“Male collapsed” turns out (on arrival and with some by-stander discussion) to be one of our regulars who “Just stepped off the kerb and laid down in the street”

“I was trying to throw myself under a bus,” he whines “But there weren’t any coming.”

I have to say it.

“You know, pal, if you’re gonna throw yourself under a bus? You’ve gotta check the timetable.”

He nods sagely, the empty vodka bottles in his pocket rattling and clinking against themselves.

More tubes, more cannulae, more LMAs.

There’s something very wrong with hovering, vulture like, around patients who are awaiting surgery - “Are you going in for major surgery? Oh good!”

Had a cannula/IV epiphany. The WHOLE tube doesn’t have to be inside that vein, just the end (I knew this,logically, but had never really applied it). So if you want to spike the patient well distal to the vein and then just sneak the tip of the needle in there? That’s just dandy. No more “The tube’s too long for the vein” nightmares in old people.

The fearsome anaesthetist that EVERYONE told me not to even ask if I could work with, turns out to be a taciturn, no-holds-barred outstanding teacher. I got three words into “Excuse me Mr Anaesthetist, my name’s Kal, I’m the trainee paramedic and I was wondering if I could come in with you for some airway management?” when he snapped
“Yes, you can intubate my patients.” and marched off into his office.

That’s all I needed to know

So…three days in and I think I’m getting the hang of things. Each day I review the surgery lists, evaluating which patient is likely to need intubating (versus other means of securing their airway) and then casually chatting up the anaesthetists and OD Practitioners “Sooo…I was wondering if I could get any airway tuition on this patient?”

Some of them say yes, some of them say no. Some of them say nothing, because I’ve been warned not to even bother asking.

Most of them say yes.

And their training systems range from hanging over my shoulder, occasionally reaching to my laryngoscope and correcting my technique to standing across the room and watching me do it all on my own. I seem to have gained their trust a little, at least so that they trust me to say “I can’t see a thing, I need your help” when this is the case.

As a whole, I’ve been hugely impressed with their acceptance of me, a stranger, wandering into their work place, pointing at people for whom they have total clinical responsibility and saying “Hey…can I intubate that dude?”

But so far, I’ve intubated five patients, still struggling a little with intra-venous cannulation, but some training there from a friendly consultant this afternoon seems to have set me back on track.

I’ve taken to introducing myself to patients before we take them into the anaesthetic room, because up until now I’ve been hovering behind them and then, on the doctor’s nod, clapping an oxygen mask over their face. It’s sort of like therapeutic mugging.

Now though, I meet the patients in the theatre suite, shake their hand and say my newly rehearsed line:

“Hi there, my name’s Kal, I’m a trainee paramedic…I’ll be working with the doctor today when we pop you off to sleep.”

Some of the patients have joked about me being a student, but nobody’s had a problem with it.

Which is good, because, if I were telling the truth, I’d be saying.

“Hi there, my name’s Kal, I’m a trainee paramedic…once you’re unconscious, I’ll be responsible for keeping your airway open and breathing for you. Your body chemistry will depend on me not making a twat of things. After that? I’ll be performing a procedure on you that, for clinicians of my calibre, is typically reserved for people who are effectively dead. Don’t worry, though, because I’ve performed this procedure…ooooh…four times before.

I’ll be shoving a big metal blade in your mouth, squashing your tongue about and occasionally scraping your teeth (sorry, I’m nervous). Then I’ll stick the end of it way down your throat, dig its tip into the soft tissues at the base of your tongue and damn near lift your head off the table. I’m not sure if your tongue is meant to suspend the weight of your head. Meh. Not my head, not my tongue.

Then I’ll take this stiff plasic tube and push it waaaaay down your throat. I’d imagine your throat will hurt like a motherfucker when you wake up.
But I’ll be long gone by then. See you in the anaesthetic room!”

Really?

If you’re on a training placement in operating theatres, what does one wear?

Personally, I went for the “Go out and buy slacks and a shirt - fuck me, I look like an second year foundation doctor” look.

Which was good, for the whole ten minutes I had them on before I got changed into scrubs.

Mmmmm…working in pyjamas and trainers…gotta love it.

Hogmanay, 2006, FriedBanana and I in the office of the boss, staff shortages means that we are two newbies flying solo for the first time, Boss summons us in.

“Just be careful, lads, aye?”
“I was thinking, boss, if we’re not sure what to do? We’ll put on lots of oxygen and drive very fast.”
“Perfect, good lad.”

-

Sarge leans against the vehicle at the end of my first day.
“You know you know fuck all, right? Regardless of how well you do at College, you come out here, you know fuck all.”

-

Grissom in the mess room.
“You want some advice? Stop trying to do twelve things quickly, do one thing well…oh, and stop trying to talk to dead people.”

-

Nelly in the mess room.
“You might be pleased to know you’ve been graduated from “Wank, with good guy tendencies.” to “Good guy, with wank tendencies.” Congratulations.

-

District in resus, a solid sinus rhythm on the patient’s ECG.
“You’re an ambulance man now, son.”

-

Kojak in the attendant’s seat.
“Kal? I’m shitting myself.”
“Me too. S’cool.”
-

DoctorKev riding shotgun in the back, transferring a flattened, but unintubated baby.
“You got his airway?”

-

TraumaDoc, lecturing at college.
“We are nothing but elaborate mechanics. We learn new skills to put air and water into people in increasingly clever ways.”

-

Patient who wasn’t known to be allergic to anything, but looked, sounded and described early stage anaphylaxis to a tee. I jagged him with the adrenaline anyway, figuring I was more concerned about his comfort than a bit of tachycardia. He phoned his mum, breathing easy for the first time in hours.

“I have two green angels in my house!”

-
Doctor in resus.
“So if your SVT patient has both AF AND Wolff Parkinson White and you give them Amiodarone, you run the risk of them conducting the AF and knocking them into VT.”
Me (in my head)
“Fuck me…I think I understand that.”

-
DTO ChaCha, on station the other day.
“You still keeping your blog?”
“Yup.”
“Novelty hasn’t worn off yet?”
“Well, when I started, I was writing very much from a “Oooh! Look at what I get to do!” point, but as I progress I’m beginning to think that, actually, I understand quite a lot of this stuff.”
“Good. When’s your hospital placement?”
“Monday.”

And this is where this post is going. As of Monday morning I’m working in BridgeHospital’s theatres and A&E for three weeks, learning the practical skills that I was taught in theory while on my paramedic course. I’m going to be intubating real people.

Real, honest to God people.

I’m shitting my pants.

However, I’m also going to spend three weeks being taught by people at the absolute top of their game; I’m a big dry sponge and I can’t wait to learn as much as they can throw at me.

Also? Once I’ve got my training documents signed, I can apply to the HPC and get my registration completed.

And then?

I’ll be a paramedic.

I’m sorry to say that thigns have been quiet round here because of a death in the family.

I wouldn’t say I had a close relationship with LionO.

This is largely due to the fact that, growing up on an island, one’s response to “fish” tends to be “breadcrumbs”, but Bam and AinoTheFinn were very attached to their fish and so, when we all moved house, Bam and I got the fish.

Apparently all the other fish have names, I’ve never bothered to learn them.

But LionO…

Oh Lion-O.

He was wonderful.

Completely retarded, utterly stupid (and that’s when measured against other fish, mind) he’d spend many happy hours getting stuck behind the filter, or headbutting his reflection.

He was my kinda fish.

But this week, wee Lion-O took a turn for the worse, we found him bobbing at the surface, making ineffectual little fin motions and clearly not a well little fishy-oh. The Eye of Thundera wasn’t going to save him this time, so I scooped him up into a food bag full of tank water, tied the top up and popped him in the freezer. I’m pretty certain that when fish get cold they get sleepy and I liked the idea of him drifting off into oblivion.

When we opened the freezer a few days later we found that Lion-O had, apparently, not drifted off into oblivion, but had instead spent his time in the freezer glaring out of his plastic cell with an expression of exasperated surprise.

He did make for an interesting back-lit photo, though. And once we were finished photographing our popsicle-bound friend, we buried him in a trench the council have dug up in front of our house.

RIP Lion-O. May you butt heads with celestial reflections.

Up on the fourth floor. November’s winds creep like smoke forced through the cracks around the skylight above the common stair.

The angles and glass reminiscent of Manhattan penthouses, but for the dreich weather. Faux Chryslers that, in summer, bathe the top floors with cosy light, sustenance for soporific moggies and rampant aspidistras. Come autumn, they’re dull and cold, letting in Edinburgh’s special brand of damp.

I lounge on our wheelchair, cold plasitc and hard steel, but better than Pally’s perch at the top of the stairs. He hunkers down, chin dipping behind the lurid green arete of his collar. A day’s nicotine withdrawal and the sleeping patterns of Pally’s Lad leaving him charming company only for himself.

The stair’s lights blinked out at six o’clock, despite the sun being scheduled to rise a half hour later. The landing is in darkness, my Streamlight clipped to my epaulette casts a cool, white glow around us; Pally reduced to a matrix of reflected hi-vis silver stripes.

We’ve rattled the letter box, chapped the door, shouted her name.

She won’t let us in without “the password”.

Control call her back and ascertain that the password is “red herring” and they furnish us with this golden key.

We chap the door again.

“Mrs Mackinlay?”

“Who is it?”

“It’s still the Ambulance Service, Mrs Mackinlay…we’ve got the password.”

“What is it?”

“It’s…’Red Herring’”

A moment’s quiet while we mug smugly at each other.

“‘Red Herring’?”

“Yep.”

“That’s not the password!” she shrieks and runs back from the door.

Pally sighs heavily (”fuckin’ mental…”) and stomps back to his post at the top of the stairs. Still standing at the door, I eavesdrop while Mrs MacKinlay makes a phone call.

“Hello? Police please…Police? There’s a man at my door!…Yes…no…no, I’m not leaving. I’m getting a knife……well, so I can kill him, of course.”

I back away from the door. I’m not really in the mood for getting stabbed, especially not by a little old lady. There’s something distinctly unsettling about the threat of lethal violence from someone where your worst retaliation is to wrap them tightly in a blanket. Self defence by tucking in, never a smart move in a ruck.

With a reverberating “foop” the stair door opens. Pally and I both peer down the well of the stair case as the police plod upwards, shaking their heads.

“Our colleagues were here earlier, she’s been calling all night…you guys are a new addition, though.”

They gingerly peek through the letter box, understandably cagey about receiving a faceful of Sabatier.

“Mrs Mackinlay?”

“Yes?”

“It’s the police.”

“…”

“Mrs Mackinlay?”

“Get lost!”

“You called the police, Mrs Mackinley.”

“I’ll call the police!”

“We ARE the f….” she takes a deep breath. “We are the police, Mrs Mackinlay. Just look through the peephole.”

The peephole is a dull yellow star against the door’s dark wood and we all watch it wink as she closes her face to the other side.

There’s a moment’s thoughtful silence, some shuffling around and we’re treated to another monologue.

“Hello, Police? There’s someone at my door trying to get in…”

Pally and I laugh, clap the cops on the shoulder and tell them to call us back if and when they ever get in.

Together we trit-trot down the stairs, swinging the wheelchair between us and drive off into the dawn.

I’m sorry, mate.

I lied to you.

You grabbed my hand and babbled at me “Don’t let anything happen to me, I feel funny, I’m not right, it’s not right. Don’t let anything happen to me.”

I squeezed your hand back and promised you, eye to eye, that I’d look after you.

If it feels good saying it?

It’s the wrong thing to do.

I couldn’t think of anything else to do.

I’m sickened by the thought that I swore I’d look after you and am now a central character in The Worst Day Of Your Family’s Life.

I’m sorry I couldn’t look at your wife when your eyes rolled back and you turned purple, that I barked at the porters to help her from the vehicle.

I’m sorry I didn’t explain to her.

Talk to her.

As I pushed on your chest.

Wishing I didn’t have to.

Ripping myself up for saying:

I’ll

Look

After

You

I’m sorry I snapped that rib.

I hope the last thing you thought of, or heard, was that things were going to be ok.

I really do.

But somewhere inside.

I know that’s not true.

You were scared and dying and suddenly dead.

Forgive me?

Please?

In response to Reynolds’ post of today.

It’s not that’s it’s so late it’s early.

Or the smell of vomit and blood in the living room.

It’s not the wrecked furniture.

Or the slivers of glass in her hair.

It’s not her swollen forehead, shattered jaw, mashed nose and almost comically fat lips.

Or her friend screaming across the room that she foresaw this and warned her.

It’s not her injuries, or her situation.

It’s the blasé way her kids wave her goodbye, totally unphased by the house full of medics and cops, tugging on trainers with their pyjamas to skip across the broken glass in the carpet and watch early morning cartoons.

No child should ever be so used to our attendance.

If you see someone pour an unidentified powder into your drink and you still drink it?

That’s not being spiked.

That’s being thick as mince.

Furthermore, you are an adult that has been offered and accepted a sweetie* from a random guy in a club that ends up with your falling over and spewing your ringer all over the toilet floor?

That’s the risk you take.

It’s not the dealer’s fault.

It’s yours.

Don’t take sweets from strangers. I have a three year old niece who could explain this to you.

Finally, I’m thinking of adding a sign to the various we have inside the vehicle. We currently have “We have the right to a safe working environment and will prosecute you if you try to hit us.” “You have the right to refuse treatment.” and “Gonnae no smoke, pal, eh?”

I want one that reads:

“Dear Patient:
The Ambulance Service is delighted to treat you and transport you to the nearest appropriate hospital facility. We appreciate that this can be a distressing time for you and your family and as such your a member of your friends or family is welcome to travel with you to provide you with emotional and practical support.

Now shut up.”

*”Sweetie” - Classically slang for Ecstasy/MDMA but has come into common usage as “any recreational drug in tablet form that may or may not have MDMA/dog worming tablets/crushed chalk/woodglue inside it”