We are in the middle of a shift and one of our mates asks us if we could do a job for them as a favour - they are off shift in a hour and the job is for an emergency transfer from someone's home to a hospital waaaay outside of our patch. We do it because it's awful to get off shift late, and to be honest, for us a change is as good as a rest.

The job is a simple one - pick up patient from their home and take them to hospital as quickly as possible - no thinking required and I don't even need to do any vital sign measurements on this job.

The patient is a one year old child in liver failure and her parents have just been told that a donor organ may have become available.

When we arrive at the home the whole place is in uproar, it's late in the evening and every member of the family is scrabbling around gathering things into no small number of bags. Clothes, food and the sort of supplies you need for a very sick little one year old.

I do my best to try and bring a little calm to the chaos but the family aren't having any of it, they are in near panic and their emotions are somewhere between fear and joy. I know when to admit defeat and I leave them be.

The transport itself is fairly smooth although the child alternates between crying and griping for the whole trip, I can't really say I blame her as I would imagine that she isn't too happy to be going back into hospital again. Her parents do pretty much everything that they can to keep her happy but unfortunately for my sanity nothing seems to work.

They seem like nice folks, they have another older child and from what little I saw of them they were well behaved and happy, always a good sign when there is a seriously ill sibling in the family.

We reach the hospital and the nurse beds them down, there is going to be a lot more testing before any operation but I've done my bit.

I like going to strange hospitals, the nurses on the ward always offer us cups of tea and I am way too polite to refuse...

So it's a nice job and we manage to get back into our area for the end of our shift, but I do wonder about the donor.

The donor must have been young, and their last journey was probably in an ambulance staffed by colleagues of ours. Their parents would have been distraught and panicky, and then they would have had to made the decision to allow the doctors and nurses to stop trying to save their child.

And then they made a decision to allow their child's body to be used to help others, a wonderful and brave decision. And because of that decision a one year old child they will never know is going to get a chance of life.

I've been on the organ donor list for years, why don't you think about it?

We are called to a young woman in her thirties. Our computer screen sends it to us as a possible broken arm.

As we arrive at the house we are met by the rather excitable husband. He is all sweetness and light, thanking us for turning up so quickly, saying how worried he is and smiling at us a lot.

His wife is in bed, hidden under the duvet, she's fully clothed so we remove the cover to speak to her. She's not very communicative and every time she says something she looks at her husband for approval.

My crewmate is attending, so she's the one carrying out the assessment, but from across the room even I can tell that the bruises around her wrist are from a hand grabbing the arm. Bruising from fingertips is really rather obvious.

We ask what has happened and she tells us that she slipped over in the bathroom and banged her wrist on the radiator, something that doesn't explain this pattern of bruising, she also tells us (after conferring with the husband in their native language) that it happened earlier today. She's obviously not happy, no-one is ever happy about hurting themselves, but this is something unusual.

We move them down to the ambulance after raising an eyebrow at each other to make sure that we both know the suspicious situation.

In the ambulance my crewmate asks about any analgesia, if she's taken a painkiller for the pain. The patient says yes, she took some last night.

Oh, asks my crewmate innocently, I thought you hurt yourself this morning.

More muttered dialogue in a language we cant understand before we are told that the painkiller is for a problem the wife gets on only two nights of the year.

If this were a 'Casualty' or 'E.R.' script I'd be laughing at the screen for the scriptwriter having such an obvious cliché while making it all too obvious.

As it is there is little that we can do - we handed the patient over to the triage nurse and made our concerns known to her, then delegated any decision upwards by noting our concerns on one of our 'vulnerable adult' forms. I'm not sure these forms are designed for this purpose, but we do what we do and if someone in the upper rungs of management wants to throw it in the bin it's up to them.

He is the thing, we have no idea what happened - no-one was volunteering information and we are only with the patient for a few minutes so it's not really appropriate to start investigating. Did the husband do this to his wife? Was it an assault in the street that they are ashamed about? Was she trying to hit the husband and she got the bruising while he was restraining her?

Who knows, I can't judge. I'm not the police so the best we can do is draw it to someone else's attention within the confines of patient confidentiality. All I am, as one politician said, is a taxi driver with bandages.

"...shouted at the paramedics who helped her. The source added: “When she came to she started mouthing off and told the ambulance crew, ‘You have to respect my privacy’. She then told them to get out."

Although, blimey, reading that copy make my teeth hurt. 'pretty 19-year-old', 'raced to the scene', 'pal'. Seriously, does anyone ever refer to people as 'pal' these days?

So, is this story in the 'public interest' and if not why does the Sun have the right to breach patient confidentiality? Because no ambulance crew would go to the press about this - we have ethical standards.

Today this blog is five years old. It's moved beyond the terrible twos and is now happily walking around on it's own, only occasionally falling over and skinning it's knee.

This is the longest period of time I've ever stuck at doing something. I've stuck at it because for some aspects of my life this blog *is* me, what I write here is the part of my personality that I extrude onto the internet. I've stuck at it because I love blogging, I love the community and I love evangelising about blogging.

I've had great opportunities because of this blog, I've done interesting things, become an international author, and most importantly I've met some really great people.

I've had a chance to be involved in a conversation with thousands of people, some of whom have become good friends to me.

Writing this blog has enabled me to reflect on my own internal thought processes and has changed me for the better, I think so at least. When I started this blog I hated my patients, now I am practiced at viewing their situation from other angles (a process I use to try and stop repeating myself) and this has made me a better ambulanceman.

While there are tropes that I've revisited I don't think I've ever repeated myself, somethings I want to bring to the attention of everyone and this blog has let me do that. Every drunk is an individual.

I love blogging and I can't see myself ever giving it up.

But.

I can feel my health slipping away due to shift work, and while I still enjoy the job to some extent, it's not stretching my mind at all. I get paid (before tax) £25,000 a year to wreck my body with shift-work, surround myself with the violent and the sick and then get threatened with disciplinary procedures for being ill too much. I watch how the job is changing and I hate the changes being made in order to please our government masters.

I look at all the things being done wrong and have no power to change them, nor will I ever have that power.

So, from today, I am officially looking for another job. I'll do (pretty much) any work for £25,000 or more. I'll work in an office, I'll wear a suit, I'll sit at a computer all day - I don't really mind. Obviously my ideal job would be something where I can be evangelical about something I love - journalism, podcasting, teaching people to use the internet, doing online PR, helping a company with it's social media strategy. Something like that would be perfect. I don't think that I want to stay in the NHS, not patient-side at least*.

Time to start looking forward rather than at the walls of this rut I've made.

Lets see what the next five years bring...

*However, I think I'd sign on to do bank, or 'casual' ambulance work at the weekends - I'm not sure I can get blue-light driving completely out of my veins.

A little later on in the shift, after we'd dealt with the patient mentioned in the previous post, we were sent to one of the police stations on our patch. The person there, who had been arrested, was complaining of chest pain.

Patient's in their twenties rarely suffer from heart attacks, and one look at him as he dejectedly sat in the police cell was enough to tell us that it was really rather unlikely it was anything serious.

But we are professionals my crewmate and I, and treat everyone the same, arrested or not.

We tried to get a history from the patient but, like a fair few of our 'clients' he didn't speak a lick of English, so we asked the custody sergeant what was going on with the patient. The police doctor had seen him and was worried that he was having a heart attack - as I say, quite unlikely, but 'unlikely' isn't 'certainly' and the doctor was quite rightly covering his bases by asking for him to be seen at a hospital.

Talking to the sergeant it soon became apparent that this patient of ours had been arrested on suspicion of beating up our patient from earlier and it was only after some hours being incarcerated that the pain had developed.

It's not often that we get to treat both sides of a fight. Dealing with 'assaultee' and 'assaulter' is incredibly unusual, especially if they aren't being seen at the scene of the fight.

We also learned from the sergeant that the victim of the assault had been sent to ITU, but had woken up with apparently no life-threatening injuries. It would appear that a large part of his unconsciousness was due to the prodigious amount of alcohol that he'd drunk and wasn't in fact suffering from a brain injury.

Still, I feel justified in blue light transferring him to a neurological centre because he'd obviously done a good enough impression of being seriously injured enough to worry the A&E doctors enough to warrant a stay in ITU.

And after doing an ECG on my current patient it was highly unlikely that he was having a heart attack.

We took him to a different hospital.

'Male, collapsed in alleyway ?attacked"

We are supposed to wait for the police before we go to such jobs, just in case the attackers are still on scene. Like many ambulance crews we don't worry about such things if the text of the job doesn't set off our 'danger-sense'. This job was during the middle of the day and in the middle of a rather busy part of our patch.

If there is an assault in a public place we'll normally cruise up to it - if there is still something dangerous happening we'll be able to drive off quickly and wait around the corner.

In this case we arrived a few seconds before the police, they had followed us down the road. At first we couldn't see the patient, but then it soon became apparent that he'd wedged himself between a wall and some street furniture. The police were talking to a group of men who were standing nearby.

We approached the patient - there are two reasons why a person wedges themselves in place like that, the first is that they think that they are going to die, don't ask me why, but people just seem to do that, the other reason is that he is so drunk he thinks that he'l be safe and comfortable like that.

His face was turned away from us, and as we turned him over to see if he was still breathing we caught a whiff of alcohol, and if I can smell it then he must *really* be drunk.

Then we saw his face.

Swollen, misshapen and with missing teeth, he'd obviously been seriously beaten. The way that he didn't resist when we pulled him out of his cubby hole made me aware how badly he had been hurt. Something clicked in his arm as we rolled him onto his back.

Now, in an ideal world we would put a hard neck collar on him before we moved him, but as we were unsure if he were breathing properly clearing his airway takes priority (as it always does).

We stepped our speed up a gear - a quick assessment showed that the patient was deeply unconscious. Time to load him onto the ambulance, stabilise him and drive past one hospital to get him to a hospital with neurological surgeons.

As we got him into the ambulance he started to twitch, a sign that there may have been brain or nerve damage. We cut his clothes off to make sure that he hadn't been stabbed somewhere, secured him to the bed and made ready to leave under blue lights.

One of the policemen poked his head into the back of the ambulance, "How is he", he asked.

"Potentially life-threatening", I answered - that's the phrase that gets the police's attention, and in this case it was certainly true. Without a CT scan and other investigations I couldn't be sure if the patient's unconsciousness was due to drink or due to his brain being rattled around his skull.

"I'll follow you up to the hospital then", said the policeman and he ran to his car.

So we blue-lighted him into hospital where we later learned that the patient was sent to intensive care.

But that wasn't the end of the story.

To Be Continued...

There was no blogpost yesterday as I was doing a five hour round trip drive to the other side of London in order to drop off the baby pigeons.

The Wildlife Centre had some really lovely staff and they assured me that the pigeons would be well looked after, once they had learned to fly they would join the flock of three hundred other rescued pigeons that lives in the area and that they feed regularly.

So a really nice result even if the journey was extended somewhat by the failure of my sat-nav at a particularly crucial point...

At least I can now sleep knowing that they are safe and that they won't end up killed to death because we don't know how to look after them.

And a big thanks for everyone who gave advice, it was very much appreciated.

Ok, so I'm a soft git sometimes.

We have had some pigeons nesting the stock area of the ambulance bay for a while - a few days ago we noticed that there were some pigeon chicks there as well. Somehow they have managed to get quite large without us noticing.

Their parents had built their nest of sh*t in a cardboard box containing (ironies of ironies) the infection control suits.

Obviously we can't have pigeons nesting in our stock area as, no matter now much I like them, they spread diseases. Phone calls were made and exterminators were called.

I have a mate who is an pest control worker, and I know exactly what would happen to the babies. So I've snatched them up and brought them home. More specifically home to my mum* who'll be able to look after them during the day. I've taken on the cat**, who is currently sulking behind the futon in my flat.

However, we have no experience in dealing with pigeons, or birds of any sort. The websites and forums have let us know what, and how, to feed them, although I don't have any experience on the physical skills needed to actually carry this out. The pigeons are a bit older than they are in that photograph.

The thing is, I don't think that the RSPCA care much for pigeons - as they are considered 'vermin', I don't think that they are allowed to look after them (and their 24 hour advice line is unhelpful in this regard).

So really, what I need to know is how to look after them until they can fly away and be wild (I'd rather not keep them, but if that is the only option then I've plenty of room in my garden to build a pigeon home... thingy...), or if there is anyone out there willing to take them off my hands.

I think that this might be related to my reading about pigeons saving lives in the two world wars when I visited Bletchley Park.

So... erm... daft soft git asking for advice here folks.

*She who used to do physical therapy on our pet rats after they had strokes.

**Yes, that cat dear twitter followers...

UPDATE: Thanks to commentator 'mc1rvariant' I got in contact with the London Wild Care Trust who will take them for me - excellent, and thanks to everyone who sent me advice. It was all very, very much appreciated.