It's a weird game this ambulance lark, especially when you are looking to write about it. Even more so when a day without a blogpost seems to leave a hole in your heart as you feel that you are skiving off.

What makes it a weird game is that I start to run out of material, I then find myself wishing that someone will have a nice interesting injury or illness - that I'll have to go to them, and that this will be a blogpost that shines.

It's not just the writing mind you - we all get like it, we joined this job partly because it can be a bit exciting and anyone who tells you otherwise is a liar. We didn't join up to have 'walk on, walk off' patients all the time. We joined up because occasionally, just occasionally, we like to have a proper injury - a car crash, a fall from height, a stabbing or shooting.

Watch the ambulance crew after a 'decent job', they'll be standing outside the ambulance bay at the hospital chatting to their colleagues. They'll be animated, they'll be interested in their job but most of all they will have a sense of satisfaction of a job well done.

We know it's not like the TV (and it's no wonder the characters on those programmes have so many relationship problems, if we went to the sort of jobs they do on a daily basis we'd all be alcoholic depressives as well). We understand full well that most of our job, 80% at the last count, don't need an ambulance or hospital treatment. We know that we won't be dealing with serious calls all the time. We are pretty happy for that, our 'burn out' rate is pretty low.

But.

But.

In four weeks I have had no interesting jobs, no jobs where I had to think about the safety or condition of my patient. A month where everything that I have done has been by rote. I get to the patient - if they can't walk or they have chest pain then we wheel them to the ambulance otherwise it's Shanks' pony. I do a set of observations, they invariably turn up all normal. Occasionally I'll need to 'blue' someone into hospital because they are having an angina attack. We drop them off at the hospital and get ready to repeat.

For a whole month I haven't had a 'decent' job. Just once in a while I'd like to think out a problem, stop some serious bleeding or give a treatment to someone. I've not even had someone having a heart attack.

It's tiring sometimes, the grind of going to people who aren't really ill all day, every day.

I have dark and horrible thoughts sometimes. If it rains after a period of heat I know that the roads are going to be slippery - perhaps there will be a car crash? It's a Friday night - maybe someone will get stabbed? The security level is critical - maybe someone will do something more scary than burn a jeep?

It worries me that I think like this, it worries me that I'm happy when people injure themselves. I know I'm not alone, I know that the other services also like a good 'shout', but it still seems wrong to want people hurt so I can test myself, so I can have an 'interesting' day.

I think that the danger we face is to stop looking at people as 'people', we look at them as the 'man flu', the 'belly ache' the 'splinter in his finger'. We see them as 'jobs'. When you start to dehumanise people like that it's only a short step to wanting some of them seriously hurt for your own entertainment.

Maybe it's just a funk that I'm in; I don't want people hurt, but I do want something interesting at work that will stretch my skills. And will give me something interesting to write about.

But that way lies psychopathy.

I am not mad.

Just bored.

Right now I'm thinking about an idea for a TV series - an ambulance worker who sets up increasingly bizarre 'accidents' in order to sate his desire to actually use the skills that he has.

It was a beautiful clear night and the full moon shone down on her, colouring her dark hair a shade of silver. She would often walk alone at night, the dark and the quiet calmed her, kept her mind from becoming too busy, too full of the things that worried her.

She slipped through the park, it was nearly midnight and the drunks had gone home. She had the park to herself.

Sure, people would be worried when they discovered her gone, her mother would panic and call the police.

But it didn't matter - this night was for her.

She slipped into the cold waters of the lake, the moonlight had turned it into a mirror and her entry cast ripples from shore to shore. She wasn't bothered by the stones on the bottom of the lake as she continued to wade out. She had kept her shoes on.

Finding the depth she started to swim - strong powerful strokes. Her muscles, initially frozen by the waters of the lake, began to warm. She was alone in the dark, water below her, the moon above.

...OR...

She had escaped from the house, her mother had locked the door but she had watched her as she hid the key. Tonight her search for death would be fulfilled.

She ran to the lake, it was peaceful here - no-one would interrupt her, no-one could stop her as she ended her pain.

She ran into the water - if she swam out to the middle she could simply let go and drift down to the bottom where she could let her lifeless body lie.

...OR...

She was a princess. All princesses need a challenge, they need a knight in shining armour to save them. If she swam out to the island in the middle of the lake someone would come and save her.

She needed saving.

...OR...

She didn't know why - She just wanted a swim.

It was after midnight and we'd been called to a woman who was swimming in the lake, the parks police in one of their final rounds of the night had spotted her. They'd pulled her out and wrapped her in a blanket. She wasn't saying much but they managed to find her mother who let them know that she had 'mental health problems'.

I asked the mother about her daughter's mental health problem, she couldn't tell me what the doctors had diagnosed. The patient just sat there, dripping wet. I asked her why she had been swimming in the lake at night.

She never answered me.

I'll never know.

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.

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.

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?

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.