Feb 07

At the sharp end,

Tag: Ambulance,I'm FineKal @ 10:25 pm

The locus is weird, not somewhere you’d find yourself as a pedestrian and the story is so over the top that we’re convinced it’ll be exaggerated by the caller.

But when we arrive, we realise that we’re wrong.

When…I hesitate to use the phrase ‘bad people’…but let’s go for “society’s fringes” find themselves with a disagreement they tend not to go for sensible discussion, the small claims court or the Citizens’ Advice Bureau.

They grab you off the street, take you somewhere far away and do beastly things to you.

And then dump you, brutalised and far from home.

Now, I’ve had my share of people being unpleasant to me, but I like to think that by not subscribing to the class of “I shall further myself by doing beastly things to other people” I’ve managed to avoid this particular shade of retribution.

Which is a nice thing.

Because it looked sore.

He’s a hard man, there’s no doubt of that. He’s so hard, it’d probably be capitalised.

A Hard Man.

But he’s crying, screaming about the pain of his cracked and shattered bones.

I can’t blame him and loop a tourniquet around his bicep.

“You’ll not find a vein on me…” he begins and I tend to take this statement with either a dose of sodium or the arrogance of the challenged, but when BTD starts searching his skin for the shadows and paths that will guide us into his circulation he realises the problem.

“Are you still using?”

“A bit. I’m on methadone. I told you, you’ll not find a vein on me.”

His veins are…gone. There’s nowhere to go, each blood vessel near the skin has been injected time and again until they’re useless. I whip the sock of f the leg that isn’t smashed up and put a tourniquet around his ankle too.

“I think there’s one down there.” he begins “The big one around the ankle bone?”

The three of us relax into an easy banter, bonded by the practice of vein finding, though two thirds of us are, perhaps, more legitimate in our experience!

“Fuck’s sake, pal, you don’t make it easy for us, do you?”

He laughs at me before turning his arm this way and that for BTD – “You’ll maybe find a wee one at the back of my elbow, I couldn’t get to that one.”

The task seems to have distracted him from his pain and he’s relaxing. Good, things are looking up. In fact, things are looking very up, a tiny nematode of a vein is just palpable in the top of his foot. With a blue cannula, the tiniest we carry, I reckon I could just about get in there. I swab it.

“Awww shite, hurry up!” he urges BTD “The big cunt’s gonnae jag my foot, it’s fuckin’ nippy….”

“Sorry pal…” I say, before sliding the needle into the skin and peering at the end for the “flash”, the sudden rush of blood up the needle’s lumen that tells me I’ve punctured a vein.



I slide it back a little, palpate again for the vein and readjust my line of attack, pushing the point of the needle forwards under the skin.

“Ayiee! Big yin! Nerve! Nerve!”

I’m defeated, yet confused. I slide the cannula out of his skin and glare at his foot. There’s the vein, right there, I can *see* it, I can *feel* it, I’m staring at the skin like a seer at entrails when my right hand complains suddenly, in particular, the end of my third finger.

I look down at my hand, tranquil and serene in gloves of duck egg blue, the uniform of the medic at the bedside, the healer, the cool cloth on the brow in your fevered night.

The tranquillity is desecrated at my fingertip, rude and passionate as blushing cheeks a perfect sphere of bright blood is forming on the vinyl. Perfect sphere. Not smeared from anyone, but bubbling up from inside me.

I’ve jagged myself.

I’ve jagged myself with a dirty needle from a IV drug abuser.

Oh Christ.


No, no.

I push the needle into a sharps bin next to me (and curse myself for not doing so earlier…stupid, stupid….) and rip the glove from my hand, squeezing the base of the finger in my fist and forcing blood out of the wound. Make it bleed, they say, flush the infection out with your own clean blood.

I make no attempt at cleanliness, I squeeze and push, milking and kneading blood from my finger that spatters onto the floor.

They teach you at college to constantly reassess the danger you’re in, change your tactic if need be. If you’re at risk, return to the start and check everything again.

I’m no longer safe, but don’t want to panic anyone.

“BTD, this isn’t working. Let’s give him some gas and go. By the time we’ve fannied about here we could be at A&E.”

“Just let me….”

“Let’s just gas him…c’mon.”

“I’ll get a set of obs?”

Fuck the obs! Fuck his pain relief! Fuck professionalism and service and duty and what’s right and everything. Fuck everything. I want to go to hospital. I want cool tranquil gloves at my bedside and someone to take this away from me. Someone to wake me up. To tell me I haven’t done what, despite what I wish, I clearly have.

I pull BTD to one side.

“I’ve stuck myself, mate. With his needle.”

His eyes widen.

“Right. Right. Ok. Let’s go.”

But the patient’s overheard.

“I’m clean, pal. You’re safe.”

It’s not an easy conversation to have with anyone, let alone when the person who YOU’RE meant to be calming and treating is now sitting in your seat, ministering to you. But I grab his lifeline and haul on it.

“When did you last get tested?”

“Six months ago.”

“And you’ve used since then?”

“Only clean works, I swear it. Honest neebor, I wouldn’t bullshit you.”

“Sexual partners? You always use a condom?”

His eyes flick to the floor for a moment before he answers.

“I’ve a girlfriend, eh?”

“And there’s no-one else?”

Again his eyes go to my boots.

My soul joins them.

I’m meant to drive to the hospital now. Four and a half tonnes of vehicle with a patient and my mate in the back, the latter not even belted in. I’m talking to myself as I go, a rising cadence and pitch to my inner monologue of “Oh Jesus….Jesus…..” before I slam the window shut between the cab and the back and talk, out loud to myself.

“Get a fucking grip. Keep the head, c’mon. Just drive. That’s all. You can’t make it better right now and you want to go to hospital. Pay attention, look at your mirrors, watch the traffic in front. It’s wet, it’s dark, mind your speed. Don’t turn the blues on, however much you want this to be over faster. Just drive. That’s it. Keep the head. Drive.”

It takes twenty minutes to get to hospital. But it might as well be a week. I radio the control room and let them know what’s happened, that I need an officer to meet me. It’s immediately as I hang up that I realise I don’t need an officer. I need a mate.

So I ring one.

I don’t work with Pally on the road so much anymore, not since he got promoted and drives his desk instead. He’s not on-call, but we’ve seen each other through some hard times before. He agrees to meet me at A&E.

When I open the back door of the ambulance the patient returns to his reassurances to me that, really, I’ll be fine. Nothing to worry about, he’s clean.

“Would you take a test tonight?”

“Sure, no problem…d’you think they’ll test me for chlamydia?”

“Oh Jesus, seriously?”

“I’m just kidding with you, pal.”

Oh? Well two can play at that game…

“Can you transmit chlamydia through blood?”


“Well maybe I should double my chances, take you out the back and shag you too?”

He guffaws and slaps my arm and I do the same to him before booking myself in, holding my mask tight to my face.
Aye. Relax. Okey dokey.

There are advantages to working in the A&E service when you book into the Emergency Department. But disadvantages too, including the fact that everybody knows you and soon finds out what you’re in with.

Margaret the receptionist gives me a sympathetic look.

“Oh son….”

“Don’t be nice to me, for God’s sake…don’t be nice to me…”

Because, I don’t know about you? But when people are nice to me and I’m just barely holding my shit together?

Being nice to me is lethal.

I handover to a nurse and she points me towards a cubicle. Pally rocks up and immediately takes the piss, which, frankly, is exactly what I need him to do.

Doctor Doug joins me in the cubicle with a med student, I tell him the story and he runs me through his plan. It’s simple, really. They take my blood to store in case anything develops later, they test the patient right now to find out if he has anything nasty and in the meantime, I take a shit-load of anti retro virals to stop my body from allowing any viruses I’ve picked up to grow and develop.

Easy, one two three. The blood is taken and stored, I’m given a Hep B booster, though I’m pretty certain I’m up to date with my inoculations for the same. Doug runs me through the chances of transmission.

“HIV in the IVDU community runs at about 3%. The chances of transmission for a used needle stick incident are approximately 0.1%. With the PEEP medication, we can pull that down by a further 80% of the current risk. Hepatitis B you should be cool for, since you’re covered and he has no history of that either. HepC may be a problem.”


“HepC infection runs at about 33% and the chances of transmission are much, much higher. That’s what we need to be worried about.”


He steps outside to talk to virology about me and on his return I buttonhole him.

“If I *do* have HepC? Which seems to be our biggest risk?”


“What would be the implications there?”

“Well, you’d have some coagulopathy issues, you’d be much more prone to liver cancer, but these are issues that we can deal with surgically or with medication.”


See? No “You’ll be dead in a week.” No “Your liver will come squirting out your bum.” A risk of cancer (shit, I’ve got a risk of cancer anyway, EVERYTHING causes cancer…) but nothing described as insurmountable.

“Professionally, I don’t know how it stands for you guys, but if I was diagnosed with Hep C, I wouldn’t be able to work in A&E. I doubt you’d be allowed to remain front line.”

Say wha’?

Because in truth, I can’t really imagine becoming critically, terminally ill, my head won’t let me.

I can imagine losing my job, though. I can see that in my mind.

And it scares me.

He gives me a stack of pills – “They basically cause malabsorption, so on the upside, you’ll lose some weight…” including a variety of remedies for nausea and diarrhoea, wishes me well and tells me that they’ll phone me in the morning with the results of any horrible diseases my patient has.

Pally drives me to the station and I drive myself home.

Bambam has a tea poured for me. I hold it in both fists and stare at my feet before bursting into tears and vomitting out the entire story, everything that frightens me, everything that has me furious with myself.

She has work tomorrow.

I clearly don’t.

I demolish a bottle of vodka to make me sleep.

It works.

67 Responses to “At the sharp end,”

  1. RW says:

    Couldn’t leave this still saying ‘Comments (0)’, so all I can offer is a meaningless ‘good luck’.


  2. Bear says:

    Such a horrible, bowel-liquefying series of progressive realisations.

    Needlestick… IVDU… Health implications… Career implications…

    I know you don’t always post at the time of the event, and I hope you’re on your way to getting the news you want about your infection risk.


  3. Paul says:

    I’ll just say I’m glad you tagged this post with “I’m fine”. Real glad.


  4. Tim says:

    Thinking of you mate, let us know how it all goes.
    Plus, if you can’t work on the road can you arrange to work light duties or something so you don’t go stir crazy?


  5. RapidResponseDoc says:

    Oh shit, man!! I’m with you all the way on this one!! That really sucks big time. I’ve had my share of sticks, but never off a user. Please tell me he tested negative!


  6. katie says:

    I’m pleased too… very pleased, hope you don’t mind, have sent the link to this to the guy who does drug education in our schools – think kids might relate to how serious it all is if they read/heard a story like this.. maybe, but AM really really pleased you’re ok :) Katie


  7. Reader says:

    Whoa. I gather it’s been days or weeks since this happened and that everything in fact turned out clean, but omg. Amazing how some of the actions with the most harrowing consequences can happen so fast with no chance to correct a split-second’s worth of mistake. If you haven’t reached your retest at six months (or whenever according to your protocols), I’ll be hoping for negative on everything (I don’t pray). Your resourcefulness, clear-thinking, and heck even kindness and competence still shine through in this story.


  8. Darkside says:

    Good luck, look after yourself, keep us posted.


  9. Morpheus says:

    Ah shit. Sorry mate.


  10. bloodystudent says:

    Jesus christ you f*cker! Some of us read these through google blogs and don’t immediately see your I’m Ok tag! Some of us are also hoping for a career in A&E and know exactly what that injury would mean, professionally and medically if it were to have gone tits up.
    So glad you’re ok. You won’t need telling any more, but FFS, be careful, you seem like a great guy and a better paramedic so don’t ruin either. x


  11. Adrian says:

    Note to self, read the tags, you scared the crap out of me! Hope you’re truly ok. Keep safe.


  12. Jo says:

    My very best wishes for clean tests all the way through, as the very minimum. You deserve better than that!


  13. Becca says:

    Kal, I know you’re fine and all but I really really wanna give you a BIG HUG round about now.

    Also, I thought I should remind you that you’re an absolutely phenomenal writer.

    There’s a hug, a spare bed, good coffee and all of Manchester’s nightlife here if you’ve ever the time and the inclination.


  14. Wanderer says:

    At least you know how you *might* have gotten the nasty buggers. Had wonky blood tests, panel came back +antibodies for Hepatitis C. About shit myself, proceeded to freak out and catalog as many encounters as I could remember whilst waiting for the good/bad news. Luckily viral load showed undetectable, but the waiting killed me. Luckily, the only sticks I’ve had are clean, pre-patient needles.

    Glad you’re ok!


  15. Parodie says:

    Oh, man. I must say the line about you not wanting people to be nice to you really resonated. I’ve absolutely been there.

    I hope you truly are “fine”.


  16. Paul says:

    Jesus Kal thats more harrowing then Brian Kellets gob vomit! Hope the tests are clear and the drugs dont screw you up too badly.

    After all with you off the line what will i read?


  17. Masher says:

    Jeez, Kal! That sucks.
    I’ve got EVERYTHING crossed for you, mate.


  18. Suzi says:

    Jesus.I hope you really are alright Kal, used to work in Critical Care and now I work in Probation and Prisons with drug users, and needlesticks are probably the thing I’m most scared of. You’re in my prayers pet, let us know how things turn out.


  19. Katherine says:

    ‘Because, I don’t know about you? But when people are nice to me and I’m just barely holding my shit together?

    Being nice to me is lethal.’

    Yes. Absolutely. Hope you’re ok.


  20. Linzk425 says:

    New reader here. Needlestick was one of my biggest concerns way back when I was a nurse. I know it’s tagged “I’m fine” but still, thinking of you.

    I shall now return to reading the archives. Looking forward to the Abu Dhabi stuff!


  21. Win-Stone says:

    Ok, harken to the words of Win-Stone – the needle goes in the patient, not the paramedic.

    Got it?? Ok, write that out 100 times and then finish it with the observation that Win-Stone says “Bugger!”


  22. Win-Stone says:

    . . . . . . . and I’ve got a horrible feeling that I’ve just done two entries. Damn.

    Oh, hold on. . . .

    make that three.

    Any advance on three??


  23. LizW says:

    Reading via RSS => I don’t see the tags. So glad people were pointing them out when I came here to leave a comment.

    That world-dropping-away feeling when you realise that some tiny, irreversible action has huge consequences is terrifying – and I don’t think I’ve ever felt it in anything like such serious circumstances.

    If you’re still taking the drugs, I hope they’re not going down too badly, and that the test results are all good.


  24. Monkey The Medic says:

    Jesus Kal, really glad you tagged this ok. Needle sticks are never fun let alone one of a user. Hope all the tests come back ok.


  25. Tom says:

    Bloody hell Kal. Got an awful fright when I read this.

    You’ve inspired me Kal, as I design and patent the first ‘paramedics thimble’ system.

    Take care.


  26. sebbie says:

    I hope the I’m fine tag means that this is done and dusted now. How terrifying for you.

    If anyone thinks this danger is confined to health workers I’m about to dissillusion them. Almost 20 years ago I was working for Royal Mail and emptying letter boxes. There is a technique for doing this so you don’t get stabbed by the needle someone has thoughtfully posted after they’ve used and a system for reporting the fact that you’ve spotted and left a used needle in a letter box (too dangerous to remove and transport). I wasn’t in the job long, I moved on and up, but in the short spell I worked at the coal face at least one colleague got a needle injury.


  27. Brian Kellett says:

    You dopy bastard, it’s not as if you were treating a pregnant cardiac arrest while hanging upside down in a burning car or anything…

    Now the piss taking is over, good luck with it all – having been through PEP myself for a month it’s no fun. My two bits of advice would be

    a) Yoghurt – plenty of yoghurt kept the nausea down without getting me *too* fat.

    b) If you use an alarm on your phone to time taking the PEP pills, choose an alarm sound that you don’t mind developing a pavlovian nausea response to. I suggest something other than what loads of people use for their ringtone.

    (I would have emailed you but your email address is on my other computer at home)

    If you want a chat about anything with someone who’s been through it, just drop me a line.


  28. Special K says:

    Shit, Kal. Shit.


  29. Sewmouse says:

    Ok, calm down, Sewmouse, he’s ok.
    Although this makes twice now, and I really do NOT want to hear about any #3 time. Take care of your precious self, my boy. *hugs*


  30. Sam says:

    Shit, Kal, good luck! Good to see the ‘I’m OK’ tag – hope you really are! Take care man.


  31. Sarge says:

    “I don’t need an officer, I need a mate”



  32. FireMom says:

    You and your cliffhangers. Thinking of you. Lots. Be well.


  33. Fee says:

    Holy Cow, I didn’t notice the tag til the end and my heart was in my mouth! I hope that tag means the all-clear has sounded.

    My other half coaches lads’ football, and they have to check the pitch before every game. Every week, he gets the same lecture about not touching needles/condoms, but I just might make him read this to back me up!


  34. maddmedic says:

    Frequent reader, infrequent commenter.
    Sorry to hear this.
    I was there once. Stuck by a nurse while working a trauma code.
    All turned out well but my rage and fear were great at the time.


  35. Mike says:

    Clumsy bastard.

    Makes you sweat doesn’t it?

    I’ve still got my GUM clinic card as a souvenir from my little adventure with a needle.

    At least you’re OK and, hopefully, a wee bit more careful.


  36. Bad Things.. « Freedom Is Just Another Word… says:

    […] Like this. […]

  37. DungeonRob says:

    Just wanted to send you my best wishes big man. Im not sure the “im fine” tag truly suffices in this situation. I hope i am right to asume that you are physically fine as well as mentally fine and that everything turned out well in the end.


  38. evilontheinside says:

    Mate, his blood’ll be no match for yours. Between the caffeine content and the alcohol, you’ll bleach his little IVDU badness to nothing.


  39. pam says:

    You need to be capitalized as well. You are one of the Good Ones. I will pray for you.


  40. Paws says:

    Holy f*ck, Kal, hadn’t been by in awhile (mea culpa) and your latest post is a scary one! Hope all goes well and that the worst of the experience is behind you!


  41. Fiona says:

    Kal, I have followed your blog for a while now, and I think you and my paramedic mates are amazing. I hope you are clear. You put my worries into perspective in most of your posts, none more than this.


  42. Carrie says:

    If you don’t let me know as soon as you find out the results there will be trouble.

    Call me if you need someone elseto talk to. Or just talk nonsense with.



  43. Andy says:

    Oh Kal, I hope it’s all OK. Let us know the results pronto. I hope the tag means this is done and dusted, but if it’s not we need to know what’s happening to you.
    I’m amazed there aren’t more accidental needle sticks. I jabbed myself a couple of weeks ago after doing my daughter’s meds. It’s astonishing easy to do even when you’re being careful. As she’s only 7 and I know exactly what she’s been up to, I know I’m safe. Best wishes for you being the same.


  44. Jess says:

    Kal, shit! It’s on my worst nightmare list in this job, I’ve seen colleagues go through the six months of waiting for the final all clear. Thinking of you and hope the PEP isn’t /wasn’t too horrible.


  45. theshortearedowl says:

    De-lurking to say this had better be a two-parter, with the other part already written and a happy ending. Or I want my money back.


  46. Nick says:

    Kal, I couldn’t not post a quick message to wish you best of luck! I really hope that the answer is that there wasn’t a problem. Please let us know when you are able to, and hang tough buddy!



  47. kai says:

    I don’t think I could survive reading your eloquent and heart-gripping tales of your descent into horrible disease, so think of me and stay healthy, eh?


  48. mako says:

    Been in a very similar position in the past mate, i know how you feel.


  49. MaireC says:

    Holy mother of…I’ve been lurking and following your blog for a long while now, and I hoped since day one I wouldn’t come across a post like this one. An unbelievably ridiculously large virtual hug for you. Like everybody else, I hope the ‘I’m fine’ tag means it’s done and dusted and that you got the all-clear, and not just the obligatory ‘I’m fine’ that everybody says so people don’t worry too much. Whether it is or isn’t, you’re still in my prayers tonight.


  50. Lucy says:

    God Kal, sending lots of love and hoping all is well. Had a couple of needlesticks myself mainly thro’ careless colleagues and the memory of the gut wrenching terror never leaves you. Keeping every thing crossed for you.

    Love and hugs


  51. blogdog says:

    Shit. So sorry you had to go through all that.

    Know what you mean about people being nice..

    Hoping you’re already at a few months from this and starting to get clear results on the follow up bloods. Will keep fingers crossed for you anyway.


  52. Rat says:

    Oh holy fuck. If I hadn’t read the comments pointing out you’re fine, right now I’d be ranting at you to keep us readers updated as soon as there’s any info. Just… GAH, man, I’m glad to hear you’re okay. Take care!


  53. Jo says:

    I missed the “I’m fine” tag, too, and my heart was in my mouth all the way down. I hope that everything is ok – please take care of yourself!


  54. Leliwa says:

    I really need to remember to read the tags, because I actually got worried bro. Good that you usually post stuff with delay…


  55. Vinaigrette Girl says:

    { Kal }. So much scary stuff; I’m sorry you had that, and you are so brave to put yourself in harm’s way, practicing Extreme Kindness but treating it as a life sport, where such accidents with potentially horrible consequences do happen.

    Now watch what you’re doing next time, you daftie, or VG, aka Somebody’s Mum, will come up there and embarrass you to death by watching for you.


  56. Patch says:

    I have a patient who has been sleeping with his wife who got Hep C 10 years ago from a transfusion. She recently found out she has it. He didn’t catch it after 10 yrs. She is doing well on Interferon and the titres are low.

    This kind of infection is not that easy to catch.

    Thinking about you mate.


  57. Steve says:

    Reading your post brought back a flood of memories and by the end I too was feeling sick; it’s not so many years ago that I went through a similar experience and spent 3 months taking PEEP. I don’t know what was worse telling my wife and daughter what had happened or the three months of medication and side effects; then the inevitable waiting for the final test results to come back. Thankfully I was given the all clear and returned to full duties. I really feel for you and what is ahead of you, be strong and I really urge you to take up the offer of seeing the team in ‘that clinic’ they were really supportive and helped dispel many of my fears. My thoughts are with you, your early recognition and initial actions coupled with quick access to treatment in an A&E dept that sounds like it knew what they were doing will have stood you in good stead. All my best wishes.


  58. Hel says:

    Hang in there Kal. I too was pleased to see the I’m fine tag. Am sending “be really fine” vibes. Hang in there.


  59. Cath says:

    So we could all tell you how incredibly small the chances are of you actually catching anything, but it won’t help. There is always the fear that you’ll be among the 0,5%. You’ll be ok, I have no doubt.
    What really makes me angry though, is that there are “stab-safe” needles out there, but they cost a penny more, so we can’t have them


  60. Lauren says:

    Note to self: Read the tags first. Hang in there.


  61. Mike says:

    Cath @ 54
    “What really makes me angry though, is that there are “stab-safe” needles out there, but they cost a penny more, so we can’t have them”

    Some clumsy buggers need Kevlar gloves though.#;-)


  62. Mike says:

    Cath @ 54

    “What really makes me angry though, is that there are “stab-safe” needles out there, but they cost a penny more, so we can’t have them”

    Some clumsy buggers need Kevlar gloves though. #;-)


  63. Black Butterfly says:

    Me too! Shit – you really scared me.


  64. MamaBee says:

    Holy crap! Glad about the “I’m fine” tag — hoping it’s in the physical as well as the emotional sense **hugs** Great retelling, though . . . as always.


  65. Alistair says:

    I’m glad you’ve put the “I’m fine” tag to this post! It’s the most horrible experience ever! Not in the medical profession but delivered first aid on the street to a person only to injure myself and then get their blood in my nice fresh wound. Ambulance turned up; he was a regular, a spot of Naloxone and he was fine…I on the other hand was an emotional wreck! That was almost a year ago now and I still remember it like it was yesterday. You’ll be absolutely fine! PEP is a barrel of laughs ;)


  66. Metamor4sis says:

    As Paul said, glad you tagged it I’m Fine. Otherwise, it’s a pretty harrowing post. Hugs


  67. Uphilldowndale says:

    :( :)


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