So the bread was lovely, and this week I thought it best to approach the nice people at the local bakery.  Particularly the hot, blonde guy.

Aarayan was all for it “Just do it, just ask him, what’s the worse that could happen?”

And so, bravery in hand I headed off to the bakery.

To find no hot guy.

No matter, I’ll talk to his colleagues, do a bit of sniffing around, check the lay of the land and all that.

I approach the lassie behind the counter.

“Ummmm, this is a bit cheeky…”

“Yes?”

“But, there’s a guy who works here…tall guy, blonde hair, glasses.”

“Pablo?”  She look in horror at my uniform.  “Is he ok? What’s happened?”

“Oh, no no no, nothing’s the matter.  I was just wondering, is he, uh…single?”

She furrows her brow.

“Why?”

“Because…I’ve, heh, seen him in here and I’d like to get to know him.”

“You like him?”

“Yeah.  Well….I’d LIKE to like him.”

She stares at me, mouth flapping like a guppy.

“So does he have a boyfriend….or a girlfriend…or no-one…?”

“He’s got a girlfriend.”

Shit.

“Me.”

SHIT!

I gabble something unintelligible, pick up my coffees and flee, my face a beamer, begging the volcanic bed rock of the meadows to swallow me up.

The staff laugh as I run.

Seize the day, indeed.

THAT’S the worst that can happen.

Ooooh.I’m Post Of The Week at www.postoftheweek.com :D 

I once attended a young girl who, through a mixture of poor hand placement and youthful exuberance, had found the end of her left ring finger neatly snipped off by the hinges of a fire door.  Understandably distressed and in significant pain, she gave me no qualms as I prescribed entonox, coaching her on breathing the gas in to its greatest effect.

Which was all just dandy, but the kid was at school, her Mum wasn’t there and a nervous classroom assistant was accompanying her to hospital.  She watched the patient intently as the entonox numbed the pain, then became more agitated as the kid began to experience the giggly euphoria that can be a side effect.

“Don’t take too much…” she warned, but I was quick to dissuade her.  Thanks to the effects of the drug the tearful, panicking six year old had metamorphosed into a relaxed, smiling wee lump of laughter, her head back, face relaxed, eyes closed.

“Is she ok?” the woman fretted “I think she’s unconscious.”

“She’s not unconscious, she’s comfortable…and happy.”

“It’s just that we’re not meant to give them any medicine without their parents’ permission.”

Which throws up a difficult conundrum.

Clearly I have a clinical and professional responsibility to deliver the best possible care to my patients, including drug therapy and invasive techniques.  Where the patient is an adult, I seek their consent to do this, or assume consent if they are unable to give it.  With children, I look to their parents to give consent on the patient’s behalf.  In the absence of parents, we tend to endeavour to reunite patients and parents as soon as possible (A&E via the kid’s house, for example).

Things get muddy when a third party (such as the classroom assistant above) has parental responsibility, but lacks the authority of a natural guardian.  What use is a carer who can’t give consent to care? 

I’d be better off alone.

Which is where I found myself last night.

Seven months old, his granny babysitting, he didn’t settle all night and in the early hours of the morning she spotted his breathing wasn’t right.  It sounded like wet sand, rough and bubbling, but my stethoscope was redundant.  He grunted with each breath, sucking skin under his diaphragm as he struggled to inflate his treacherous lungs.

It was when I laid him across both my hands that I knew conclusive that he was sick.

You shouldn’t be able to feel a kid flexing his back muscles just to take a breath.

Already exhausted and worsening before our eyes, we explain to Granny that we need to leave and leave now.

“But his sisters are upstairs…I’ll need to get them ready…unless…”

“Unless?”

“Unless you just take him?  I’ll phone his Mum and let her know where he is.”

And with that we were left literally holding the baby, along with his physical, social, clinical and parental responsibility.

I try not to think too much about the immediate and enormous trust people place in us, the magnitude of it makes my brain explode, but this case illustrated it a little too thoroughly. 

It even changed my treatment of him.  Typically I’d have the patient on the trolley, the parent by their side for reassurance.  It didn’t seem right to care for him solely clinically.  We hooked him to the monitor and I cooried him up on my knee, rocking him until he calmed down and didn’t have to battle between screaming and struggling for breath.

Even Pally, hard nosed North Cunt that he is, was touched - “I don’t like the idea of him in hospital alone, I’m just imagining PallysLad in here without me, it’s not right.”

But, practically and medically, it was exactly the right decision to make.

It’s just that practical medicine doesn’t get to you.

It’s the social issues that do.

“Thank God you’re here, he’s really bad.”

He certainly looks it.

Rusty stripes down his chest and face, fresh blood steadily trickling over his neck and shoulders, he’s slight, short, still a bit pissed and slightly coked up.  He won’t tell us what happened, only that there had been a “Bit of an argument”.  His participation appears to have come to an abrupt end when someone put a hole in the back of his head.

“So when did this happen?”

“About two o’clock.”

We’re the day-shift.  It’s just past six in the morning. 

“So what have you been up to for four hours while your head bleeds all over you?”

“I’ve been at the hospital.”

*blink blink*

“And why are you not STILL at the hospital?”

“Well, I thought it wasn’t too bad, you know?  So I asked if I could leave.”

“And they said…?”

“No.  So I sort of insisted that I was leaving.”

“Uh-huh.”

“Yeah.  I…ummm…I don’t think they’ll want to see me again.”

“I see.  Were you abusive?”

“Well, not abusive, no.  I was insistent.”

“Did you threaten anyone?”

“Not really…I was just firm.”

“Ok, put it this way.  If your Mum had been there, would she have been pleased with your manners?”

He shakes his head emphatetically while staring at his boots.

“No.”

“So we can perhaps expect the nursing staff at the hospital to be less than pleased to see you?”

“Hmmm…Maybe I’ll stay here.”

“Nup. No way, mate, you need stitches.”

“Can’t you do that here?”

“Sorry.”

“Awww, man…they’re going to kill me.”

I feel sort of sorry for the laddie.  He’s hard to place, age-wise, but at a guess I’d go for seventeen or eighteen.  I figure it’s time for some worldly wisdom.

“I think this might be one of those times to swallow your pride, accept the fact that you’ve been a bit of a prick, man up and face what’s coming for you.  They’ll not be that bad, and, to be fair, it sort of sounds like you deserve it, huh?”

“I guess…” he mumbles, still shoe-gazing.

We drive to the ED, plonk the laddie into a wheel chair and take him to the nurses station.  Where they are not pleased to see him.

“You are KIDDING ME!  How DARE you walk out of here and then phone an ambulance to bring you back?  This is COMPLETELY out of order!  What if someone’s DYING out there and you’re using up these guys’ time because you can’t be arsed getting a taxi?”  She turns to us.  “Stick him in the waiting room, I don’t even want to LOOK at him.”

As I trundle him to the end cubicle he starts up, “Fuckin’ out of order talking to me like that, taking the fucking piss…”

“That’s enough, mate.”

“Not MY fucking fault.  Stupid cunts.”

“I said that’s enough.”

“Fucking bitch…”

“Oi!  Enough, right?” I point to the elderly woman also sitting in the waiting cubicle.  “This lady doesn’t want to hear your foul mouth.  Straighten yourself out.”

I snip his hospital bracelet from his wrist and head to reception to book him back into the hospital’s system.  While I’m walking his paperwork back to the nurses I clock his age.

He’s not a teenager, and hasn’t been for some time.

He’s 2 years younger than me.

And still a daft wee laddie.

“I thought youse were an emergency service,” she snipes “Me and Liz watched you unload, you took your time.”

“Yeah, well. The sign at the gate says you’re a hospital, we figured you’d be able to handle a real patient for a minute or two. ” I volley in return “Or are you out of your depth?”

She laughs and leads us to the ward, four beds with occupants of varying degrees of psychiatric distress.  Behind one curtain a voice is yelling at its limits.

“Check breathing, check pulse.  If no pulse, begin CPR.”

It’s metallic and jaggy, all electronics and cheap speakers.

It’s clear why the patient is wired to the shock-box as soon as I spot him.  Already skeletal, his puce, sallow skin is loose between his ribs.  Flat out on the bed his chin sinks to his chest, his mouth a startled “oh” at this sudden acceleration towards his terminus.

He is, however, alive.

The wire-frame armature of his ribs sighs up and down like a defeated accordion and I’m concerned, but not surprised to fail at palpating a radial pulse.  His BP’s crashing out, soon it’ll have nowhere to go, a physiological drunk sipping cleaning products with the radio on and the curtains drawn.

Surrounding this stricken old boy is the hospital’s “crash team”.  More accustomed to daily pysch evaluations and tinking with sedative dosages, this unseasonal flurry of emergency medicine has everyone shaken.  A flustered junior doctor looks crestfallen.

“Do you have any wide-bore cannulae?  We’ve only got greens.”

I always check the bag for paramedic equipment at the start of the shift.  Even before I went back to college for the para course I took pride in knowing that anyone could grab my bag at a job and find what they needed.  It’s extra weight to tote, but I can’t help feeling the alternative sells my patients short.

Milhouse flips the bag open to the IV board and the houseman selects a brown.  The biggest needle we carry, its point is as broad as the tip of a ball point pen.  I raise internal eyebrows at his chances of getting that monster into the patient’s veins.  Novice as I am at cannulation, his veins look crap to me.  Thin and weak, flattened from his shock, tentative, tenuous squiggles of biro-blue under sagging skin.

There’s already a moderately sizes cannula in one arm and its drip is running well.  The doctor seems intent on following the tenets of traumatic fluid resuscitation - “Bilateral wide-bore cannulae”.  But I’m thinking more of the advice from the consultants at college - “The biggest line possible in the biggest vein possible.”

Or, as I was taught at North.

“Pish with the cock you’ve got.”

I begin.

“So what’s the situation, doc?”

“Nurses found him unresponsive and called the crash team,” he begins “While we were assessing him he had a huge PR bleed.”

“Define ‘huge’”

“At least a litre.”

GI bleeds scare me.   Bleeding from wounds can be stemmed and the severity assessed.  Haemhorraging into your GI tract can develop suddenly, only become apparent once the volumes become sufficient to be expelled and, without surgical intervention, can kill people in short order.

“Oh, SHIT!”

I look over, the drainpipe he’s tried to put into the old boy has burst the vein, an accusatory purple dome rising under the skin.

We have a quandary, the doctor has clinical skills and knowledge far beyond mine, but I outstrip him in emergency care experience.  Furthermore, I know HOW to stabilise this patient, but until I’m registered as a paramedic I’m not allowed to DO it.

I decide that it’s better to run fluis at a moderate speed and transport then to hang around trying for the perfect IV.

“Doc, look, this green’s running fine.  Let’s push another bag while we move. I think he’ll need another once this is dry, don’t you?”

“Oh yes.”

“Right, I can’t prescribe that, but I’ll push it en-route with your approval?”

“Fine, no problem.”

Suddenly the patient is mine.  I rattle off a list of jobs: history, allergies, drugs, next of kin, transfer letter and a nurse escort, please.  The gaggle of staff at the foot of the bed leap into action as though electrified.

We’ve moving a very sick person to hospital very fast.

And we’re good at that.

Fair enough, this job’s unpredictable. You never know what’s coming down the road, what the radio holds for you.

But there are certain calls that you can apply a blueprint to, an overlay that the job fits into on the majority of occasions.

Like drunks.

“There’s a man lying on the floor back there, he’s not moving, he might be dead, or drunk.”

The call handlers will respond with a barrage of questions and, typically, because the caller is too hopped up on media pish about the dangers of approaching other members of the human race who may be in distress, they’ll respond:

“Well I don’t know, I drove past him a minute ago.”

Typically we arrive at drunk people and wake them up, give them a minute to get their shit together and then make an educated decision as to what the best course of action will be. Mostly that involves:

“D’you wanna go to hospital, pal?”

“Nut.”

“Off you go then.”

“I’ll just sit here.”

“Naw you’ll no’. We’ll just get called back. Get yourself up and away or you’ll be lifted.”

And up they get and off they fuck. The threat of involving the police and all the associated hassle that brings is normally enough to get the most dedicated drunk on their feet and heading off into the sunset. If they can’t walk, or we’re concerned about them, they go onto the trolley and sleep it off in a cubicle in A&E.

See? Easy. How to be a paramedic in three easy lessons, tune in next week for pharmacology.

Our plan falls flat, however, when there’s a language barrier. And these days there’s frequently a language barrier. The Polish community has swollen in numbers in the city over the past year and, frankly, we tend not to see a lot of them. They’re unlikely to phone us, treating themselves in their own houses the majority of the time, only dialling 999 as a last resort. I like them, the majority of Polish people I’ve met have been pleasant, polite and extremely grateful for our assistance, which is more than can be said for some of our home grown scavs.

But some of their young men have responded to their lack of work by hitting the bottle, and we now have a core group of jakeys in town who do not speak English. This makes the whole “On your toes and off you go” process somewhat more complicated and several unilingual Poles have found themselves in A&E bemused, a long way from home and thoroughly pissed off.

This week Pally and I decided to sort this out, we nabbed a friendly Polish porter at hospital and had him teach us some basic phrases. Mostly I wanted “Hospital” and “Police”, so that I could give folk the two options.

“No problem - that’s ’szpital’ and ‘proszę’.”

-

And so, fully armed, my mucker and I head off to a “male collapsed” on the Royal Mile. The bottom half of this illustrious address is a contradiction in itself. At the top of the hill there’s Edinburgh Castle, at the bottom, Holyrood Palace. The Scottish Parliament building occupies the foot of the street in all its controversial Miralles splendour and half a block from it all stands the Sally Army homeless shelter and one of the scabbiest, most notorious estates in the city. Tourists gape at us as we pull up, cheap tartanry spilling out from their seams; goths and emos from Cockburn St slope past, muttering and giggling at us towering over the shabby young dude crashed out on the slabs.

We shake him awake, check him over, and with our best accents on questioned him

“Szpital?”

He waves his hands in front of us.

“No…no.”

I shoot him some evil eyes and break out my big threat.

“Proszę? Hmm? Proszę…szpital?”

He sighs, shrugs and drags himself to near-standing.  We huckle him onto the trolley and I roll off to A&E, pleased with my application of new found skills.

-

Having dropped him off, I’m grabbing a cup of tea when I spot Moley and Sloth the Polish Porters.  I give them the good news, how my proto-polish has made me a more efficient greensuit.

“But we need more words.”

“Uh-huh?”

“I need to know ‘What’s your name’? ‘Where are you sore?’ ‘How old are you?’”

“And we need to know ‘Get up!’” laughs Pally from behind the kettle.

“That’s easy,” says Sloth “It’s ’stavai’”

“Whoa…whoa.” butts in Moley “You cannot say ’stavai’ to someone, I would say ’stavai’ to my dog. It’s rude.  You should be polite, maybe say ’stavai, proszę?’”

I’m confused.

“Why would I say that?”

“Because you should be nice to people.”

“But how is saying “Get up, police”….oh!”

I explain that I don’t need to say ‘please’, but threaten people with the cops.  Everyone laughs at me, noone more than myself, realising I’ve been aggressively pleading with drunken people, frog marching them down the street while glaring in their face and insisting “Hospital, please?  Please! Please!”

No wonder they were so compliant, they must all think we’re desperately concerned for their welfare!

There are two places to buy coffee in the Meadows. There’s Peter’s Yard, the amazing Swedish bakery with the honesty box coffee (come in, pour it, pay for it, walk out) and beautiful artisan breads. And there’s Starbucks.

Peter’s Yard is cheaper, friendlier and serves better coffee.

No contest.

Especially since they randomly chucked free bread at me today, a large sourdough (mmmmm) and a tomato/garlic rustic (mmmmmm).

So, Peter’s Yard, Meadows, Edinburgh. They rock.

Also - if anyone knows the really, really gorgeous Nordic looking guy that works there?

Introduce us, won’t you?

A letter from the Procurator Fiscal regarding this day.

“Dear Mr. Traumaqueen - your attendance as a witness on the ##th of ### is no longer required, due to the following reason:

A warrant has been issues for the accused’s arrest.”

Which, forgive me for saying so, appears to translate as.

“Dear Kal.

We lost the boy.  Sorry.”

I was thrilled to see that “You Are No. 3” had been chosen for inclusion in the WarChild fundraiser “You’re Not The Only One.”

It’s always nice to see your work in print, so I’ve ordered a copy from Lulu, proceeds go to a good cause, so naturally I’d encourage you guys to nip over and pick up copy.  There are loads of quality writers in the collection, a fine bedtime read all in all.

I was disappointed, however, to reread my work.  Written in a state of emotional comedown, it now feels weak and flabby, overly wordy, poorly phrased.  Never mind, hopefully as people read it for the first time the impact of the day will be communicated.

What made me laugh, though, was realising that I’d typoed a word in the piece.  I’d meant to write “We’ll take the kid to resus” but instead have written “rhesus”.

Let’s hit the road, this baby needs monkeys and he needs them stat.

Tuesday afternoon I’m driving home after a long, sticky day riding the bike around the city centre.

Hours on the bike - 8.

Jobs I was called for - 0

Jobs that occured within my patch but I wasn’t called for - at least 1.

I’m grumpy and sweaty and tired, I want a litre of chilled orange juice and some fruit and then I want to go to sleep.

A man approaches me across the forecourt of Tescos, a rag in his top pocket, a squirty bottle of something frothy in his hand.

He beams at me and, in heavily accented English - “Hello sir, can I clean windows for you today?”

I don’t even think about it, wave my hand, don’t even smile.

“Not today.”

Shoo fly, don’t bother me.

As I walk to the front of the shop I see him turn away, his smile slips, his shoulders drop, his friend is sat on the wall, he shakes his head.

Why am I being such a dick?

I turn around.

“Hey mate! How much?”

“A pound?”

“Do a good job and I’ll give you two.”

He grins massively, runs to my car.

While I’m queueing to pay, I watch him bobbing up and down as he polishes the glass, squinting from different angles, getting all the smears.

He does a not bad job, I give him the quid and the rest of my pocket change.

“THANK you, sir.” his pleasure is almost embarrassing.

-

Anyone who lives in Edinburgh will have been approached by sob-story beggars.  The patter normally runs : “Hey pal, sorry to bother you, but my wife’s gone into labour/my bag’s been stolen/ I’ve been mugged/ my eyebrows are slipping off/ my wee boy’s at home alone with a hungry polar bear/there’s an international diplomatic emergency and I really need to get the bus.  GOD this is so embarrassing, I’ve been asking everyone, I just need another 50p, but nobody will help me, I’m so sorry to bother you, I’d never normally ask.  Thankyou, thankyou, God bless you, blessings be upon your house.”

The stories are so convoluted and rehearsed it’s often easier to give them 50p, just to make them fuck off.

At least the guy at Tescos is offering something in trade.  Fair exchange is no theft.  I’ll pay to have my windows washed with diluted Fairy liquid any day over being subjected to a tired and hackneyed story of misfortune and misery.