You are going to love this...

I'm at work, it's 7am and I'm checking the ambulance to make sure that all the kit is there and that it is placed where I can find it. As it is 7am and I'm not a morning person I drop the electronic thermometer, part of which falls under the trolleybed. I get down on hands and knees to retrieve it...

...and hear a pop in my right knee.

Lots and lots of excruciating pain follows.

So I collapse onto the floor and scream a bit.

One of my stationmates hears me and comes to investigate, "What the bloody hell* are you doing down there?".

He goes and gets some help. Help to stand there, point and laugh at me. He includes some trainees in the mockery. I think he is getting his revenge because I keep calling him tubby.

I get given some entonox, a painkilling gas better known as 'laughing gas'. For some people this gas does nothing, for me - three puffs in - I'm giggling like a schoolgirl and can feel hardly anything. That which I do feel doesn't seem that important. I laugh a lot, use my good leg to get onto the ambulance trolley, and have some more entonox.

Mobile phone photographs are taken.

The trainees take my blood pressure, pulse and the like. I refuse to take my clothes off as I am a *bad* patient. I am also, as the young people say, 'off my head' on the entonox. It's good stuff, and to think they give us huge bottles of it to play with.

At the hospital, inbetween giggles, I am assessed by my favourite nurse (who, sadly, is escaping that A&E department soon) and I get seen by an Emergency Nurse Practitioner. I know Dr Crippen moans a lot about ENPs and the like, but the one who sees me is a good one - a full exam, a justification for an x-ray and good clinical skills.

The x-ray shows an effusion and maybe some ligament damage. I may get an MRI scan in the near future.

My duty station officer arrives, his first words? "If I'd known it was you I wouldn't have bothered coming, I thought it was one of the trainees".

He is, of course, joking.

So I'm hobbling around on crutches, with painkillers should I need them and an appointment to see the knee surgeon in a little while.

A big thanks to everyone involved, from my stationmates to the folks at the hospital, the care was excellent.

I have a few computery type things to do, but then I'm going to be at a bit of a lose end. I'm pondering learning a computer language, something that I can use in Xcode to knock up a Mac app. I'll search for a book on the Mac API in a bit, I just need to find a good one. It'll give me a chance to write some stuff for Mental Kipple, but I'll have to ration the eight or nine post ideas I have here. No work equals no inspiration.

*He may have used words stronger than 'bloody hell'.

...And of course as I go to drive to my mum's for dinner, the battery on my car decides to stop working. So I'm sitting in the car, in the dark awaiting a pick-up.

Merry Christmas all.

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Sent from a mobile phone, from my knackered car. Buggerit!
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No late job (thanks to the kindness of Control) so now I'm heading home for the family dinner and the exchange of swag.

Back tomorrow for more of the same...

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Sent from a mobile phone, probably from the cab of an ambulance.
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A(nother) little old lady, this one fainted. Both her and her family were lovely.
Then an attempted radio slot on BBC Radio 5 live, aborted due to the poor mobile phone reception at the local hospital.
Half an hour until the end of shift. Will I get another job?...
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Sent from a mobile phone, probably from the cab of an ambulance.
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Maternataxi

*Message ends*

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Sent from a mobile phone, probably from the cab of an ambulance.
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A run out of our area for a 50 year old with a cough that he has had for three weeks. Quite a thin chap which always makes such things look worse.

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Sent from a mobile phone, probably from the cab of an ambulance.
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Even the receptionists in A&E are getting in the festive mood. (I make no comment on the boots...). One of the girls has antlers on her head.



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

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Another little old lady who fell over last night but, 'I didn't want to bother you' so waited until this morning to call us. Lovely woman who may have cracked a rib. She has lots of friends who were all concerned for her and were very helpful for us (again, a rarity).

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Sent from a mobile phone, probably from the cab of an ambulance.
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Bless them all - loads of businesses get together and send us food for Christmas. I'm devouring the chocolate now...



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

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A little old lady who tripped and cracked her head open. She broke my heart and I found myself emotionally bullying the nurses with the phrase 'we need to show some Christmas spirit'. It's making me feel a little tearful, so this job will be a proper blogpost later. It's a happy ending though, which is good.

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Sent from a mobile phone, probably from the cab of an ambulance.
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Got called an 'angel' by our first job at five past seven, a very nice 63 year old chest pain. Patient called the emergency GP first which, considering his cardiac history, was probably the wrong thing to do. Cardiac chest pain = 999 in my book.

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Sent from a mobile phone, probably from the cab of an ambulance.
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Preparing the ambulance for the shift, making sure it is fully kitted. All while drinking a big mug of tea.

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Sent from a mobile phone, probably from the cab of an ambulance.
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Half past five and I'm getting up for work. How is that right or fair? It's not all bad though, I'm working with Laura and she is bringing food.

Shift runs from seven until four. With any luck it'll be a nice easy shift

I am working all over Christmas, yet as I feel the need for a holiday I'm going to stop blogging until the new year. With one exception.

On Christmas day itself I shall be doing my 'mobile posting after every job' series of posts. No-one will read it in real time as you all have better things to do, but it'll give you a good idea of another regular Christmas.

I'll also be ignoring all emails until the new year - they'll be going straight into the trash.

Happy Christmas everyone, and have a good new year.

Too damn tired to do anything except sit in a corner and breath quietly to myself, am barely able to string a sentence together - so here is a link to what Ben Hammersley is up to at the moment. I wish I could take photos like this instead of just dealing with the people.

(Favourite trick of the moment when called to an 'unconscious' drunk? Shine a torch in their face and shout 'Go towards the light!' Wakes them up without me having to touch them).

"Patient is suspended"

We rushed to the scene and the FRU arrived seconds before us. The patient, an elderly man, was laying on the floor. He wasn't breathing, he didn't have a pulse and he looked dead.

"He's dead, isn't he?", asked his wife. I could tell by the look on her face that she knew he was dead.

I could only tell her the truth, "He isn't breathing at them moment and his heart isn't beating. We are doing everything that we can for him, but you should expect the worst".

She nodded, she'd seen the colour of him and seemed resigned to his death.

My crewmate put the defib pads to his chest - he was in 'VF', a rhythm that we shock. So we shocked him and did some CPR, all according to our training. Then we shocked him again, gave him some drugs, breathed for him, shocked him again and eventually (and surprisingly) got a pulse back.

We all looked at each other - this sort of thing doesn't happen to us. Normally our dead patients stay dead.

We packaged him up for hospital, three times his pulse stopped but after a couple of minutes of chest compressions he'd get it back. Surely this wouldn't last, eventually he would die.

His wife seemed confused, but happy. Perhaps he wouldn't die after all.

We rushed him to the hospital, I think he lost his pulse twice more, each time we got it back. By the time we reached the hospital he was chewing on the breathing tube.

The hospital worked on him for a long time - still he didn't die. They tried everything, they even gave him a drug that costs more than £600 in the hopes that it would help stabilise him. They did everything, they thought that he may have had a chance as well.

His wife had hope. The last we heard was that he was transferred to another hospital where there was an intensive care bed. I'm guessing that I'll never learn what happened to him in the end.

I wonder if it was for the best that we saved him. My guess would be that, even if he does make a recovery, he will have some form of brain damage - he went without CPR for too long. The alternative is that he never leaves hospital. I wonder if his wife will continue to hope until he fades away in ITU.

From her acceptance that he was dead, to a probably vain hope that she would get him back, I wonder if it was cruel that our resuscitation was 'successful'. At the time we have no chance to make such decisions, we do what we do and get on with it. It's later, as you see the family around the patient, the monitoring machinery showing life but the patient making no movement, only then do you wonder if it is right.

I can't remember many of the people who die despite my best efforts (the cynical would suggest it's the sheer numbers I see that make it hard to remember). But this one will stay with me for some time.

The radio squawked into life, "Can anyone assist with an emergency call in Alice street?"

We were around five miles away and there were three ambulance stations between us and the call, obviously everyone else was further West than us or already busy on their own calls.

"Sod it", I said to my crewmate, "It'll be fun for you to have a decent run on blue lights..."

So we made our way there as quickly as we could in the traffic that seems to come from nowhere at 11pm in East London.

As we approached the scene we saw our FRU already on scene along with a van full of police. My heart sank, I knew that this wasn't going to be a simple job as I could see the police stringing the 'Do Not Cross' tape around where our patient was lying. The locals, as usual, were ignoring the tape, the police were getting exasperated.

Jumping from the ambulance I headed over to the patient. Our FRU paramedic was leaning over the patient's head and as he straightened to greet me I saw that the patient's head was... well... mushed.

He had huge swellings around his eyes and head, he was semi-conscious and covered with blood and vomit.

"Apparently". our FRU told me, "he's been hit once with a lump of wood".

Looking at his head I wondered why, if he'd only been hit once, it was such a strange shape.

"OK", I said, "We aren't going to hang about, lets run him to hospital".

There was some commotion as his drunk friend gave his story, in fractured English, to a police officer while more locals ignored the police tape which was cordoning off the crime scene. I needed to know how many times the patient had been hit, as it would change my treatment of him. His friend was adamant, he was only hit the once and his face normally looked misshapen. It wasn't outside the realms of possibility that our patient was just... ugly.

As we lifted the patient onto the trolley he let forth a long stream of vomit, my boots were merely splashed.

In the light of the rear of the ambulance I could take a closer look at our patient - he did have a very lumpy head along with plenty of 'soft tissue injuries' to the face. One eye was swelling up and he was still leaking blood from a large cut on his scalp. He was still semi-conscious and I made the decision to 'blue' him into hospital.

But which hospital? If I was sure he had a brain injury then I could take him a couple of extra miles to a unit with a neurology unit, but, if his drowsiness was as a result of alcohol (and we had been told that he had been drinking a lot) then the much closer local unit was a better bet. In the end I decided on the closer unit, they would be better able to assess him and if needed could easily transfer him to the hospital with the neurology unit.

So, after making sure that he hadn't been stabbed or shot (not..ahem...unknown in East London), we started towards the hospital.

The police officer who travelled with us asked if our patient's injuries were life threatening, I could only reply that it was a possibility but he'd have to wait until the hospital ran some more tests.

It was only as we were pulling into the hospital that I noticed one of his pupils was getting larger where previously they had been equal - this is not a good sign as it is an indicator of a serious head injury, it's normally quite a late sign though and he didn't look that neurologically impaired. Still it was too late to change our destination. During the transport he had turned his head to vomit on the floor (and this is the picture at the top of this post), and on arriving at the hospital did the same on the lift of the ambulance.

Straight into resus and I gave my handover to the doctor in charge - the team descended on him and, after booking the patient in, we left to begin the long, smelly and mucky task of cleaning out the back of the ambulance (and changing my now spattered uniform).

We went back to the hospital later to find out what had happened to our patient - after exhaustive tests it was found that his facial bones had been broken in
several places and he had a fractured skull - his friend had obviously been lying when he told us that he had been hit only the once. The reason why the patient's pupil had started to change was because the optic nerve had been damaged, there was a strong chance that he would lose the sight in the affected eye.

Thankfully I'd made the right decision, after CT scans it was determined that there had been no brain injury and that the reason he was so 'out of it' was because of the alcohol he had drunk over the night.

It later transpired that the beating was in part due to the 'inter-tribal' warfare that often takes to the street of London. Country 'A' hates Country 'B', and so they decide to beat each other up. The ambulance service and A&E departments along with the police are the lucky souls who get to pick up those pieces.

---

OK, I have now run out of stories to write about, so I hope I get something 'interesting' in the next four days... Also I now have an empty Inbox, so if you have sent me an email and expected an answer then it's been lost somewhere.

I have a location for the aforementioned drink up.

6.30pm onwards (on 21st of December)
Upstairs @ The Horse & Groom
128 Great Portland Street

There is even a map.

Please RSVP to Heather Smith: heather@thefridayproject.co.uk

As promised, Joel Veitch has released an MP3 for the Tommy's Charity. Tommy’s exists to save babies’ lives because right now in the UK, one in four women loses a baby during pregnancy or birth. Go, buy, enjoy. There is also one of his trademark animations to go with it. It really is 'rather good'.