind, bugger off.”

I’ve started carrying multi-packs of chewing gum in my pocket, it keeps my breath fresh and they make great “Thanks for not being a total little bastard.” gifts to kids who ‘guard’ the ambulance while I’m in a house, or carry the bag back to the vehicle. The way I see it, it’s worth keeping them on side, it might stop them lobbing bricks at us once they become teenagers.

Node and I were sitting in the motor last night having been yelled at by this woman, she’d got drunk and fallen from her wheelchair. Uninjured and again furious at our perceived meddling she howled and swore at me, threatening me with a stream of violence and injury. I caught her once as she mentioned her cat. “How is Angel?”
“How d’you know Angel?”
“I’ve been to your house before, I know Angel.”
She softened briefly, smiled and once again started roaring about how if I hurt Angel I would pay. Once I’d got her calmed down she signed the PRF, agreeing that she didn’t want to go to hospital and we left her to it.

So we were found, sitting in the vehicle in a supermarket car park, just round the corner from the pub, with the heater on, while I wrote up my paperwork.

A tap on the window. At the very bottom of the window.

I look down into two grubby faces, one short and skinny, the other gaining some adolescent muscle, I roll the window down, they stare at me, WeeMan and Muscle.

“Hi guys. What’s up?”
“That wifey’s still sitting there.”
“Which wifey?”
“The one you were talking to. Are you no’ takin’ her to the hospital?”
“No, she doesn’t want to go.”
“But what will she do?”
“That’s up to her, mate, she lives not far from here, she’ll get a taxi home I guess. What are you guys doing tonight?”
“Nuh’in”
“No? Staying out of trouble?”

WeeMan jumps in.

“He’s ALWAYS in trouble, he gave the teacher at school the finger so he got sent home.”

Muscle looks pleased with himself.

“And you’d NEVER do something like that, right? You ALWAYS behave yourself.”
“Naw, well, naw, but….”
“And I’ll bet you guys don’t smoke, either, do you?”
“*I* don’t smoke.”
“Or drink?”
“Awww, well, everyone drinks, eh?”
“No, no, they don’t. How old are you?”

Weeman drags himself so he’s standing tall. The kid is tiny, really, really tiny. I’ve always been pretty good at guessing kids’ ages, but I’m having problems coinciding my estimate with the fact that he’s out after dark. He’s so small and slight I could lift him with one hand, comfortably. My eyes tell me he’s about six, my logical brain argues that doesn’t compute.

“Ahm ten!”
“Ten?! And you drink? What do you drink?”
“Blue Wicked.”
“Mate, that’s really not cool, you’re going to end up dead.”
“Naw ah’ll no’!”

I have a moment of inspiration.

“You know how you will end up, if you keep drinking?”
“How?’
“Like her, that lady outside the pub. That’s all because she drinks, that’s how you’ll end up, in a wheel chair, missing a leg, getting scraped off the pavement by ambulance men.”
He looks sceptical, his friend laughs.
“That’s pish! Drinking’ll no’ make your leg fall off!”
“Aye it will, it knackers the blood in your legs and your leg dies, then it has to get cut off in the hospital.”
They quieten, Weeman is thinking hard, he comes to a conclusion.
“She’s radge, eh?’
“Aye, aye she is. Is that who you want to be in twenty years time?”
“Nut.”
“So no more drinking, right?”
“Right.”
“Shake on it?”
He shakes his head, offers more concrete oath, extends his fourth finger.
“Pinky shake.”
We pinky shake, they scuff off into the gloom, we call Control and clear, ready for another job.

She was blind and partially deaf, 85 years old, sitting up in her nursing home bed, she’d had chest pain earlier on in the evening after returning home from hospital that morning. While in hospital in the past week she’d had a heart attack which she’d recovered from well.

The nursing home gave her Gaviscon “To rule out any gastric complaint”, though this concept of ruling out a minor complaint when facing a potentially lethal one smacks somewhat of giving a paracetamol to a decapitation - “In case it’s a migraine”

By half past eleven she was really toiling, struggling for breath, grey faced, blue lips. Her eyes were wet, though this turned out to be more anxiety at returning to hospital, rather than the possibility of her imminent death.

I stroked the back of her hand to alert her to my presence, leant my mouth close to her ear and bellowed my questions, she smelled of Lily of the Valley and papery skin.

She grabbed my hand, wouldn’t let it go.

“You’ll not take me back to that awful place, will you?”

We ran up an ECG and my heart sank, there on her S waves (the big spikey bit you see on the telly) were elevated T waves (the spikey bits weren’t un-spiking quickly, but sloping gently down to their originating line). This is the most concerning symptom we look for, evidence of a STEMI (S-T Elevated Myocardial Infarction) or heart attack.

Once again I took her hand, put my head by hers and explained, I couldn’t leave her there, I just couldn’t. She nodded, “Whatever you think, you’re the boss.”

She smiled all the way out into the ambulance, though she was obviously in pain. She laughed heartily when I asked if this was all just a ploy to get men in uniform in her bedroom in the middle of the night. I apologised for taking her back to hospital, asked her if she’d rather come “to the dancing.”
She gave me a wink “Was a time, son, was a time.”

I don’t know if it was her demeanour, her age, her frailty, or the instant intimacy that was caused by our communication difficulties, but I found myself urging her to make it, wishing in my head that she’d be alright. I gave the nod to my partner who passed a standby to the hospital, alerting them to our imminent arrival, ensuring a medical team was waiting for us.
Her disabilities stopped her seeing the blue lights, hearing the sirens, though I’m sure she felt us shaking about the back of the vehicle as we sped to hospital.

Her nursing escort asked me, sotto voce, if we were worried. She asked me this as I knelt unrestrained on the floor of the ambulance, holding the patient’s hand and holding myself upright by shifting my weight with the vehicle’s high speed rocking. I gave her a look - “I don’t sit like this for the ones I’m sure are going to be ok.”

“So this is serious?”
“Yeah. Yeah, this is serious.”

Last I saw her she was sitting up in a cubicle, still smiling, now rosy cheeked, awaiting a discussion with a cardiologist and a taxi home.

We had a chat, squeezed hands, and I left her to it.
I love my job.

My job on paper is fairly straightforward, I take you, an abstract, analogue being, with feelings and emotions and I sieve, filter and categorise you, sliding you into a high tech health service.

I’ll reduce your heart, the centre for everything you’ve ever felt, to squiggly lines on an ECG that I can digitise and send over the airwaves to the hospital. It’ll be saved, in digital form, in your notes. I’ll interpret for your relatives at the hospital reception desk, choose one of a number of stock phrases to summarise whatever’s happened to you, disgregarding the pain and anguish you’ve felt, ignoring how grim it may have been for you.

You may well have agonising pain when you inhale, maybe you’re unable to breathe deeply, maybe you’re starved of oxygen, maybe you’re scared, maybe you feel you’re going to die, maybe you’re terrified for your spouse, your kids, spinning endless possible consequences through your head. It doesn’t matter a docken. As far as your notes are concerned, you are ‘pleuritic pain’.

And yeah, sometimes I’ll fix you, live up to everyone’s preconceptions. Ease your pain, relieve your distress, I may not even have to take you to hospital. If I can fix you at home and save you the journey, I will.

But there’s another facet of what I do. I stand in the middle of the weirdest shit, big heavy scary stuff, the dead and dying, people who’ve “not been seen in ages” who we find festering on their mattresses, surrounded by a stained outline that saves the police some chalk, people who’ve slashed their wrists in the midst of a houseful of screaming relatives.

I have a social task, I’m a cup, a bowl, a receptacle for grief and sadness and misery. My job is to stand in the middle of it all, deal with it, sop it up, and move on without going absolutely nuts. I’m a shit sponge, my professional distance allows me to not go mad.

I asked Node on my first day “Do you care about your patients?”
He explained that he hoped for the best for all his patients, but no, he didn’t care.
I didn’t understand.
Now I do.

Unfortunately a young man suffered a particularly eye-watering injury sometime ago, one might say he staked the family jewels on the outcome..

Fortunately we were passing at the time.

Unfortunately we already had a patient in the back of the vehicle.

Fortunately our patient , a 13 year old laddie, had stabilised.

Unfortunately I had no choice but to leave the youngster in the ambulance, unsupervised while I jumped out to assist my partner. I left him with clear instructions - “My name’s Kal, ok, if you need me, or anything at all, you stick your head out of the door and scream until I come back, ok?”. Jumping out of the back doors and scrambling to get my gloves on, I made my way over to the bleeding bloke.

Fortunately the police were on scene, holding the patient in the position he was found.

Unfortunately they were just preparing (with the best intentions) to do absolutely the worst possible thing to him, which could well have resulted in him bleeding to death in front of our eyes.

Fortunately I was able to stop them in time.

Unfortunately they weren’t inclined to believe me.

Fortunately a few *cough* well chosen words were sufficient to get them on my side.

Unfortunately they held a grudge and were later heard indignantly muttering “We were going to save him, but the AMBULANCE man wouldn’t let us…”

Fortunately the cops were big strong guys who could support the patient while we worked on him.

Unfortunately they didn’t have big strong stomachs and spent a lot of the time while supporting the patient dry retching. As the patient became increasingly hypoxic he thrashed about, ripping away his own flesh and falling free of his predicament. At this point, the cop holding his feet lost his lunch all over his boots. I tried very, very hard not to laugh and turned my attention to the massive increase in blood loss that was now occuring as a result of the patient’s actions.

Fortunately i had shed loads of dressings in my pocket and was able to arrest the bleeding, while my colleague poured fluids “wide open” into his veins.

Unfortunately, while packing his gaping wound I caught one of his testicles in amongst the dressing, a fact that only became apparent when I pushed the heel of my hand into the cotton gauze with all my weight and he opened his eyes and bellowed.

Fortunately I realised my mistake, retracted my hand and his ball and replaced the pressure, muttering an apology to him.

Unfortunately at this point i remembered my young asthma patient. Looking around i saw a woman hanging around the back of my ambulance. I grabbed a cop “Here pal, get that lady to chat to the lad in the back of my motor? Just make sure he’s not scared.”

Fortunately she turned out to be patient’s mum, who’d been following us into hospital. I’d not met her, as my partner had left me with her son when she went to speak to her.

Unfortunately since our ambulance already had a patient in it we weren’t able to transport the bleeding young man, so we weren’t sure of his prognosis once he arrived at hospital.

Fortunately the police let us know.

Unfortunately the news was that he was likely to die.

Fortunately he didn’t! He lived! Meaning that since there wasn’t likely to be an investigation I could blog about it.

Unfortunately the press got hold of the story, (though God knows who told them) and published the details along with his photo and name. Meaning that he’s totally identifiable and to write about it in any great detail would drop me in hot water.

Fortunately i have to write a trauma case study in my first year and this *totally* beats the classic RTA/ entrapment scenario that most probationers produce.

Every cloud, eh?