It's not often that a patient drives his own ambulance to the hospital.*

For the past two weeks I've been having a little 'bumps' in my heart rhythm, once or twice a day I'd feel my heart skip a beat. Not a problem I thought it would resolve itself.

However last night I was getting run after run of these missed beats, this made me feel a little nervous and I thought that a quick assessment at the local hospital would rule out anything scary.

So we waited until we had we took a patient into the hospital (a woman who'd fainted and was refusing to talk or open her eyes) and I let the nurse in charge that I would be booking myself in.

A few moments later I was in the resus room being poked and prodded. A twelve lead ECG was done, which showed nothing unusual (as the missed beats are intermittent).

I've put in a countless number of cannulas into patients - for the first time ever I had one stuck into me.

I was hooked up to a heart machine that does printouts and when I felt the missing beats I'd shout to the resus nurse who would come running and hit the 'print' button.

This is what I got.

Unifocal bigeminy

Now, in the big scheme of things this isn't that worrying a rhythm. As my bloods came back all normal I was discharged and will have a 24 hour ECG recording which will be arranged by my GP.

I'm still getting them, but not half as many as I was.

The staff at the hospital were great, they looked after me really well. On more than one occasion I had one of the nurses come in to see how I was. They'd have a laugh and a joke with me, and I could hear my fellow patients in the resus room also having similar chats with the nursing staff.

(They'd also look at the tracing and mutter 'Oh shit!' under their breath. Which is nice of them).

I also had one of our station officers come down to see me, and he couldn't do enough to help me out. We shared gossip on the big fire in Plaistow, the smoke of which that was making the meridian laser beam look really pretty.

Also there were a fair few stabbings and shootings in the area which was making life 'interesting' for the local police.

The nice thing about it was that the station officer stood me down from working tonight (he also wanted to drive me home, something I refused, I was driving around on blue lights for most for the shift, a little run home in my own car wasn't going to be a problem.)

It is a bit weird to be a patient, especially when you don't know what is causing your illness. I normally self treat my own illnesses, but in this case I needed some help and the hospital and my workmates were all excellent. Just goes to show that the NHS can work well.**


*Big tip of the hat to my crewmate who pointed this out.
**Of course, if I suddenly drop dead then I may change my opinion...

And with this post, and this comment, I sob like a baby.

(I am loving the comments that have been made on my last few posts - many more and I'll have to start a forum...)

There comes a time in the life of every emergency worker when they start to suspect that they have become a psychopath. You find yourself losing empathy for your patients, they become yet another body moving through the conveyor belt of treatment and audit. They become speed-bumps on the much more important task of meeting the targets set by our governmental over-masters.

(See, ORCON, 4 Hour A&E Breach targets, Caesarian birth targets, Police detection rates and whatever the fireservice are measured on).

You find yourself going home and not worrying about your patients - this is where TV dramas have it wrong, we don't tend to have nervous breakdowns, we just slowly become unfeeling bastards.

And then you get a job that nearly moves you to tears. And you hang onto it, because it reminds you that you are still human.

Mine was a lovely elderly lady. She's 93 years old, lives alone in her spotless flat and has no health problems to speak of. She often pops down the shops for her food, and yesterday was going to have a look to see if she could find a coat for winter.

We were called to her because she'd 'fallen over'.

What had actually happened was that some scummy bastard had mugged her - grabbing her handbag and knocked her to the ground. She's 93 years old, small enough to be put in your pocket and some 'man' had picked her as an easy target.

Luckily she wasn't seriously injured, but she was a bit shaken up. So we took her to hospital for a check up and, as I sit in the back of the ambulance talking to her, I'm having to fight back the tears that are making my eyes moist. I feel so sorry for her, I just want to snatch her up and give her a cuddle.

Then I want to hunt down the fucker that did this to her and remove his teeth one-by-one.

While I booked her into the hospital my crewmate made her a cup of tea, in the circumstances it's the best we could do. It's incredibly unlikely that the police will catch her attacker as she wasn't able to give a good description of the mugger.

She tells me that this is the second time she has been mugged, but "didn't want to make a fuss and get anyone in trouble".

My feelings go between sadness for what has happened to this inoffensive, polite, lovely woman and utter burning hatred in my gut for the scum that did this.

I once went to a 'patient' that admitted mugging people to maintain her Temazepam habit, and I sat there listening to her as she made herself out to be a victim.

I suspect that I would not be so calm if I had to pick that patient up again. And yet we must, otherwise we would be 'in trouble'. We can't let our feelings affect the way we treat people. But just once in a while it would be nice.

And yet, as I type this, sad and angry, I'm thankful that at least I'm feeling something.

For those that were following the comment threads on my BBA post.

The NICE Guidelines have been published.

Interesting idea about birthing pools - and if someone can point me to the evidence that they are superb, rather than an infection risk, I'd be grateful.

There is a campaign site for normal birth. Something that I would agree should be everyone's choice.

The only thing that I'm not sure about with this emphasis on 'choice' is that there are a fair numberof people out there who I don't think are really competent to make an informed choice. If people are daft enough or self-deluding enough to get pregnant and not realise it, then can we really say that every mother is clever enough to make an informed choice.

But then this is where the skill of being a midwife comes in. Much as I urge some people that I meet about their healthcare choices.

I would have liked to write more tonight, but I am absolutely knackered. Not only have I been working twelve hours (ending up with a car being cut open around me), but I then have to go to my brother's house in order to help him install the huge TV he's just bought. I expect a big birthday present in two months time brother...

Tomorrow I get to do it all again.

So I'm afraid I shall just have to tell you a little about the post yesterday. You see, there was a 'secret' question in there, one that only I knew about. It wasn't to trick you (because I really am interested in hearing people's views on the numbered questions), but it was to see the reaction of my readers.

A few of you picked up that I mentioned that my patient was a 'new European', and commented on it. The reason I mentioned the patient's race was to see what comments would be made. Those of you who have read my blog a lot know that I don't mention race a lot on this site - it's too easy to be misunderstood and be accused of racism. I only tend to mention race when it is important to the story.

The reason why I wanted to see what people might say when I mentioned his race was because, of late, it seems almost allowable to disparage Eastern Europeans.

It seems fine to say that they are the cause for a 17 fold increase in drink driving, and while I can't find the link for it, another police chief today has said that he has trouble dealing with the heavy drinkers from Eastern Europe. It would be unusual to hear a police chief bemoaning Bangladeshi killing each other for feuds that start in their home country. Or that South American's like beating their wives (see the comments...).

I've always been a believer in the 'substitution rule' (before you ask, yes I am a Guardian reader). This rule says that when talking about a group of people you should replace the description with the word 'Jew'. Then see how distasteful it sounds.

So go back and read the post as if I'd written that my patient was Jewish. See if it makes sense, or see if it sounds acceptable.

That is why I tend not to mention race in this blog. Despite what I might think, it's a thin line that I have to walk between reporting the truth and being seen as racist. My views on my being racist are pretty much unchanged from 2003. I hate everyone equally.

So is the stereotype of the hard drinking Eastern European correct? Maybe it's something that can be researched and perhaps I should make note of the country of origin of all the drunks I pick up?

Should we be 'race blind', or should we target certain parts of the population with education or behaviour changing publicity?

(See: Female circumcision, Belladonna in the eyes, black on black gun crime, honour killings)

Right - I'm off to bed before I fall asleep on my keyboard and wake up with a pretty keyboard pattern on my face and drool gumming up my laptop...

I shall leave you with a teaser for an upcoming blogpost - Rule #1 - When an EMT fights a 90 year old, it is the EMT who ends up bleeding...

I'm really interested in what people have to say about this post (I may be doing this all week - I'm on a run of twelve hour shifts).

Our patient is one of our recent 'new Europeans', he'd dialled 999 because he was feeling 'generally unwell'. His English is pretty poor, so it was a case of me asking questions and him saying 'yes' or 'no'.

His problem was that he had a headache, was a bit dizzy and his heartbeat was a bit fast. The reason?

He'd been drinking for two weeks.

He wasn't much fun, although I treated him with the same respect I treat all my patients, he complained that I was laughing at him.

It sits at the back of my mind that this was a completely self inflicted injury, he'd dialled 999 for an 800 yard journey and he complained the whole way.

So the questions I want answered are,

At what point does this become an abuse of the Ambulance/A&E system?

When am I able to point out that this might not be the best use for an ambulance?

What do I do when I get a complaint from the patient for 'being rude'?

What is the best way to stop this sort of call happening again?

From the BBC (and thanks to everyone who pointed this story out to me)

A woman who drunkenly abused doctors, nurses and ambulance staff in Leeds has been banned from calling the ambulance service in England and Wales.

Kathryn Gummery, 28, received the Asbo, which also bans her from the two main hospitals in Leeds, at the city's magistrates' court on Thursday.

Great, about time - people like these are a terrible drain on the NHS*.

An exception to the terms would be made if she had a genuine medical emergency.

Which will make this ASBO pretty much useless for the ambulance service. You see (and if there are any crews that know her, please let me know if I'm wrong) I would imagine that most calls to her are 'female collapsed in street'. Or even 'female with chest pain'. Either of these are emergency calls. Maybe she phones herself, in which case I'm sure that she has realised that saying yes to the question 'have you got chest pain' means that she has an immediate ambulance.

So ambulance Control will no doubt continue sending to her, crews will continue running to her and they will probably keep taking her to hospital.

Why will they keep taking her to hospital? Because they don't want to be the crew who leaves her at home only for her to choke on her vomit or fall over and break her neck. Coroners can ask some awkward questions and in the normal run of things the ambulance crew would probably lose their job.

They don't want to be the crew who leaves her in the street only for someone else to call. And if they call the police because she has breached her ASBO, the police won't want her either because you can't have drunks in police cells in case they die.

And I find it hard to imagine a magistrate locking her up for the breach (if only because she is the 'victim of a disease'*).

What did strike me as funny (and all emphasis is mine).

Police, hospital chiefs and the council applied for the Asbo due to Gummery's catalogue of aggressive behaviour.

"We're absolutely committed to working towards the policy of zero tolerance when it comes to violence and aggression towards our staff."

'Zero tolerance' indeed, if it needs a 'catalogue' of aggressive behaviour to force legal action of some kind.

---

*OK, here is the thing - I'm wondering where we draw the line on medicalising bad behaviour. It seems that everyone is 'ill' these days rather than 'bad'. Alcoholism is a disease, heroin addiction is a disease, beating grannies up to feed an addiction is a disease and being violent towards people is a disease.

Very seldom does the thought that some people may have become alcoholics or heroin addicts just because they were chasing a bit of fun at other peoples expense come into view. There is always some 'reason' behind it, some reason why they are the 'victim'.

There is a continuum of behaviour from 'ill' stretching all the way to 'just plain nasty'. At what point do we draw the line on the continuum where we say that the person isn't 'diseased', but is just a nasty person to know?

An alcoholic who refuses treatment, keeps drinking and is a drain on the NHS. Well aren't they just 'diseased'? If so, why the ASBO?

This is definitely a topic for a post on it's own.