Spongebob Squarepants is our third man tonight. I don't know who invited him, but he's not very good at putting on bandages.



(Of course, if the picture doesn't show, then the above will look like the ravings of a madman. More than normal that is...)



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Sent from a mobile phone, probably from the cab of an ambulance.

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I've been a bit lapse in blogging of late, partly because it's been one of the few occasions when I could spend time with Laura (and it will be weeks before I can see her properly again, something that I'm not happy about), and partly I've just been completely overflowing with procrastination. Never mind - I'm looking to blog every day until the new year. Plus do 'other stuff'.

Now to ambulance things.

I love Google, I really do. It does a wonderful job and helps me out in nearly endless ways.

But.

It seems that more and more calls that I go to have a computer running in the background. These computers are often displaying a 'health information' webpage. While I think that having readily available information is a good thing, it is important to be able to interpret that information. It is not enough to read and understand the words that are shown on screen, it needs to be filtered through some form of expert knowledge, even if it is just the skill to use a bit of common sense.

Take for instance a job I went to recently. The patient is a fit and healthy 25 year old. He works on a building site and this involves plenty of heavy lifting. For the last two weeks he has had pain in his left arm. He'd already been to A&E because he was afraid that it was something serious. The hospital did plenty of medical tests, all of which came back normal.

So, why was he calling for an ambulance when the illness was so old? He'd looked on a web-site and it had mentioned that left arm pain can be caused by having a heart attack. He'd read this, then started to have a minor panic attack, as he continued reading it also told him that difficulty in breathing is also a symptom of a heart attack.

Now - most people would realise that, given his history, it would be very unlikely that he would be having a heart attack lasting two weeks. But this patient read the webpage uncritically and so convinced himself that the cause of his pain was cardiac in nature.

Obviously this was one of our high priority calls, so the FRU car was already there although we weren't too far behind. All I could really do for the patient was to reassure him, check his vital signs and symptoms, and then drive him to hospital so that he could be 'checked out'. He was a nice enough bloke and he accepted that some of his symptoms were caused by his fear, so for me it is an easy job and one that got me off shift on time.

I think that you need to develop an easy-going attitude to these sorts of calls, you can get very annoyed by these calls that seem like a waste of time. I just put it down to fear and lack of knowledge, not something a lot of people can do much about.

however with that lack of knowledge rather unfortunately often comes a lack of critical thinking about what turns up on an internet search. While Google can be helpful, it isn't the be all and end all, you still need people who can interpret it, after all 15 out of 26 diagnosis isn't that good a hit rate.

It was supposed to be a simple job, pick the little old lady up off the floor and either take her to hospital, or leave her at home. Unfortunately there were a number of complications.

The first complication was that there wa a powercut in the area. As it is the middle of the night the whole place was pitch black. We have lovely torches in our ambulances. Well... It turned out that we had 'A' torch. It wasn't working.

Brilliant, all our actions would be under the light of our pentorches.

We managed to find the house quite easily, there were two candles in the window. The paitnet herself doesn't open the door, she's too scared. Instead one of her neighbours has a key and lets people in. He wasn't much younger than the patient herself and had been drinking a little.

We arrived and, under feeble torchlight, managed to determine that she had a black eye, a cut on her shin and a small cut on her face. She refused to go to hospital. All she wanted to happen was to be put back to bed.

I looked around, I couldn't see a bed.

The patient sleeps on the sofa because she is too frail to climb the stairs to her bedroom. So she puts lots of pillows on the sofa and throws a blanket over herself. Because of the powercut she didn't have any heating either.

Like Ms Nightingale before me, this (ex)nurse was forced to clean and dress the patient's wounds under candlelight - my crewmate did a good job of holding the candle only dropping it the once.

Still the patient refused to come to hospital.

I asked her if she had any carers, she told me that her son comes every couple of weeks to stock her cupboard with food, but other than that she has no social services/care input at all. This is partly why she was sleeping downstairs on the sofa, she hadn't been offered to have a stairlift put in.

I wasn't very happy to leave the patient at home, but she had the capacity to refuse treatment so I had no choice. In a case like this I like to have a GP come to visit to make sure that I haven't missed anything important (I know my limits). Unfortunately the emergency GP couldn't give us a time when he would be able to visit - as the keyholder was going to be going to bed (it was edging on to 11pm), there would be no-one to open the door for them.

So with some regret I arranged to have the patient's own GP come out to visit them in the morning. It was basically the best I could do for the immediate future.

Then the patient needed to use the toilet, my (female) crewmate took care of this for me (for which I'm very thankful). It was about now that I realised that the light on my pocket pc/camera made a really good torch.

For a longer term look at her care I filled in a 'vulnerable adult' form. This got faxed off to our Control who then deal with any concerns that we raise. In this case they will speak directly to the local social services and hopefully they will provide some help to enable this patient to live safely in her own home.

I have to do all this, it's how I get to sleep at night. If I'd just left her and crossed my fingers then I'd be worrying for days about her. By doing all the above I've done all that I can, and it is now up to the GP and Social Services to do their job.

A conscience is a terrible burden sometimes.

Of course it would have all been a lot easier if there hadn't been a powercut, if it wasn't during the hours of darkness (when the regular services all vanish) and if she opened her own door.

Actually it would have been much easier if I'd been able to persuade her to go to hospital.

A tricky job to write up as it touches on a ‘thing’ that has squatted in the back of my head for some time.  Something I thought I dealt with years ago, but obviously haven’t.  My mum will read this and I don’t think it’s something I’ve ever really talked to her about, but I asked her if I could write this, and she agreed.

We were stuck in traffic on our way to someone with a headache.  It was a ‘Green’ call so we didn’t need lights and sirens, we just had to trundle there, pick up the twenty year old and trundle into hospital.  It’s a nice easy job and gets us a bit closer to the end of the shift.

Then we heard Control asking if there were any free ambulances to attend to a female who was giving birth, the nasty bit was that the woman was only 26 weeks pregnant.  Control told everyone that the babies head was visible.  We called up and mentioned that we were on a low priority job and if they wanted to send us we would quite happily go.

A crew was already on their way and as the information came in that the woman has just given birth we were dispatched as a second crew to help out.  If she has given birth to such a premature baby, then every hand can help.

We were on the other end of our patch and the daytime traffic was hectic, but I drove like a demon and we were soon there.  The job was at the top of a block of flats so we grabbed our kit, jumped in the lift and made our way to the right floor.

The doors of the lift opened and standing there was one of my mates with a tiny baby in his hands.  It wasn’t breathing.

“Do you want the baby or the mother?”, he asked.

“Give us the baby, we’ll run with it”, I answered.  With that he handed us the baby and the lift doors closed.

We were met downstairs by the father who had ran down the stairs, so we rushed out to the ambulance to ‘scoop and run’, to get this baby to the hospital as quickly as possible.  All I could look at was how tiny the baby was, it looked like the baby birds that you sometimes find fallen from the nest.  It’s arms were like matchsticks, it was covered with blood and there were no signs of life.  My mate was in the back doing trying to resuscitate the baby while I drove us the, thankfully short, distance to the hospital.

We got to the hospital and the doctors there tried their best, but inevitably the baby was declared dead soon after we got there.

It turned out that the woman, while believing that she was 26 weeks pregnant, was only 20 weeks pregnant, so the baby didn’t stand any chance at all.

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This job shook me up because I believed that it had a chance.

I was less than a year old when my mother gave birth to my brother Mark, he was premature at 23 weeks gestation.  Survival rates for child at that age today are around 17%, back then in the 1970’s it was much lower.  After a few days of life my brother died.

I thought that it was something that I had put behind me many years ago, that I had a brother I’d never met, who’s grave I’ve never seen.  It’s not something that we talked about much as it still pains my mum to think about it.  Some years ago, for no reason, I started wondering what he would have been like if he had survived.  I long thought I’d put those thoughts behind me, but looking at a child that I thought was 26 weeks gestation brought those memories flooding back.  I wondered if that had been what Mark had looked like.

At the hospital there was an officer – he told us to return to station to have a cup of tea and a ‘de-stress’ and to return to work when we felt able, also that if we wanted to talk, he’d be around to listen.

A cup of tea helped, and I felt able to keep working after a little sit-down.  But now, as I write this, I can feel the sadness in my chest – not for the child that never had a chance at life, but for the brother that I never met.

Once more this blog turns into therapy.

Four jobs into the shift and none had wanted to go to hospital, it was a mix of the uninjured and the ‘can’t be bothered’.  This is not normally a problem, but in this case my crewmate really wanted to use the toilet.

“Two people stuck in a lift for two hours, one has collapsed.  Fire service on scene”.

Great…this could take hours.

So we dutifully made our way to the train-station when the lift was stuck and, after traipsing around a bit carrying our kit, managed to find the affected lift.  There were a couple of firefighters, some station staff and three lift engineers.  It turned out that two teenage boys had been jumping around in the lift causing the emergency locks to jam, they had been stuck for two hours and were making a lot of noise.  From the shouts of both of them it was obvious that neither of them had ‘collapsed’.

There was little for us to do while waiting for the engineers to free the lift apart from chat to the firefighters and watch a fireworks display going on across the river.

Twenty minutes later and the lift was freed and the two little hooligans rolled out.

“Who’s gonna take us to get McDonalds?”, were the first words out of one of the boy’s mouth.

No, “Thank you”, no, “Cheers for getting us out”, and definitely no, “Sorry to waste all your time”.

We told the boys to…ahem… ‘Go home’ and set about packing our gear away.

One of the firefighters turned to us, “Fancy a cup of tea back at our station?”.

My crewmate still needed to use the toilet so we agreed.  A quick drive to their station to ‘use their facilities’ and a nice cup of warm tea.  Excellent company as we put the world to rights and five minutes later we were back on the road ready to continue.  It was handy of them to offer us the use of their station as it was a lot closer than our ambulance station, so we were back on the road quicker than we could have been otherwise.

I’m occasionally dismissive of the fire service (mainly because they don’t wave when we drive past each other), so it was really nice to be human to each other.  And while I do take people as I find them, a simple cup of tea has meant that I can look at some of them in a much different light.

We should do it more often.

 

Actually I think that we should have rideouts between us, the fire service and the police – it’d only help to improve our working relationships (although us ambulance people and the police tend to get on well anyway due to us often attending the same sorts of jobs).

The has been some really interesting conversation over in the comments thread for the post 'Beaten', while I don't have a lot of time to reply to comments I do read each and every one.

The very next day we were called to a woman who had been assaulted. We arrived to find her talking to two police officers in her house, she had been punched in the face and would have a black eye coming up soon. They were getting details on the male who had assaulted her.

The story was fairly simple. The male was her ex-boyfriend but she had stopped seeing him some weeks ago, however he kept coming to her place to persuade her that he still wanted to date her. This time though he had seen fit to break into the house and then to punch her in the face.

The police knew of the male and were trying to get the woman to press charges.

For some reason she didn't want to.

Was it because she knew him and worried that he would come back and kill her if the police were involved? Was it because she didn't want to go through the trouble of the courts? Or was it some other reason? I couldn't understand it myself, but then, having never been beaten, I don't expect I would.

So the police could only refer her to the domestic violence team and leave the patient in our care.

Sometimes I'd like more 'closure' in my work.

For some reason Amazon has reverted to an old draft cover for my book. It makes me glad that we went for the one we did. Amazon should be changing it back soon, so hurry if you are interested. Also, can I take this time to mention that 'Blood, Sweat and Tea' would make a wonderful Christmas present for the whole family (that's one for each family member, not one per family...) Also be prepared for strange posting times as I'm on late shifts this week, which means I can lay in bed as long as I like...

The BBC are very nice people.

A little walk down a few canal paths took me from the hotel in which I was staying to the hotel where the 'Medical Day' talk was taking place. Along the way I took a few pictures of swans and boats and the like. I am such a tourist.

There were around thirty writers/producers there and we were to listen to a number of talkers, myself being one of them.

The first talker was presenting a piece of BBC research, it was the distillation of a number of focus groups about what the people of the UK were most worried about. Some interesting views that were obviously media led, but in my experience have little basis in reality.

The second talk was from a Bristol psychiatric liaison nurse explaining his role. For those that are familiar with Casualty, this is the role taken by the character 'Abs'. It was a very entertaining and useful talk, and would be something that I'd like the local hospitals in London to be able to see. He highlighted a lot of the problems that psychiatric services have with A&E departments and wasn't afraid to criticise others when warranted.

Then it was time for my chat - while the others had Powerpoint presentations for their talks, I had a scrap of paper - I have a distinct dislike of Powerpoint unless it is full of pictures of flying dogs and kittens in chocolate boxes. The session was a bit of a two-way conversation between myself and the audience, which was something I was hoping for. For the writers to get the most out of the session I thought it important that they could ask the questions that they wanted answering, while at the same time I could bring new aspects of ambulance care to their attention.

Then lunch where I had a very enjoyable chat with a high-up producer and some writers. While aware that they are producing a drama, rather than a purely accurate recreation of life in A&E, I told them about some of the things that make us people who do it in real life groan. It was a good chat because I learnt a little about how the TV programme is written and produced, and how it differs from the American way of doing things. All very interesting and I appreciated them taking the time to explain things to me. Then I was given a stack of my books to sign, the department had bought twenty copies of my book. My bank manager thanks all you TV license payers.

Then a taxi to the Casualty studios which is situated in an industrial estate and doesn't look at all how you would expect it from the outside. Taken under the wing of a lovely PA, I had a period of disconnect when I walked in and saw the extras sitting around. Here were large numbers of people dressed as nurses and paramedics, but they were all actors! The costumes, hair and similar were all extremely convincing, even the two police officer leading someone off in cuffs during the scene had the same tired look as all the real police I know. I felt like I wanted to talk to the paramedics sitting at the table to ask them what the work was like in Bristol...

The set itself is superb, it really does look real. The ceiling tiles are the same, the equipment is the same and there is even the little bits of detritus that gather in real A&E departments. The trollies (probably disused trollies taken from a real A&E) were, while old, the exact trollies I used to use. They were also bashed around in the same way that real trollies are. The only real difference is that the fake department has more blankets and pillows than a real A&E.

Unfortunately I wasn't allowed to take any pictures... perhaps if they were to invite me back in an 'official blogger' role (hint, hint)...

I sat quietly while they rehearsed and shot a scene several times from different angles. It was interesting to see all the work that goes into a section of filming that will only last two minutes on screen. They make 48 episodes a year, which means they work much harder than I do.. Filming the scene were the actors James Redmond and Janine Mellor who play the parts of 'Abs' and 'Kelsey'. I don't think I could do their jobs, to much standing around and then repeating yourself... There was also an actor who has been in loads of programmes, but whose name I don't know. Again the costumes and the way they carried themselves reminded me of people whom I have worked with in the past.

After leaving (with the fun goodie pack pictured above) I had a meal in a local pub and then caught the train home (where I wrote this post).

Now to sleep before work tomorrow. Seven evening shifts - my favourites...

The video thing yesterday was purely a bit of fun. It's in Quicktime .mov format for those that had trouble viewing it. If I ever do it again, I don't think it'll be on this blog. It was my attempt to do a 'ze Frank' when I had a spare hour. It only took two takes and I think that speaks for itself. It is also viewble on Youtube.

Live Video Update

Created in my hotel room using my Macbook's built in camera and microphone. Minor fiddling about with the file via iMovie HD. I know I said I wouldn't post it straight away, but I've been sneaking a free internet connection, so photos (if allowed) will be later. how does a hotel get away with charging £15 for 24 hours connection when they charge £140 a night for a room?

(Now I just hope that the link works...)

I'm sitting in the back of the ambulance watching as a sixteen year old girl cries while explaining to the policeman why her father beat her.

Her tears are falling onto her clothes leaving small salty circles.

While she is in pain, this isn't the reason why she is crying.

She uses up the last of our tissues.

Her jaw and chest are hurt where he used his fists and feet to beat her. I'd say that she has at least one broken rib.

I sit there listening to a long list of abuses her father has visited upon the whole family, from the seven year old up to his wife.

She didn't deserve this.

Her tears only stop once we reach the hospital.