After a long stretch of work (including the sheer and bloody horror that is getting in to work at 6am), I finally have a few days off. I have a feeling of utter joy at the huge stack of laundry that stares at me whenever I enter my bedroom. Maybe if you all buy my second book¹

I also find myself laughing at the ineptitude of the terrorists of today. Burning a car is a local pastime for the children around my area, and they aren't daft enough to set themselves on fire. As for the London car bombs - I could make a better bomb. It seems that if they are really al-Qeada, then that bunch of stone-age wannabes are really scraping the bottom of the barrel.²

I'm not scared of terrorism, no-one I work with is scared of terrorism³. We recognise that the chance of dying in a terrorist attack is much, much smaller than the numerous other causes of death and injury that we face everyday.⁴ What makes us more nervous is considering what the British government might do in response to these pitiful attacks.

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The other thing that has been in the news is another cluster of stabbings in London. It was only a few nights ago that I found someone in what I like to call a 'pre-stabbed' state.

Seventeen years old, he'd come home from 'hanging around' in another part of town. While standing around on a street corner some men in a car had pulled up, grabbed him and beaten him up. No reason for this attack was given. He had a few minor injuries - a head wound that could be glued together, some grazing to his arms that could do with a clean up and a nose that was swollen.

The police arrived at the house moments after we got there, as he wasn't seriously injured I told the police that they could get their interview done before we took the boy to hospital.

Of course, it wouldn't be as simple as that - he started off by claiming that he didn't know where he had been 'hanging out'. He also didn't know who he had been with, what type of car the assailants had been driving, what they had looked like or even his friend's home address or phone number. He wasn't going to tell the police anything.

All of this was given in a terrible Jafaken accent (the accent du jour around these parts, always hilarious to us emergency workers).

My local knowledge let us know where the assault took place, it's just down the road from where I live, and I know the 'kids' do so love to stand on that particular corner eating their chips and play chicken with the traffic.

But that was all he would say, the police understandably decided not to waste any more time with him. So our patient and his mum walked onto the back of the ambulance and we headed off to hospital. While in the back his mum told me how he was always getting beaten up, that she had tried to stop him going out and meeting up with the wrong sort of people. She'd enrolled him in college and recognised that he was walking a thin line. He'd already been convicted of a minor crime and she was obviously concerned that he may end up in more serious trouble.

So I gave him my lecture about the people who we pick up having been stabbed - how they are mostly people like him. That they hang around in gangs, that they indulge in minor crime and that they tend not to listen to their mums. I told him how you lose all your macho attitude when you have half a dozen stab-wounds in you. It's an attempt, no matter how pointless, to try and scare them into turning their backs on that kind of life.

¹ Yes, there should be a sequel; this blogpost also took an hour longer to write than it should because I was trying to find a way to write superscript elements in Ecto without having to handcode them in the HTML view. Then I realised that the Rich text view won't show it anyway. Now I'm having a nice cup of tea.

² I'm of the strong belief that we should mock terrorists, we shouldn't call people 'suicide bombers', instead they should be referred to as 'Brainwashed morons who blow themselves up because of superstitious fairy tales from the middle ages'. The pleasure of being an atheist...

³ Most of us can remember living under the IRA for a start. I long for the days of 'Special Black' rather than 'Critical'.

⁴ Look at my driving for instance...

Not too busy to say congratulations to the ambulance crew who spotted the smoking car bomb. Who knows how many lives they saved.

No, I'm not going to mention who they are.

It would have been nice if police and the media had given a bit more of a 'well done' to the LAS crew though.

We were met downstairs by a young man.

"I think she's passed away - but I couldn't bring myself to tell her mother. She's old. I thought I better call an ambulance".

We had been called to a forty year old woman - 'Drunk - ?Passed'.

I was met at the flat door by a woman in her seventies. She didn't seem distressed as she led us into the living room. Everywhere I looked there was evidence of her daughter's alcoholism. The flat was cramped and squalid. Her mother had been visiting her.

Her daughter was obviously dead, her skin was yellow and waxy, and she was in full rigor mortis. It was obvious that she had been dead for some time.

I had to tell the seemingly oblivious mother that her daughter had died.

I sat her down and explained that her daughter had passed away some hours ago and that there was nothing that we could do to help her.

I braced for tears, or a scream, or an "I thought so".

The mother didn't cry, she didn't scream, she just sat there and whispered a quiet, "oh".

The daughter had come out of her bedroom the night before and told her mother that she didn't feel too well and had laid on the sofa. Her mother had fallen asleep in the armchair. When the mother woke up she couldn't wake up her daughter.

She'd then sat with her for at least six hours before knocking on the neighbour's door to see if he could wake her up.

Talking to the mother it was obvious that she was suffering from early dementia. I'm not sure if she secretly knew that her daughter was dead, but wasn't letting herself accept it.

It was strange - no tears were shed, but several times we were treated to the mother's life story.

We had to stay around for a few hours with the police because there was a chance that the death may have been suspicious, although it was more likely to be natural causes.*

It was saddening to see the mother wandering around, her dead daughter laying on the sofa covered only with a sheet just a few feet away. Talking to her about the changes that the area has gone through, about her dead twin and about her other daughter.

Had she sat alone with the body for so long because she couldn't face up to the truth, or did she really not realise what had happened? Either was possible, and I'm not sure which one gives most comfort.

It's the sort of job that will stick with you for some time.

*There are legal and confidentiality reasons why I'm not mentioning the full details of this job.

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This evening I shall be at the London CC Salon having a chat with Becky Hogge of the Open Rights Group. I'll mainly be talking about the reasons why I chose to release my book under a Creative Commons license. It should be good fun and I'm looking forward to hearing some of the other people there.

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.