On Monday I posted about what was apparently ‘bullying’ behaviour on my part in order to get a patient the best care that I could give.  As I was writing this post I realised that I’ve done it again.

I used to swim.  I used to swim alot and so it was a nice surprise to be called back to one of the swimming pools that I used to spend so much time in.  Unfortunately it was for a drowning.

Rather obviously we raced around to the pool.  A member of staff kindly ran us to the first aid room where we would find our patient.  During this run, carrying pretty much the entire contents of our ambulance with us, I was going through my mind about everything I knew about drowning – I was expecting a lot of work on this job.

We entered the first aid room, and the patient, a young lad, was wrapped in a space blanket, sitting up chatting with his friends.  My crewmate and I both breathed a sigh of relief.

We spoke to the patient, his friends and the two lifeguards who’d pulled him out of the water.  The patient had been unconscious on the bottom of the pool for around 30 seconds, after the lifeguards had pulled him out the patient had started breathing on his own.  A short period of time after looking ‘shocked’, and ‘shaking’ the patient had made an apparent full recovery.

“I don’t want to go to hospital”, he told me, “I’m alright”.

My crewmate and I looked at each other.

I turned back to the patient, “You haven’t got a choice mate – you are going to hospital”.

As I looked at the patient the thing that was foremost in my mind (and the mind of my crewmate) was ‘Secondary Drowning’.  In secondary drowning there can be damage to the lungs caused by the inhalation of a fluid.  The patient will then die a couple of hours after being pulled from the water.

He was going to hospital.  I just had to persuade him.  So I tried all the nice ways, the ways that won’t worry the patient, the ways that maintain respect and autonomy and all those other hippy words that are apparently so important even if the patient is bleeding to death in front of you.

None of it worked.

Time for the big guns.

“Ok mate”, I said, “the reason why we are taking you to hospital is because of a thing called secondary drowning – you are alright now, but it can cause you to drop dead in a couple of hours, and there would be nothing we could do about it.  So you are coming to the hospital with us – you have no choice in the matter”.

He agreed to come to hospital with us.  He was a pleasant young man, and he was given the all clear a bit later that day.

My point is – despite the cries of the ‘respect brigade’ (and I don’t mean any of you dear readers – all the comments in the previous post were good points), sometimes you have to become a patriarchal bully in the best interests of the patient.  Sometime it’s the only way to get the patient the care that you know they need.  I don’t like bullying people, but sometimes it’s the only way to protect both the patient – and my job.

So, sod it, sometimes I’m a bully.

Yes – I am posting today.  No – I haven’t been in World of Warcraft.  I’ve just been busy catching up on some of those bits of business that accrue during night-shifts.

My crewmate sent me a message today – she has actually managed to break her 4th metatarsal.  I think she did it to show solidarity with Wayne Rooney.  This means that she will be off work longer than expected.  Lets all send her healing thoughts.

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The picture is of the floor of the reception area in the local hospital.  Look at how expertly the lino has been laid, see if you can spot the subtle repair-work with masking tape.  The patient area is little better, except that it has transparent tape sticking it down.

Why am I posting a picture of a hospital floor?

It’s because our station’s kitchen boiler is broken. 

It’s also because of the debt the NHS is in.

It’s actually been broken for nearly three months.  Initially the company ‘didn’t have the part’, after a number of emails from one of our station officers that ended up verging on the rude the company managed to get the required part.  It hasn’t been fixed though – instead it’s been condemned.  We are still waiting for a new one. 

We ordered new chairs for our station through a certain ‘high street catalogue shop’, our old ones were falling apart.

They sent us the wrong chairs, then took another three weeks to deliver five correct chairs.

But this isn’t about our boiler, or our chairs – it’s about how contractors deal with the NHS.

Everything is overpriced and shoddily done – because the NHS doesn’t complain, and it’s so large that any company ‘blacklisted’ by one part will still be able to get business from other trusts.

I have a friend who is a carpenter, he told me that his company adored getting contracts from the NHS.

“You can charge them twice as much, take twice as long, do half a job, and yet they never complain – it’s money for old rope”.

 It’s not just small things either for individual trusts, I’m worried about the upcoming NHS national procurement for IT.  It’s been renamed ‘Connecting for Health’ presumably in an effort to rid itself of some bad press.  The IPPR has already suggested that it will fail (for them it is the lack of consultation and and skills that is their predictor of failure).  The Register tells us about the upcoming National Audit Office report.

Remember – it is costing £6.1 Billion.

When we are sacking nurses and closing beds is this money well spent?

 

£250 million (the total NHS debt) is 1/244th of the cost of the NHS-NfpIT programme. 

UPDATE:  Thanks to commentors and emailers who have told me the the UK uses two definitions of ‘billion’, a scientific and an economic.  No wonder I’m confused…

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My legal advisor has suggested that I state that all the bad things I’ve heard from friends placed in NHS-NpfIT and any other company are hearsay.  I am not suggesting that the various companies involved in the NHS are anything other than fine and upstanding.

Please don’t sue me – you won’t get much.

I’ve been thinking of writing something about Lord Joffe’s bill to allow doctors to kill patients assist the terminally ill to end their life.  However Dr. Crippen’s excellent post has pretty much summed up my feelings on the matter.

Except for one further point – while I would trust myself to take my own life, given the standard of many of the GPs in my area I wouldn’t like to trust them to help me do myself in.

Besides, (and I think Dr. Crippen missed a trick on this one) how long would it be until the government introduced targets for doctors to hit in the amount of people they snuff assist to die?

Still – I find that the Bill does have an important use - it is causing us to discuss such issues as palliative care and suicide in the public arena, where such things are normally whispered behind closed doors.

There is a big difference in allowing someone to die with as much dignity as possible (Do Not Resuscitate orders) and polishing them off by injecting them with drugs designed and dosed to end a life.

More excellent discussion on this at Black Triangle and Norman Geras.  While Secondhand Smoke is a blog centred around euthanasia.

 

While pointing you to Dr. Crippen, I’d like you to note that I worked for a short time at the Mental Health Unit mentioned in this post – and there was indeed a thriving drug use culture amongst the patients there.  The sleeping areas stuck to high heaven of cannabis, and those areas seemed to be ‘no go’ areas for the staff.  As an excuse for my complicity, I was a mere student nurse at the time.

I’m fully accepting of the need for some people to make suicide attempts and I’ll treat them with the same respect that I treat all my patients.  However, I’m only human and sometimes those people really annoy me.

We were called to a 25 year old woman living in a shared flat in a nice part of town – she had taken an overdose three hours earlier, it was now 2am in the morning so we were at the location very quickly.

We were met by a housemate who told us that she had taken some Ibuprofen tablets earlier – she had then sent text messages to her friends telling them that she had overdosed.  Then she refused to answer the phone when her concerned friends had tried to contact her.

As we walked in the door the patient told us, “I’m not going to hospital, I’ve taken 20 Ibuprofen before, so I know I’m safe”.  The patient had taken around eight of the tablets which, while an overdose, isn’t life-threatening.  This meant that the patient knew what she was doing, and I considered her actions to be manipulative rather than a serious attempt on her life or even a parasuicidal action.

Still, it didn’t matter, we still treated her with professional care – we advised she should come to hospital so that we could be sure that what she was saying was the truth, and so she could receive a psychiatric assessment.

But she was adamant that she wasn’t going to go to hospital – we tried to convince her, her friends (some of whom had driven for three hours to reach her) tried to convince her, but she wasn’t going to come with us.

The way she was talking and acting – laughing and joking, not in a “parasuicide has been cathartic” manner, but instead a more, “I’m the centre of attention” fashion – coupled with her history led me to believe that she wouldn’t be in serious danger if she were left in the care of her friends.  While I knew that the overdose probably wouldn’t harm her, our protocol and a wise protocol at that because I can always be wrong (IANAD*), dictated that we talk to our Control, and that they contact the poisons unit for the all clear.

While waiting for Control to get back to us, another of her housemates arrived at the scene – he was obviously a very sensible chap, a drug counsellor he told us some more about her history and agreed that while hospital would be the best place for her, we very well couldn’t kidnap her.  He told us that he was more than happy to take responsibility for her and would keep an eye out for her.

Just as we got the response from our Control one of the patient’s other friends came running out and told us that she had started to cut herself.

So…we went back inside and found her with some very minor cuts to her arm.

That was the final straw – she had undertaken self harm while her friends were present and while she knew an ambulance was sitting outside the house.  There was no way that we were going to leave her at home.

But still she refused.

I’m still not allowed to kidnap her.

I went back outside and told Control what had happened and that they should get the police to come to this address as in cases like this the sight of some ‘boys in blue’ often changes the patient’s mind.

Returning to the house I tried a little trick that has come in useful in situations like this – I offered her a choice.

Choice (a) was to come to the hospital with us under her own power.

Choice (b) was to wait for the police to arrive, we would then arrange for a social worker and two doctors to attend in order to have her ‘sectioned’ under Section 2 of the Mental Health Act 1983.  She could then be handcuffed and dragged from the flat kicking and screaming, ending up in the padded room at the local hospital.

With some help from her friends she chose Choice (a)

This is good, because Choice (b) is a royal pain in the rear to arrange, especially at 2am.

So the patient ended up at the hospital where her wounds were dressed and was left waiting for a psychiatrist to see her.

But, as I may have mentioned before, referral to psychiatric services never go smoothly – so when, after three hours, no psychiatrist had arrived (it is after all a long 200 yards to walk from the psychiatric unit to the A&E) she took her own discharge.

Another job well done…

 

A round of applause though for her friends who were absolute diamonds throughout this whole saga – supportive, sensible and caring – everyone should have friends like them.

*IANAD – I am not a doctor (nor do I want to be one)

For some reason the post that I tried sending from my mobile phone has disappeared into the ether – so should a post titled ‘Foamy’ turn up at some inopportune time in the future, just blame the time warp that is Newham.

I have a week off work.  I shall be mostly doing very little.

Sunday, however, is taken as I shall be in Covent Garden for the Britblog meetup.  Meetups are generally good fun and it’ll be good to meet some people from outside the ‘normal suspects’ of the London blogging ‘scene’.  Please do turn up to say hello and to make sure that I keep my vow of not drinking any booze.

I’ve got plenty to write about over this coming week, so any lack of updates is purely because I am being lazy.

You may take the silence of the rest of the night in one of two ways...

1) I was asked to move to a station so far out of my area that no mobile phone signals reached me so I couldn't post. Also I did jobs so interesting that I didn't have any time to write stuff.

...or...

2) There wasn't another 'single' ambulance staff anywhere in London so I was able to have a nice sleep on West Ham's sofa.

Hint: I'm rubbing sleep from my eyes.

There are a couple of options tonight, all of them involve me working - so I shan't be getting paid to sleep anymore.

I'm not really looking forward to tonight because of what is happening later today and because of where I work.

I work at 'West Ham'.

Later today the football team 'West Ham' are in the FA cup final (sort of like the UK version of the Superbowl for any Americans).

It looks like it will be a warm day. The pubs will be open - and showing the Cup Final Match. I suspect that there will be (as a friend of mine would put it) plenty of chance for police overtime.

In addition ambulance manning isn't at it's best.

Oh well...


Of course - now I'll probably get nothing but babies with runny noses while two streets away there will be running battles between two groups of drunk football hooligans - something that we have a long and valued history of in this part of town.

Well... That's the last time that I try and predict what will happen in a night.

For a change it's not me that is injured, but instead my crewmate.

We had just returned to station and as she climbed out of the ambulance her foot caught in a hole between the kerb and a dip in the grass, I looked over and saw her rapidly disappearing from view.

To be brutally honest, both myself and the FRU driver's first action were to... *ahem*... 'make fun' of my crewmate - that was until she told us how badly her ankle hurt. A quick examination under the darkness of night told me that the best place for her would be the A&E department.

So I drove her, in her own ambulance, back to the A&E we had just left.

Our Duty Station Officer met us there, discovered what had happened and left her in my capable hands as he drove off to deal with a crew that had been assaulted.

My crewmate was seen quickly in the A&E (perks of the job you see) and x-rays were taken of her badly swollen ankle - thankfully nothing was broken, although the prognosis is that her recovery will take 2-6 weeks.

I'm going to drive her home, then come back to station and see if Control has found someone to replace her.

Oh well - it was nice having a regular crewmate - if only for a little while...

Second job of the night is a two day old baby that coughed up 'something white'. It's an easy job where the parent carries a healthy baby into the ambulance, I drive it 800 yards and the local hospital provides reassurance.

Forgiveness is also due because the birth was difficult and the baby was born two weeks early. Although there is some negative marking for thinking that baby '...needed suctioning for amniotic fluid still in the lungs'.

I'd just like to say that my (female) crewmate finds babies cute.


I don't.

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Sent from a mobile phone, probably from the cab of an ambulance.
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For those that are interested, I'll be in Second Life from around 2pm on the Radio 1 island. The BBC are apparently simulcasting their music festival

So the first job turned out to not be an elderly person with common medical ailment, but instead a young man who had hit a car. Then while limping home had caused three people to call an ambulance.

Add in another call in the same general area and you had a potential for chaos - however our Control staff are pretty good so everything was sorted out.

The patient had reached his home and then started hyperventilating, with all the symptoms that this brings. Luckily he wasn't seriously hurt and once he had calmed down it made for a fairly easy job and a pleasant trip to the hospital.

If you are wondering when I have time to make these entries - I'm driving tonight so I can post these while my crewmate books the patients in.

I'm looking after the patients tomorrow which fills me with some dread...

...More of which later.

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Sent from a mobile phone, probably from the cab of an ambulance.
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I was wrong about our first job. We are yet to go out as the crew who had our ambulance before us had to deal with someone who had nearly cut his arm off with a falling window.

We let them go and cleaned the motor ourself.

There was a reasonable amount of blood on the floor.

I 'm sure I've told you before that I don't get the sexy' jobs...

We also needed to get fuel and head down to another station to do some paperwork. I am now eagerly/anxiously* awaiting our first job.


*delete as applicable.

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Sent from a mobile phone, probably from the cab of an ambulance.
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Thanks to Heather, who let me know about this.

There is a copy of the Emergency Workers (Obstruction) Bill posted on the internet.

Looks interesting – the proof that will be needed for a successful prosecution will be so high only those people who really make an effort to obstruct us will fall foul of it.

I would have thought that existing legislation would have been enough though.

Feel free to discuss in the comments.

After working for two weeks straight I have had a chance to spend two enjoyable days hiding from the world while sitting on my backside reading,watching TV and of course – playing World of Warcraft.

Now I return to work for a Friday, Saturday, Sunday nightshifts.

Deep. Joy.

 

The standard breakdown for a weekend nightshift is as follows.

19:00 – Clock on at the station.

19:01 – First call, normally to someone elderly, probably chest pain

20:00 – Man with ‘man-flu’

21:00 – First assault of the night, outside a pub.

22:00 – ‘Unconscious’ male in street – normally a homeless guy.

23:00 – Another assault.  Fueled by alcohol.

00:00 – ‘Unconscious’ – drunk in street.

01:00 – Child with a high temperature – everyone in the house is awake.

02:00 – Young man with bellyache / young woman with dizziness. (We are now the only ambulance running from West Ham)

03:00 – Nightclubs kick out.  An assault who doesn’t want to go to hospital.

03:30 – Drunk in the street or a drunk who has injured themselves.

04:30 – Get back to station.

04:31 – Maternataxi.

06:00 – Another Maternataxi.

06:30 – Return to station – start watching the clock for sign-off at 07:00.

06:57 – Get a job for a little old lady, miles out of my area with cardiac chest pain.

06:57:01 – Start swearing.

07:25 – After a ‘scoop and run’ return to station to sign off – all ready to repeat the night in just 11 hours and 35 minutes.

Tell you what – I’ll do one of my ‘updated throughout the night’ things.  I can’t guarantee that this is how things will unroll (and this in part is the pleasure of this job), so we can see how far away from my prediction things fall…

I have just felt a surge of rage.

Some *%^$! just told us to F-off just because we dared approach his crossing point on blue lights and sirens and expected him to wait the second it would take us to pass.

Somehow (don't ask how) I managed to avoid jumping out and punching him in his gobby mouth.


...and breathe and relax...breathe and relax...

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Sent from a mobile phone, probably from the cab of an ambulance.
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This is the Tate and Lyle sugar factory, cunningly enough it lives on Factory road pretty much smack bang in the middle of my ‘patch’.  When I was on the FRU and ordered to, “go and drive around – see if you can find someone injured”, I would often drive past it.  As you may know I’m a bit of a geek and factories full of pipes, chimneys belching strange smelling smoke and arcane bits of machinery interest me greatly.  However, until today I’d never actually been inside this behemoth of a factory.

The call was pretty simple – the hydraulics of a fork lift truck had burst, and the fluid had splashed into his eyes.  Luckily he had been wearing safety goggles, so had been spared the full brunt of the spray.  The companies first aider/fireman had already washed his eyes out with plenty of saline, so there was little for us to do except take him to hospital to make sure that nothing had scratched the front of his eye.

But that wasn’t the fun bit…

To show us where the patient was a security guard met us at the main gate – then he jumped into a Vauxhall Astra and drove like a man possessed through the factory grounds towards the patient.

I was driving.

I got to chase him.  I got to chase him the length of the factory.

More importantly I got to chase him through narrow turnings and under footbridges full of pipes.  Smoke was billowing out from vents, while I dodged between lorries and powered up ramps.

In my head the theme music to The Sweeny was playing.

I just may have giggled like a nine year old girl.

While my crewmate attended to the patient I had time to whip out my phone and take a picture of the factory floor.  The place is huge and this is just a small part of the process that goes towards getting a spoonful of sugar in your morning cup of tea.

Yet another thing that I love about my work – I get to go into some strange places.

That, and I get to chase cars.

(No, this blog is not about to turn into www.picturesofrandomwarehouses.com.  But I would like to go back there with my proper camera and get some nice pictures of rusty walkways and the like)

I had two new experiences yesterday – I’ll tell you about the job I had that left me unhappy that I couldn’t help more.

We arrived at the same time as the police to find an Indian woman crying on her bed.  We had been sent round to the house because she was supposedly threatening to jump from a window and there were signs of a disturbance all around the bedroom.  The woman herself wasn’t seriously physically harmed although she had a few scratches to one of her wrists, an obvious sign of attempted self harm.

She was laying face down on the bed sobbing uncontrollably, her husband told us that he had ‘done something wrong’ and that she had gotten upset over it.

She was obviously in no fit state to remain at home but it took a long twenty minutes to persuade her to make a move down to the ambulance where we could have a private chat with her.

Her story was simple, yet one I haven’t come across before.

Her marriage had been ‘arranged’, she had met the man who was to be her husband just four months before they married.  The pair of them lived in a house with her husbands mother and sister.  The husband was apparently seeing other women on the side and his mother had told our patient that this was ‘normal’ in England.  Our patient told me, between sobs, that her mother in law and sister in law both bullied her.

Her only family was out in India, and today, when she had told her father about her troubles he had started crying.  This is what had sent her into such a distressed state.  She was distressed because she had made her family unhappy.

My only choice was to offer her a trip to hospital so that they could clean and dress her minor wounds.  The police officer however could offer more, she took my patient’s mobile phone number and promised that she would pass that number on to the groups that deal with situations like this.  All I could do was get her out of the house for a couple of hours so that she could collect herself and start thinking about what she could do next.  As I often feel in such cases I wished that there was more I could do for her.

I would imagine that due to the ethnic make-up of East London there are quite a few arranged marriages, I’m always suspicious about the marriages where a forty year old man is married to a twenty six year old female.  While I’m not completely against the idea of arranged marriages, there does need to be specialist support for those people who are quite obviously powerless in the relationship.

Arranged marriages should not be about power over a woman being given to a man.

I’m hoping that the woman that we left in the A&E department will be able to get the support she needs, and I hope that the short period of time I knew her will be a turning point for her.