The patients you get on a night shift are of a generally different calibre. Until the pubs and clubs shut you can find yourself dealing with a near constant flow of drunks and assaults. Alcohol makes people violent, or suicidal; so after the pubs have closed we tend to have a run of people who have had an argument with their boy/girlfriend and have taken an overdose/slashed their wrists.
While the pubs are open you get the drunks asleep in the street, drunks who have fallen over in the street, drunks who have been fighting, and drunks who have punched a window/door and have broken their hand. We see a lot of drunks...

The number of seriously medically ill people tends to drop, mainly because most of them are in bed asleep, rather than collapsing with heart attacks. You do get your occasional medical problem, but not as many as on a day shift.

As the night progresses towards 3-4am you get your young men with minor illnesses who, because it is dark outside, get scared and call an ambulance. Perception of the seriousness of illness increases during the night, so we tend to get a lot of calls to people who have had diarrhoea/vomiting/headaches/bellyaches/coughs/colds and sniffles all day. You will also get the small child who has a high temperature - parents panic more once the sun goes down.
The night before last we had to go to a tearful mother who's newborn baby was desperately ill - it's umbilical cord had dropped off, I'm guessing that she was asleep in class when the midwife explained that this is what normally happens...

Then as dawn approaches, there are the 'maternataxis', pregnant women who think that they are going to deliver their baby in the next 20 minutes, and so can't call a taxi. This can be a nice easy job to see you off shift, and as long as they walk (and don't moan too much) I'm normally fairly happy to deal with them.
You live in dread for the last job of the morning though, it is fairly common to have a 'suspended' call as one half of an elderly couple wakes up to find that their partner has died in their sleep. Not normally a good end to a shift.

For a start off night shifts are bad for your health, humans are 'designed' to sleep when it is dark, not to charge around like loons looking for people who have fallen over because "My drink was spiked". Shiftwork can increase the risk of...

Obesity.
Cardiovascular disease.
Mood changes.
Higher risk of motor vehicle accidents and work related accidents.
Cause a 1.5 times increase in breast cancer.
It can increase your chances of colon cancer by 35%
Increased likelihood of family problems, including divorce; in my case the difficulty in maintaining a relationship due to a non-understanding girlfriend.

Why do I do this again?

My skin tends to get very bad when I'm working nights, and it is on nightshifts that I'll catch coughs and colds; the stress of working unnatural hours no doubt knocks my immune system on it's arse. Unless I eat nearly constantly I'll also find myself having a general feeling of nausea throughout the night. When I do get to sleep, I'll find myself sleeping longer hours, which means less time for social contact outside of work - not very good for your mental health I would suspect.

On the positive side - if you need to put on some weight, then the diet of chips and kebab that you find yourself forced to eat (ever tried to find a salad bar that is open at three in the morning?) will soon 'pad you out'.

I've been working night shifts all last week, four normal shifts followed by two on overtime (Saturday and Sunday - what a glutton for punishment I am). Then straight into seven late shifts which run from 4pm until 1am in the morning. It's got me thinking about night shifts. So for the next couple of days I'll be telling you about the horrors, and pleasures of night shifts.

Consider this a theme week, or a theme five days, depending on how much I can get out of the subject...

Last night we were out all night, I think we managed to wave at the ambulance station as we drove past on yet another call. Most of the calls were either drunks (injured hand, asleep in the street, fall and head injury), Maternataxis (including one who was 300 yards from the hospital and was having contractions every 10 minutes), and one overdose who walked on and off the ambulance, but was vomiting a bit.

We were also pulled out of our area to Whipps Cross, and the Royal London which was happening to every ambulance, as I saw a Becontree and Homerton ambulance at Newham. At 4am Control were desperate for ambulances as they were holding seven calls in our area, and there was one ambulance to go around.

I'm working the same shift tonight, starting at 7pm Sunday evening, finishing at 7am Monday morning, going back into work at 4pm later that day. Makes me glad I don't have a long commute.

This isn't my normal post, I tend not to do the 'Linklog' thing, but The Evening Standard has a number of recent articles about alcohol and how it affects Ambulance staff.

In this article they give a basic run down of the problem, including the statistics that out of 62 calls, 40 were alcohol related. This ties up with my own experiences.

In the second article they describe how an EMT has had to come off the road because of the amount of abuse they have been getting.

And finally this article describes a plan to identify pubs and clubs that let their customers get too drunk. It costs us around £18.6 million pounds to deal with drunks each year, perhaps getting some money back would be a good idea.

Normal non-linky post tomorrow/later today.

Lots of people want to know what happened to the lady in my previous post, so tonight I spoke to the nurse who was looking after her.

The patient continued to be unable to talk, although (perhaps sadly) she could understand everything that was happening to her, and around her. She was also unable to use the entire right side of her body. It seems that the stroke was caused by an infarct (or clot) in her brain, and not the more life-threatening cerebral bleed. She went to one of the better wards in the hospital after spending some time in the resus room, during which her husband constantly stayed by her bedside. The nurses looking after the pair of them felt a lot of sympathy towards them, and I think they all fell a little in love with the husband.
I mention that the nurses looked after the pair of them, because that is what good nurses do, they look after everyone affected by the illness
Sometime later today or tomorrow she will have a CT scan of her brain to determine the extent of any infarct, and then she will start the long road to a hopeful recovery.

I used to work in a medical ward, and we would have a lot of stroke patients. Unfortunately there is no magical medical treatment for a stroke once it has taken place - instead it is a long gruelling slog through physiotherapy, speech therapy and occupational therapy. It can take months to recover some function, and for many they do not recover at all. They remain chair, or bed bound - and are discharged into a nursing/care home until they succumb to an infection that kills them.

Unfortunately, given the type and strength of the stroke this lady has had I would not hold much hope for a recovery. Miracles do sometimes happen, and I suspect that this entire woman's family will be praying for such a miracle.

Some jobs will just make you sad, and it's those that you'll find yourself carrying around with you for a time. It isn't always the death and horror that affects you - and you can be surprised by the things that haunt you.

We got a call to a block of flats, it was given as a 69 year old female who is unresponsive and who has a history of schizophrenia. Her condition could be caused by any number of things, so you carry all the equipment up the flats and you never know what you are going to encounter.

We were met by the woman's husband who led us through to the bedroom where our patient lay. She was on the bed and was not talking to anyone - with one hand she was 'fidgeting' and plucking at her clothes. This was normal for her, and could be due to the anti-psychotics which she uses to treat her schizophrenia. Looking at her prescription sheet we found out that she is also a diet controlled diabetic, but her blood sugar test showed a normal amount of sugar in the blood. The patient was unable to talk, and looked very scared. Was this episode related to her schizophrenia?

Our physical exam however, showed a complete loss of function and muscle tone down the right side of her body; this led us to think that she had had a CVA, or stroke, and that this had affected her speech and muscle function. We rapidly removed her to hospital, and to be honest, the job itself went like clockwork.

The thing that stays with you though, is her husband telling you that they have been married for fifty years, and for the last twenty of them he has stuck by her while she was suffering first from manic depression and then schizophrenia. To have stayed by her side while she was under the shadow of these illnesses shows true love. Every so often, during the transport to hospital, her husband had to wipe a tear from his eye, he was sitting holding his wifes hand - trying to provide some comfort to her, and to try and ease the scared expression on her face.

Now, if she survives the stroke, she will probably be permanently disabled, and will require quite intensive care for the rest of her life.

I think her husband will continue to stand by her.

In unrelated news...I was so tired driving home this morning that I took the wrong turning to go home and went down the wrong street. Aren't you glad I'm looking after the health and well being of people?

An ambulance has caught fire. Luckily no-one was hurt and the crew weren't carrying a patient. I notice how the ambulance official makes sure everyone knows that the service will not be affected...

Found by Dung Beetle, one of my regular commenters.

There exists, up in the lofty reaches of ambulance control a thing known as the 'TAS desk'. TAS stands for 'Telephone Advice Service', and 'desk' is what the phones sit on. With this modern day marvel, those people who dial 999 but do not actually warrant an ambulance are redirected to this desk. The patient will then talk to a specially trained call-taker who will attempt to advise the patient on a more reasonable treatment - for example by advising the patient to make their own way to their GP, in order to treat the verruca that they have had for the past six months.
Until recently, if the patient insisted, Control would have to send an ambulance - which is why I have picked up, as an emergency case, someone with a verruca for the past six months. The recent 'No Send' trial has meant that Control can now refuse to send an ambulance.

However, the staffing in Control is awful at the moment, and this means that there was not enough people to staff the TAS desk tonight.

Which may explain why we have been so busy going to utter crap calls all night. I could argue that only one patient actually could do with an ambulance, that being a young girl who had started to bleed fairly heavily from her tonsil operation site. About 250mls of clotted blood were in her bath when we got to her, and we later found out that she had needed to be transferred to a specialist unit.

But the rest of our calls were for the likes of - a 30 year old man with a cough, a 13 year old with a temperature for three days, a 9 year old who was upset because she was staying with her gran and missed her mother, and a couple of other jobs that were so pointless I can't even remember them.

It's now 6am, so I have an hour to go until the end of my shift, and this is traditionally the time you have a 'maternataxi' run into the local hospital. This would finish the shift off nicely.