Friday 28 June 2013

Can I Go Down There?

It is with great pleasure that I open the floor to my first Facepalm Friday guest post! This week I welcome the award winning, much revered, mental health guru that is @MentalHealthCop from MentalHealthCop! It occurred to me that all the emergency services interact with the public and therefor, we all come across candidates for the Darwin award on a daily basis! This comedy gem from Inspector Michael Brown is from his earlier days as a police officer. At a guess, it was probably in the late 1870's! ;-) 

"Adult male, wanting to go down there" 

I found the Friday Facepalm idea intriguing! - 999 services see human stupidity on an epic scale and we've all got these stories, but my blog doesn't lend itself easily to letting off the necessary steam around them.  Thanks to Ella, I have offloaded some major stress from my early career.

Well over ten years ago, I was a front-line PC in Birmingham.  My partner and I were called to a gas explosion on a very small traffic island where four approach roads intersected.  A engineer for a telecoms company had been working on underground pipes / cables, on the pavement which rounded the corner of two of those approach roads and had managed to ignite gas by cutting electrical wires.  The subsequent blast singed his hair without causing major injury and sent a thirty foot high flame into the sky.

An early Facepalm! for the engineer - but this is merely incidental to the stupidity that followed.

All three 999 services went down there: Ella's lot were helping the engineer change his underwear whilst Simon and Dennis were using their hoses to put out the fires caused to trees and bushes as the gas plume licked back and forth in the wind, torching anything within it's reach.  The only way to stop the plume of burning gas was to get the gas company to dig up the road around fifty metres away and isolate the supply - this would take hours so we were asked to support cordons on the roads and pavements for public safety.

The fire truck blocked one road, the police car another and the two less frequently used approaches were taped off.  There were two cops and a few fire officers to keep saying "No" to the question that always gets asked on these occasions -

It's been the since human pre-history that when you put a cordon on something, some members of the public will still ask "Can I go down there?"  It's important to understand I'd managed nearly two hours of "Can I go down there?" whilst sweating profusely on a what was already a very hot day, underneath a thirty foot plume of burning gas and we'd had to get another patrol to drop cold drinks up to us because it was quite demanding.  So to say I was a bit tetchy about "Can I go down there?" is to understate things.

The clue is:  my police car is across the road with blue lights flashing, we've taped off the road and you can see highly dangerous flames burning brightly and gently toasting us all.  They're licking backwards and forwards fairly unpredictably and there are fire personnel putting out fires as quickly as they can each time one starts.  You've probably seen other people approaching us who ended up heading back the way they came, so what do you think the odds are that you can "just go down there?"

Then happened one of the most unbelievable things I have ever seen - I will remember this until I die:  on the less often used approach, which was taped off and kept in view, but where no-one was permanently standing, a suddenly saw a young boy approach the tape and lift it in the middle. There was a Mercedes in the road, facing me and the boy looked like he was attempting to allow the car underneath the tape. Hang on: that car is slowly moving FORWARD!!


*Double Facepalm!*

I ran from the opposite, busier cordon shouting "No!"  The vehicle's bonnet was under the tape, the tape stretching across the windscreen and the boy trying to lift it higher as the car inched slowly forward. There was a hairy arm out of the driver's door also attempting to force the tape higher and flick it over the height of the roof.  "Stop!"  The vehicle was approaching the roundabout on the side where the plume of flames was nearest.  Surely he can see it?!  The fire engine was to the right hand side and he could see it from where his car was and both Simon and Dennis were waving frantically in between planning their second jobs and having a snooze.

"What on earth do think you're doing?" I enquired.  "I live up there." he said, implying outrageous unreasonableness on my part.  The wind blew the flames towards us and I felt the temperature really increase before subsiding as the wind dropped.

"Can't you see the tape, the explosion, the blue lights?" 

"But I live up there!"

"It doesn't matter,  Sir - this road is CLOSED!"

"But I live ... just there!!"

"So find another way around, but this road is closed."

"This is ridiculous - I can just drive on the opposite side of the roundabout.  I'll be home in seconds."

"No you won't - because THIS ROAD - IS CLOSED!"

"You're being obtuse, officer."

"If we're offering viewpoints - I have one about using your son to lift police tape without permission and pushing him into demarked areas of extreme danger.  Shall we talk about that?"

"It can't be that dangerous ... they're letting you move about in it."

"They also let me arrest violent criminals, Sir - I'm guessing you don't want your son doing that either?"

"Fair point."

It took the threat of prosecution to get him to reverse and find another way.  I walked up to his house - it was just fifty yards beyond the opposite cordon and gave the appropriate advice.  I think I had hoped he would have realised the main learning opportunities from this encounter.  It amazed me to find he was still furious for the extra five minutes on his journey.  He informed me of that he would be complaining about my attitude and would like to speak to the duty inspector in respect of the complaints procedure.  Fortunately, Carlsberg do make duty inspectors - a man on whom I've modelled my very own approach to that job.

*Triple Faceplam* - the scale of fail.

Thursday 27 June 2013

Climbing for Little Angels

"28 year old female, climbing a load of mountains"

A few days ago I posted a blog called 'Little Angel'. I wrote it a long while ago but it never seemed the right time to talk about what is a very difficult and distressing subject. 

'Sudden Infant Death’ is the term used to describe the sudden and unexpected death of a baby or toddler that is initially unexplained. The usual medical term is ‘sudden unexpected death in infancy’ (SUDI). Some sudden and unexpected infant deaths can be explained by the post-mortem examination revealing, for example, an unforeseen infection or metabolic disorder. Deaths that remain unexplained after the post mortem are usually registered as ‘sudden infant death syndrome’ (SIDS). 

In February this year I learnt about Matilda Mae, who was the daughter of @Edspire and at the age of just 9 months tragically died due to SIDS. Jennie wrote some brave and heart breaking posts, none more so than 'Dear Matilda Mae: The night we found you sleeping'. Please, please read it to see SIDS from the families perspective. 

In the UK alone, each year there are 300 unexplained infant deaths. It was seeing  this number and seeing the amazing work Jennie, her family and her friends have done to raise money for The Lullaby Trust that made me want to do something. The Lullaby Trust provides specialist support for bereaved families and anyone affected by a sudden infant death, and it is this support which is invaluable to the many families affected by SIDS.

On the 1st August 2013, me and a friend are embarking on a challenge to raise money for The Lullaby Trust. We will be climbing the 4 highest peaks in Great Britain and Northern Ireland over 2 days. Starting in London we will drive to Northern Ireland and start with tackling Slieve Donard (850m). From there we will drive to Scotland and haul ourselves up Ben Nevis (1344m). Once Scotland has been conqured, we will drive to the Lake District where Scaffell Pike (978m) will be awaiting us. After that it's just a case of nipping into Wales, staggering up Mount Snowdon (1085m) and driving home.

Unlike the traditional 3 peak challenges, we have no support team to do the driving while we rest. We will sleep when we can and where we can. There is 1451 miles of driving which will take about 30 hours and about 24 hours of climbing (at best)! We expect to reach the summits of all 4 mountains within a 48 hour time window! 

Please, please, please sponsor me. The petrol costs, ferries and any accommodation will all be self funded. 100% of sponsorship will be going to The Lullaby Trust to help continue their crucial work. It costs them £1.6 million each year to do the work they do so anything that can be raised will help. 

This is my Just Giving page:
I will of course be showing proof from the top of each mountain so you know I actually went up there! Please dig deep! Anything is better nothing. 

Thank you :-) x

Sync Complete

I should probably start this post with an announcement. I HAVE A NEW LAPTOP! How amazing is that! I've been wanting / needing one a long time! My old one was bought in 2007 and can no longer cope with the simplest of tasks! 2007! It's amazing when you think back THAT far! My son hadn't been born, I was married, I was working Monday to Friday in a tragically dead end job! It is amazing what can change in just six years! Anyway, yesterday when I finished work I wandering into the Apple store and bought my new MacBook Air and totally abused my 'old' student card to blag the discount! I was pretty damn chuffed as I walked out, new toy in hand! I drove home, opened the box and started syncing! What a day!

Then I thought, 'yeah, what a day'. My mood descended somewhat into one of reflection. It's easy to get caught up in a moment. Like I said, it is amazing how much can happen in six years. It's also amazing what can happen in 12 hours. It is also amazing what I'd managed to forget over 12 hours. Maybe not forget, but certainly the prospect of indulging in a new laptop had become top priority in recent hours. So much so, that it wasn't until now, starring at the words 'Sync in progress' that I realized that there were other people, people who I had seen today who weren't enjoying their evenings. 

"09:05 - 57 year old female, cardiac arrest"

I shot off up the road, dropped into 'sport' and started tackling the remains of the rush hour. I knew the road well having walked down it twice a day, to and from school for many years. I knew I would be the first to arrive and wanted to get there as quick as I could. 

Four minutes after someone had dialed 999 I pulled into the street. I screeched to a halt, grabbed all my stuff and rushed inside. I was beckoned up the stairs by the distraught looking husband. Lying on the floor of the bedroom was my patient. There was nothing I could do. She was dead and had been dead for quite a while. Rigor mortis had set in and there was post mortem staining present. I exited the room and closed the door behind me. 

"I'm so sorry, but there is nothing I can do. I'm afraid your wife has passed away."

The man fell forward, wrapping his arms around me and began sobbing. As he cried, their son appeared on the landing in his dressing gown, also sobbing. I managed to escape his grasp and let them cry together. I went and put the kettle on to make some tea and I cancelled all other resources. In situations like this, tea always seems sensible. They came downstairs and sat on the sofa crying. They looked totally lost. No idea where to turn, no idea how they will move forward. 

I waited with them, comforted them as best I could until the police arrived. I left them to deal with their unmeasurable loss. A very tragic start to the day for all involved.

"12:09 - 33 year old male, ? slurred speech, ? stroke"

My initial thoughts on being sent this were skeptical. Come on! 33 years old! Having a stroke! Not likely! It only took me 3 minutes to get on scene and my patient was sat at the roadside waiting for me! He staggered towards me like someone who's been drinking! I kept him at arms distance whilst I spoke to him. Within about 10 seconds it was clear he wasn't drunk. He was having a stroke.....

His speech was slurred and he couldn't find his words. He was limping and had very little power on his left side, hardly any grip at all and he was drooling slightly. He had no risk factors which made it all the more bizarre. I called control to tell them it WAS as given and I needed an ambulance ASAP. 

33! Unbelievable. He was a successful guy, had a lovely house in a lovely area. He was very confused and had been found staggering around the front garden by a neighbor. He was due to get married in a few weeks time to the woman pregnant with his child. Surely his life can't be ruined at 33? Surely he will get a chance to do all the little things with his baby? Surely he can still get married to his childhood sweetheart? So much was suddenly unknown. So much had changed. 

The ambulance arrived and rushed him off to the stroke centre. I phoned his fiancée to give her the news......

"16:01 - 26 year old male, RTC, Car Vs Motorbike, ? unconscious"

Again, I knew the road well. It's a busy, fast, duel carriageway. This guy could be in a serious condition. That ominous sense of urgency engulfed me. As I approached the stretch of road, it was clearly serious enough to cause a complete standstill to all lanes of traffic. I managed to get myself into a bus lane and shot down the inside of the traffic to the incident. Lying on the floor, surrounded by people was the motorcyclist. About 100 meters further down the road was his bike. By all accounts he'd been clipped, flown through the air and then hit by a car. 

The guy was unconscious, he had a pulse but his breathing was extremely slow. Under normal circumstances, you need two trained staff to remove a helmet. It was just me and the ambulance would have a nightmare getting through the traffic. Based on my initial findings I immediately called and requested HEMS. Luckily the helicopter was 'on line'. ETA 8 minutes.

I couldn't wait to take his helmet off. I enlisted the help of a by stander and got it off. I got someone to kneel either of his head and hold it still whilst I started cutting of his leathers. His battered, blooded body was fighting to survive but I got the sense he was deteriorating. I attached him up to the machine to get his blood pressure. It was extremely low. I put in an airway and started ventilating him. I was aware of what was being said by people around me but was trying to ignore it. 

"Red base, this patient is about to go into cardiac arrest. Any other resources near by?"

"Rog, we have a car about two minutes away from you."

As she said that, I heard the sirens. What a relief.....

Too late....his pulse had gone and there was now no respiratory effort. I started CPR. The police and FRU arrived together and now the chopper was circling above. We set about running the resus. Airway, chest decompression, IV access and secondary survey. HEMS landed in the road ahead of us and promptly took over. He was given blood infusions, injuries were treated and eventually his heart started beating again. He was taken off in the chopper to the trauma centre by the HEMS team. 

He was pronounced dead shortly after arrival at the hospital......

"20:12 - 28 year old female, starring at new laptop"

Not such a great day after all. Whilst I sit here enjoying my new laptop there are three families who's lives have been destroyed today. Three families where I have been a huge part of their day. Telling them their wife and mother have died, telling them their husband to be and father to their unborn child is having a stroke and trying in vein to save a husband, brother, father and son. Two lives over, one changed forever. It is too easy to forget about these people. They aren't my family or friends and I have no obligation to mourn their losses and in all honesty, after today I'll most likely forget about them. That doesn't mean they didn't have an impact on me though. They did. 

'Sync complete'

Wednesday 26 June 2013

The Elephant In The Room

"33 year old male, bleeding per rectum"

I'm not going to lie. The prospect of visiting a man with a bleeding rectum isn't how I wanted to start the shift. In all honesty when I signed up to this job I didn't know bleeding rectums existed! My issue with them is this. First, there is nothing I can do. Secondly, despite what the patients who are suffering the bleeding rectum think, I will not be examining, visually or otherwise. Finally, when people have a bleeding rectum they invariably find out on the toilet. This then leads to that awkward moment where they want you to visual inspect the content of their toilet bowl. On special occasions, they save used toilet paper in a bowl to look at and more often than not, are insistent that you look! I can promise you, a description of events will usually suffice and no, you need not bend over, spread your cheeks and tell me to look.

Today, I was on the car. Generally any job involving genitals, rectums, embarrassing bodies or anything else that may cause embarrassment, I prefer to be on an ambulance. Maybe it's because I like to share the awkwardness, or maybe because in some situations there should always be a witness! Anyway, sometimes, awkwardness is unavoidable and it's our job to try and not make things worse! 

I rang the buzzer of the flat and was met at the door by the patient who immediately darted back up the stair case. I reached the landing of the flats and headed into the open door. The patient seemed very nervous and anxious. He was breathing very fast and sweating profusely. I spent the first 5 minutes or so just calming him down! His blood pressure was through the roof but I put it largely down to his nerves and fear of being seriously ill. 

He explained what was wrong, and offered for me to look at the blood in the toilet. He told me it was bright red and there were no clots so I didn't feel the need to cast my antique-roadshow-esque eyes over his toilet bowl contents! The reason for the bleeding was somewhat of an enigma, so I just carried on with my questioning hoping that some kind of cause would become apparent. This is what can be awkward. There is me and the patient, alone, and no ambulance to be seen and I have to fill the time with asking questions about his rectum and toilet activities. You can see why it was a little cringe!

I asked about any medication he was on. He started trying to recall them, with little success so I asked if he had a prescription. The patient was sat on the end of the bed, I'd grabbed one of his chairs and sat opposite him. Next to us was another chair with his coat sitting on it. He reached forward, grabbed the coat and pulled it towards him. As he did so, in slow motion, something fell from the chair.....

As it fell, it rotated. I think I saw it slightly before he did. My eyes fixed on the moving target, as he realised what was happened. He lunged his hand out to try and catch it but missed. As it hit the floor it bounced slightly and began rolling towards me. It was like watching it on a super slow-motion camera. I knew it was going to hit my foot but I couldn't move to stop it. Contact was inevitable. Then it hit, wobbled and stopped. Motionless it laid there. Looking at me. A panicked swipe by the patient scooped it off the floor and back under his coat. Now there was a Mexican stand-off of sorts. Who was going to mention it first? Or would we both pretend that nothing had happened and that I'd seen nothing?! Maybe he was hoping I hadn't seen anything?!

I didn't know where to look. I didn't know what to do. There was an elephant in the room. My face stayed emotionless. Behind the cool exterior there was utter panic! My mind was screaming at me......



"DON'T......SAY......A......WORD. You'll just make it more awkward. BUT IT WAS A DILDO! A FRICKIN' DILDO. And it's HUGE. And it hit my foot. HIS DILDO HIT MY FOOT."

Whilst my inner monologue continued, the patient was shuffling through his jacket pocket 'trying to find the prescription'. I imagine he knew exactly where it was but his mind was probably busy screaming....


"DON'T......SAY......A......WORD. You'll just make it more awkward. BUT IT WAS MY DILDO! MY FRICKIN' DILDO. And it's HUGE. And it hit her foot. MY DILDO HIT HER FOOT."

I think both of us wanted the ground to open up and swallow us whole. Where was the bloody ambulance. This situation was now 'time critical' because I WAS GOING TO DIE! Despite my trusted inner sanctum telling me to keep my mouth shut I had to be the one to discuss the 'elephant'.

"Have you....errrr....could that you think's the cause of the bleeding?"

*Awaits answer* CRINGE!!

"Yes, I think so, sorry"

Before I could respond there was a knock at the door! The ambulance! I shot off down the corridor to let them in. I gave them as sensitive a handover as I could. I managed to avoid blurting out 'THE DILDO HIT MY FOOT'. I said goodbye to the patient (we shared 'a look') and I hurried back to my car. I got in, turned the engine on and laughed out loud!



Sunday 23 June 2013

Little Angel

WARNING: Some may find this post extremely distressing. It's on the subject of Sudden Infant Death Syndrome and contains some very upsetting descriptions. 

I remember when I first started training, being told about all sorts of things that we will see. Some rare, some common and some unheard of. The prospect of the sheer volume of things I would see scared me  but having never seen anything, it was all a big unknown. I didn't know how I'd cope with the shifts, the people and the emotions of what is commonly touted as 'A job like no other'. I was assured that when the time came I'd be with a 'grown up' and all the training would come flooding back. I could only hope.....

It soon became apparent that the training did come flooding back, time and time again. As the weeks, months and years went by more and more things became second nature. My body got used to the shifts (kind of), I got use to the people (kind of) and on the whole my emotions were kept in check. You do get an emotional attachment to some patients from time to time. Some faces stay with you. Some are gone within seconds of leaving them. There is a constant emotional tight rope with me thinking that I'm either dead inside or too fragile to do the job. I suppose that balance is what has kept me grounded most of the time.

We'd been having a pretty non-descript shift. I couldn't begin to tell you the patients I had seen or what was wrong with them. That would be the 'at arms length' approach to ambulance life. The first real detail I remember of this day was my index finger reaching out and pressing 'Green Mobile'. Within a couple of seconds the job appeared on the screen.

"4 months old male, cardiac arrest, CPR in progress"

I felt the blood rush away from my face, my hands became cold and my heart rate doubled. I started imagining everything that could happen next. I pictured the child in his cot, his parents frantic. The only image of the room he was in that I could conjure was that of my own son's room. The thought choked me. Surely, this can't be. It must be an error. He must just be asleep. It must be a false alarm. I don't know why, but this felt different to all false alarms that have come before. This had a strange reality. I knew this was real. Then the radio started ringing.....

"Guys, I believe this is as given, we have another truck and an FRU on way but you are currently nearest. I have also requested the police."

My heart genuinely sank. I couldn't for the life of me remember the resus protocol. I knew it, but I convinced myself I didn't. I was the clinical lead. My crew mate was a student and was equally terrified. I tipped my bag upside down and started flicking through pages of A4 paper with recent clinical updates. I had about 0.3 miles to refresh my memory and then it was all on us. 

We screeched into the road, the familiar waving met us at the kerb. This time it was all the more frantic. All the more desperate. All the more real. The child's dad, consumed with grief, overcome with fear was begging us to do something before I'd taken my seatbelt off. I jumped out, grabbed some bags and ran into the house while trying to find out what had happened. A woman, who I assume was the grandmother was stood in the hallway clutching on to two young children. Tears were pouring down their faces. A shiver ran the length of my body.  This is as real as it will ever get. As I neared the top of the stairs I saw the mum. She was kneeling on the floor, desperately trying to breathe for her beloved baby boy. 

"Please, do something!!" she cried at me. 

Her voice alone broke my heart. I'd never experienced such pain and hurting. I could imagine the desperation and her thought process but without living through it, imagination won't ever come close to reality. 

I looked down at the boy. He laid there lifeless, peaceful, like he was sleeping. He was dead. His short life had come to a tragic end and I knew there was nothing I could do. There was nothing anyone could do.  

"Do something, please!" she wept. "My beautiful baby boy. I'm so sorry, I'm so so sorry."

In that split second I made a decision that I have questioned over and over, ever since. I held the mask to his face, filled his lungs with oxygen and started CPR. I lifted his lifeless body off the floor. With him lying on my forearm and using just two fingers I continued the chest compressions down to the ambulance. My crew mate followed with the bags. The FRU had arrived by now. He saw me rushing out of the house with the baby, and opened the back doors for me. The mum and dad got on board and we left. We had been on scene no more than 2 minutes. I looked at the guy on the FRU and just shook my head slightly. 

As we drove through the streets all I could do was go through the routine of CPR and ventilation. I felt in that moment it was what the parents needed to see. They needed to see us do something. Anything. I struggle with the morality of giving false hope though. Was I prolonging their pain? Who am I doing it for? Was it me who felt the need to do something? 

"I'm so sorry my baby boy, I'm so so sorry I wasn't there when you needed me, I'm so sorry my little angel."

Despite my best efforts, tears started trickling down my cheek. I couldn't help but see my son lying there, imagining what I would do in this unimaginable situation. 

The doors swung open, I picked him up and ran into resus. A small team was waiting. They'd been warned by control we were coming with a patient who was deceased and all our efforts were for the benefit of the family. I handed over the brief history I had. He was put to bed at 6pm. At 9pm, mum went to check on him and he wasn't breathing. Here we are now. 

The doctor told them he had gone. He tried to do so in the most compassionate way he could. Maybe that's why I started CPR. Because I couldn't have that conversation. I couldn't be the one to break that news. News they most likely already knew. Maybe I fell into the trap of having to do something. I don't know. To be honest, I didn't know anything. I couldn't process what was happening. 

I left. It wasn't until I got back to the ambulance that I realised we were all crying. We sat there in silence for a good ten minutes. What could we say? What could we discuss? There is no job more distressing, more tragic and more emotional. What we were feeling however, pales into insignificance in comparison to what the family were going through. The more I thought about it, the less I was able to comprehend the impact this event would have on a family. It literally didn't bear thinking about.

The police arrived and asked us some questions, and then one of our officers arrived. We were told once we were finished at the hospital we could go home if we needed to. We all did. I didn't come in for another week. I couldn't. We were offered support and counselling if we wanted it but I turned it down. I suppose the last thing I wanted was to talk about it. I didn't want to think about it. I wanted another job. I couldn't do this again. Ever.

I did come back. I still don't think I could go through that again. I know there is a chance I will and that will have to be dealt with if and when the time comes. Those parents have to not only come to terms with the loss of their child but somehow be strong for their other young children. The least I can do is carry on offering that false hope where it's needed. It would be selfish to walk away.

You cannot quantify events like these. Saying 'these things happen' doesn't do the loss any justice. I felt like a fraud moping around, feeling sorry for myself. This will be with that family for the rest of their lives. There are no answers that can be given. No meaningful explanations as to why. Nothing will make it better. The words 'I'm so sorry my baby boy' will forever be with me. I will always remember their little angel. I know she did nothing wrong, the doctors know she did nothing wrong, but I also know she will probably take a feeling of blame with her to her grave. I imagine all parents would. I know I would.

Friday 21 June 2013

Keep On Running

"22 year old male, severe pain in legs, unable to stand"

To say I was sceptical would be an understatement. 22 year olds, generally speaking, don't spontaneously lose the ability to walk. 82? Maybe. 22? Not a chance. There was no other information to go on so we'd have to wait until we arrived to in what critical condition the invalid was in. My crew mate was less than impressed with the presenting complaint. He had run the London Marathon the day before but had forgotten to book annual leave. His legs hurt but he'd dragged himself into work knowing there was a distinct possibility his tired legs would have to carry people down stairs. He was however, content in the knowledge that this patient would not be carried anywhere!

We arrived in middle class suburbia, new build after new build, mid range hatchbacks on every drive way and headed to the front door. A woman opened the door. She pointed up the stair case in quite an abrasive manor. 

"He's up there." she said.

Up we went. My crew mate didn't seem overly impressed at having to negotiate 13 stairs! One door on the landing was open so that's where I headed. Lying on the bed, topless and wearing just his boxers was our patient. He had a pained expression on his face like he was in a Greek tragedy. I wasn't buying it.

"Hello Sir, what's the problem today?"

"The pain, the pain in my legs is just too much, I can't even stand."

"Where exactly is the pain?"

"All over."

"And what pain killers have you taken?"



"And why not?"

"Because the pain is too much, they won't help."

"Is this a new pain today? What's caused it?"

"I woke up with it."

"And have you done anything that could have caused it?"

"Yeah, I ran the marathon yesterday."

*Double Facepalm*

I stepped back and allowed my crew mate to take over. Not because I had nothing to say, but he had much more to say!

"I ran the marathon yesterday, and I'm at work today. You ran 26 miles. Your legs will hurt. Take anti-inflammatories, take pain killers, have a massage! Pain is normal!"

He really was getting quite animated! I was loving it. The patients mum appeared in the door. I assume she'd been listening in!

"I told you. I told you not to waste their time. When will you grow up and start acting like an adult?"

YEAH! What she said!

"So, what do you want to do today?"

"Erm....go to hospital." he said in the most sarcastic of voices.

"You don't need to go to hospital. They will tell you that you have just run a marathon and should go and take pain killers."

"You lot are all the same. Just lazy. That's what the last ambulance said to me. You're idiots man."

"You've already had an ambulance today?"

"Yeah, about an hour ago" his mum said.

*Triple facepalm*


Wednesday 19 June 2013


"63 year old female, cardiac arrest"

There's that all to familiar ominous feeling when we get dispatched to a cardiac arrest. There is a heightened tension in the cab and my senses are much more focused on the drive. I can feel my eyes fixed on the road ahead, assessing the movement of everything ahead of me. What our advanced driving course taught me most was awareness and hazard perception. After 5 years of practice it's all second nature but still requires concentration. At any one time on a blue light drive we are planning our movements based on everything in the distance and just in front of us. It's changing constantly. 

I was racing through the high street, watching for pedestrians on both sides of the road, scanning the parked cars for potential movement, monitoring all 3 sets of traffic lights and looking for gaps in the traffic for me to weave through. A car 100 meters ahead on the other side of the road flashed to let me through. They were just before a traffic island which had a pedestrian standing on it. I pulled out onto the wrong side of the road, my lights and sirens were on and headed towards the gap the car had created for me.

As I approached the island, I could see a man waving at me. I started to slow down in case he was flagging us down. As I got closer I could see the expression on his face. I could also see it wasn't a wave. He was doing a 'wanker' hand gesture, whilst mouthing expletives at us. His eyes full of of hate and anger. As we were drawing level with him he raised his middle finger and spat at the ambulance. We continued on our way.......bemused.

Please, someone explain why people like this exist! How can anyone have such hatred for the ambulance service?! You could see the hate in his eyes. Is it a uniform thing?! I genuinely don't get it!

I'd loved to have stopped and asked for an explanation or to hear what he was saying but a lady was dead and we needed to fix that! We arrived, fixed it, she survived and wrote a thank you letter. I wonder if he would have behaved the same if he'd walked past us doing CPR! Hmmm......

Thoughts on a post card please. I'm looking for answers and solutions! Sensible or not!

Sunday 16 June 2013

A Chance - Part 2


Moving a patient in cardiac arrest isn't easy. He needed to be put on the spinal board, lifted to the bed and wheeled onto the ambulance. All the while, CPR had to continue, as did ventilations and suctioning. Neighbours were holding up fluids and moving cars to enable the ambulance to get closer. The patients wife, son and daughter were stood watching, grief pouring from them. Their pain was palpable for all involved. A neighbour suggested they didn't watch but nothing was going to stop them being by his side. When someone is begging you to save their loved one it is a pretty chilling feeling knowing that you probably can't.

We got him on board, put in the blue call and left. The other FRU took the relatives and we left en mass. 2 ambulances and 2 cars in convoy to the hospital. On route there was no change to the patients condition. As every minute passed, the outlook became bleaker. One hand on the hand rail and one on his chest, CPR continued over every bunch and round every corner. When we arrived at hospital he'd been 'down' for well over an hour. The only thing that could save him now was the definitive care provided by the hospital. If they could find the cause and it was something they could treat and reverse then maybe, just maybe he had a shot.

People watched on in shock as we emerged from the back off the ambulance on to the tail lift bouncing up and down on the patients chest. As the lift was being lowered my eyes met with his wife. I felt a lump in my throat as I pushed back the tears. The six of us, all doing or carrying someone, wheeled the patient into resus to the waiting crash team. There were fifteen members of the hospital staff who swarmed around him. He was transferred to the bed, the anaesthetist took over the airway, a nurse took over CPR, junior doctors begun getting further IV access and blood gasses, a scribe was writing everything down and the consultant insisted on silence for everyone to listen to my extensive handover. 

"62 year old male, witnessed collapse, 1 minute tonic clonic seizure followed by cardiac arrest. CPR started immediately. Initial rhythm was VF, he received 6 shocks and has been in slow, wide PEA ever since. We have a patent airway with good CO2 maintained with suction. He has patent cannula and IO access in the humeral head. He's had 18 x Adrenaline, 500ml of saline and 300mg of Amioderone. He's been down for 1 hours 18 minutes. We've been through the 4 H's and 4 T's."

I stood back and watched. The consultant was fantastic. Clear direction, paying personal attention to each member of his team, giving individual instruction and calming down the junior doctors who were getting a bit flustered. I've never seen a doctor so clear and articulate. He asked us to bring the family into resus which I haven't seen before. Normally they are left outside. They appeared in the cubicle, eyes red and clearly distressed. Blood gasses were sent of, focused heart echoes were done and to be honest I wasn't holding out much hope. He went over and quietly spoke to family explaining what was going on. 

A nurse returned with the blood gasses and handed them to the consultant.

"Right guys, this patient has been down now for nearly an hour and a half. He's had the best care possible. His blood gasses have returned suggesting he's at a point no longer compatible with life. On two focused echoes his heart is showing complete myocardial standstill. I've discussed this with the family and following that discussion, combined with what we are faced with I am of the opinion we should terminate the resus. Does everyone agree or does anyone have strong feelings that we should continue on?"

His statement was met with silence from the 21 of us in the cubicle. 

"OK, with regret, time of death 18:04. Thank you everyone for your efforts." 

The body of our patient was then covered, his face cleaned and airway removed so his family could spend some time with him and say their goodbyes. I was choked up. Everyone was. It is impossible to remain emotionally detached from your patients. Impossible.
The consultant called all the staff outside of the room. 

"Brilliant job guys. You guys in particular (talking to us) did a phenomenal job and thank you to everyone who helped out here. Lets all have a cup of tea, I'm here to answer any questions you may have or if you want to get anything off your chest, let me know"

He then did a full debrief, explaining his decisions, explaining possible causes etc. I've never had a consultant like him. Not only genuine care for his patient and the relatives but for all the staff under him. He didn't talk to anyone like a subordinate, but like an equal. It was refreshing and we all left somewhat lifted by his manor. Today the NHS can be extremely proud.

This job goes to show that death can't be avoided. Sometimes, even when all the cards are dealt in your favour, the house still wins. 

NB: I tried to find out who the boy was. No one recognised him and he left half way through the resus. Our patient only had a chance because of him. I wish I'd got his name. His efforts deserved recognition.

Saturday 15 June 2013

A Chance - Part 1

"82 year old male, collapse, ? seizure, O/S"

This wasn't just a collapse in the street, this was a cardiac arrest on a residential street on a weekday afternoon. It was witnessed by neighbours, family members and children. For many of them, it will be the single most distressing thing they will ever have the misfortune to see. Cardiac arrest survival is always improving but survival relies on a three things:

Early CPR. If CPR isn't started by a bystander within a couple of minutes the chances of survival decreases by 10% for every minute that passes. It takes an ambulance roughly 8 minutes to arrive. No CPR in progress means only a 20% chance of survival and they'd most likely be brain damaged. 4 minutes without CPR means the brain will almost certainly be damaged, regardless of whether we can start the heart again.

Early intervention. We need to arrive quickly to do advanced life support. On top of the CPR we need to secure an airway, oxygenate the patient, de-fibrillate and give various drugs to try and start the heart again then stabilise the patient and transport.

Good definitive care. A hospital with a crash team and any specialities that are required to treat the cause and assist recovery. Once stabilised, the long road of treatment lays ahead before the ultimate goal of discharge is reached. Only then do the government get what they want.....a return to tax paying status.

Miss one of those three and it is quite simply, Game Over.

"UPDATE: Patient now in cardiac arrest, CPR in progress"

I felt my foot push down on the accelerator, drop-gear kicks in and I accelerate. I'm only about half a mile away, I'm likely to be first there and on my own. Scrap that, as I crossed the next roundabout an ambulance appeared in my rear view mirror, driving with the same intent I was. We pulled into the street and headed to the crowd. About 8 adults of various ages waved frantically in the road. I screeched to a halt, grabbed my bag and rushed over. Lying on the pavement was an elderly man with CPR being done by a 13 year old boy. All the adults started talking / shouting at me trying to tell me what happened when the boy doing CPR shouted...

"QUIET.....I saw this man fall to the floor, he had a fit for about a minute so I called 999. He then stopped breathing and the lady on the phone told me to roll him over and start CPR. I've been doing it since. I've also done rescue breaths like I was shown in first aid."

Wow! Just wow! Despite the chaos the adults were causing, a 13 year old boy had taken the initiative and done an incredible job. I was so amazed. He didn't even know the guy, just saw him collapse while walking to a friends house. If the patient survives it will be down to him and him alone. I was a tad speechless. Clearly someone has had the sense to teach him first aid.

Whilst talking to him, one of the ambulance crew took over CPR and we began the 'Advanced Life Support' part of his treatment. As chaotic as these situations are it is important to recognise and encourage the efforts of others. Like I said, this is the most distressing thing they will ever see and they need to know they did well. As I have mentioned before, a resus is not as glamorous as 'Casualty' and 'Holby City' would have you believe. It isn't a case of a few gently chest compressions, a shock after rubbing metal pads together, shouting 'Clear' and one shock followed by High 5s and celebrations. It's messy and to be quite frank, brutal. 

The patient had been incontinent of urine and his stomach contents was filling his mouth which required constant suctioning through the airway. There was the unmistakable sound of ribs cracking, when the cannula went in there was a lot of blood. Throughout the resus this blood got spread about onto gloves and kit. To gain further IV access we drilled into his shoulder and his clothes were cut off. There is no dignity in a public cardiac arrest and no way to soften the blow to the watching friends, neighbours and family. With every shock, the electricity surges through the body causing it to jolt violently. All the while there is someone forcing air into his lungs, there is someone doing CPR with enough power to physically squash his heart through the rib cage to pump the blood around the body. I'm knelt by his side vocalising everything we are doing, giving drugs, trying to ignore the watchful eyes, many of whom are crying. This is the reality of a resus. Brutal.

After 5 or 6 shocks from the defibrillator his heart rhythm changed to one that couldn't be shocked. He had what is known as pulseless electrical activity (PEA). All we could do was continue CPR and push through adrenaline every few minutes. After half an hour or so we knew we had to go. There was nothing more we could do here, his only chance remained at the hospital.

To be continued.........

Friday 14 June 2013

I Didn't Think

Welcome to Facepalm Friday! I've decided that each week I will share with you a patient, or a conversation or an encounter that has simply left my head in my hands. Far too often I'm left questioning how some people manage to exist being so moronic! If anyone has their own tails to share, of people they've met or contenders for the Darwin award, I'm happy to have guests posts! Enjoy!


"47 year old female, dizziness, pain in jaw, headache"

10:15am: Patient phones NHS 111 and lists her symptoms. She told them she had chest tightness radiating to her jaw. She said she had severe ear pain. She said she was dizzy. She also had a headache. Despite it's faults, NHS 111 correctly requested an ambulance to be dispatched because of the priority symptoms. 

10:26: Because the patient has told the call taker she has chest tightness it is categorised as a high priority of call. An FRU (Fast Response Unit) and an ambulance were dispatched.

10:32: FRU arrives on scene (me!)

10:33: Ambulance arrives on scene

10:51: After much knocking and shouting and several attempts by control to phone the patient back the door is answered by the patient. 

"Sorry, didn't think you'd be so quick, I normally have to wait ages for my ambulances. I thought I'd have a shower before you arrived."

In my humble opinion, if you are well enough to jump in the shower whilst you are waiting for your emergency response you are a) not that ill and b) not an emergency. Also, the phrase 'my ambulances' grated on me. It means she has us out a lot, probably for similar symptoms. 

"What's the problem today?"

"I already told them on the phone!"

"But that wasn't us was it?!"

"OK, I've got this awful headache and dizziness and this pain in my jaw."

"Do you have any chest pain?"


"Oh, you told the call taker you did! What pain killers have you taken?"

"I haven't taken anything."

"Why not?"

"I didn't think they would work"


Seriously! Why do people not take pain killers! The clue is in the name! Time and time and time again it's the same futile conversations! "Are you in pain?", "Yes", "Taken pain killers?", "No". Why?! Why?! Why?! Can someone please suggest an answer to this age old question!

"So what time did the symptoms start?"

"About 2 weeks ago."


"Has you seen your GP?!" I asked, fully expecting her to say 'No'!


"And did he diagnose anything or give you any medication?"

"Yeah, these." she said as she passed 2 packets of drugs.

Ah, clarithromycin and prochlorperazine! The former, an antibiotic which she was given to treat an ear infection and the latter is a medication used to treat dizziness caused by inner ear problems. Both should be alleviating her symptoms.

"How long have you been taking these?"

"He gave them to me a week ago but I haven't taken them."


"Why not?!"

"Because I thought they'd make me feel sick ."


Notice she said 'thought'. She hadn't felt sick because of them. Her, an expert in general practice and pharmacology (not) had opted against the medication given to treat her symptoms. Instead, she called for us! The conversation continued in much the same way whilst we were checking her over. We did her ECG and the full battery of tests we do on most people and found nothing untoward. 

"How about we leave you at home, you take your course of medication and if that doesn't work make another appointment with your GP?"

"Nah, I think I should go to hospital. I know my body, something's not right."


Yeah, you have an ear infection and needed clarithromycin and prochlorperazine to cure your symptoms! It's not rocket science! Why do people go to their GP, call 111 or 999 and then ignore all the advice they are given?! Why?! Why?! Why?!

I gave it my best shot at convincing her she didn't need to go to hospital but she was dead set! We walked her out to the ambulance. On board I continued to ask her questions about her symptoms, specifically the jaw pain. 

"So how long have you had this pain in your jaw?"

"About a month, I've seen my dentist about it and he says I have a tooth infection."

"And did he give you anything for it?!"

"Yeah, these." 

She produced a box of Amoxicillin from her hand bag. I don't know why I had to ask, I knew what the answer would be but I was curious!

"And have you been taking them?!"

"No, I don't agree with antibiotics."


11:17: I got out of the ambulance to let them get on their way.

11:37: (ish) Patient arrives at A & E and her 4-6 hour journey of waiting, triage, waiting, being told off, waiting and discharge begins. 

There are times when I write my blog and I really really wish that what I was writing about isn't true. Frustratingly, it is painfully true and not uncommon or an isolated incident. It happens every day!

NHS 111 has its faults, the GPs have their faults, hospitals faults are well documented as are those of the ambulance service. As for dentists, again, it isn't perfect, but we know we have to a) wait and b) pay. People have a got over the 1996 semi-privatisation of dentistry so don't moan as much! My point is though, all areas of the NHS have faults, but people like this are not the fault of anyone. The GP and the dentist saw the patient and offered treatment. She didn't take the medication. NHS 111 had to call an ambulance because she lied about her symptoms and we had to take her to hospital because she insisted. The hospital then had to see her, triage her and waste the valuable time of the doctors and nurses; for what?! To give her another prescription that the tax payers are funding and she isn't taking. She can't be charged the £1000s she cost the NHS. She is unemployed. She can go home, not take her medication and then call us back in a few days because she's still ill and the cycle continues until her body heals itself....until the next time anyway. Unfortunately you can't medicate stupid.


Thursday 13 June 2013

Playing Cards

"24 year old female, chest pain, DIB"

I tend to be very cynical about young people with chest pain. It is very, very rare that the chest pain is anything sinister at that age. However, I'd reserve judgement until I met the patient and oh what a treat I was in for!

The door was ajar when we arrived, so pushing it tentatively open I shouted a speculative 'Hello?!' as I entered. We were summoned through to the living room where our patient was sitting on the sofa, smoking and watching TV. 

"Hello there, what's the problem today?"

"I got a cough innit."

"OK, how long have you had it for? What has your GP said?"

I always ask that question knowing full well that 99% of people haven't bothered with their GP, but it's my way of subtly making a point!

"Bout 2 days, I ain't bovvered wit ma GP coz they are useless innit." 

She said that while exhaling smoke into my face. 

"Can you put that out please?"

*kisses teeth* "Ya can't tell me what to do in my OWN house, ya get me." 

"Firstly I asked you, I didn't tell you, and secondly can you also refrain from kissing your teeth at me."

*kisses teeth* "Whatevs man."

There is nothing I hate more than teeth kissing. It winds me up something chronic. We don't ask to go to people's houses, they ask us to come to them. Show us some respect and courtesy. In this case, that means no teeth kissing and no smoke in the face. It really isn't asking much!

We checked her over, did an ECG etc and decided that she should go to hospital. The reason for this, she didn't know who her GP was so we couldn't refer her on. She was also complaining of pain in her chest and although it was most likely to be caused by the excess coughing, without a blood test we can't rule out cardiac problems as the cause. As we were getting ready to go to the ambulance she said:

"I can't walk, I feel dizzy."

She wasn't about to be carried. We explained there is no medical reason she can't walk. Her legs are fine all she has is a cough. Cue farther teeth kissing. We assisted her to standing and started walking her to the truck. She then took it upon herself to throw herself on the floor and pretend to faint. I've seen enough people actually faint and plenty that fake it to know the difference. After a few stern words she magically came round, of course, with selected amnesia and no memory of dropping to the ground. Miraculously, she made it to the ambulance. As she climbed up the steps I told her to take the second seat on the left. She laid down on the bed. Brilliant!

The journey to hospital was uneventful and lacking conversation. Her dying swan routine was in full swing and she didn't seem in the mood to answer questions. When we arrived she wouldn't get off the bed, so rather than arguing, we took her in on the bed. I handed her over to the nurse in charge who promptly directed us to 'the lounge! (The waiting room!)

*kisses teeth* "I ain't goin' to da waiting room, truss me bruvs." she said to the nurse.

He looked at her, looked at me and simply said "waiting room"! I love the power nurses have! We started wheeling her back down the corridor as her expletives and mood began to worsen. She had certainly found her voice again! We largely ignored her rant. It was nothing to do with us, it was the hospitals choice where she waited! 

The waiting room was packed. We wheeled the bed up to the chair and asked her take a seat. After a slight delay and a little fuss she clambered onto a chair. My crew mate took the bed back to the ambulance whilst I booked the patient in at reception. Suddenly there was a commotion from the waiting room. I cast my eye over and my beloved patient was lying on the floor, half faking a faint and half faking a seizure. Her movements were not involuntary. It was was one of the worst fakes I'd seen, but the waiting room was in uproar, demanding help and a bed. As people were looking at me to do something, I wandered over. 

"Up we get, sit on the bench, this won't get you seen quicker."

*keeps up charade*

"Come on, you're embarrassing yourself." (and me).

At this point another patient of similar age decided she'd seen enough. Not of the patient faking illness to get seen quicker, oh no. Of me and my failure to treat her!

"You're a disgrace, how can you stand there and not do anything, it's well out of order."

"She is faking it. I know it, and she knows it."

"If she was white she'd have a bed and you wouldn't leave her on the floor."

Ahhhh, the race card. If at first you don't succeed, accuse someone of being racist! At that point, I decided to walk away. I wasn't going to get drawn into a race row in a crowded waiting room.  I never discuss the colour of my patients in my blogs or in real life unless it's relevant. It very rarely is. Today it wasn't. It makes absolutely no difference to me. I don't see a difference, race doesn't even register on my radar. Yet here I am, stood in front of 40 odd people, being publicly labelled a racist. 

I could have informed her that I have siblings that are black. I do. I could have listed to her my Indian, Chinese, Egyptian, Polish, Romanian and Nigerian friends. I could have told her about my black gay friend who I shared a flat with. But I didn't. I don't need to defend myself. I don't need to acknowledge her ignorance. I don't need to feed her desire for an argument. If anything, my being white was an issue to her. I left the department with my patient pretending to fit on the floor and her new found guardian shouting obscenities at me! 

Living the dream.....