Benny and I are in Tesco, choosing salad and cold meat when the phone rings in my breast pocket.

“432, that’s a job in SmallTownOutsideEdinburgh, upgraded urgent for a female with dehydration.”

When a doctor or rapid response paramedic arrives at a patient they sometimes arrange “urgent” transport, an ambulance will respond without lights and siren and ferry the person into hospital. They arrange that this job will be done within a certain time limit, usually one to four hours and that the patient or their family can call back if they take a turn for the worse, in which case the job will become an emergency.

It’s a resource management trick and it works.

But like most tricks, it works both ways.

Nursing homes are exceptionally guilty of calling back for urgents. It’s understandable and, perhaps, not entirely their fault. Picture the scene.

Your elderly relative is not well. The nursing staff in their home call you. You drive over and sit with them while the doctor attends and phones for an ambulance to come and pick them up this afternoon.

“In the next four hours…” they blithely say and head off.

The nursing staff don’t want to intrude on your familial moment, so they leave you all alone.

And you sit and watch your relative.

In bed.

Your relative who, chances are, was pretty sick before they went into the nursing home.

Who is now sick enough to need the doctor to visit.

To get an ambulance.

To go into hospital.

In four hours.

You sit and watch them. Maybe they’re sick. Maybe they have an accident. Maybe it’s your imagination, but perhaps their lips are a little bluer than before? Perhaps they’re a little paler? Are they crying harder? You call the nurse back in.

The three of you stand in the room, patient, nurse, relative. The nurse can’t do anything tangible to improve the patient’s condition, neither can you. An awkward impasse develops between the two of you.

The nurse calls ambulance control.

“They’re worse. Make it an emergency.”

And off we go, lights and sirens, my lunch languishing on the supermarket shelves, Benny and I cursing to ourselves.

We step into the bedroom.

Sure enough. Nurse, care home manager, two worried looking relatives.

And a corpse on the bed, a tiny, dried up little dead woman with the downie pulled to her waist.

No.

Wait.

Not a corpse.

Not quite.

She’s emaciated, dessicated, her head too heavy for her neck lolling on the pillow, her skin hanging in dead sheets between her shoulder blades and ribs. She’s foetal, her mouth hangs open, her eyes are closed.

But she’s breathing. Hauling in handfuls of air with every breath. Her ribs crank up and down, her dusty, dry skin crackling like baking parchment with every inhalation. She looks like a terminal accordion.

Corpses don’t breathe.

Not the last time I checked.

I should know.

Shouldn’t I?

The nurse hustles the family out of the room, come along, come along, let the paramedics do their job, we’ll call you in a moment once she’s ready, nothing to worry about, I’m sure they’ll look after her but there’s very little room and you don’t want to get in the way.

She shuts the door behind her and turns to Benny and me.

“Thank fuck you’re here, she’s totally shut down, I thought she was going to go off on me.”

Wha’?

Who is this woman? With her “shut down” and “go off”. Those are our words, the words of emergency medicine, the words of the ED. They are not the words of nursing home staff, they are not the words of staff who shrug when we ask about medical history, who claim to be “covering a shift for a friend.”

They are words of someone who really, really knows when their ward is really, really sick.

I congratulate her.

“I’ve never met a care home nurse who talks like that.”

Then she hits us with another whammy.

“I’m not a nurse. I’m an auxillary.”

“So how do you know…?”

“I worked in OAPHospital for years. She’s dying, isn’t she?”

I gape at her, switch my head back and forth between her and the patient.

“Oh, she’s completely deaf. And profoundly demented.”

I’m startled by her candour, but recognise a colleague who shares our pragmatic style, I still drop my voice a little.

“In that case, yes. She’s very sick. What’s been going on?”

“She had three coffee ground vomits last night, then this morning five bouts of diarrhoea.”

Coffee ground vomit typically means you’ve either been eating coffee grounds, or your stomach lining is bleeding. Digested blood is black, lumpy and granular.

“I’ve had to change her every time. She’s got pads on, but she’s messing right through them.”

Benny leaves me the defib, bag and oxygen and excuses herself to get the trolley. I loop a tourniquet around one scaly bough of an arm and hang it over the side of the bed. She’s floppy, languid, as her hand swings uselessly I feel at her opposite wrist for a pulse.

Nothing.

My fingers in her throat give me a carotid, but weak and feeble and fast. She’s in “Stage III shock”.

“Stage IV” is an immediate precursor to cardiac arrest.

Shock classically occurs when people lose blood, but any sustained fluid loss will do it. The patient in front of us is literally shitting herself to death. Her gut sucks fluid from its walls and ejects it with every stomach cramp, a system frantically working to expel some invader that it deems more dangerous than self-destruction.

I slide the cannula into one of the stringy veins that crawl across her forearm as Benny reappears with the trolley. The care home manager offers to help us move her across onto the stretcher, but stops, his mouth flapping like a guppy when he realises that we’re taking the pillow she rests on.

“Will it come back?”

“Probably. I think its important that she’s comfortable, though, don’t you?”

“Ummm…”

Benny raises eyebrows at me in response to his hesitation, he notices and backtracks.

“I mean, of course, of course, we should keep her comfortable.”

The auxilliary catches my eye and winks, “Can I carry anything for you?”

Benny nods at the defib on the floor.

“If you could get that, it would help.”

She lifts it with an “oof” and by the end of the corridor she’s resting it on one thigh, bumping it along with the swing of her leg.

“Aye, now run up a flight of tenement stairs with it,” I tease as we roll the trolley outside.

Before we leave I catch up with the manager.

“See her?” I ask, pointing at the auxilliary.

“Yes.”

“She is, with no sense of exaggeration, the best care home staff member I have ever met. If you ever let her go, you’ll be making a grave mistake.”

“She’s very good with the clients.”

“She’s better than that. Keep hold of her.”

I leave him scratching his head as I hop back into the ambulance to join Benny. She’s already hooked the patient up to the monitor. She taps the screen.

“Not good.”

I flash eyes over the data. Sinus tachycardia - her heart working well, but three times faster than normal. BP 72/37 - when the first number dips below 80, the brain shuts down; when it descends past 70, your kidneys abandon their task of filtering poisons from your blood. SpO2 78%, despite high flow O2; despite me shoving oxygen into her as hard as we can, her systems are so trashed they can’t move it around to her hands.

I hang a bag of fluid from the ceiling of the ambulance while Benny radios the hospital, cool and calm as a night time phone in disk jockey she quantifies the plight of the woman in three lines.

“Eightyfour year old female, profoundly shocked, GCS 3, ETA 10″

I hook the fluids to the cannula in the patient’s arm and wrap my fists around the bag, squeezing its walls to force the fluids into her vein as fast as possible. In minutes it’s done and I replace it with a second. I’m swinging from the handles by one hand, crushing the bag with the other while Benny hustles us up the road. Halfway through the second bag, the patient opens her eyes. Looks at me.

“Hello, love!” I greet her, more surprised than I care to admit.

She smiles and replies.

“Hello.”

I drop to one knee, lay my mouth against her ear and yell.

“My name’s Kal. I’m an ambulance man. We’re taking you to see the doctor.”

She fixes me with a stare.

“Rabbits. In the garden.”

Ah.

That’ll be the dementia then.

We’re in resus in minutes, the doctors teasing us. “GCS3, you said, profoundly shocked, you said, what’s this then?”

I wave the empty bags of fluid at them.

“Amazing what a litre of water will do for you, isn’t it?”

“We are nothing but elaborate mechanics. We learn new skills to put air and water into people in increasingly clever ways.

Dear All

I am in the middle of writing a terribly clever post filled with sharp social commentary and wincing imagery and have an hour spare this morning to finish it….

However, I am also acutely aware that the lights and siren arrived for the Parabike this week and, as such, I’m off to work an hour early to strap them on and cycle around the car-park going “Mee-maw”.

Because, while intellectually, I’m about four years old, I’m also four years old but with a REALLY FUCKING COOL TOY.

During my time on the bike I was lucky enough to fall in league with various circles, the police, the council wardens and the street performers all accepted me as one of their own, I was Kal, the paramedic on the bike.

The performers in particular adopted me, making jokes about me as I pedalled past their acts, nodding a greeting in passing. The fact that I patched a few of them up through the month probably helped as well.

Ringleader of the lot of them is Todd Various, a ginger bearded American with a wickedly friendly attitude to his audience. Whip-smart and one of the fastest improvisers I’ve ever met, I stopped to watch his show on at least a dozen times.

In the first week of September, once the Fringe had closed down and the streets were a little quieter, I was strolling up the Mile when I spotted Todd in suit and tie.

“You’re all dolled up today?”

“Oh man,” he began with trademark enthusiasm, “This guy wants to propose to his fiancee this morning and he’s asked me to hide the ring under one of the cups. It’s gonna be amazing.”

“When?”

“Eleven o’clock.”

The news spread like SARS through the crowd and, by the time show time rolled around, every regular on the street: the performers, cops, wardens, stallholders and me knew what was going to happen.

We watched Todd flip balls in and out from under the cups until he lifted one.

“Oh.”

A little green velvet box sat where, a second later, any spectator would swear we saw a tennis ball sitting.

“Does this belong to anyone?”

The proposer stepped forward, led his girl forward and knelt in front of a whooping, howling crowd.

(And she said yes!)

So was qualified my Moment of the Fringe.

I’m on the bike when the phone rings.
“Kal? I’ve got an emergency, but I think it’s out of your jurisdiction…”
“Where is it?”
“It’s in Belfast Road.”

Belfast Road is outside my jurisdiction, but only just.

“What’s the job?”

“It’s a five year old male with breathing difficulties - we’ve got a warning on the system that he’s got significant health problems.”

Suddenly I know exactly the house she’s referring to - I saw this kid about three years ago - he has some serious issues, in-house nursing and a set of parents who have the “ambulance phoning” tolerances of people who are used to their kid being, habitually, far, far sicker than your average bairn.

If they’ve called us, there’s something serious going on.

“I’ll go.”

Down the hill I go, through junctions and lights, filtering when I can; Edinburgh cyclists are notoriously rubbish at obeying traffic laws anyway, drivers aren’t too shocked to see me cutting up the inside of roundabouts.

I’m wheeling my bike into the front lobby of the house, all custom wheelchairs and trikes, when my phone rings again.

“Are you on scene, Kal?”
“Just arrived.”
“Mate, we’ve got a single crew making to back you up, but nobody for transport. I’ll clear a vehicle as soon as I can and you’ll be top of my list, ok?”

Great. Stuck in the house with a patient who probably needs to be in hospital. Now. Smashing.

The patient is Jamie, his Mum, Dad and nursing team brief me calmly, but quickly. Jamie is breathing far too fast, he’s far too hot, his lungs are full of phlegm. Where most kids have a bedside light, Jamie has an oxygen saturation monitor; where other kids sleep with Vick on their pillow, Jamie sleeps with plastic tubes in his nose giving him supplemental oxygen.

He cannot turn himself, or sit unaided, or tell me about his symptoms. Where I’d ask his peers questions, I resort to chatting to him about what we’re doing, explaining myself as I press the head of my stethoscope against his chest and back, apologising as I hoover around the inside of his cheeks, the back of his tongue, slurping snot and drool from his airway with a suction catheter.

Jamie makes eye contact, his cognitive abilities are comparable with his peers and he’s very, very sick.

He just can’t tell me.

Through the open front door I hear the diesel clatter of an ambulance pull up and a solitary technician walks in, I bring him up to date.

“I’d just sooner he was in resus, rather than here?”

He agrees, but there’s a problem. He’s single crewed, I’m on a bike. He can drive the ambulance, but I’d need to travel in the back to look after the patient en route. If I was in an RRU we’d just park it up outside, but the bike’s a little vulnerable to theft for that. These aren’t the sorts of jobs the bike typically responds to.

I come up with an idea, it’s unorthodox, but might work. I turn to Jamie’s Mum.

“We can take him into hospital now, but it would involve leaving the mountain bike in your hallway - do you have a spare set of keys I could borrow so I can come back and collect it?”

She, with that unquestioning trust that shocks me everytime I experience it, digs in a dresser drawer and passes me a set.

“Just post them through the letterbox when you’re done.”

We load Jamie up, crash him into Resus and leave him with the staff there.

I cadge a lift from an RRU back to Belfast Road. The car vanishes around the corner and leaves me on the pavement, keys in hand.

I slide the first into the Yale lock.

It doesn’t turn.

I try the second key.

It turns a little, but jams.

Fuck.

They’ve given me the wrong keys.

Unbe-fucking-lievable.

My response vehicle is locked INSIDE THE PATIENT’S HOUSE.

I realise I’m going to have to phone Control and get them to send another vehicle to pick me up, return to the Sick Kids, swap keys with Jamie’s Mum and then return here. This is a kerfuffle that I would rather not subject the mother of a critically ill child to.

Also, I will look like a dick.

Unless….

I lean on the front door, hard. The wood flexes around a single point - perfect, the door is only secured by a single Yale lock, its spring forcing the bolt into the stay on the door frame. It’s an old door, with plenty of give in it.

In my pocket is a Quick Guide to ECGs. It’s long and thin and made of stiff, flexible plastic. I don’t need it for reading ECGs anymore, but it’s JUST the job for shimming doors open. This’ll be easy, I’ll force the door, grab my bike, leave the keys on the mat as though I dropped them through the letterbox and sneak away. I am practically a cat burgling assassin secret agent.

I slip the plastic down the doorframe, saw it back and forth and feel a little tingle of illicit satisfaction as the lock says “snick” and the door opens.

The hallway is full of large palms.

A wooden chair sits by a side table.

A coat rack occupies another corner.

A radio plays in the background.

There are no wheelchairs.

No trikes.

No children’s coats on the rack.

The picture montage of Jamie that hangs in the hall of Jamie’s house…isn’t there.

Shit.

I’m next door.

I shut the door silently and run on tiptoes to Jamie’s house, where the keys fit beautifully, the bike is where I left it and I’m able to beat a rapid retreat down the street before anyone spots me burgling anywhere else.

And then I don’t tell anyone.

Until now

We must take a moment to wave at Mal (*waves* Hi Mal!) who is down at College currently on his Techy course. Mal is a friend of FlatMateBam and he came over for dinner some months ago to discuss the job and whether or not he fancied it.

We congratulate him on getting a place at College and are confident he’ll do just fine, he was wandering around Station the other day while I was eating my porridge and looked very official in his training blues.

Bam reports that he has found himself in that charming frame of mind where he is Just. So. Excited. about learning new things and wants to share his new found knowledge with EVERYONE.

This week, apparently, Bam and Mal were at a party and Mal was complaining that, while they got to practice intramuscular injections on oranges, he was concerned that he didn’t get a chance to stick a real person before he did it in anger.

The conversation turned to the limitations of practicing on one’s colleagues and Bam mentioned that while I was on my paramedic course, she’d offered her arms up for me to practice IV access.

What she meant to say was:

“While Kal was doing his para course? I said he could practice putting cannulas in me.”

Bam, however, was a little pissed.

And said.

“While Kal was doing his para course? I said he could practice putting catheters in me.”

We’re close.

But not that close.

Another post from the series I wrote for the BMJ, these are less funny than my normal stuff and *designed* to make people argue

-
Obese, but not morbidly so, the CVA had left her with no movement down her left side. When we arrived she was lying on a mattress on the floor, a spreading puddle of urine under her..

“I just can’t get comfy…my back hurts.”

We advised her on painkillers, helped shuffle her back up the bed and suggested that perhaps she might like to come to hospital?

“I’m not going back there. I only came out today.”

I looked around the foetid room, the bare mattress, the plastic bucket of faeces on the floor.

“Did they not arrange nursing care for you?”

“Well, they said they would, but nobody’s been round.”

“And they let you come home like this?”

“Oh no, they said I shouldn’t, but I didn’t like it in there. They were giving me drugs. I signed myself out.”

“Against their advice?”

“Yes. My husband helped me into the taxi.”

He’s at my shoulder, frothing.

“It’s a disgrace, the way they’ve let her come home.”

She gestured around the room.

“You can see the state of the place, what am I meant to do?”

I bit my tongue.

-
“He’s shit himself.”

Indeed he had. Nineteen and drunk, you might well, but he’s fully conscious and walking. I prescribe a lift home, a roll of Andrex and a shower. His father disagrees.

“But what if he’s sick in the car? What about the seats? Take him to hospital. I’ll pick him up when he’s sober.”

-

The NHS was developed to provide free, accessible health care for all. It is, in principle, how health care should be run. Our patients don’t fret about their insurance, or the bottom line. They can worry about getting better.

Sure, the waiting lists may be longer than we’d like, both on the surgery lists and in the waiting room, but we’ll get to you every time, gratis.

We’ve heard plenty about private health care encroaching on the state’s own provision. The debates surrounding “top-up” fees are fierce and always conclude with someone bawling about a “two-tier” system.

Well here’s an idea.

How’s about a third tier.

For those who abuse the system.

We in the NHS will deliver you free health care, accessible to all, at any day or night. We’ll come to your house, we’ll involve you in our clinical decisions, we’ll give you a voice in your care. We’ll do it to the best of our abilities, with the best equipment we have. All for free.

In return, you respect the state’s provision, if you fail to do this, you lose the privilege.

As motorists, we pay an extra premium each month to cover uninsured drivers involved in collisions.

We recognise that the innocent victims of their irresponsibility do not deserve to be out of pocket due to someone else’s callousness or criminal activity.

And when you’re found to be operating a motor vehicle without insurance, you’re reported to the Procurator Fiscal

If employed, we all pay National Insurance. We recognise that our NI contributions go towards funding the percentage of the NHS that cares for those patients who do not pay contributions, through being out of work or otherwise.

But when we find “uninsured” patients who demand ever higher resources from the Health Service, who phone ambulances because they don’t want to risk their upholstery, or check themselves out of hospital against advice with no thought to how they’ll continue their daily lives, then demand the emergency services and A&E haul them out of a problem of their own making?

Is it time we had a third tier for these people? We let the rich top-up their treatment with privately obtained treatments, why not issue bills to those people who waste resources through their own actions, stupidity and flagrant irresponsibility?

“Free health care for all”?

That would be nice.

Right now I feel I’m paying an awful high price.

I’m not terribly good at political stuff.

The recent discussions about healthcare reform in the States leave me disheartened at best.

And more to the point, everybody is talking about it, why go with the crowd?

Instead, I’d like to introduce you all to my new plan for the world, which is going to revolutionise all our everything.

I call it “Nazi Darwinism”.

As a health professional, I firmly sign up to the concept of survival of the fittest. That which adapts to thrive in its environment will enjoy genetic and procreative success.

If you grow a big neck, you can be a giraffe.

If you develop thousands of teeth and super sonic swimming speeds, you can be a shark.

If you develop all of those things, you can either be the most bad-ass giraffe on the plains, or the spackiest shark in the ocean. Adapting to your environment makes you a more successful species.

But as humans, we’re falling behind.

We have become so accustomed to wangling our way around environmental challenges that the need to evolve is fading.

Therefore it is time to engineer our surroundings in such a way to generate positive evolutionary developments in the human race.

And we’re going to start with dickheads.

Under my new plan, I believe we can selectively breed out dickheads in under ten years.

This is how it’ll go down.

All members of society in whom the dickhead gene is absent or recessive (”nice people”) will be issued with a pool ball in a sock. The carrying of this will be mandatory.

On discovery of a subject displaying signs of dickheads genes, the nice person will be entitled to strike the dickhead on the head with said sock/pool ball.

It is hoped that within a short time and with the assistance of an intensive press campaign, the majority of dickheads will either moderate their behaviour (thus negating the necessity for a cue ball to the temple) or persist in behaving in such a manner as to ensure repeated cephalic blunt force trauma and their subsequent death within a number of weeks.

Lets be clear.

I am not advocating death squads or genocide.

I am merely proposing a system by which those members of society who have suffered the ignoble misfortune of being mindless bumblefucks are encouraged to take control of their destiny and be the drive behind their own self improvement.

Or die.

We have seen in recent years the phenomenal social restructuring that can take place with imaginative promotion. Fifty years ago, driving home from the pub was seen as an acceptable, if quaintly risky, route home. Nowadays, drink drivers are social pariahs.

I fervently believe that within five years of Nazi Darwinism being rolled out, “eating in public with your mouth open” will be as morally repugnant to society as violent sex offences.

For those of you unsure as to which side of the dickhead/nice person differentiation you lie, the following questionaire may help.

Do you play music through the speaker on your mobile phone on the bus, forcing everyone else to listen to your pish taste in Ibiza Trance?

Do you fail to say thankyou when someone holds a door or lift for you?

Do you stop in traffic across side streets and then pretend to fail to notice the line of cars waiting to pull out?

Are you taking part in a hen party that involves hilarious plastic devil horns/angel wings/bunny tails and endless bloody screeching?

If you answered yes to any of the above, you are at significant risk of being Dickhead Positive.

See your General Physician and watch out for armed Nice People.

The rest of you?

Your pool balls are in the post.

I’m noodling around Parliament Square on the High Street, chatting to stewards and watching shows when my phone blares in my ear. I’ve got all SAS numbers set to a particularly obnoxious ringtone, a submarine’s dive alarm.

I blip the handsfree button at my jaw.

“This is Kal.”

“Kal…where are you?”

“On the High Street. Where’s the job?”

“We have a male colla….correction…we have a male in cardiac arrest just down the road, can you attend?”

Damn straight I can, even with the dense crowds between myself and the patient I’m on scene in just over a minute. A man lies on the floor and a couple are performing textbook CPR on him, bobbing up and down in perfectly timed synchronisation.

My wheels stutter on the granite setts in the road as I approach.

“Paramedic!”

The man doing compressions looks up as I approach.

“We need a defib!”

“No problem.”

There’s a crowd around the patient and I point at the largest member, a burly, tattooed man with mirrored shades on.

Dismounting from the bike, I thrust the handlebars into his hands.

“You. Hold this.”

Congratulations, dude, you’ve just become my bike stand.

The bike is a big heavy mother fucker to try and unpack in a hurry, with six weeks experience under my belt I’ve learned to do it without dumping everything all over the pavement, but the simple act of pulling the bags out can make the front wheel swing from side to side. Far easier to get a bystander to hold it tight.

The defibrillator lies right at the top of my panniers. Funnily enough, it’s remarkably similar to the model I first trained on with the British Red Cross almost eight years ago, a simple “shock-box” with one cable, one socket and one button to press. They’re hard to screw up, but I realise as I unpack it that I’ve never actually used one in anger.

Thankfully the defib proves to be simple plug and play, truly idiot proof. As soon as I plug the pads in it starts shouting at me in its Mid-Atlantic twang.

“Apply pads to patient’s bare chest.”

I shred the patient’s teeshirt, cutting right up the front and through the collar, the fabric flops backwards over his shoulders in a tattered yoke.

The couple are still pounding away at CPR and haven’t delivered their classic panicked bystander lines of “We’ll get out of your way?”.

That’s odd.

I nod at them both.

“You guys doing ok?”

They nod back.

“I’m a GP, my wife’s a midwife. He just dropped in front of us. We could see he’d gone off.”

“No pulse since collapse?”

“None.”

“You ok to carry on?”

He’s red faced and sweating, but nods steadfastly, putting his hands back on the patient’s sternum.

“Sure thing.”

The pads in place, the defib is now yelling at us “Do not touch patient, press flashing orange button to deliver shock”.

Its cheap LCD screen shows coarse ventricular fibrillation, the first thrashes of an arresting heart. It is arguably the healthiest “dead heart” rhythm to be in.

“Ok, I’m shocking. Stand back, please.”

The GP and midwife sit back on their knees, I swing my eyes from the patient’s head, down his arms and torso, legs and feet. No puddles, no metal grates, no-one still clinging to a hand.

“All clear! Shocking now.”

I push the orange button and the patient turns rigid for a second, before flopping limbs back down onto the pavement.
The screen still shows VF, the defib recharges and yells again for us to shock. The GP reaches for the button, before I stop him

“Hang on, please mate, let’s give him another round of CPR first.”

The heart can only take too much punishment and we’ve just electrocuted it, plus we’ve been “off chest” while we did it. A phase of CPR will do the myocardium the world of good, flooding it with oxygenated blood and giving our next shock the best chance of a good result.

“Back on the chest, please, somebody?”

Compressions start again. I kneel by the patient’s head, pull his chin up and back and snag the intubation board from my bag, push a mask over his mouth and nose and breathe for him.

A voice in the crowd shouts out.

“I’m a cardiologist…can I help?”

“Right here, please, doctor.”

He’s by my side.

“What can I do?”

“I’m going to tube him, everything’s on the board there, can you prep for me, please?”

This is clearly not the role to which he is accustomed, but he makes no complaint, busying himself with endotracheal tubes, lubrication and laryngoscope blades. He passes me every piece of equipment as I need it and I’m just pushing the ET tube through the patient’s vocal cords when I hear the chord of siren and engine behind me. Squaddie jumps from his response motorcycle, flips up his visor.

“Do you need any kit?”

I shake my head and he jogs over to us, all creaking leather and armoured boots.

“You got any access yet?”
“Nope.”

“I’m on it.”

Returning to the patient’s airway I find my ET tube has slithered back up the throat and is lying, useless, in his mouth. How the hell did that happen? Dead folk don’t spit back.

I feel like I’m in an emergency Punch and Judy show, whenever I turn my back someone steals the sausages - “Now children, if that naughty crocodile extubates himself while I’m away, you will shout for me, won’t you?”

I’m sliding the laryngoscope back down his throat when the defib starts up shouting again - “Push orange button to shock!”

The GP takes his hand from the patient’s chest and reaches for the defib.

“All clear please.”

At this point I’m still holding the laryngoscope, all steel and carbon fibre, inside the patient. A defibrillation at this point will probably fire me across the street.

“No shock, please, doc.”

He stifles a quiet laugh, my voice clearly had hints of panic in it.

“It’s ok, we’ll wait.”

Once again I push the ET tube through the cords and again the patient’s gag reflex fires it back up the trachea at me. I’ve never met a person who’d lost their pulse and breathing, but maintained the ability to protect his own airway.

My textbooks come back to me - “If the patient repeatedly rejects intubation, reconsider if the procedure is necessary.”

It’s not just the procedure, I need a moment to reconsider the whole job. This is the first arrest I’ve run as a paramedic. There’s plenty to be gained in a resus situation from backing off and taking a moment. I sit back on my heels.

“Go with the shock, please.”

The GP checks us up and down, Squaddie puts his hands in the air, as do I. The patient jolts from the shock and slumps down again.

The defib screen shows pulseless VT, a cardiac rhythm that is significantly more coordinated than VF, but just as bloody useless at sustaining life.

Of course, VT is “more coordinated” than VF in the same way that a cat is more likely to organise a successful jumble sale than a set of patio furniture.

A dark blue Beemer pulls up alongside us and TopCat, our resus doctor, hops out in shirt and tie. He appraises the situation while Squaddie shocks the patient a third time.

The violet patient’s face suddenly regains its pink hue. He drags one long breath into himself. I feel for a pulse at his neck and grin when I feel it hammering along under my fingers.

“What’s the story, Kal?”

“Witnessed collapse, immediate bystander CPR, shocked three times, VF, VF, VT, now regained an output, rejected a tube twice, no drugs yet. “

He surveys the scene and smiles, satisfied.

“Cool.” He looks me up and down in my shorts, bike shoes and teeshirt.” ..are you on the mountain bike?”

“Yup.”

“Sweet.”

An ambulance arrives and we hoist the patient onto the trolley, lifting his head and shoulders with his shredded teeshirt. He vomits copiously over everything and I regret not getting that tube into him, but within minutes he’s fully conscious and asking the ambulance crew what happened to him.

Squaddie and I are left to tidy up the wreckage on the pavement, both grinning like idiots. TopCat hops out of the back of the ambulance and snaps a shot of the two of us, arms round shoulders, grinning at his camera.

“The day the Parabike proved itself!” he declares, before returning to the patient.

Squaddie and I return to picking up, he rips into me.

“You’re not going to claim this is a save for the Parabike are you? You wish. It was MY finger that shocked him the third time.”

“Fuck you cunty baws!” I retort “It was my legs that got the defib to him in the first place!”

The head of security for the Fringe is standing on the sidelines. We used to work together at the Edinburgh Dungeon as actors before we both got ourselves proper jobs. He’s shaking his head at the two of us.

“That was the most amazing thing I’ve ever seen. You just saved that man’s life.”

“Pretty much.” we answer.

“What does it feel like?”

I’m beaming at him, jiggling up and down in my shoes.

“It tastes pretty damn good.”

I take my bike back from the man in the sunglasses who shakes our hands, a barman from a nearby pub offers to drive the patient’s family, total strangers to each other, to the ED.

I restock my panniers from Squaddie’s kit and we say our goodbyes. We clip helmets back onto our heads and he claps my shoulder.

“Good job, son.”

“Cheers mate.”

He starts his bike, revs the engine and is about to vanish into traffic when I wave him down.

“One last thing?”

“Yes mate?”

“I think you’ll find you owe me a fiver.”

He laughs, gives me the finger and roars off.

The taste lingers for hours, I spend the day smacking my lips, running my tongue over my gums. The potent visceral rush of life from death clings to my teeth; it shines when I grin.

The security guard and other bystanders tell each other the story at coffee breaks.

I duck my head, shy now and bashful of the attention, but still breathe out the flavour into my collar and, while no-ones looking, inhale it back inside me for one (just one more, I promise…) last illicit taste.

The following was written for a British Red Cross magazine, so it’s written in a nicer style than usual. Those of you who just want gory pictures should scroll to the end where there’s a slideshow.

—
Over the first weekend of July a team of first aiders from Edinburgh University First Aid Group travelled to Oldenburg, Germany to represent the UK in the First Aid Convention in Europe (FACE) 2009. A major aspect of FACE each year is a first aid competition, setting teams of first aiders from around Europe against each other to manage and treat a range of simulated scenarios.

Comprising of Paul “Grinst” Budgen, Scott Clarke, Daniel Costigliola, Heather Barnshaw, Rachel Macintosh and led by Emma Padfield, the team have been training for the past year, having won the UK’s NAFAC (NAtional First Aid Competition) previously.

Their training has consisted of many weekends of hard work in Edinburgh and one intensive weekend’s training in June in Staffordshire, all under the watchful eye of Lyn Covey. Also representing the UK were a team from the south of England, “Team UK 2”. I was touched and privileged to be invited along as team photographer.

Come Thursday the 2nd of June, the team was gathered in the check-in hall of Edinburgh Airport, bags packed, first aid kits triple checkedand the conundrum of “how do you transport a flag and flagpole?” solved.

The morning represented the culmination of months of fastidious, near-obsessive organisation and preparation but the team were dismayed to find queues at the check in desks looping back against themselves. Once the luggage was checked in, it became apparent the team had a mere 10 minutes to get to their gate and board their flight. The line for security clearance was fearsome, but nowhere near as alarming as the thought that the flight would be missed, the event delayed and the wrath of Lyn Covey brought down on the team’s head!

A runner was dispatched to the front of the queue to plead the team’s case and within a few minutes they were hustled to the front of the line, fast tracked through security and waved on towards their gate. It later transpired that the team member who’d spoken to the security guard had made a meal of the fact that a “Red Cross medical team” were “flying out to Eastern Europe” and had to make their connection in Schipol. The fact that Oldenburg is closer to Amsterdam than Berlin and that the Iron Curtain fell over 10 years ago was innocently glossed over - words can be powerful things!

Arriving in Oldenburg (after a fraught sprint through Schipol airport to make the connecting flight) the team were welcomed with a warm round of applause and barrage of camera flashes - turns out men in kilts are fairly thin on the ground in Germany - and united with Fidi, our host for the weekend. It was Fidi’s job to ensure we were in the right place, at the right time, wearing the right clothes and doing the right thing.

Imagine a job description somewhere between a Border Collie and Mary Poppins and you’ll not go far wrong. Barely seventeen, Fidi was smiley, pleasant and accommodating with textbook English.

It took her less than an hour of democratically asking the indecisive, easy-going team what they wanted to do in Oldenburg with their free time before she realised she’d need to be a little more proactive. By midafternoon on the first day Fidi had developed a classically Teutonic method of leading. She would stand up, address the group, “Now we are going for ice-cream in the town square. Come on.” and the team would follow her like a row of obedient ducklings.

The day culminated with an enormous open-air barbecue, twenty eight teams from across Europe (and further, in some cases) came together in the conference centre’s car-park. It was here that the team met their supporters, friends and familiar faces from across Scotland who had flown out specially to cheer them on in the competition. Their dedication was mind-blowing and their energy and enthusiasm certainly kick-started the party!

Friday’s schedule included lectures, a convention and a parade through Oldenburg to commence Saturday’s competion. The supporters took a day-trip to a nearby harbour town while the team made full use of the convention’s attractions, including challenging each other to fitness tests and donating blood.

The Deutsches Rotes Kreuz had clearly pulled out all the stops in displaying their equipment and services, including several trucks with the brilliantly dramatic legend “katastrophenschutz”.

In the absence of Lyn (who was sadly unable to join the UK teams, despite her best efforts), the Scottish team snagged a DRK first aid trainer and were put through their CPR and recovery paces one last time before returning to the hostel.

The weather for Friday evening’s parade was intensely hot. At 28 degrees in the shade I was in equal parts thrilled that I could wear shorts and a polo, while sympathetic for the two UK teams in their smart trousers, buttoned collars and ties. All participating teams were represented in the parade, lining up in disciplined ranks in Oldenburg’s town square while a host of local and DRK dignitaries addressed them, before leading the whole flag-waving, horn-tooting, song-bellowing horde through the town’s streets.

What struck me firmly during the parade was the town’s pride in the Red Cross volunteers that marched past them. The DRK answer and manage approximately 50% of emergency ambulance calls in Germany and the emblem and organisation are viewed with respect and gratitude. I spotted one little lad on his father’s shoulders in the crowd waving a home-made Red Cross flag and sporting a “Junior Rescue Team” teeshirt.

When was the last time you heard of a kid in Britain aspiring to be “A Red Cross first aider” when they grew up? It was clear that this country knew a thing or two about promoting the organisation.

Saturday’s competition pulled no punches and occupied a sector of Oldenburg several square miles in area. The team were up at five, breakfasting at six and shuttled to their first station at seven. The competition’s format was spread across twenty eight stages, divided into first aid challenges, fun challenges and rest stops. As the day went on, those rest stops would become ever more important!

Piling out of the shuttle bus at the first challenge, the team were pleased to see they were being given an easy run-in; a “fun station”. Even more pleasing was the merry band of saltire waving supporters standing at the kerb, cheering and shouting for the team despite the early start we’d all had.

I’m confident I can speak for all the team members in thanking our supporters again, especially for their assistance before the competition where they agreed to pose as casualties for one last practice scene. The opportunity for the team to blow off steam and get their “game heads” on was extremely valuable and, I’m sure, was a great part of the team’s impressive performance through the rest of the day.

At eight o’clock sharp the team and I were advised that we were now “in isolation”, permitted only to talk to each other, Fidi our host and competition officials. We would remain in this state until the competition’s conclusion some ten hours later.

The pace was unrelenting throughout the day. The fun stations had the team balancing on stacks of milk crates high in the air, swinging each other on massive wooden A-frames, diving in ball pools and milking wooden cows. The rest stations were manned by ever-smiling teams of DRK volunteers, with endless flasks of coffee, bottles of water, and baskets of fruit and snacks.

The first aid stations, however, were another matter entirely.

On their second scene the team were met by a firefighter in full turn-out gear and helmet who explained that “the van was very hot” and that “the fire crew will keep you safe”.

They followed the firefighter around the corner to find a van in the middle of the town square, its walls scorched, windscreen smashed out, smoke pouring from its shattered windows and a fire crew hosing it down. Water vapour and spray filled the air, the thud of the fire appliance running in the background made conversation difficult at best.

In the middle of the scene a gas cannister had exploded, shards of metal bursting outwards. To one side a resuscitation dummy lay on the floor, its head split open, blood and (I suspect) minced bratwurst spilling onto the pavement. Two workmen lay nearby, one with a spike of metal embedded in his forehead, another with major burns to his face, chest, arms and airway.

The team got stuck in, made the difficult decision not to resuscitate the dummy and set to treating the two seriously injured patients.

This was a far cry from the “a man has cut his hand in the kitchen” scenarios we so often churn out for our first aiders to practice on.

The pace of the competition didn’t let up throughout the day. There were car crashes with trapped patients, industrial accidents with heavy machinery still in operation and a bungled bank heist in the middle of Oldenburg High Street, using a branch of the local bank as the backdrop, complete with bullet-riddled car and panicked, gun waving security guards.

In fact, the cruellest twist the competition set was to have the team walk off a particularly harrowing incident into a “fun station” that comprised thirty questions on the life history of Henri Dunant. Those Germans, they know how to pile on the stress!

Sunday ended with dinner and an awards ceremony, the team, smart and united in matching kilts and sashes placed a most respectable 5th out of 28 teams overall before setting thoughts of first aid aside to concentrate on the far more important task of partying the night away.

Standing outside the conference centre, watching my colleagues and friends hugging, dancing and chatting with complete strangers from around the world, purely on the basis of wearing the same emblem, it struck me that the seven principles of the International Red Cross have a very real significance outside our voluntary service.

Many of the participants at FACE 2009 didn’t speak a lot of English (but then, my Croatian is notoriously ropey these days) but the simple act of wearing the Red Cross or Crescent was a clear, unspoken declaration to everyone else in the room.

“This is what I believe in…I see you have the same values…let’s be friends.”

I’m confident there are hundreds of people the team spoke to and socialised with over the weekend that they will never see again.

It doesn’t matter.

The international relations that are developed at such events are far more important than the personal ones. We’re a member of an international organisation, we all know that.

But to meet, work and socialise with hundreds of your colleagues from across the globe?

Then you really know it.

—–

I’ve cut the slideshow down to just the “challenge” in the middle of the day, so you guys don’t have to sit through photos of people you don’t know at a party you didn’t attend. The slideshow is still 100 images, but you should really take a look, there was some incredible moulage in there.

Just next to Starbucks on the Royal Mile is a building with a wee porchy bit, all enclosed by a full height barred gate. There are signs on the gate that tell you off, prophylactically, for chaining your bike up against the railings.

What they don’t have, however, is a sign prophylactically telling paramedics off for leaning their bike up against the railings while they stand inside the porch out of the pissing fucking rain and drink coffee.

Thusly, I’m allowed.

I am too.

Shut up.

Occasionally people come out of the front door. When they do I turn into The Most Charming Man In The World where I smile and say “Afternoon ma’am, you don’t mind me popping in here out the rain, do you?”

Because the only person who would say “Well, actually, Mr Man Whose Job It Is To Save Other People When They’re Dying And Doesn’t Have A Vehicle With A Roof On It, yes, I do mind.”?

That person would not be “The Most Charming Person In The World”. That person would be “The Nice Old Lady Who, It Turns Out, Is A Cunt.”

This porch talk isn’t really that important, the porch doesn’t have a major role in this story, the porch doesn’t even feature as a location, it’s just that’s where I was standing when a man strolled past me and deployed a voice as though he was commenting on the weather, or the presence of something terribly dull, like, say, a Conservative.

And in this voice he said, while tipping his thumb casually over his shoulder.

“Lady hit by a car, back there.”

Oh, well fabby doo. Let’s not worry about it, shall we?

Apparently (and I only mention this because it was pointed out to me after the event), my response was “Oh right, that’ll do I suppose.”

Damn my casual casualness.

I rolled my bike the whole 50 yards over to the junction and there, lying in the gutter, in a splendid recovery position, was a woman in her forties.

She was surrounded by a crowd, who were performing “Emergency care by committee.”

I opened with my normal line.

“Evening folks, what’s the problem?”

“I think she’s dead!”
“She’s concious and breathing!”
“She’s unconscious!”
“She’s allergic to penicillin!”

Wha’?

I’m still waiting for the “The car just didn’t stop and it hit her and oh god I thought she was dying.”

Nobody is making any RTA noises, but I’m not keen to move the patient until I can confirm what’s happened to her.

In the meantime I’m kneeling in the gutter of one of the busiest city centre roads in Edinburgh. Buses whoosh past my feet, I deploy a security guard to stand up-flow of me with his arms spread wide, waving the vehicles away from us.

They pay little attention to him. Gotta love Edinburgh bus drivers.

I turn my attention back to the crowd.

“Did anyone see her get hit by a car?”

“No.”
“I think there was a car.”
“A car drove past when she fell over.”

“So, did anyone see her fall?”

“I did.”

“And was there a car hitting her at the time?”

“No. She just fell over.”

Splendid. I marshall a nearby punter to help me drag her out of the road and onto the pavement, where I rapidly conclude that she is guttered drunk and requires nothing more than being sat up and toddled into the back of a motor.

I am still surrounded by public when it comes to my handover, so I’m swift and acronymous.

“This is Shirley, she is D&I, PFO, uninjured.”

The crew nod, understood and take her away, allowing me to return to my Starbucks.

Now then, any non-medics out there fancy a bash at “PFO”? Kudos to the winner - medical professionals and those by association need not apply