We had an exceptionally pleasant day last week, far removed from the usual belly aches and drunks that we normally find ourselves attending.

'SCBU transfer - Newham to Oxford'

In all the years that I've been in this job I've never had to do a SCBU (Special Care Baby Unit) transfer. Normally it is the job of BETS (Baby Emergency Transfer Service... I think), they have a special vehicle, special staff and they do this sort of thing all the time.

What this meant for us was that we would have to store our normal trolley-bed at station, pick up the special straps that are used to secure an incubator in the ambulance and then transfer the baby in the incubator along with the Doctor and nurse team to the other hospital.

I don't mind telling you that neonates, especially sick neonates scare the living hell out of me. It's purely a lack of experience thing, when I was working in A&E I almost never saw any child under the age of six months or so, in the ambulance service the aforementioned BETS deal with these very young, very sick patients.

A couple of my friends have done secondments on the BETS team and they have all enjoyed it and learned a lot from it - the Doctor and nurse team like to involve the ambulance crew as much as possible so that you aren't just 'the driver'.

I'm not entirely sure of the reason behind the BETS team needing a frontline A&E ambulance to do their work that day, through conversation, I suspect that they are a bit short of their normal ambulance staff because local ambulance managers are refusing to release them from their normal duties to work on BETS. 'Losing' a member of staff to a secondment doesn't help with the much more important ORCON eight-minute target.

We arrived at Newham hospital in good time, having just been taught how to use the straps to secure the incubator - the bags the straps come in have illustrated instructions on how to fit them, which is good for us slightly dense ambulance staff.

Sadly for my crewmate and I, who like a nice drive out to the country now and again to see the trees, the transfer location had been changed to a local hospital.

The BETS Doctor and Nurse (and departing night-shift ambulance person) were incredibly nice, and very jolly. They involved us in the baby by explaining what was going on with it - they don't need to because in this situation all we are is essentially a very specialised taxi-driver, the Doctor and nurse look after the patient, all we have to do is (a) Not get lost, and (b) Don't crash. However it's very nice to be involved with the patient, and in those few minutes I learned some new things.

The transfer itself went very smoothly and the team told us to grab a cup of tea from the receiving SCBU tea-room. It would be rude to refuse such an offer.

The doctor then informed us they they had another transfer if we were interested...

I called up Control and explained the situation, as we already had the securing straps and had left our trolley-bed on station I thought that it would be worthwhile for us to continue with this second transfer rather than faff around getting another ambulance ready. Control agreed, as they often will do when 'on the ground' knowledge seems to make sense.

So we drove to a hospital on the edge of London and transferred another neonate into a specialist unit.

These two transfers were so involved that, with the exception of an early morning back pain call, they were the only jobs we did that day.

It also gave us the warm fuzzy feeling that we rarely have, the feeling that you are actually helping someone who needs serious medical care. Both these patients were incredibly sick and we were playing a little part in the chain of care that they were getting from the midwives, Doctors, nurses, HCAs, radiographers, haematologists and all the others in order to give them the best chance of life.

I doubt anyone from the BETS team read this, but if they do I'd just like to thank them for an exceptional day and for making us feel welcome in their world. They aren't often talked about in public, but with around seven transfers a day, they do an incredibly important job.

The police officer met us outside the station. Both ourselves and the FRU had driven fast through the traffic to reach the station. To be honest, our driving fast may have been because we we due off shift in around twenty minutes. We don't like having to go home late.

"Sorry gents", the officer apologised, "we nicked him for shoplifting, then he said he had difficulty in breathing and our Doc said he's not fit to detain".

"No worries mate", I told him, "where is our punter".

The officer pointed to a dishevelled man sitting on the bench.

"He's a heroin addict", the officer told me.

Never mind, I thought, do the necessary and pop him into hospital no skin off my nose.

The man, our patient, stood up and gathering his things walked towards me.

"What seems to be the problem?", I asked.

The man then proceeded to puff air out his mouth in what I can only describe as the world's worse attempt to fake an difficult. I took a step back to get away from the cone of foul smelling junkie breath that washed over me.

"I. Can't. Breath." He whispered between puffs. "Asthma.", he added as a coda.

"That ain't what asthma sounds like", I told him, "C'mon out to the ambulance. Is he still under arrest?", I asked the officer.

"Nope, we bailed him - he's free to go".

-----

Once we got in the ambulance, the man's attitude changed completely - from apparently being unable to breathe he started to breathe normally and a big grin spread over his face.

"So", I asked, knowing the answer before the question left my lips, "How long have you had problems with your breathing".

He cackled, "Since I got arrested".

"Are you telling me you faked it?", I asked, again not needing to hear the answer.

"Yeah, well I wouldn't have got bail would I?".

Images of murder flashed through my head, lingering a little longer than normal on the incredibly painful ones.

I took a deep breath. Then another one because the first one didn't calm me.

"What does it say on the side of this ambulance", I demanded.

"Ambulance?", he said.

"What else?"

"Dunno".

"It says 'Emergency', not 'get out of jail free'. It's a good job you convinced the doctor, otherwise I'd march you right back in the for wasting my time."

"Why would you do that?", he whinged, "that's not very nice".

"Because, you idiot, I could be going to someone who is really sick, not someone who's faking it to get out of trouble". I didn't add that I could have escaped going home late after a twelve hour shift with no break as well.

I continued, "All my patients today have been lovely, but you had to go and ruin a pleasant day".

"Don't be like that", he whined.

I decided to spend the rest of the journey in silence. Just in case I said something that I would later regret. It was obvious that this person's universe began and ended with him. Consideration of other people just wasn't in his programming. It was this that made me angry, not the thought that he considered himself smart enough to fool us into treating him.

I still did all the clinical things that I would be expected to do, but instead of my normal kind words and a gentle explanations I did them in silence. Quite literally biting my tongue.

-----

We got to the hospital where he tried lighting up a cigarette in the waiting room - until I told him to take it outside. You could almost hear his brain thinking 'but it's cold out there''. So we left him, sitting in a waiting room for a 'cough' that only barely existed.

I left, knowing full well that were he so inclined, he could complain about my 'attitude' and I'd end up disciplined. Meanwhile I write it here, in the public domain, to show you the sorts of things we really have to put up with.

So the next time you hear about people waiting too long for ambulances, consider for a moment the patient above. That might be why the ambulance arrives later than expected.

It is a proven scientific fact that people who make hoax calls to the emergency services have much smaller than average penises.

Just thought you'd like to be made of that fact.

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We had found ourselves on station, something of a rarity, and like all good emergency workers at 5am in the morning had dropped off to sleep within seconds of sitting down.

I'd like to say that I'd been asleep long enough for my drool to stick my face to the sofa that I was laying on, however in all honesty I tend to drool before I go to sleep.

But then, as is always the case, the activation phone went - we were being sent on a stabbing!

Of course I've given away the surprise twist to this story, I wouldn't be dealing with something interesting that actually required an ambulance, instead we would be driving up and down the road looking in vain for what I was hoping would be an interesting blogpost.

The thing that made us think that it was the genuine article is that there have been an ton of stabbings in my patch at the moment, probably, but not limited to, fallout over the boy who was stabbed to death a few streets down from our ambulance station.

For a while it seemed that everywhere we drove there would be police tape across the road, cordoning off another stabbing.

But not for us, no blue lighting to a trauma centre. Instead a search of the area and a message to Control of, 'Area searched, no trace'.

And then, the very next day, someone was stabbed to death around the corner.

The call was given as a 'chest pain'. Hopefully this is something that is going to change soon, I read about it on Nee Naw's blog, not that us road staff know anything about it because we are like mushrooms.

So, knowing little else, we whizzed along the empty night roads to get to this man in his forties having chest pain.

When we got to the house he was walking around the bedroom looking like he was about to go for a stroll, he wasn't sweaty, he wasn't distressed, in fact he looked healthier than me.

"I had a dream", he told us, "about my family and it upset me, because sometimes my dreams come true".

To be honest he didn't look upset.

"Erm... what would you like us to do about it?", said my crewmate (because I was the one driving that day).

"I'd like to go to hospital", he stated.

"Erm... you know they aren't going to be able to do anything for a nightmare", my crewmate replied.

"It wasn't a nightmare, it was a dream, and it might become true. They do that sometimes."

He didn't have the slightest whiff of chest pain, so where that came from we had no idea. Actually, that isn't true, I suspect that in a lot of occasions the person making the phone call just says 'Yes' to everything our Control ask. Add in the number of people in our area that don't speak English, and the number of people who we go to who are, frankly, a bit dim and you can see why our calls get over prioritised.

Well, there is no point arguing - 'patient' wants to go to hospital, we can't refuse, so off we went.

We left him sitting in the waiting room along with his concerned friend. I have no idea what the treatment is for 'patient thinks they have had a vision of the future', I don't think the psychiatrists would be too impressed to have him referred to them.

I'm sure its only a matter of time before I go to someone who has seen a ghost.

-----

So, Monday's question. Tell me about a dream you've had. Extra 'woooo' points if it came true.

As is typical on nightshifts my brain has turned largely into mush. I work, I sleep, I eat and I wash. Beyond that very little penetrates the gray haze that surrounds everything.

Which is my way of trying to excuse any impenetrability of the following blogpost.

-----

I am trying to get away from writing about patients who are being a bit daft anymore. A lot of the time it's not really their fault that they just don't understand their body enough to realise what is an emergency and what isn't.

But.

Last night we found ourselves going to multiple calls with multiple patients all suffering from 'shock'.

For those of us in the medical field Shock means something rather definite, it means that the tissues of the body are lacking in oxygen, in most cases this is caused by people losing the red, sticky stuff that flows around the body and carries oxygen to those same tissues.

What 'shock' seems to mean for everyone else is 'a bit worried, a bit scared or a bit upset'.

This is not a medical emergency.

While I dearly love the police, they do seem to have a habit of sending us on calls to patients suffering from this second form of shock. So during the shift we found ourselves going to a woman who had been involved in a verbal argument with her son and two car crashes.

Take one of the car crashes as an example.

When I say that I could do more damage to their car with my size 12 boot than had been caused by this collision you understand that it was a minor bump rather than anything serious. But still we are sent to the woman who was hit who was complaining of... well... feeling a bit upset.

And, of course, she wanted to go to hospital in order to be 'checked out', and as she wanted to go we had no choice but to take her. After a ten minute drive with my crewmate chatting to her in the back she was feeling somewhat better, but still seemed surprised when the triage nurse (rightly) sat her out in the waiting room.

A later call had someone who had been mugged as, once more, 'shocked'. And once more it would be fair to say that they were actually just a bit shook up. Nothing that a fully equipped emergency ambulance and A&E department could do. Certainly nothing more technical than to make a cup of tea and have a good sit down and a natter. Important, yes, but not really something for a vehicle that has the word 'emergency' written on the side in big un-friendly letters.

My point about the use of terminology is not one of making sure the 'right' term is used out of some sort of grammar nazism - instead it's so that people think twice before calling an ambulance for someone a who is 'upset' rather than 'shocked'.

Night shifts.

Brain frazzled.

Emails backing up again.

Please send sleep, drugs and weapons.

Interestingly I have new allocator.

Once more it's the elderly that causes me the most sadness.

We were sent to an extremely demented woman in her nineties, she lives with her husband and, while in the kitchen, had collapsed.

When I spoke to the husband he thought that she was about to die.

Not any more though, she had taken a shine to me and was grabbing my hand, singing songs and pretty much dancing around the living room.

I tried to get the story of what happened from the husband, but it was quite hard as our patient would keep interrupting us with streams of confused conversation and singing of hymns.

It was in the ambulance that I saw her husband bury his head in his hands. His eyes were wet with tears.

He was the only person caring for her, and so, for twenty-four hours a day, seven days a week, with no weekend breaks and no holidays he was nursing this confused and agitated hyperactive woman.

They had no other relatives to help them out, social services had arranged for a cleaner, but he did most of the cleaning for himself so there was little for the cleaner to do. Three or four times a night she would wake him up so that he could take her to the toilet, he hadn't had a good night sleep in years.

"It's like looking after a baby", he told me.

He had to run down the shops when she was asleep, and he constantly worried that she would wake up and find herself alone in the house.

Sometimes she would get angry and hit him.

Once more I found myself more concerned for the relative of our patient than for the patient herself. Thankfully one of my favourite nurses was taking my handover and I let her know that I thought that the pair of them could do with some more effective social input, perhaps respite care for her once a week so that he could have a day when he wasn't caring for her.