First off, a big 'thank you' to everyone who wished me a happy birthday yesterday. You are all very kind. Also a big thank you for keeping the comments in 'Two In Two Nights' so civil. The internet is often used as a place for willy-waving and I am proud that my readers are so atypical of this.

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One of our more regular jobs is to the Newham Mental Health Unit (MHU). It is one of the more bizarre side effects of the way that the NHS is structured in that while the MHU shares a physical site with Newham hospital, they are completely different trusts.

As each trust has it's own portering staff, if a patient needs to be moved from the MHU to A&E... they call an ambulance.

So we get calls to patients who need to be moved a grand total of 400 yards down the road. I've worked in hospitals where you would need to wheel patients on trollies for longer distances just to get them to the wards. Unfortunately neither Trust will take responsibility for wheeling patients between the two buildings.

It doesn't help that I'm not enamoured of the medical care of people in the MHU...

Sometimes we will be called for something as simple as a chest infection, or that the patient needs blood tests or an x-ray. Sometimes you will go to something that sounds 'genuine', but which ends up being something simple.

Take for example the last time I went there. The patient was a young girl and her diagnosis was 'Pulmonary Embolism', now this is a serious and life-threatening illness, it is a clot on the lungs which causes severe difficulty in breathing and shock.

This patient however had none of the risk factors or symptoms for this. She was shaking like a person with Parkinsons disease but her vital signs were all normal. Without turning this post into a list of symptoms found and not found she had nothing that suggested an embolism. She had also been in this state for a couple of days.

It looked to me like a toxic amount of one of her anti-psychotics.

Oh well, 400 yards later and she was safely in A&E where they quickly ruled out an embolism and sent her back to the MHU with one of the private contract ambulances. I'd be interested to see how much that trip cost the hospital.

The cause of her illness?

A higher than normal level of anti-psychotic in her blood.

It was a bit of a 'stabby' weekend, I don't normally do 'sexy' calls but for some reason I had two stabbings on two consecutive nights.

The first was a young man who had been stabbed in the street. His main injury was a stab wound through his thigh, he'd leaked a fair bit of the red stuff, but not enough to particularly worry us. He also had a slash wound across his chest but this was fairly minor. What made the job tricky was that there was around 40 youths all milling around, all wanting to talk to their 'bruv'.
Our patient was more concerned with getting his mobile phone back from one of his friends. I'm guessing, given his demeanour, that he wanted to arrange a retaliation. Meanwhile more and more of his friends were arriving and causing trouble for the police. For some reason the people of Newham seem to enjoy ignoring 'Police:Do Not Cross' tape.
We blued him into the local A&E where he was treated (and probably discharged later that day).

The next day had another stabbing, this one somewhat different.

The patient didn't want his girlfriend to leave him, so he stabbed himself in the stomach.

(No, I have no idea either, especially as this was the third time he'd done this to himself).

What made it annoying was that the patient was pretending to be unconscious. As it was difficult to see how deep the wound went, and we had been told that it may have been three inches deep, we blued him into the local A&E. After the doctors there poked a metal probe into the wound they discovered that it was a minor injury. I left him in the A&E still pretending to be unconscious.

The police officer who came with us just wanted him to admit that it was self inflicted, then he could leave. He was only there to check that it wasn't the patient's girlfriend who had stabbed him.

I'm reliably informed that this job came out as 'Man knocked down'. It's a big fear that we all have that we get attacked while going about our work and it is for this reason that we will hold back and wait for the police if a job seems 'dodgy'. The problem is that sometimes you have no idea that there is a danger in the area.

My thoughts are with those affected by this, both the man who was killed, and the others who have been hurt. I hope the crew involved aren't badly hurt and I wish everyone a speedy recovery.

There are a lot of people in my area who don't speak English as their first language, actually, there are a lot of people who don't speak English at all.

The reasons why I don't like it when people can't speak English are because it disadvantages them both personally and in society.

Personally I like to be able to talk to the patient themselves, while we often use other members of the family as translators it is a poor substitute for talking to the patient, being able to interpret their tone of voice and body language.

Certain topics can be tricky to deal with via a translator, the recent spate of domestic violence cases I have been going to are much harder to deal with through a translator, I always have the fear that the patient is being misinterpreted either accidentally or on purpose.

Then there are conditions for which some translators are perhaps ill-suited. We often use small children as translators as they often have the best understanding of English. Using a small child to translate for their auntie who is having a miscarriage is always tricky.

A huge part of my job is to reassure people, it's a lot tougher to reassure someone if you can't speak their language.

Then there are the societal problems with people who don't speak English. I go to a lot of places that are quite insular. The people I meet buy all their goods from people who speak the same language as them, their friends all speak the same language and they only watch the television that comes in their language.

This leads to people not becoming a part of English culture. Now, you may call me imperialistic, but I think that English culture is pretty good - we have sex/race/cultural/diasability equality (with varying success), we frown on people beating their children/wives and I'd say that we are fairly open with respect to other people. When people come to live in this country I like to think that they would take on some of these properties, but this is much harder if they don't speak English as it means that they can remain insulated from 'English' culture.

To help with the translating we have 'language line' which is a telephone translation service. It enables us to use our mobile phone as a 'universal translator', which is very cool, but also very expensive. To be honest I'm yet to need to use it - I'm pretty good at understanding people based around body language, the few words of English that they can speak and the waving around of hands.

To be fair, for a lot of people it's not that they can't speak English, but it's more that they are not confident to speak it, I try to encourage them and to provide a space, in the back of my ambulance, where they can try talking English without fear of being ridiculed.

It keeps my working day interesting at least.

There are times when it is simpler, and better for the patient, to stand back and let the relatives decide the best case of action.

I went to an older woman who had suffered from a stroke some time earlier, she had made as good a recovery as expected and was being looked after in her home by her family and some paid for carers. There was a lot of equipment in the house. Lifts and hoists had been installed, the patient had a modified wheelchair and a specialist bed. The reason why we had been called was because she had developed a chest infection - this can be very serious in someone who is essentially bed-bound and so she needed to go to hospital.

As I walked into the house I sensed a vague negative attitude towards us - it may have been that they were waiting some time for the ambulance (as it was one of our low priority calls), it may have just been that they were rightfully unhappy that their mother needed to go to hospital again. So the atmosphere in the house meant that I would have to handle the family carefully. The family had a lot of experience with their mother, so, where we would normally 'barge in' and take control of the situation I decided that I would discuss the best way to move the patient with them.

At every one of my suggestions I explained the reasoning behind my thinking, and I let the family use their equipment to carefully, and in their own time, move the patient to the hospital.

And the end of the journey the relatives were a lot happier, all because I let them do most of the 'work'.

If there are any spelling/grammar mistakes in the above post - tough. Today is the only time in three weeks I get to see Laura. I hope you understand.

"Our eyes met across a crowded room"

One of the things that Peter Bradley, the boss of all the London Ambulance Service, does is to occasionally come out on the road and do a shift working on an ambulance. Last night he was in our area teamed up with a team leader, running an extra FRU car. Whenever he has been around I've not been working, however last night I was working at the same time...

We were called to a 37 year old man who was 'suspended', not breathing and with no pulse. Control told us that there was a hysterical woman on scene and that it was a child who had called us. We rushed around there and saw that we had been called by a passing teenager. Hopping out of the ambulance and I saw a FRU pull up behind us. In it a team leader...and the Boss.

My crewmate and I ran into the room and found the man dead - there was nothing that we were going to be able to do for him. Sticking out of one leg was a needle and on a nearby workbench there was some citric acid, a spoon, a lighter and other drug paraphernalia. It looked like he had overdosed.

There was nothing that we could do except for wait for the police, the team leader and the Boss looked after the distraught wife and the man's young daughter, while my crewmate and I made sure that no-one altered what could be a crime scene. It's very sad to see someone so young dead, and to leave behind such a young child is terrible. We try to rationalise this by saying to each other that perhaps she is better off without a drug user in the house, but... I just don't know.

The Boss and Team Leader came back in with the police to show them the body and I bid farewell to the Boss with a cheerful, "Welcome to Newham sir".

The team leader seemed very eager to get him away from me, I have no idea why. This is a shame as I would have liked to have asked him how crap it felt to be screwed over by the government so much.

Actually, I think that may have been why the Team Leader was so eager to get him away.

The health secretary admitted there would be difficult decisions to be taken on staffing, because "some parts of the NHS in England have taken on too many doctors and nurses".

Good grief, Hewitt is bonkers.

I'm beginning to think that 'Care in the Community' for our mentally ill has gone a bit too far when one of them has become Secretary for Health.

NHSBlogDoc is as incredulous as I am.

I'm watching the TV and a politician has just referred to people who 'binge drink' as 'people who drink to get drunk', a phrase I first used on this blog a year ago. Maybe someone in government is reading this site?

I've written before about how I am a different person when I'm wearing a uniform, how I am more confident, more proactive and sometimes a bit more 'shouty'. The reverse is also true and I think that this is, in some way, due to the way that people treat me when I'm wearing the uniform.

People see me in uniform and permit me to direct them, advise them and do things physically to them. Without the uniform I can't do this.

It all became obvious on the way home from the centre of London one night. I was using the tube and, on coming up an escalator while changing between lines, came across a man who had collapsed.

There were two members of the public with him, a station officer and a station cleaner. As I approached I saw that he was pale and sweaty, he triggered that bit of my brain that says 'this person is properly ill'.

I tried to walk past, I really did. I think I got two steps beyond him before turning around and returning.

"Hi there, I work for London Ambulance, can I help?"

He'd apparently became dizzy and then had collapsed, a little chat with him revealed a significant history of internal bleeding in the past. Feeling for his pulse I couldn't find a pulse in his wrist, this meant that he had a very low blood pressure, this would explain his paleness and sweatiness.

I asked the Station officer if he'd called an ambulance, and he mumbled something in the affirmative. I tried to take control of the situation, but it all came out a bit vague and quiet. I put the cleaning bucket under his feet to try and raise his blood pressure a little and awaited the ambulance.

All the time this was going on I was feeling rather vulnerable, unlike when I am 'on the job', I could also tell that the people I was with weren't taking me as seriously as I would had I been wearing a uniform.

The ambulance crew arrived and I handed the patient over to them. They didn't seem impressed, again probably because I wasn't wearing my uniform.

As I walked away I felt rather bad, If I had turned up in a FRU car, then the job would have felt very different, but without my uniform I wasn't as confident.

It's funny what a green shirt can do for your confidence.