The St. John lot I've met so far are all really nice, although they do
seem to like nursing their drunks outside their ambulances.

Three jobs so far, two drunks (one who'd fell over) and a bellyache.

Normal Monday night then.

Sent from my mobile.

Why do people bring little kids in buggies to such events? Madness!

Sent from my mobile.

(I may forget what number I'm up to at some point of the night)

Currently having a cup of tea from the St John 'Teapot 2' parked under
Admiralty arch.

Did have to lug the kit by foot from St Thomas' to here, for some
reason all the roads are closed...

Heading for a 'mingle'.

Sent from my mobile.

We are fully kitted up. I'm working with another LAS EMT and one St.
John fellow. Just getting ready to roll out.

Sent from my mobile.

About to get free food at St Thomas' so not all bad then...

Sent from my mobile.

Just been allocated my area. Trafalger sq. I may be killed.

Sent from my mobile.

First part of our briefing is over. Still way more chiefs than
indians, oh well. We've been told that this is the biggest year ever
with 500,000 people expected over a larger area than before.

The briefing started with a Primal Scream tune playing over videos of
crowds. I'm pondering running away.

Seems well planned though, lots of lessons learnt from last year. We
also have a fallback communication system for if/when Airwave falls
over.

There are 13 treatment centres dotted across the area and I'm one of
12 Forward Incident Teams.

There are 17 SJA ambulances and 4 LAS ambulances. We may end up
waiting for one for a while.

Now I'm waiting for the FIT briefing, about what we are supposed to be
doing when we hit the ground...

Sent from my mobile.

Waiting for the briefing to start. I've never seen so many officers in
one place.

It makes me, who tries to avoid management whenever possible, a trifle
nervous.

Sent from my mobile.

While most of the world is out partying, I'll be running around central London on foot with two members of St John ambulance dealing with drunks sick people.

Three words.

Hogarth, Gin Lane.

I'll be live-blogging the night (if time permits) and, all going well, The Guardian should be publishing a piece by me tomorrow.

Wish me luck!

Christmas evening and she's sitting in the kitchen. Mascara running down her face, one eye swollen and puffy from where he has hit her.

Two police officers are trying to take a statement, but she isn't interested. She's not interested in talking to us either.

Several small children are running around our feet while another woman I take to be her sister is wiping down the kitchen counter.

I don't think that the children are hers, she seems too young.

He's been arrested and removed, she doesn't want to press charges.

It's that same old story.

I don't know what's going through her head, but it's not what would be going through mine if I'd been punched in the face.

She has no explanation, she sits there saying nothing, wanting nothing, doing nothing.

We leave, we are powerless to do anything.

To see what one person can do to the other, and for that other to let them get away with it grinds away at our souls.

It's like a bad cliché, like a Christmas in Walford or a night in Emmerdale.

We do our paperwork and go to our next call.

---

The last domestic violence case I went to was also a cliché, she told us she would be leaving him. Four hours later he was picking her up from the hospital full of hugs and apologies. Sometimes, just sometimes, I want to show these bullies what it's like to be a victim of violence.

Christmas, day of good will and peace to all men.

Which is obviously why the first call of the day is to a man hit over
the head with an axe during a traditional East-end pub fight.

Merry Christmas!

Sent from my mobile.

It was the milkman that missed her. The milkman who phoned the police and told then that he hadn't seen her for a few days.

The police were already there when we arrived. The house was secured, the battering ram was fetched and used on the wooden door. A panel popped out and we were able to enter.

She was lying face down on the floor, old and naked and unmoving. One look was all it took to realise that she was beyond our help.

So we stood over her body. The police and us, trying to make sense of her death. Was she an alcoholic? There were a few drinks bottles around the place, but not the 'usual suspects' of strong lager or cider. Was it violence? The only marks on her body were from where her blood had pooled. Was it suicide? There was no note, no empty pill packets. Ill health? We couldn't find any medicines.

It looked like she had just died, in earlier times it would have been called 'old age'. Now, probably 'cardiac arrest'. The result the same, the heart just runs out of beats.

Her front room was cluttered with her belongings, the doors at the top of the stairs were secured. The police entered them, there was nothing there except the hints of a long lost husband, a man's coat, the hospital appointment card in his name, the bedrooms covered with cobwebs.

Downstairs then, that was where she lived and slept. Ate and drank. And drew.

The walls were covered with her drawings, beautiful colourful pencil drawings of all subjects. She had an eye for the human face, she obviously liked to draw wildlife. Everywhere you looked there was a small colourful picture, out of place in this dark and crowded room.

An unfinished drawing rested on a table.

And at the bottom of each drawing her signature.

We joked with the police, especially the probationer. We chatted and did what we needed to do, the paperwork, the reports, contacting the coroner. We looked through her papers, to see if there was someone to contact, or some reason for her death. To the outsider our chat would seem disrespectful, but to us it's just life, another one gone soon to be forgotten as we move on to our next job.

Still she lay on the floor, we couldn't move her until the coroner came.

But my eyes weren't on her, her bare flesh, her outstretched hand.

They were on her drawings.

After two days of meeting good Social care managers and GPs, what else should I find today but a superb pair of Social workers.

Blimey! It's enough to have you regain your faith in human nature.

Quick nurse! I need an injection of cynicism.

Two consecutive days at work, both starting and finishing exactly the same.

Both days start with an early morning call to a 'maternataxi' which, while I moan, is a nice way to ease into the day. Especially at six-thirty in the morning.

Both days ended pretty much the same, but that's not the remarkable thing about it.

Both calls were to GP surgeries, both patients were men in their fifties and both were suffering from a chest pain that could have been cardiac in nature. Both had been feeling the pain for eleven hours.

Both men were also in high risk groups, one a slightly overweight Asian gent with diabetes, high blood pressure and high cholesterol. The other was also overweight and had previously had a heart attack and regularly suffered from angina.

But this coincidence of time and illness wasn't the surprising thing. I'll tell you about the GPs and regular readers will soon realise what is unusual.

The GP of the first patient still had the patient in his consulting room, he'd started treatment by giving the man an aspirin, which is really rather important. As we entered the room the GP apologised for not having an ECG. He had also phoned ahead to the hospital to prepare the medical team for the patient. I explained that we would do an ECG in the ambulance and if the patient was having a heart attack we would take him to the cath-lab for immediate angioplasty. The GP didn't know that we could do this and asked if he could see the patient's ECG once we'd done it.

When we showed him the normal ECG, the GP apologised for calling us out. I told him not to be silly, as he'd had a good suspicion of the patient having a heart attack and had started the appropriate treatment, and that this was remarkable.

The second patient was also lying in the GP's consulting room. In this case, not only had the GP given the patient an aspirin, but they had also done a ECG. Not only that, but there was a typed note with the patient's medical history on it, and were in the process of phoning the patient's wife to let her know what was happening.

Compare this to the usual GP situations I find myself in.

These separate GPs had made completely reasonable diagnoses and had started treatment. This, rather shamefully, shocked my crewmate and I. We are much more used to attending to 'heart attack' patients that are sitting out in the waiting room, haven't received any medical treatment and are clutching a roughly scribbled letter addressed to 'Dear Doctor'. That, and the GP will be hiding in their room.

Two days on the trot, two superb GPs. What with yesterdays post, I may well run out of things to moan about.

Well, I can have a slight moan, both GPs booked their patient into a hospital far away from our station, thus making us late off home - but you can't have everything. After all it was the closest hospital to the surgeries.

---

Can I mention, for no real reason, that Medgadget have opened the nominations for the best Medical blogs for this year. No reason at all... Nope. None.

It's sad I know, but in all my years working in healthcare I've never met a social services person who filled me with confidence. I'm sure that there are thousands out there, but it's just that they seem to hide under the table whenever I'm around.

So it was a real pleasure to meet a social care manager who actually gave a damn.

We were called to our patient, a woman in her 80's - let's call her Doris, by the social care manager.

The reason for us being there was to look at Doris' leg. One of them was described as 'black', and as we travelled up to the flat I wondered what I would see. I was grateful when it turned out to be lipodermatosclerosis, a condition where, due to problems in the veins of the leg, te leg turns dark and 'woody'. It's something I saw a lot of when I was gadding around with the district nurse service.

It's a chronic condition, and one that the Doris had been suffering from for some time. Unfortunately Doris is a little confused sometimes and so couldn't explain how long she had the condition.

Also in the flat with the social care manager was Doris' day helper - a carer who comes in three times a day to help wash, dress and do the little things around the house that need doing. I could tell that the social care manager wasn't too impressed with her, partly because of all the notes she was taking and partly because she told us so on the lift ride down.

The care manager had called us because (not being medically trained) she wasn't sure why Doris' leg was a funny colour. I also don't think that she particularly believed anything that the carer said about it.

The care manager also made a note of the heating of the flat, the rather shoddy windows, and tried to persuade Doris that she might enjoy visiting a day centre every so often. On the ride down in the lift, after Doris had told us that she didn't want to go to the hospital, the care manager explained how she hated that particular 'care' supplier, but that her hands were tied in that she could just select another one.

She also explained how she would need to 'be creative' in order to get Doris the care that she needed.

All in all I was impressed by the enthusiasm that she showed to her job - it was a real refreshing change and I left confident that Doris was in good hands.

It's getting to be that time of the year again, the time of Christmas parties (drunks), Work parties (drunks), grannies who hit the port a bit too much (drunks), people depressed and drinking alone (drunks) and the people who are stone cold sober and have to deal with them (us and the police).

November was the busiest month in the history of the London ambulance service. It doesn't help that there is a grotty chest infection going around at the moment that has made a lot of ambulance crews feel particularly unwell in addition to increasing the number of calls.

December seems to have continued in the same vein as November, we start the shift and seconds later hit the streets, rest-breaks aren't being given and a new computer system to aid dispatch is making us dizzy.

I'm obviously a glutton for punishment as not only am I working the nights of the 24th-28th of December*, but I'm also doing a bit of overtime on New Year's Eve night.

On foot.

In Trafalgar square.

With two St. John ambulance people to help me.

I also get a new title - 'Forward Incident Team', or FIT. I think I'll need to be as I need to carry all the kit that I need with me for twelve hours**.

But it's not all bad working over Christmas, I get to sleep through the Queens Speech and the Bond film. I might get to deal with the more humorous 'topical' injuries ("How did you get the bauble stuck up there!?"). If it goes the same way as every other year I've worked it there will also be some horrific tragedy, there normally is this time of the year, either someone dropping dead or killing themselves in front of the kids.

There is one particularly poor showing though - I work in a hugely Islamic area, but the rotten sods all close their kebab shops for Christmas, so I'll end up starving. It's not as if Muslims celebrate Christmas, do they?

There is one slight glimmer of hope - that of the patient or relative offering you a small item of food.

We aren't supposed to accept 'tips', but the odd chocolate or mincemeat pie isn't seen as a problem. And who's to know?

Of course you do need to do a rapid assessment of the situation. Accepting any food that comes from an opened packet needs you to look at the hands of the people who've been eating the other items of food. If they rub their hands against their brown-stained trousers, I wouldn't accept.

Likewise food from the crack-house you've just resuscitated someone in is probably not that clean.

Actually, food from resuscitations are a bit tricky all round, as you may feel you are being rewarded for 'polishing off' gran. Or they may just be offering you the portion that their dead relative was about to eat.

It is rather rare though, which is why a recent job surprised me. We were sent essentially as a transport service to pick up an elderly lady who needed some hospital treatment. We go there to find her daughter already present, it was obvious that this would be a job where the most we would really be doing would be having a chat with the pair of them.

So we were both pleasantly surprised when the daughter (who, again, isn't the sort of person to be celebrating Christmas) gave us a box of chocolates.

It was such a nice gesture that it put my crewmate and I into a brilliant mood for the rest of the shift.

So - like last year, please consider your local ambulance crews. If you are near a station why not send a card, or a box of chocolates as a thank you for us being there when you have the world's worst day. And we are there 24 hours a day, 7 days a week, 365 days a year.

Except me - I'm trying to lose weight.

*Not by choice, and my regular crewmate has been lucky enough to get them as annual leave.
**For which I can only say, "You've gotta be kidding" before offloading it off onto my St. John teammates.