Lets call her Gladys. I meet a lot of people called Gladys in my work. Gladys is in her eighties.

Gladys had taken a tumble but not your average tumble, she had fallen down the escalators at one of our tube stations.

Not just a few steps. She'd fallen down at least 30 of the hard metal stairs.

Two members of staff met us at the now familiar 'Rendezvous Point'. You can spot them outside the stations, they are the little plaques with 'RVP' written on it.

I arrived to see Gladys sitting on the now stationary escalator surrounded by Underground staff. I'd come fully expecting to see someone covered in blood who would need to be 'collared and boarded' out.

Instead she was sitting up, apparently not in pain and in good spirits.

Now, I'm a bit of a 'nervous Nelly' when it comes to people injuring themselves in such a manner - I have a strong desire to take them to hospital to be looked over by a doctor.

Unfortunately Gladys was refusing.

I checked her out. She had a lovely lump on the back of her head, and that was about it. I checked her neck and she told me that there was no pain. I wanted to make sure that she hadn't collapsed or fainted, she told me that it was her luggage that made her fall backwards. I let her know that I wanted to take her to hospital, she refused.

I did manage to persuade her to come to the ambulance for a blood pressure check, and there I was able to confirm that, apart from the bump on her head, she seemed unhurt.

A little trick for my fellow ambulance personnel. After an accident people will often feel fine and this is the effects of adrenaline pumping around the body. Then, as the adrenaline leaves the bloodstream, the person becomes a lot more 'shaky', and may feel sick. It's best to wait until this 'shaky' time is over before you leave them. Sometimes the effects of this will let you persuade the patient to come to hospital.

Gladys didn't get shaky.

I sat chatting to her for twenty minutes, and she was fine throughout. She was adamant that she be allowed to continue on her train journey home. If she'd lived in London I would have taken her home myself. Unfortunately I think that Control would have a dim view of me wandering across into Kent.

And this is where I was impressed by the staff at the Underground station - not only had they looked after her really well while they called for the ambulance, but they then arranged to have her met by staff at the other end of her tube journey. The staff would also talk to the tube driver so that he could keep an eye on her. Then one of the Underground staff stayed with her on the platform until she got on the train.

Top service.

I wasn't hugely happy about her heading off on her own, but she seemed a sensible soul and she wouldn't be on her own sitting in a busy tube train. She also promised to call an ambulance if she felt unwell at any point, and as she lives in a warden controlled flat she wouldn't be alone there either.

All that was left to do was the paperwork (meticulously written to cover my back should anything happen to Gladys), then get ready for the next job.

Over the weekend both my brother and I will be at the Birmingham Comic Convention. Where I may be pimping a script idea for a comic about ambulances. If you are around feel free to say hello.

Premiership footballers who agreed to donate a day's wages to a nurses' hardship fund have coughed up less than a third of the money, organisers say

Well, wouldn't want those poor footballers to be short of money - Christmas is coming up isn't it...

There is nothing I like better than coming back from an exhausting shift to find that someone has personally dropped spam comments all over my blog. They aren't even good spam messages as the person placing them appears to have forgotten to link to the 'Online pharmacy drugs' that they are supposed to be promoting.

What they don't realise is that every comment made gets emailed back to me, so I get notice of those spam comments even if you try burying them in posts I made three years ago.

There are fewer pleasures in this job than being able to sit down and relax a bit. It's not often that we get the chance while we are with a patient.

We had been working all day and after a pretty long dry spell the heavens had opened up and it had absolutely poured down with rain.

"We'll have an RTA next", stated my crewmate as the rain stopped.

Our ambulance terminal buzzed and the job appeared on the screen - 'Three car RTA, man unconscious, multiple injuries'.

The location was one of our local 'A' roads, it's easy to hit 50, 60 or 70mph on these stretches of road, and it was obvious that the recent rain would make the roads more slippery.

So we drove off, lights and sirens going, not knowing what we would expect.

It was indeed a three vehicle accident, two cars and a van. The ambulance service were the first on the scene, an FRU was already there and looked fairly relaxed, we were the first 'proper' ambulance' on scene. Luckily it would seem that we wouldn't have a repeat of the triple death we'd gone to a few days earlier. The FRU told us that there was one patient in the middle car and one in the lead car. Neither of them seemed seriously injured, definitely there was no-one unconscious. We left the FRU to arrange with the police to close off the road (so we could work without getting run over by an inattentive rubbernecker), also to call off the helicopter ambulance as it wouldn't be needed.

While my crewmate checked the lead car I went to the car in the middle, it had been struck from behind by the van and shunted into the car in front. So both the front and the back of the car was pretty mashed up.

My patient seemed not badly injured, he hadn't lost consciousness, nor did anything seem to be broken. He only complained of some pain in his neck and back. I had a quick feel down his neck and couldn't rule out a serious neck injury. He needed a hard neck collar and spinal immobilisation. Putting the collar on was the easiest bit, but you can't just leave someone waggling their head with just a collar on - they don't work like that.

So I pulled open the back door for the car (with a bit of effort as it was jammed due to the damage), sat myself in the back seat, carefully avoiding the broken glass, and grabbed his head in my hands.

"It's alright mate", I said, "All we are going to do is keep your neck nice and still so that it protects your spine. Then we'll open the car up around you".

We called for the Fire Service while I chatted to the driver, he was a nice bloke - but the car was his wife's. I explained that 'Trumpton' would cut the roof off the car so that we could get him out safely. Meanwhile he joked about how his wife always wanted a convertible.

The Fire Service arrived and did the things that they do; chocking the wheels so that it doesn't move, spraying shaving foam on the windscreen where they cut in order to protect against glass fibres, and placing protection around the patient and myself. Meanwhile I was having a relaxing time of it, explaining what was happening to the patient while holding his head still. The great thing was that I was able to do all this while sitting on my backside.

I don't know if you've ever been cut out of a car, but it gets a bit noisy, even if you are wearing one of the wonderful LAS safety helmets which block both your ears and, because the visor is so scratched, your vision. My job was simply to keep the patient happy and minimise any head movement.

Snip, snip, snip, snip went the pillars of the car and, by sliding a back board behind him, we soon had the patient out nice and smooth. The patient was happy (well, happyish), the Fire Service were happy (they like cutting cars into small pieces), and I was happy (because I had got the chat to sit down and natter for half an hour).

A smooth ride to the hospital and I believe that the patient was released an hour or two later with no serious injuries.

The only problem was that the traffic, which we had stopped, was still tailing back when it came for us to go home. So I had the pleasure of sitting in the traffic jam that I had 'created'.

I've just come back home from Cheltenham. It was great fun, and I'll have a quick run down of some of the best points.

• The hotel I was put up in was so posh a tiny bag of KP nuts cost £1.75. This is not a complaint.
• I can find a Wetherspoons pub anywhere. It's a skill.
• One of the staff in the 'Writer's room' wrote her dissertation on my publisher The Friday Project, including my book in it.
• Another volunteer who looked after the panel did some work experience for The Friday Project.
• Both of the above are obviously intelligence people of taste and distinction. Also pretty.
• All the guests on the panel were lovely, as was the host.
• Jed Mercurio, as well as being lovely, has given me a lot to think about.
• Feedback from the audience was apparently good - I'm glad that they enjoyed it.
• I did my first ever signing - it was *superb*.
• I still feel like some sort of a fraud. I think that I need to get over myself.
• I managed to get my favourite book of all time signed by the author ('Microserfs' by Douglas Coupland) and I managed to blabber like a fame struck idiot at the same time.

This is the first time that I've done anything public around 'literature' as opposed to internet/blogging. If they are all as interesting, well thought out, and perfectly organised as this one I'd like to do some more.

I'd also like to thank all the people involved for inviting me - it was great.

Now - back to work at 6:30am tomorrow, and back to writing about ambulance things.

As part of my talk with the panel at the Cheltenham Literature Festival I mention that there are a fair number of UK based medical blogs. I'm linking to some of them below (in no particular order, just the order I clicked on them in my RSS Reader).

This is set to post just as the panel starts and will be the 'datashadow'. Here's hoping anyway...

The social worker blog is a bit too 'corporate' to be what I'd consider a 'proper' blog (whatever that means), but there seems to be an absence of personal social worker blogs. I also can't find a UK based radiographer blog.

Suggestions of additions to this list gratefully received.

A&E Nurse blog.

Ambulance controller.

Mental Health Nurse blog.

Patient blog.

Medical Student blog.

Hospital doctor blog.

Midwife Blog.

GP blog.

Physiotherapist Blog.

Pharmacy Blog.

The collection of Social Worker blogs (Not really what I'd call blogs, but there you go...).

Now, I'm not a football fan in the slightest. Part of the reason is because of this episode.

Now, if I were one of the pitch medics having seen the goalkeeper overact in such a fashion I'd have wandered over to him, kicked his boot and told him to stop being such a daft sod.

Just like I would if it happened on the streets of Newham.

(I seem to remember it being a 'rule' that anyone injured on the pitch is stretched off - but I'll be damned if I'm putting my back at risk by stretchering off someone with absolutely nothing wrong with them).

It's got nothing to do with him probably earning more in a week than I do in a year.

I think that it's Ambulance Law #17 that states, 'In a fight with a 90 year old patient, the ambulance crew will always come off worse'.

Our call was to a ninety year old woman described as, "Not getting out of bed, not eating, not washing. Suffers from dementia".

Now, this might not actually require an emergency ambulance but I'm getting soft in my old age and am more forgiving of certain types of 'non-emergency' calls.

It was the patient's daughter-in-law who had called us, normally her husband looked after his mother (our patient), but he'd had to go into work that day and had delegated the task to his wife.

The first thing that I noticed was that the daughter-in-law looked to be at the end of her tether, the patient was soaking in her own urine and was resisting all attempts to change her clothes. The daughter-in-law told us that the patient's dementia had become worse over the past few days. My highly trained nostrils suggested that the reason behind this sudden deterioration may well have been caused by a urinary infection.

Urinary infections can cause all sorts of symptoms and, especially in the elderly, can cause people to become confused. With the already demented patient it can increase their confusion.

As our patient was quite happy to sit in urine drenched clothes I wasn't hopeful that she would happily toddle off to the ambulance to go to hospital.

I wasn't wrong.

She refused *everything*, we tried persuasion, we tried reason, we tried bribery. None of it would work.

The daughter-in-law suggested that we leave and 'go help someone more deserving'. I let her know that this patient, and her, were our concern right now. I promised that we would get something 'sorted'.

I wanted to take the old woman to hospital for two reasons. The first, and most obvious was that if our patient did have a urine infection, and it was left untreated, then there were serious concerns for her health.

Secondly and thinking more long-term, I wanted her to go to hospital because then the hospital would help her. The patient's family were unable to care properly for her, so they were looking for a care home place for her. The social services had promised an assessment, but that it would take over a month to arrange. Then there would be the waiting while a suitable place was found, etc, etc...

It would take a long time.

By taking the patient to hospital, and hoping that they would admit her, we would be forcing the social services to deal with the patient a lot quicker than they otherwise would.

I imagine that the social services do their own prioritising. As this patient was 'safe' in her own home and is being looked after by her family she is a low priority. If she is 'bed blocking' in hospital then they will arrange the care she needs more urgently, probably because of some governmental target.

And why was I 'cheating' the system this way? It was because I could see the eyes of the daughter-in-law as she told me the strain that it was placing on her and her husband. It was because I could hear the tone of her voice as she explained the trouble they had in caring for the patient. And it was because I could see the bruises on the wrists of the patient where she had been restrained from attacking the people caring for her.

So taking her to hospital was the only real option. But how? We had already spent an hour trying to talk her into coming to hospital.

We'd have to kidnap her.

It is legal for us to forcibly remove someone to hospital if they are deemed 'not competent' to refuse and if they have a serious illness. As I mentioned earlier, a urine infection can become very serious in the elderly. In addition she was refusing to eat. This, in my view, means that her well-being was in danger. Her dementia was so far advanced that I considered her unable to understand the consequences of remaining at home.

So legally and ethically we were on safe ground.

I don't like forcibly removing people, it's a lot of aggravation and there is always the fear that someone will get hurt. Sometimes we will get the police to attend in order to help us remove the patient. In this case I didn't think that police would be able to do anything different to what we would do.

But...

Any confrontation would be rather one sided. Us, as an ambulance crew, are trying our best not to hurt the patient - it'd look bad if we broke her arm. Our patient on the other hand is more than happy to punch, bite, spit, claw and go for my testicles.

Which she did even though we had wrapped her in our blanket. Never underestimate the strength of a demented patient.

She managed to draw some blood from me (an inconsequential scratch on my arm), but at least we managed to safely get her downstairs into the ambulance. When she got in the vehicle she calmed down a little and she didn't seem hugely upset to be in the hospital.

The daughter-in-law couldn't thank us enough.

I knew that the patient would get medical care, I'm just hoping that she also got the social care that was desperately needed.

I've been a bit slack posting of late due to that nasty old 'black dog' that comes around in these shorter months. With a bit of luck I'll shake it off soon.

I am still alive, although I've been very busy for these past two days.

Mostly sleeping.

I just thought that I'd mention that this coming Saturday and Sunday I'll be in Cheltenham for the Times Literature Festival.

Saturday will be spent mainly wandering around checking out some of the talks.

Then on Sunday I become one of the guests. For an hour I'll be on a panel with Jed Mercurio (who is a writer I greatly admire) and Dr. Thomas Stuttaford (who writes for The Times).

There are details online.

I'm listed as a 'performance'. This amuses me. It also amuses me that I'm considered Literature.

If you want to see me there is a payment involved and I'm getting paid for my appearance.

This amuses me no end.

I'll also be around for book signings and 'photocalls', it's part of the work contract I signed.

I doubt I'll be much bothered by constant calls for my picture to be taken.