We are led into the living room by the patient's daughter, she shows us her mother - small, birdlike and perched in a chair. A tiny thing of skin and bones in a nightdress, head bent over, not making eye contact.

The GP had called us, the daughter handed me the letter the GP had left.

'Weight loss, chest infection, depression. Lost the will to live'. The letter said more, polite words to introduce this woman to the doctor at the hospital, but this is what it boiled down to.

Barely able to stand, unable to walk, we had been called to take this woman into hospital.

We explained what we were going to do and lifted her incredibly light body into our carry chair. Younger than my mother, but looking so much older we wrapped her in a blanket to keep her warm.

Into the ambulance and the normal tests were run, pulse, temperature, blood sugar. We took her blood pressure, her arm so thin we had to use the cuff we normally use for small children. Through this poking and prodding the head never lifted up, the eyes barely opened, the mouth spoke no words. Her vital signs were normal, this was an illness of the mind.

You can tell when there is someone with depression in the room, it is an aura that all but the most oblivious can notice - the people around them talk quietly, walk softly, try not to disturb them. No-one wants to say the wrong thing, hurt the person more than they are already hurting.

The ambulance moves off and I start with some simple questions, yes or no answers, my voice kept soft.

She answers and emboldened I start to talk to her about other things. Slowly her eyes open and her head lifts up. She tells me about tragedies, about illness, about loss. When you have depression it is impossible to remember the good times, only the times that keep you low, under the thumb of this illness.

I wish there was something I could say to make her feel better, but I know that nothing I say can help. I want to tell her that it will be all right, that one day she will feel happier - but I can't say that because it probably isn't true. I can make sick people happier just by talking with them, but I know that this illness has me beaten. She will sit there and she will refuse food and she will probably die.

And I feel powerless to help her.

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This is the second attempt at this, the first one vanished into the ether and was, I think, a lot better than this post.

There is a week of predicted high temperatures in the UK. The recent mostly high temperatures have resulted in us being exceptionally busy over the last few days - 5,200+ calls per day.

Please follow the advice given and try to keep cool.

Heat exhaustion (AKA heat prostration and heat collapse). This is the most common heat-related injury, and its basic mechanism is the same as heat cramps. The basic causes are heat exposure, stress, and fatigue. (It doesn’t have to be particularly hot before heat exhaustion is a possibility — wearing multiple layers of clothing that limit the effectiveness of sweating will do the job just fine. So, if you’re out hiking, take off layers; when you stop to rest, put on layers.)

The signs and symptoms of heat exhaustion are:

• Dizziness, weakness, fainting, nausea, and headache.

• Onset while working in a high heat/high humidity/poor ventilation environment and sweating heavily. Infants, the elderly, and the unacclimatized may experience onset at rest.

• Cold, clammy, skin; ashen pallor.

• Dry tongue; thirst.

• Vital signs within normal limits, although the pulse may be rapid and the diastolic blood pressure (that’s the bottom number; the pressure when the heart isn’t contracting) may be low.

• Normal or slightly elevated body temperature.

What to do about all this: Take off any excessive layers of clothing, particularly around the head and neck. Get out of the hot environment (say, into the back of a nice air-conditioned ambulance). Drink a liter or so of water (slowly, so nausea doesn’t develop). Loosen restrictive clothing, lie down with your feet up, and use a fan for cooling.

I suggest that you go and read the whole article from the excellent Making Light then spend a few hours going through the archives. Although good luck trying to find an ambulance that has working air conditioning - I spent a long hot day in an LDV ambulance with the windows wound down gradually going deaf from the sirens. In a contest between hearing loss and headstroke, I guess I picked hearing loss*. Air-con seldom works in the newer ambulances either, and by the time it gets fixed there is normally snow on the ground...

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*All of which makes me laugh at the people who cower when we go past on sirens, remember folks - I'm sitting under the bloody things all day and if the air-con doesn't work I'll have the window wound down working on my 'trucker's tan'.

She tells me, at the start, that the reason that we have been called is that she fell over. Her friend is comforting her in the bedroom, but she's crying and her mascara is running.

"I just tripped over", she tells me.

I look her over, it seems that there is nothing too seriously wrong with her on the physical level. But still she seems upset, sitting quietly, then suddenly bursting into tears.

Her boyfriend comes with her to the hospital, he strokes her hair and tells her that it will be alright.

Something in the front of my brain tickles, his actions seem 'off' somehow - not in any way that I could describe, but in some vague way his actions ring as false.

They argue about a phone - she wants to phone her dad, he won't give her the phone.

Now it's not the front of my brain that is tickling, it's my whole body.

We get to the hospital, the triage nurse looks at her and seeing no obvious injury sends her to the minor injury waiting room. I voice my concerns, but the nurse still thinks that the waiting room is the best place for her.

It's busy and loud, not the best place for this young, tearful woman.

Before we get there she turns to me and, between sobs, tells me that she and her boyfriend were arguing and he pushed her. Pushed her hard.

I head back to the nurse, I explain that I'm really not happy to sit her out in the waiting room as she has just admitted to me this domestic abuse. The nurse now agrees and we sit her somewhere quiet.

Before I leave I crouch on my haunches in front of her and hand her a tissue, she's still crying. I offer to call the police for her, but she refuses. I tell her that the police have specially trained teams, that there are people that she can talk to. She still refuses.

The best I can do is show her how to use a hospital phone to call her father.

I leave the hospital, walking past her boyfriend who is pacing outside.

"Will she be alright?", he asks me.

"I'm sure she'll be fine", is the only answer I can give.

And inside I feel powerless.

First off, apologies for the lack of blogging, but I've been working a 60 hour week, coupled with a two day conference and other stuff (including being contacted a lot about Nightjack - about which I appeared on Channel 4 news, but which I, myself, missed.)

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I was woken from my sleep by a text message from a friend telling me that I was in the News of the World. As far as I know the publishers hadn't planned anything with them so it was a bit of a surprise.

He sent me this picture of the article.

I was somewhat perturbed. Actually I was flaming furious. You see, despite the mistakes, it also implies other things.

For comparison you can read the original post here.

Firstly, I didn't say anything, I wrote it. Over three years ago. Hardly news. I'm also not based at the Royal London hospital - we have these things we call ambulance stations. And they get the name of the book wrong. So far not exactly quality reporting.

(And why I do have more than one blog, I think they are mixing up 'blogs' and 'posts', which while annoying is perhaps a little petty to bring up)

The ambulance arrived and took the baby to hospital (sorry 'brain bug tot'), the baby didn't travel in the neighbour's car at all.

The implication is that the baby definitely had meningitis (which it didn't) where in the actual article I try to show that it isn't meningitis. Also things have changed for the better and FRUs are waiting on scene for long times a lot less often than when I did it.

I would guess that the News of the World got hold of a copy of my book - reached page four (where this story is printed) and got no further because they smelled something they could get outraged about. Rather than, say, doing some work and seeing how busy the ambulances were that day (three years ago).

While I've never expected quality journalism from the redtops, it still surprised me how easily they twisted the facts to say what they wanted to say, while getting even the basics wrong.

The sad thing is that this sort of coverage will probably make my bosses look a little less favourably upon me, even though I had nothing to do with the paper printing it, or with putting their own spin on things.

Notes on the Nightjack verdict, written in haste, in anger, and unedited (because I'm knackered and I have no time to do it justice. My apologies - I think I made more sense when speaking to a Guardian journalist about it)

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When I started writing this blog I made some effort at remaining anonymous, it wasn't a big effort mind you, but it involved writing under a pseudonym and not shouting about it in the messroom. When my real name was found out I discovered that I was very lucky, that the communications department of the LAS didn't want to come gunning for my job.

There are laws that protect you should you wish to 'whistleblow', if someone is doing something illegal or immoral then you can be protected if you brig it to someone else's attention. Of course, in the real world, that 'protection' is only as good as the lawyers you can hire to fight for those protections.

A lot of what bloggers bring to light is the chronic state of the their day to day life - a classic example would be police bloggers letting us know about how much administration that they must fill in whenever they make an arrest. Part of what I write about is to highlight the flaws in the governmental running of the NHS. Other bloggers do this more than me.

What bloggers do is humanise and explain their section of the world - public sector bodies do well to have bloggers writing within them, after all these are the people who care about what they do, about what improvements should be made and about where the faults come from. They highlight these things in the hopes that, in bringing this information into the public consciousness, they can effect a change that they would otherwise be powerless to bring about.

Anonymity provides a protection against vindictiveness from management who would rather do nothing than repeat the party-line, or lie, that everything is perfect, there is no cause for concern. Having seen management do, essentially illegal things, in order to persecute and victimise staff - anonymity is a way of protecting your mortgage payments.

It is not just for bloggers this protection of anonymity - consider a support forum for people with mental health problems, anonymity allows these user to perhaps be more open, more honest and more themselves then they would do were they forced to reveal their own identities. It is the nature of the internet that our identities are fluid.

Perhaps that can be the Times next 'scoop', tracking down the people behind anonymous forums in the cause of 'public interest'.

Journalists work to protect their sources, some ending up in prison over their refusal to breach the privacy of their sources. This is right and proper.

So - when Judge Eady told the Times that they could breach the privacy of the police blogger Nightjack, it has lead to a very real fear of what this means for the rest of us.

The thought that Nightjack breached laws on writing about criminal cases (when the details are all in the public domain post-trial) seems petty, and if he did indeed compromise trials then why is his force only giving him a written warning rather than prosecuting him?

I won't dwell on the 'public interest' of unveiling bloggers, they have done it before in utterly despicable ways and for some reason it seems to be their 'cause' - were I vindictive I'd be looking into their expense accounts right now for some justified retribution. Or googlebombing them as a bunch of tossers.

Instead I'm mindful that a lot of exceptionally interesting, thought-provoking blogs might now come to an end. What is to stop companies and public bodies from hunting down people who may have been negative about them. What blogger, with bills to pay and mouths to feed, is now going to take the chance of lifting the lid on mismanagement, badly though policies or idiotic governmental decrees when there is the very real chance that their identities can be revealed for nothing more than a lurid headline on someone's chip wrapper.

Why should bloggers put their careers at risk, over subjects that they are evangelical about, when the simpler, safer option is to fall back into the horde of people who grumble under their breath yet risk nothing to change things for the better. The world can then continue with less public scrutiny because people are scared to speak out.

If it is so important to know a bloggers name so as to better judge them as a source, then I think that it is time to do away with the journalistic practice of protecting sources. After all, without producing the source, the journalist could be (gasp) making up lies. I think we should also know, for definite, what enticements a journalist has had to write a piece for a paper - that 'holiday in France' piece, was it 'bought' by the holiday company that receives the good review?

(The answer is that this does go on - I've seen it with my own eyes)

I wonder if Judge Eady reads blogs, or even has any idea what a blog is. I wonder if he has any idea of what a door he has opened for witch hunts and the reduction of our knowledge of public services to bitesized PR fluff. I wonder if he realises that anonymity is one of the strengths of the internet, not a weakness.

And as for the Times - I wouldn't wipe my arse on it.

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I am exceptionally busy this week, with a 60 hour work week, two days of conference and numerous other things dotted around the place. I barely have time to sleep, let alone eat or write.

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Photograph by Robotson licensed under a CC license.

I've been off promoting myself on behalf of my second book. For those that are interested here is my, short, appearance on Sky News.

As I'm speaking I'm sitting in a dark room with two spotlights on me staring at some little red lights and trying not to drool or just sit there with my mouth wide open.

I really wish that I hadn't used the word 'sexy' in relation to trauma...

Also, can I just say that there is something about TV that makes my teeth look like they are arguing with one another, I'm sure they aren't that bad in real life.

I was also in Sunday's Observer.

I was interviewed sitting in a park in Whitechapel, and while the text of the interview is online, only one of the photographs is there. Having my photograph taken by a splendid team made me feel like a rock star.

"Let's try to be charitable," says Reynolds, when I meet him in Whitechapel, where we sit in a park past which he drives on almost every shift (the Royal London Hospital is just down the road). "There are two worlds, really," he says. "There's the world that a lot of people are part of: the world that you are part of. And then there's the world of people who are isolated, socially and financially. How many crack houses have you been in? How many functioning alcoholics do you know? No, the two worlds don't overlap very much, do they?"

Only one small mistake in the article (understandable considering the noise of the park) and that is that Emergency Care Practitioners are the highest trained road staff.
I think that's all the promotion I'm doing at the moment. At least I can't see anything else in my calendar at the moment.
Now I'm working my normal job for pretty much the rest of my week - which makes me happy as it's something that I understand.

As I mentioned in yesterday's post it can be hard to get feedback on the treatment that you have given a patient, was is right, was it the best, was our diagnosis correct?

It was the end of the nightshift, we'd been run ragged all shift without a break and my eyes were hanging out of my head. We were sent to an elderly man who was complaining of chest pain.

It is one of our bog-standard calls - an elderly gentleman of South Asian origin, complaining of something that could be cardiac chest pain. He has a previous history of diabetes, high blood pressure and previous heart attacks. The pain started an hour ago and is one of two things - either his heart or the recent chest infection he's suffering from.

No problem, we wheel him out to the ambulance and start checking his vital signs, pulse, blood pressure, respiratory rate and so on and so forth.

Then we do an ECG, a heart tracing.

I've mentioned before that one of the things that the LAS and NHS in London do extremely well is the diagnosis and care of heart attacks. If the patient is having a heart attack that is detectable on the ECG done by the ambulance crew then, instead of going to the local A&E, they instead head straight to an angioplasty lab where the top level treatment is available.

It works really well and is the thing that the NHS and LAS does that I'm most proud about.

Our patient's ECG was just under the threshold of going directly to the angioplasty lab. In part this was due to the poor quality of the ECG we were able to get. Essentially one heartbeat just about looked like it should go to the angioplasty lab, the next heartbeat looked like it should just about go to the local A&E.

We spoke to the history, did another three or four ECGs and needed to make a decision.

When it comes to the interpretation of ECGs my crewmate tends to look to me - as an A&E nurse I used to do twenty or more ECGs every shift and, because I find ECGs interesting, I used to study each non-normal one that I took. She recognises that I have a lot more experience looking at these things.

Normally I can tell at a glance whether we should go to the A&E or the angioplasty lab.

In this case I wasn't sure.

I squinted and strained my eyes. I took my glasses off. I used a ruler to see what straight lines I could and I used the pattern recognition part of the human brain to try and come up with a decision (for those medically trained, all our ECGs had mildly wandering baselines and I was seeing if the ST segment was elevated by 2mm or more).

The decision that I made was that the patient didn't fit the criteria based on the history and the ECG. But it was pretty borderline. I suspected that a blood test would need to be done and some more ECGS taken at the hospital to be sure of a diagnosis.

So we headed off to hospital, pre-warning them that we were bringing in a chest pain patient.

We were met at the hospital and before we could off-load the patient a doctor who I've only seen once before asked to see the ECG.

"This is ST elevation", she said rather forcefully, "You should have taken them to the angio lab".

"It might look it Doc", I replied, "but the wandering baseline needs to be taken into account".

She grumbled a bit.

We got the patient out of the rain, but the doctor stopped us just outside of the resus room to question us some more.

Essentially she was convinced that we should have taken the patient to the angioplasty lab - I let her know that if she was that sure we could easily load the patient back up and take him there. I'm not too big to admit a mistake and I'd rather the patient get the care that they need rather than massage my ego.

For some reason though the doctor didn't seem ready to commit us taking the patient off to the angioplasty lab on her say so, so we left our patient in the A&E department. The doctor then wouldn't listen to our handover and was generally very rude towards us.

If it had been earlier in the night I may well have been annoyed, as it was I wasn't in the mood to argue. So I let it slide.

But it played on my mind - had I done the right thing? Had I misdiagnosed a patient? Had I taken the patient to the A&E department instead of the angioplasty lab for some ulterior reason?

So I had a bit of a sleepless day, even after examining my role in the care of the patient and so I resolved to find out what had happened to him.

The next day we looked up our patient's notes - turns out that the pain was being caused by his chest infection and that his ECG was 'normal for him'.

So I was happy - I'd made the right diagnosis, I'd treated the patient correctly and I could rest easy knowing that he'd been taken to the right hospital.

Leaving the area where the notes are stored I saw the doctor again, she was writing some notes - I didn't bother her, I'm not about scoring points, even towards people who were quite incredibly rude towards me and my crewmate.

But I will remember it, should she choose to be rude to me again.

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The point of this isn't that the doctor was wrong at the first glance of the ECG, nor that she was rude. The point is that, without that feedback from looking at the patient's notes, I had a sleepless day and would probably still be fretting about it. I think it would be very beneficial if there were a more formal feedback procedure that went beyond making complaints.