Still no drunks - but, the weekend starts today and my shift ends at 2am...

I'm going to describe a job I went to last night.

The patient is female and 30 years old. She is married and is attempting to get pregnant. She is currently only taking fertility treatment, and having unprotected sex - she is normally fit and healthy and has no allergies. Her normal menstrual period is regular, however her period is over two weeks late this time around. She has been having nausea and vomiting for the past three days. She has no abdominal pain, and is not tender or guarding. She has no pain or increased frequency of passing urine. All vital signs are within normal limits.

So - given this information...

a) What do you think is 'wrong' with her?

b) Does she need a trip to hospital in an ambulance?

c) Why do you think she hasn't done a pregnancy test?

Five jobs last night, none of which were particularly interesting - and none of which involved alcohol. I love Murphy's law for making these shifts particularly pleasant...

I offer this further bit of information with no bias, nor any particular message - but the Newham registry office has released the most popular names for babies in the area. For boys, the most popular name is Mohamed, while for girls, the most popular name is Fatima. As an aside, there are a lot of people who have the exceptionally original name of "Mohamed Mohamed", to which I always ask which is the first name, and which is their second name...

Three jobs that warrant a mention - the first was a 39 year old male with a racing heart-beat. We got to him and discovered that he was in SVT, so we "blued" him into hospital where four doctors were waiting to treat him. His heartbeat returned to normal after they treated him with Adenosine. Why four doctors? Well I suspect it is because, like dealing with hypoglycemic patients, you can make an immediate difference in someones condition - and the patient normally comes away impressed. Dealing with SVT's were my favourite type of job when I worked in hospital.

Another vaguely interesting job was to a 16 year old female who had fallen from a garden fence after arguing with her sister. Fairly minor injuries - but a friendly, appreciative family. The memorable thing is that they live on an estate that is spread out over a wide area (the sort of place that is a nightmare to navigate, because the house numbering scheme seems like it was designed by a madman). Roaming the streets was a gang of feral teenage girls who, to be fair, did help us find the address - but I wonder at the parents who let their young children run around at half ten at night.

Finally we had a job for a kid who lives at "The Residential Home For Children With Behavioural Difficulties", which is where feral children end up - and where they are allowed to stay up past 11pm watching music television, complain about the allergic reaction that their nicotine patch is giving them, and boss around the 'carers' who are supposed to be providing an example to live by, but are instead (I suspect) just looking forward to their next paycheck.

Bring back National Service I say...

This is why I'm not a manager - I am working seven days this week - and seven days next week...

I did manage to pick up two people who were drunk last night - one had a nosebleed, while the other was a 17 year old who had been fighting with 'friends' in the park at midnight, and had gotten kicked in the ribs. Lungs were both alright, although the way he was behaving you would have thought that he was about to drop dead.

Stand out job of the night was getting a 22 Stone, immobile woman, who was dizzy and vomited whenever her head moved, down some stairs and into hospital. This could have been a complete nightmare of a job, but is wasn't, if only because both the patient and her daughter were very pleasant people (and it helped that they had a stair-lift in the patient's home). It went a bit worse because the hospital was exceptionally busy, and we kept being pushed from pillar to post while they searched for a bed for her. It took us nearly two hours to do this one job.

We also went to a five year old who had a swollen top lip - probably because of a minor allergic reaction, not a real emergency (she'd had it for over an hour, and it wasn't getting any worse). What made the job memorable is that the rather large family, wanted to go to the Royal London hospital, and not the closest (by about 2 miles) hospital at Newham. I might have taken them to the Royal London if they hadn't been so rude about Newham... (by policy, we are supposed to take people to the nearest hospital, and can only take people to other hospitals "at our discretion") I took the mother, daughter and sister (who apologised for the behaviour of her brother) to Newham and within 20 seconds of arriving, were met by the rest of the family, who had driven up in two cars full of people. There was one patient and nine relatives (I counted nine, it might have gotten even more) most of which were 'angry young men'. They spent the next two hours dominating the Paediatric waiting area, and I was reminded of the Toronto hospital which only allows one 'support person'.

I apologised to the nurse at the hospital - but it's not my fault they all turned up...

So far the count is 10 Sober jobs, to 2 Drunk jobs.

As predicted, none of my patients were worse the wear for alcohol - I expect this trend to continue for the next five days.

I thought I was working seven days, but that is actually next week - I'm only working five days this week, plus a visit to the Old Bailey on Monday - my day off.

We did however have a delivery driver, who was allegedly robbed by having CS gas sprayed in his face. The police present asked me very politely if I wouldn't park my ambulance on their crime scene - I obliged because they were bigger than me. The patient didn't want to go to hospital, and after letting his eyes dry out we left him in the care of the police present. Medical tip, don't wet your eyes if you have been sprayed with CS gas, it will only make things worse - instead face into the wind and let your eyes dry out that way.

We also went to a five year old who was apparently having an asthma attack - when we got there the child was asleep and had nothing more severe than a runny nose. I had to put on my teaching hat because the mother didn't understood what asthma is, so I had to explain the difference between that and a runny nose.

We had a 73 year old lady who collapsed in a GP surgery and when the GP measured her blood pressure as 90/40 (rather low), he thought it would be a good idea to sit her in a chair, rather than lay her down. Luckily for him, she didn't faint again...

Our last job of the shift was to a 91 year old man, who had become unable to stand - the carers who helped his elderly wife look after him didn't know what to do, and refused to call out the GP despite the wifes request. The wife called the GP herself. The GP visited, took the patients blood pressure and told them that they should call an ambulance to get the patient into bed, and then they would arrange a hospital admission in the morning. As the GP is a locum doctor, I doubt that this would happen at all. This is disgraceful - the GP should have referred the patient at that time, rather than pass the patient onto the day doctor. As it was, we thought that it would be best to take him into hospital that night (which is what he wanted), so that they could try and find out why he was unable to walk.

Last week we went to a 70 year old female who had chronic leg ulcers and terrible eczema, her husband had called us because the district nurse, who is supposed to dress these types of wounds, hadn't visited in the last 10 weeks. The patient had have what appeared to be a stroke in the last two days, but the husband who called us "didn't want to bother anyone"... I was glad that we could take the patient into hospital, because it seems that this is the only way should could receive the care that she required.

I told the handover nurse about the lack of community care, and she has promised to do something about it - it's one of the few things that I miss from nursing - being able to shout at useless 'professional carers' over the phone. The situations that people find themselves in, where their final resort is to call for an ambulance, make me extremely angry, yet there is little I can do in this job to change that situation.

On Sunday we remembered those who fought in the various wars, and yet the best that we can do for the elders who lived through those times is to treat them like a problem and pass them on to someone else. Is it really so difficult to provide care for these people who have worked their whole life?

The cat is indeed, out of the bag. Ambulance personnel across the Complex know that I blog, they worked out my nom-de-plume (the only 'falsehood' on this site) mainly because of a picture or two of myself I have on the site. So far the response has been along the lines of "You want to take that picture down, you look like you've just escaped from the Day Hospital", and someone wrote a vaguely negative comment in my last post, to which a tonne of very nice people leapt to my defence.

I figured it would happen at some point - a few people knew about it a while ago, but kept it their little secret, so I have been prepared for this day. I've actually been prepared for it since I started posting about my ambulance work, so very little, if anything will change on this site.

I've added a little "these views are mine alone, not those of the LAS" to the intro over on the right of the page - it's always been implicit, but I thought it wouldn't hurt to make it explicit.

I've always maintained confidentiality, both of patients and of staff, trusts don't normally get that privilege because they need to be held accountable for the things they do. I've deleted one post that could have possibly identified a member of staff - it wasn't an important post, but I thought that it came too close to crossing the line that I have set myself.

I'm convinced that this blog shows the LAS, and the NHS in a generally good light - I do tend to fixate on the negative side of things, so I may try to be a bit more upbeat in the future in order to provide a bit of balance. This promise may be unlikely to be kept...

I don't think that "Da Firm" is going to try and make me stop blogging, if only because they tolerate the "Big White Taxi Service" website and forum, and I believe that there is some subtle use of that site and forum to understand exactly what the road-crews think of various issues. I have at least one very smart person who has volunteered to defend my blogging should management try to stop me. Although if they did try to stop me, I'd blog about it, and I think it would greatly increase my page hits...

I'm going to keep writing under the name Tom Reynolds, I'm kind of used to it, and people know me by that name anyway. Tom is my middle name and I prefer it to my actual forename. And my mum will hate me for saying that...

I fully expect to be called a wanker by some people in the service - but I would imagine that those would be the people who haven't actually read this site, and were just hearing rumours about it. That and I am fairly thick-skinned. My crew-mate knows about the site, although I don't think that he has read it himself, but he is supportive of my writing. I'll soon let you know if I get called into the office though...

For the next seven days, I am working shifts from 16:00 to midnight, and as an exercise I shall be keeping a tally of people who's illness or injury is caused by alcohol. On these shifts it is often half our calls that are related in some way to drink, and by publicly keeping count, I fully expect the universe to toy with me and make sure that none of my patients are drunk - so that I look like an idiot.

But I doubt it.

It looks like the first case of 'granny dumping' of the season. Every year, around this time, families will do their best to get their elderly relatives admitted to hospital. I've personally see quite a few cases of it. It isn't helped that, because no-one wants to get sued for sending someone home who isn't suitable to be discharged, people are sometimes admitted for 'social reasons'. This ties up hospital beds in acute wards because the patient has nowhere else to go.

It is a sad state of affairs - and in this case I would want to see the family prosecuted, if only because I think Oldchurch is an awful hospital...

I'm back at work, and it's 4am on a grotty Thursday morning. Our Control contacted us and told us that we had a job to go to, while she was telling us this the dispatcher kept apologising, so I knew it was going to be a rubbish job. We got a Category 'A' call to a man who is "Not alert, severe respiratory distress, unable to talk properly, intoxicated". So we race around to the bus garage that the call came from, to find three, very well looking people standing around talking.
Apparently our patient (who is as fit as a fiddle, and not even that drunk) managed to fall asleep at the bus station while waiting for his nightbus, and another man became concerned and called for an ambulance. Luckily for the caller, I was driving - and so I didn't ask him why the hell he told our control that the patient had severe difficulty in breathing, or why he thought that calling an ambulance was a good idea. The patient didn't want to go to hospital, and wondered if we could give him a lift home (his home is about six miles away) and when we said we couldn't take him home, the patient decided to wait for his bus , much to the surprise of the caller.

Once more, a bystander/good samaritan is confused and frightened by someone who is asleep - and that they believe that this warrants an ambulance, and then when we turn up they try to tell us that the person 'needs to be in hospital'. I would be mortified if anyone called an ambulance for me whenever I fell asleep on the train/bus/tube.

Can I also ask that if you phone an ambulance because you are having a baby - can you at least wait the 11 minutes it takes us to traipse across our area to reach you, before making your own way to hospital. This is especially true if it is five o'clock in the morning. Either wait for us, or make you own way to hospital without waking my crewmate up from his sleep on the sofa.

This is the final post about my Toronto trip - I'm back on night shifts for a bit, so if you are lucky I'll have to pick up something other than a drunk/unwell child/maternataxi, and will therefore have something interesting to post about.

As I believe I mentioned before, the trip to Toronto was great. There were a load of great people that I met, essentially because of this blog, and I'd like to thank them all for making the trip so enjoyable. I'd like to thank Joey for letting me come to his party and somehow arranging two wild racoons to turn up in his garden for me to look at - also I'd like to thank Eldon and a couple of others who reminded me that it would be a bad idea to try and stroke those same racoons. I'd like to thank those who took me to the 'secret swing', and let me know about the first of the two Canadian laws I broke on the duration of the trip. I'd like to thank Andrew for the ex-pat information, and the drinks before I flew back, it was nice to see someone who remembered London before it all went wrong. I'd also like to thank Jovanna and her family and friends for a lovely breakfast. I'd also like to thank Jovanna and her friend (who's name I have rather shamefully forgotten) for the tour they gave me 'backstage' at the Royal Ontario Museum, I never knew that Egyptian mummies weren't stored in hermetically sealed hi-tech boxes, but instead were wrapped in a bit of plastic. I saw some very interesting items stored there, and even got to smell some mummified crocodiles - and they smelt quite a bit like some of the houses I get called to.

I'd like to apologise to Lee for not being able to meet with her, but our schedules just clashed, perhaps next time, or if she ever comes to London I can make it a point to see her.

I was impressed by the cleanliness of the streets (although apparently the Toronto inhabitants are up in arms about a recent increase in street rubbish), I was also impressed by what seems a genuine desire to recycle rubbish - possibly due to recent changes in how their rubbish is disposed.

I never managed to get to talk to an ambulance crew - when I visited the hospital there were no ambulances there, and then I got escorted off the premises by a very polite security guard, who appeared within seconds of me getting my camera out. I only saw one ambulance, and that was driving along the street, but I did see a couple of fire trucks running on blues. On this evidence alone I'd suggest that Torontonians are a bunch of healthy arsonists.

The flight back was not as bearable as the flight over - there was a two year old child who insisted on crying throughout most of the trip, the food was awful, I was in a middle seat, the in-flight entertainment was a bleeding awful 'chick-flick' and the legroom was a lot less.

But the plane landed safely, which is always a bonus - and the final tube ride home was uneventful.

I would like to offer drinks, and a tour of a local ambulance station for anyone who I met during those few days who may find themselves in London - I appreciate everything that you folks did, and I apologise for anyone who I have forgotten about, and haven't mentioned here.

I'm typing this in an internet coffee shop that is connected to the hotel, and I'm here waiting to meet up with an ex-pat called Andrew before I fly out later this evening. The computers here are awful, and security is even worse (they have removed the 'Start' button from the toolbar, but typing "C:" into Internet Explorer brings up the root drive... Fear my L33t hacking skills).

I'll do a proper post about my time here after I get home, but to do a quick summary - Toronto is a really nice place, the people are great and I had a fun time. It was weird to finally meet Joey, and I realised just how insane I was to travel halfway across the globe to meet a bloke I only know from the internet, and a huge number of people who didn't know me at all.

(Thankfully there was the social lubricant of beer available, so I was only uncomfortable for a bit - more on the party, and the other people I've met here in my next post).

I have drunk way too much coffee, and walked for miles (so much so that at one point I couldn't get out of bed...) I now have an eight hour flight to get back to London at 6:30am. Then I shall sleep, before doing a couple of night-shifts. See how easily I slip back into my normal life from the lifestyle of an international traveller.

So, more later, assuming my plane doesn't want to pretend it's a submarine and plunge into the Atlantic.

(Can you tell I'm nervous flyer?)