It had to happen, the city’s getting increasingly violent.  Gang culture and violent retribution is becoming more accepted.

The city’s fog bound, darkness falls earlier as a result and transforms this friendly suburbia into the stage for a stand-off.  An urban Tybalt stands on the pavement, trainers worth more than my daily wage, jeans sagging, a sharp hair cut, gold stud in his left lobe.

His shoulders slumped, all his bravado and swagger draining onto the kerb by his feet.  The weapon on the floor in front of him, his opponent sliding forwards to check it out, sniffing over it, securing it under his toe.  He looks up at the lad and growls, stares him down.

The gunslinger’s face is streaky, tears and snot drying to a new facade across his, a terrified laddie out of his depth.

We drop the window and my mate leans out to speak to the tot.

“You alright, buddy?”

He gasps back through tears.

“The…the cat won’t gimme my GUN BACK!”

We hop from the cab, shoo the pet off into the bushes and rescue the lurid yellow plastic Super Soaker.  He snatches it up and runs for the hills.

‘Nother life saved.

But my response to this is simply “Splendid.  Carry on.”

Darwin is alive and well.

I know you’re all expecting the results of this week’s Chinese Calum Challenge.  I know it’s late. I know I suck.

Sorry.

Have spent the weekend at Len and Ambers.  A good friend of thiers has been steadily losing a battle with cancer over recent weeks and I headed over to the house to watch the kids so that L&A could be with Alisdair and his family.

It was clear on Saturday that Alisdair was worsening, the details that Amber related to me in hushed tones triggered pictures of other patients I’ve seen in similar conditions.  His middle daughter came over and myself and the five kids sat up late watching movies and American trashy TV, midnight snacks, YouTube, stupid jokes.  Pouring fun onto the smouldering, nagging knowledge that her Dad might not be about when she woke up.

Amber returned to the house in the morning and gathered the lassie up into her arms and car.

He’d gone.

I cleared the bottom half of the house out to let them have a minute, ferrying kids up the stairs with a hissed “Because I *asked* you to…”, then sat the two youngest down and explained what had happened.  There were tears, understandably , but also the quiet, flattened stares of kids who are struggling to vocalise emotions.

I know you’re supposed to offer them words at that point, give them yes/no answers to try and make sense of what’s going on.

“You ok?”

A head shake.

“It’s a very sad thing.”

Nod.

“And maybe a bit scary?”

Nod.

I stopped there.  Because I had a feeling that what was scary was the idea that a parent can die…and if HER Dad’s dead, then maybe MY Dad could die…

There was, however, the chance that that link hadn’t been made.  And I’m fucked if I’m planting a seed of that magnitude.

Amber left, the kids slouched on the sofa, tired from a late night, rattled by bad news.   I figured it was time to intervene.

“We should go out…let’s go to the park.”

“The park sucks.”

“OK.  You come up with something.

“Let’s just stay here.”

“No way, it’s too nice to lie about all day.  Let’s go out somewhere.”

Hannah, drenched in teenage sardonicism… - “We could go to the beach.”

I checked the map.  We are exactly equidistant between Scotland’s east and west coasts.  Austria has more accesible beaches.

But I’ll take the bone when it’s thrown to me.

“The beach it is, then.  We’ll go to Troon.”

(Troon has a beach, right?  I’m sure it does, it’s like Cramond, right?)

“Can we take our swimming stuff?”

“Nah, you’ll not need it.  You can paddle.”

To be honest, I wasn’t really expecting to GET to the beach.  The four of them were in such a grump, I figured we’d get to somewhere between here and Troon and decide to go THERE instead.

We all piled into Len’s insanely nippy car, because my car is just fine if you want to drive somewhere without passengers.  Also? My exhaust fell off on my way over here, so while it SOUNDS like Len’s car, it doesn’t GO like Len’s car.  And I’m not driving to Troon at 40miles an hour.

Len’s car had an olfactory memory of petrol in its tank, so we limped to the nearest garage and I chucked a tenner’s unleaded in it.  I also chucked a bag of Opal Fruits in the back seat, climbed into the driver’s seat and turned the key.

Nothing.

Another shot.

Nothing.

Oh fuck.  I’ve broken down, in my mate’s car, somewhere in a Barrat home/industrial estate toilet shit-hole in east Ayrshire.  With four grumpy kids.  And I can’t phone the owner of the car/children, because they’re dealing with a grieving family.

Key turn.

Nothing.

Fuck.

Fuck fuck fuck fuck fuck fuck fuck.

Nothing for it.  I decided to phone Len - if these kids aren’t entertained, they may flay me alive and leave my skinless corpse swinging from a tree.

I dug my mobile from my pocket.

No bars.

Fuuuuuuuuuuuuuuuuck.

The dashboard flashed a red key at me.

Bingbingbingbing.

Ohhh….immobiliser.

Puh-plip.

Vrooom.

We roared off into the sunshine, played tunes on the radio and ever so slowly, the voices in the backseat began to brighten.  By the time we’d arrived at Troon (having found nothing else to do on the way; what are the odds in Ayrshire, huh?) they were like whippets on leashes - “I can see the seeeeeaaa!”

“Can we swim?”

“You can paddle.  Roll up your jeans.”

They rolled up their jeans to their knees…and battered into the waves up to their waists.

It appeared that I had greatly underestimated the draw of the sea…and overestimated my ability to keep them out of there.

There were setbacks.  The four of them got completely soaked, clothes and shoes and all.  By some genius logic, they all decided that, having drenched their clothes, it would be best to strip off their outer layers and swim in their underwear.

“Because then our clothes will dry in the sunshine.”

These kids have read too much Enid Blyton - in my experience, clothes don’t ‘dry in the sunshine’ - they get covered in damp sand and end up abrasive, cold and soggy.

They swam and chucked seaweed at each other and collected a horrendous ZipLoc bag of various, malodourous dead marine fauna.

I waded in with my jeans to my knees and took photos, pretending I was Anton Corbijn.

Thing is, I don’t think Anton Corbijn ever said to a thirteen year old “It’s fine, we’ll leave the stuff here, it’ll be safe, the tide’s going out anyway” before turning around to find the tide had come in and swamped all the towels.

Oops.

Damp and sandy, we all clambered back into the car and slurped on ice-creams while we drove home, distracted, tired and sun-kissed.

Pictures to illustrate will appear on Flickr just as soon as I’ve processed them.

A straight fall backwards, no trip or stumble, no complaint of dizziness.  Just a sudden drop from perpendicular to parallel, arrested only when the back of her head smashed into the kerb.Sitting up on our arrival, Meridian the RRU Paramedic raising her eyebrows at us.

“Blood from her left nostril, Kal.  Really watery…left eye’s funny, too.”

Nosebleeds don’t phase me.

Watery nosebleeds scare me shitless.

The brittle little doll of a woman leaning back against the railings tips me a wink.  Her right eye blinking rapidly at tears, her left staring straight ahead.

Once she’s on the bed with her spine secured I can take a closer look.  Both pupils focus, both cower down under the beam of a torch; but only the right will close.  The left glares accusingly at me under a collection of grit and dust, the surface visibly drying as I look at it.

I stroke my fingertips over her eyelashes, a trick we normally exploit on ATIT unconscious patients.  Your nervous system can’t help but blink when your eyelashes are stimulated.

Unless it has suffered a serious insult.

Like having the bottom of your skull stoved in against the pavement.

And drowning your brain in blood.

I soak a dressing with saline and lay it over the eye.  Protecting her cornea is a long way down the list of priorities, but short of trepanning with a biro, it’s all I can do for her in the vehicle.

She babbles to me en route, grabs at blankets, seat belts, BP cuffs.  I sacrifice a third set of obs for holding her hand and softly shushing her frantic, meandering yammering.  Clinical responsibility has its place, stabilisation and rapid transport is right there alongside.  There’s a time for reflective jackets, flashing lights, vehicles slewed across lanes of traffic, torch beams in the dark.

And there’s another for recognising that your patient is scared and alone and dying.

While working on the para-bike and attending to a pleasant lady with a dislocated shoulder.

Turns out she didn’t quite get the “Working solo is harder work than with a partner” thing.

She gestured towards the mountain bike: “So how long do you have to ride that before you’re allowed to drive the ambulance, then?”

Some of you may remember some months ago when I was raving about the brilliantly monikered Turtle Bunbury and how I was then subsequently embarassed when Mr B got in touch. 

Turns out he’s a charming chap and we swapped some very pleasant emails.

Jen over at Spiral Skies has been caught by Keith Chegwin (I know, I know) being a little…ummm…ascerbic about his SwapShopness.

He’s not too pleased.

I think its hilarious.

(Sorry Jen….)

Get your guesses into the comments, the results will be posted in a week.

(BTW - if you guess this…you’re a better man/woman/hermaphrodite than me)

When an unstoppable force meets an immovable object…something happens…I don’t know…I did biology.

What I did discover, however, is what happens when Norrie meets an observer.

Allow me to explain.

Norrie rocks the house, he’s not long qualified, but is firmly in the “Thank god” camp of the “Who would you like to see back you up when a job goes south?” acid test.  Calm, fast and personable;  he knows his job and helps you do yours.

Which is just as well, because whenever we work together, things go wrong.

Really badly wrong.

People throw warm corpses at us, the breath of babies dwindles away from us, carnation red vomit sprays the walls, heads unravel before our eyes,  patients develop new orifices.

Recounting our memories at the start of our shift, we both levelled the same accusation at each other.

“You’re a fuckin’ Jonah!”

So it was with much trepidation that we drove out of the Station gates, ready to face whatever medical emergencies the people of Edinburgh had for us.

Which turned out to be remarkably little.   One little old lady who might be in DKA or might be septic, it was unclear which;  she was the scariest patient we saw all day.

Hardly taxing.

Four hours before the end of our shift, Smeats came and joined us for a bit of observing.  The “curse of the observer” is well documented, people come out wanting to play at being nine-one-one rescue heroes and instead spend the entire day assessing urinary tract infections.

We had time, the three of us, to sup coffee in the city centre and discuss Smeats’ recent work at T in the Park.

Until twenty minutes to twelve, a mere third of an hour away from the end of our shift.  Outside the rain is pouring from the sky in metric tonnes, it’s cold and dark and miserable.

“That’s a two car RTA on HardToFindButProbablyVeryFastCountryRoad, no word on casualties, but the fire service are making for it too.”

Norrie and I stare at each other.

“This is your fault.”

Smeats is electrified, bobbing up and down in the passenger seat.  Norrie and I are more subdued.  The thought of a long running late call in the pouring rain and pitch black, potentially with critically injured patients doesn’t excite either of us.

The curse of the observer has been defeated.  The job’s come in.

Except that half a mile down the road the Cab Based Terminal chirps at us, a big grey box over the map “Stand-down received, please confirm.”

When an irrepressibly unlucky crew meets an irrepressibly unlucky observer?

The crew wins.

A gigantic orange and gold sequined wizard’s hat, with black cobwebby dangley bits.

THAT’S WCCGOHH.

The only person who guessed correctly was Luvgugs, who can away and shove it, as she has an unfair advantage, having SEEN the hats in our flat.

To that end, we’re left with selecting either the closest, or the most entertaining guess.

There was fierce competition in the guessing stakes, with a great many wild submissions, once the blue touch paper of “A hat” had been lit. You can view the entries yourself, they make good reading.

As is, I’m going to select GuitarGirl RN as this week’s winner, for her suggestion of “A large, white, ten-gallon hat with a humungous curving ostrich plume in the brim. And inside the crown are six hundred-dollar bills in case he ever makes it to Vegas.”

The judges (that’s me) were drawn not only to GuitarGirl’s highly specific guessing, but also the hint of dreams and pathos in the image of money.

Poor wizard Chinese Calum…dreaming of bright lights and the cabaret stage, stuck in his castle, casting beard spells to pass the time.

GuitarGirl? Get in touch (kalATtraumaqueen.net) and we’ll discuss sending you your prize.

The rest of you? Stick around - round two starts tomorrow!

Rockin’ out to the Queen riffs in my head.

The comments on “Patient Advocacy” have turned into a discussion on the use of ICE on mobile phones - the concept being (for those who are not familiar) that you have an entry in your mobile’s phonebook under “ICE” in which you list an emergency contact, just in case you’re horribly incapacitated and we’re not able to find out who you are and who you belong to.

ICE isn’t something that we habitually check for on all mobiles, but it is an avenue that I’ve explored in the past with people with no ID in their wallets. Sadly, the information is often woefully inadequate; what I’d really love is for ICE to list:

The patient’s name
The patient’s address
The patient’s date of birth
An emergency contact name and number
Any medical conditions the patient suffers from
Any medication the patient habitually takes
Any allergies the patient suffers from.

Modern mobile phones are more than capable of holding this much information in basic text fields for each contact, so there shouldn’t be a problem

There are countless projects all over the world trying to standardise the information held therein, and I know of one Cambridge student who’s doing research into the feasibility of a national database (Hi Jat!).

But the info above is what I’D want from an ICE, so go put it in your phone right now, then do it for your family and friends.

Right now.

Medical professionals with extra information they’d like to see added? Please list in comments below.

——EDIT—– ImpactEDNurse is also blogging about ICE this week, with a different take on the solution.  Personally?  I kinda like his idea.——