No proper blog post today. I am ill with a stinking cold, and by extension was sicker than *all* the patients I went to last night (unless you count the hideously drunk and vomiting eighteen year old as 'sick' and not 'wimp who can't hold his drink...)

I now sleep and drink tea and gently recover my strength.

Patient number one.

He's 34 years old and lives (like an increasing number of my 'client group') in a hostel. We have been called because he has 'Chest Pain'. Chest pain calls are pretty much all 'Cat A' calls and therefore whizz round there on blue lights to jump through the government mandated eight minute hoop.

He has chest pain and is feeling a bit dizzy. The most likely reason behind this is the four lines of cocaine and five ecstasy tablets that he took a few hours ago. His hugely dilated pupils stare up at me as he tells me how worried about the pain he is. To try and stop the pain he has also self-medicated with some illegally gained sleeping tablets.

This isn't the first time this month he has been in the back of the ambulance for chest pains - last time the pain came on after smoking some cannabis. He asks me not to tell the hostel owners about his drug use as if they find out they will throw him out on the street. It's a Christian faith-based hostel and it strikes me as a particularly unchristian thing to do. But what do I know, I'm just the Hell-bound atheist that looks after him an takes him to hospital. I agree that I won't tell the hostel staff about it, it's never been my job to be an informant if no-one else is getting hurt.

In the back of the ambulance I do an ECG - cocaine is well known for causing heart attacks. Thankfully it's all normal. We then talk as we travel into hospital. He tells me of all the things that he has lost due to his drug use - his girlfriend, his family, his friends. He tells me about losing the middle part of his nose due to all the drugs he'd been stuffing up there. He starts crying.

A month ago he had been 'clean' for six months - then for reasons he can't, or won't, tell me he started using again.

What can I do? I tell him that he is foolish to start using again, and that drugs, while nice in the short term, never solve any problems - they only create them. I tell him that he should talk to the nurses so that they can refer him on to someone who can hopefully stop him backsliding.

What else can I do?

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Patient number two.

He's in his late seventies and as fit as a butcher's dog. He'd been to the GP for the first time in years and had been diagnosed with a simple heart arrhythmia (AF for the medically minded). He'd been referred to the hospital for further assessment and treatment. This would be in a few weeks.

Then he got some chest pain and, like many men, ignored it for a while. Then it got a bit worse so he called for a cab and made his own way up to the hospital. I saw him when he walked in and told the receptionists that he had chest pain.

Twenty minutes later I was transporting him to another hospital for a primary angioplasty in order to treat the heart attack he was having.

If he'd called an ambulance we would have diagnosed the heart attack and transported him straight to the specialist centre, cutting out the middle-man of the local hospital. It hadn't crossed his mind to dial 999 and ask for an ambulance.

I gently told him off. I also told him that, seeing as he'd spent his whole life working to pay his national insurance contributions, it would be a good idea to call an ambulance if he had chest pain again and that it would be our pleasure to pick him up.

He'll make a good recovery - but I wish he'd called us first rather than getting a cab. We spend so much time going to people who don't need an ambulance it drives us mad to see 'genuine' patients muddling through without our help.

Two jobs in the same night, both with the same job description. Both very different.

I've just finished the fifth 12 hour shift of seven and am both tired and angry. It's been a slow build with very few 'worthy' jobs, the normal roster of drunk and people who can't be bothered to see a GP.

But I have a story of pure stupidity to entertain you.

A man brings his little child into A&E because she has suffered a very minor injury, not treatment required to be honest. While in the department he starts to feel unwell.

So he goes home.

And dials 999 and calls for an ambulance.

...Which he obviously gets, and is returned to the exact same department that he recently left.

I wonder how he can breathe and walk at the same time.

We do sometimes get people who turn up at the A&E department, decide that they don't want to wait, so go home and call an ambulance thinking that it will get them seen quicker. This is the first time that I've heard this particular variation on a theme.

My last job of the shift was for a drunk 16 year old girl who had called an ambulance because "She has drunk too much".

So we whizz round to the hostel and find her just having vomited on her carpet. We start off being nice but she is obviously playing us around so I decide to be honest with her.

"Why did you call an ambulance?", I ask.

"Because I don't feel well", she replies.

"Why do you think that is?"

"Why do you think!", she pretty much shouts at me.

"Is it because you drank too much alcohol?", I remain polite throughout this questioning.

"Yes".

"Don't you think that ambulances have better things to do than pick up drunks?", I venture.

"No"

"I mean, I should be going to dying babies and people having heart attacks shouldn't I?"

"No"

"No? Is that because you consider yourself the centre of the Universe and therefore much more important than other people?"

"Yes"

"More important than babies choking to death?"

"Yes - stop being rude!"

"I'm not being rude, I'm just asking some questions"

"Be quiet"

"Ok, please be comfortable on our trolley bed, but do try to stop spitting on the floor of the ambulance, I find it most disgusting".

And then we took her to hospital where she will no doubt sleep it off on a comfortable hospital trolley before returning home and getting someone else to clean up the vomit burns to the carpet. But of course I was the one who had to mop out the ambulance where she had been spitting.

I do wonder why I do this job sometimes.

This little story has popped up on my radar.

First the crime.

(Trainee Paramedic) Stephen Mason was attacked in August last year. He was unconscious for 12 hours and off work for four months.

Now the people who admitted the attack.

Soldier Jake Roe, 21, and doctor Nik Mann, 27

And the punishment?

200 Hours community service and a £3,000 (or £300, reports differ) compensation.

The reason the judge gave for why they didn't receive prison time?

"If they receive prison sentences they will lose their jobs which serve the country and the community," he said.

GAH! And possibly a false assumption.

Primarily the judge is sending the message that you can nearly beat someone to death, and as long as you have a 'worthy' job you can receive a much lighter sentence. This isn't as bad as the judge that told the paramedic who was beaten by his patient that it was 'part of the job and he should expect it', or the mental health trust that had a job description including "Exposure to verbal and physical aggression from patients and their relatives and or carers."

So a trainee paramedic gets the crap kicked out of him, but because the guilty parties have the right jobs they pretty much get away with four hours a week for a year of voluntary work.

My brother the teacher is taking this story into his school today, so that he can explain to the children that if they get good exam results and a decent job then they can get away with a lot more than if they are unemployed. Also that they shouldn't work for the ambulance service, because then your bruises (and coma) mean less.

I wonder if I would get a similar sentence were I to come across these people and put them in a coma? Or would I get a heavy sentence because these jobs are more 'worthy' than mine?

There is nothing quite like a story like this to make you realise exactly how valued you are.

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I'm going to be kicking a lot of 'friends' on Facebook in the next few hours - After looking at it I think that it will be much more use if I restrict that particular network to people that I know rather than including people who read my blog. I'll still be accepting anyone on Livejournal and Myspace. Sorry - it's not that I hate you, just that I think that Facebook works better if I keep the numbers small.

Comments have been disabled from this post so that no-one can influence any further action from legal or professional bodies. I am so proud of people that it didn't turn into a classic internet flame-war.

I like Dr. Crippen, I think that he writes well and with passion about the NHS. He also hates Patricia Hewitt. So he isn't all bad.

But there are two things that do annoy me somewhat about him. I thought it was only one, but I have since discovered a new annoyance.

The new annoyance would be an ad hominem attack on another blogger criticising their spelling and grammar. Disagree with the persons views, but to moan about grammar in a blogpost is the province of the forum troll, not that of reasoned debate.

And to quote,

Please feel free to criticise me in any way you like. I have but one request. Your spelling, your use of commas and apostrophes and your general grammar are embarrassing. All doctors have passed “O” level or GCSE English. Could I suggest you get one of them to glance at your copy before you publish?

Two small points - do all doctors pass "O" Level or GCSE English? Even our foreign doctors, including the ones who do not speak enough English to call for an ambulance or have not been properly tested? Secondly, there is a reason why the handwriting of doctors is traditionally seen as poor, and that is because it often is. I write my notes in the back of a moving vehicle and I would be hard-pressed to obfuscate the meaning as easily as your average doctor can.

But the one thing that I have the most problem with is the "I met a bad example of this profession, therefore all member of this profession are idiots". Take for example his recent post on grief that his partner got from an ambulance worker. When someone posts a comment that perhaps some GPs don't have much of a clue what they are doing he tells us that we shouldn't engage in 'playground insults'. Which I believe translates into "I can see more clearly than you, I am more intelligent, you are foolish and how dare you disagree with me". Or rather a shouted "Am not!"

He then goes on to call one of his commenters a fuckwit. Which obviously elevates the conversation above playground insults. He then says in reply to the 'fuckwit' commenter that he never used the phrase 'Ambulance driver'. For your entertainment I present a short excerpt,

Only yesterday we had trouble with an ambulance crew. My partner had assessed a patient, discussed him with the hospital physicians, arranged an admission and called an ambulance. The ambulance driver arrived, carried out his mickey mouse medical "assessment" and then told my partner, in front of the patient, that he did not see why an admission was necessary.

I may have accidentally bolded a word or two in that quote. I did resist putting <sic> by the uncapitalised 'Mickey Mouse'

There is a reason why ambulance crews do what they do, for most of us it is for an easy life. If we do as we are told to do then we won't get the sack, as we cost less to train than a doctor it is very much cheaper and easier for us to be sacked. A doctor has 8+ years of training to stand up in front of a coroner and explain why the patient's blood pressure wasn't measured - we ambulance crews don't.

The seeming belief that Dr. Crippen has is that the best nurse practitioner in the world is far worse than the most idiotic doctor. This is something that I do not agree with.

Take today for example, I went to a GP referral where the patient was sitting in the surgery waiting room. She was to see the psychiatrist at the local hospital. The doctor had written a letter explaining that the patient had a bottle of water with many pills dissolved in it. The patient had not only fainted in the consultation, but has also been allowed to keep the bottle. When I got her in the ambulance and took the bottle from her (handed to me when I asked for it) she told me that she had drunk half of it before entering the surgery.

The GP had taken no vital signs, had left the bottle in the patients possession and had written a referral letter that neglected to mention the faint.

If the doctor had told me that taking her observations was a waste of time and that I shouldn't bother, or that my 'Mickey Mouse' assessment of asking the patient if she had drunk from her overdose bottle would be a waste of time. If the patient died in the hospital from the unknown overdose, then you can imagine that the coroner would have some severe words for me and the LAS would probably sack me for negligence.

Finally on this post,

Ambulance crews are valuable, and have an important role at the scene of road traffic accidents but, in the domestic environment, when the problems are medical rather than truamatological, they often apply inappropriate protocols to problems they do not understand.

Which would be why GPs in my area refuse to see patients and instead tell them to 'just call for an ambulance', and this for obviously non-emergency reasons. It would also be why I have seen GPs doing CPR on patients who are feigning a fit. Why I have seen GPs taking brittle ninety year old asthmatics off oxygen because they need the examining room to see the child with a nappy rash. It's also why I've seen GPs sending people with a pulse rate of 220 walking home to wait for the ambulance and also sitting heart attack patients on the brick wall outside their surgery.

And another example from today - GPs who are unable to refer a patient to hospital in the correct manner (writing a little letter and phoning the hospital) rather than just dialling 999 and running out the house. I like Drs letters, they tell me what is wrong with the patient as I assume that they know a lot more about medicine than I do.

Uh-oh, I think I just descended into that 'playground insult' game...

There are idiots at all levels of the NHS and while the fight against the dumbing down of the NHS is an admirable one, we should perhaps stop making such sweeping generalisations.

We should concentrate more on white elephants similar to the one that he mentions in this post. And that is why I keep reading his site, because when he isn't being a arrogant twit he is being absolutely right.

A lot of simple and ultimately uninteresting jobs last night, but two slightly funny things.

The first was our first call of the day - a man who had fainted in a betting shop. When we arrived we were told by the other patrons of the shop that the patient had already left. They shoved us to the door and pointed in the general direction of the busy street.

"There he is!", they shouted at us, waggling their hands in a general direction of 'outside of the shop'.

"Who?", I asked. "There are loads of people out there."

"Him - the one with the head".

I was a bit surprised by this description.

"They all have heads you silly sods!"

(We didn't find him in the end, he can't have been that ill to outrun an ambulance.)

The second started off as one of our usual types of calls, a four year old boy who had been vomiting. His mother was concerned and so we agreed to take him to hospital. As there was no other adult in the house the mother had to take the boy's sister with her.

Our patient was fine, fairly happy and no further signs of vomiting.

The sister however waited until we were within sight of the hospital before puking all over the floor of our ambulance. It seems that we are making people sick (literally) in the back of our ambulance.

I correctly identified the child's dinner as chicken and sweetcorn. Then I had to mop it up.

It's a glamorous job I have.

Ah, the joy of Windows computers. My desktop system has gone 'kerblam' and I find myself having to do a complete reinstall of the whole **expletive deleted** system. Which isn't as easy as you would think. Whatever happened to systems being sold with driver disks? It's not like I like to do anything 'fun' with my time off. Why, I haven't looked at my email or twitter alerts for at least two days.

But it's not all bad, I had a shift where everyone was really rather nice.

An elderly woman whose GP had called and decided that she needed hospital treatment. The family were lovely and completely understood why we were a couple of hours late for taking their mum into hospital. They were even nice enough to offer to carry our bags of medical equipment for us while we carried the patient downstairs.

Then there was the mother of a small child which had suffered a febrile fit. The mother was somewhat panicked but our showing up soon calmed her down, especially after we explained what had happened to her child. At the hospital she looked me in the eyes and thanked me, something that is unusual enough that it sticks in my memory.

Then there was the elderly man who was suffering severe back pain, especially when he tried to move. We arrived and the paramedic I was working with gave him some intravenous morphine to try and ease the pain a bit before we tried moving him. While she was doing this I was outside giving the patient's wife a hug as she was crying thinking that she was going to lose her husband. Thankfully the cause of the pain wasn't too serious and the man should make a full recovery.

Our other patients were similarly nice.

No lives saved that day, but everyone got the care they needed and thanked us at the end of it - so one of those days to mark up in the 'win' column.