Until now I've had 30 days worth of articles on my main page, this has had to change because a recent spike in visitors has threatened to put me over my bandwidth allowance (Hi there Guardian readers!).

So...If I only have 10 days worth of articles on the main page it should mean I cut my bandwidth usage by nearly two-thirds - right?

I didn't sleep well last night, I think a total of an hour and a half - so if I'm a bit incoherent I'd like to register that as excuse number one. No real reason for the lack of sleep, it's a disadvantage of rotating shifts that every so often your body clock just throws up it's hands in despair and goes to sulk behind the sofa - leaving you suffering insomnia and/or intense fatigue.

Last night was actually quite pleasant, the first job of the shift (at around 4pm) was given as an 80 year old male collapsed in the street. Making our way there we were beaten by not only the police and fast response car, but also by a Duty Officer who had taken an interest in the job. It turned out to be a drunk Russian, actually in his early fifties who had decided to lay down and sleep it off in an alley. I suspect he was very surprised when he woke up to find himself surrounded by three police officers and four ambulance bods of various ranks. He was a pleasant enough fellow, who didn't speak a word of English, so to be on the safe side we loaded him onto the ambulance and took him to sunny Newham hospital. When we got there (and remember that this is around 5pm) the crew before us, and the crew who followed us, both had people who were worse for wear for drink. Luckily for both our patient and the hospital; a Russian nurse was working, so he could translate that the patient had indeed just drunk too much, and would very much like to be left alone so he could go home. I'm always impressed by people who can speak another language, two people talking what sounds like utter gibberish, yet making complete sense to each other never fails to entertain.

When taking this gentleman to hospital I drove past six known drunks in the space of one street. Alcohol, and alcoholism is a big blight on our society - some shifts the only jobs we have are those influenced in some way by alcohol. Most assaults can be attributed to alcohol, frequent callers (sometimes six times in one day) are very often alcoholic, and the amount of "collapse ?cause" jobs that turn out to be drunks is frankly astounding.

My personal view (and not the view of the LAS by any means) would be to prohibit alcohol, but legalize cannabis. Not only would it cut our workload by, at my estimate, 60-70% but I've never had anyone high on cannabis try to hit me. Cannabis users are very rarely violent, tend to be generally easier to handle and seldom get loud and annoying. It's true that there are long term health consequences, and that heavy 'stoners' can waste their life away - but the same holds true of alcohol and alcoholics.

On the rare occasions that I get called to someone on cannabis, it's normally because it is their first time and they feel 'dizzy' - often a pat on the head, and an explanation that this is what is supposed to happen is enough to calm them down, and they will rarely require a trip to hospital. Because the intoxicant effects are fairly self limiting, people tend not to overdose on cannabis, unlike alcohol - which is why you find people collapsed in the street.

There is one problem with the use of cannabis - I'm never sure what to call it in order to sound 'hip to the kids', the slang just befuddles me. Is it 'green', 'pot', 'hash', 'reefer' or 'draw'? At least alcohol is just 'booze'.

(Note this will be the last post on my HIV result, honest.)

Well I did go out with my brother for a drink to celebrate the fact that my blood isn't a biohazard. I had three pints, got completely tipsy and suddenly realised what a cheap date I've become. I don't drink much these days, partly because of the complete state I see other people in night after night, and partly because I started getting hangovers - when you only have a few days off, you don't want one of them to be spent in bed nursing a sore head.
The brother also bought me two DVDs when I whined that I had no money, he is a good bloke.

My brother is a teacher, and going by what he tells me, should he ever decide to blog about his job, I'd have some stiff competition. The education system truly is the pits. He'd just got a criticising memo telling him that his department was "getting on too well", nothing like too much morale to spoil a workplace...

Today I went to the panel discussion on "cyber-activism", which was interesting, but I felt wildly out of place there - loads of students and lecturers were there, and while I knew about the issues (Asian or Gay?, although I note no-one has protested the "British or Gay?" one...) I still felt out of my depth.
Still it took an effort of will to turn up, as I may have mentioned before - without my uniform I'm massively shy; with a uniform I can drag you off the street, give you drugs and undress you - without a uniform I get uncomfortable talking to strangers. So there was a bit of trepidation, especially when I realised I was the first person there...
All the speakers on the panel were very good, although as three of them were from North America I felt their talking about the 1st Amendment was perhaps a little out of place.

Still some good ideas came out of it - perhaps the main four being, "make the issue interesting", "there is no Civil Society", "we should seek engagement with the 'enemy'" and "hassle your MP". I may post more on this later, if I can make sense of my notes.

Back to work tomorrow, 4pm until 1am; should be fun.

Well...I've had some sleep so I can now post in a slightly more focused fashion.

First off, thanks to everyone who has shown support, either through the comments box, or via personal emails - it's all gratefully received. It looks like I'm going to have to find something else to die from now.

Tomorrow my brother and I shall be going for a nice relaxing drink, the first proper pub visit in over three months - there may well be a hangover involved.

I only had to wait 45 minutes at the 'clap clinic' for the test result - pretty hard to stay awake, but I think the emotional numbness that comes with exhaustion only helped me deal with the wait. The 'consultation' was over in less than 15 seconds - led into a room, asked to sit down and then being told by a shaved head counsellor that everything was fine. I didn't have a massive flood of emotion (possibly due to the aforementioned exhaustion), but afterwards I sat on a stone outside the hospital, rang my mum and brother, text messaged my old crewmate and breathed a sigh of relief. (Old crewmate told me that I had to go and repopulate Newham - something I don't think I'll be doing quite yet...)

Last night was exceptionally busy - I think I waved at the station once as we drove past. We were bounced from job to job; we only got back to the station at around 5am, and then copped a late job out of area. This had an effect on our sense of humour, as a lack of caffeine is not healthy for ambulance personnel.

This lack of humour wasn't helped by one of our jobs; a woman called us from out of area (and remember, we were one of only two motors covering the area) because she was feeling dizzy - she'd had a couple of glasses of wine, felt dizzy and so had drunk a few more glasses - and began feeling more dizzy. Also with her was her drunk husband and their child of about 6 years old. This was at 2am. I noticed that they had an accent, so asked where they were from.

Portugal.

(For those not in Europe, last night our national football team was knocked out of the European tournament by the Portuguese, aided by a Swiss referee who was quite blatantly as blind as a bat)

Ho-hum.

For some reason there wasn't that much violence following the game, and no suicide attempts either. No 'proper' illness or 'trauma' either, with patients able to walk on and off the ambulance with such complaints as "Abdominal pain for seven weeks" and "Cough for three days". One RTA, with no injuries and an elderly lady with difficulty in breathing (easily solved by a Salbutamol nebulizer) finished off the night.

It doesn't help that it starts getting light at 4am in the morning...

Sunday I shall, as mentioned, probably be nursing a hangover and catching up on some TV from the week before.

On Monday I shall be at 'TechActive', it looks interesting and I managed to swing some annual leave. I believe this is called 'going out', something I've been meaning to have a try of. I want to collar Cory Doctorow to tell him how copyright is preventing the people of London from getting the most effective health care available.

Yep, the subject line says it all - HIV test is negative, Syphilis test is negative and Hepatitis tests are negative.

Needless to say I am so far beyond 'relieved' as to be numb with it all.

I spent the last 20 hours awake, first at work, then in the 'clap clinic' waiting room; I now think I deserve a deep relaxed sleep.

Goodnight, I'll write more when I wake up...

posted at 11:13am local time

No sooner than I say that I'm not posting for a day than I get a couple of column inches in the Guardian (page hits have since quadrupled), very strange, but I feel weirdly proud about it all, mainly because I know I can't write; and my life isn't that interesting surely? Apparently I'm 'compelling', which makes me think of Derren Brown...

Anyway for those who have just turned up and are wondering why I'm having an HIV test, that whole saga starts here, and continues for that month (if you like a nice read about the side-effects of the anti-viral treatment I was given).

If you are curious about some of the medical/slang terms I throw about you can have a look at this previous entry, only some of it is tongue in cheek.

My 'About me' page is here, but to be honest it really isn't that interesting - it's traditional to have 101 things, but I had trouble thinking up 81.

Once you are up to speed I recommend that you have a look at some of the links on the right of this page - there are people who write a lot better than I do.

It's now 4:40 am, and I'm bloody knackered - we haven't stopped all night, at least in part due to there only being two ambulances on from 3am until 7am covering a large area (Barking to Bow for those who know London) - and we are one part of that cover.

Four hours before I descend on the 'clap clinic' and demand (with menaces if needed) my HIV result.

I'm feeling a bit fragile at the moment - these nights are really taking it out of me for some reason. I think the main thing that is getting me down is that I should be getting my HIV test result on Friday; as predicted I haven't been worrying for the past 3 months (is it really that long ago?) but with the result due, it is sitting at the back of my mind nagging away. I'm confident that I'll test negative - but even so I have the framework for two blog posts, one Negative, and one Positive.

Either way I think I'll be having a drink or two after I get the result.

At the moment there is some confusion about how I actually get the result - the receptionist at the clinic didn't know if their telephone text messaging trial was still being used - I suspect that on Friday I'll hang around the ambulance station after the end of my last night-shift and then walk down to the clinic and get them to give me the result at nine o'clock. It would be cruel to make me wait until after the weekend...
...So it'll probably happen, or they will have lost the sample or something similarly evil...

Tonight, the only job to really stick in my mind was a 'purple plus' (someone who has died and is beyond our help due to the amount of time they have been dead). It was an 85 year old female, leaving behind her husband of nearly 70 years after she died as he held her hand. A very sad job, he was putting on a brave face, but I think later today it'll sink in - hopefully his son will be with him when it does.

So, dear readers, the next update to this blog (unless my leg drops off) will be after I get my HIV result; I'm not in a frame of mind to write anything legible at the moment (as I'm sure you have noticed). Hopefully my next post will be Friday, but I'm a strong believer in the inherent evil of the Universe - (so I'll talk to you on Monday).

The second night-shift of a batch is always the hardest, your body clock doesn't know whether it is coming or going and you really aren't emotionally equipped to deal with people who want to give you a hard time.

This might explain why the desire to run over the patient who decided to run out in front of the ambulance and 'collapse' was really rather strong.

It might explain why, after a twelve hour shift, when you call up with 15 minutes to go because 'I've had a cold all week', you may get a less than friendly EMT.

And it might explain why, given our recent diabetic death, we 'Blue' in a 47 year old with a blood sugar of 24mmols, one kidney and a respiration rate of 42.

One bizarrely enjoyable job was an alcoholic Indian who had fell, while drunk, between two cars - his wife was on-scene telling him off, while he lay in the pouring rain, splashing around in a puddle. In March he had broken his hip, and now it looked like he had possibly dislocated it. But he was so intoxicated he was waving it around like it was just troubling him a bit, rather than writihing in the excruciating pain that you would expect. When we managed to scoop him up and get him in the back of the ambulance his hip looked 'wrong' - unsure whether it was due to his operation, and given the amount of alcohol he had on-board, we treated like a fracture and took him into hospital.
All throughout transport the patient, his wife and myself had an enjoyable chat - mainly about his drinking and how he is 'daft'. An enjoyable job despite scrabbling around in the cold, wet, cramped conditions that he found himself in.
The hospital x-rayed it and said 'something is wrong - but we don't know what' - an admirably vague diagnosis.

SPAMPOT: 2 Spams (Filtered), 0 Unfiltered Spams.

The night started with a feeling of impending doom, as I had forgotten that England was playing a fairly important football match against Croatia - I live in a block of flats with a load of Croatians so I wonder if they are still standing, and will the night-shift be full of people injuring each other over a game?

As it turned out the night was remarkably free from people beating each other up - one call to a family who'd had a fight between husbands/boyfriends and sisters with a 18 month baby getting in the way of a punch as well. Luckily the baby was fine, and the man who hit the baby was rather battered, in a minor injury sort of fashion. We'd also gone to an nurse who'd taken an overdose and was very drowsy - she initially refused to travel, but after half an hour of persuasion (including me asking her that if she really wanted to kill herself, why did she phone her work up and tell them what she had done? And where was the suicide note?) she travelled to hospital where she spent the night on a cardiac monitor.
We had one 'matern-a-taxi' to the Homerton hospital where the mother was booked in - even though Newham hospital was half a mile away. It was one of those jobs where the patient tells you she is having five minute contractions, but as soon as they get in the ambulance time dilates and you don't see one contraction during a 15 minute transport...
And finally we got a 23 year old female who had vomited once, and had a touch of diarrhoea - she decided not to transport to hospital so we left her in the care of her boyfriend - an easy job all round.

We did a total of five jobs during the night, which counts as a very quiet night for us. Three of the jobs were off one street - we just kept getting sent to the same area. It sometimes happens like that, you send ages without visiting a place and then get called there three times in a night.

Other crews reported that there were not as many violent incidents following this game - I even found my flats still standing when I returned home this morning.

SPAMPOT COUNT: Still Zero...but I have plans...

Yesterday we got a call to a 27 year old male, diabetic having a fit. It was only 4-5 miles away, but travelling through Newham on a Saturday afternoon is always slow business - this was compounded by one of the roads which we use as a shortcut being closed for relaying. It took us 14 minutes to travel those 4 miles. Then it was up five flights of stairs into a flat where the first thing we could hear was hysterical sobbing. As I've mentioned before it's one of those sounds you know means trouble.
Squeezing past a large bed we entered the bedroom to find a first responder 'bagging' the young man who was laying motionless on the floor - sitting on the bed wailing, was a young woman who we discovered later to be his fiancée. The patient was connected to one of our cardiac monitors and it was showing sinus rhythm. Kneeling on the floor I did a quick pulse check - beat, beat, beat...then nothing, no pulse for ten seconds. During the pulse check I was getting a history - apparently the patient was an insulin dependant diabetic, who had possibly been neglecting to take his insulin injections - he had become more agitated during the morning until he collapsed and started fitting after having an argument with his fiancée

With a monitor showing an apparent sinus rhythm the patient was in 'pulseless electrical activity' - we can't 'shock' this rhythm so I started CPR. From out of his mouth flew some bloody saliva, straight towards my face, luckily impacting on my forehead rather than ending up being swallowed (I don't want to make that a habit). One round of CPR later (3 minutes) and we got a pulse - the patient started 'cramping up' all his muscles had gone into spasm. A very quick blood sugar measurement reading showed 'HI' - a reading of over 32.0 mmols of sugar - the normal is 4-7 mmols. Immediately I started thinking of DKA - a condition that occurs when blood sugar goes too high, a life threatening condition that could explain his cardiac arrest. There was little that we could do on-scene as he needed immediate medical treatment beyond what we could provide.

With a 'Load and Go' order my crewmate set up the chair and the three of us dead-lifted him over the bed blocking the door and into the chair - I felt the familiar trickle of urine down my leg and looking at the patient he seemed to lose all colour. Another pulse check followed - his heart had stopped again.

I had to make a decision then - would we start CPR again only for him to continue this cycle of pulse/arrest, or do we make a run for the ambulance all the time starving his brain of oxygenated blood so that we could get him into hospital to correct the cause of his arrest.

I decided that we should 'run for it', if we got a pulse back it would be a purely temporary measure until his high blood sugar could be corrected. It was a very difficult removal - my back was spasming as we carried him down the five narrow, dark, winding flights of stairs and ran him across the 100 meters of pavement to our ambulance. Throwing him and his fiancée in the back of the ambulance we started the long run back to the nearest hospital. For ten minutes I did CPR in the back of the ambulance while my crewmate tried his best to get through the exceptionally busy traffic - stopping and starting, swerving across the road, over pavements - he drove to the limit.

Throughout transport the only rhythm we had was 'asystole' which is when the heart isn't beating at all - with our first responder 'bagging' him and myself doing CPR we we doing all we could to support his life. During the transport the fiancée told us that he had had a previous arrest when he had stopped taking his insulin, but that he had, obviously, recovered.

Rolling up to the hospital we were met by the 'Arrest Team' - senior doctors from across the hospital. They descended on the patient, trying to get IV access, a secure airway and running diagnostic checks. It seemed however that the team leader didn't want to listen to our handover. I was later told that he was concerned about getting the audit times right. The first thing he said was 'the patient is biting on the airway' suggesting that the patient wasn't actually in cardiac arrest - because he hadn't listened to my handover he didn't know about the cramping episode earlier. The hospital staff did their own 'pulse check' and were confused about feeling a pulse (in a stressful situation doctors often feel their own pulse rather than the patients) It was only after some time that I could actually give the team leader a complete handover that he paid attention to.

The team worked on him for over an hour - blood tests showed that his potassium was sky-high 7.5; this was probably the main cause of his arrest. It transpired that the patient had renal failure and the high potassium and high blood sugar probably meant that the normal biochemical reactions in the body were being interfered with leading to his fitting and cardiac arrest.

One hour later the patient was declared dead.

His fiancée was distraught, the patients parents had to travel 170 miles to the hospital and so it was necessary to tell them what had happened over the telephone - I can only imagine the drive down to London. The fiancée was convincing herself that it was her fault - that it was the argument that killed him, or that she should have recognised his symptoms of a high blood sugar before they became fatal. Both myself and the nursing staff tried to console her - to tell her that it wasn't her fault; but would the parents blame her?

I was thinking, would he have survived if we had remained on scene longer? Was making a run for it the right decision, given that I knew we had to carry him down the stairs? Would he now be alive if he had lived in a house rather than a flat? Did he die because he was an 'angry young diabetic' who didn't want to comply with this treatment? He did have a history of taking an insulin overdose two weeks before.

It was a bad job, travel time was longer than it should have been, the flat was awkward to reach, it was difficult to remove the patient and the return journey to hospital was too long. It could have gone so much better - although the patient may still have died it would have made us feel better. In all that job has left my crewmate and I a little depressed. Two deaths in as many days, one a 'victory' the other a real loss. I have today off so I'm going to relax and prepare for the joys of a night shift tomorrow.

One question for my medical readers - In the same situation would you 'Stay and Play', or would you 'Load and Go'?