A care home, using a man's t-shirt as underpants. He's naked apart from the 'pants'.

Another home, a man on the floor. The carers there haven't picked him up, when we do we find that he probably hasn't had a wash for days. We smell of him for the rest of the shift.

She lies on a bed with no sheet, 'she keeps bleeding on them' say the nurses. My teeth grit.

And then I go to Holy Joe's and my faith in decent care is reborn.

Anyone want to pay me £25,000 a year or more to go round 'care homes' and utilise my pain stick?

---

(As always, I know there are good homes out there, it's just I rarely seem to visit them. Only a short post as I've so much 'stuff' to do today).

There has been a little thing that I've been keeping quiet about (because when groovy stuff happens, I like to know that it is going ahead before I mention it in fear of jinxing things).

Richard Monks has turned part of my book into a Radio play for the BBC and it is due to be broadcast this coming Friday (Radio 4 - 21:00).

It was some months ago that Richard came out for a ride-along with me so that he could get an 'ear' for the language and turns of phrases that us ambulance people use. I should also say 'Thank you' to the LAS folks who let him do this. Numerous war stories were told and I think that Richard got a lot out of it.

A little while later I was sent the draft copy of the script to check for dialogue and to make sure there wasn't any huge medical errors. To be honest I didn't have to do much at all, it seemed that Richard had a firm grasp on the subject.

I was then given the chance to sit in while the play was recorded. So I found myself getting the tube to the BBC studio at Maida Vale.

As always at the BBC I was made to feel extremely welcome - Are there any nasty people at the BBC? I got to meet the cast, who were all lovely, the first person to speak to me was Liz White and I *shamefully* completely blanked on where I'd seen her before, only one of my favourite TV programmes...

I managed to take some photos, although apologies for the quality, I couldn't really bring a tripod, and a flash was out of the question as I didn't want to distract the actors as they worked.

I also got the chance to chat to Martin Freeman who plays 'Paul' in the play an ambulanceman who has a cynicism dial turned up to eleven. Martin was also a great bloke and we chatted politics over a BBC lunch.

It was also excellent, especially for a geek like me, to see how the 'wild track' was created, and to see how they made the various sound effects. An example - an ambulance trolley sounds remarkably like a knackered baby stroller. I was able to offer my opinion as to what certain bits of kit sound like. I even managed to get a part, 'voice in crowd moaning about drunk person #3'.

It was a great experience and I'd like to thank everyone involved for some really nice days out and for turning my book into a great little play.

When it gets put up as a 'Listen again' I'll pop the link up here so that people from outside the UK can hear it (I think). Also if the slideshow works, you can click on the big pictures to read the descriptions.

Just time for a quick one (I'm working twelve hour shifts at the moment and am spending as much time as possible asleep).

I get a call to a stabbing in a park. Not as nasty a stabbing as they can be, but bad enough to have me sweating a little while chanting my mantra 'scoop and run, scoop and run'. I like to get people in this sort of position to hospital as quickly as I can, I'm not the gung-ho type to perform surgery in the back of my ambulance, and that is what this patient needed.

The job is going remarkably smoothly - a team leader on a FRU was already there and was of the same mind as me.

So, we are just doing the needful things before we can move when an officer from another complex turns up.

"Can I help?", he asks.

I let him know that we are going to be leaving soon as there is little that we can do for this patient besides get him to hospital sharpish. So no, thanks for the offer but we have things under control.

"I notice you haven't got epaulettes on", he says.

I'm cutting the patient's clothes off (to make sure he hasn't been stabbed anywhere more serious than where he has already been stabbed), so I throw the comment that, yes, I know - but the were in my car when it got nicked and I'm waiting for some more.

He mutters something, but to be honest I'm not hugely interested. I've put in memos, spoken to my officers and I'm still waiting, it's not my problem any more.

(Also I'm wearing boots that I bought in good faith so I could get back to work, but our office has lost the paperwork on them so I'm £60 out of pocket until they decide to pay me for them - I might threaten them with not turning up to work wearing 'personal' footwear - that might get a few cogs moving).

We get the patient to hospital, the patient should be fine.

Now, I'm not saying that proper uniform isn't important. Personally I think that crews who don't tuck their shirts into their trousers look awful, it doesn't give us a professional look. Likewise, epaulettes are important as they are the marker of our 'rank'. It's just that there are better times to bring this up with a crew than when we are dealing with someone who might die in the next few minutes. Especially when the officer in question doesn't know us at all.

I'm not the only one who gets pulled up for uniform while doing something a bit more important.

I was met by a friend and as I walked into the corridor I saw my patient sitting on the stair-lift. She saw me, turned and smiled at me.

Eighty three years old, Jamaican born and already dressed ready to go to hospital.

"Hello there, what seems to be the problem?", I asked, kneeling down so I wouldn't be towering over her.

"I fell down the stairs", she replied.

She'd fallen down all fourteen stairs, tumbling backwards from the top. She's landed at the bottom and had hit herself on the stairlift parked there. She couldn't remember the fall and the only obvious injury was a swelling to her leg. Nothing obviously broken but she'd probably have a few bruises the next day.

I take these sorts of things seriously, it's a long fall and with old bones there is a real chance of serious injury. While she looked fine, I wasn't going to take any chances, so I popped a hard collar around her neck to help protect it if she had injured it.

It was only after we had safely secured her in the ambulance that she told me that the fall had happened more than twenty-four hours ago, and that it was only because she couldn't walk on her painful leg that she had called us there.

She hadn't been able to walk because of the pain, yet had only now considered it serious to call an ambulance. I also suspect that it was only because her friend had visited and 'bullied' her into calling an ambulance that we were there now.

Thankfully, after a load of x-rays at the hospital, it turned out that the pain in her leg was from a large bruise and that she hadn't seriously injured herself.

This is why any suggestion for a charge for an ambulance, or for a charge for an inappropriate call won't work. The people who need us will struggle on because they 'don't want to be a burden', while the people who think they are 'entitled' to our free taxi every time they get a sniffle will continue to use us as such - if only because any 'fine' won't be paid, or the person will be so poor they won't be eligible for being charged.

I can't begin to count the number of elderly who I've picked off the floor where they have spent the whole night because, "I didn't want to bother anyone at that time of the night".

I fear that the only solution is education, maybe education administered by me and my stick o' pain.

'Category A call - 25 year old woman with thrush, itchy genitals. Difficulty in breathing'.

Yep. Thrush.

This warranted a fast car response as well as my fully equipped ambulance.

I have two options here.

Option One
I explain exactly how this is a waste of an ambulance, especially as how the hospital is 800 yards away from the woman's address. I suggest that a taxi would have been more appropriate. I could explain how people who are actually ill are now waiting for an ambulance while she gets a free ride to hospital. I could refuse to take her.

Then I get a complaint, then I get fired.

Option Two
I shut up, take her to hospital, make ready for my next call as son as possible and get to keep my job.

Yeah, I'm a coward - I always take option two.

The problem is this, the people up in Control aren't allowed to use the 3lb of grey squishy stuff nestled between their ears to determine how important a call is. They have to mindlessly follow a computer script, if they deviate from the script they'll miss out on any chances for promotion.

While the computer script is useful it's a real shame that our call-takers can't use their common sense. It's why we end up going to people who 'aren't breathing', yet are able to make a 999 call.

And all because the computer system we use has never been sued.

SCENE ONE

Two men of the same age in a sparsely decorated bedroom. One man (REYNOLDS) is an ambulanceman, the other (SPOTTY BLOKE) is a man suffering from Chickenpox.

REYNOLDS enters

REYNOLDS
Hello sir, can you tell me what the problem is?

SPOTTY BLOKE
I have Chickenpox.

REYNOLDS
(Slightly non-plussed): Yes, sir, why have you called an ambulance?

SPOTTY BLOKE
I have a pain in my chest. I went to the hospital yesterday and they said to take painkillers.

REYNOLDS
And what else did the hospital say?

SPOTTY BLOKE
Nothing.

REYNOLDS
Nothing? Surely they said something, they must have spoken to you.

SPOTTY BLOKE
They said I have Chickenpox.

REYNOLDS
See, that's something. So the pain is the same?

SPOTTY BLOKE
Yes - I want to go to hospital.

REYNOLDS
I don't think that they are going to do anything different from yesterday sir.

SPOTTY BLOKE
But I'm ill, my son has Chickenpox and it's not bothering him.

Reynolds is obviously biting his tongue.

SPOTTY BLOKE
I want them to do blood tests.

REYNOLDS
For Chickenpox?

SPOTTY BLOKE
Yes.

REYNOLDS
It won't do any good, they'll just give you more painkillers.

SPOTTY BLOKE
I don't care - I want to go to hospital.

REYNOLDS
(Worried about being sued for leaving someone at home)
Fine sir, your choice. The ambulance is outside, we'll take you the 800 yards to hospital. Did you have an ambulance turn up like us yesterday? With blue lights and sirens?

SPOTTY BLOKE
Yes.

REYNOLDS
(Wondering if someone at the hospital might sue him for bringing a potentially infectious patient to sit in the waiting room for a few hours)
Sigh...

SCENE TWO

REYNOLDS again, now with a WOMAN a year or two older than him. The WOMAN is coughing rather a lot. We join them as the initial patient assessment is nearing the end.

REYNOLDS
...So, you've had this cough for a few days now?

WOMAN
(nodding) COUGHCOUGHCOUGHCOUGH.

REYNOLDS
Would you mind putting your hand over your mouth please?

WOMAN
(The woman doesn't move) COUGHCOUGHCOUGHCOUGH.

REYNOLDS
Ah. No then. Never mind, it's been a while since I've had a chest infection, and I'm only in a *little* bit of trouble for being sick so much.

WOMAN
COUGHCOUGHCOUGHCOUGH.

REYNOLDS buries his head in his hands and wonders how long he has until retirement. The WOMAN spits on the floor of the ambulance.

---

(And yes, I know the formatting is a bit wonky for a proper script, but it can be a complete pain to format stuff for this blog, some of the dialogue on REYNOLDS part may be slightly made up. But not by much).

I sitting opposite my patient, the patient that the police have managed to stop from killing himself. This wasn't a cry for help, he had chosen three different suicide techniques, and then tried them all at once.

Blood drips from him onto the floor, he's crying as well so his tears mix in with the blood. Mucus is dribbling from his nose as he lets out huge heaving sobs. The police officer with him rubs his back with a gloved hand with her other hand she holds his arm, to stop him beating himself. The officer has formed a bond with my patient, one that I won't be able to replicate in the short time he is in my care. I leave the police officer to it as she's doing a fine job, one perhaps not in her normal job description.

We let him have a cigarette in the back of the ambulance with the doors open to let the smoke out, we are thankful that it's not a cold night. It's not 'allowed' but sometimes you have to break the rules for the patient. This is only the second time I've let someone light up in my ambulance. I'm away that the curtains are twitching in the tower blocks around us. A real life soap opera, entertainment illuminated by blue flashing lights.

He tells us the story of his life, one of pain and the worst forms of betrayal stretching from his childhood to the events that have brought him here tonight. Sometimes he has shown weakness, at other times a strength that I'm not sure I would have had. Often I wouldn't believe such stories, he won't meet my eyes as he talks but, instead of signifying deceit, it only makes his words truer. As his story comes to a conclusion I can see why he would want to kill himself. Everyone he has ever trusted has turned against him, not from simple neglect but from active abuse.

We leave him at the hospital, a side room with privacy. I thank the police officer for her help. I book him in, then head back to station to mop the floor of the ambulance - to remove the blood and the tears. It's my last job of the evening so I drive home. My car radio stays off, I drive in silence.

I have known him only for a moment, the police will know him for a little more, the nurses longer still.

But what he has told me will stay with me.