Continuing evidence as to how Len and Amber’s laddie, Dan, keeps me young.

We were trying to explain my family to the kids, with all the step-half-brothers and what-not and not doing a particularly good job, it was too convoluted; Hannah leapt up.

“I’m going to get some paper.”

Heidi followed.

“I’ll get a pencil.”

Dan is also on his feet.

“I’m gonna get a smart person.”

We laugh too hard to stand, I adore this kid.

Early evening and I’m standing in my kitchen, iron in hand, pressing hasty creases into my uniform while I slurp an instant coffee and cram satsumas into my mouth.

I sigh.

“I can’t be arsed tonight, you know? I really can’t.”
“Oh?”
“Honestly, all week I’ve gone to pish, utter pish. I can’t remember the last time I had a genuinely interesting job.”

Fate listens.

Half an hour later I’m surrounded by blue flashing lights on one of the City’s major commuting routes. A people carrier sits innocuously in the middle of the fracas, unremarkable except for the ‘bullseyed’ windscreen and the young lad trapped beneath it. He stepped out to hail a bus and misjudged the traffic, the car struck him, bent him double (he smashed with windscreen with his head) and he was then pulled under the front wheels. When we got to him his head was lying just in front of the nearside rear wheel. Another foot and he would have been a smear on the pavement.

The paramedic I did my first observing shift with is lying on his belly by the vehicle, he was the first medic on scene, I recognise faces, an off duty paramedic was cycling by and has stopped to help, as has an ED doctor heading home from his day shift. I quickly glance at the situation; I’m usually able to second guess paramedics as to what they’re going to do next and am able to make the first steps, but I’m not clear what their plan of action is. Only one thing for it.

“Hey guys. What can I do for you?”

There’s no hesitation, nobody clocks me for a probie and sends me on my way, my partner (God bless ‘im!) lets me get stuck in, despite being infinitely more qualified and experienced than me, stepping into the background as my gopher.

“Fluids, please Kal, and ten of Morphine.”

My partner catches my eye - “I’ll get the Morphine.” - while I dash to the vehicle’s wall mounted fluid warmer. We keep bags of saline in a dinky little heater, they’re constantly at blood temperature, since rushing cold fluids into shocked patients is an excellent way to exacerbate their condition. They’re also rather nice makeshift hot water bottles for cold people, not desperately effective at that, but the emotional boost of having something warm and soft to cuddle tends to do people good.

I digress.

Back to the car and I start to struggle, normally when I’m running fluids I’m doing it in the back of the ambulance where you can hang the bag from the ceiling while you organise the tubes and spikes necessary to run it into the patient’s veins. No such luck here, not even any spare firefighters (known as ‘drip-stands’ in the business, for good reason). An older man stands at the periphery, away from the group of rubber-neckers on the pavement, he’ll do.

“Here, you, hold this.”
I thrust the bag into his hands, he pulls them back as though I’ve thrown a Gin trap at him, waves his hands in my face.
“I’m not a medic! I’m not a medic!” he bleats, frantically.
“That doesn’t matter, just HOLD it.”

My plan was to put him at ease, just have him grip the bag while I ’spiked’ it and ran the fluid through the tubing. I must have done too good a job because he starts jabbering at me.
“Ooooh, it’s lovely and warm!”
“Huh? Oh, yeah.”
“I never knew you made them warm, it’s quite nice, I could stand here and hold it all day, how do you warm them up? Do you have a special machine that does that?”

A voice from the car.
“Kal! Fluids!”

I shove the spike into the bottom of the bag, grab it from him.
“Thanks mate,” and hurry back to the car.

Fluids being ‘pushed’ (poured into the vein as fast as possible), I’m finally able to get a good look at what’s going on. The lad’s not old, maybe 18 and lying on his back. He squirms and screams as the firefighters chock the car with inflatable hoists and wooden wedges, at the doctor’s request I pour another syringe of Morphine into his arm.

There’s precious little blood, but he’s obviously developing some form of shock, he’s pale, sweaty, shivering, complaining that he’s freezing cold. He’s losing blood somewhere, possibly into his abdomen, though as he’s fully clothed and we can’t reach him to cut them away examining him in this position is nigh on impossible.

What’s clear, though, are his leg injuries. His right leg won’t flatten, despite the limited space he howls like an animal anytime we try to unbend his knee, sobbing that his hip is sore, to please, please let him hold it up. I have to stare at his left leg for some seconds before I can work out that no, his shoe hasn’t come off, his foot really is twisted through 180 degrees and yes, his lower leg is sufficiently damaged that his heel is resting against the back of his knee. I’m looking down his body and his toes are pointing towards me, behind him. I don’t need to be a radiographer to tell you that that’s bad.

Having stabilised him, there’s very little else to do while we wait for the fire crew to lift the car sufficiently for us to extricate him. This is always a tense moment, fire crews are really big on safety, understandably, as they’re responsible for the ’site’ safety at any incident. Unfortunately, at times, their zealousness for ensuring everyone’s safety can spill over into other realms (such as our responsibility for the patient) and they can come across as being rude and bolshy, barking orders at other emergency personnel and starting to move equipment (and sometimes the patient!).

While all this isgoing on, I’m at a loose end, the first on scene medic is holding the lad’s head still, protecting his spine, the off duty doctor is briefing the trauma team from the hospital who’ve just arrived and my partner is lining up a spinal board, collar, blankets and a trolley ready for the patient once we get him out. His right arm is stretched out against the floor, the plastic cannula in his wrist bright against his pallid skin under the light of bobbing torches, his fingers lie in a half fist. I realise there’s something I can do.
I wriggle onto my belly next to the paramedic, slide my fingers into his and hold his hand. His grip is amazing, vice-like, his nails cut into the inside of my fingers, so intense is his reaction. He’s shivering from cold, but the tremble of his hand has nothing to do with the temperature, he’s terrified. I mumble a litany to him as the car is lifted further and further above us - “Alright mate, not long now, you’re doing really well, we’ll get you out of here, you’re going to be fine. Doing great, mate, doing great, good lad.”

A litany of my own mumbles in the back of my head “You’re lying in the road with a car hoisted above your head - I hope this fire crew knows what they’re doing.”
So do I.

We slide a spinal board under his shoulders and, with the help of as many hands can feasibly grab his arms, shoulders, clothes, belt, drag him along it’s shiny surface until he lies with his head between it’s orange padded shoulders. I fasten a collar around his neck to protect his spine and a padded box splint onto his left leg, holding it in some form of shape until we can get him to hospital.

Then it’s onto the trolley, into the vehicle. My partner, as the senior clinician, rides in the back with the trauma team while I drive us to hospital, fashioning a delicate balance between speed and comfort.

I left him in Resus, though checked on his progress with the receiving doctor later on in the shift, his lower limb injuries were as suspected, he had some internal problems, but nothing drastically life threatening.

I must look in on him this week, it’d be good to say hi.

Dial 999 and this man will arrive.

The man who:

Stalled the vehicle at lights and only noticed when he tried to pull away.
Dropped the fruit he was buying in the supermarket, having to chase apples all over the shop.
Dropped all his change while paying for said fruit.
Jumped out of the ambulance at a job, landing right in a big pile of dog shit.
Forgot that the power hose was broken, so that when he turned it on water and detergent sprayed out of it all over him and the washbay.
Stalled the vehicle while arriving at an RTA, surrounded by police officers.
Punched himself in the jaw while adjusting his collar.

Fills you with confidence, doesn’t it?

Oh, and further to that, and on the explicit request of Evilontheinside, here is a picture of a large rooster that belongs to him, allegedly.

I went to Prague, I took pictures, I will share them with you soon.

In the meantime work’s not been particularly eventful, though I have had a number of moments, such as:

The night shift where I slept for 8 hours at time-and-a-half.

Jimmying a door open with a credit card.

Kicking a door open with my big fat plates of meat (felt.so.butch).

Sent to a patient “with no heartbeat”. “Cardiac arrest?” we enquired. “No, patient states she has no heartbeat”. Riiiiiiight.

Opening the back doors at hospital to take the patient out of the ambulance just as the family of an apparently recently deceased patient came stumbling out of the front door and stood together sobbing in that blunt, blank, animal grief-ridden way that makes you shiver.

Being bailed out brilliantly by Pally when my car broke down - he picked me up with no notice and got me to work on time, drove me home afterwards, tried to jump start my car for me and, when that failed, returned that afternoon and towed me to a garage that he knew and trusted (and had booked me into!), stopping only to blurt out “I’m gonna be a Dad!”, apparently so full of the news he had to tell someone.

Being told by a patient, on hearing my Anglo-Orcadian twang “I’m glad you’re an Aussie and not an English cunt.” and subsequently altering my accent so I sounded like an extra from Neighbours, much to the confusion and later amusement of Pally as he opened the back doors and I greeted him in my new tongue.

Red -
The job’s in a tower block, not far from the pictuesque centre of town, we barrel down medieval cobbled streets, the vehicle’s radio antennae level with overhanging faux-heraldic signs. A hard right at a royal residence and we’re there, broken glass and concrete litter the ground, dog shit and needles, condoms and swollen rubbish bags.
The details of the job arrive halfway to our destination, we’ve been responding to “an emergency” up until we request further information. The block’s not a nice place, not somewhere to blindly storm upstairs, no point in battering in through a front door and finding yourself mixed up with knives, drugs, guns, or plain violent anger. It’s the kind of place you’d slide a torch into your belt before stepping inside. The radio chirrups, the metallic voice on the speaker “This is an 87 year old woman with diabetes, in cardiac arrest.”

The diabetes is a nice touch, while certain types of cardiac arrest can be caused by variable blood sugar, it’s very much a secondary consideration, we’re worried about the patient’s airway, breathing and circulation before we start making them toast and tea.

Into the lift, a puddle of piss to step around, I push the button for the third floor, the mechanism judders and convulses, creaks and screams and vomits us out onto a balcony, the wind blows clean and cold over the rooftops below.

She’s a big woman, purple faced and still as she lies on the floor, her fingertips pale against the 70s purple carpet. I kneel at her head, rake her chin upwards and her head back, twist a plastic airway into her mouth, securing her tongue. My fingers against the side of her trachea feel no pulse, my eyes along the midline of her chest, now naked since we sliced down the front of her teeshirt with shears, see no chest movement.

Defibrillation pads are pushed on, one on her clavicle, one on the base of the opposite ribs, the monitor shows us a flatline. I push oxygen into her mouth; her belly rises, bloody bile pours from her mouth. I’m inflating the stomach, not the lungs, so readjust her head, squeeze the bag again, with the same results.

“There’s haematemesis in the kitchen, looks like she’s aspirated.”

I nod at my partner, it appears her lungs are full of gastric juices, she’s drowned on her stomach contents which are maintaining such pressure in the lungs that they can’t be adequately inflated, chances are her lungs have been burned and partially digested by the stomach acid she’s inhaled. It doesn’t look good.

I rise up on my knees, put my fists in the centre of her sternum and push; knackered lungs or otherwise, she might still have a chance if we can stimulate her heart. My hands sink into her chest with a crunch, her ribs splintering and cracking under my weight, her intercostal muscles so flaccid they don’t support the bones at all.
Three minutes of CPR later and she’s still flat-lining. My partner shakes his head at the patients daughter.
“I’m sorry.”

“She’s DEAD?!”

Jesus, her tone of voice tells me that she hadn’t even considered this as an outcome; I wonder to myself exactly what this woman thought was happening to her mother.

We complete paperwork, cover up the body, call a GP and the police while the daughter and her friends make tearful phone calls in the hall.

Back out onto the balcony, back into the vehicle, sombre drive to station.

Amber -
“Collapse in city centre, CVA.”
We wrily exchange glances - “CVA? Didn’t know the staff at that location had the capacity to CAT scan patients.”
We’re cynical about this, the location smacks of transience, the diagnosis over the phone rolls our eyes. On arriving the patient is on a bench, his head on a jacket, he looks like he’s sleeping, staff mill about him.

“Alright guys? What’s going on?”
“We got the call that he was just lying there, we’ve not moved him.”
“Has he woken up at all? Said anything?”
“No, nothing…he doesn’t seem to be breathing much.”

I drop my ear to his face, listen and feel, watch his chest for movement. Nothing. Nothing?
Jesus, he’s not brea…
“Huuuuuuhhhh.”
“Breaths at two a minute mate.” My partner opens the response bag, digs out a BVM and O2, I look at the staff.
“Gimme a hand getting him on the deck, guys?”
Helping hands grab fistfuls of clothing, I support his head and we lay him out on the floor, I bag him vigorously, my partner slaps the pads on his chest. His heart is beating well, but the rhythm looks weird, I’ve never seen anything like it, not on screen, nor in text books.

“What is THAT?”
My mate shakes his head, sotto voces.

“I’ve got no idea, but let’s not piss about, eh?

Onto the trolley, into the ambulance, run like hell to hospital, one eye on his breathing, one on the monitor, pleading silently for him not to arrest en route. We leave him in resus, the doctors puzzling over his condition.

Green -
“That’s a job in GreatBigShop, in the Food Hall, cardiac arrest, RRU’s enroute.”
Gas to the floor, through the traffic, force the vehicle’s nose into small gaps between cars to expand them, switch the sirens over and over, notice me, move, notice me, move. The RRU is parked outside, a good sign.

“I’ll take a spare O2 in, right? You bring the bed?”
I nod, he pops his door, grabs the cylinder and jogs to the entrance, a staff member waiting for him to usher him in.

I wrestle with the trolley, roll it down the ramp, bump it over the kerb and hustle across the pavement, marvelling at the public’s ability to stare at us in our green uniforms without apparently thinking in the slightest that it might be a wise idea to get the fuck out of our way.

The staff member is at the door for me as well. “Your colleague said you’d need a lift to get downstairs, come with me, I’ve got security to open the goods lifts at the back of the store.”
We roll between displays of clothes, flowers, politely shoving little old ladies aside.
Into the goods lift, down a floor, the two employees with me speculating “I don’t know what’s happening, it seems pretty big, everyone’s shitting themselves.”
“It’s pretty serious.” I confirm.
“Yeah?’
“Yeah.”

Doors open, a manager stands outside the lift “They’re between yoghurts and cheese”, she blurts, waiting for me to move.
“Don’t tell me, show me, I don’t know the shop like you.”
“Right, right, of course.”
We’re off again, dodging afternoon shoppers, pensioners who’ve applied make-up to get their messages. These customers are well to-do, serenely picking out their wine and flowers, corpses aren’t a common feature in their days.

I notice that, while the staff who are stacking shelves and directing customers are dressed in green smocks, all the staff who are handling our presence are wearing black fleeces. Their name badges have “Emergency Team Member” across the bottom of them, they are apparently some form of GreatBigShop SWAT team, acting together to deal with crises on the shop floor.

The aisle I’m led to is cordoned off on both ends, portable plastic barriers stop public getting in and a Roman tortoise of black fleeced colleagues stands along each one, catching the eye of rubberneckers, calling their bluff, the politest “Can I help you sir? Then fuck off.” I’ve ever seen.

Two women are sitting inside the aisle, sipping chilled mineral water, compliments of the staff members who are standing by them, hands on shoulders, nodding sympathetically. They, a nurse and a cop, were apparently standing beside the patient when he collapsed. They started CPR and screamed for help. The younger of the two confides in me later “I think I broke a rib…”
I smile “I break them all the time, don’t worry about it, no-one will mind.”

My partner and the paramedic, a chap called District are by the patient. District’s on his belly, laryngoscope in the patient’s mouth, intubating him, while my partner breaks open the cardiac drugs box we carry in the response bags. The pads are already on, the tube’s in his throat. We’re ready to go.

“Alright guys? What can I do?”
“Bag him for the moment,” District replies “I’m going to get IV access. Give him this down the tube in the meantime.”

When patienst are in cardiac arrest we can give them drugs via a number of means, the best being intravenously, but a close second lies with putting the drugs straight down the endo-tracheal tube. These drugs end up in the lungs and, with vigorous ventilation, can be pushed through the lung tissue into the blood stream. District throws me two tubes of adrenaline. I’ve only ever seen drugs given down an ET tube, I’ve never done it myself. I pop the caps off the glass vials, screw plastic plungers into them and flip the lid off a small port on the side of the ET tube. The liquid dribbles down into the patient’s lungs, I hear it rattle and gasp as my partner bags it into him.

The monitor leaps into life; “Push…analyze” its mid-Atlantic accent yells. The adrenaline has kick-started the heart from it’s static position into VF, ventricular fibrillation. This rhythm is useless to the patient, as it means that heart is squirming and convulsing, not pumping blood at all. However, it IS a rhythm that we can shock, the electricity momentarily freezing the wriggling organ so that the brain has an opportunity to regain control and start the heart pumping normally.

My partner reaches for the monitor, charges it’s capacitors, calls out “Shocking - stand clear.”
District and I sit back on our heels, put our hands in the air.
“Clear.”
“Clear.”

The electricty floods the patient’s body, his back bucks against the floor, his hands and feet bounce, I slide my fingers against the side of his throat. I can feel a pulse!

“Output! Strong and regular.”
District grins.
“Good, keep bagging him, keep an eye on the pulse.”

I squeeze the bag steadily, breath in, breath out, in and out, my fingers feeling his pulse beneath them. It feathers, the solid beats reducing to a whispering, fluttering sensation, like a horse blowing out it’s lips. I can feel his heart losing it’s rhythm, starting to fibrillate.

“Output’s dropping…” I glance at the monitor as its alarms start to ring again, “…he’s arrested.”

We shock him again and again he recovers, stabilises and rearrests. On the third time I become aware of a presence over my shoulder, it’s the first CPR woman.

“Can I help you?” I ask.
“I just wanted to say goodbye, I’m, ummm, I just wanted to say goodbye.”
“That’s fine.”
“How is he?”
“He’s…he’s not as bad as he could be.”

My partner calls out “Rearrest, charging, stand clear.”
The woman’s hand stretches out towards his shoulder to pat him goodbye, District and I both shout at her.
“No! NO! Stand clear!”
She doesn’t stop moving towards him, I turn to my partner.
“No shock!”
I grab her wrist, push her back.
“Clear! Shock him.”
He lurches.

She’s tearful, apologetic, upset, explains that she just wanted to bid him farewell. A staff member takes her away.

We load him onto the trolley and begin the journey back to the lift, a SWAT member carrying our gear. He rearrests in the lift and, terrifyingly (as we’re all standing in a cramped metal box) we shock him back to life. An elderly woman stops us as we move towards the front doors.
“Who’s that? What’s that man’s name?”
“We don’t know, step back, please.”
“No,please, let me see him.”
“Madam, step BACK.”
“I think it’s my husband.”

You are fucking kidding me.

She lingers over his face for a moment, bursts into tears, shaking her head.
“It’s not him, it’s not him.”

Up into the back of the vehicle, leave the Rapid Response Unit there, District and my partner will stay in the back and I’ll drive up to the hospital. We’re there fast, a simple alert message passed “A&E, standby, repeat standby for 70plus male, cardiac arrest, ETA 8 minutes.”

Into resus and we’re all busy, I compress his chest while the nurses line up the “thumper”, a machine that performs CPR for you, District hands over to the doctor at the patient’s head and my partner returns to the vehicle to print out a summary of the whole event from the monitor. He’s alright, his heart holds up, he starts to make respiratory efforts on his own and is ultimately transfered to ITU.

District stands by me at his bedside. I’ve been nervous of him, to be honest, he’s known for being blunt and to the point and in my first month told me “I don’t care how well you did at college or how good everyone says you are, until you prove to me that you can do the job, you’re a pain in the fucking arse.”
He claps my shoulder. “Good job son. Well handled.”
“So I’m not a probie pain in the arse, then, District?”
“Oh fuck no, not after that. Good lad.”

We head back to the shop to collect the RRU and he and I step inside for a drink. We’re immediately swarmed by managers “Is he alright? I suppose you’re not allowed to tell us, are you?”
After a brief wrestle with the anonymity moral dilemma, we plump for “He’s not dead.” which they seem happy with. We’re able to give them his name so they can check on him later on in the day. The two CPR women were apparently put into complimentary taxis and sent home with bunches of flowers and they planned to send either the patient or his family a comparable bouquet, depending on the outcome. We got waved through the checkouts with our smoothies, the staff’s thanks ringing in our ears.

They were incredible, really, genuinely incredible, I can’t fault the shop’s handling of the job in the slightest and while I’m not allowed to tell you the location of the job, nor the shop in which it happened, suffice to say that this was not just any cardiac arrest, this was a GreatBigShop cardiac arrest.

Off to Prague with SMM this week, normal service will resume once we’re back.

All text in italics should be read as my thoughts.

“Hi guys…Hi, hi, I’m a third year med…ummm, I’m a medic, I’ve just qualified.”
“Oh right? What year?”
“Third.”
Golly, three years of medical training, he should be alright.
“Ok. So what’s going on?”
“Well, this is Louise, Louise has presented to me (presented to you? Who the fuck are you? Doctor Findlay?) after we’ve been out tonight, she’s been struck in the head and basically, she’s ummm, basically she’s got asthma and nausea.”
“Uh-huh.”
“That means she can’t breathe and feels sick.”
“Yeah, yeah, we got that bit.”
“I’ve been periodically titrating her inhaler medication to her breathlessness.”
That’s not that impressive, considering asthma inhalers are administered by the patient themselves as and when they need them. What’s more astonishing is that by looking at this girl, head injury ot otherwise, she’s obviously having a panic attack and hyperventilating, not having an asthma attack. The last thing she needs is salbutamol, a drug which will open her airways even further, pouring more oxygen into her and exacerbating her condition.
“So she’s taken her inhaler, then?”
“Yes, yes, but it seems to have brought little relief.”
No surprises there.
“Well, thanks for your help, we’ll take it from here, maybe you could all step outside and let us have a chat with Louise?”
Everyone troops outside.
The door reopens.
“Guys?”
Oh Jesus, why won’t he go away?
“Yes?”
“Just so’s you know, I’m actually a Doctor.”
“A third year medic, you mentioned, yes.”
“Yes, so, if you need anything? Just let me know.”
Pally delivers the killer line.
“Trust me mate, if we find ourselves needing someone who’s as qualified as you, we’ll call.”
He nods, smiles, looks confused, mildly offended, smiles again and wanders out, leaving us in peace to do our job.