Jun 11

Clot-busting II

Tag: Ambulance,Thrilling InstallmentKal @ 3:57 pm

I look up at Turismo and mouth the word “thrombolyse!!!!” at him (my facial expression adding the exclamation marks) and his eyes widen with mine.

We draw masks over our faces, calm and professional, friendly and reassuring as we load the patient onto the chair and begin to roll him down the stairs. Dezzy has the handle at the back, I’m lifting the front wheels, Turismo following behind with the oxygen bottle and tubing snaking over the patient’s shoulder and into his non-rebreather.

Turismo tells me later that he only hears what happens next, that he sees nothing, but hears me shout:


Then, anxious.

“Aww, fuck!”

Followed by a thick, fleshy thud as I punch the patient hard in the chest.

Pete’s head swings uselessly at the end of his neck while his limbs stutter for a few seconds as their oxygen reserves run out, his heart having stopped on the way down the steps.

I’m not mathematically minded, in fact I’m practically innumerate, but I’m running lightning calculations in my head – how far are we from the vehicle? Is it more dangerous to delay CPR by rolling him to the ambulance or will the more controlled environment help us to run this arrest most effectively? I reach my conclusion.

“In the motor – go!”

We roll the chair, fast as hell, Pete’s arms and legs flapping in the wind as we go and shove the whole shooting match into the back of the ambulance, slinging the patient onto the bed.

I’m shamed to admit it, but a tiny part of me is relieved that now I won’t have to thrombolyse.

This is just a cardiac arrest – I can do those.

“On chest, Dez.”

He jumps to it while Turismo unpacks me a BVM before ripping open a set of shock pads and slapping them onto Pete’s chest.

“Coarse VF.”

“Shock it.”

“Charging! Clear!”

We all throw hands in the air as the defib shock bangs Pete up and down on the bed. Dezzy is back on the chest immediately and I’m thinking about what size of ET tube I’m going to stick down the guy when Dez interrupts.

“He’s responding!”

Pete is eyes open, mumbling. As his face grows increasingly pink, he becomes more vocal, ripping the BVM off his mouth and nose, crying, shouting. I shush him, try to calm him, but his brain has been starved of oxygen for too long.

Nothing but time will bring him back and, sure enough, a few minutes of gentle talking and oxygen therapy and he’s back to full consciousness, looking around himself at the three of us.

“Did I black out?”

“Yes, mate.” Turismo begins, before he’s interrupted by the mobile ringing again.

It’s CCU, requesting an update.

We fill them in, the patient is now post-arrest, he’s had a minute of CPR and one shock.

“Ok, go ahead with the Tenecteplase.”

Turismo and I rendezvous at the bulkhead of the vehicle and sotto voce for a minute.

“Have you done this before?”

“Nope. I was hoping you had.”

“I’ve seen it done.”

“Me too. Shit. Right, look. You have the chat, I’ll push it. OK?”


Because we’re not just preparing to inject this guy with a kill-or-cure drug. .

We need to ask his permission to do so.

Put yourself in Pete’s position – he’s suffered crippling chest pain, the worst pain he’s ever experienced. He can’t breathe, he wants to vomit, his brain is telling him that he is going to die. Then he wakes up on an ambulance trolley, two burned patches on his chest, his ribs aching like someone’s been punching him in the sternum a hundred times a minute. The effects of oxygen starvation have him feeling like he’s got the worst hangover of his life.

Then someone leans forward and says “Hey Pete? We can fix this with drugs that might reduce your brain to summer pudding. Fancy your chances?”

Before we go any further, we need to know that he’s fully competent, so I question him as to the date, our location, who he is, who we are and why we’re all in this fix today. He’s a little frustrated by the questioning, but answers correctly everytime.

Fully oriented, person, place, time and situation, or “AOX4” as I’ll later record him.

Turismo crouches by Pete’s bedside and runs him through the situation – how the benefits of this therapy greatly outweigh the risks, but that “it may cause bleeding and that could include bleeding into your brain, causing stroke or death.”

Pete nods along with us as Turismo completes his consent conversation.

“You’ve already had one episode of unconsciousness due to this chest pain.”

The patient looks him in the eye.

“What would you do?”

“I’d take the drugs.”

He mulls this over for a moment, nodding slowly.

“Are you happy for us to go ahead with this procedure?”

Pete delivers his killer line.

“I’m not happy, no. But if you tell me it needs to be done, then we’ll do it.”

Turismo gives me the nod and I rip open the cardboard box of Tenecteplase. The last time I did this was in my paramedic course at a sunshiney desk.

I mix the drugs with water in its handy wee plastic cup and sook the mixture back up into the syringe, lifting it to the light to check that the powder has dissolved properly, that there are no particulates that may lodge in the syringe, or worse, in the vein.

Then I double check the dosage with Turismo. And he double checks it back with me.

The walk from the bulkhead to the patient’s side is two steps, but it feels like it takes an age. I turn his arm and flip open the cap on his cannula, slide the tip of the syringe onto the drug port and give it a half twist, locking them together.

I’m reminded of the course director at my para course when he dressed down an arrogant technician student who asked “Really, what’s the difference between their job and our job?”

He coolly replied – “I teach technicians to use drugs that save lives. I teach paramedics to use drugs that kill people.”

In honestly, I’m also remembering Pally’s thrombolysis story. How he pushed the drugs and watched the woman arrest in front of him, how her husband screamed at him for the journey to hospital, how he didn’t sleep for days afterwards, how he was summoned to CCU to discussion the situation with the consultant.

And I’m also remembering the patients I’ve had arrest in the back and reminding myself, loud and clear, that without this therapy, this man is going to die.

I slip my thumb over the plunger, look Pete in the eye.

He nods, closes his eyes and leans back in the bed.

I push the drugs, twist the syringe from the cannula and call through to the cab.

“CCU, please, Dez. Smooth over fast, but fast as you can, OK?”

He gives me a thumbs up through the bulkhead window.

“Don’t throw us around, mate. We’re working back here.”

“On it.”

The engine starts and the vehicle pulls away from the kerb. I strip my green shirt off and throw it in the corner, my chest and back dripping in sweat already.

Pete remains in position, lying back, eyes closed. I place a hand on his arm.

“How you going?”

He doesn’t open his eyes.

“I’m ok.”

“And your chest pain?”

“It’s bearable.”

“Still there, though?”


We reassess his blood pressure and give him another dose of morphine. There’s no need for either of us to be standing, but neither Turismo or I can seem to sit down, preferring to hang from the bars in the roof, hovering around Pete.

At one point the colour drains from his face and he scrambles to sit up straighter – I’m rechecking the monitor for arrythmias, but he instead grabs a sick bowl and fills it to the brim with rancid, watery brown vomit. Turismo and I form a human chain and work an operating line, replacing clean for dirty, stuffing paper towels into the bowl to sop up the puke and shoving the soggy mess into orange rubbish bags. Again and again Pete vomits until he’s left with just dry heaves which eventually subside. He sits back in the bed and I mop the sweat from his face.


“A little.”

I try to start a conversation about his hobbies, his family, his friends, but he denies having any of the above. We ride the rest of the journey in relative silence, only asking Pete relevant clinical questions as we go.

At CCU we’re met by a chest pain nurse, the same lady who taught me most everything I know about acute 12-Lead ECGs. We roll Pete on the trolley into the hospital, the monitor clipped to the side of the bed, one of us always watching him, his rhythm, ready for him to arrest as we go.

Instead we roll into the ward without incident, transfer him to a hospital bed and hand over to the cardiology team – they apologise for not being able to take him into the operating theatre and thank us for thrombolysing – “Now I can go home early!” laughs one nurse.

We head back down to the vehicle to complete paperwork and while Turismo is typing, I go back up to CCU to collect a replacement box of Tenecteplase. A gentleman in shirt and tie buttonholes me as I enter.

“His 12-lead is almost completely normal, now. He’ll be home in a few days.”

“Really? That’s great news, thankyou.”

“Been working hard?”

He nods at the spreading damp stain across my chest and I laugh.

“Oh, no. That’s the first time I’ve thrombolysed in the field – raises the pulse a bit.”

“You should be proud of yourselves, early thrombolysis is better than poor angioplasty and poor angioplasty is delayed angioplasty. You said he arrested on scene?”


“He’d never have made it without the Tenecteplase – you guys saved his life, without question.”


He turns to go and I realise I have no idea who he is.

“Sir, forgive me? I’m afraid I don’t know your name.”

He extends a hand, introduces himself with a name I’ve only heard in conversations.

He runs the entire department.

Remembering Wilco doing the same for Sophia and I in Abu-Dhabi after a shitty job, I grab three ice cold lemonades from a machine in the corridor before meeting Dez and Turismo in the ambulance. We sit together on the trolley and grin at each other, though the can in everyone’s hand trembles just a little.

Dez takes our paperwork back upstairs for us and on his return recounts his conversation with Pete as he sat up in bed, rubbing his chest and frowning.

“When I blacked out, did I stop breathing?”
“And did my heart stop?”
“You guys did CPR on me?”
“And shocked me, too? You shocked me with that machine, didn’t you?”
“That’s right.”
“I was dead?”

The patient stares at him, wordless. Dez wishes him the best and leaves him to it.

For every pisshead, smackhead and time waster, for every late job or NHS24 – scared-of-your-shadow “meningitis” and “chest pain”, for every snotty GP or adolescent hawking phlegm on the floor, for every “spiked drink”, maternataxi and pseudoseizure.

I will take a thousand of you for this feeling.

You will not dilute why I joined this profession, you will not browbeat me into submission.

Because occasionally?

Just occasionally.

All of your shite is eclipsed by knowing that, through the actions of my colleagues and myself, someone is alive who otherwise wouldn’t be.

That’s why we do what we do.

And that’s why we keep doing it.

60 Responses to “Clot-busting II”

  1. Mike says:

    Fucking Magic Kal.


  2. Andy says:

    Totally amazing. Well done Kal, for the job and for the story.


  3. David W says:

    You, sir, are a good man.

    Keep it up ;-)


  4. Sarah says:

    Excellent work. It makes me happy that one gets praise where due from on high too.


  5. Leliwa says:

    Mate just keep doing it! You guys are the superheroes of today! I am saluting you and wishing all the best and thanks for those stories they are important to us!


  6. Dave the Dog says:

    Beautifully written Kal. I was that man last year. possibly unusual but I knew what was happening. My response to thrombolysis was ‘get on with it! I understand the risks’! I’m now back at work. I shouldn’t be except for you guys and the rest of the cardiac team. Cabbage done and dusted. Thank you. It’s not enough, but words never are………


  7. Rick T says:

    Kal, you and your team are heros. Full Stop.


  8. Wanderer says:

    Strong work! Even with PCI available ASAP he still would’ve been veggies. Ups the pucker factor a bit eh?


  9. Lauren says:

    We get told that paramedics do thrombolyse for MI, never really known what it really entails though, thanks for the beautifully written explanation, I somehow thought it was more common, but that’s probably because about half of the calls we get up here are for folk in the “oh holy crap you’re far away from a hospital” areas of Scotland.

    And no offence taken, a fair few of the calls we send your way are in all probability a pile-o-poo, but if you can’t see someone you’ve kind of got to take their (or their mum’s) word for what’s going on with them. Not that I’m going to try and defend it. I (and everyone I work with) have so much respect for the SAS, not least because we don’t have to see our patients.


  10. David Bain says:

    Way to go, Kal, keep doing it!


  11. Heyho says:

    proper stand up and applaud writing, Kal x


  12. Cadbury Moose says:

    | |
    | 0 . . . 1 . . . 2 . . . 3 . . . 4 |
    | ^ |
    | KINNELL | |
    | | |

    That is all.

    (Hoping the ASCII art works OK.)


  13. Cadbury Moose says:

    Argh! Wretched blank-stripping code, we hates it we do, _FOREVER_!

    (The post above was supposed to show the British Standard Kinnell meter reading 4.0)


    I shall go and have a cup of tea.

    But first: Well Done Kal!


  14. Diane says:

    Completely in tears at the end. Believe me, there are a lot of us out here who are extremely glad for people like you in the world.


  15. Jess says:

    Fantastic, it’s an amazing feeling! I had a similar job a little while back It still gives me a warm glow now thinking about it, dead to back home with family three days later, especially on the fifth drunk of the night.

    Congratulations :-)


  16. Cath says:

    Just occasionally. And totally worth it. Very well done :-D


  17. Steven Fisher says:

    Well done! Wasn’t sure what to expect at all from the second part.


  18. Fee says:

    *applauds loud and long*

    I was reading that so fast in order to get to the end, I had to read it over again to take in the details. You certainly earned your cold drink on that call.


  19. Sam says:

    Here here!! Absoulutely! And an ‘Amen to that’ for good measure!


  20. pam says:

    Great writing, great save. I look forward to your blog, and am glad you are on the job.


  21. Andrew says:

    Hoping that neither myself or loved ones ever need your services….but if we do I hope we get someone as good as you.

    Hmmm does this qualify you as a Resurrectionist ?


  22. Lucy says:

    Yet another brilliant way you’ve saved a life and beautifully told.

    Does make me wonder if the SPC with the drug should also state in the side effects “May also induce dreadful sweating, nausea and anxiety in you as well as your administering paramedic”



  23. Squeezey says:

    Amazingly written! :)


  24. Liz says:

    Epic post is epic!

    Well done – awesome para… awesome writer ….


  25. Jo says:

    That was fantastically written! Thank you so much – I was holding my breath all the way through!


  26. Linda says:

    Kal, I’ve been reading you from Michigan, U.S.A for a long time. That post shows your amazing medical abilities, but your talent as a writer is mind-blowing. Most of the time when a blogger writes a book it’s a terrible tragedy because of the wasted trees, but it is a crime that you haven’t. If you ever do, I will buy it. I don’t even care what it’s about. You tell a story perfectly.


  27. Stophocles says:

    You had me fuming for leaving us hanging with the first part of the story… But thanks for the writeup – it makes a great read. I’m a volunteer ambulance officer in country WA and have got a little frustrated with a few jobs lately… but you reminded me of a job last year where because of the choices I made, we probably saved a life. Thanks for being the catalyst for change in my mindset!


  28. PJ says:


    And you’re right about how these stick with you…I will remember my one-and-only survive-to-discharge cardiac arrest patient for as long as I live.


  29. Sam says:

    Felt like punching the air as I got to the end! Wonderful, wonderful story-telling! Congratulations, and thank you.


  30. Jon says:

    Kal – Amazing. Alaways nice to get positive feedback from “on high”, and great to see a good outcome.

    great writing, too!


  31. Chrissy J says:

    This is fantastic writing.

    I’ve patched up a couple of people in my time (as a combat medic) and I wrote a blog, but this is Something Else.
    I’m in awe of you, of your work and your words. Seriously.


  32. Marcie says:

    Bravo!And heartfelt thanks to all three of you, for daring to do the job you do.


  33. Charbob says:

    This has to be one of your best blogs by far. You should write a book! Pure genius :)


  34. Marie says:

    Superb, you write it all up so well.

    The first one is very scary and so’s the 2nd, 3rd and 4th! thank goodness we are getting more emergency cath labs.


  35. Maggie says:

    I bet your mum’s proud of you


  36. Metamor4sis says:

    When you put all this in a book, make sure you add our comments here and there LOL!

    Awesome, simply awesome stuff.

    Genius to do it in two parts.


  37. Piper says:

    Cool – well done you. Thrombolysis in CCU is bad enough – can’t imagine it in a moving ambulance…..


  38. Lucy says:

    Worth waiting for. Great writing Kal – and a great job well done. Glad you’re out there.


  39. arrestedrogue says:

    Kal we love you guys and thank you from the bottom of our hearts for the job you do for little money and even less thanks so on behalf of all your “pissheads, smack addicts and various other low life scum you deal with day on day” we thank you and all your colleagues………THANK YOU ALL……..


  40. Worrals says:

    Good for you, Kal. Walk tall.


  41. Sewmouse says:

    How cool are YOU!!?? I kind of teared up a bit there at the end. And I must admit, I was surprised at the guy saying “I was dead?”… how scary it must have been for you both.

    *raises glass* – Here’s to you, Kal!


  42. Pa State Cop says:

    Fuckin’ Brilliant! Damn well done.


  43. Utility says:

    Fantastically Well done mate, to you and everyone on scene :-D
    Scary Stuff, we all hate those, “I don’t want to be here, doing this, but I have to” Moments.
    Glad to know you guys are out there for us, and fantastically well written, best read I’ve had for ages, thank you :-D


  44. Clare says:

    Holy Crap, that had me on the edge of my seat! If I could drink right now I`d be having one for you. As it is, you can make do with and orange and cranberry. Just knowing you got one make it all worthwhile, eh?
    Though I do like that you never explained why you punched him in the chest. It`s like you were just really pissed off at him for pulling that sort of shit on the way down the stairs.
    By the way the cat just sat next to me and stared at the screen for the whole time I was reading, think he`s impressed too.


  45. Katrina says:

    Fantastic. Utterly fabulous. The way you write leaves me hanging on tenderhooks, i cant read and take it in quick enough. You sum up exactly why i am in this profession. Keep up the good work.


  46. Loth says:

    Dammit Kal, you made me sniffle again. I wish I could write one tenth as good as wot you can.


  47. G says:

    I know its been said already, but thought I’d come out from my silent blog stalking to mention how good that and so many of your other posts are. Exciting, funny (“shit, I was hoping you had”) and definately inspirational.

    Thanks Kal.


  48. Megan says:

    Dammit, you un-lurked me by being brilliant. And by echoing stuff I’ve had rolling around in my head all week about living with meaning – you’re doing it.


  49. PA State Cop says:

    Precordial Thump. Haven’t heard of that done for a long time. Got taught that as ways back. Way Old School. Had to be a witnessed event though. Hasn’t been taught for a long time. Saw it done enough on “Emergency”. Worked everytime there. ;)


  50. Wendy says:

    Long time lurker, first time commenter.
    Your writing is fluid and intense and it seems to me that your life is too :)
    Thank you, thank you, thank you for sharing your life, your humour,
    your insight and your stories with us!


  51. steph moore says:

    Bravo, Kal. Bravo!

    Why you haven’t won a Webby award is beyond me. Your writing is stellar and your medical skills ain’t bad, either (grin).


  52. G says:

    Also, if the link works, here is some research into PCI v thrombolysis which may interest some folks:



  53. M says:

    G, Good work promoting our little project there! I too have come out of my silent blog stalking, that story was amazing and so relevant!


  54. Yorkie says:

    Nice one Kal.
    Vivid picture you paint my good man!
    D’ya know, in Glasgow i couldnt tell you the last time we had Tenectaplase on the wagon. Certainly not been any this year. Not sure if it’s a costing issue or not but sad all the same.



  55. Alison says:

    makes me glad we have people like you on the road. I thnk of these stories every time I pass an ambulance holed up outsideSt Mary’s Cathedral, waiting for the next emergency (or stubbed toe!).


  56. Amanda says:

    Wow… that’s intense. We have a STEMI bypass protocol – if you are within 30 minutes (approx) of the Civic hospital you bypass any other hospital enroute and head straight in. The usual ASA, nitro, morphine and drive like mad. That’s cool you have the option for thrombolytics – sounds like it would be a good option for some of our rural paramedics.
    I would love to compare EMS systems one day… oh to travel…


  57. Miss Waz says:

    FANTASTIC!!!!! A+ – great read, inspiring stuff x


  58. grousebeater says:

    RESPECT, I doff my cap to you and your colleagues sir


  59. Ellie says:

    Hey Kal, just catching up on your posts. Well done! On the job, and the brilliant writing. From the fleshy punch to the trembling cans, that’s very real storytelling, I enjoyed it, and can’t wait to get back on the job. My service doesn’t thrombolize though.


  60. JustMyBlog says:

    I have goosebumps. And I would pay a fortune for a book of these stories.


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