I walked in through the door and there she was, standing stark naked in a pool of her own blood.

Heavily pregnant, she was sobbing while blood ran down her legs. Her neighbours were making an attempt at comforting her, all the while trying to clean the blood away. Meanwhile, between great sobs of tears, the patient was trying to fit a sanitary pad to herself.

As I write this I can still smell the blood.

The ambulance was ten minutes away.

Make that two maternataxis.

So at least three people in my area have called an ambulance because of being in labour.

Something else that upsets/annoys me is that a family bought in their dead toddler by private car, and never thought to call an ambulance.

Make of that what you will.

...when you contemplate running someone over, just so you can have a 'decent' job.

So far- a maternataxi, two children with coughs, a panic attack and a belly ache. I'm not complaining, I could do with a peaceful night.

Four miles away 'Bob' was about to stop breathing.

Bob's friends had seen him come out off rehab earlier that day, they had then invited him around to their flat where they then saw him inject some heroin.

Bob's friends had then watched him pass out for half an hour, and then his breathing had slowed and he had gone a funny shade of blue.
His friends decided that now might be a good time to call for an ambulance.

I arrived at the same time as the police who were there to make sure that I was safe.

One of the residents held open the main door to the tower block.

"Another fucking junkie?", she asked, "It's a fucking crack house up there".

We got in the lift, carefully avoiding the nasty smelling puddle in the middle of it, and I hit the button with my gloved finger.

Sure enough, if you worked in film making, and were asked to create a set based on a crack house - this is what you would come up with. Actually, as crack houses go, it wasn't too bad - there were no human faeces spread around for a start. No carpets either, which is a good thing because it's easier to spot the wet patches on lino.

To give Bob's friends some credit, they had managed to put him into the recovery position in the middle of the kitchen. Bob had either vomited, or his friends had poured some water on him. Either way there was something sticky on the floor around him.

For the second time on this job I was really glad I was wearing gloves.

His friends were both clutching cans of cheap, but strong lager. One of them was so skinny he would have made Iggy Pop look like Pavarotti. I left the police talking to them.

So Bob had decided that breathing four times a minute was quite enough for him but the blue pallor of his skin, and my training would tend to disagree with him. Bob was very nearly dead, I suspect he would soon break the first habit of his life - the habit of breathing. So I put an airway down his throat, pulled out my ambu-bag and started breathing for him.

He soon pinked up and perked up and his breathing got better, so I could stop 'bagging' him. Now I could relax a bit, and watch him while I waited for the ambulance to arrive - which wasn't long.

We moved him into the carry chair, being careful not to stab ourselves with any needles that might be lying around him (or in his clothing, his pockets, or lying underneath him). It was about now that he started to wake up.

Another life saved, although no doubt his habit will kill him one day.

It strikes me as ever so annoying that for some reason I can manage to save heroin addicts, but not 12 year old girls.

The second job of my shift had me racing through the night towards a '19 month old - child not breathing'.

Now, normally, this doesn't bother me, I get there, I do what needs doing, and then everything goes back to normal.

But tonight, for some reason I was shaking like a leaf, my pulse was pounding in my ears, and there was a sick feeling in my stomach.

"The first pulse you take is your own”*, a mantra that I've often found useful should I ever find myself distressed or anxious at a job.  But for some reason it wasn't helping.

I reached the house and could hear the family crying and shouting inside.

"Fuck", I thought.  Actually I may have said it.  My hands continued to shake, and I started feeling sick and light-headed.

The door was flung open, and I found myself staring into the face of a crying woman.  Pushing past her, I could see the child laying motionless on the floor.  The child was of African descent, and this causes me a bit of a problem, in that Caucasian children when dead, look dead while it's a lot harder to tell if African children are recently dead because they just go a bit grey.

"Fuck", I thought again.

I got closer, hoping to see him breath.

The the child moved.  And more importantly he breathed.

"Thank fuck", I thought.

So all was good.  The child had suffered from a febrile fit, he'd had one previously, and would soon come round.  Even so I was still really happy to see the ambulance crew turn up seconds after I reached the patient.

Sitting in the car doing my paperwork I was still shaking and my pulse was still racing.  Why had this job shook me up so much?

Was it because it was my second job after having a week off, and so wasn't up to speed yet?

Actually, I think that it's because I've got a bit of an infection at the moment, and the changing seasons have probably depleted the happy juice from my brain.  I'll probably get worse over the course of these next four nights...  So I'll apologise in advance.

Oh and the local mosquitos have been using my face as a buffet bar.

* - It's a quote from the excellent "House of God" by Samuel Shem.  If you read this blog, you should read this book.  Sorry for the whining.

I think I must have a slight infection or something - all I want to do is sleep, and I've lost all motivation to do anything other than sleep and lay around doing nothing. This is Not Good, and something I'll regret when I'm back at work

Shift work is a bastard.

I really do mean that, it's bad for your health, your social life, and your ability to interact with the world around you.

So how do I deal with working shifts?

Firstly, no matter when I'm awake, there is a timezone somewhere in the world where it is daylight. So by having friends spread around the globe, there is always someone to talk to no matter the time.

But there does comes a time when you need to reset your bodies timezone with the timezone that you are physically in. If your shift is a 'one off', then you can reset gradually, by going to bed an hour later every night until you catch up with the rest of local time.

The problem that many of us shiftworkers have to deal with is that while I'm getting up at 4pm right now, in three days time I need to be getting up at 5am. So for me, it's time for some pain.

Going from night shift to a day shift is really painful. I finish work at 06:30, I go home, I stay awake until 21:00.

I'll have been awake for 21 to 23 hours, but despite the pain (and trust me, spending almost all your life in a state of perpetual jetlag is no fun), you can then set your alarm clock for 7am where you wake feeling as fresh as a daisy.

(Or rather in my case, feeling like a nearly-dead thing, that wishes to be completely-dead).

Turning a dayshift into a nightshift is easier for me because I'm naturally a nightowl. What I do is on the day before my nightshift, I'll snooze until midday, then stay awake until about 5am. I'll set my alarm for 8 hours sleep, so I'll wake up at 1pm, but will be ready to do my nightshift without feeling too awful.

Of course, the real trick of this trade is making sure you don't work rotating shifts.

Some people seem to think that faking unconsciousness is a good idea, either they are mentally ill, drunk, or more commonly, have had some form of argument and have decided to ‘go unconscious’. 

For some reason, benefit offices and rent payment offices are popular places, as are police cells, magistrates courts and at the checkouts of supermarkets.

The easiest, and quickest way to see if someone is faking unconsciousness is to lightly brush your finger against their eyelashes.  If their eyes flicker, then they are almost certainly faking it.  Also if they try to keep their eyes closed when you try to open them, they are definitely faking it.  Another way of checking is to hold their hand over their face, and let it drop.  People tend to be reluctant to let their hand hit them on the nose, and so the hand will instead magically drop to one side.

The other giveaway is that they open their eyes to look at you when they think you aren’t watching them…

But what happens if someone is able to wake up, yet is refusing to?

Let me quickly explain an important part of measuring someone's Glasgow Coma Scale.  The Glasgow Coma Scale is a way of measuring how deep someone's level of unconsciousness is.  (I could just quote the Wikipedia article, but if you want to know what a GCS is, then click the link).  Part of this process of assessment is how they respond to pain.

The official method of applying this pain is to push hard against the upper part of the eye socket.  This does no damage but is apparently painful.

Not to me it isn’t, and not if you are deeply drunk.

So there are other painful stimuli, one of which (my favourite) is the ‘sternal rub’, where you rub the knuckles of your hand against the patient’s breast-bone.  Some lilly-livered people think that this assessment is too close to assault, but I would ask them to consider that if we didn’t get drunks to wake up, we would be forced to undertake invasive medical procedures on them in order to ensure that their airway is clear.  If you can tolerate my sternal rub then there is something seriously wrong with you, and you need emergency treatment – but if you wake up then I have effectively ‘cured’ you.

Either way the assessment is complete.

Of course I did get a broken rib for my troubles when curing an unconscious drunk who had sexually assaulted a female pedestrian.  I also can’t see how one way of causing pain may be assault, but another isn’t.

The moral of this story is simple : Don’t pretend you are unconscious, because we will know – and don’t pretend to be unconscious when you are drunk, because it can get painful for you.

My favourite tale of how to uncover a pretender in a hospital setting was a doctor, who would loudly ask for the ‘brain needle’, to draw off some brain fluid from the unconscious patient via the ear.  Of course, he would continue, the patient needed to be unconscious because otherwise they might flinch and the needle go into the brain itself.  This was normally followed by the patient ‘waking up’ and asking, “Doctor, where am I?”.