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More Blood, More Sweat and Another Cup of Tea
Tom Reynolds
What happens behind closed (ambulance) doorsMeet Tom, an Emergency Medical Technician for the London Ambulance service. It is Tom who shows up to pick up the drunk tramp, the heart attack victim and the pregnant woman who wants to go to hospital in an ambulance because she doesn't want to call a taxi. Tom is also a man who rails against the unfairness of it all, who bemoans the state of the NHS and who ridicules the targets that state that if the ambulance arrives within eight minutes and the patient dies it is a success and if the ambulance arrives in nine minutes and the patient's life is saved it is a fail.Welcome to the topsy-turvy world of the emergency services. From the tragic to the hilarious, from the heart-warming to the terrifying, Blood, Sweat and Tea 2 is packed with fascinating anecdotes that veer from tragic to hilarious; heart-warming to terrifying and Tom deftly leads the reader through a rollercoaster of emotion.In the brilliant and bestselling Blood Sweat and Tea Tom gives a fascinating – and at times alarming – picture of life in inner-city Britain and the people who are paid to mop up after it.Captures the thrills, heartbreak and frustrations of medicine in a way that resonates with readers around the world.


MORE BLOOD, MORE SWEAT

and ANOTHER CUP of TEA
Tom Reynolds



Copyright (#ulink_f0b49052-844e-5f6a-8b3b-47728ae93c5f)
More Blood, More Sweat and Another Cup of Tea is not authorized or endorsed by the London Ambulance Service. Opinions expressed in this book do not necessarily reflect those of the London Ambulance Service.
The Friday Project
An imprint of HarperCollinsPublishers
1 London Bridge Street
London SE1 9GF

www.harpercollins.co.uk (http://www.harpercollins.co.uk/)
First published by The Friday Project in 2009

Copyright © Tom Reynolds 2009
Tom Reynolds asserts the moral right to be identified as the author of this work

A catalogue record for this book is available from the British Library

All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this e-book on-screen. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins e-books.

HarperCollinsPublishers has made every reasonable effort to ensure that any picture content and written content in this ebook has been included or removed in accordance with the contractual and technological constraints in operation at the time of publication.
Source ISBN: 9781906321406
Ebook Edition © MAY 2013 ISBN: 9780007332694
Version: 2016-08-08

Dedication (#ulink_174827e8-fa15-59c5-814e-cecc72149826)
Without my patients I would not be the person that I am today –and ultimately it is to them that this book is dedicated.

Contents
Cover (#uc185a5d0-38bd-5144-9083-dabdd8336faf)
Title Page (#u305b3239-7931-5df0-8e5b-5030c92105fc)
Copyright
Dedication (#ulink_61d651ac-80f2-544a-b815-0884e21b3ee8)
Prologue: A Good Job (#u24775b21-dff6-5052-8c45-29df57412835)
Introduction
Chapter 1 – Taxi (#ulink_41ce3ae6-44a5-5b40-b9de-4bb70f80e987)
Chapter 2 – Leaving My Job (#ulink_dad078a7-9295-509b-b812-f5871a57fc63)
Chapter 3 – Zafira (#ulink_c235e8a7-8e8e-53f1-81e9-ab6c69d63c69)
Chapter 4 – NYE Night (#ulink_95d4bf97-5325-5c94-a7b8-a627bc9b507e)
Chapter 5 – Ten Deep Breaths (#ulink_83dd1a6b-9433-5465-9eb6-63d3a8ae4c49)
Chapter 6 – Taxi? (#ulink_0c780555-18bb-591e-9d41-3a603b62d2ef)
Chapter 7 – Chickenpox (#ulink_4e2def5f-09d2-57c5-8ea3-db108c0bbce0)
Chapter 8 – Rough (#ulink_0e41e98d-aba9-5229-84da-eadff4b77575)
Chapter 9 – The Black Dog Has Been Taken Outside and Shot (#ulink_895ae710-5254-5c71-8de2-8b6b25f66a6c)
Chapter 10 – Complaint (#ulink_40488f59-0198-5b07-8919-07070ccc958c)
Chapter 11 – Snapshots (#ulink_f1c695d5-3073-5d4c-a347-4fc0be01b939)
Chapter 12 – Repeat Offender (#ulink_9c74eb4f-aefb-5141-b7f1-855de25bfe15)
Chapter 13 – Algesia (#ulink_fd52622b-ea82-5c94-a44a-34c9fda7820d)
Chapter 14 – Back on the Car… (#ulink_989a8aaa-c25b-5550-bf36-1e37402c5a97)
Chapter 15 – Wee-Wee (#ulink_e5bd717e-b2d8-577f-adfe-07c7a77473ca)
Chapter 16 – Swagger (#ulink_c61ad533-3a03-5c4c-b3a3-3bc90dfdd46c)
Chapter 17 – Scent (#ulink_227f5778-317a-5873-a050-12a25e582c23)
Chapter 18 – Betting Shops (#ulink_906bdefd-3692-5cda-8da3-425ed72a6130)
Chapter 19 – It Says ‘London’ on the Side (#ulink_1a815ff6-b5fe-55da-9d1f-90ce696b1dc5)
Chapter 20 – Good Job/Bad Job (#ulink_de2e553f-b388-5866-a8b3-c0f3bfe398f7)
Chapter 21 – Valentine’s Day (#ulink_57332ed2-06d4-523b-aeb0-27ab50d589be)
Chapter 22 – Tagged (#ulink_8b5dee88-7ec1-5cd1-ad90-5be280ecae3b)
Chapter 23 – Lost Words (#ulink_6416cb86-1533-55a2-b5d6-45ce3eb51aeb)
Chapter 24 – Bleurgh (#ulink_58640fda-750a-5d2e-ae15-84e3913e1764)
Chapter 25 – Free-Market Oxygen (#ulink_e17661b8-a116-555a-bc68-a19b73539da8)
Chapter 26 – Uniform (#ulink_c2c42695-9a5b-552f-851f-273fc81870e0)
Chapter 27 – Abuse Your Ambulance Crew (#ulink_73aaea78-6b03-545a-9fc3-61b0b18fd920)
Chapter 28 – Slow Suicide (#ulink_eb7d93f5-bd5a-5190-a16e-0a491527cf7a)
Chapter 29 – I Wouldn’t Trust Them with My Dog (#ulink_ce2f2db4-26cb-5163-8a07-1b57da398ee7)
Chapter 30 – Laughing Policeman (#ulink_706a4884-2aad-5731-8d27-60f53353483e)
Chapter 31 – Structural Collapse (#ulink_e2bde21a-a933-5d97-ad4c-ba5ab089938b)
Chapter 32 – Shorn (#ulink_4e0183c7-911f-54d2-b6b5-371c128e7b33)
Chapter 33 – 12th November 2046 (#ulink_c6df169f-793d-528a-9cb4-6c73c0a67e16)
Chapter 34 – On the Power of Blankets (#ulink_0c7482c0-75c9-53ac-960b-d1a098bec8df)
Chapter 35 – Friday Night’s All Right for Fighting (#ulink_fdd6415e-10d6-56a4-b1f8-092de656004d)
Chapter 36 – Gassed and Splinted (#ulink_b83e53ae-b262-5081-ae91-c56594624295)
Chapter 37 – More Crap GP Work (#ulink_498d10f7-9cbe-5499-a501-27498d76c9b2)
Chapter 38 – Wasting the Time of a GP (#ulink_1fef4ac9-a08f-5b82-abc2-55195b1cc4f7)
Chapter 39 – Small Observation (#ulink_5b564a9b-7004-508e-9fef-33beaef65e39)
Chapter 40 – (Another) Nan Down (#ulink_9183937d-471c-55fb-868c-a004e31c2764)
Chapter 41 – More Madness in East London (#ulink_b740b4b9-228b-5f25-b1e6-3c8189a842c4)
Chapter 42 – Ethnic Relations (#ulink_dba30582-df58-565d-92b1-056e0925b512)
Chapter 43 – Lying to Patients (#ulink_9d61d79d-5c08-5db2-b88f-6bb8d6ad1b67)
Chapter 44 – Patientside (#ulink_a5bd9054-4b4f-5eb6-b0c6-c38185f887c3)
Chapter 45 – Hit and Run (#litres_trial_promo)
Chapter 46 – Happiness Is (#litres_trial_promo)
Chapter 47 – Offering the Chance (#litres_trial_promo)
Chapter 48 – Shaken Baby (#litres_trial_promo)
Chapter 49 – On the Strange Thoughts that Assai I You at Five in the Morning (#litres_trial_promo)
Chapter 50 – Taxi Driving (#litres_trial_promo)
Chapter 51 – An Upsetting Job (#litres_trial_promo)
Chapter 52 – Being Lied to (#litres_trial_promo)
Chapter 53 – Clockwatching (#litres_trial_promo)
Chapter 54 – Thank You Taxpayers (#litres_trial_promo)
Chapter 55 – Helpful Demons (#litres_trial_promo)
Chapter 56 – Absurd Council ‘Thinking’ (#litres_trial_promo)
Chapter 57 – Last Night’s ‘Off Job’ (#litres_trial_promo)
Chapter 58 – Wild Geese (#litres_trial_promo)
Chapter 59 – Why You Should Pull Over and Let Us Pass (Or Hahahahahaha …) (#litres_trial_promo)
Chapter 60 – Arranged (#litres_trial_promo)
Chapter 61 – Sugar (#litres_trial_promo)
Chapter 62 – F-off (#litres_trial_promo)
Chapter 63 – The Standard Weekend Night (#litres_trial_promo)
Chapter 64 – Moped Madness (#litres_trial_promo)
Chapter 65 – Sucking Lungs (#litres_trial_promo)
Chapter 66 – Persuasion (#litres_trial_promo)
Chapter 67 – The Jobs We Do… (#litres_trial_promo)
Chapter 68 – On Dealing with a Brain Surgeon (#litres_trial_promo)
Chapter 69 – Forgetting Your History (#litres_trial_promo)
Chapter 70 – A Warning (#litres_trial_promo)
Chapter 71 – Bloody CPR (#litres_trial_promo)
Chapter 72 – Stabbings and Sex Politics (#litres_trial_promo)
Chapter 73 – New Terms (#litres_trial_promo)
Chapter 74 – Rioting and Waiting (#litres_trial_promo)
Chapter 75 – Not with Your Ten-Foot Barge Pole (#litres_trial_promo)
Chapter 76 – Not All Bad (#litres_trial_promo)
Chapter 77 – Minimalist Blogging #1 (#litres_trial_promo)
Chapter 78 – Minimalist Blogging #2 (#litres_trial_promo)
Chapter 79 – Minimalist Blogging #3 (#litres_trial_promo)
Chapter 80 – Minimalist Blogging #4 (#litres_trial_promo)
Chapter 81 – Minimalist Blogging #5 (#litres_trial_promo)
Chapter 82 – Community Care (#litres_trial_promo)
Chapter 83 – Things that Make Me Want to Go Stabby (#litres_trial_promo)
Chapter 84 – Why I Keep Telling My Mother that I Would Rather Wear Glasses to Work than Contact Lenses—Namely Their Protective Quality (#litres_trial_promo)
Chapter 85 – The Usual Suspects (#litres_trial_promo)
Chapter 86 – Maybe (#litres_trial_promo)
Chapter 87 – Heatwave (#litres_trial_promo)
Chapter 88 – Blue, Blue, Blue and Blue (#litres_trial_promo)
Chapter 89 – Armed Siege (#litres_trial_promo)
Chapter 90 – Working for Your Pay (#litres_trial_promo)
Chapter 91 – Boating (#litres_trial_promo)
Chapter 92 – Intermediate Tier (#litres_trial_promo)
Chapter 93 – Double Fall (#litres_trial_promo)
Chapter 94 – Fall-Not As Given (#litres_trial_promo)
Chapter 95 – Faux Pas (#litres_trial_promo)
Chapter 96 – ‘Cheating’ to Get Care (#litres_trial_promo)
Chapter 97 – Oh FFS! (#litres_trial_promo)
Chapter 98 – Shattered (#litres_trial_promo)
Chapter 99 – Tilt (#litres_trial_promo)
Chapter 100 – The Truth
(#litres_trial_promo)
Chapter 101 – Why Your Train Yesterday May Have Been Delayed (#litres_trial_promo)
Chapter 102 – Three Glass Stories (#litres_trial_promo)
Chapter 103 – Hit (#litres_trial_promo)
Chapter 104 – Allergic Reaction (#litres_trial_promo)
Chapter 105 – After the Epilepsy Comes the Work (#litres_trial_promo)
Chapter 106 – Snails (#litres_trial_promo)
Chapter 107 – Mugging (#litres_trial_promo)
Chapter 108 – Danger Bus (#litres_trial_promo)
Chapter 109 – Dog (Or, Why I Like Animals More than Most People) (#litres_trial_promo)
Chapter 110 – Thursday Night (#litres_trial_promo)
Chapter 111 – Thank You West Ham (#litres_trial_promo)
Chapter 112 – My New Plan for Hoax Calls (#litres_trial_promo)
Chapter 113 – On TV Dramas and Documentaries (#litres_trial_promo)
Chapter 114 – Dotty (#litres_trial_promo)
Chapter 115 – Unknown Aggro (#litres_trial_promo)
Chapter 116 – Church (#litres_trial_promo)
Chapter 117 – Saviour or Service Abuser (#litres_trial_promo)
Chapter 118 – Possession (#litres_trial_promo)
Chapter 119 – The Humanity of the Officer of the Peace (#litres_trial_promo)
Chapter 120 – Abandonment (#litres_trial_promo)
Chapter 121 – Both Boxes Ticked (#litres_trial_promo)
Chapter 122 – Cynical Minds Thinking Alike (#litres_trial_promo)
Chapter 123 – Veil (#litres_trial_promo)
Chapter 124 – A New Kind of Stupid (#litres_trial_promo)
Chapter 125 – Forked (#litres_trial_promo)
Chapter 126 – Hypo (#litres_trial_promo)
Chapter 127 – Parklife (#litres_trial_promo)
Chapter 128 – 9010 (#litres_trial_promo)
Chapter 129 – The Things that We Do (#litres_trial_promo)
Chapter 130 – Helpful Passers-By (#litres_trial_promo)
Chapter 131 – Government Targets (#litres_trial_promo)
Chapter 132 – Hectic (#litres_trial_promo)
Chapter 133 – Beaten (#litres_trial_promo)
Chapter 134 – Beaten II (#litres_trial_promo)
Chapter 135 – Inter-Service Relationships (#litres_trial_promo)
Chapter 136 – Ghosts of the Past (#litres_trial_promo)
Chapter 137 – Pitch Black (#litres_trial_promo)
Chapter 138 – Google Health (#litres_trial_promo)
Chapter 139 – Another Monday Night (#litres_trial_promo)
Chapter 140 – Is It Wrong? (#litres_trial_promo)
Chapter 141 – The Right Choice (#litres_trial_promo)
Chapter 142 – The Slow Attrition of the Soul (#litres_trial_promo)
Chapter 143 – Knee (#litres_trial_promo)
Chapter 144 – Extended Role (#litres_trial_promo)
Chapter 145 – The Stanford Experiment (#litres_trial_promo)
Chapter 146 – Da Boss (#litres_trial_promo)
Chapter 147 – Standing Back (#litres_trial_promo)
Chapter 148 – Two in Two Nights (#litres_trial_promo)
Chapter 149 – MHU Transfers (#litres_trial_promo)
Chapter 150 – No Boom Today, Maybe Boom Tomorrow (#litres_trial_promo)
Chapter 151 – A Little Good (#litres_trial_promo)
Chapter 152 – Anger (#litres_trial_promo)
Chapter 153 – A Night on the FRU (#litres_trial_promo)
Chapter 154 – Attention (#litres_trial_promo)
Chapter 155 – Meal-Breaks (#litres_trial_promo)
Chapter 156 – Battered (#litres_trial_promo)
Chapter 157 – The Long Job (#litres_trial_promo)
Chapter 158 – Christmas (#litres_trial_promo)
Chapter 159 – Man Down (#litres_trial_promo)
Chapter 160 – Pre-Christmas Crisis (#litres_trial_promo)
Chapter 161 – Bus/Follow Up (#litres_trial_promo)
Chapter 162 – Curse of the Observer (#litres_trial_promo)
Chapter 163 – His and Hers (#litres_trial_promo)
Chapter 164 – On the Possible Causes for a Collapse (#litres_trial_promo)
Chapter 165 – Non-Carers Who Care (#litres_trial_promo)
Chapter 166 – Canvas, with Handles (#litres_trial_promo)
Chapter 167 – Essex Boy (#litres_trial_promo)
Chapter 168 – Parents (#litres_trial_promo)
Chapter 169 – A Query on a Phone Call (#litres_trial_promo)
Chapter 170 – Wheelchair (#litres_trial_promo)
Chapter 171 – More of the (Shameful) Usual (#litres_trial_promo)
Chapter 172 – Violence (#litres_trial_promo)
Chapter 173 – Increasing Calls (#litres_trial_promo)
Chapter 174 – Mr Grumpy (#litres_trial_promo)
Chapter 175 – Yellow Card (#litres_trial_promo)
Chapter 176 – Fat Bastard (#litres_trial_promo)
Chapter 177 – On the Failings of My Stab Vest (#litres_trial_promo)
Chapter 178 – Broken Finger (#litres_trial_promo)
Chapter 179 – Returnee (#litres_trial_promo)
Chapter 180 – Another Good Job (#litres_trial_promo)
Chapter 181 – Infested (#litres_trial_promo)
Chapter 182 – Small Annoyances (#litres_trial_promo)
Chapter 183 – Friday (#litres_trial_promo)
Chapter 184 – The Same Old Story (#litres_trial_promo)
Chapter 185 – Yellow (#litres_trial_promo)
Chapter 186 – Hive Mind (#litres_trial_promo)
Chapter 187 – From Sun to Scum (#litres_trial_promo)
Chapter 188 – More Real Work (#litres_trial_promo)
Chapter 189 – More Strokes (#litres_trial_promo)
Chapter 190 – Midwife to Tragedy (#litres_trial_promo)
Chapter 191 – Rat Poison (#litres_trial_promo)
Chapter 192 – Filth (#litres_trial_promo)
Chapter 193 – Why I Like Old Folk (#litres_trial_promo)
Chapter 194 – Cordoned Off (#litres_trial_promo)
Chapter 195 – Invisible Dogs (#litres_trial_promo)
Chapter 196 – Why the Government Hates Us (#litres_trial_promo)
Chapter 197 – Thanks to a Bystander (#litres_trial_promo)
Chapter 198 – Smoky (#litres_trial_promo)
Chapter 199 – How to Fix the Ambulance Service (Part One) (#litres_trial_promo)
Chapter 200 – HOW to Fix the Ambulance Service (Part Two) (#litres_trial_promo)
Chapter 201 – Hidden Abuse? (#litres_trial_promo)
Chapter 202 – The Term of the Day (#litres_trial_promo)
Chapter 203 – A Good GP (#litres_trial_promo)
Chapter 204 – Twit One and Twit Two (#litres_trial_promo)
Chapter 205 – Two Amusing Things (#litres_trial_promo)
Chapter 206 – Deceased (#litres_trial_promo)
Chapter 207 – Fuming (#litres_trial_promo)
Chapter 208 – Night Swimming (#litres_trial_promo)
Chapter 209 – A Sheet of A4 (#litres_trial_promo)
Chapter 210 – Tough as Old Boots (#litres_trial_promo)
Chapter 211 – Strength (#litres_trial_promo)
Chapter 212 – Lexicon of the Ambulance Service (or What ‘Punter’ Means) (#litres_trial_promo)
Acknowledgements
About the Author
Also by the Author (#litres_trial_promo)
About the Publisher (#litres_trial_promo)

Prologue: A Good Job (#ulink_c67e21e4-d531-5c51-96a8-36ed153926d2)
Two a.m. and we are standing on the side of the road waiting for the fire service to take the top off the car in front of us. The wind whistles across the flats making us all shiver despite our fleeces and our jackets.
Two cars have been involved in a high-speed road traffic accident (RTA), the parked car that was hit has been shunted forward leaving ten-yard-long skid marks. The cars aren’t too damaged but the seats inside have shifted around, trapping the occupants.
There are seven ambulances here, four fire trucks, half a dozen police and three ambulance officers with clipboards. There are eight patients, all but one need cutting from the cars and collaring and boarding. The only woman involved is ‘walking wounded’.
The reason that it is taking so long for our car to get its lid removed by the fire service is because of the position of one of the patients inside. He looks rather unwell and the crew looking after him really would like to get to him sooner rather than later.
Our ambulance was fourth on scene. When I arrived I spoke to a stationmate to see what he wanted us to do, who he wanted us to look after. Normally he is the station clown, now he’s all serious and professional, no fake beards or silly glasses.
Everyone gets checked over, all the ambulance crews are calm, it’s serious but it doesn’t look like anyone is about to die; more a case of being careful moving the patients ‘just in case’.
The roof comes off the car and with the help of another crew and some firefighters we get our patient out safely and strapped to a board. He is freezing cold. He is not wearing warm clothing so the delay in getting him out and the terrible weather have us concerned for his body temperature.
We are in a new ambulance so the heater works. Turning it up to full we are soon sweating as we assess the patient and prepare for transport.
I get on the radio to pre-alert the hospital. For some reason the radio isn’t working properly and our Control can’t hear me, so I use my phone instead. Thankfully it works.
I travel a mile over speed-bumps to get to the hospital; there is no other route and every bump makes me aware of my patient in the back being jostled around. It’s not the first time that I curse the council.
After all our patients are safe at the hospital we stand outside and laugh and joke. We reconstruct the accident, we talk about the more injured ones and we mock the driving skills of one of the officers.
We occasionally help people.
It’s a good job sometimes.

Introduction (#ulink_b978fa46-02bc-5882-a7aa-dbd3d12da9d4)
I’m not special. All I am is one of the faceless people who work for an ambulance service. If you are lucky you’ll never meet me in a professional capacity. Most of the time you won’t even think about us; perhaps only occasionally sparing a thought for our work when an ambulance whizzes past you on the street, lights flashing and sirens sounding.
This book is a series of snapshots from the life of one ambulance worker. For the past few years I have been writing about ambulance work on the internet, regularly updating my website. From around the world people have come to read, and comment on, the sorts of jobs that I go to on a daily basis.
This book is not special—there are no tales of heroics, no exciting derring-do, nothing to compare with what the dramas on TV and film would have us believe. This is what ambulance staff the world over deal with day in and day out.
This is a book that lets you understand some of the situations that ambulance staff encounter every day, some of the pressures, and some of the humour that we use to let off steam.
Every time I talk about a patient in this book that situation has happened for real, to a real person.

Taxi (#ulink_14541dc0-c4c0-5061-a092-5a7d9577ea0b)
The staffing of ambulances at the moment is…to put it bluntly…poor.
Working on the fast response unit (FRU—a car that is designed to get to the sickest patients quickly) means that I often get to an emergency call within minutes of it being made. Unfortunately, with so few ambulances on the road, the patient and I are often left staring at each other for long periods of time; in a couple of cases up to an hour.
I was sent to a young man having an asthma attack. It was late at night, and he had been queuing to get into a nightclub when he had started to feel his breathing getting tight, the sign of an asthma attack, so had headed to a taxi office in order to go home. Unfortunatel, his asthma progressed and so an ambulance was called. What he got was me, on my own, in a car.
After dealing with the drunken group of teenage girls that had taken time out of waiting for a cab to start loudly ‘caring’ for my patient, I started my assessment. It was a cold night so I sat the young man in the taxi office and listened to his chest. I could hear a nice loud wheezing from his lungs so I started him on the first dose of our asthma medication. I got his details and checked his vital signs, and waited for the ambulance to turn up.
It takes between five and ten minutes for the asthma medication to finish, and by the end of it there was still no ambulance.
I listened to his chest again, still an audible wheeze, so I gave him a second dose of the medication. So there he was, sitting in a cab office at three in the morning with a mask over his face, ‘smoke’ pouring from it, and all around us were intoxicated people getting cabs home.
It was not very dignified.
We started chatting, and I was impressed by this polite young man with good manners and common sense. The second medication finished and so we continued to wait, and wait, and wait for the ambulance. I phoned up my Control and asked if there was an ambulance assigned.
‘Sorry EC50, we are still holding calls in that area.’
I was on my own with this patient for the foreseeable future.
Sometimes I can transport a patient myself to hospital, it’s not technically allowed. Actually, we’ve been told that we shouldn’t do it at all, but in some cases I think I’m doing the right thing for the patient. So I will load them into the car (which only has the front passenger seat, the rest of the car is taken up by equipment) and nip into the nearest hospital. Control is often happy for me to do this, as it means one less job that it needs to send a proper ambulance to.
I couldn’t transport this patient, though, because he wanted to go to his local hospital, which would mean driving past two other emergency departments and out of my area. I couldn’t see Control, or my bosses, being too happy with that.
So the patient, at his insistence, got a cab to hospital. The double dose of medicine had cleared his lungs up nicely, but he would probably need some short-term steroid treatment. I rechecked my assessment of him, and was happy that his physical condition was good enough for him to get a cab to hospital. I wasn’t happy, though, that there was no ambulance for this patient who actually warranted one.
As I write this I wonder what would have happened if he hadn’t responded to the medication that I gave him.

Leaving My Job (#ulink_84fb56fb-139e-5e3e-ac0a-3a07bd13c760)
I think I’m going to be leaving my job soon.
I went to a six-month-old baby with possible meningitis. The baby had the right sort of rash (although it was only on the back of the knee and, after checking, nowhere else). It had a temperature, but was one of the happiest, most alert children I’ve ever had the pleasure of meeting. It just didn’t seem as if it had meningitis, and trust me, I’ve seen a fair few children and adults with it so I have a pretty good idea what it looks like.
Then, as in the past, I was left waiting for an ambulance.
For around 45 minutes.
There was no way I was going to be able to transport the patient in my car. It’s just not equipped to carry such a small child. We don’t have baby seats and as the family didn’t have a car they didn’t have one either.
So the family ended up phoning a friend to take them to the hospital. The ambulance turned up just as they were getting into their friend’s car.
All I had going through my head was the potential newspaper headline ‘No Ambulance For Baby Dying Of Killer Bug!’
Later that night I went to a woman who was having an extremely painful miscarriage. There is nothing I can do for that on scene, the patient needs to be in hospital. Thankfully the ambulance wasn’t too far behind me, but if I had been waiting on scene then it would have been a very awkward and distressing wait (again, because of the pain, it would have been impossible to transport her in my car).
More and more I’m looking at my watch as an ambulance fails to arrive. It’s only a matter of time before I have someone die in front of me while waiting for an ambulance.
So, I’m seriously considering leaving the FRU and going back to work on an ambulance. That way I can pick up sick people, and take them to where they need to be: a hospital.
So after the holiday season, I think I’ll be sending a memo up to the office asking to return to my ambulance role.

Zafira (#ulink_0a0a5edd-12e1-56ed-8527-c43c6bf77014)
I’m not perfect.
I arrived at work to find that my FRU car was nowhere to be seen. There was no one on the early shift, so where had my car got to?
The week before a friend of mine had had an accident in the Newham FRU car (in front of a load of police officers, which had given them some amusement I would imagine). So the car that I would normally use was being borrowed by Newham station.
So the plan was for me to get picked up at my station by a station officer, go to Newham, get the keys to the brand-new Vauxhall Zafira, return to my station with the car and start working.
The station officer met me and drove me down to Newham station. He asked me, because I was leaving my secondment on the FRU, if I could write up my thoughts on what was good, bad and what could be improved about it.
I told him that I’d be more than happy to point him in the direction of where my thoughts lay.
The brand-new Zafira was parked in the garage at Newham so I hopped behind the wheel and, after some struggling with the new design of handbrake, managed to reverse it out and into the parking area.
Where to the absolute horror of the station officer I drove into another car.
Oops.
Luckily there was no damage to the Zafira (which had less than 600 miles on the clock) and very slight, if any, damage to the other car.
The first accident I had in over 18 months and it was in front of a station officer…
Not a good start to the shift.
My thoughts on the Zafira are these; if you wanted a rapid response vehicle, the Zafira shouldn’t have been chosen. It is too top heavy and wallows like a hippo in thick mud. The acceleration is awful, you hit the pedal and it takes one and a half seconds before the diesel engine gives you any sort of power. It is comfortable to pootle around town in, and the high-up viewing position is quite nice.
But there is no way that it could be considered a ‘Fast’ car.
I think the reason why we have them is because they are able to carry patients, and I imagine that soon FRU drivers will be asked to take the coughs and colds that we see so much of to hospital.

NYE Night (#ulink_2ea4fc7c-1e33-5dbf-963a-d2dc4ff3c316)
New Year’s night was a busy one for the London Ambulance Service. There were 38 stabbings over the course of the night. I spoke to my workmate who was on the FRU that night; he attended four stabbings one after another.
By 5 a.m. there had been in excess of 2000 calls (we normally do a shade under 4000 calls over 24 hours).
On the television one of our top-ranking management people described the night as ‘horrific’, which I would say is a pretty fair assessment.
I am extremely glad I wasn’t working that shift.

Ten Deep Breaths (#ulink_46e6b6d0-4402-5b60-9935-31e9f61cebe4)
The call details appeared on the computer terminal in the FRU:
‘Nineteen-year-old male—Patient has lump on ribs—difficulty in breathing.’
Halfway to the address, a private house, my screen was updated:
‘Patient has taken cocaine.’
I was met at the front door by a young male, stripped to the waist and obviously agitated.
‘Comein, myribsfeelfunny, andmyshoulderbladedon’tfeelright.’
‘Slow down,’ I said, taking his pulse—110, a bit on the high side, but he was bouncing off the walls.
‘My ribs man! They don’t feel right! Have a feel.’ He then started running his hands up and down his chest.
‘Have you fallen over? Been hit? Anything unusual happened?’ I asked.
‘No man—just feel them…FEEL THEM!’
‘Look, you need to calm down,’ I replied. ‘I can’t do anything while you are hopping all over the place.’
He started shouting, ‘FEEL THEM! JUST FUCKIN’ FEEL THEM!’
He turned his back to me, indicating that I should feel his normal-looking ribs.
A sudden wave of anger passed over me—it was all I could do to not punch him in the back. I examined his ribs; they felt perfectly normal to me.
‘There,’ I said, ‘your ribs are fine.’
‘What about my shoulder blades man?’
‘Look, you’ve taken cocaine right? You are feeling paranoid, it’s normal, just try to relax a little.’
‘WHAT…ABOUT…MY…FUCKIN’…SHOULDER BLADES!’
He turned his back on me again. I gritted my teeth and grabbed his shoulder blades. ‘They are fine. Now. Sit. Down.’
He sat down. Then he stood up, then he paced around the kitchen, then he did a few circuits of the sofa, then he sat down again, then he stood up and hopped around a bit. I was getting tired just watching him.
‘Look,’ I said trying to calm him, and me, down, ‘is this the first time you’ve taken cocaine?’
‘No man!’
‘OK, well if you want we can take you to the hospital, get you checked out if you’d like?’
‘NO!’ he shouted. ‘I’m not going to hospital.’
Fine, I thought, not that the hospital will thank me.
‘OK mate, then are you alone in the house?’
‘Nah, my dad’s asleep upstairs.’
‘Well, I’d like to have a chat with him, so he can keep an eye on you.’
‘NO! Get out of my house.’ He started advancing towards me. ‘No hospital, no waking my dad up, just get the fuck out of my house!’
I left the house. While a fight with the patient would have done absolute wonders for my stress levels, it certainly wasn’t worth the hassle, the risk of injury and, most importantly, the paperwork.
But what should I do now? If a patient isn’t transported then we should leave a copy of our patient report form with them. Should I post it through the letterbox? The problem with that was if his father saw the report I’d be breaching patient confidentiality. I guessed that the police wouldn’t be too interested in paying him a visit either. So I left the form sitting in my car—there was little else I could do for him, as he didn’t want help.
I sat in my car, filled out my forms and took a couple of deep breaths. It would be a long Christmas…

Taxi? (#ulink_03c71ebb-32d0-57a7-9646-556c8b85c368)
I’ve had a couple of people send me a story that appeared in the newspapers.
Nursing staff from a Telford hospital have been accused of using an ambulance as a taxi after a night out.
It was claimed some of the nursing staff got into an ambulance outside The Swan in Ironbridge on Sunday.
The ambulance service has found a crew did provide unauthorised transport to staff but said it was not in operation and returning to base at the time.
To be honest this tends to happen a bit with nurses asking if you can give them a lift to the train station and the like. You tell the nurse ‘Hop in the back, we’ll give you a lift—if we get a call you’ll have to hop out again.’ It helps keep relations good between the hospital staff and ourselves. It doesn’t hurt anyone and it definitely doesn’t remove an ambulance from service.
In fact, it can do good. A crew I know was giving a nurse a lift to the train station after her shift finished when they then got a call to a cardiac arrest and the nurse was able to help out. As long as the crew wasn’t refusing calls then I can’t see the harm in it. In London I’d imagine that our Control would love it as it would mean we are out roaming rather than sitting on station, something our management is eager for us to do.
And if I’m going to spend all shift taxiing drunks around, I don’t see why we can’t sometimes help out the poor buggers who work their fingers to the bone looking after those same drunks.
I wonder if the person who complained is the sort who expects an ambulance to turn up seconds after they’ve cut their finger?

Chickenpox (#ulink_1918193a-1e09-53cd-904c-3ccbb1babf93)
I went to two cases of adult chickenpox last night. The hospital says that there was another adult with chickenpox the day before that. It seems like we have a little outbreak here.
As both my patients were Nigerian, I have a sneaky feeling that the big (mainly Nigerian) church in Newham may be where the disease was spread and the timing of the symptoms would support this.
As one of the families had school-age children with the disease, I’m going to guess that a lot of children will be ill over the next few days.
Off the top of my head, I can’t remember if I have been vaccinated against chickenpox—but I do know that I had it twice when I was a child, both times at Christmas.

Rough (#ulink_0edff383-a604-5f56-a104-27f8d8995c80)
It was cold, it was dark and it was raining the sort of thin greasy rain that soaks straight through your clothes. I was making my way to one of the Docklands Light Railway stations for a ‘Male—collapsed, caller not willing to approach patient.’ I’d been to this station in the last week for a hoax call and I wasn’t sure if this was a repeat performance.
At the bottom of the stairs just sheltered from the rain was a young man in his twenties, dirty, dressed in filthy clothes and curled up next to a plastic bag. Standing over him was another man, this one dressed in a suit, looking a bit concerned.
(The London borough of Tower Hamlets has both the richest, and the poorest population in London.)
‘He’s just laying there, not talking,’ the smartly dressed man said. ‘I didn’t really know what to do…’
I let him know that I’d take care of the patient, and that he had done the right thing and could go home.
It was just me and the patient. Given the way he looked it was a reasonable assumption that he was homeless. If he was homeless then there was a reasonable assumption that he was drunk and given that he was in such a public place there was a chance that there was something physically wrong with him.
I attempted to wake him up—he was keeping his eyes closed when I tried to open them, so I knew that he wasn’t really unconscious.
‘Look mate,’ I said, ‘if you don’t open your eyes, I’ll have to check your blood sugar, which means poking a needle into your finger. If you open your eyes then I won’t have to do that.’
No response.
So I checked his blood sugar along with the rest of his vital signs; everything was fine.
I crouched down opposite him.
‘Look, you can open your eyes and talk to me you know—we’ll still take you to hospital. To be honest, I can’t blame you, an A&E waiting room has got to be a pretty good option on a crappy night like this.’
Some commuters walked between us; they didn’t look at us. I looked in his plastic bag; there was a sociology textbook.
‘Sociology? I could never enjoy reading that sort of thing.’
He opened his eyes. ‘’S’ all right.’
Excellent. He was talking to me, which meant that the paranoid voice in the back of my head telling me that he might be seriously ill could shut up. It is something that always worries me—that despite my experience I’d miss something serious on a drunk or homeless guy.
We had a little chat while I was waiting for the ambulance to arrive. He’d been a rough sleeper for two years; he admitted to drinking too much. He seemed a nice enough person.
‘Bloody freezing tonight,’ I said to him. ‘I reckon the hospital has got to be a fair bit warmer and drier tonight.’
‘I don’t want to go to hospital,’ he said back to me.
I was surprised. ‘Are you sure mate? It’s no skin off my nose if we take you in.’
‘Yeah, I’m sure. I’ve just had too much to drink.’ He mentioned a hostel nearby. ‘Which way is it from here?’
I pointed him in the direction of the hostel and he wandered off down the road.
I’ve got to admit that I felt sorry for him. I didn’t know why he was homeless, and I’m not a strong believer that all homeless people are victims, but because I’d sat and spoken to him, because he hadn’t tried to hit me and because he seemed like a reasonable person I felt some sympathy for him. He must have made some sort of impression on me as I can still remember the job six weeks after it happened.
Maybe I’m just getting soft in my old age.

The Black Dog Has Been Taken Outside and Shot (#ulink_3024563e-ea35-5ba5-b0de-e1e5f9445b7a)
I left work this morning with a song in my heart and joy in my step; last night was my final shift on the FRU car.
No longer will I be standing around with my hands in my pockets for 45 minutes while a six-month-old child lies in front of me with possible meningitis. No more will I be told by Control to go and drive around and look busy when there is something good on telly, and no longer will my only conversation with people consist mainly of ‘Where does it hurt?’ for twelve hours straight.
The letter that I wrote my boss telling her that I wanted to come off the FRU takes effect from Friday. I’ll soon be back to working on a ‘truck’, a nice big person-carrying medical-taxi truck.
Lovely!
I was hoping that this last shift would fly by in an exciting cascade of trauma, life-saving and dramatic illness.
Ahem.
It was actually a fairly quiet night. I did seven jobs, four of them being people with coughs (one cough having lasted three weeks before the patient decided to call an ambulance at five in the morning). My last call was to an elderly gentleman with emphysema (and a cough) who actually needed hospital treatment.
However, my first two calls were to drunks.
My second job was a ‘classic’—‘Male collapsed in street, unknown life status—caller refusing to go near patient or answer any questions.’ So I rushed there and found two female police officers standing over a drunk male who was asleep in the street. I did all my normal checks to make sure that he was only drunk (as opposed to being drunk and in a diabetic coma, drunk and has had a stroke, or drunk and has been stabbed). Everything pointed to him being just drunk.
We woke him up and were prepared to send him on his way. He stood up—took one look at me, and smacked me in the mouth.
I ‘assisted’ him onto the floor. The police officers and I then stopped him from injuring himself by sitting on him in a professional manner.
The police have been trained in restraint—they are all careful because they don’t want people dying of positional asphyxia. I haven’t been trained in restraint (well, not in the ambulance service) but I’m guessing that someone isn’t going to die because I’m kneeling over their arm while holding their wrist.
So we carefully restrained him (for around 25 minutes), while he explained how he was either going to kick my head in or sue me. By then the police had tracked down a, now mortified, relative who came and took him away.
No damage done to me, although I would think that as he wakes up this morning he’ll have a number of bruises. I hopped in my car and told Control that I had been assaulted twice in two jobs, so I asked if I could head back to the station for a calming cup of tea, which they allowed. They also made sure that I was all right and didn’t need any other help.
When my mother found out about my being assaulted, did she ask how I was? Did she ask if I had been hurt or damaged?
No.
Her comment was, ‘At least you’ll have something interesting to blog about.’
Bloody lovely that is…

Complaint (#ulink_40459158-787f-5375-b460-84e19a587a95)
It is a constant danger in this job that a patient, or more likely a patient’s relative, will make a complaint against you. While a member of the public can moan about a perceived insult (and half of the complaints against the ambulance service are due to ‘attitude’), there is little that we can do about a patient who is generally acting like a twit.
I have been pretty lucky in my career in that I’ve only had two complaints made against me: once while a nurse and once while working on the ambulances.
The nursing complaint was that I checked the correct dosage of a drug with another nurse before giving it to a child. For some reason this person had decided to complain about me for following the sensible rules laid down by my superiors. My boss at the time called me into the office, patted me on the head and told me I was a good boy and should keep up the excellent work.
The ambulance complaint went to a local investigation.
I was called into the office and asked if I remembered calling a patient a ‘bitch’. As I have a poor memory I didn’t remember until the ambulance officer gave me the paperwork for the job.
We had been called to a patient who had been arguing with his family, he’d drunk a bottle of wine and pretended to be unconscious. As he didn’t want to ‘wake up’, we decided to take him to hospital. While in the back of the ambulance he slapped my leg.
I told him that he ‘slapped like a bitch’ and that he really shouldn’t do it again or I might get upset.
I know, not the best insult in the world. He’d surprised me and I had to come up with something witty on the spur of the moment. If he’d hurt me then I would have thrown him off the ambulance, but as it was such an ineffectual strike I found it more amusing than anything else.
The officer had to investigate the allegation so he interviewed the other staff present and they supported my side of the story. He then had to travel to the patient’s home and interview him there. Luckily the officer saw the character of the patient and convinced him not to go any further with the complaint.
If I’d complained to the police it would no doubt have been considered ‘not worth prosecuting’ by the CPS, but if the patient had continued to complain I could have been seriously disciplined.
All of which only makes me think that I shouldn’t leave any witnesses alive…

Snapshots (#ulink_5b6d28f8-0f5d-5be8-96ab-5392ed56a448)
…We get the call to the RTA, a car has crashed into a bus; normally these things are ‘nothing’ jobs. We put on the blue lights and head towards the crash…
…The radio bursts into life, there is an officer who ‘lucked’ onto the scene—he tells Control that he needs a lot of ambulances, the fire service and the police. The injuries are all serious. We wonder if he is talking about the same crash we are going to…
…We crest the hill, with one look at the car and the bus we know it’s going to be serious…
…I jump out of the ambulance and head to the car; I ask the officer what he wants us to do. He tells me that we can’t wait for the fire service to arrive to cut out the first patient as his breathing is so ragged. We agree that he needs to be out of the car immediately and that a possible neck injury is a low priority…
…We get him out and I watch as he takes his last breath…
…We work on him; he is so young we have to make the attempt. The DSO (duty station officer) and other FRUs work on the other people in the car…
…He is lying lifeless in my ambulance and the BASICS doctor declares him dead—then we rush off to the next casualty…
…This one gets sedation. I write the dose and time on his chest so that the information doesn’t get lost in the chaos. Another ambulance crew speeds him to hospital…
…The next one is declared dead as the firefighters cut him out…
…The other dead man is left in the car, there is nothing to do for him, it will be some time before the firefighters are able to free him…
…I check on the people in the bus, there are some injuries that will need hospital treatment. I’m trying to keep them calm and relaxed. My crewmate and I move from our ‘all-business’ personalities to our ‘reassurance’ ones in the time it takes us to walk to the bus. I deal with the multiple casualties one at a time, my crewmate helps me out…
…My ambulance becomes a mobile mortuary; the police are checking for identification. The blood is pooling on the floor…
…I’m sitting on the back step of the ambulance, two of the dead are in my ambulance; one, wrapped in a sheet, is at my feet. We are waiting for the undertaker…
…The police investigation team is chalking the outlines of vehicles and taking photographs of the scene…
…My paperwork is done. It seems like such a little bit of writing for such a serious call where three men have been killed…
…Medical equipment and wrappers mix with the debris of the accident. There is the familiar ‘tick-tick-tick’ of our blue lights revolving in their housings…
…Back at the station I have a face mask on as I clean the floor and trolley of the ambulance with the jet spray we normally use on the outside of the vehicles. My crewmate is doing the gentler job of cleaning the equipment. The blood comes off eventually…
…It’s time for our next job.

Repeat Offender (#ulink_d79b66f8-892a-55d5-9c96-16b59a7235ba)
On Saturday one of the first jobs was to go to someone whose name my crewmate recognised.
‘He’s a nice old boy,’ he told me. ‘When his wife was alive she’d call us every time he coughed. He’s deaf and blind. He used to be a British champion boxer. He’s a big fella so I hope we don’t have to carry him downstairs. We don’t see him much now; he hasn’t called us out in ages.’
The patient was sitting alone in his flat, scattered around him were books that he could no longer read. In the corner was a television that probably hadn’t been turned on in years. He was just a frail man sitting quietly in his chair marking time. On the table next to his chair were the remains of some ‘meals on wheels’. I could see that he had once been a ‘solid’ man, like the old men still living in our area who used to work on the docks—tall and thick with muscle. He wasn’t that man any more. He was frail, shaking, and seemed nervous of everything, not something that you’d expect from an ex-boxer.
It was hard getting his history as I needed to lean close to his ear and shout. At one point he let out a hacking cough just as I was up close to him so we took him to hospital with a possible chest infection.
Our last job of the day was back to the same address—he’d been discharged from hospital and just wanted someone to ‘check his pulse’.
We didn’t mind.

Algesia (#ulink_de7855fe-1f38-553e-b6c9-eccf5cc9d92c)
Seven-hour shifts are really easy to do, especially when you have spent the last year doing only twelve-hour shifts.
The jobs tonight were pretty easy—even easier for me as I was driving the ambulance rather than treating the patients. We had a 16-year-old girl with a sore throat, a pair of drunks, one of whom had a twisted ankle, a little old lady who’d fallen over indoors and had a nasty scrape to her arm, and a young woman, twelve weeks pregnant, who had been assaulted at work and struck in the stomach.
The real standout job for me shows just how daft some people are.
The patient was a twelve-year-old boy. We got the job as ‘child banging head on walls and floor’ and when we turned up the child was indeed clutching his head and hitting it against a wall. The parents and child spoke poor English, but we easily managed to learn that the child was suffering from an earache, and that this was the cause of the head-hitting.
‘How long has he had the pain?’ asked my crewmate for the night.
‘Five years then, three hours now,’ replied the father.
We understood what he meant—the child had an earache five years ago, but this current episode, and the reason why we were called out, had lasted three hours.
‘Have you given him any painkillers?’
‘No,’ the father looked confused.
‘Do you have any painkillers?’ my crewmate asked.
‘Yes, but we haven’t given him any,’ said the father.
So the family could see their child rolling around the floor, screaming in pain and banging his head against the walls, and didn’t consider that a painkiller might have—oh, I don’t know—helped with the pain.
I can imagine the scene in the hospital when the nurses give the child some pain relief—the parents looking at each other, slapping their foreheads and saying, ‘Doh! We could have done that!’
There are a lot of daft people out there—and I get to meet most of them.

Back on the Car… (#ulink_c838af95-e199-53c4-a8b3-5f868e0d440a)
There is a slight problem I have with returning to the ambulances, and that is my new partner is currently on sick leave, and has been for some time. No one knows when she will be fit to return—so I often find myself ‘single’ with nobody to work with.
When you are single you can be teamed up with another single pretty much anywhere in London.
At the moment our sector is having trouble reaching our government targets (which are calculated at the end of February). Of particular concern is Poplar ambulance station which, because of atrocious manning, is struggling to meet them. To counter this management have made it known that any shortfall in manning Poplar must be corrected as a priority.
So, when I’m single I’m often going to find myself making my way over to the Poplar area.
Last night, however, there was no one for me to work with at Poplar so they asked me to work on the FRU.
Fear of being asked to travel over to the other side of London if I refused meant that last night I was once more a solo responder.
This meant I had the right hump.
Thankfully it wasn’t too busy; the usual complaints of ‘my child hasn’t eaten properly for two days’, ‘I’m having an angina attack’ and ‘I’m drunk’ were quite enough. There was one interesting job though—a policeman hit a pedestrian with his car.
Thankfully he wasn’t travelling on blue lights, nor going too fast for the road. The woman apparently ran out into the road without looking, which given some of the pedestrian activities I normally see wasn’t out of the ordinary. Luckily for the woman involved there was an anaesthetist walking past, and he managed the immediate need to keep her neck still. After our examination our main concerns were that she was concussed and that she was cold from lying in the road—thankfully the ambulance was pretty quick, and she was soon in the warm, where our further examination showed no immediate injuries.
The area was cordoned off and as the woman was being looked after by the crew I went to make sure that the policeman who had been driving was all right. He was quite shaken up by the event, and I hope he gets support from his work.

Wee-Wee (#ulink_832922d8-0f71-5742-a494-aab0ae141a9e)
The plan was perfect—we’d just taken a drunk to hospital and the patient (a 45-year-old man, married, father of two) had decided to urinate in the back of our ambulance. Both my crewmate and I were happy at this as we would have to return to our station to mop out, and on the way my crewmate could grab a chicken takeaway meal.
And I could get a cup of tea.
This apparently flawless plan was spoilt when we stopped for the food and a man came running out of a pub to tell me that a friend had ‘a fuckin’ big gash in his head’ from when he had fallen over.
So I dutifully entered the pub, to find a 50-year-old man with a cut down to the skull running from his hairline to his eyebrow. Most impressive.
Less impressive was his friend telling me that the patient had taken some speed earlier.
I don’t know about you, but I consider myself too old to be taking that stuff, let alone someone old enough to be my father.
Not that I’ve ever taken speed myself. I like my brain cells exactly how they are, thankyouverymuch.
Luckily another ambulance turned up and took the patient off our hands, and so we returned to the station where I completed the job of mopping out the urine that had been washing backwards and forwards on the floor as we drove along.
I just wish I could be a fly on the wall when our original drunken patient tries to explain to his wife exactly why he has pissed his trousers.

Swagger (#ulink_d584c32c-f2dc-5d9d-9229-01d3830afa92)
‘He’ll end up in the bush,’ I said.
‘Nope—the road,’ replied my crewmate.
‘Bush.’
‘Road.’
The man we were watching dropped to the floor—in the road.
It was the last call of the night—a police CCTV camera had seen a man sitting in the middle of the road in what can only be described as a ‘dangerous’ part of town.
We arrived to find our patient rather drunk and sitting in the road under a CCTV camera. Circling him was a hungry pack of feral children who scattered when they saw us arrive.
We had a pleasant little chat with him—he had scraped his face when he had fallen over, and had no desire to get out of the road.
We spent twenty minutes trying to persuade him to get out of the road. We tried being nice, we tried reverse psychology and we even tried explaining that the police would soon be here and they would make him move on. He refused to move, and he refused to go to hospital—he was a very stationary object.
We got back into the ambulance, where it was warm, to await the police. We’d already parked in a ‘fend off’ position so that a passing car wouldn’t hit our patient.
I don’t believe in making work for myself.
‘Control, have we got an ETA for the police please?’
Control replied, ‘I can only tell you what they have told me—there are no policemen in the big policemen storage box, as they are all out dealing with other things.’
Great.
Right, I thought, time to try a little trick I learnt while reading a book about how the human brain works. Certain gestures and objects have ‘hard-coded’ responses in your brain. So if you walk up to someone who is sitting in the road and give them your hand (as if you were about to shake theirs), they will often take it, and from there it is fairly easy to get someone standing.
Success! Our patient was now standing (well…swaying) and indicated that he wanted to go home. His home was about 400 yards away in one of the tower blocks that surrounded us.
He took two steps and started to fall—he grabbed at my crewmate’s jacket, spun himself around her and by some miracle remained upright.
‘I’m fine,’ he said. ‘I don’t want you helping me walk home.’ He pulled his arms out of our grasp and started to stagger home.
We got into the ambulance and slowly followed behind him.
A message from the police (via our Control) appeared on our display terminal. ‘Are you all right? Does the man have any warning signs?’
Warning signs?
‘Control,’ I was back on the radio, ‘I’ve got this message about “warning signs”. Well, I don’t think he has any signal flares, or any of those reflective red triangles you put behind your car when it breaks down.’ Yes, I know…I was being silly.
While trying not to laugh Control replied, ‘I wondered what the police meant by that as well.’
What I think had happened was that the CCTV operator had seen what looked like my crewmate being attacked by the patient when he was just stumbling around.
We kept following the patient.
He started to swagger.
He started to sway.
He swaggered some more.
We quickly laid bets on him falling into some bushes by the road.
I chose the bushes.
I lost.
We got out of the ambulance and picked him up again. This time we decided that ‘technically’ breaking the law and frogmarching him home would be in the patient’s best interest. So we grabbed an arm each and in a jolly fashion walked him home.
With the three of us all with linked arms making our way down a deserted street, it was inevitable that I’d start whistling ‘We’re off to see the wizard’.
The patient got home safely, although I’d guess that the family member who answered the doorbell wasn’t too pleased with him.

Scent (#ulink_15ffaa8b-199d-51f4-a41c-ee4d69cf662d)
Way back in my past I trained to be a teacher (of small to medium-sized children). Rather thankfully I’ve managed to block out much of the trauma from those days. My poor memory does have some positive sides.
However, I’ve just done a job in a primary school, and all those memories came flooding back.
To be honest I think it was the smell that did it. Smell is strongly tied to memory, which is why certain odours can transport you back in time, say to helping your mum bake a cake, or to painting a shed with your father.
In this case it was the smell of the floor polish coupled with the scent of the powder paints in the air that flung me back to my days of trying to control 33 mini-disaster machines (or as they are known to the general public ‘children’).
I’m sure that new parents must have the same experience when they first visit their child’s school.
The job itself was quite an easy one, one of the teachers was having a panic attack, which is fair enough really—I know that if I were still trying to teach, I’d be in a constant state of panic attack.

Betting Shops (#ulink_5554306f-2c9f-5c4e-9b85-2e60e9b449fd)
I know I’ve written about having a wager with my crewmate about which way a drunk would fall, but I don’t want to give you the wrong idea.
I think betting is silly.
I have no idea how to work out any odds. Terms like ‘odds of 11/7’, ‘each way’, ‘accumulators’ and ‘handicap’ make no sense to me at all. Since childhood the betting shop has always seemed to me to be a seedy place where hard-drinking, and hard-smoking, men flush their money down the toilet. Not somewhere I would ever visit.
Occasionally I do find myself, because of the duties of my job, frequenting these dens of vice. And to be honest most of them aren’t that bad. The most common reason why I am sent to these places is because someone has passed out in the toilets due to drugs, or less commonly, drink. For some reason betting-shop toilets seem to be really popular places to take drugs.
Don’t ask me why.
These jobs are fairly rare, so I was surprised to find myself called to betting shops on two separate jobs in one day. Even more surprising was that neither of these jobs was junkie related.
The first job was to a 50-year-old male who had collapsed, and when we arrived the FRU driver was looking a bit concerned. The patient was as white as a sheet and not talking. We were all worried that he was going to die while in the shop, so we quickly loaded him into our chair and removed him to the ambulance.
While trying to do this, every other user of the betting shop continued around us without batting an eyelid. Normally we’d get a bit of an audience, but not so in this case. At one point a man ‘tutted’ me because I was standing between him and some vitally important bit of paper on the wall.
I’ll leave it to you, dear reader, to guess my reply to that.
As soon as the patient was in the ambulance he started to come round. All of our investigations showed nothing unusual, so we concluded that it was just a ‘simple’ faint. As it was a slightly prolonged one we took him to hospital for a few more tests.
The second job to a betting shop was for a 60-year-old male who was having a critically low blood sugar. He was a diabetic, and when we arrived he was rooted to his stool watching the horses racing on the TV screens. His wife was starting to get frantic at his refusal to talk.
On checking his blood sugar we discovered that it was very low, and this would explain his strange behaviour.
We tried to persuade him to drink a can of coke but he refused so we made the decision to give him an injection of glucagon. This drug, when injected into a muscle, is often good enough to reverse a low blood sugar for a short period of time. The plan was to get his blood sugar high enough for him to come out of his confusion for long enough so that we could get some sugar in him.
That was the plan at least.
Instead, we just gave him enough strength to start fighting us, his wife and the betting-shop lady who threatened to ban him if he didn’t do what the ‘nice’ ambulance people told him to do.
In an effort to get him into the ambulance, we ended up wrestling with him in the street. It was a bit strange to be physically restraining a pensioner while trying to (a) not hurt him, and (b) not look like a bully, even though he was a good couple of inches taller than me.
Then a police car drove past us.
It did a U-turn in the middle of the road and pulled up in front of our ambulance.
A couple of police officers got out and helped us persuade the patient to get into the ambulance where we could finally get him to drink the can of Coke we gave him. Sometimes it just needs a couple of big men in black and white uniforms to get a patient to do what you want.
This is one of many reasons why we like the police.
What didn’t help was the wife who would alternately berate her husband for poorly controlling his diabetes, and then spend time telling us that she was a devout Christian.
Thankfully the Coke did the trick and the patient made a full recovery—we left him and his wife in the nearby café getting something more substantial than a can of Coke and a Mars Bar.
Two good jobs, and not a trace of drink or drugs on them.
Makes a nice change.

It Says ‘London’ on the Side (#ulink_371c3410-ff75-568c-abdf-455de624f52b)
Last night was a bit strange, which for a change had nothing to do with the patients I was seeing.
Newham hospital was packed to the gills with patients, there were no beds available there, so a lot of my workmates ended up transferring patients from Newham to other hospitals around the area. At one point it got so bad that for two hours Newham ‘diverted’, or closed to non-‘blue light’ ambulance jobs. Hospitals don’t like doing this as they get fined for restricting their services, but when the situation is dangerous it’s actually in the best interests of the patients.
But my crewmate and I had to be that little bit different.
We had managed to return to station for three minutes when the phone went. Control wanted us to transfer a patient from a hospital out of our area to another one on the other side of London. We were told that there were no ambulances available in the originating hospital’s sector.
The patient was a young lady who might have been in premature labour with a pregnancy of 30 weeks. The nearest SCBU (specialist care baby unit) with an empty bed was in Hammersmith. Hammersmith is on the other side of London. I suppose we should have counted ourselves lucky that it wasn’t in Brighton.
So I drove through our sector, into another sector to pick up the patient and the midwife. We then drove 30 miles through the centre of London to get her to Hammersmith hospital. I don’t drive through London very often—I don’t need to, London Underground is cheaper and easier than trying to find a parking space. Thankfully all our ambulances now have GPS navigation systems installed—so it’s a simple case of following the arrows on the little screen and avoiding the cars that insist on trying to crash into you. I had a strange feeling of pride that I managed to find the hospital without getting lost or crashing. I then cruised around the hospital looking for the maternity entrance, and managed to find it by sheer luck and good fortune.
The hospital itself was completely different from the hospitals in our area—it was clean, it had comfy chairs, and the doctor who met the patient showed us the staff kitchen so we could get a cup of tea.
The only thing the same as the hospitals ‘back home’ was the angry glare from the midwife as we entered the unit.
On our way back to Newham we managed to get a job.
‘Aha!’ we thought, ‘this might be an interesting one.’
But no—it was exactly the same sort of patient/job that we get in Newham: an elderly Bangladeshi gentleman with all over body ache and a heavy head.
Still, he was a very pleasant man so we didn’t mind.
This patient went to St Mary’s hospital by request, and I’ll admit that on my first attempt at getting him to the hospital I drove past the obviously well-hidden entrance ramp. So I had to enter the one-way system, adding an extra mile on our journey. St Mary’s have a ‘welcome mat’ outside their A&E department. You don’t get welcome mats at Newham. At Newham you have to force open the ambulance bay doors…

Good Job/Bad Job (#ulink_9514d7e6-0c37-5a41-b736-6cdf8e242aa0)
Good Job
Any time where a patient actually needs an ambulance.
People having an acute flare-up of a chronic condition (diabetes, asthma, heart disease)
People who can’t walk, but who live on the ground floor.
People who make an effort towards managing their chronic conditions.
Maternal emergencies.
Nice people.
Old people.
Children who don’t cry.
Any time a patient, or their relative, says a simple ‘Thank you’ at the end of their trip.

Bad Job
Runny noses, coughs and colds. Verrucas.
People who have had an argument with a family member.
People who can’t walk, but live at the top of a block of flats with no lifts. And are heavy.
People who abuse their bodies with drink or drugs.
5 a.m. matern-a-taxis.
Gangsters crying because they have been stabbed for dealing drugs on the wrong street.
Awful nursing homes.
Parents who weep over their child’s cut finger causing them to have hysterical screaming.
Mr ‘I know my rights’.

Valentine’s Day (#ulink_ddc331de-b713-5069-afeb-13b56616284d)
First off…
…Bah humbug.
(It’s not just for Christmas.)
I’ve just finished with a job that makes me question this whole ‘love’ idea.
I had been sent to an alcoholic who had just had an epileptic fit and I arrived to find his fiancée looking very worried.
She told me, ‘I’ve known him for ten months and I’ve only seen him fit once, so I’m afraid I got scared and called for an ambulance.’
I reassured her that this wasn’t a problem and that she had done the right thing.
I looked after the patient, it was an easy job, and I spent some time waiting for the ambulance to arrive. (I was ‘single’, so I had been asked to work on the FRU again; the alternative was to work out of Waterloo station.)
I looked around the room they were staying in. It was not what you would call ‘homely’; it was the typical house of a young alcoholic (he was the same age as me). Cans of cheap cider were lying around the place, there was no furniture apart from a settee and a TV, empty cigarette packets littered the floor and the pictures hadn’t been mounted on the walls.
There was an axe leaning against the fireplace.
His fiancée was young and not obviously unattractive, she didn’t seem particularly stupid and she didn’t look like a fellow alcoholic. So I was confused as to why she would want to marry an alcoholic.
I’m afraid it just befuddles me as to how you can love someone who loves their next drink more than you. In any partnership you will come second to an open bottle of cider.
I just don’t understand.

Tagged (#ulink_3a385e68-1d25-5cb4-81d2-997571e83415)
We help the people of Newham.
One of these people has seen fit to ‘tag’ one of our ambulances with graffiti.
This means that the ambulance will be taken off the road so that it can be cleaned.
This will cost money.
It will also remove an ambulance from the road.
This means an ambulance might get delayed coming to a call.
I hope it is a call to the ‘tagger’, and I hope that they are in a great deal of pain.
In the past we’ve had people break into our ambulance station to steal radios from the cars parked there as well as steal the station’s TV. When you are working yourself into an early grave on a cold and wet night shift it makes you want to pack the whole job in.

Lost Words (#ulink_caa29253-a45f-5137-9c45-904287a09df2)
Canary Wharf has a skating rink at the moment and my crewmate and I were sent there to attend to a ‘fall, head injury’.
‘Excellent,’ we thought, ‘a nice simple job—nothing complicated.’
We were met by a worried-looking ice rink worker who wobbled across the pavement on his skates to meet us.
‘We wouldn’t normally bother you guys, but we think it might be serious.’
Grabbing my bags I was led to a woman sitting in the changing area with two youngsters, both of whom were looking a little concerned.
‘Hello there. I’m with the ambulance, what seems to be the problem?’ I normally start with a version of this as a conversational opening gambit.
The patient replied, ‘Well, I had a bit of a fall—’ She paused. ‘I—’ She paused again. ‘Head…hit…migraine—’
She seemed to be having trouble finding the right words to use. I quickly examined her, and was happy that she hadn’t hurt her neck and the small lump on the back of her head didn’t look serious either. So why was she acting so strangely?
‘I get migraines,’ she told me. ‘I…lose…um…er…um…words, and I…eyes…eyes…go blind.’
This is a pretty rare presentation of migraines, but not unheard of.
We got her into the back of the ambulance and all my examinations there were normal. She was complaining of ‘losing her words’ (expressive dysphasia) and of going blind in her right eye. She didn’t seem too upset by this and had already taken her normal migraine medication, although I’m not sure how paracetamol and metoclopramide would help with these symptoms as I’m not an expert on migraine treatment although I know that triptans can sometimes be used.
Her symptoms started to get worse, she couldn’t find any of the words that she wanted to use, and so I needed to get a more thorough history from the two youngsters. They were her nephews and she had been treating them to a trip to London. Although young, they were both very mature and helpful and after some prompting from the patient (‘Laptop…look…laptop’) we found a patient information card in her purse. The card let us know that all the symptoms that she was experiencing were indeed part of the presentation of her migraine.
It was a short trip to the hospital, during which she started to make a slight recovery and we left her in the capable hands of the A&E nurses. Unfortunately for the patient, the hospital was extremely busy, so I’m guessing that she had to wait a little while for any treatment.
The three of them had come from Surrey, so they didn’t know the area well, although we were able to give them directions home from the hospital. We had chosen this one over another slightly closer so that it would be easier for them to get home after any treatment.
A day out in London turning into a trip to the hospital—it happens more often than you would think.

Bleurgh (#ulink_41322ee7-07de-5e82-84f5-0f09dea1c2e3)
For the past five nights the majority of my patients have been sick with one or more of the following:
High temperature,
Runny nose,
Vomiting,
Night sweats,
Lethargy,
Cough,
‘Generally unwell’.
So there must be at least one highly infectious disease epidemic in the area. While you or I might want to curl up in bed with some Lemsip and paracetamol, it would seem that a large number of Newham’s population would rather sit for hours in an A&E waiting room.
Madness.
Which leads me to the point. Ambulance crews spend a lot of time around these infectious patients, who have often never been taught the good manners of putting their hand over their mouth when they cough.
So is it any wonder that I’ve got painful eyes, a streaming nose, a constant mild headache and a feeling that I’m suffering from a mild hangover.
But:
Ambulance crews mustn’t have more than three periods of sick leave in an 18-month period.
So I’m having to drag my potentially infectious body into work—where maybe I can infect some more people…
So in conclusion:
Send me nurses—pretty female ones with plenty of drugs.

Free-Market Oxygen (#ulink_bb00ed46-e130-5d7a-97df-e0a47a2ecee2)
Some patients with chronic lung disease need oxygen, and rather than keep them in hospital, these patients often have cylinders of oxygen delivered to them at their home.
Until recently it was the pharmacist who supplied these cylinders, but the government in its infinite wisdom has decided to privatise the supply of oxygen. This means more paperwork.
And now a patient has died, possibly because of a delay getting her oxygen delivered. It drives me crazy that I spend my time in my ambulance going to 23-year-old men with coughs, yet apparently no ambulance was called for this woman.
It all comes down to the government wishing to run the health service like a business.
I know that some people believe that the free market will constantly provide superior service to anything run by the government. Unfortunately healthcare isn’t a ‘market’ and this market view of the NHS leads towards some very silly initiatives. It’s why ‘failing’ hospitals get less money than ‘successful’ hospitals. Who would want to throw money into a failing business?
Why are hospitals so dirty? It’s because of the free-market contracting of cleaning to the cheapest supplier—regardless of the quality.
It’s also why, despite increasing numbers of patients, more calls, very few new staff and all the other reasons why we may not meet our government ORCON target this year, we’ll get less money to be spent on improving our service.
But what do I know—I’m a van driver not an economist.

Uniform (#ulink_df2d17ce-a188-562e-b3a5-c6233d8ccf48)
The thing about wearing a uniform—it really changes your behaviour.
I’m guessing that a lot of you are aware of the Milgram experiment, where members of the public more willingly follow instructions if the giver is wearing a uniform or other symbol of authority. (Go to the internet for a more complete explanation. If you’ve never heard of this experiment, it and the Stanford prison experiment make scary reading.)
So when I am wearing my uniform I am more confident and can order people around. The police, firefighters and members of the public tend to do what I tell them if there is someone sick around. Obviously I only use these powers for the force of good, but without my uniform I am a much shyer person.
I noticed this when I went to a recent gathering of internet people. When I arrived I knew one person there, and once I’d stopped talking to her I became an instant wallflower.
But there is a flip side to wearing an ambulance uniform, you also become more passive.
Out of uniform, if I was in the street and some drunk tried to hit me—I’d punch them on the nose. If I was verbally abused—I’d soon be in their face shouting and ranting along with the best of them.
Yes, I know three paragraphs before I said I was a wallflower, but this is in a social situation. When my temper is roused it is a terrible thing to behold.
But in uniform I’ll gently restrain the drunk trying to hit me and I’ll ignore any verbal abuse that is thrown at me. Unfortunately the anger that I feel is then turned inward, which I am guessing is not a healthy thing to do.
I wonder if it is the uniform, or the risk of having a complaint put in about me, that turns me into such a wimp. It might just be that I spend so much time trying to keep patients calm, that I’m feeling very mellow when people abuse me.

Abuse Your Ambulance Crew (#ulink_b25436b3-9a4b-5d39-813d-0aa8cea3fed1)
I was racially abused on Friday night, and it meant I spent the rest of my shift gritting my teeth and wanting to punch someone.
We were sent to a ‘standard’ abdominal pain with vomiting. The patient, a black woman, had vomited ten times that day and had lower abdominal pain. As always I treated the patient with respect and compassion (as that is my ‘default setting’). All her observations were within the normal limits. Talking to the patient was a bit tricky as she insisted on having me ask every question at least twice before answering.
So we took her to hospital, where I handed over the patient to the triage nurse. She was happy to have another nurse perform a further assessment (for example, an analysis of the patient’s urine). Unfortunately the place for this assessment was physically full, so we were asked to take the patient into the waiting room until some space could be made. My crewmate did this, while I booked the patient in with the reception staff.
My crewmate told me that when the patient saw she was going to be put in the waiting room, she let out a loud ‘Tut!’
My crewmate then joined me in the reception area which overlooks the waiting room.
The patient then threw herself on the floor and pretended to be unconscious (trust me, when you’ve seen people really pass out in a chair, you can tell when they are faking it).
The waiting room erupted with two people jumping to her aid. The security guards went to get a nurse. Then a lot of the people in the room started shouting at us to come and help. Never mind the half-inch-thick glass between us and them.
We told them that a nurse was on the way.
‘Look at her! Look what’s happened to her!’ shouted one man.
‘Yes mate,’ replied my colleague, ‘there’s nothing wrong with her—all she’s trying to do is get seen before you.’
The patient was loaded onto a trolley and taken into the main area of the A&E.
The crowd in the waiting room then started moaning at us.
Then both my crewmate and I heard the comment that would have us angry for the rest of the shift.
‘You wouldn’t treat her like that if she were white.’
My crewmate stormed out of the department—he was, quite rightly, fuming.
All I could do was laugh loudly at the black teenager who had said this. ‘Well, if you are that stupid, you’ve just opted out of talking to me,’ I said to her.
I left the hospital.
Here is the thing that made my crewmate and me so angry. We like our job—we both like helping people and we’ll help anyone, we don’t care what colour their skin is, which religion they believe in, or if they can speak English or not. I don’t even care if they are an illegal immigrant. We sure as hell don’t do this work for the pay. My crewmate is a trained plumber so he could be earning much more money installing radiators.
We don’t need to work in this area—I could put in for a transfer to a more ‘white’ area tomorrow. But I enjoy working in east London—it’s a challenge—and I enjoy working with all the different cultures that make up our ‘demographic’. For me, a predominantly white area would be incredibly boring.
But that comment: ‘You wouldn’t treat her like that if she were white.’ It made me despair as to how we are seen by the non-white population. Are we all seen as being racist? Does the assumption that I would treat a patient better if they were white sit in the minds of the people I treat? Is this why I get so few thank yous? When I walk into a household, do the people there think ‘I won’t get good treatment from these two, they are both white’?
I wish I’d gone around to the person who had made the comment and challenged her. I wish I’d gone into the waiting room and explained exactly what had happened. But as I’ve mentioned earlier, the uniform that I wear makes me more passive than I would normally be. So I turned the other cheek and walked away.
I’m still fuming.

Slow Suicide (#ulink_66e00c7e-74b8-5070-a293-fa8fdc6728da)
Imagine that you are 23 years old.
You are also a ‘brittle’ asthmatic. This means that you can have asthma attacks that can rapidly progress to life-threatening status. You have been intubated in ITU a couple of times—this is a last ditch treatment to keep you alive.
So why, whenever you get taken to hospital, would you treat your disease as a mere annoyance?
Also, why would you smoke 20-40 cigarettes a day, knowing that it will make your asthma worse?
And why would you self-discharge yourself from the resuscitation room against medical advice only to require a blue light return straight back to the resuscitation room?
It’s just a form of slow suicide.

I Wouldn’t Trust Them with My Dog (#ulink_c75e04b5-2f1f-5832-b924-c9a7ffe16fde)
I have another example of why I don’t think that the free-market system is particularly good for the health service, or at least not good for the patients who use it.
I was working in another area a little while ago, and while there got sent to a private nursing home. The patient was given to us as ‘80-year-old female with difficulty in breathing’. We arrived and saw what looked to be two nurses having an animated discussion in the main foyer.
Grabbing our equipment we followed one of the nurses into the depths of the home, and were shown to the patient’s room.
The patient was very much dead.
Also in the room were four nurses. They were standing around and they weren’t doing CPR, they weren’t breathing for the patient. They looked at me for guidance.
I immediately switched into commanding mode. ‘Why isn’t anyone doing CPR?’ I asked.
‘We were,’ one of the nurses replied, ‘but I saw you coming in the mirror and stopped.’
The mirror was positioned so that if she had been doing CPR, she would have had to have eyes in the back of her head to see me coming.
When someone isn’t breathing you have to breathe for them—this is the ‘ambu-bag’ that TV doctors put over someone’s face and operate by squeezing it. It forces oxygen into your lungs. Unfortunately the patient had a normal oxygen mask on her, which would just bathe her face with oxygen, but it wouldn’t get it into the lungs where it needed to be.
The patient was also lying on an air mattress, which would have meant that any CPR which may have been done would have been ineffectual because you need the patient on something hard so you have something to push against.
I felt the jaw of the patient—rigor mortis had already set in, so there was no point in attempting to continue any resuscitation attempt.
Someone had tried to take the patient’s blood pressure, as there was still a BP cuff around her arm.
As is usual in these cases where we know or suspect that care has been—shall we say—lacking, we offer the services of the London Ambulance Service (LAS) to teach the nursing staff more effective resuscitation skills. However, they should have these skills anyway as qualified nurses. Talking to one of the people who teaches these courses, it seems that many of these nurses have forgotten how to do this. It’s free to them although I don’t think we get any extra money from the government to run it.
The nurse in charge, who was busy photocopying in the office while all this was happening, refused.
So, in a world of competition between privately owned care homes, it would seem that the care has not improved. Instead you get poorly skilled nurses, managed by staff who don’t want them to improve. This despite a number of suppliers who are all in competition with each other—it’s a lucrative market providing elderly care.

Laughing Policeman (#ulink_79bd2aef-a99f-5e31-9864-576705e9dee8)
You’ve got to laugh when an ‘old salt’ police sergeant tells you that he’d like to meet the person who assaulted my patient…
…And shake their hand…
…And you agree with him even though you’ve only known the patient for 20 seconds.

Structural Collapse (#ulink_cd30937b-e449-5bd6-90e8-a77d3c4f4081)
The radio sparked into life, ‘General Broadcast, General Broadcast—are there any crews able to deal with a ceiling collapsed on a mother and her two-year-old child?’
We were just finishing up the paperwork on our previous job so we asked for it to be sent down to us. I was driving and we were soon at the house. From the outside everything looked normal.
However, inside the house it was pure chaos.
There were seven children running around the house, all of them under the age of twelve. A single mother was clutching her two-year-old to her chest. At first glance they looked unharmed. The mother seemed more frightened and angry than injured.
We soon got the full story: the mother and her child were having a nap in the bedroom when the ceiling had fallen on them. We entered the bedroom expecting a few scraps of plaster. Instead we were met with the sight of one-and-a-half-foot plaster and lath ceiling, a huge chunk of which had fallen six foot onto the bed.
The hole in the ceiling was about five feet in diameter; there was a lot of heavy debris spread across the bed and floor.
Rather understandably the woman was a bit upset—the individual pieces of plaster that had dropped on her were about the size of my hand and were over an inch thick. I couldn’t estimate the total weight of the plaster, but each lump was very heavy.
It was about now that the headache I’d thought I’d got rid of earlier in the evening started to return.
As a single parent who had just moved into the area she had no other relatives to help look after the children so she was refusing to go to hospital. My crewmate took her and the toddler into the ambulance so that he could examine her more fully. If he found nothing too serious then we could leave her at home to look after her children.
So off they went to the ambulance.
Which left me looking after six anklebiters.
I don’t like children.
While he was in the ambulance my crewmate phoned the patient’s GP and arranged for them to come and visit the patient. He then arranged for the police to turn up and give the patient some legal advice. Rather obviously the patient was a trifle annoyed at the landlord who had assured her that the house was fit to be lived in.
Meanwhile I was doing my best to entertain the children. My best wasn’t enough.
I was relieved when the children’s older brother arrived with some takeaway chicken meals. Yes—there were now eight children in the house of this 36-year-old woman. This older brother was more like a father to the others and he soon had these apparently feral children under control.
Luckily for the woman and her child our initial guess was correct—neither she nor her child was seriously injured.
My crewmate and I escaped from the scene as soon as the police arrived.

Shorn (#ulink_1d23a0f7-2714-5883-9e3d-215260ba4a58)
An ideal invention for the blogger in your family would be a pair of video-recording glasses—wear them all day, and should something interesting happen the wearer presses a button to save the last 30 seconds of video to a small storage device.
If that were possible I’d now be showing you a video of a lovely young man.
I was driving along on blue lights and sirens (to an ‘intoxicated—feeling unwell’) just heading past the Underground station when from the pavement I could hear someone shouting: ‘Wanker…Wanker…Wanker.’ He was also making the traditional hand gestures.
A quick look at him led me to believe that he was either homeless or an alcoholic, or both. I could see that he had no front teeth and he only looked around 30 years old.
I slowed the ambulance so that my crewmate and I could laugh loudly in his general direction.
He turned his back on us.
He bent over.
He pulled his trousers down.
Suddenly we were confronted with a skinny white arse, and dangling between his legs were equally white and skinny testicles.
They looked shaved.
Just then a police car came over the hill.
I wound down my window and spoke to the police driver, ‘See that fellow with no teeth? He just exposed himself to me.’
‘The one calling you a wanker?’ asked the policeman.
‘That’s the one…Have fun!’
We continued on the way to the call as best we could between tears of laughter.
It’s strange the things that make your day.

12th November 2046 (#ulink_76fa5272-1e93-5d69-943f-6eed9deea013)
The young man breathed a sigh of relief as he finally sighted his quarry of the past four days. The old man was sitting on the park bench enjoying the sun and feeding the ducks.
‘Hello fella,’ the young man said as he sat down on the bench. ‘You said that you’d be able to tell me about the old days? About 2006? About the blankets?’
The old man tore off another piece of bread and threw it in the pond and watched a small crowd of ducks hungrily fight over it. ‘Sure, if you want to hear about that sort of stuff.’
The young man started a mini-recorder and placed it on the bench between them while the old man continued to talk.
‘It was back in o-six, about the middle of February, and if you believe the reports it was the first winter of the “big freeze”. I remember the years that followed, OAPs dropping dead in the road, cats frozen stiff in the streets…Happy days.’
Before continuing the old man took a swig from a bottle of something, probably illegal, which he’d concealed in a brown paper bag.
‘As you know I was working in London for the ambulance service, it was a pretty good job, but back then the health service was run and funded by the government. So a lot of things went wrong.’
The young man interrupted, ‘That was when Blair the Deceiver was in power? Just before the Party started to dissolve parliament?’
The old man looked sullen. ‘That’s right, bad days, very bad days.’
Sensing that the old man was about to enter a fit of depression, the young man decided to prompt him, ‘But about the blankets…?’
‘Yes,’ replied the old man, eyes suddenly snapping into focus, ‘we used to say back then that the only equipment we really needed was a chair and a blanket, but on that day there were no blankets to be found. We searched the stores, we even tried ransacking disused ambulances in case they had some—but there were none to be found.’
‘What did you do?’ asked the young man.
‘Well, we got onto our Control—they tried to contact someone in management, but no one seemed to be around. So Control spoke to their overseers—the people who had the job to look after these emergencies. They were no help.’
‘Was the management ever any good?’ the young man asked.
The old man was quiet for a moment before continuing, ‘In this case it turned out that there were no blankets at our central stores. Normally the blankets would be stored there before being delivered to individual stations by a tender driver. But the warehouse that washed and packed the blankets hadn’t delivered any to the stores.’
‘With no blankets, how could you help patients?’
‘Well, after talking with Control they suggested that we “liberate” some blankets from the hospitals in the area—so some of us went on stealth missions. We’d take in a drunk and while the nurses’ backs were turned your crewmate would sneak out with an armful of blankets.’
The old man threw another chunk of bread to the anxiously waiting ducks. ‘We didn’t call it stealing. Besides, the hospitals had more than enough.
‘Of course,’ the old man continued, ‘back then we’d share a blanket among a couple of patients—there wasn’t enough for one blanket each. This was before the H5N1-MRSA cross-breed became epidemic. You’d never get away with it these days. But back then if there wasn’t filth on the blanket, you would use it again. We had to or there would have been blanket shortages every day of the year.
‘In this case the shortage lasted for a couple of days. It turned out that nearly everyone in the blanket warehouse had applied for annual leave at once, so there was hardly any staff working. In those days you had to use up most of your annual leave before April. That year they prevented the ambulances from collapsing by letting us carry over more leave to the next financial year than normal, but they forgot about some of the support workers.
‘We were lucky that year…we didn’t know it was about to get worse—’
The youngster clicked off his recorder before the old man could continue. ‘Yes, but we all know what happened in twenty-o-nine. I’m just researching the precursors to the health collapse and I was thinking that this might be of some use.’
‘Well, I hope I was of some help,’ the old man said standing up from the bench with a groan. ‘I’m off to stretch these worn bones. If I can be of any more help, just let me know.’
‘Will do Mr Reynolds,’ said the young man, ‘will do.’
Yes, we did have a shortage absence of blankets a couple of days ago. So far there is no official reason, but the tender driver told me the theory that I used in this story. It’s also true that we have to reuse blankets for different patients. There was a manager around, but he was in a meeting. I don’t know what the ‘overseers’ suggested.
There is no H5N1-MRSA cross-breed. I’m keeping my fingers crossed that I’m still alive in 2046.
Yes, I wrote this because I have too much time on my hands.
Sorry.

On the Power of Blankets (#ulink_60f9df7d-4313-55de-ba98-2ba3a6da0ee8)
I have mentioned that the blanket is one of the more important and versatile bits of kit that the modern ambulance can have. In the good old days of horse-drawn ambulances the proto-EMT would refer to his equipment as ‘one and one’, meaning one carry chair and one blanket.
Even today, with our increasingly technologically based healthcare system, the humble blanket has a multitude of uses. For those of a ‘hitchhiker’ mindset think of a blanket as a towel writ large.
Primarily it is used to stop little old ladies (LOLs) from getting cold when you drag them out of their nice warm house into the often freezing conditions of the ambulance.
Said little old ladies don’t like being wheeled around in our carry chair—it has no handrests and feels very unsafe. LOLs will often try to grab out at things to steady themselves—this is dangerous, especially if we are carrying them down stairs. So we wrap the patient in a blanket, and make sure that their hands are gently restrained.
You can use the blanket as a sliding/carry sheet when transferring a patient from a bed to a stretcher, or from the ambulance stretcher to the hospital trolley. The ambulance blanket is thick and strong with a close weave. While I wouldn’t like to try using it to lift someone off the floor, I would imagine that it is strong enough to do so.
When in the ambulance we can use the blanket to protect modesty. Some of the things we do to people require them to bare their chest, for females this can be troubling. We can use the blanket to cover the patient as much as possible.
If the patient has been incontinent while wrapped in the blanket, we can ‘gift’ the blanket to the hospital—it’s what nurses are for (and we don’t carry warm soapy water and wipes in the back of our ambulances). Nurses soon learn to unwrap carefully the patient who has been left in the ambulance blanket.
Because of the thickness of the blanket, and the difficulty of carrying vomit bowls into houses, the blanket can catch any vomitus the patient may produce while leaving the house. Reassuring the patient that it is fine to vomit on the blanket is important in case they become embarrassed.
When moving a dead body from a location, two blankets in the ‘T-wrap’ will disguise the lack of life from bystanders. It’s also good for wrapping up very frail LOLs when it is freezing outside.
With the addition of two triangular bandages the ambulance blanket can be converted into a pelvic splint. This helps stabilise pelvic fractures which can become life threatening if allowed to wobble. As an aside, the next time I see a trauma surgeon flex the pelvis in a suspected fracture, I’m going to find their car and let down their tyres.
If you don’t have the head blocks that go either side of the head to protect a possibly broken neck, then by the correct folding of the blanket you can form a snug-fitting c-spine restraint. I prefer the use of blankets to the specialist kit here because the blanket is better able to form itself to the patient’s head and neck.
Our blankets are red—this makes them ideal for hiding blood.
If you have a nasty trauma in a public place the blankets are large enough to be used as screens. This requires the use of two firefighters to hold each end. Don’t worry, they were probably standing around doing nothing anyway.
The blanket also works well as an ‘NHS special’ pillow. We don’t carry pillows on our ambulances and many hospitals are short of them. So roll up your blanket and place under the patient’s head. LOLs with a curvature of the spine will be especially grateful, as in a moving ambulance without a pillow their heads tend to roll around like a nodding dog.
If folded correctly, you can put it on your trolley bed and have ‘AMBULANCE’ written down each side. This not only looks good but also makes it really easy to wrap patients up in it.
If you have a patient who might become aggressive then the blanket—if tucked in tightly—can provide a mild restraint.
Doing CPR on the floor for an extended period of time can be wearing on your knees—a folded blanket makes a nice cushion to rest on while pounding away on some dead person’s chest.
If someone decides to have an epileptic fit in the back of your ambulance, the blanket can be used to protect the head (or other part of the body) from hitting the ambulance wall or other hard surface.
Have you had a huge spillage of some noxious fluid? Are you worried that as you return to your station to mop out the back of the ambulance the fluid will run through the door into the driver’s cab and thus contaminate your packed lunch? Simply mop it up with a blanket.
If someone tries to attack you, throw it at them like a net—it may distract them long enough for you to run away.
There are probably a hundred more uses for the ambulance blanket—and no doubt as soon as I publish this I’ll think of another 20. Still, I think that you will see that the humble blanket has many more uses than our defibrillators and ECG machines.

Friday Night’s All Right for Fighting (#ulink_45ff1d45-c3be-5877-be5d-2945ab9873d2)
The first job of our Friday night was to a little old lady (actually, she wasn’t that little). She had been standing on her bed with her daughter to fix the curtains when she’d felt dizzy and fell down. She then bounced off the bed and landed on the floor. Unfortunately for her, she had landed on her neck and head.
One of the first things that I do in a case like this is to make sure that there isn’t an injury to the neck. I’ll do this by gently feeling the neck while the patient tells me if it is sore. If there is soreness to one side of the neck then this will normally be a muscular injury while if the pain is in the middle of the neck then there is a chance that the injury is more serious. Like a broken neck.
This woman nearly leapt from her bed when I gently touched her neck—she had a potentially serious neck injury.
So we needed to be extremely careful in order to make sure that if the patient had broken her neck, we wouldn’t make her injury worse by bouncing her down the stairs from her flat to the ambulance. Unfortunately, everything we had to tell the patient had to be translated by the daughter. I need to learn Bengali; it’s a real shame I have no head for languages.
The patient had to be moved down the bed so that our scoop stretcher could go under her then she needed to be securely strapped onto it ready to be carried downstairs. In this case I used a blanket roll to secure her head rather than the more expensive and less effective head blocks. We called for another crew to give us a hand because in a case like this it is better to be safe than sorry, and you need to be careful carrying a potentially unstable neck fracture down two flights of stairs.
We were all really impressed with the neatness and effectiveness of the strapping. I wanted to take a photo of it because it doesn’t often look as good as it did with that job.
As mentioned, she wasn’t too light, and it’s really tricky to manoeuvre a six-foot-long orthopaedic stretcher out onto a balcony, around half the building and down two flights of stairs. At one point we had to suspend the poor woman’s head over the balcony in order to get her around the awkward architecture of her building—pretty lucky that she wasn’t looking down at that point.
The job itself went like clockwork.
My back, however, was starting to hurt from the less-than-safe lifting that we needed to do to get the woman out her flat and into the ambulance.
We then had a couple of ‘nothing’ jobs—coughs, colds and bellyaches.
We got to around midnight when we were sent on a call for a ‘17-year-old male, has a knife, cutting wrist, suicidal’. As it was in the street I thought that we’d go and have a look—if he was violent then we could soon drive off and await the arrival of the police.
The young man was lying on the floor, his left hand was covered in blood and there were already two policemen there. They looked happy to see us.
A quick assessment later and it turned out that the patient had nearly severed his left little finger. He was covered in blood and refusing to say anything except that he wanted to die. I managed to get a ‘quick and nasty’ bandage on his hand while the police and I wrestled with him. He wasn’t very happy with being put into the ambulance and once inside fought with us like a man possessed. Blood was everywhere, he was trying to bite us and the police had to handcuff him (which for some reason, probably paperwork, they really didn’t like doing). It took the three of us struggling with him to get him to hospital and when he reached the department there needed to be six police guarding him in the psychiatric room.
He was, to use an ambulance service technical medical phrase, ‘proper mad’.
I felt sorry for the fellow—he didn’t ask to go out of his gourd.
I also felt pain.
Pain in my back.
While fighting with the patient in the back of the ambulance I had somehow wrenched my back and the whole right side of my body was in pain.
So we went back to station, I filled out the required paperwork and went home. I stayed home for the next two nights, partly due to the pain and partly due to a desire on my part to avoid exacerbating the injury.

Gassed and Splinted (#ulink_e8f23f12-16cf-5d13-a361-acd5ccf2696f)
I often bemoan the fact that I tend not to get sent to many jobs involving ‘trauma’. If you’ve been stabbed, I’ll be down the road picking up a matern-a-taxi. If you’ve fallen out of a second-floor window, I’ll be one street over dealing with the sleeping drunk. And if you’ve thrown yourself under a tube train, I’ll be one stop down dealing with the twisted ankle.
It’s not that I like people to be badly hurt, it’s just that I occasionally like to have a job that I have to think about. So the smallest little traumatic injury makes me happy.
We were sent to a 50-year-old man who had fallen. We made our way up the stairs to the gentleman’s bedroom and saw him lying on his bed; with him was a woman in a nursing uniform crying her eyes out. The patient had indeed fallen; his foot was the main injury.
The patient normally wore a caliper on his foot because of nerve damage from having polio as a child. He had fallen and the caliper had caused the toes of his right foot to bend upwards. He had split the skin on the underside of his foot where the toes meet the body of it, and he had probably broken something.
The woman in the nursing uniform (who turned out to be the patient’s wife) told us that at least one toe had been dislocated and that the patient had twisted it back into shape himself.
He was, unsurprisingly, in a lot of pain.
First, we gave the patient pain relief, some Entonox. The paramedic I was with was going to give him something stronger, but the patient’s pain completely disappeared with the ‘gas and air’.
We then bandaged his foot and placed it in a vacuum splint. This is pretty much a sand-filled bag that becomes rigid when you suck the air out of it. They are very handy when dealing with injuries in awkward areas. I don’t get to use them often, but when I’ve needed one, they are perfect.
We then had to very carefully carry the patient down the stairs.
All the time the patient was thanking us for looking after his pain and for helping him get to hospital. He was a genuinely nice man, and his wife was nice as well. It was a good job. We were able to aid someone who needed help and while we needed to put on our thinking caps as to how best to get the patient out of the house the job went smoothly.
I spoke to him later in hospital—he’d managed to break three toes and one of the bones in his foot; his wife was still with him and once again they thanked us (and let us know that the Entonox was a better painkiller than anything the hospital gave them).
It put me in a good frame of mind for the rest of the day.

More Crap GP Work (#ulink_99972719-1ae1-5835-96e8-5b077e6142e8)
I was working on the FRU again for a shift; I’d turned up to work on an ambulance, but there was no one else to crew up with me.
One of my first calls was to a possible heart attack in a GP surgery.
Once again I found the patient (a very pleasant lady) sitting out in the waiting room. There are a number of treatments that should happen with someone who is having a heart attack. First they should have a full set of vitals, then oxygen should be given along with an aspirin and, if the blood pressure is good enough, a squirt of glyceryl trinitrate (GTN). It’s pretty standard stuff and does a world of good for the patient (aspirin alone increases your chance of surviving a heart attack by around 25 per cent).
So, how many of these things had the GP done?
Well, he’d taken some vitals but they were very different to what we got in the back of the ambulance. However, vitals can change and I wouldn’t want to call the GP a liar.
At no point had the GP given aspirin, GTN or even waved some oxygen under the patient’s nose. The receptionist was helpful, and she led the patient from the waiting room into her office so that I could better assess her without everyone in the waiting room listening in.
I checked the patient’s blood pressure, gave her some GTN, an aspirin and put her on oxygen; all things that should have already been done by the GP.
Thankfully, the ambulance was pretty quick in turning up, and the patient went off to hospital.
I had a chat with the GP—it’s one that I’ve had a couple of times now. It’s a chat about how possible heart attacks shouldn’t be sat out in the waiting room, about how ISIS-2 and NICE say that an aspirin should be given. How GTN is a good thing to give such a patient, and that oxygen can really help with the pain and anxiety.
‘I don’t care about that,’ said the GP, ‘I just want her to get TROP-I.’
(TROP-I is a special blood test to determine a heart attack.)
He then didn’t want to hear that sitting a woman out in the waiting room with a potentially life-threatening condition was, on reflection, a bad idea. I know GPs are busy, but is a two-year-old with an ear infection really more important?
I’m left in awe of GPs who don’t seem to want to treat anyone. Like nursing homes I’m sure I only meet/remember the rubbish ones. But if my mum was having a heart attack and went to the GP I’d be fuming if they sat her in the waiting room for an ambulance to arrive. It’s not hard to give someone an aspirin, it’s not hard to give them oxygen and it’s definitely not hard to keep an eye on them in your examining room while you wait the (less than) eight minutes it takes for an ambulance to arrive.
I’ve mentioned before how the LAS will visit and help train rubbish care homes—I’m beginning to wonder if we should also go to GPs and let them know what the ambulance service (and by extension the local A&E departments) expect.

Wasting the Time of a GP (#ulink_5d476be6-7d6c-59e5-aead-2125360110cb)
I’m not aiming to annoy GPs, but the day after the ‘heart attack in the waiting room’ I went to another case where the GP was less than helpful.
It sounded like one of our ‘crap’ calls: ‘six-year-old female, losing weight, tired’, not what you’d mark down as needing an emergency service.
The ill child was very thin, and her concerned parents told us that she had been losing weight for the past couple of weeks. She was lethargic, wasn’t eating well (she was mainly drinking a lot of fizzy drinks) and had been having spells of dizziness. To my eye the child did look rather unwell.
The father had taken her to the GP earlier in the week, and the GP had told him that he was ‘wasting his time’ and that the child would soon put the weight back on. The father asked for the child to be sent to the hospital, and the GP refused this.
We got the child into the ambulance and starting running our tests.
Her pulse was normal, as were her blood pressure and oxygen levels.
Her blood sugar was not normal. It was above 33 mmols (which is, I think, around 660 dg/l). The normal value is around 5 mmols.
The child was (almost certainly) an undiagnosed diabetic.
In my ‘big book of how to tell what might be wrong with someone’ there are six probable causes for severe long-term weight loss. They are Malignancy, Depression, Thyrotoxicosis, Uncontrolled Diabetes, Infection and Addison’s Disease. Within minutes of meeting this child for the first time, we had a provisional diagnosis.
It’s not hard to do a blood sugar test in a GP surgery; it takes less than 30 seconds.
So why did the GP tell the parent to go away? Was it because the GP was so busy trying to fill the government’s targets? Or was it the case that the GP considers severe weight loss in six-year-old girls a ‘phase’ that they will grow out of?
However, now I realise why the ambulance service is doing diabetes screening.

Small Observation (#ulink_e6d856bb-ef90-5564-b34d-f9ea7b5649fd)
When the weather is nice, a polite 90-year-old woman who has drunk a bit too much wine and has fallen over can be a very endearing patient.

(Another) Nan Down (#ulink_cdfc3ce0-fd48-5b89-8be9-0fc9b8afe9cf)
Since I am feeling (and to be more honest looking) fat I’ve decided to take up cycling again. I’m sure that I gave a great amount of joy to anyone who saw this particular tubby man puffing and panting against the wind while cycling along at 1 mph. Still, if I want to stop from looking six months pregnant I need to start some exercise. Another reason is a job I did yesterday.
We were sent to a strange call. It was given as ‘Elderly woman lying on the green as you enter Kellett Road. Woman may have got up.’
Rushing to the green we found it empty. So we decamped from the ambulance, grabbed our bags and went for a little wander to see if the patient was hiding in a dip in the ground. Across the green, near some houses, some people started waving at us so we trotted over.
The patient was a very elderly woman. She was wearing a nightdress, a threadbare cardigan and nothing on her legs. She was also barefoot—I was surprised that the thin skin on her feet hadn’t been torn apart by the pavement.
The temperature, not taking into account the strong windchill factor, was around 1° Celsius.
She was—unsurprisingly—a bit blue and she felt like a block of ice.
We only had our medical equipment with us; we didn’t have a blanket so I took off my fleece and wrapped it around her before running back to the ambulance to bring it closer to the patient.
I was shocked by how out of breath I was after jogging about 150 yards. Twenty-four hours later and my ankles were still in pain.
I brought the ambulance closer and we bundled the patient into the back, turned the heating on full and wrapped her in our blankets. The patient was one of those little old ladies that you would want to give a good cuddle to if she were your gran. We had a short and uneventful trip to the hospital where she was soon receiving the attention of the nursing staff.
My crewmate filled in a ‘vulnerable adult’ form, which means that the social services will get involved so that the patient will (hopefully) get any long-term care that she needs.
I managed to get my fleece back.
It now smells of granny wee.
It’s in the washing machine as I type this.

More Madness in East London (#ulink_09168721-2ffc-5210-b02d-4378c92a2002)
We were called to a fourth-floor flat in one of the many housing blocks in the east of London where we found an unkempt man in his forties pacing back and forth along the access balcony to his flat.
He wasn’t wearing any shoes, socks or a shirt, and his trousers and pants were falling off him.
While he paced he was muttering about God and the Devil.
The patient obviously had mental health issues, but we also suspected something else was causing this behaviour. At one point he made to throw himself over the balcony. We stood in his way to prevent him doing this, and more importantly to stop him making us go through the, frankly hard, work of trying to save his life in the face of major trauma.
As we led him back into his flat to get some shoes/clothes we realised that the reason why he was behaving so strangely might have been exacerbated by drug use. We nearly tripped over an empty bottle of methadone.
The flat was—as I’ve mentioned before—exactly how you would expect a drug den to look. There was drug paraphernalia strewn around the place, mattresses on the floor and the heavy curtains looked like they had never been drawn.
The patient continued to pace around while occasionally becoming quite agitated. While we didn’t think that he would become violent we were still rather wary of getting too close to him or letting our guard down.
After half an hour we had managed to get him dressed and were able to lead him downstairs where we ‘ahem’ ‘gently’ got him into the ambulance.
While I drove us to the hospital my crewmate did his best to keep the patient calm. We pre-warned the hospital that they would need security and the secure room ready for us. Unfortunately, the hospital switchboard wasn’t picking up the phone so there was no one there to meet us when we rolled up outside the A&E doors.
At one point he exposed his genitals to my crewmate.
A bit of a struggle began where the patient wanted to jump off the ambulance and run away, so my crewmate and I ended up restraining him until security arrived to help drag him into the department’s ‘padded room’.
I had a similar job the day before, another job where I ended up wrestling with a mentally disturbed patient.
What struck me as amusing was that on consecutive days the first job of the shift was to someone with an altered mental state who was blaming their God and the Devil, and who would later go on to show us their genitals.
I wonder if it’s something in the water?
I also sometimes wonder what the mentally disturbed would rant and rave about if we hadn’t thought up the idea of religion.

Ethnic Relations (#ulink_0f80dd32-e594-5b53-bcc6-fbc9a722c959)
After two days of struggling with people, it was nice to go back to the simple jobs that are a joy to do. It’s also good to see a sense of community.
In this case it was a little old lady who had tripped over a wobbly pavement in one of our local markets. She was surrounded by people of all backgrounds. There was a black market warden who had put cones over the offending paving stones. A Bangladeshi man was chatting to her and two Greek-looking men met me at the ambulance and led me to the patient. A Sikh stall keeper also pointed me in her direction.
The patient herself was one of the dying breed of ‘traditional’ English east Londoner. Normally an extremely healthy 80-year-old, she had a graze to her nose that refused to stop oozing blood. A real pleasure to talk to, we chatted about how the east of London has changed in her lifetime and how she still enjoyed living here.
‘I’m an ethnic minority now,’ she told me, ‘but there are still a lot of people around who’ll help you out.’
And she was right—as an ambulance person I tend only to see the worst of people. I go to the assaults and the arguments. I hear about the murders and the abuse, the neglect and the trouble. Just as this woman was, for me, an unusual patient in that she was a healthy 80-year-old, so it was that I saw the unusual event of people helping someone in distress.
It was one of those jobs that leaves you with a smile on your face for the rest of the day.

Lying to Patients (#ulink_2c0f05ad-39d0-541c-a66c-d07d423cb9e4)
Here is the thing—I’m a pretty poor liar. I don’t get much practice, I don’t like doing it and as part of my personality flaws I love sharing things that I know with anyone who’ll listen. Unfortunately, in this business you need to try to keep some things to yourself.
I was called to a place of work where a 55-year-old woman was complaining of constant headaches. When I arrived on the scene a work colleague was comforting her as she had obviously just been crying.
I got a verbal history from the patient—the headache had been coming and going for two weeks and normal painkillers weren’t touching the pain. There was no other history of ill health, she hadn’t been to the doctor for years and she had no allergies. She told me that on that morning she had woken up with the headache and also a feeling of ‘not being connected to the world’. Once more, her painkillers hadn’t even touched the pain.
A quick ‘n’ dirty neurological examination didn’t reveal anything particularly scary and her observations were all normal apart from a moderately raised blood pressure. I discounted the blood pressure as her being scared and sitting in the back of an ambulance looking at my ugly face.
So we had a drive over to the hospital.
All through the trip I could see that her main fear was that she had grown a brain tumour. The words were never mentioned but her fear was of such intensity and direction that I knew that this is what she was thinking. I would have loved to lie to her. I would have given a lot to be able to put my arm around her and tell her that there was no chance of the headaches being caused by a brain tumour.
But I couldn’t.
I had to sit there and explain about all my ‘negative findings’. I could tell her that her pulse was fine, that she hadn’t had a stroke, that her blood sugar was better than mine and that her short neurological exam didn’t show anything unusual.
But I couldn’t tell her what she wanted to hear.
We reached the hospital, and while I handed over to the nurse one side of her face started to become numb…
A little later, while returning to the hospital with another patient, I saw our woman in the resuscitation room. She was sitting up and talking to her work colleague who had accompanied her in the ambulance. I wondered why she was in there but was too busy to ask the resuscitation nurse.
Towards the end of my shift I saw our patient walking back from the toilet (with colleague still in tow). I asked her what the doctors had found.
‘They are keeping me in,’ she told me and my heart sank, ‘apparently I have a really high blood pressure, and that’s what’s been causing it.’
‘Oh superb!’ I said. ‘They can cure that!’
You could see that she was a lot more relaxed, and that her main concern was that she was now going to be in hospital while the doctors treated her blood pressure.
Hardly a concern at all.
The thing that I didn’t tell her was that her blood pressure had been so high, our machine for recording it hadn’t been able to measure it correctly. Which is a little troubling.

Patientside (#ulink_42d26fa7-7d82-5a5f-8e09-71dac5bf639a)
Let’s imagine that you are old and need a bit of care in your home—simple stuff, nothing too taxing, just a bit of a hand to help you wash when you wake up. Maybe you need help with some of the fiddly little tablets you have to take. Perhaps you just need someone who’ll help you keep your flat tidy.
Then, for the sake of argument, let’s say you’ve had a bit of a fall—nothing too serious, it’s just that your legs are starting to get a bit weak, and you don’t want to use the walking frame the hospital has given you. You are lying by your front door. You press the community alarm button you are wearing and when your carer arrives she lets herself in and then the ambulance people.
The ambulance people quickly check you over while you are on the floor—they let you know that they don’t want to pick you up if you’ve broken your leg. So you let them examine you, and when they find nothing, you ask them if they can just put you in your normal chair by the television. You wonder why the ambulance crew are tutting at your carer for not at least putting a pillow behind your head while you were stuck on the floor.
The ambulance crew help you up and put you into your favourite chair. As you aren’t hurt by the fall you don’t want to go to the hospital—you’ll only sit in the department for several hours before some young doctor tells you that you should be using your walking frame. It’s easier to sit in your own flat. The ambulance people seem pretty nice, though, and they want to give you a full physical check-up to make sure that there is nothing obvious that would cause you to fall.
You tell the ambulance people that you’ve been having a few falls as your legs have been getting a bit weaker recently, but that you get around all right and that you have the community alarm button around your neck should you get into any trouble. The ambulance people try to persuade you to go to hospital, but you refuse again. One of the ambulance people checks various pulses and pressures and sugars and heart tracings before agreeing that you can refuse to go with them.
The ambulance man is looking around your flat and tutting at the carer again. He doesn’t like it that as he walks around he is making a crunching noise as he crushes your tablets which are strewn all over the carpet. It’s not your fault that you sometimes drop them. It’s not the carer’s job to make sure that you can take your pills.

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