It would seem that you just can't trust those people who misuse illegal drugs...

We were called to someone who'd smoked some heroin, drunk some beer and also smoked some crack cocaine. He was... 'not alert', hardly surprising really.

The flat was full of drug users, our patient was the one being propped up by a woman.

“He'll be alright”, she said, “I've been taking heroin for over twelve years”, she proudly announced.

Our patient was semi-conscious, sweaty profusely and was breathing rather slower than is normally considered healthy.

A quick shot of Naloxone, a drug that reverses the effects of Heroin, and our patient was a bt more responsive. With the aid of some police we managed to spend the next hour getting the patient out to the ambulance.

Once outside his 'friends' disappeared back into the flat and locked their front door. The police were no longer needed and so we sent them off to deal with a fight in a pub (probably) and started checking out the patient.

“I'm not going to hospital without my jacket and bag”, he told me.

But what would you know? It would appear that some people who take illegal drugs are perhaps a little bit untrustworthy. His 'friends' wouldn't open the door to us or to the patient.

So he refused the ambulance and our offer to call the police back. Instead we left him standing outside the flat, swaying slightly from the effects of the alcohol, no doubt until he got bored and stumbled back to his hostel down the road.

Strange thing about this 'client group', they are all very “I love you bruv”, until you give them the chance to steal something from you.

Incidentally, the reason why our patient had such a strong effect from the drugs? He'd been released from prison that very day, and so his tolerance for drugs had dropped during his time inside. Being released from prison has led to the death of more than one Heroin addict from this mechanism.

In some fluffy way it seems that victims are sometimes victims to other victims.

Or something.

I had my first letter of thanks yesterday, the first one I have ever had.

It was a simple little job, one of those jobs that you tend to do a lot of. The call was to an elderly woman who had maybe collapsed behind her locked doors. The problem that faces us was that front doors are often locked and it's hard to gain entry. We never really know what to expect from this sort of job, sometimes the person is fine and they've just fallen over. Sometimes the person is seriously ill and this is the reason behind the collapse.

Occasionally the person will have died in the night.

The patient's sister, who was also elderly, had gone to the house and was unable to raise her sister. She'd then gone to the police station and they had contacted us.

We arrived to find the police already there, as the door was sturdy they were waiting for the officers who had the battering ram. The sister had also returned with one of the police officers.

The battering ram arrived and the door splintered inwards. The police officers entered the flat and we followed them in to listen and see who found her first.

Thankfully the patient was alive and well and lying on the bedroom floor.

She's a stick of a thing and well into her late eighties. We quickly check her over to make sure that she doesn't have any injuries, then pick her up and lay her in bed. What then follows is little more than a more extensive examination of her and a bit of the old 'chat'. We talk to her and her sister while checking her blood pressure and the like about such diverse subjects as dead husbands and playing 'knock down ginger', about how out patient hates doctor yet how kind her GP is.

It's nothing unusual, it's nothing that we don't do for all our patients in order to put them at ease. They will often refuse to go to hospital so, assuming nothing too obviously wrong with the patient, we arrange a GP to come and visit then leave and make ready for our next job.

But somehow a card of thanks makes it's way to us. The younger sister had walked up to the hospital and asked the ambulance crews parked outside to make sure that we got it.

So I return to work, look in my letter tray and find the card. It's a simple little thing, it just says 'thank you', but it means a lot to my crewmate and me.

It's rather strange how things work out.

Take the job that we had recently - it was given as a woman who'd fainted but was breathing fine and had nothing else wrong with her.

We were pretty much round the corner, so it wouldn't take us long to get there.

We arrived at a junction smack bang in the middle of the road that we wanted. Do we turn right or left? We turned right and found the address.

The address was a bunch of flats, the name that we had been given was spelt wrong but as we are clever ambulance workers we went straight to the correct address.

I walked into the house, for some reason I was carrying pretty much all our equipment with me, I can't say why I was doing this, some sort of intuition I would guess.

And our patient was on the floor and wasn't breathing. Her heart was beating a quarter of the speed it should have been and she was not so much knocking on Death's door, but halfway down Death's hallway hanging up her coat*.

So we set about doing a few things for her, breathing for her and monitoring her heart. After we'd pushed some oxygen into her she started to breathe for herself and her heartbeat sped up to more normal speeds.

We left her at hospital with a pretty good prognosis.

But that only came about because of good luck - if we had been further away she would have died. If we'd turned left instead of right she could have died. If I hadn't carried some of our weirder bits of equipment into the house she could have died. If she lived on the top floor of the flats instead of the ground floor she could have died.

With the exception of her stopping breathing in the first place, it would seem that luck was with her.

*Stolen from the rather excellent Alan Moore.

JULY

Another call, oh well. Never mind, it's a nice day and it's better than being cooped up in an office. Let's get there while waving at the small children who wave at blue lighting ambulances. Hmmm, one of our regulars drunk in the street - still it gives me faith in humanity to know that someone on a bus driving past was concerned enough about their fellow man to call an a ambulance. Let's get him up. Hello Fred, another trip to the hospital? I wonder what drove him to drink, I wonder why he keeps losing hostel places. Its a shame really, wasted lives and all that. Why can't we provide a decent detox programme, I'm sure if we spent the money on him it'd save the NHS in the long run. Oh well, easy enough job - walk on, walk off, no hassle. Time for our next job.

NOVEMBER

A call? Bet it's some bastard pissed in the street. And why is no wanker getting out the way of our ambulance - can't you see big yellow ambulances with blue flashing lights you twat? Oh great, it's Fred, yet another pisshead. Some 'good Samaritan' who didn't actually want to stop to see if the obvious homeless guy is alright. Suppose they'll feel like a hero now calling us out to this waste of space. Blimey, he smells worse than usual - has he been rolling in his own piss? How weak willed do you have to be to get like this - the bottle is never a god idea for solving problems. I bet he gets thrown out of hostels because he takes a dump in their corridors, just like he did to my ambulance yesterday. Pull him up and throw him on the back, off to the hospital while we wait for him to die. Then we et to do it all again once the hospital discharges him.

The trick, of course, is to remain the professional while these different thoughts are rattling around in your head. It gets a bit hard in winter. Actually the hardest part is dragging yourself out of bed to go into work, knowing that these are the sorts of people you'll be spending most of your time with.

It can be awkward trying to hide your feelings when all you want to do is curl up in a corner and sleep.

My phone keeps buzzing from the Twitters of my friends. The big topic of conversation is the hailing rain and the gales.

I know all about it, I'm dripping wet at the side of the road. Two cars have collided and I'm standing in the dark in an attempt to stop any bystanders from stealing something from the wrecked cars. It's a November night at that indeterminable time of the night that could be ten, or midnight, or 3 a.m.

The leaking oil is reflecting streetlights and it makes pretty patterns beneath my feet.

I'm waiting for the police, our Control has let us know that they have no units to send. It's a shame, but the police station is only a little way up the road. I can just about see the 'Police' sign through my water-covered glasses. My crewmate is in the ambulance dealing with the two people who only have minor injuries from the crash.

Then from up the road appears a police sergeant. He's walked up from the station to come and give us a hand.

It seems that the local police are a bit thin on the ground and the sergeant talks into his radio to call some police away from paperwork to help make the place safe. It's dark and the immobile cars are a hazard to traffic. We've already tried to push it out the way ourselves but some hidden bent bit of metal is making that impossible.

The officers arrive and we all turn our hands to pushing the cars out of the way, finally they start rolling and we soon have them on the side of the road.

I'm left standing in the rain as the back of the ambulance is getting a little crowded, patients and relatives - none with coats. As I'm the only one wearing something approaching weatherproof clothing I'm left standing outside.

My phone buzzes, more Twitters arrive. Apparently it's raining. I'd never have guessed.

Eventually more relatives of the two women who have been sheltering in our ambulance turn up. They shake our hands and thank us, then the people are away. No need for hospital and they have things that they need to do.

I climb into the cab.

I steam slightly. At least it's the end of the shift, actually it's past the end of the shift and I now have less than eleven hours before I have to do it all again.

A big drop of cold water runs down my back.

Normally if I get sent to someone who isn't 'sick' I'll start grinding my teeth and begin composing angry blogposts in my head. However, sometimes it's great to go to someone who isn't acutely ill.

We were on the edge of our patch following our last job and were dismayed to find that the current job was going to send us far, far out of our area. We assumed that it wasn't going to be an easy job either as it was sent to us as 'Mentally ill man, walking down middle of the road'. The last job I remember like this the man was 6'2" tall, naked and covered in his own faeces...

But the police were the ones who called us, so we guessed that the scene would be safe.

Our patient turned out to be in his fifties and suffering from dementia. A check showed that he hadn't suffered any physical harm. The police had already determined where he came from - he'd escaped from his care home two days ago. He'd also crossed the river so in order to return him home we'd have to head into the dreaded South London.

To be honest, I don't know why the police didn't return him themselves - I suppose that there was a fear that they would miss some tricky medical condition. Or maybe it was just that they share our dislike of crossing the Thames.

It's their own fault then that they didn't get to meet the care staff, nor have the satisfaction of being thanked and seeing the patient returned home safely.

It actually seemed like a nice home, the carers seemed decent people and

I commented on the security bars over the windows of the home to one of the staff, suggesting that it should have made it harder for our patient to escape.

"Oh", she said, "that's not to keep the residents in, it's to stop the locals from smashing the windows and stealing the residents property".

Is it any wonder I don't like going South of the River? At least in my part of London all we have to worry about is terrorists.

And if I can be allowed one bit of snark at the expense of two people who might be found innocent, is it any wonder the NHS is in the state it's in if doctors (who are supposed to be smart) can 'mastermind' one of the crazier attempts at bombing civilians? Exploding gas cylinders? Really? Is that the best they could come up with? Still they did manage to get one half of suicide bombing right.

I mean - civilian crazies are better at making things explode, even if it is at the wrong time.

Please note, all disparaging remarks about being South of the River, and of the inhabitants of South London being the sort of people who eat their own children have been made purely for comedic effect.

And when did Iceland become terrorists?, I mean, there isn't any other reason to use anti-terror legislation is there?

It's a small pleasure we take in our patients sometimes, take one lady. She's in her eighties and originally from India, during the day she felt dizzy and fell to the floor. By the time that we'd arrived the next door neighbour had picked her up and sat her in the kitchen.

She greeted us politely and we all started to have a little chat, the thing that brought warmth to the cold hard nugget of coal that was my heart was that when she laughed she giggled like a schoolgirl. A laugh of that 'age' means a life well lived.

On the other hand I find that, in the words of a certain Mr John Lydon, 'anger is an energy'.

Another old woman, with us called by one of the 'carers' who visit he four times a day in order to clean her and her house.

The first thing that the carer did was complain about how long the ambulance had taken (half an hour, it wasn't a priority call), she told me that she had been there for an hour and a half.

...and for that hour and a half the patient had been left swimming in a bed full of piss.

The room stank, it stank of ammonia and it stank of flesh slowly being burned in ammonia.

No attempt had been made to clean her, nor change her clothes. We were instead 'ordered' by the carer to take the patient to the hospital.

My crewmate interrupted my discussion with the 'carer' because she could see the direction that it was suddenly taking...

(Methinks it's good for my career to work with people like this, while making crap 'carers' break down in tears is good for my sanity it isn't that helpful for the patient).

So we cleaned the patient and put her into a new dress, which took all of three minutes, and took her to hospital for her very minor injury.

Then it was time to turn all that anger into making sure that our patient was referred to the proper social services department. Which made me feel much better.

Oh yes.

Although I may have pushed a little too heavily on the paper in some parts.