Random Acts Of Reality

Mr And Mrs Sundin

Reynolds — Sun, 15 Nov 2009 21:14:17 +0000

A couple of days at work and then two days off where my brain refused to get out of idle means that I've seriously fallen behind schedule for NaNoWriMo. If I don't have the chance to get going then I'm unlikely to 'win'. Still, even if I don't finish the 50,000 words by the end of November, I'm still planning on finishing this thing.

What I do with it once it's written may be something... interesting.

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It would seem that Judith’s lead has paid off, she’s leading be down some cobbled Swedish backstreets to a bar where I’m to meet a family that is dodging their responsibility to the ‘Home Care Plan’. They have a relative that is comatose in hospital and while they should be taking care of him, instead they had sold everything and gone underground.

Judith is ahead of me, and I’m watching her short ponytail swinging left and right in from of me. Every few steps she takes another puff on the cigar that she has clenched between her teeth.

She was late back to the hotel last night, I heard her crashing into the ajoining room at 4am. This morning she smells of sweat, smoke and alcohol. She’s also in a grumpy mood.

“In there”, she has abruptly stopped and started pointing at a tiny ramshackle bar, “I’ll be in later, I just want to make sure that we haven’t been followed. Lots of dodgy bastards around here.”

She then ignores me and pretends to take an interest in the clothing shop opposite the pub, staring deep into it’s large shop window.

I enter them pub and it’s so dark it take a moment for my eyes to acclimatise to the dark. Sitting at a table, a bowl of bacon pasta in front of them are the two people I’m here to see.

Mr and Mrs ‘Sundin’, (not their real name), are essentially on the run from the law.

Every family in Sweden (as in much of the developed world) has a responsibility enshrined in emergency legislation to look after any close relative that becomes affected by CLBD-7. These laws were passed to enable hospitals in countries with socialised medicine to continue providing care for those unaffected.

One year ago Mrs Sundin’s mother failed to wake up from a night’s sleep, since then she has been comatose.

The law says that, once all other causes have been ruled out, the nearest relative takes on the responsibility of caring for that person, be that in their own home or by purchasing private healthcare. Either way the state isn’t going to help you.

The Sundin household is not a rich one, Mr Sundin tells me that he has work as a freelance web consultant and Mrs Sundin gave up her work as a secretary when her mother became ill.

The thought of having to look after her mother filled Mrs Sundin with fear, she tells me, she has had no training in how to care for people and hates the thought of having to spend twenty four hours a day looking after a ‘vegetable’.

She says that she tried, her mother was transported home by ambulance only a few hours after the ‘Home Care Advisor’ had left the family home, the advisor had told Mrs Sundin about pressure sores and cleaning incontinent patients as well as how to change the food bag that led directly into her mother’s stomach. She counts herself lucky that she got that advice as soon afterwards the Home Care Advisory Service suffered a number of cutbacks making people rely on advice from the internet.

After one week Mrs Sundin tells me that she had stopped crying, that instead all her emotions left her and she settled into the routine of turning, washing and, after her mother was incontinent, changing the bed.

She tells me that her home used to smell nice, that it was clean and presentable - but that now it only smelt of urine and shit and talcum powder.

She tells me that when she was working she used to spend time socialising with her work-mates, every Friday the staff at the small insurance office where she worked would go out to a local bar for dancing and drinking. Now, as she was not at work, she never went out except to get shopping.

Two months into the care of her mother and she finally snapped. No-one to turn to, no one except her husband to help, no support from the government all wore down her resolve and she started to make plans to run. She tells me that she no longer saw her mother as her mother, instead she saw her as a lump of meat, there was no spark of recognition. Sometimes her mother would open her eyes and Mrs Sundin would stare into them hoping for some spark of intelligence. But it never happened.

Mr Sundin had made a number of contacts in the internet community so when it came time for them to disappear he knew people that could help them. They sold the house, placing Mrs Sundin’s mother in a short term care facility, they then took the money and vanished.

Mr Sundin tells me that they had to make deals with several people from outside the law. Those are his exact words, ‘outside the law’. These people, and he doesn’t elaborate any further, gave them new identities. Now Mr and Mrs Sudin have new names and a new address, the house that they rent is much smaller and Mr Sudin had to give up his job, the web market is too well connected for him to take his new identity anywhere else. Mrs Sundin returned to secretarial work, although she doesn't attend the Friday night drinks at her new workplace.

Mr Sundin now has work in a postal office.

As for Mrs Sundin’s mother, I cannot say. In Sweden they have large warehouses full of comatose patients, stacked away and looked after by minimum wage carers. The death rates are terrible there, but it is all the government can afford.

Mrs Sundin doesn’t know if her mother is still alive, she knows that she’ll never find out.

If the law ever catch up with Mr and Mrs Sundin they could be put in prison for up to ten years. Mrs Sundin tells me that she would rather be in prison than tied to a house looking after someone who doesn’t recognise her any more, feeling the love for her mother, the woman who raised her, slowly ebb away.

I leave Mr and Mrs Sundin at the bar, nursing their drinks, eating their pasta. Judith is still outside, still smoking the same cigar.

We head back to the hotel.

Sweden

Reynolds — Fri, 13 Nov 2009 10:32:24 +0000

Sweden has long been held as a perfect example of socialised healthcare, that and the UK. I went there to find out how Sweden coped with the first outbreaks of CLBD-7

I’m speaking with a Doctor Anders Kask in a beautiful park. Judith meanwhile is next to some trees aggressively smoking a cigarette while watching some young men play football. She’s got her back to me and I think it’s the first time she hasn’t had her eyes on me. I swear she waits outside the toilet for me to finish, eyeballing the other patrons to see if they are international assassins.

I ask Dr. Kask how the healthcare system of Sweden coped with the early days of CLBD-7.

“Like everywhere else we didn’t know what was happening”, he says in thickly accented English, “People going mad in the streets, emergency rooms filling up with what we thought were psychiatric patients. And of course those who just slipped into unconsciousness.”

For the first time I’ve heard a doctor mention those who died. We are so fixated on those that were left alive we often forget those who died.

“It was the unconscious ones that we tried saving first - it’s all about triage. Triage is this wonderful idea thought up by the French in the first world war. You deal with the most serious life-threatening cases first, then the less serious and finally the walking wounded. We’ve been using it for years and it’s a good way to deal with problems coming in quicker than you can deal with.”

“In an emergency room setting you deal with unconsciousness before you deal with psychiatric problems, the unconscious patient can not wait to be treated. So you put your resources towards helping them while the other patients wait.”

“But there is one part of triage that often doesn’t get spoken about, and that is for the patients for which you can do nothing. You don’t treat them at all. The dead are dead and they remain so.”

“Of course, if we have the resources we attempt to resuscitate the dead - in 2010, the year before CLBD-7 we have a cardica arrest survival rate of 10.7%. Not a good rate, but better than a lot of other places.”

“What we didn’t know was that the unconscious ones were beyond our help. And even if we did know, how could we be sure that it was this new disease and not something that we could assist with?”

“It turns out that of those people showing symptoms of, er, I believe the colloquial is ‘being Clubbed’ around 20-30% would become unconscious, never to re-awaken, another 20-30% would become increasingly violent and the rest would follow normal, if rapid, onset of dementia. Around half of those who became violent, your ‘zombies’ if you will, further progress to a more normal dementia. Those who do not? Well, you have to decide what to do with them.”

But in those early days we didn’t know this, so we would have people brought in by ambulance deeply unconscious, some from stroke, some from diabetes, some from other causes, but a vast majority of them would be due to the disease. We had to treat them all the same, rule out the obvious causes and then find beds for them if they remained unconscious.”

“All the time of course our emergency departments were filling up with deeply psychotic patients”.

“So we were terribly stretched, in a normal week we might deal with three, maybe four or five patients who were persistently unconscious. Those who did remain so would normally go to the intensive care department. The ITU in my hospital has eight beds, and barely enough staff to run those beds. You see, it is not enough to merely have the physical bed, you also need the doctors and nurses and cleaners and all the others to staff that bed. Even working twelve hour shifts you need a minimum of four nurses to look after a bed for a week. And that isn’t counting the cover for annual leave and sickness.”

“And our staff weren’t immune to CLBD-7 themselves.”

I remember when one of our senior nurses was found by his wife unconscious in bed, he was brought in to us and when he was wheeled through the doors it was all we could do not to stop and stare at him. We knew then that the chances of him ever waking up were nearly impossible. We also knew that there were no beds in the hospital, no beds in any hospital.”

“It still shames me that he would be the first person we put on the general wards.”

“Until then, every unconscious patient went to ITU for one on one nursing care, now were were having to use general medical and surgical wards. While the nurses there did their best, they weren’t very well trained in the care of comatose patients. They also didn’t have the staff numbers, one nurse for eight or more patients? How could one person with some untrained helpers look after that many high dependency patients?”

“It started with the sudden deaths of the comatose, we were later to find out that many of these had died from an occluded airway, ‘swallowed their tongue’ if you would. This was because the ward nurses didn’t have the experience of keeping a patient’s airway open, not eight of them at once.”

“Then came the pressure sores, if you cannot move your body then where it touches the mattress, or even another part of the body, the circulation of the blood is restricted and the tissue starts to die. The position of patients should be changed every two hours at a minimum - and it just wasn’t happening, the nurses were too busy. Once a pressure sore happens the skin breaks down and falls away, and then it gets infected and starts to eat away at the patient.”

“I remember one woman who had a tiny spot of a sore on her sacrum, her backside. But the decay went much further, far up along her spine. She had a tunnel, a cavern, running along her back that you couldn’t see. Each day the nursing staff would dress that little spot wound, knowing that there was nothing that they could do for the metre long wound hidden just beneath the skin.”

“The thing I remember most? The terrible smell of infected wounds, Staphylococcus aureus was a big killer in those days and we barely had enough IV antibiotics to give them. After all you can’t give pills to a comatose patient. You would walk onto the ward and the smell would be like a physical wall - I can see why our predecessors thought that disease was carried by smells.”

“So we did our best, until the beds filled up, and then we made more bed, camp beds. Wards that were designed to hold twenty patients would hold twice that number. But the number of staff could not increase, where would they come from? Every country was having the same thing happen. The nurses that we employed from overseas were heading back to their home countries to look after relatives, and that meant our staff numbers dropped even more.”

“And CLBD-7 wasn’t the only disease, we still had people attending hospital with heart attacks, strokes, gall bladder problems - and they all wanted, and needed to be seen.”

“I think the American hospitals had it somewhat easier than us - their insurance companies stopped paying out for CLBD-7 treatment and so the hospitals would discharge them for patients that could pay. I don’t know what they did to those stricken who had no relatives to look after them. I mean, I have heard the stories, the terrible stories of ambulances taking them to places out of the way, under bridges and the like and just leaving them there, but I find it hard to believe that such things really happened.”

“It took us longer. No one in parliament wanted to propose what we knew would have to be done, and sure enough they got voted out the next year - but it saved many lives. The ‘Home Care Plan’ was passed and now anyone stricken who had a family would have to be cared for at home. There were some attempts at training the relatives as to how to look after the sick - but the funding soon ran out and so the information was put on the internet.”

“No one knows how the health service survived. I think that for a little while we just stopped worrying about death, just accepted it and did what we could to prevent it. We aren’t back to pre-outbreak levels, I don’t think that we ever will, but we are slowly recovering.”

I looked over to where Judith and the footballers had been, the field was empty and I couldn’t see Judith at all.

A few minutes later she sends me a text message to tell me to make my own way back to the hotel as she was following a lead.

Two Rumours

Reynolds — Thu, 12 Nov 2009 12:13:24 +0000

A short break from the NaNoWriMo posts so that I can tell you about two rumours that I've heard. Note that these are rumours, if I had the time/energy/inclination I'd check them out to see if they are true, instead I'm just relying on the trust I have in the person who told me them.

If anyone knows if these rumours are untrue, feel free to let me know.*

Rumour number one is that a man from the Department of Health visited the ambulance service recently and told people that the moment the government changes (i.e Britain has a collective brain fart and a memory wipe of the last tory government and votes in the Conservatives) the London Ambulance Budget will be cut by £25 million.

This despite hitting our (stupid and clinically irrelevant) targets, despite ever increasing calls and despite the suspected pigocalypse of everyone calling an ambulance when they thing they have swine 'flu.

Additionally, somewhere out there in 'I could find it if I had the energy to Google it-land', is the government plan that a certain percentage of A&E ambulance work should be done by private ambulance firms paid for out of our budget and you can see that we will be going for the cheapest bid, which is never a good sign of quality.

Oh, and I nearly forgot - we have the Olympics coming up soonish.

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The second rumour is to do with a bit of our kit changing. This rumour however has been repeated by several people, including officers. The rumour is that because too many are going missing we will be doing away with our electronic blood sugar machines which are quick, accurate and easy to use in any circumstance. Instead we will be going back to the old chemical dipsticks that you have to wait two minutes for the result, and the result is a range of values that you read by comparing the colour of the stick to a chart.

Which doesn't work all that well, I think, considering half the time we are working in 'less than optimal' lighting conditions.

Also the dipsticks are also apparently far cheaper. And much less accurate.

Instead money is being spent on filter masks to protect me** from a milder, less fatal 'flu than is normally present at this time of the year.

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So, less money, less effective equipment and more calls. Probably less training due to the lack of money (training is normally the first thing to be cut). I can see us going back to being men with vans and bandages. Except of course that someone in government wants us to do the GP role on the cheap, but without the training is that really safe?

Expect deaths.

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To be honest I'm getting past caring. The few improvements that we've had in the service have constantly been overshadowed by new policies and ways of working that seem to exist only to destroy morale and chase unscientific government targets. We are being expected to do more for a frozen pay and with equipment that is falling apart.***

Why should I care any more? I can't do anything to change anything. Instead I should just turn up to work, pick up people who think that they are sick and take them to hospital. Then come home and watch some TV and forget about the feverish children that I couldn't record a temperature on because we didn't have a working thermometer.

Why should I get angry over it when I can't change it?

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*LAS management don't talk to me, they mostly ignore me, so I don't expect any confirmation/denial. Here is a challenge to my management - deny that either of these rumours are going to happen - here and in public. I'd ask you myself, but the organisational chart is so complex I don't know who'd I'd need to talk to.

**Sadly not only is my face such a strange shape that I can't get a mask to properly secure, but in attempting to get it fitted I managed to break my glasses.

*** An example - We drove the newest ambulance in the fleet, around 1,500 miles on the clock. We had to take it off the road twice in two days for various faults and, looking at the logbook, these were not new problems. Thank you Mercedes.

A Written Statement

Reynolds — Wed, 11 Nov 2009 03:19:32 +0000

I really need to get hold of a proper written statement so that I can make sure the format and language is more realistic, rather than sounding like one of my statements to a coroners court. What this hopefully shows is that the story is not going to be all first person/interviews.

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Personal report of Cpt. P. Almert, Bureau des Impôts 12th March 2011.

On the date in question I was commanding an armed fire-team at Jersey Airport. Our duties for that day were to provide a rapid response to any situation that required a less than lethal/lethal response.

I was initially informed of the incident by officer Tregourny, he had called for general assistance over the radio to the arrivals terminal. As we were nearby I instructed my team that we would provide this assistance.

On arrival to the scene I saw that a number of passengers were bleeding, in the confusion and panic of the public it took me approximately four minutes to reach officer Tregourny. He then indicated two people who seemed to be the cause of the disturbance.

The adult male had gained possession of an asp and was using this to attack member of the public, I later learned that this asp was issued to officer Hawes (deceased).

The adult female was attempting to scratch anyone who approached her, as I watched she removed a shoe and brandished it as a weapon.

At this time I did not see the female child.

As the scene was unsecured with large numbers of the public still present it was my decision to utilise less than lethal options.

Officers Ferruge and Halls advanced upon the two adults and with assistance from the rest of the fire-team subdued the two assailants with incapacitant spray and non-lethal blows and control techniques.

It was then I received a call from our control desk that another attack was happening in the female toilets of the arrival terminal.

As the rest of my team were still dealing with the two adults I made the decision to attend the scene on my own in order to secure the safety of the public. I knew that as soon as the rest of my team were free to assist they would make their way to my location.

I approached the female toilets with my issued incapacitant spray in my hand. From within I could hear the sound of a female screaming.

I entered the toilet and made my way to the end stall. It was there I found the female child biting into an adult female’s stomach. My instant assessment was that the wound that the child had caused was immediately life-threatening.

I shouted a warning at the child and she turned to look at me. Her mouth was covered with blood and in her hands she held viscera of the adult female.

As I prepared to use the incapacitant spray the female child leapt at me and knocked me aside, my spray was also dislodged from my hand.

I was knocked to the ground and the female child turned to attack me again. I was aware that this child had the chance of inflicting serious or life-threatening injuries to me. I was also aware that the attacked female needed immediate medical attention.

I then discharged my pistol into the female child three times, all three rounds striking the child in the chest.

I believe that the female child died immediately from these wounds.

I then radioed my team for assistance and called for immediate, urgent medical assistance for the attacked female.

I later learned that the attacked female died from complications of surgery.

Jersey

Reynolds — Tue, 10 Nov 2009 09:38:03 +0000

Once more I find that I'll be checking some research when I come round to editing this. Right now I'm struggling with SAD. Where I was on schedule two days ago I'm now dropping behind because I'm self-medicating on World of Warcraft which is the only thing that'll get me out of bed at the moment. Maybe I'll get a chunk done later today.

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I got to Gatwick airport for our flight to Jersey with plenty of time, despite my luggage (one carry on and one booked suitcase, plus several pockets full of gadgets) weighing a ton. Judith was waiting for me through security sipping an over priced coffee.

Our flight was due to leave on time so we had time for a breakfast, something light for me while Judith tucked into a plate piled with bacon, sausage and eggs. With more coffee.

The was a joke once upon a time that the safest flight would have an autopilot, a dog and a pilot on the flight deck. The autopilot would fly the plane, the pilot would feed the dog and the dog would bite anyone who tried to turn the autopilot off. It was no longer a joke. Too many planes had crashed when one of the pilots had started showing symptoms of CLBD-7, either the hallucinations or the paranoia. So the new policy for all airlines was three pilots and one autopilot. The autopilot would fly the plane and it would require codes from at least two of the three humans in order to be turned off.

Crashes were now at an all time low.

The few times I’d flown were in the big commercial jetliners, so the little propellor plane that would fly us out to Jersey made me a little nervous, there is something strange about sitting in your seat at the back of the plane, yet being able to see all the way down to the door of the flight deck.

I think that Judith noticed my nervousness and she just grinned and me and told me that we’d no doubt be flying in smaller, and far more rickety planes than this. All I could think of was the comedy films where the hero was flown over mountainous terrain in a plane held together with bailing wire and flown by a crazed lunatic. It didn’t make me feel any better.

The flight was through beautiful weather, looking down and the ground, the cars, the towns, the fields, it all seemed so peaceful - as if there were nothing wrong with the world.

We soon landed at Jersey after Judith took advantage of the duty free to buy a huge bottle of vodka.

The sun was shining and the skies were blue as we cleared customs, it was a scene spoilt by the remnants of the machine gun outposts pointing at the doors of the airport. It was the reason for those that I was here to talk to Ben Slade, who was a Jersey Senator during the early years of the outbreak.

We caught a taxi to his townhouse at St. Heliers.

“We were worried”, he told me after pleasantries were made and tea was served, “We had heard reports of an unusual disease, the same stories we all heard, of people suddenly going crazy, of being overcome with mental problems, of violence and terror. You have got to remember that no-one knew what was happening in those days. We didn’t know that the incubation period was so long. After all we’d just got over the second wave of Swine ‘flu, isolation had worked for us there.”

He was right, in the second wave of Swine ‘flu, Jersey had implemented strict quarantine policies - thermal imaging at airports and docks, reduced internal travel, mandatory health checks for people in certain professions. This had limited the spread of disease in Jersey to minimal levels.

“We thought that we could do the same with this new disease. After all, we’d barely wound down the Swine ‘flu systems so it would be a minimal matter to bring them back into effect. Of course, then we’d had the airport attack.”

“I read the reports after the attack, they said that we were just unlucky, that a family with a predisposition to the disease had all manifested symptoms on the same flight from Russia. I can only imagine what it must have been like, three people running through the terminals, attacking people, biting them. You may ask why our security didn’t shoot them, but can you imagine shooting an eight year old girl just because she is biting people?”

“We weren’t sure that it was the disease at first, but the newspapers got a hold of the story and it was on the front page for several days. That caused panic and the public demanded that we do something. So we got more strict. Tests on people before they could leave the airport. Of course that took time, especially because we didn’t know what we were looking for.”

I interrupted him, “What happened to the people who were bitten?”

“Oh, they were sent to a quarantine camp. Well, the Jersey people were, those bitten who came from other countries were denied entry and sent back to where they had come from. Possibly not a wise idea in retrospect but the officials at the airport were scared, they acted without understanding what had just happened. I think they had seen too many zombie movies”.

“More and more people were being turned away, mostly those with high body temperatures - we didn’t know that this way of screening was useless, and with the frenzy whipped up by the papers about these ‘zombies’, we were forced to do something”.

“And so we closed the ports and the airports to non-commercial traffic.”

“No private citizen would be allowed onto the island, only those with a valid commercial reason, and they would largely be restricted to the ports and terminals. No-one would be allowed to come onto the island to stay. We had been lucky after all, the only cases of CLBD-7 that we had were from those bitten at the airport. There were no cases of infection within Jersey proper”.

“But there were attempts to enter the island, after all, we were famously ‘infection free’, us and Madagascar at least. So people fleeing from France and the UK tried to breach our borders. They would sneak aboard the mail planes, or aboard the container ships brining us supplies. After one or two near misses where someone managed to breach the cordon we put up the machine gun posts.”

“Understand that we didn’t want to do that, we didn’t want to end up shooting people who were just trying to be safe, but you have to remember that we were all scared in those days, we thought that Clubbed was going to end the world, that we’d all be dead, or worse, within ten years. We wanted to to be safe long enough to give the scientists a chance to find a cure.”

“But that day never came. Instead, despite our paranoia, we started to get cases of infection within our borders. We now know that this is because the incubation period was so long, that the infected were already living here before the first symptoms started showing up on the world stage, but that we’d been lucky that in our cases the incubation was very long. I suppose it’s just because we have less people here to be infected.”

“I still remember when the WHO declared Jersey as ‘infected’, all our precautions had been for nothing, the people shot while running for the fences were killed for nothing. The quarantine camps were a waste of time and the endless hours that I and my fellow senators spent trying to protect the people of this island was for nothing”.

I asked him why he stepped down from being a senator.

“You might think that it’s because I was ashamed of what I’d done, the people who we’d killed in an attempt to save ourselves. But it wasn’t, it was much simpler than that - my wife was showing signs of infection and I didn’t want her to go through it on her own, with me away from home for long hours at the States building. So I shucked my duty to the island for the duty of caring for my wife”.