It's not May yet, but I'm starting to feel some energy returning to me from over the winter. It's only a little and it's not being directed towards anything useful, but at least it means that the worst of winter is over.

Why do I say May? Well it's when there is a spike in suicides from all those winter depressives finally having enough energy to do something stupid.

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You may ask yourself why I'm thinking about suicide, well it's because of something rather stupid that I did during a recent shift.

We'd been to this house before a week or two earlier - the sole male occupant said that he was depressed and that he wanted to kill himself. We'd gone along and had been sent some police assistance in case the patient felt violent. We knocked on the door and the young man eventually opened it.

We asked if he'd called an ambulance and told us that he had, but had changed his mind because he'd had a spliff and was feeling much better.

I looked at the police, the police looked at me and, deciding that there was nothing much for either of us to do we completed our paperwork and departed.

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This time he'd called 999 and told the calltaker that he had cut both of his wrists and as it involved a knife the police were sent with us again.

We arrived to find the front door open and on entering found our patient sitting on a sofa, smoking a spliff and with remarkably unscathed wrists. No telltale scars from deliberate self harm in the past either.

A knife was sitting on the table next to him so I moved it to another table further away...

...Which had another two knives on it.

And there were knives in the bookcase.

Our patient seemed jolly enough and told us that he wanted to go to hospital - he wanted to go to a specific hospital and, as we were pretty much in the middle of two hospitals we agreed (even though it would take us out of our area).

He walked out to the ambulance and we started our journey.

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We were nearly at the hospital when his phone rang - he answered it and started talking to someone who I presumed to be a friend. He then told the friend that... 'when I get to the hospital I'm gonna cause a load of trouble'.

He hung up and I told him that he should behave at the hospital as not only were they going to try and help him there, but that he was the one that wanted to go - that we hadn't forced him to go.

At this he began shouting at me, which ended with him telling me that he was going to stab me.

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OK, it's here I should have called for police aid, hit the emergency button on my radio or just grabbed my crewmate and escaped the ambulance.

But I didn't.

For some reason, a reason that I can't explain to myself, I jumped up from my seat, stood directly over him and shouted in his face...

'WITH WHAT?'

He looked more than a bit worried.

'See this!', I pulled out my radio and waved it in his face, I noticed with some pleasure that he flinched, 'If I press this button I'll have thirty coppers and half a dozen pissed off ambulance crews coming to help me!'

I sat down and started speaking to him normally again.

'Now either behave yourself, or I'm kicking you off this motor'.

He behaved himself.

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I really have no idea where that stupidity came from, he had a house full of knives and he could well have hidden one about his person - what I did was incredibly stupid, even though it did seem to work.

I don't know - maybe I was tired and my judgement was impaired. Maybe it was the speed of his change of attitude that put me into fight or flight mode, and for some reason I chose fight.

I know I'm not suicidal, but I could have fooled myself there.

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So, I went back to station, filled out the paperwork to mark his address as one that, should we be called, the police should attend (with a little note that if you they are going to transport him, he should be searched first) and a Station officer appeared to check that we were both all right.

I was fine - filling in the paperwork had given me the chance to cook and eat my pot noodle.

"I know you like doing that sort of thing", my crewmate said, "but I can do it this time seeing as you are getting old and fat".

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It was 3am in the morning (as it always seems to be) and we were being sent out of our area, although quite close to where I live, to go and see an elderly woman who had called for an ambulance and seemed a bit confused.

Knocking on the front door I could see a hunched shape moving around in the hallway. It came to the door, fiddled around a bit and then wandered away.

It's more normal that when people call for an ambulance they open the front door for us.*

I tried knocking again - this time the living room window opened and I was suddenly face to face with a little old lady.

"I can't let you in, the door is locked and I can't find a key", she waved her arm at me - even in the dark I could see that it looked like she was sporting a broken wrist. "I know what", she said, "I'll try the back door".

My crewmate and I walked around to the back door where the same event played out. This time she opened the kitchen window.

"Oh dear, this one is locked as well", she said, "Maybe the front door is unlocked".

I explained that she had already tried the front door.

I eyed the kitchen window. It opened pretty wide, I was certain I could climb through it.

"Can you climb in through the window?", asked our patient. Behind me I could hear my crewmate groan. She knows I love climbing over, through and into things.

"I know you like doing that sort of thing", my crewmate said, "but I can do it this time seeing as you are getting old and fat".

Well, that was a red flag to a bull. I had to climb through the window now.

My plan was simple - the patient was obviously mildly confused, I'd nip through the window, find the keys and open the front door to let my crewmate in.

Climbing through the window was fairly easy, and if my crewmate leaves a comment saying that I barely squeezed through and was panting and red faced by the end of it then I would trust you all to ignore her.

Once I was in the kitchen I could give our patient a look over - my suspicions were right in that it looked like she had broken her wrist while climbing out of bed, although my patient couldn't remember falling, her obvious dementia meant that she couldn't remember much.

But she was a nice old stick and we had a nice chat while I searched the house for the front door keys.

I looked everywhere, from where you would expect to find keys to the more inventive places that someone with dementia can hide something (ovens, fridges, teapots) - but no keys were found.

My crewmate had gone to sit in the cab, there was nothing she could do standing around in the cold.

I'd noticed, because I'm funny like that, that there was a 'keysafe' on the outside of the house - this is a little combination lock box that holds a spare set of keys, it's normally used when a person has carers but isn't always able to open the door for them.

"Do you know the code to the keysafe", I asked hopefully, "the little box outside that holds the keys for your carers?"

"I have a keysafe?", she answered, "Sorry love, I've no idea".

I looked in the care notes for an out of hours phone number - surely they would know.

But, of course, the sun had gone down and the 'out of hours' phone number just went through to the normal office phone.

"Our hours are between nine am and five pm.... please leave a message". Considering my shift ended at 7am I didn't fancy waiting that long to get an answer.

So I called up Control on my radio and asked them to try and get in contact with the care suppliers - maybe they could find a different number and ask what the code to the keysafe was.

-----

A little while later Control got back to me - the care provider didn't have the slightest clue about the lady.

So I set about a bit of detective work and found the phone number for our patient's daughter. I didn't really want to ring them (it was about 3:45 by now), but she was my last hope if I didn't want to be stuck in the house all night. While the company was lovely, her wrist really needed looking at by a doctor.

The first ring went to an answerphone, but I know how difficult it is to find your phone when you've been woken from your sleep, so I hung up and dialled again.

This time success!

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Now, one thing I learnt when I was a nurse and was ringing relatives all the time, is that you need to keep them calm and relaxed, otherwise they can think the worst.

"Hello there, this is the London Ambulance Service, I'm with your mother and she's absolutely fine, just a bit of a fall...."

All absolutely true - and it's best to get the 'absolutely fine' bit out of the way before their imagination jumps in with "...and she's dead as a dodo".

I apologised for ringing at that time of the morning and I told her my situation. I was very thankful that she didn't laugh down the phone at me.

Happily the daughter knew the combination to the keysafe, and wasn't bothered by me waking her up at the crack of sparrowfart.

So my crewmate was able to open the box, retrieve the key and then fail horribly at trying to open the front door.

One of the keys fit, but it just didn't turn in the lock...

Thankfully one of the keys fit the back door and we could soon get our patient off to hospital where she was well looked after.

-----

I'm glad that we managed to get the door open, because otherwise it would have needed the police to arrive and rescue me by kicking down the door. Something I could do without...

Sadly, although not unusually, I was let down by the lack of coordination and information from the care team. It really does seem that once the sun goes down and the firefighters all go to bed** it really is just us and the police out there to keep people safe.

But of course, all that will soon change - what with Labour's plans. Why, I fully expect every carer to be bright, determined and committed. Not underpaid, undereducated and uncaring - that would never happen, and certainly never be the norm. I'll tell you what Gordon, Andy, and whoever the Conservatives will have as health secretary - let me come and explain why ambulances count as social care, it was something that your predecessor was surprised to hear from me.

Never mind, I'm sure that the numbers will show that there is more social care - but I bet they won't show the increased ambulance usage because the social care is so slipshod.

What is really sad is that I sometimes see superb social and residential care - it's just that it is increasingly rare.

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*However, I could not count the number of times someone has called for an ambulance, we've turned up four minutes later and on knocking at the door the occupants have asked who it is...

**I do of course jest - they don't go to sleep. They watch porn instead***.

***I love 'em really - mostly because a lot of them look like they box for a hobby and could take me in a fair fight.****

****Especially the women.

A lack of energy from these winter hours, night shifts and a feeling that no matter how hard I shout about things nothing is going to change has meant that I've been lacking the will to write. I keep thinking 'no-one listens', or at least nobody who has any power to change anything.*

What I should be writing about is the private ambulance companies that are being contracted to do our A&E emergency work, which is an incredibly bad idea. I should be writing about the utter tosh calls I've been going on of late. I could even be moaning about how our training day was 'postponed' because there is no-one to train us, and even if there was they have no idea how to train us, or what to train us in.

I'm sure it's just the season and that, come spring and a bit more energy, I will once more be waving my fist at the sky and shouting 'all Gods are bastards', albeit with the same effect that doing that always has**.

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When I get angry I find myself doing two things. First I wave my arms around like an epileptic chicken. There is a simple reason why I do this, it's because I keep raising my hands to hit someone, but then realise that, while enjoyable, it probably wouldn't do much good. I also have worked far too long in emergency medicine to be doing anything stupid like punching a wall.

The second thing that I do is I vibrate. I get filled up with energy and start shaking - first on the inside and then as I get angry the shaking spreads to my limbs.

I also shout a lot. Well... not so much shout as 'talk loudly and firmly'.

I have a long fuse, but a huge explosion.

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Why do I mention this? Well the other night I ended my shift an incredibly angry person.

We had picked up a young woman who was alternating between rolling around the floor and pretending to be unconscious. Her problem was apparently 'abdominal pain', but it turned out to be period pain.

Who am I to judge? Besides, it was nearing the end of the shift so if she wanted to go to hospital we were more than happy to take her.

We should have walked her out, but when dealing with someone suffering from Status Dramaticus it can sometimes be easier to just pop them on the carry chair and wheel them out - especially if they are light. So we did this and as we were about to load her into the ambulance she decided that she didn't want to go to hospital - so this poor flower, who moments earlier was 'unresponsive', undid the seat belt and started walking back towards the house.

I was just about to wave her goodbye when the FRU stepped in and convinced her to go to hospital. I can see the FRU's point, if our patient were to go back home and overdose on painkillers it'd be our fault.

So the patient agreed to come to hospital and I jumped into the driver seat while my crewmate did the things that we do in the back of ambulances.

We were halfway to hospital when the patient took off her seatbelt, threw herself on the floor and pretended to be unconscious again.

-----

We got to the hospital and, expecting the patient to continue the dramatics, I went and got a wheelchair so that she wouldn't have to walk. She stepped down from the ambulance, looked at the wheelchair and, once more, threw herself on the floor. I say 'threw', what I actually mean to say is 'died like an extra in the original Star Trek or Dr. Who series'. You know, 'collapsing' without hurting yourself.

"Why did you do that?", I asked.

"Fuck off", she told me, then stood up and threw herself into the paediatric waiting room where she, once again, threw herself on the floor and acted like she were struggling with death itself.

There then followed a long ten minutes where myself and two nurses persuaded herself to sit her arse in the chair so we could take her around and put her on a trolley. This was accompanied by both swearing and drooling***.

-----

I washed my hands while my crewmate booked the patient in onto the hospital system, and then went to leave.

One of the nurses then turned to me and asked me my name - I know the nurse's face but haven't really spoken to her.

"Why is that?", I asked.

"Because she told me that you called her a nigger", the nurse said - and the way she said it made me think that she believed the patient.

-----

Oh yeah, the patient was black. Didn't really give it much thought until then. After all I can go days at work without seeing a patient that is to be recorded in the great UK ethnic coding database as 'White British', so different skin colours don't hugely register on me.

There are three points I would like to make at this moment in time.

1) I've marched against the BNP. Several times.

2) I don't hate people due to their race or colour or however you want to slice it. I hate everyone. Equally.

3) I may call you a moron, an idiot, a fuckwit, a wanker or an utter... well, you know. I would never use colour or nationality to insult someone - much as I hate hearing kids using 'gay' as an insult. You are what you are and you don't make that choice, so why would I insult you based on that? If I insult you, I'll insult you because of what you do.

What really riled me us was that the nurse seemed to believe the patient.

-----

I think I said something in reply along the lines of, "Excellent - tell her to write a complaint, maybe I'll get suspended with pay, I could do with a holiday". But inside I seethed with anger.

I phoned the on duty Station Officer for advice. He told me that I should go to the police, that I should have a cup of tea, and that there was nothing he could do about it.

What. The. Hell.

No, "Let me come down and see you and chat about it". No, "Let me go and talk to the patient and see if we can sort things out". No, "Don't worry, I'll take a statement from you while it is fresh in the memory".

Nope - cup of tea and call the police if I feel that bothered about it. Oh, and the implied suggestion that I get back on the road within the next 15 minutes.

Thanks for that.

-----

So there I was, stalking up and down the messroom before having to fill out the 'incident report' paperwork with my crewmate.

Knowing, full well, that this is the sort of thing that ends careers, after all remember, I was investigated for a complaint after I told a patient that he slaps like a bitch after he assaulted me.

Racism is, quite rightly, not tolerated in the ambulance service - but is the proof on me to prove my innocence in a 'my word against hers' complaint'? I just don't know.

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As I write this I don't know if a complaint has gone in. Has this malicious liar decided to put pen to paper and complain? Or pick up a phone and ring our 'patient experience' line? I just don't know.

What I do know is that I found it very hard to sleep for the next two nights - not so much because of a fear of losing my job, but because I've put a lot into this job and the people who live where I work. My health is shot to shit because of the rota I work and the patient lifting I have to do. My social life is pretty much non-existant because of those shifts.

And yet - one of the people who I serve, and yes, it is serve, called me one of the things that I hate the most - a racist.

And she did it without thinking, as an easy way to try and get me into trouble.

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My thanks are due to my station mates who were there that morning, firstly for giving me advice about what to do next, and secondly for making fun of me by suggesting that it was obvious that I'd soon be wearing a white hood while erecting burning crosses across East London...

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I almost forgot - the lovely Kal writes a very insightful piece on 'Race Relations' in medicine. Go and read it, then go and read Kal's blog.

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*Brought about, in part by the testimony that Tony Blair gave at the Chilcott inquiry and how he seems to avoid arrest for war crimes. That and if I performed as poorly in my job as many of the people I come into contact with there would be a lot more dead people in London.

**i.e. none whatsoever.

*** Not attractive, and a reason to be wearing gloves.

So it would look like Amazon has blinked first.

On Amazon's discussion board,

“Dear Customers:

Macmillan, one of the “big six” publishers, has clearly communicated to us that, regardless of our viewpoint, they are committed to switching to an agency model and charging $12.99 to $14.99 for e-book versions of bestsellers and most hardcover releases.

We have expressed our strong disagreement and the seriousness of our disagreement by temporarily ceasing the sale of all Macmillan titles. We want you to know that ultimately, however, we will have to capitulate and accept Macmillan’s terms because Macmillan has a monopoly over their own titles, and we will want to offer them to you even at prices we believe are needlessly high for e-books. Amazon customers will at that point decide for themselves whether they believe it’s reasonable to pay $14.99 for a bestselling e-book. We don’t believe that all of the major publishers will take the same route as Macmillan. And we know for sure that many independent presses and self-published authors will see this as an opportunity to provide attractively priced e-books as an alternative.

Kindle is a business for Amazon, and it is also a mission. We never expected it to be easy!

Thank you for being a customer.”

At least now Macmillan and it's ebooks will stand or fail on the pricing that Macmilan chooses to set, as opposed to being forced to set a certain price by Amazon. Although it is interesting to see Amazon try to paint themselves as a victim in all this as opposed to trying to force a monopoly and monopsony in the ebook market.

One amusing part of this message is this.

"We want you to know that ultimately, however, we will have to capitulate and accept Macmillan’s terms because Macmillan has a monopoly over their own titles"

Yes - they have a monopoly over the books that they own - that is, after all, what copyright means.

Which is, of course, completely different to having your books only readable on a Kindle...