I have my new permanent crew-mate. This makes me happy and I think that we will work well together. She says that she never gets a serious job, something that I think applies to me as well.

So of course - on our first two days together we end up with some really rather seriously ill patients.

It's been unseasonably hot and we had already been called to an elderly man who had collapsed - we ran our full barrage of tests and it looked like it was due to a few too many layers of clothing. We'd also been to a woman walking around in the middle of the day wearing a puffa jacket who was feeling dizzy. Probably something to do with the high temperature.

So we were called to another collapse, we arrived and thought that he was dead. His whole body was either white or purple and it was only because our first responder was talking to him that we knew he was alive. Gradually a bit of colour came back to him and he told us about the abdominal pain that he had been suffering with from earlier in the day.

As he was laying flat out in the kitchen and we needed to get him to the ambulance we gently sat him up in order to get him into our wheelchair. His eyes rolled back into his head and we quickly lowered him back down to the floor. Again he lost all his colour and I quickly checked that his heart was still beating.

This needed a rethink. A quick examination showed a pulsating lump in his abdomen. This is typically a sign of an Abdominal Aortic Aneurysm (a 'triple-A')which, should it start leaking or burst, will kill you. The only treatment is surgery. Which means getting him to hospital very quickly. So we grabbed our scoop stretcher and carried him out flat. It's a lot more awkward and took more time, but if he was going to collapse every time that we sat him up it was the only way to get him out the house.

A few quick checks on the ambulance to make sure that he wasn't having a heart attack (and would therefore be going to the angioplasty lab) and we 'blued' him into hospital.

As I hopped out of the drivers seat and opened the door I noticed that his colour had improved greatly and he was a lot more talkative. As we wheeled him into the resuscitation bay I said to the doctor, "Well, on scene he looked like a triple-A".

We left the hospital to it and did a few more jobs.

It was only later that we saw him being wheeled out for a transfer to another hospital - it seems that our initial suspicions were correct and he was indeed having a slow bleed from his triple-A. While he was currently stable (stable enough apparently to transfer him without a nurse or doctor escort), I would guess that he would still be needing surgery.

Once more, a 'good' job, one where we made a difference. I don't know what is going on - all these genuine jobs... Whatever happened to nice simple broken fingernails and watery eyes that walk on and off my ambulance and mean little work on my part.

It's a dichotomy this job. One minute you are dealing with a blithering idiot, the next you are working to save someone's life.

Take yesterday - we were called to a woman who *lives* on hospital property. The A&E department is less than 200 yards away. Our patient had dialled 999 for 'sore feet'. She was fully able to walk and hadn't taken any painkillers because 'they don't work'. Well they definitely don't work if you leave them sitting in the packet. For this I'd driven on lights and sirens halfway across town.

She also had me fuming because after our arrival at hospital she didn't want to sit in the waiting room, and then she wouldn't give our ambulance blanket back (even though I promised to get her a hospital one). I've got to admit that I *really* wanted to punch her in the face, right there and then. Instead I stormed off, my hands in fists. Let the nurses at the A&E department deal with her, we've done our part.

I may be getting anger management problems...

But then our next job was a beauty. A 72 year old man with a cough, a burning sensation in his chest and pain that got worse when he coughed. It looked (and sounded) like a classic pneumonia. We wheeled him out to the ambulance and did a 12 lead ECG to see what his heart was doing.

Yep - he was having a heart attack.

Yet again the patient didn't present with the classic picture of a heart attack and it is only because we are thorough that we discovered this.

So - off to the London Chest Hospital where they do the excellent and lifesaving angioplasty. It turned out that the patient had a blockage in the same place as the last person I took there. Another potential 'Widowmaker'. While they were clearing the blockage, they found another two areas of concern and cleared them at the same time.

I've got to make the point that the London Chest Hospital has always been extremely friendly towards me, I think that they are very 'pro-ambulance'; when we go there they are professional and are more than willing to let us watch the operation and explain to us exactly what they are doing.

I think that this partnership between us and the angioplasty centres around London is (one of the few) success stories of the NHS.

So there you have it - one of the reasons why I like this job, you can be dealing with utter rubbish one moment, and the next you can be doing something completely worthwhile.

And the job after that one? A Maternataxi.

You know there are 'firefighter' calendars? Twelve months of *ahem* hunky men holding their hoses? Have you ever wondered why there isn't an ambulance equivalent?

Because we look like this bunch of ugly sods.

But it's not just drooling hideousness that they have to offer, for despite their physical unattractiveness, their hearts are huge.

You see, they are undertaking a sponsored climb of some mountains in order to benefit The Richard House Trust, which is the only childrens hospice in London. I've been there a couple of times and I'm always heartened by the staff and facilities there. I'm always moaning about nursing homes, but this place is different, the staff really do care and they do a wonderful job there.

And like most of the best parts of the NHS, it relies on charity.

My mates, madmen (and madwomen) are going to attempt to climb Ben Nevis, Scarfell Pike and Snowdon in the space of 24 hours.

So, instead of a night out down the pub, why not stick your hand in your pocket and donate some money to a bloody good cause. That and spread the word around on your own blogs and forums. They are over halfway to their target, I'd consider it a personal favour if you could help them reach it.

I'll be donating once I get my royalties cheque.

Sometimes you have a run of jobs that just annoy. Take for instance the nursing home who just assumed that we would be happy taking two of their patients away. We did it anyway, but it was us doing them, and another crew being sent out of their area, a favour.

Later on in the night I took in a woman who's one year old has vomited. Once.

She rolled her eyes and pulled a face when I told her that we would be taking her to the nearest hospital (about half a mile away) rather than her local hospital of Basildon. Which, you know, isn't even in London.

Then both her and her husband both pulled a face and rolled their eyes when they realised that they wouldn't see a doctor 'immediately'.

Apparently it's all my fault. Most of the time this sort of thing rolls off me like water off a duck's back.

But then there are some days when it drives me potty.

Which means it's a good thing that we picked up the 'mad woman who pretends to be unconscious and sticks out her tongue' before these annoyances, otherwise I may not have been so charitable towards her.

(I tried posting something like this from my ambulance cab, but for some reason it never turned up).

Another young man has been shot, this time just down the road from my station. A bit earlier someone had been attacked with a machete. Sometimes Newham feels like a warzone.

Another teenage boy has been stabbed to death on my patch. I had reason to go to the receiving hospital just after it happened, and already the friends and relatives were gathering. I saw the now familiar emotions of grief and anger. During the night more people came and the emotions seemed to settle into a stunned silence. Questions were asked, but it seemed that there were no answers.

The hospital staff looked after them in a professional manner. It's unfortunate but seems that we are getting more practiced with such things.

A crew wheeled a drunk teenager, clothes torn and barely able to raise her head past the grieving relatives - It's a strange feeling to take in such a patient; you almost feel embarrassed to bring such an idiot in while mothers and brothers and sisters are weeping.

Not a good night in East London.

But sadly, not unusual.

Apparently it's Easter. Whatever that means.

I don't have a regular crewmate at the moment (I drove the last one insane within a matter of months) so I've found myself working with loads of different people over the last half a year or so. Yesterday there was no-one in my area who was spare to work with me, so I was asked by our resource centre to go and work out of Islington.

Bear in mind that I don't drive in central London much, if I need to get around then I use the tube. To be honest driving in central London gives me kittens.

I arrived at Islington to discover that the person I would be working with also doesn't come from that area - and that she wanted me to drive. We would be relying on the inbuilt sat-nav system to get around.

As an aside, the sat-nav from one of our ambulances was stolen during the week - which is pointless as all they will have got was the screen, all the electronics are buried deep in the vehicle.

So i found myself driving from places that I didn't know into places that I didn't know, relying on the great Sat-Nav magical talking totem perched on the dash..

And boy, did we get around. We visited University College hospital, St Thomas' Hospital, The North Middlesex Hospital, Whipps Cross Hospital and probably another one - but I forget it was all a bit of a blur.

Still, it makes a nice change to see some of the tourist landmarks from the cab of an ambulance rather than the happy souls of Newham walking past.

The patients were much the same, a collapse except that it was in a posh M&S with everyone buying their Easter wine rather than the collapse being in the local Morrisons. A young Mediterranean girl pretending to be unconscious after a fight with her boyfriend rather than a young South Asian girl. A seventeen year old man with pain in his chest after vomiting (Given, as per usual, the highest category that you can get without actually being dead).

And that last was a 'late job' meaning that I got away from work an hour and forty-five minutes late. Still, at least I get paid for it.

Despite all the stress of not knowing (a)Where I was, and (b)Where I was going, it was a fun shift. As they say, a change is as good as a rest.

I wonder if I'll get sent somewhere special tonight?

I was being sent to one of our regular nursing homes - I'd been to 'Rose Cottage'* a few days earlier for a patient who 'wasn't eating' and had a low blood sugar. This time it was for a patient with chest pain.

It's not the worst nursing home that I go to - the place is clean and tidy, some of the nurses speak good English and the patients aren't beaten. But it's still not as good as it should be; the normal problems of the staff not knowing about their patients, and the usual cold cups of tea siting just outside of the patient's grasp render it an impersonal and borderline neglectful place.

We arrived to find that our patient was a 93 year old female, bedbound and only recently discharged from hospital. She also had dementia although more of the 'pleasantly confused' type. I have found that there are two main ways that dementia manifests itself in nursing homes, the 'constant screaming, scratching and crying' type, and the 'pleasantly stoned' type where the patient is dotty but fairly happy.

This tiny little bird was of the second type, she looked at me as I walked in the room and gave a big toothless smile.

Our patient had been discharged from a good hospital less than 24 hours ago. She had been in hospital because, even though she is bedbound, she managed to break her hip. While in there she caught a chest infection but had since recovered enough to go home where she would continue to be nursed.

Fat chance of that.

The nursing home staff had called the GP who had decided that the patient should go to the hospital. Like most out of hours GPs he saw us arrive, threw a letter at me and ran off.

For some reason they don't like talking to other medical people they can't bamboozle in person.

The doctor had decided that the patient needed to return to hospital - Fair enough, at the end of the day it's what I'm here for.

"She has chest pain", the nurse told me.

I asked the patient if this was true.

"Only when I cough", she was just finishing her course of antibiotics and this was to be expected.

It was obvious that the patient was dehydrated, the heating in the room was high and a full cup of water sat out of reach.

"She hasn't been eating or drinking", the nurse told me.

"Would you like a drink?", I asked the patient.

"Yes please", she replied.

So I did what nurses are supposed to do with patients like this - I helped her have a drink of water. At this point the nurse scuttled out of the room to 'photocopy the notes'.

I noticed that she had a recent cut and some bruises to her arm that were undressed - probably nothing as she does have frail skin, but I made note of it anyway. I lifted her to the trolley and, wrapping her up, took her back to the hospital.

"It's a Rose cottage special", I said to one of the doctors. She replied that she could tell that from a distance without needing to speak to me. The charge nurse who I handed over to spotted the cut to her arm before I had chance to mention it, which puts me in a good mind about the sort of care she'll get at the hospital.

So she returns to hospital where he will probably get another chest infection, and this one might kill her.

Even while the patient is in hospital the care home will be charging in the region of £500 a week for the empty bed. Is it any wonder they call for an ambulance at the drop of a hat? I would imagine that a care home with all it's patients in hospital would be very good for the shareholders.

At the moment I'm looking very seriously at the Commission for Social Care Inspection and their Expert by Experience as I'm getting fed up of tackling things on a case by case basis - I want to change things for the better permanently, something I just can't do in my current job.

*Not it's real name, although some people may well get the reference.

Over at Mental Kipple I have my review of Sunshine - I think it's the last time I'll be invited to a press screening...