'Midwives to tragedy'

It's an awful phrase that came to me as we were returning to station after our latest job. We often are there at a transition between a normal happy life, and one that has taken a sudden, permanent, and terrible turn for the worse.

When the job came down the computer terminal we thought it would be one of our regular types of calls - A 35 year old man was complaining of numb hands and legs. This sort of thing often turns out to be someone having a panic attack, a frightening, but fairly harmless condition.

We arrived on scene and was met by the patient's wife, a number of small children milled around her feet. She led us upstairs to her husband and I could see straight away that it wasn't a panic attack.

He was unable to talk to me and he was unable to use the right side of his body. Surely he couldn't be having a stroke?

But further investigation ruled out anything else - he was having a stroke and there was little that we could do about it. So we carried him downstairs and rushed him to hospital.

Half an hour ago he was fit and well - then, moments later, he has been struck down with a debilitating illness. His wife has gone from looking after her children, with a husband who provides for her to someone who will end up nursing him, possibly for the rest of his life and will need to rely on disability benefit.

He won't be able to dress himself, or clean himself after going to the toilet - he'll rely on his wife to do these basic things for him.

As it gradually dawns on his wife that their life together is forever changed she looks at me in the hope that it is not true.

And me? It's another job, another life destroying event that I'm a witness to, there to watch as the realisation sinks in that their lives will never be the same.

Another to go on the list that I can no longer remember.

He is the same age as myself - it can really hit you how a life can instantly change when it happens to someone you can relate to.

There comes a time as you approach the end of your shift when you start looking for an ‘off job’.  This is a job that will put you at your local hospital as the clock ticks over the shift end.  It’s nice to to get away from work only half an hour after you officially end.  So you try and arrange things so that you are free forty-five minutes from the end of your shift so that you can do that final job.

Then you can go home, sleep and do it all again in eleven hours.

We’d just dropped our patient off at the hospital and had fifty minutes until the end of our shift – we heard a call go out for a 33 year old man who had eaten some rat poison, it was just around the corner.  We called up for it and were there in a few minutes.

The man was visiting his sister’s house, he’d forgotten that there was rat poison behind the sofa and had pulled out the sofa a bit to sit on the floor and eat some rice.  His son and his nephew had crawled behind the sofa and reached the rat poison that looked like crumbled biscuits.  One of the children was at that age where everything goes into it’s mouth.

The children had played next to our rice eating patient and when he looked down and saw what had happened he’d thought that maybe the children had put some of the poison into his rice.  When we arrived he was really rather nervous.

He asked us to take him to hospital.

I suggested that we took the two children as well.  He didn’t understand why until I suggested that the children may have eaten some of the poison as well.

So we found ourselves driving to hospital with three adults, three children and myself in the back of the ambulance.

It took an extended time to book the patients into hospital because this family is of a culture that has half a dozen names for themselves, which means repeated running backwards and forwards asking if they were ever known as one of a handful of names.

Then it was time to fill in three sets of paperwork.

You wouldn’t think that you’d ever get writers cramp in this job.

Still, it did see us off in time.

The patients will be fine, apparently you have to eat a whole lot of the poison before it has an effect on you.

Picture the scene.

You are in a house that hasn’t been cleaned in years – the walls are filthy, there are carpets rolled and stacked in the stairways.  The occupant, our patient, lives alone in a tiny room at the top of this house.  His heating is a paraffin burner and there are half full cans of fuel dotted around the room.  Actually, I nearly hang myself on a bit of string stretching from one corner of the room to the other.  I can’t see the carpet because of all the rubbish on the floor.

Our elderly patient has obviously been wearing the same clothes for weeks on end.

The patient’s ex-wife is the one who called us, she is pawing at me, telling me not to let him die.  He isn’t going to die today, his blood sugar is low and he has had a diabetic collapse.  We give him some sugar and he comes around.

There is something ‘not right’ about him.  I don’t think that it will be safe to leave him here, besides his diabetes there is a good chance that he’ll burn the place to the ground one day.  He seems somewhat confused, he won’t talk to me although his wife is clear that he can speak English.  We’ll need to take him to hospital.

So it boils down to ‘capacity to refuse’; does he have enough presence of mind to refuse treatment and be left at home.  I tell him this, and he doesn’t answer me.  I explain that if he wants to stay at home he just has to talk to me – he just says ‘No’.  We recheck his blood sugar level and it is back to normal, there is no obvious medical reason for him to be ignoring us.  I consider that he may have something neurological going on inside his head, that or psychiatric.

Without him answering me, I can’t tell that he has capacity to refuse.  This means that in the patient’s best interests I can forceably take him to hospital.

I don’t like doing this.

Actually I REALLY don’t like doing this.

So after half an hour of trying to persuade him, during which he blatantly ignores me we realise that we will have to get him out via other means.

If his house wasn’t such a tip we could maybe wrap him in a blanket and strap him to our chair and carry him out.  But the amount of rubbish in the stairwells means that we’d probably break our necks.

So we have to try and drag him out.  This is also something that I don’t like doing.  It’s night-time, there is no-one else around besides the police at this time of night.  I really hate getting them out in order to help us get a sixty-five year old, five foot nothing tall man out of a house.

(That and they’d probably send two five foot nothing female police officers to assist us – which damages my ego even if I do know that either of them could kick my arse without breaking a sweat).

So we drag, pull and try to get him to let go of the door handle – he finds that just by sitting down we are unable to move him.  We get to the point where I’m considering doing painful things to him out of spite.  Then the FRU (who was first on scene and had left to do his paperwork) returns.  I explain what we are trying to do.

“Mr Smith”, the FRU says, “come downstairs into the ambulance”.

And of course he does.

So then he sits happily in the back of the ambulance, still ignoring us and we take him to hospital.

We tell the nurse we handover to about the situation at home, we tell the nurse in charge of the department – I advise them that he’ll need some sort of input from the Social Services before he gets discharged.  You know, the sort of thing that I would do as a nurse.

So when we see him being wheeled out to the private ambulance to go home without any apparent social service input we fill in the LAS ‘Vulnerable adult’ form detailing the self neglect and the fire hazard.  We’ll make sure that he gets help.

…Are we so short of homeless alcoholics that we need to import them in from other countries?

…Why do they always have really poor tattoos?

…Cider.  Why?  Just why?

…Why can’t passers-by recognise them as drunk and not dead?

…For once, can you not paw at me as I walk you to the ambulance?

…After a year or two on the street, why do they all start to look like clones of one another?

…What is it about ambulances that makes them want to urinate in the back of them?

…Will you stop fighting each other?  Just for a bit. Please?

…

…However, when you do get one in the back of the ambulance, they are really good for taking the blame for any farts you might do.

We’d just dropped our last patient off at the hospital, twenty seconds later we were sent another job – business as usual then.

The job was given as ‘fall, cut leg’; an ‘Amber call’, and the FRU was already outside.

As an aside, it used to be that the FRU only ran on ‘Red’ calls, now, after being told off for concentrating too much on Red calls and not enough on Ambers the FRU are now sent off to these lower priority calls in order to ‘stop the clock’.  It wouldn’t do for us to have more ambulances would it…

Our patient was an eighty year old woman who’d fell over in her very small toilet, a large lady she was stuck there.  She also had a foot long cut to her leg that had leaked a fair amount – probably more than half a litre.

Her family were there, and they were lovely – they didn’t moan that they had been waiting eighteen minutes for an ambulance, they didn’t moan that they had been sent a solo responder in a car, and they didn’t moan that we were going to have to take the removal of the patient a bit slowly.

If fact, the family and the patient were all lovely people.  The family were happy to help us by carrying some of our kit for us and by moving furniture.  Our patient was in good spirits despite a nasty cut to the leg and the FRU was happy just to see us.

Three bandages later and we’d managed to control the bleeding from the leg and we moved her out to the ambulance.

The patient told me that her blood pressure was high, and after I measured it I let her know that it was a pretty good blood pressure, as quick as you like she replied, “I suppose all that bleeding has lowered it a bit, perhaps I should cut myself more often”.

We got her to the hospital, and I explained that, “In a minute I’ll get you to cuddle me so we can slide you across onto the hospital bed”.

She nearly leapt across the bed to give me a hug.

The family collapsed with laughter, “He said in a minute!”

---

A really nice job – unfortunately the hospital were unable to deal with the wound, so she had to be transferred to a plastic surgery department at another hospital.  It’s always a shame when bad things happen to nice people.

Just coming up to half past six in the morning.

I've just come into work and I'm brewing two cups of tea while my crewmate is making sure that the ambulance is fully stocked.

The clock clicks over to six-thirty and the activation phone rings.

There is a major incident at the local hospital and some of our workmates are involved. We are being sent to relieve another crew who are on standby to make sure that none of the firemen hurt themselves.

We drive there to discover a dozen fire vehicles (including command and control base vehicles) and the whole access road to the hospital blocked off.

We liaise with the officer in charge of the situation. He tells us that some men came into the hospital via ambulance and it was discover that there may be a chemical contaminant involved.

(I'm being deliberately vague with the details because all sorts of people are 'interested' in the events leading up to this)

There is a double cordon in place, our HART team are there (The HART team are Paramedics who are trained up to use breathing apparatus and can go into the 'hot zone' of a situation. I think that they also run into burning buildings...).

It's all quite calm, the policeman standing in front of the 'Police - Do Not Cross' tape has only had to have one argument with a woman who wants to walk through the center of the incident. The incredibly inventive Ordinal Malaprop reads my 'Twitter' on this and advised me that this is because the tape says 'Police - do Not Cross' as opposed to 'Public - Do Not Cross'.

We sit in our ambulance watching the sun come up while drinking our tea - it's a hard life sometimes. We are listening to the radio chatter on the posh new radio that we were given as we arrived.

Then it's all over - the patients have been treated, the hazardous materials people have goven the hospital the all clear, and I hear over the radio, "Incident over, everyone stand down, You in the ambulance, don't forget to bring our nice radio back".

We have a little chat with the HART team as they pack up to leave and get the fiull story - and that everyone is fine. Then we make ourselves ready and head off for another ordinary day.

I spent twelve hours working a night shift, picking up drunks and druggies. Then I had four hours sleep, travelled in to the Apple shop to see a genius. Dealt with my computer then went back to work for thirteen and a half hours without a break, once again dealing with drunks and druggies.

I am having a sense of humour failure.

The previous night had us going to the same drunk twice.

"I vomit", he says in a thick Russian accent as we drag him out of an alleyway. He then spits on the floor, no sign of vomit.

So we take him to hospital where they check him out (even though he is apparently a regular) and discharge him.

A couple of jobs later we are called to him again because he is 'unconscious in a bush'.

Once more, our only real option is to return him to hospital where he settles down to sleep in the waiting room. He isn't homeless, he just gets drunk in the street.

So... Guess who our first patient is on the following shift.

This time I'm so annoyed I call the police on him, they move him along (whatever happened to arresting 'drunk and incapable' people? I'm guessing that they have run out of cells).

The big question will be... Will I see him again tonight?

(Actually, the big question is rather, 'Will he survive seeing me again tonight?').

My laptop will take 7-10 days to repair; which is hassle I could do without. What makes it annoying is that I'm busy over the next week or so, and could have done with it to keep my life in order.

I'm going to have to use my old windows laptop in the meantime as the old Mac that I'm using to type this has a flaky wi-fi adaptor that only works sometimes.

Last night was very busy, I nearly run out of room on the paperwork to list all our jobs. We also had the pleasure of a 'late job'.

Picture the scene, after eleven hours of work without a break we are looking for an 'off job', something nice and simple that means we are at hospital when the end of our shift rolls around.

We get a perfect job sent to our screen, a not seriously injured child, not far from the hospital - it'll do us just fine.

Except, as we arrive on scene we get cancelled for a 'higher priority' job. A transfer from one hospital's ITU to another hospital.

So we turn up and wait an hour and a half for them to get the patient ready for transport. They faff around with lines and drips and photocopying notes while I stand there and watch the minute hand of the clock drift past the end of our shift.

Finally we are on our way, so we whizz to the hospital, off load the patient and then watch as they faff around even more before returning the equipment and travelling doctor back to us.

An hour and a half after our twelve hour shift finishes and I'm falling into my car for the drive home.

I'll be back in ten and a half hours.

For more of the same.

Will the people of Newham survive?

I've spent all day clearing my Inbox of unreplied to emails - If I ever let it get like that again, somebody shoot me. If you have been expecting an email from me and didn't get a reply, then I send my apologies and advise you to resend your email.

For those that are interested about joining the London ambulance service... We aren't recruiting. Sorry.

In a fit of 'doing things', I've signed up on Livejournal, Facebook and Myspace. I'll happily accept 'friends' from anywhere, but I would ask that you tell me a little about yourself - there is a bit more on this over here. I'm still playing around with them, as well as wondering what kind of content to put up on there, chances are that they will remain mostly unused or used for small dumps of writing.

Additionally loads of people read my Twitter feed - I'd be interested in finding out who all you lot are as well... I like finding out about people who know me because of this site.

Tomorrow is Laura's audition for X-Factor at Arsenal, I'll be with her and I may post up some pictures somewhere.

I'm curious, are there any people who work with leather reading this blog? How about blacksmiths? Preferably within a couple of hours drive of London - it's for an article that I'd like to write.

Further non-ambulance blithering will be on Mental Kipple, which I have been shamefully neglecting.

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Finally two nice ambulance links sent to me by readers-

A lovely written article about the Yorkshire ambulance service following the 'Tonight' programme. (Thanks Clive).

Then a story about a 'patient' who would have suffered from a broken nose had I been sent to him. (Thanks Matt)

I came out of the house and started coughing. I was glad that I'd needed to leave, it was so I could get some fresh air.

Picture the house, an elderly married couple, both chainsmokers, both requiring home oxygen for emphysema, both suffering from recurrent chest infections. As our patient put it, "I think they are fed up with me down at the hospital, I was only there a few days ago".

The walls were yellow-brown. Actually everything was yellow-brown. An old Labrador had wheezed it's way up the hallway to great me, it's tail wagging furiously. My crewmate was attending so I was free to play with the dog.

Thankfully it was nothing serious, a chest infection that hadn't gone with the first round of antibiotics, our patient would need something stronger.

I could feel the tar seeping into my skin, there was a horrible taste in my mouth and I started wondering what the lethal dose of nicotine is. Would it be a good idea to get our hazardous rescue team out in their noddy suits?

They were a lovely couple, rattling and wheezing away, rows of cigarettes lined up like soldiers. Cigarettes put into cigarette holders, something that I haven't seen except in movies set in the 50's.

Hundreds of souvenirs, all covered with a patina of tar, nicotine and heaven knows what else told me of their life before they became housebound. they were quite happy in their life, they had each other, their had their 'little sin' and they weren't hurting anyone.

They were lovely, we had a little laugh and a joke with them, I stroked the dog a bit more and we took our patient off to hospital.

But I could taste that house for the rest of the day.

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Browsing through the BBC news website I came across the following. Imagine being the ambulance sent to this call...