We'd just started our shift yesterday (twelve hours) when we heard on the grapevine that the local hospital wanted to transfer a patient across London to Ealing. As we had just started our shift we offered up for it - that way someone who is looking to go home i a few hours doesn't get stuck halfway across the world.

The patient was quiet - well, he had no choice, he was paralysed and intubated, and we had an anaesthetist travelling with him. So it was a simple case of loading him up and shuttling him, on blue lights, across London.

16.9 miles might not seem too far, and I can hear rural ambulance people sniggering as I type this, but it is unusual for us. London is a funny old place and for a lot of us 5 miles is considered a long way...

Relying on the Sat-nav in our ambulance, we had an uneventful trip and our patient was soon unloaded.

Once more I came to meditate on the difference between hospitals in the West of London and the East. While both our local hospital and Ealing hospital are NHS hospitals, it seems that Ealing has had a lot more money to spend on it. It seemed cleaner, more modern and more up to date. As well as less busy. I had cause to think the same when I did a similar transfer to the Chelsea and Westminster hospital.

It seems that postcode lotteries apply to hospitals as well, as all our local hospitals have troubles with their budgets and look...well...a bit rubbish.

Heading back we got sent to two jobs, both really nice elderly people - and one of them gave me and my crewmate a bar of chocolate each. Nice chocolate as well, none of that Cadburys stuff.

Eventually we made our way back to our own area and noodled around doing our usual calls. Of which I will write of later, when I'm not running late for work...

DG's latest post is genius. Other people have written about such things, but not as evocatively as this post.

My memory is poor, but I'm sure that, when I was a nurse, the NMC had it as a condition of being the sort of nurse who gives drugs to people that the aforementioned nurse understand what a drug does and what it's side effects are.

It's 3am in the morning and I'm miles out of my area on the FRU*. I have been sent, as a blue light response, to a nursing home where one of their 'clients' is sleeping.

Yep - sleeping.

I get there and the patient is in the reception area of the home sitting in a wheelchair. He is... asleep.

The 'nurses' at the home tell me that normally he is very active at night and often comes to see the night nurses and sits chatting with them. He's ninety-eight years old and mildly demented.

I bite my tongue and do all the checks that I can to make sure that there isn't anything obviously medical going on. All his observations are fine and he responds somewhat when I try to wake him. I'm sure that if I provided enough pain stimulus I could fully wake him up, but it would just seem cruel.

I look at the patient's drug chart. Two days ago he was prescribed a rather strong sleeping pill.

I ponder, for about 2 milliseconds, if this might be the cause for his sleeping. At 3am in the morning.

I suggest this to the nurse.

She shrugs.

The staff don't say anything, but I get the distinct impression that they have been getting tired of this patient being awake while they are at work. If all your patients are sleeping then the night shift has little to do. If this patient has been awake, then they actually have to talk to him. In a lot of the nursing homes that I've been to the nursing staff don't like talking to the patients.

In a fair few nursing homes that I've been to the staff and the patients rarely share a language, and so everyone just 'gives up'. As a digression, the good nursing homes that I've been to have been those where the staff and patients do talk to each other, and the care of the patients is considered to be more of a 'partnership'.

The nurses, who I suspect have got exactly what they asked for, aren't happy. They've already rung the elderly relative of our patient (at 3am!) to let her know that he is heading into hospital.

The ambulance crew arrive and I have a real problem explaining to them why we have been called.

"The nurses wanted this patient to sleep at night. They have given him a sleeping pill, and now he's asleep", doesn't really seem reasonable for a trip to the hospital.

But the 'customer' is always right - and so the patient is driven off to the hospital.

I talk to the crew a few days later and they tell me that the receiving nurse at the hospital was as befuddled as the rest of us.

I don't know, jobs like this make me despair at the general intelligence of people, not less the intelligence of the sorts of people who look after the elderly.

Oh well, at least one of us had a bit of a kip that night.

*I really need to tell you about FREDA one day - perhaps a joint post with Nee Naw.

---

I'd like to apologise, blogging has been a bit slow of late. Mostly this is due to working on the sequel to 'Blood, Sweat and Tea' - I'm needing to put some concentrated effort into it. this is not easy with twelve hour shifts accompanied by the utter lack of energy I have at this time of the year.

Medgadget are running their annual Medical Blog Awards - you should go over there and have a look at the nominees, there are some really good ones there. Also there is no other motive for suggesting you visit the link. No. None at all...

I've read every single one of your 'Seven random things' let in the comments of the last post and if people still want to write things there I'll still see them because all comments are emailed to me.

As some people have asked for them, here are my seven.

1) I have a habit of thinking everyone is as interested in trivia as I am. This means that my particular derangement is in thinking that people want to hear about it.
2) I have pretty much a zero sex drive. I also like living on my own. This is possibly the reason why most of my 'have a girlfriend periods' tend to last less than a month.
3) I strongly believe that we should not have to give up childish things. The pursuit of joy is everything and we truly are Homo Ludens. This may be why I am an annoying Apple evangelist.
4) I have manic episodes where I get monomaniacal about something. Then a few weeks later I move onto the next new thing. This is why I am surprised that this blog has lasted so long.
5) Sometimes I want to give up ambulancing and do something 'normal', preferably without shift-work. Writing for a living would be nice, but what would I blog about? Often this feeling passes. Lately - not so much. I think it's because it's Winter.
6) I want to shave my head - but my mum would disown me. Her cooking is lovely, so while she still breathes I have hair.
7) I like to think that, with the rapid acceleration of medical advances, that I might belong to the first generation that doesn't have to die. Damn-it, I want to see the future.

It's pretty tough to come up with things that I've not written about before - yet are vaguely interesting.

I don't want to pass this meme on to people who wish to ignore it, so instead consider it an open invitation to do this meme on your own blog if you wish.

This also makes me realise that my '100 things about me' page is terribly out of date. I must do something about it.

Some time ago I got tagged with the 'Seven things' meme from Diabetes Mine. I don't normally do memes, I've often got enough to write about (at the moment I have a little black book that is full of article notes and ideas, this makes me feel relaxed and unconstipated).

The meme is to write seven random things about yourself. I'm supposed to write it and then pass it on.

The problem is that I am pretty open and simple, so I don't think that I have seven random things that I can tell you. Honest. Well...nothing that wouldn't get me arrested.

So I'm turning this around - why don't you tell me seven random things about yourself? Leave them in the comment section and I can get to know you all a little better.

Go on, have fun...

If they are good I might be inspired to do my own.

(You can read Diabetes Mine's seven things here.)

Due to my crewmate skivving off over the holiday period I found myself with no-one to work with. The resource centre rang me up and asked if I wouldn't mind working on the FRU. I've found that it's in my best interests to do as they ask, otherwise there is a fear that they'll send me to the other side of London for a giggle...

So I loaded my kit onto the car and got ready for a busy night.

Fifteen calls in a twelve hour period later and I was glad to be heading home.

Luckily for me, a lot of the calls were for 'Man-flu' and in one case the female version of the same - 'Bird-flu'.

Ahem.

Blame fellow 'twitterers' for that joke.

With all this man-flu going around I wasn't surprised when I saw a call come down to my FRU. "27 year old male, unwell ?cause". So I whizzed round to the address and was met by a woman I would find out to be the wife of the patient. She led me into their one room flat where my patient was lying on the bed.

My immediate impression was that he was fine. No obvious difficulty in breathing, no rolling around in pain. As I entered he looked at me and his gaze followed me around the room. So unlikely to be anything serious then.

I looked at the wife, she'd started crying.

"Don't worry, he'll be fine", I said.

"No he won't", she sobbed, "He's going to die".

Well, he didn't look like he was going to die to me, and I'm normally a pretty good judge of people who are likely to stop breathing.

So I asked the patient,"What seems to be the problem?"

"I'm going to die tonight", he said with utter conviction, "God is calling me".

Oh great.

"What makes you think that?", I asked.

"I just know, I've already phoned my family back home and told them".

So now his family halfway across the world would be worried. Happy Christmas!

After some prompting from me he continued, "In my religion, Islam, God sometimes calls people. That is why I know I'm going to die tonight".

"Look mate", I told him, "I work round here, so I meet a fair few Muslims, none of them have ever mentioned that before".

I spoke to his wife, they had just come back from shopping, there hadn't been an argument or anything unusual that day. He'd just taken to his bed and declared that he would die.

At this moment the ambulance crew arrived. I explained what was happening and we all agreed that he needed to go to hospital. While he (almost certainly) wasn't going to die that night we were worried that he might take matters into his own hands.

Rather predictably he didn't want to go to hospital.

So now we were looking at arranging a Section. Which needs two GPs and an approved social worker. At 3am in the morning. Over the Christmas holidays.

The chances of arranging that were slightly less than him actually being right and God beaming him directly into Heaven that night. I contacted our Control - they had the same view that we were pretty much stuck on our own.

Our hands were tied, if he were in a public place we could get the police to emergency section him, but as he was in his own house, they were as powerless as us. Except... There is a bit of information floating around in my head that with enough high-ranking officers we can maybe section him anyway.

Time to turn on the charm.

"Look mate", I said, "the thing is that we think you are having a psychotic episode. So we'd like to take you to hospital. I don't feel happy leaving you here. So I'm going to give you a choice. I'm all about choice me. Choice 'A' is that you come with us now - spend some time at the hospital and have a chat with someone. Choice 'B' is that we contact the police and ask them to come down and see if they are able to persuade you to come to hospital. Either way I think you'll be going to hospital".

"Ok", he said and got his shoes on and walked out to the ambulance.

There is a line between persuading someone, coercing someone and forcing someone to do something. I think that this was persuasion rather than coercing, as I truly would have called for the police and often they can persuade someone to go to hospital. I would have been really unhappy to leave him at home as if he wasn't suddenly suffering from a mental health problem it could have been something more physical and life-threatening. Either way his life could have been in danger and, while I don't have the power to force him to come to hospital, I can do my best to persuade him.

I've not had a note from the coroner's office yet - so I don't think that his God's plan was for him to die that night.

---

So far I've been keeping my 'Photo a day' thing over at Mental Kipple. Thanks to those who have offered services, but I'm pretty well set up with Flickr and my Wordpress blog.

Ergh.

So. New Year.

Every previous year I've taken the completely reasonable and logical view that, as the turning of the year is a completely human (and Western human at that) tradition, that it hasn't meant anything.

This year however is somewhat different. I don't know, maybe I'm getting soft in my old age, but for the first time in my life I'm thinking about New Year resolutions.

Maybe it's just because I've found myself slowly giving up on doing anything except having a nice kip over the holiday period and so feel the need to 'reboot'. A new year is as good a point to start again as anything.

So, resolutions...

Most of the resolutions can be boiled down to one.

• Get off my arse and do the things I want need to do.

Of course, it's not that simple... Perhaps it would be an idea to list the things that I want/need to do. Some are hopelessly optimistic, but why the hell not.

• Write the sequel to Blood. Sweat and Tea - I have a deadline, so that'll be the first thing that I do.
• Write a comic strip series, I need to find an artist or maybe just release it into the public domain.
• Find an agent who can pimp me into writing TV stuff.
• Make some sort of social network or forum based off this site. Although I wonder if there is a market for it.
• Fiction. I must write fiction.
• Meet more people, both bloggers and people in 'real life'. Reconnect with people who I haven't seen in ages, and meet new people.
• Start a Podcast. Or a Vidcast. Something creative at least.
• A photograph a day. I need to get into recording things.
• Start following 'Getting Things Done'.
• Find the right people to create a UK based group-blog of interesting things.
• Sleep less.
• Oh, and get more of my Alts up to Level 70 in WoW - just for fun.

I think that'll do for now - especially as, due to the nature of my NYE work, I'm unable to move in much more than a hobble at the moment.

I'm bloody knackered.

NYE was probably the hardest twelve hours I've ever worked, mostly because I was on foot for the night. Partly because I was carrying a huge bag.

This picture is of Alex, the St. John member who was assigned to me and another LAS person. Just take a look at the size of the bag on his back. I was carrying something similar. The difference being that I am an old, unfit man with newly fallen foot arches. I think they dropped sometime during the night.

Oh yes - you can read my Guardian article here.

I shall now do a retrospective on my liveblogging.

17:15 - Waiting for the briefing to start. I've never seen so many officers in one place. It makes me, who tries to avoid management whenever possible, a trifle nervous.

Well, it turns out that the 'FIT' team briefing was at 19:00, not 17:00 but no-one had told me or two of my colleagues. So we got to sit through the management briefing. There wasn't anything particularly exciting about this briefing, no secret orders or anything.

18:20 - First part of our briefing is over. Still way more chiefs than indians, oh well. We've been told that this is the biggest year ever
with 500,000 people expected over a larger area than before. The briefing started with a Primal Scream tune playing over videos of
crowds. I'm pondering running away. Seems well planned though, lots of lessons learnt from last year. We also have a fallback communication system for if/when Airwave falls over. There are 13 treatment centres dotted across the area and I'm one of
12 Forward Incident Teams. There are 17 SJA ambulances and 4 LAS ambulances. We may end up waiting for one for a while. Now I'm waiting for the FIT briefing, about what we are supposed to be doing when we hit the ground...

The 'more chiefs than indians' comment was before I realised that we were in the management briefing. I think that in the end there was a handful more people 'on the ground'. The Primal scream music was laid over CCTV footage of last years event, to give us a rough idea what the event was like. Some of the video was in 'night-vision', which just made me think of the footage from military planes blowing up bunkers...
The general plan was a good one, communications work flawlessly and the treatment centres were placed in good positions.
I didn't see an ambulance until all the celebrations were over - but then there was no way they could move through some of those crowds.

19:44 - Just been allocated my area. Trafalgar sq. I may be killed.

So the plan was to have various FIT teams allocated to different areas. We would be the one team covering the square and The Strand. As most of the people were expected along the Embankment to watch the sparkly fireworks I was hoping that we'd miss the worst of it. How wrong could I be...

19:48 - About to get free food at St Thomas' so not all bad then...

Chicken curry and rice, and lots of it. We were also given a 'packed lunch' (which turned out to be yet more weight to carry). A nice thought, but why don't I get a packed lunch when I'm expected to work twelve hours without food normally. I suppose it might be because we are on foot all night.

20:45 - We are fully kitted up. I'm working with another LAS EMT and one St. John fellow. Just getting ready to roll out.

I was placed with two chaps, the St John bloke as pictured above, and another LAS EMT. Both were superb and it was a real pleasure to work with them. There was a lot of kit to carry, but not an excess of stuff. At no part during the night would we want for kit that we didn't have.

21:37 - (I may forget what number I'm up to at some point of the night) Currently having a cup of tea from the St John 'Teapot 2' parked under Admiralty arch. Did have to lug the kit by foot from St Thomas' to here, for some reason all the roads are closed... Heading for a 'mingle'.

Yes. That was my first and last tea of the night. We thought that Embankment was a bit crowded, little knowing that it would get four times as bad before the night ended. So we decided to mingle by visiting each of the treatment centres in our area.

21:53 - Why do people bring little kids in buggies to such events? Madness!

They are potty. Do they not realise what it is like here? I wouldn't bring anyone under the age of eighteen here.

23:05 - The St. John lot I've met so far are all really nice, although they do seem to like nursing their drunks outside their ambulances.
Three jobs so far, two drunks (one who'd fell over) and a bellyache. Normal Monday night then.

Yep, while I'll lose LAS respect for saying this, but all the SJA people I spoke to were lovely. I t was a pleasure to work with them. The whole 'nurse drunks outside the ambulance' does make sense, they can't close the treatment centre while they mop out the inside of the truck, so nurse the drunks outside on stretchers and chairs, then they can make as much mess as they want.

The jobs were nice and simple and were self presenters to the treatment centres that we just gave a hand with.

12:21 - Just dealt with someone who would rather die than miss the firework display. He was properly I'll, yet refused our aid and instead ran off with his mates. It wouldn't surprise me if we get called to him dead in the street. Unfortunately he has the capacity to refuse treatment, even if it's really dumb.

We were just about to head down the Strand to watch the fireworks when the lad walked up to us clutching his chest. Turned out that he had a serious heart condition and that his pain wasn't going away. We commandeered the nearby British Institute building (under the watchful eyes of a bemused security guard). Our patient's heart was racing, his blood pressure was in his boots and he really needed to go to hospital. If I were in an ambulance I'd have been blue lighting him straight into resus.

But no, he wanted to watch the fireworks, and as soon as he heard the first ones go off he ran out the building with his mates. I'd already told him that there was a good chance that this might kill him, but he wouldn't be convinced and he had the capacity to refuse treatment. There was nothing we could do except watch him disappear into the night.

01:31 - Its all gone mental.

No sooner had we finished with that patient than we got a 'Cardiac arrest' call down the other end of The Strand. Grabbing our bags we ran across Trafalgar square to the sounds of 'Auld Langs Tyme', I was trying my best to keep up with my fitter colleagues but the crowds were slowing us down a lot. When we did find our patient it turned out that he was just drunk. Following two police officers carrying a girl with a twisted ankle we walked him to the Treatment Centre.

Next two off duty St John young men directed us to a man with a dislocated knee. It took us half an hour to travel 200 yards as we were struggling through the crowds trying to get to Charing Cross underground. Five people remarked that with our backpacks we looked like ghostbusters. The man had indeed dislocated his knee and with the help of the two off-duty St John and a handful of police, we carried him out of the area to the treatment centre. It was awful, but the man didn't complain.

Then we were sent to Regent street to a woman who'd apparently been sprayed with CS gas - by the time we got there she'd gone. It was about now we needed to rehydrate, so I stripped off my stab vest and we drank a bottle of water. As I looked around steam was coming off my vest.

Then three or four other calls that had us trudging to patients who had either got better on their own, or had been picked up by the police or a passing ambulance. We saw a twisted ankle, and another drunk. Sent to Covent garden we were waylaid by some police who'd arrested a drunk. We threw him in the back of a police van and took him to another Treatment centre where he was de-arrested. Thanks for the lift lads!

Back to Covent garden where the location was given as being outside a shop - no-one had heard of it so using my iPhone I called up it's location on Google maps.

The patient had already gone.

Then we made our way back to our Treatment centre, only then to be stood down.

It was a long haul back to St. Thomas' hospital to drop off our kit.

Then I hobbled home, collapsed into bed and on waking have posted this entry.

(Which might explain the grammar/spelling in the above posting).

It was certainly an experience, but not one I think I'd repeat. I quite like having an ambulance to ferry me between patients, and to have the same ambulance available to drive us to hospital. I don't think that my bones could stand doing this duty again.

Now - I need more sleep.

Happy New Year everyone! Here's hoping it's a safe one.

Its all gone mental

Sent from my mobile.

Just dealt with someone who would rather die than miss the firework
display. He was properly I'll, yet refused our aid and instead ran off
with his mates.

It wouldn't surprise me if we get called to him dead in the street.
Unfortunately he has the capacity to refuse treatment, even if it's
really dumb.

Sent from my mobile.