Dark street.

A man who has been beaten unconscious.

I kneel down, and use my hand to steady me.

Under my palm I find two of his teeth.

Saturday night in East London.

The first job you get after a week off tends to set the tone for the rest on the night - not tonight though.

My first job was for an eighty year old collapsed outside her front door. I turned up and sure enough, there was a clean. tidy little old lady laying under a quilt (provided by her neighbours). Completely unresponsive, I burst into action (*cough*), checked her blood sugar levels, and found that it was rather low.

(2.0 mmols, don't ask me what that is in 'American').

One injection later and by the time the ambulance crew were carrying her down the stairs, we were all having a laugh and a joke.

So a good job where I managed to "cure" someone.

But then the night has appeared to take bit of a downturn (so far...), with a 'maternataxi', a 'hot and sweaty' 20 year old (no jokes please), and a series of 'assaulted outside pub', which ended up with me calling the police because it started to 'kick off' again.

I did have another job, where I was going to a "blind 18 year old, possible broken bone, unable to walk, learning difficulties". Control asked me if I wanted to police present as the patient was apparently 'upset'.

I told them that I didn't really think I needed the police to manage the situation.

Here is hoping that the drunks of East London decide to stop beating each other up for a bit...

Some good news though - the pregnant woman I wrote about who was mugged has just given birth to a healthy baby.

Apparently an ambulance has crashed into a car in Enfield. The crew are alright, but we don't know how the people in the car are. If I find out more I'll let you know (or point to the story on a news site).

The first rule of Book Club is not to talk about Book Club.

Person #207 to use this ‘joke’ according to Google.

Some time ago I was asked by the strangely named, but very lovely, Giskin Day to come and have a chat with her medical humanities book club about Safelight by Shannon Burke.  So I read it yesterday (and finished it in the bath today) and found myself in West London in University College London with a glass of wine and some depressingly young looking medical students.

Everyone was really nice, even though I wasn’t too impressed with the book itself.  Partly technical – Eyes ‘bulging out’ after hanging for three weeks in a fly filled room when there wouldn’t be any eyes left.  And partly because of the style of the writing – lots of short vignettes written in a very detached way, nothing flowing very well, and one of the cheesiest end lines of any book I’ve read.

And I know I’m not a great writer myself, glass houses, stones, and all that notwithstanding.

So I had a nice little chat, and discovered that the department has a blog!  It’s an interesting one, I’d describe it as the ‘Boing Boing’ of medical humanities.

Go there now, and look at the comic a post or two down, for UK readers it’ll ring a few bells.

Asked what advice to give to the medical students, my reply was to find a good nurse, and listen to them, as they are the ones who have been working the job day in and day out for years.

One of them mentioned that the vignettes in the book are a bit like blog posts, and was I going to write a book?  I did a bit of hand waving on the subject…maybe if some publishing houses started knocking on my door I’d do it, otherwise it’s a lot of work for something that no one would want to publish.

So, this week I’ve spoken at OpenTech, been on the BBC website, and been a guest at a Book Club.  On Friday it all settles back to normal when I start the first of four nightshifts, and it’ll give my ego a chance to deflate as I wade through the vomit and blood of East London.

Joy.

Although there is the Great Britain Beer Festival coming up soon, and I do have that Wednesday off…

UPDATE: Actually I was at Imperial College London not UCL. At least I didn't confuse it with UCLH.

I'm on the BBC website, which makes me think two things.

1) How easy it must be to fill up column inches with blog extracts (even if they are virtual column inches).

2) I really need to change my "About me" page.

Not that I'm ungrateful for the attention mind you...

And for new readers, all the juicy stuff is in the archives.

On Saturday I went to OpenTech 2005, and not only did I get to meet some great people and listen to some very interesting talks, but they also let me try to entertain the crowd by talking about how to keep your job while blogging.

I’ve been to these sorts of talks before, and have felt a bit disappointed when people just talk about things that they have written on their blogs – but I’ve now got some sympathy for them having just done it myself.

The keynote talk by Danny O’Brien about living life in public was very good (and you can download an audio of it), basically you lot (dear readers), know much more about me, than I know about you…

Would you like to change this?  Tell me about yourself in the comments field.

He has also set up a Pledge, that I have signed up for (and I am a stingy git).

If you think that the need for someone in the UK to fight for Digital Rights is worth £5 a month, then I suggest you take a look at the pledge as well.

Ewan Spence was there, and his “Ipod Shuffle shuffle” was another highlight.  I do think that his little Lego banner needs a bit more grey in the hair now.

My talk went as well as I thought it would.  I do get the impression that blogging is “so last year”, which is only spurring me on to get my backside in gear and start podcasting.

Gia gave me one of the nicest introductions going (and she later bought me a beer, and continued to embarrass me by saying nice things).  I then got up, talked about Libel and not calling your boss a git and showed loads of cute pictures of kittens.

Personal evaluation of performance : Could have been a bit better, but could have been a lot worse.

Other talks which I saw, and was interested in were the “What should I read next” launch (which will refer you to books you might like based on previous books you have read and enjoyed), MythTV (although I may have to wait for a Windows version, because Linux gives me a headache), the Big Brother social network (I’m trying to think deep thoughts about how this technology could be used in a health setting), and Backstage BBC, which is frankly stunning in its forward thinkingness

At one point after the last talk (at the bar – naturally), I was surrounded by Stroppycow, Annie Mole, Rachel and Gia and it made me feel like a right stud.

*Cough*

The (nicest ever) picture of me is by Neil Turner (no…I’m not trying to steal the video camera)

So, it seems that there isn't anything chemical/biological to worry about - so no doubt the Decontamination team are all disappointed...

The police commisioner has told all us Londoners to carry on as normal, but to avoid the affected areas.

The last I heard was that some of the team were looking at a "white powder" incident - but we get a couple of them a week, so it's unlikely to be anything serious.

Once more, most Londoners will look at what happened today, shrug their shoulders and make a cup of tea.

(Something I'm going to do now...)

One of our crews has been told to "Blue Light" down to Headquarters in order to provide cover for the area affected.

Decon officer is still on standby.

Everyone here is fairly relaxed about the whole thing, but we are quite a way away from everything.

Our Decon officer has just been told that he has to come off the road and be ready on standby. This means that our level of threat has been raised a bit.

Could it be because they are worried that there may be a chemical component to an unexploded bomb?

Apparently there are chemical suited people going down into Warren St station.

(Probably just making sure that everything is 'clean').

No-one on station has had a 'normal' call for the past 40 minutes.

Looks like it might be fairly minor - current theory is that a bomb has failed to go off on a tube. So far it's not being declared as a major incident.

At the moment we are all on station sitting watching the news.

Here is hoping that no-one is hurt.

I suspect I can direct you to your normal news-sites, as I'm not going to have any great insights from here on in.

Decon officer has been told to get ready for potential incident.

Looks like it might be kicking off in London again. An FRU has been sent to Warren st station, smoke has been seen. Decon officer on station hasn't heard anything yet.

Are you interested in the ethics surrounding Blogging?

Then a rather large report has just been put up on Blogspot

It's a pretty readable report, and I remember filling in the survey back in May.

I did have to look what this 'ethics' word meant though...

There is a special diagnostic procedure that us seasoned medical professionals use.

"Handbag medicine".

To the lay bystander it may seem that we are standing over the unconscious (or merely uncooperative) patient, rooting through their belongings, looking for something expensive to steal. For women this is normally a handbag, for men you will find us going through their wallet.

But! It is not true that we are seeking to boost our wages (meagre though they are), instead, dear reader, we are trying to help the patient.

If the patient is unconscious then we need to get as much information as possible, and one way of doing this is to go down their possessions.

The best thing that we can find is a card that is big, bright, hard to overlook with "I have epilepsy" written on the front (with the patient's name, date of birth and next of kin contacts written on the back).

The next best thing is often an address book/diary, it's especially helpful if the patient has filled in the front "personal details" bit.

At a pinch we can use our detective skills with envelopes (opened and unopened), credit cards, GP slips, prescription forms (often very helpful), immigration or asylum documents (popular in this area) and (also popular in this area) court summons.

So, an East Anglian Paramedic Bob Brotchie has come up with a rather good idea, given that people today, (myself included) seem wedded to our mobile phones.

ICE

Basically you put the details of the person you would like contacted In Case of Emergency into your phone under the name 'ICE'.

It's a good idea, and the drawbacks (the phone might be broken or separated from the patient) are the same drawbacks as anything that you would write on a piece of paper.

So, do it today!

True, if you are seriously injured enough, then we won't be rooting around your mobile phone (we'd be actually treating you), but it'd help the staff in the hospital when they get a quiet moment.

There have been hoax emails going around saying that if you put ICE into your phone then you get your phone credits drained away. This is absolutely a hoax.

This has been a public service announcement.

Or..."The reason why Barking road will be closed for an hour or two".

* If you have broken your arm and leg, please don't wave them around, as the sight of your bones trying to protrude through the skin isn't a pretty one.

* If the nice ambulance man puts your neck in a hard c-spine collar and tells you to stop waving your head around - listen to him. Broken bones heal, broken necks can be a bit more final

* Do try to get hit down a side road - if you get hit in a main road, then the disruption to traffic will be a lot worse.

* If your 'friends' say that they saw everything and will be at the hospital, try to have the sort of friends who will actually turn up there, and not just think better of it and bugger off to whatever hole they crawled out from.

* Yes, I know your arm and leg is broken, but seriously - keep your neck still.

* If you don't want me to know your name that's OK. Just make sure you carry some identification in your wallet.

* Having a shaven head makes it really easy to spot a head injury, thanks for that.

* Loose clothing is really easy to cut off. Please dress appropriately.

* Keep...Your...Bloody...Head...Still!

Why the flippancy? Lets just say that he and his friends are "well known" to the local police, and to the odd ambulance crew. Also, you want to know how we deal with nasty trauma? Dark humour...

Avoid Barking road near Canning town for the next few hours. More later.

My last call for yesterday was to a "65 year old female, fall in street, possible head injury", I was only two minutes away, and I was happy to do a nice simple job.

Falls in the street are often minor injuries, where I have to do little other than minor treatments, and give a bit of the old Reynolds chat

I pulled up on scene and saw a crowd of people standing around, looking fairly relaxed, and in the middle of them a woman lying on the floor. Someone was stroking her hand.

I walked up, looked down at my patient and said, "Hello, what seems to be the problem".

There was no answer, and her eyes kept staring ahead.

I checked her pulse, she didn't have one, nor was she breathing.

"Oh... Bollocks", I thought.

I quickly started our treatment for this condition. Connecting my defibrillator to her (A box that monitors heart rhythmn and can 'shock' the heart), I saw that she was in 'VF'. 'VF' is what is called a 'shockable rhythmn', which means that I can give her heart an electric shock in an effort to restart her pulse.

When you see Doctors on the telly shouting 'clear!' and then the patient's body jumping, this is what is happening.

So I 'shocked' her three times, when I wasn't shocking her, I was doing CPR (pushing on her chest to keep the blood flowing to her vital organs) and breathing for her with my ambu-bag. I'd had to cut her clothes off (so I could attach the pads through which to deliver these shocks to her chest).

All the time I was fully aware of the crowd around me, and I was hoping that none of them had a cameraphone. None of the bystanders had seen anything, and none of them knew the woman (it looked to me as if she was just popping down the local shops).

The crowd were thankfully no trouble, actually they tried to be helpful - one person offered to help me with her breathing (I refused, because in reality it's tricker than it looks). There was another person who helped me, by running into their house and getting me some paper towels.

Why paper towels?

Well, I tend not to wear gloves, and while trying to resuscitate her, the patient had vomited up her last meal. So my hands were covered in her vomit. The paper towels were so I could wipe my hands before belatedly putting some gloves on.

So the crowd were, as we say in this part of London, "As good as gold". They didn't get in the way, they didn't annoy me by asking awkward questions while I was busy, and even the little kids who were watching were well behaved.

It took a long nine minutes for the ambulance to arrive, not their fault, they were a long way away, and the traffic at that time of the day is pretty heavy.

We continued to attempt a resuscitation, and at two points we managed to restore the patient's pulse. Unfortunately she later died in hospital.

Once more I was left thinking about the relatives, who would be sitting indoors wondering why mum/gran was taking so long to get back from the shops.

Also, a resuscitation attempt is not the most dignified thing to have happen to you. That this woman had to have me cutting her clothes off, me jumping up and down on her chest and vomiting over herself, all in full view of the crowd, is not the best way in which to leave this world.

I'm hoping I have nothing but minor calls today...