Some people might have noticed that my publishers The Friday Project have gone into administration and are being sold.

What this does is place any sequel to Blood, Sweat and Tea into a kind of limbo (along with, I presume, any royalties). I know that they can't comment about it until the sale has gone through.

What I do hope is that Clare and the others who work at TFP are all alright - they have always been very nice to me and I wish them the best whatever the future holds.

From tomorrow I'm back at work - which, because I'm looking forward to it, obviously makes me bonkers.

My memory is poor, but I'm sure that, when I was a nurse, the NMC had it as a condition of being the sort of nurse who gives drugs to people that the aforementioned nurse understand what a drug does and what it's side effects are.

It's 3am in the morning and I'm miles out of my area on the FRU*. I have been sent, as a blue light response, to a nursing home where one of their 'clients' is sleeping.

Yep - sleeping.

I get there and the patient is in the reception area of the home sitting in a wheelchair. He is... asleep.

The 'nurses' at the home tell me that normally he is very active at night and often comes to see the night nurses and sits chatting with them. He's ninety-eight years old and mildly demented.

I bite my tongue and do all the checks that I can to make sure that there isn't anything obviously medical going on. All his observations are fine and he responds somewhat when I try to wake him. I'm sure that if I provided enough pain stimulus I could fully wake him up, but it would just seem cruel.

I look at the patient's drug chart. Two days ago he was prescribed a rather strong sleeping pill.

I ponder, for about 2 milliseconds, if this might be the cause for his sleeping. At 3am in the morning.

I suggest this to the nurse.

She shrugs.

The staff don't say anything, but I get the distinct impression that they have been getting tired of this patient being awake while they are at work. If all your patients are sleeping then the night shift has little to do. If this patient has been awake, then they actually have to talk to him. In a lot of the nursing homes that I've been to the nursing staff don't like talking to the patients.

In a fair few nursing homes that I've been to the staff and the patients rarely share a language, and so everyone just 'gives up'. As a digression, the good nursing homes that I've been to have been those where the staff and patients do talk to each other, and the care of the patients is considered to be more of a 'partnership'.

The nurses, who I suspect have got exactly what they asked for, aren't happy. They've already rung the elderly relative of our patient (at 3am!) to let her know that he is heading into hospital.

The ambulance crew arrive and I have a real problem explaining to them why we have been called.

"The nurses wanted this patient to sleep at night. They have given him a sleeping pill, and now he's asleep", doesn't really seem reasonable for a trip to the hospital.

But the 'customer' is always right - and so the patient is driven off to the hospital.

I talk to the crew a few days later and they tell me that the receiving nurse at the hospital was as befuddled as the rest of us.

I don't know, jobs like this make me despair at the general intelligence of people, not less the intelligence of the sorts of people who look after the elderly.

Oh well, at least one of us had a bit of a kip that night.

*I really need to tell you about FREDA one day - perhaps a joint post with Nee Naw.

I'd like to apologise, blogging has been a bit slow of late. Mostly this is due to working on the sequel to 'Blood, Sweat and Tea' - I'm needing to put some concentrated effort into it. this is not easy with twelve hour shifts accompanied by the utter lack of energy I have at this time of the year.

Medgadget are running their annual Medical Blog Awards - you should go over there and have a look at the nominees, there are some really good ones there. Also there is no other motive for suggesting you visit the link. No. None at all...

As spotted by Mr Ellis

Also, please note - the competition still has a few days to run. Get those entries in now, and yes, you can enter more than once.

As I've mentioned to a few people I'm current;y in the process of writing a sequel to 'Blood, Sweat and Tea'. This book will have the usual reprinted and updated posts with comments on them - but it will also have roughly a third new content, unseen anywhere else.

All will be released under the same Creative Commons license as the first book.

I'll keep you updated as to it's progress over the next few months.

What my publishers and I thought would be nice, would be a competition to name the new book. 'Blood, Sweat and Tea 2' just doesn't seem right, so we are opening it up my readers.

...For they already have proved themselves fine folk of distinction and taste by reading this blog in the first place...

The prize for the one we pick (or the best one if we come up with something better ourselves*) is a collection of books from The Friday Project and signed copies of both 'Blood, Sweat and Tea' and whatever the new book will be called.

All you have to do is send an email to competition@randomreality.org with your name, your suggestion and a valid return email address- the closing date is midnight on Sunday 16th December**.

Feel free to mention this on your own blogs - the more the merrier.

*Unlikely.
**All emails will be deleted after Sunday and, apart from the winner, no personal information will be stored.

I've mentioned before about the superb care the people of London get in respect to heart attacks. They get diagnosed in the ambulance by a twelve-lead ECG, they will then get taken to a specialist centre for the gold standard treatment of an angioplasty. It is excellent and I love it, it improves the patient's outcome and gives us ambulance crews a warm fuzzy feeling to have done something other than pick up a drunkard.

I've had two such cases recently - both of them men in their early forties, both of them not recognising what was happening to them. Neither of them had any sort of medical history, it had just struck out of the blue. Both of them waited before they got treatment.

The first was an Eastern European chap who'd had pain in his chest since the morning, he'd gone to work and feeling unwell waited until his work was finished before walking to the hospital. It was only when the nurses there did the ECG that it became apparent that he was having a heart attack. We were called to 'blue light' transfer the patient to the angioplasty centre. He'd already been transferred to the CCU, so we also had a nurse coming with us. Like all CCU nurses she was excellent with the patient's care, all the paperwork was up to date, she kept explaining things to the patient to keep him informed and she treated us like professionals.

All throughout the patient didn't want to 'be a problem', he'd agree to anything, offered to help us (including walking to the ambulance!) and when he reached the angioplasty centre he told the doctor that they could 'do whatever they want with him'. He kept apologising that his English wasn't too good, but we muddled along fine.

The Consultant who performed the operation told us that once a patient had been through an angioplasty they normally gave up the smoking that nearly killed them. As this was the only risk factor the patient had, and as he was a really pleasant chap, I hoped he would find the strength to give up.

A really nice job.

The second job was picked up from the patient's place of work. Our FRU was already there and as soon as he saw us he shouted across that the patient would need a stretcher. As soon as you laid eyes on him it was obvious that the patient was having a big heart attack. He was sweating, he was clutching at his chest and he was scared that he was going to die. It was a perfect 'Hollywood heart attack'.

We wheeled him onto the ambulance where a very rapid ECG showed a big heart attack. My crewmate put the pedal to the floor while I tried to gather as much information as possible. The chest pain had started a few hours earlier, but the patient had ignored it and driven to work. He also had a phobia about needles, but the angioplasty centre managed to get the required needles into him through a combination of persuasion and brute force.

It's amazing to watch the screens as you see the blood flow return to the heart when the blockage is cleared. To know that the patient's chance of recovery is very good makes you feel that you have done a 'proper' job.

Both of these patients had a 'widowmaker' - a Left Anterior Descending Myocardial Infarction. These are the sorts of heart attack that can cause you to suddenly drop dead. Both were very lucky, despite their waiting to get treatment.

Both of these lives have been saved - but their outcome would probably be better if they had called an ambulance when they first got the symptoms.

Seriously - don't hang around with chest pain. If it's not obviously a pulled muscle (from lifting heavy objects or from coughing too much) then call an ambulance - the worst thing that can happen is that you get effective treatment quickly, the best thing is that you get a clean bill of health.

Oh - and quit smoking and/or taking cocaine.

As a public service announcement here is the British Heart Foundation description of the symptoms of a heart attack

“The most common symptoms of a heart attack tend to be pain in the centre of the chest which can spread to the neck, arm or jaw. It is often associated with nausea and shortness of breath.

“While women can experience the classic symptoms of a heart attack, they often present with more vague symptoms. These include a dull ache or heaviness in the chest, indigestion like pain, or feeling light headed with chest pain."

You only have one heart, don't take it for granted.

I have the physical manuscript of the American version of Blood, Sweat and Tea - the one where they take out all the letter 'u's. Every page as a column of red copy-edit changes. I don't think that the copy-editor likes ellipsises much either...

What strikes me as amusing is that the American publishers sent me (by FedEx) the printed out manuscript and want me to send it back with my alterations on it. Wouldn't it have been much simpler, cheaper and kinder to the environment, to just email it to me? They want it back in nine days - for the next four 'days' I'm on night shifts. I'm tempted to just fire off an email saying that they can do whatever they want with it.

I've just come back home from Cheltenham. It was great fun, and I'll have a quick run down of some of the best points.

• The hotel I was put up in was so posh a tiny bag of KP nuts cost £1.75. This is not a complaint.
• I can find a Wetherspoons pub anywhere. It's a skill.
• One of the staff in the 'Writer's room' wrote her dissertation on my publisher The Friday Project, including my book in it.
• Another volunteer who looked after the panel did some work experience for The Friday Project.
• Both of the above are obviously intelligence people of taste and distinction. Also pretty.
• All the guests on the panel were lovely, as was the host.
• Jed Mercurio, as well as being lovely, has given me a lot to think about.
• Feedback from the audience was apparently good - I'm glad that they enjoyed it.
• I did my first ever signing - it was *superb*.
• I still feel like some sort of a fraud. I think that I need to get over myself.
• I managed to get my favourite book of all time signed by the author ('Microserfs' by Douglas Coupland) and I managed to blabber like a fame struck idiot at the same time.

This is the first time that I've done anything public around 'literature' as opposed to internet/blogging. If they are all as interesting, well thought out, and perfectly organised as this one I'd like to do some more.

I'd also like to thank all the people involved for inviting me - it was great.

Now - back to work at 6:30am tomorrow, and back to writing about ambulance things.

I am still alive, although I've been very busy for these past two days.

Mostly sleeping.

I just thought that I'd mention that this coming Saturday and Sunday I'll be in Cheltenham for the Times Literature Festival.

Saturday will be spent mainly wandering around checking out some of the talks.

Then on Sunday I become one of the guests. For an hour I'll be on a panel with Jed Mercurio (who is a writer I greatly admire) and Dr. Thomas Stuttaford (who writes for The Times).

There are details online.

I'm listed as a 'performance'. This amuses me. It also amuses me that I'm considered Literature.

If you want to see me there is a payment involved and I'm getting paid for my appearance.

This amuses me no end.

I'll also be around for book signings and 'photocalls', it's part of the work contract I signed.

I doubt I'll be much bothered by constant calls for my picture to be taken.