The patient sat across the ambulance from me. I'd spent a few minutes trying to work out what was wrong with him, it certainly wasn't the 'difficulty in breathing' that we had been sent on.

His head was twisted, his teeth were clenched. His legs were twitching. His eyes were darting around, sweat dripping from his forehead.

He was obviously in some form of distress, but I was at a loss as to what was causing it.

Then he mentioned he'd taken some of his brother's medication.

Medication that could cause these physical symptoms as side effects. Suddenly it all fell into place - by taking the medicine that hadn't been prescribed to him (and a sizeable dose at that) he'd brought these symptoms on himself.

I looked at him across the ambulance, while distressing I reassured him that the symptoms would be temporary and were not life-threatening.

"You won't be taking medicines that haven't been prescribed to you again will you?", I asked.

"Nnnnneeeerrrrrggghhhh", was pretty much all he could say through clenched teeth.

-----

I saw him walking out of the hospital a few hours later, fully recovered. We cheerfully waved at him as we drove past on our way to another 'difficulty in breathing'.

-----

For those who didn't spot it, the post yesterday was a parody of a BBC news item - a few changed words and a final insane sentence, and yet still all too believable. I would imagine I'm on a 'list' now...

-----

For this week's Monday question, my mum always complains, after she breaks a fingernail, that 'that's the one I use to pick my nose, how am I going to to pick it now!". And I'm sure that we've all had parents say, "If you fall and break a leg, don't come running to me". My Nan taught me that the Salvation Army kidnap and brainwash children.

What weird things have your parents said to you? What strange things have they had you believing?

"Look here", one of our ambulance officers said to me after I'd been wrestling with a confused patient, "next time, just let them go, don't try and restrain them - if they want to wander off and die it's not your fault".

I nodded, "OK, I'll be sure to tell the coroner that...".

-----

The call was sent down to us as "Woman threatening to jump from a window". As I'm getting past the age of talking people down from tall heights I checked that the police were also being sent to the call.

Unusually we got there before the police, and as the location was distinctly absent of anyone standing in a window, we approached the house.

We were met by an on-call GP and the mother of the patient, the GP explained that our patient was suicidal and kept threatening to take overdoses or jump from a high place, consequently he wanted us to take her into the local hospital for a psychiatric assessment.

What was unusual was that the doctor was still on scene, normally the closest we get to see of them is the rear lights of their car disappearing once they see us arrive - I often wonder if they are scared of us...

Our patient was upset, but agreed to come to the hospital, her mother would also be coming with us. As everything seemed to be calm we cancelled the police from attending.

It was all going fine until our patient suddenly decided that leaping from our moving ambulance into fast night-time traffic would be a good idea.

Needless to say, I disagreed.

So, once more, I found myself wrestling with a patient in the back of the ambulance - she wanted to run away and kill herself, I considered that she didn't have the capacity to refuse psychiatric assessment and so there was a bit of a struggle in the back of the ambulance while my crewmate called for urgent police assistance.

I'm sure that if Liberty or Amnesty International looked at my actions in a court of law I could have been prosecuted for kidnapping, but I sincerely believe that an upset suicidal patient shouldn't be allowed to kill themselves on what seems like spur of the moment decision (even though they may have been thinking about it for a long time).

Importantly I couldn't see any coroner or family member accepting any account of me not trying to stop someone from killing themselves.

I like to think that I'm fairly knowledgeable about Capacity and Consent, and while it might be argued that what I did in keeping her in the ambulance was outside the limits of the law, it was definitely within the limits of human decency.

Besides, there wasn't time to do a formal Capacity assessment when your patient wants to dance in traffic.

The police arrived and were superb in helping me transport her to hospital - they were the police who'd been running to assist us in the first place when we'd cancelled their attendance.

We soon reached the hospital with only a few more struggles, and the duty psychiatrist saw her straight away.

I ended up with sore wrists, that were eased somewhat by an icepack - but I could soon ignore them for the crack on the head that I got from the collision we had on the way to our next job.

I've never been too good at listening to our officers...

-----

Any comments from mental health professionals on how to act when a patient who may or may not have capacity suddenly wants to kill themselves in front of you would be gratefully received. Sometimes, when looking at nursing literature, I think that the accepted thing to do would be to hand the patient a razor blade as a part of 'fulfilling their self-directed life goals'.

It's why I don't read nursing literature anymore.

Not the credit crunch, but the sort of crunch you get when two large pieces of metal and plastic try to occupy the same place in the space/time continuum.

We are driving under blue lights to a 'male, not wearing any trousers' in the local shopping centre, my crewmate is behind the wheel and I'm nursing some sore wrists from our previous job*

It's snowing, but it's only just started to lay, unmelting, on the floor. It's dark, but we are lit up like a particularly obnoxious Christmas tree.

My crewmate slows to get us through a gap made by a car who has pulled over and a traffic island. I meanwhile am deep in my own thoughts.

*Crunch*

I instantly know that someone has driven into the back of our ambulance, my head whips forward and then back - back into a hard bit of rubber secured above the back of my chair which seems to only have the purpose of being there to annoy the taller ambulance person.

There may have been swearing.

Immediately there appears a face at the driver's side window - we recognise it as one of our local police officers, a good one at that. He's off-duty and driving into work and he tells us that he's seen everything and is going to 'stick one on the other driver'.

I get out to hear him telling the driver of the other car that he's seen him following us down the road, tailgating us to get through the traffic and that he's going to be charged with 'driving with due care and attention'.

The driver's car is mashed, but there are no injuries. The ambulance doesn't have a scratch on it.

The officer has to get into work, but takes everyone's details, gives us his shoulder number and heads into work.

The other driver gives me his insurance details and drives off - despite me warning him that I don't think that his car is in any fit state to drive. Back in the cab of the ambulance I ask Control to let the police know that he's driven off in an unroadworthy car against my advice.

Then we have a slow crawl back to station to fill out the accident paperwork and take the vehicle off the road to be checked by the mechanics in the morning. Eventually our manager phones us to see if we are alright - it's implied that any sick time would result in being disciplined. She promises to get us another vehicle.

Another ambulance is driven down to us, one of the old LDV's**, we get in it to find that the heaters aren't working - at the request of Control we drive slowly through the snow to fill it up with fuel. Past the bendy buses that have jacknifed, past the cars unable to get over the flyovers. We creep through the night and fuel up - then creep back to the station.

At no point do the heaters work. I sit, curled up in my seat, trying to keep my legs warm.

By the time we get back to the station we have half an hour to the end of the shift, so we take the ambulance off the road to be fixed and watch the clock until we get to go home.

-----

*More on this tomorrow - for some reason I'm telling these stories in reverse order.

**About which more later, oh yes, much, much more...

So, apparently it snowed a bit in England, and in some places it is still snowing.

And so we find ourselves watching the TV with indignant sounding news presenters asking those in power 'Why wasn't something done!'. Sadly none of those being interviewed gave the answer I would have, "How much extra tax would you like to pay so that this one in twenty years event has no impact on your life?"
We aren't Russia, or Denmark or any of those cold countries, and the cost to fully prepare for aberrant weather conditions like this would be too high.

But.

It did seem that the London Ambulance Service was a bit unprepared. Did you know that we don't have anything to go on the wheels of an ambulance to stop it slipping in the snow? We have some covers for the officer's cars, but nothing for the vehicles that actually take you to hospital. To be fair, I'm not sure if this is economics, or down to a technical issue that they aren't able to be fitted by staff themselves.

The other problem that I heard over the radio was that some hospitals have ramps leading to their A&E department, and that the ambulances weren't able to climb them - so at least one 'blue call' had to bypass one hospital and head to one further away, one that had a ground floor entrance.

If you look closely at the ambulance on the right, you can see that it's a bit damaged. What you won't see is the damage caused to my ambulance by some idiot driving into it (and I'll tell you that story tomorrow).

Locally at least, we do have more blankets than we had this time last year, so it's not all bad.

The snow did seem to have taken LAS management by surprise though - there was only one Duty Station Officer covering the entire East side of London. Given that we were the third ambulance to have an accident, and that an officer should deal with each of those I would suggest that the next time severe weather is predicted the resourcing of officers might need to be improved a bit.

It was also about midnight when 'Gold Control', the people who normally worry about how much of our ORCON targets we are hitting decided to suspend the rest break policy. The message that was sent down the vehicle computer terminal seemed to suggest that forced overtime would be compulsory.

I doubt that that was the case, but it's definitely what it read like.

As NeeNaw says,

"I’m watching the TV before my nightshift tonight. They keep saying “the ambulance service is under severe pressure and will only respond to life threatening calls”. Surely we should only be responding to life threatening calls anyway?"

Which is sweet, but I suspect that, were I working tonight, I'd still be going to the usual twaddle of runny noses and one instance of vomiting.

I don't often write about things that have happened to other crews, I think I've only done it the once - but I thought that you should hear about something that happened to two of my station mates a few nights ago.

They were heading to the hospital with a patient in the back when a young man ran into the middle of the road and laid down.

The ambulance stopped.

Then some broken bottle were thrown at the ambulance - the crew, on realising this, called for urgent police assistance.

The radio wasn't working properly so Control had difficulty hearing what they were saying. So the crew used their emergency phones, the phones that we have been given to call for help if we are being beaten up while away from the ambulance.

They didn't work either, apparently it is a software problem - road staff have not been informed about this problem.

While waiting they saw the same person throw more bottles at cars as they went past.

Finally they managed to get Control to understand what they were asking for and the police arrived.

Along with a sergeant that some of us think has a dislike of the ambulance service.

While taking the details of what happened (and holding the people who threw the bottle) the police didn't seem too interested as 'no damage has been caused'.

They also didn't care that one person was shouting abuse at the ambulance staff, why they were giving their statement.

No arrests were made and not even an apology was elicited from the bottle thrower.

All in all a nasty state of affairs - firstly that someone thinks that it is fun to throw a bottle at an ambulance, then the lines of communication seem to have broken down in what could be a critical way. Then the police appear to think that it is acceptable to throw bottles at ambulances, or if not, that there is no chance that it would go to court - even with a suspect that they 'know well'.

It's a real shame, because us and the police tend to get on exceptionally well, and I make note of this event only because it is so unusual. I'm wondering if there was an underlying reason behind the apparent lack of interest that night.

What I can admit that if it had been me that the bottle had been thrown at I wouldn't be sitting here typing this, I'd be in a police cell for giving some scumbag* a bloody good beating.

*Except, of course, he's probably poor, or an alcoholic, or a drug user, which would excuse his behaviour. There are no 'nasty people' anymore, just poor victims of socio-economics.

-----

Your Monday question :- Quite simply the best track to listen to while blue lighting it to a job is Queen's 'Don't stop me now'; what other tracks that get your heart pumping would you recommend listening to when racing to a job?

I came across this heartening story while browsing the BBC News site.

A mother from Bristol resuscitated her baby boy four times when he stopped breathing - with the help of a 999 operator on the phone.
Driving instructor Cordelia Nolan, 25, said she was "petrified" when her 10-week premature baby, Emrys, lost his colour and turned blue.
Ms Nolan started resuscitation straight away and a cousin dialled 999 and relayed the operator's instructions.

I'm glad that the baby is doing well. If the baby had stopped breathing then the mother did exactly the right thing.

-----

I can usually count on a few 'Baby not breathing' calls each week the number of calls that I've actually been to when a child hasn't been breathing can, thankfully, be counted on the fingers of one hand*.

Often the 'child not breathing' is actually a child having a febrile fit, by the time we get there the fit has normally stopped and the child is either asleep or crying. It's scary but incredibly common, when an infection is spreading through my area it seems that the only calls I go to are for febrile children. I sometimes joke to parents that the only children that I see are either fitting or vomiting.

During a febrile fit a child can get blue lips, if a child holds their breath they can get blue lips - blue lips tend, on their own, to be 'not terribly worrying' on the scale of things us ambulance types worry about.

Rather obviously a child who has blue lips is a scary prospect for a parent and so they, quite rightly, call for an ambulance. Sometimes they say that the child has stopped breathing, after all that's why lips go blue.

When we arrive the child has normally made a full recovery from it's breath holding, but as we are not doctors we recommend that the child comes in to hospital with us.

What is less common, but a bit funnier is when you have a drunk who has seen his friend 'die' and managed to 'save' him with a bit of CPR. Or as we like to call it 'waking him up by pushing on his chest'. A tip - if he's pink and trying to push you off he's probably not dead**.

*After an accident with a threshing machine.

**Except when you are doing really good CPR on a dead person and they open their eyes and look at you - it's only happened twice with me and it freaked me out both times - especially as neither of them survived.

The last week was a week off from my 'day job', (is it still a day job if you work nights I wonder), what this let me do was catch up on all the things that I can't do when I'm working. What this really means is that my 'week off' was a week spent in meetings, plotting plans, doing writing work and other such things.

This week is also going to be a busy one, not only do I have forty-eight hours of ambulance work, I also have a PR conference where I am a panel guest. I also have the final changes to the sequel to Blood, Sweat and Tea to have in by the end of the week - with some luck I'll have some interesting news about both books in the near future.

Then I need to start planning out the narrative arcs for my third book, which will be fiction - something that I've never really done before.

I'll also hopefully have some good news about a gig that is quite unlike anything else that I've done before - I'll let you know what that is as soon as I can.

Finally I'm chasing yet another writing job that could be extremely interesting.

But tucked away at the end of everything else is a regular podcast and the possibility of another website.

Oh yes, and I should write some blogposts for this blog before I get carried away...

I think I need to employ an assistant.

All of this means that my time spent doing my 'day job', my ambulance work, will be one of the few moments that I'll have to relax - which is obviously a bit strange.

For those that want to take part, this Monday's question (to be answered in the comments) is, "Tell me about a teacher that made an impact on you". I ask this because I'm reading 'Moab is my washpot', the early autobiography of Stephen Fry where he talks about his teachers. Due to my shocking memory I can't remember any of my teachers, so I'd like to hear about yours.