The Complete Blood, Sweat and Tea

Then we went to a 14-year-old girl who was ‘fitting’ but when we got there was confused and combative – she was a diabetic so we checked her blood sugar, which was low. Being confused is one of the symptoms of a low blood sugar and we normally give them an injection that brings them out of it. We gave the injection and waited for it to work and receive the grateful thanks of the parents.

But it didn’t work.

We checked the blood sugar again, and it had come back up to normal levels, yet the condition of the girl was unchanged.

So we (rather quickly) took her into hospital – we haven’t been back there yet to find out what had caused her confusion. Was it drugs, alcohol, psychiatric problems, CVA (cerebrovascular accident) or even just a bad nightmare? Once we get back to the hospital which we took her to we will no doubt be able to find out. She didn’t have a high temperature, didn’t have any medical history besides the diabetes, her pupils were normal and responsive; all observations were normal.

We spend a lot of time dealing with things that are simple to cope with. You can fix them almost by rote thinking, but every so often you get a job that throws you off balance. Normally you ‘wake up’ and deal with it by going back to basics, but other jobs just completely confuse you, and this was one of those jobs.

This post got me a large number of people coming to my site looking for the search term ‘Daddy fucking daughter’. Sometimes the Internet is a scary place. It turned out that the girl had been drinking vodka, and that this was the reason behind her confused and combative state.

ORCON!

ORCON – the biggest problem with the ambulance service, and the biggest cause of staff/management friction. Every so often I will revisit this topic, as it’s of such importance.

I’m single at work at the moment (which means I don’t have anyone to work with – so am sitting on station twiddling my thumbs), so I thought I’d tell you all about the great God ORCON and how he rules the life of every EMT/paramedic in England.

This is really boring, so I’ll not be hurt if you don’t bother reading any further.

The government likes to give everything targets, from school grades, the waiting time for breast cancer referrals to the number of trains on time.

The ambulance service has only one main target to reach, that of ORCON. ORCON was started in 1974 and governs how fast we are expected to respond to ‘Cat A’ calls. (‘Cat A’ calls are our high-priority calls, although because of the way calls are assessed, they are rarely seriously ill patients).

Essentially, for every ‘Cat A’ call in London we have to be there within 8 minutes.

Simple really.

It doesn’t matter what actually happens to the patient, just so long as we get there within 8 minutes. For example, if we get to someone who has been dead for 2 days within 8 minutes, that counts as a Success. If we get to a heart attack in 9 minutes, provide life-saving treatment and ensure that their quality of life is a good as possible it counts as a Failure.

For those who don’t live in London, let’s just say that traffic is often heavy, and there are speed-bumps and tiny side-roads. We have more than 300 languages spoken in London, which may delay getting the location we are needed at. We are hideously overused and understaffed, we face delays at hospital owing to overcrowding and delays on-scene because of the ignorant people we have to attend to.

None of this matters – all that matters is the 8-minute deadline. If we make 75% of all calls in 8 minutes we get more money from the government, which means more staff, vehicles that work etc. … If we don’t make 75% then we don’t get any more money and we continue to struggle. This year it looks like we are going to make it, but only just.

There isn’t any reason behind 8 minutes being the time we need to get to people: brain death occurs after 4 minutes or so; trauma, while needing to be treated as quickly as possible, has the ‘Golden Hour’. The current rumour is that it is how long MPs have to vote when the Division Bell rings in parliament – who knows? No-one I have spoken to has any decent answers.

Well, that should be the last of my posts on the boring ‘day to day’ running of the London Ambulance Service.

You may all rejoice now.

Oh … Bollocks …

Rather obviously this topic dominated my weblog for some time – I’m including only some of it here, because I’m sure that you didn’t want to pay good money to read about me being horribly ill. I haven’t edited this post for this book – it’s much how it originally appeared on my website. I started writing it less than 2 hours after I was exposed.

There is a fear that every health-care worker has. Tonight that fear jumped up and slapped me in the face.

Second job of the shift, we were called to ‘50-year-old male – collapsed in street’. Normally this is someone who is drunk, but we rushed to the scene anyway, just in case it isn’t (we rush to everything – it’s the only way to be sure you are not caught out). We reach the scene and see the male laying on the floor talking gibberish. He is bleeding from a cut on his face and possibly from his jaw. Bystanders tell us that he ‘just dropped’. He then starts to vomit, and because it’s dark we get him on our trolley and into the back of the ambulance.

Our basic assessment finds that he has no muscular tone on his right side, although all his observations are within normal limits. Deciding against hanging around we start transport to hospital. Halfway to hospital he starts to vomit and cough – part of this vomitus/blood flies unerringly across the width of the ambulance …

… right into my open mouth.

Pretty disgusting, but what can you do? The patient then starts to come around, now able to move all limbs and to talk. This is good, it means I’m able to get some history from him. So I get his name, date of birth, address. Then I ask this 50-year-old if he is normally fit and well.

‘No’, he says, ‘I have AIDS (acquired immune-deficiency syndrome)’.

Bollocks.

I’ve never had anything from a patient in my mouth before (apart from the odd chocolate when I was a nurse), so of course the first time is with an HIV (human immunodeficiency virus)-positive patient.

My crewmate looks in the rear view mirror, and that look passes between us. Ambulance people will know what I mean – it’s the ‘Oh shit’ look that you give/get when something goes horribly wrong.

We get to the hospital and the patient is looking a lot better, fully orientated, full strength and starting to feel the pain from a probably busted jaw. So I get to hand over to the nurse, which turned into a bit of a comedy moment …

Me: ‘Patient witnessed collapse, had right-sided hemiparesis, now resolved. Previous history includes AIDS’.

Handover Nurse: ‘Fine’

Charge Nurse: ‘You can’t say that’

Me: ‘Pardon?’

Charge Nurse: ‘You can’t say AIDS – people will be prejudiced against him’

Me: ‘Well they shouldn’t be, and this is medical stuff. It’s a syndrome like any other’

Charge Nurse: ‘You have to call it something else’

Me: ‘I don’t really care for political correctness, besides I’m a patient as well – I swallowed some of his blood’

Charge Nurse: ‘Oh, well … lets get you sorted out then’

I then went through the rigmarole of having blood taken, then I asked to be put on PEP, which the charge nurse agreed I should be put on. PEP is ‘Post Exposure Prophylaxis’ – basically a cocktail of antiretroviral drugs that, taken over a 4-week period, will hopefully reduce any live virus to non-infective amounts. Common side-effects include nausea, vomiting, headache, diarrhoea, cough, abdominal pain/cramps, muscle pain, tiredness, flu-like symptoms, difficulty in sleeping, rash and (I love this one) flatulence.

Other more uncommon side-effects are … pancreatitis, anaemia, neutropenia, peripheral neuropathy, and other ‘metabolic effects’.

I’m in for a barrel of laughs for these next 4 weeks …

The charge nurse looked really sympathetic when he offered me stuff to look after the side-effects – he used to work in an HIV clinic so I guess he knows better than me what I’m in for …

Then we talked about rates of infection, which is why I’m feeling kinda relaxed here. HIV is a tough virus to catch (compared with hepatitis, which is the one that worries me). If I were to stab myself with a needle after drawing HIV-positive blood I would have a 0.004% chance of catching the virus. Swallowing a bit of blood/vomitus is less risky than that, especially as I have no mouth/stomach ulcers. With the PEP my chances of ‘seroconverting’ are as close to zero as you can get. I knew all this before I set foot in the hospital, which probably explained why I wasn’t a quivering wreck.

So far ‘only’ two medical workers have seroconverted after needle-stick injuries. I greatly doubt that I’ll be the third.

So ‘The Plan’ is that I go to see Occupational Health on Monday, and they will advise me on what happens next. I’ve been told already that I’ll have to avoid sexual contact for the next 3 months (not a hardship – I’ve managed ‘no sexual contact’ for 2 years before now) and that I’ll probably need to take 4 weeks off work due to me feeling too ill from the side-effects of the antiretrovirals.

We’ll see about that … I don’t ‘do’ ill.

Anyway, if I do need to take time off it’ll give me a chance to read some books I’ve got sitting on my shelf – and complete ‘Zelda – Windwaker’.

Gotta go now, I feel flatulent already …

I never got around to completing ‘Zelda’.

‘Donor’ Takes on New Meaning

I got a lot of support over the previous post, and to be honest I would have been a lot less calm if I didn’t have my blog where I could offload some of my worries.

First, thanks to everyone who has contacted me over my ‘exposure’, I appreciate it all, even if I haven’t personally replied to you (you’ll find out why I might not have answered you a bit later in this post …).

I went to Occupational Health on Monday, basically to let them know about my exposure, and that I was on PEP. The LAS showed how nice they are by lending me a spare ambulance to drive to my appointment – GPS navigation comes in handy when you don’t know where you are going.

Occupational Health is south of the river at King’s College Hospital, which is a bit of a trek. ‘Occy Health’ took baseline blood samples, so they would know if there was any effect on my liver/kidneys/white cell count, and filled in a couple of forms about my exposure. Then they told me that they would get in contact with the ‘donor’ to see what his virus load and hepatitis status was.

Until now I always thought of ‘donor’ as a ‘nice’ word – heart donors and the like – I never really thought it would happen to include this circumstance.

During the consultation they told me that I’d need blood tests every fortnight for the next month and a half, and that my first HIV/hepatitis status check would be in 3 months, with an additional one in 6 months. Should they both be negative then I would be in the clear.

They also told me of the side-effects of the antiretrovirals that I am taking, and seemed surprised that all I was experiencing was similar to a mild hangover.

That was yesterday – today was spent vomiting/sleeping to avoid nausea/and experiencing the joys of explosive diarrhoea.

My station officer called up and asked me how I was. When I told him, he basically told me to take it easy and go back to work when I felt better.

However, there was some good news when the Occupational Health nurse contacted me, and told me that the donor’s viral load was low, that there were no resistances to the PEP drugs I’m taking and that in 2002 he was free of hepatitis. That has eased my mind somewhat.

Some people have commented that I’m taking it rather well. There are a number of reasons for this, not least that the chances of me becoming HIV-positive are less than 1 in 5 000. The other thing is that I can’t do anything now to change those odds, apart from continue to take the PEP.

The other side-effect of the meds I’m taking are that I’m having a certain ‘vagueness’: my mind isn’t operating on all four cylinders, so if this seems disjointed, I’ve got an excuse …

Even today I’m not sure that the PEP drugs didn’t permanently ‘disjoint my mind’.

Pavlov’s Dog

Well, the PEP is still going down, unfortunately I’ve developed a Pavlovian response to the hours of 8 o’clock. Every 12 hours I need to take the pills – I start to get nauseous just thinking about it, the familiar copper taste hits my mouth and I just want to lie down.

I also seem to have lost any control over my circadian rhythms, I’m sleeping for 14–16 hours straight and I’m drowsy for the rest – doesn’t matter whether it is day or night.

At the moment the rather wonderful ‘Scissor Sisters’ album is chilling me out nicely, particularly ‘Return to Oz’ (which has a bit that puts me in mind of The Kinks’ ‘Lola’).

I am, however, losing the motivation for cooking food, not least because of the large amount of washing up accruing in my sink. It makes me feel like a student again.

Also, my PC is screaming out for a complete overhaul – I just can’t be bothered.

Mothering Sunday

Well, Saturday was the last day I worked but Greenfairy (another blogger) mentioned something that I wanted to write about – but forgot, for some bizarre reason …

The first call of Saturday was to a ‘?Suspended’.*

So we hack along the road, knowing full well that because it is the first job of the day the patient is definitely going to be dead.

We arrive at the house and the FRU is there before us – I grab my kit and bound up the stairs past the daughter who called us and into the bedroom. Where a very dead lady was lying on the bed while the Rapid Responder was completing his paperwork.

One look is all you need to tell if someone has been dead for some time – and this lady had that look. It turned out that the daughter last saw her mother alive an hour ago, but that she was feeling a little unwell and took to bed. The daughter had checked on her half an hour later and found her not breathing. She then waited 20 minutes to call us as she was in such a ‘tizzy’. A quick look told us that even if we had been there when it had happened it was unlikely we could do much: various clues led us to think that a stomach ulcer had ruptured and she had bled out into her stomach.

All around the house were flowers and cards – the next day being Mothering Sunday.

No sooner than we had informed the daughter that her mother had died than the doorbell went and my crewmate went down to see who it was. It was only a bleedin’ flower delivery man, delivering flowers to the (now) dearly departed. My crewmate told the delivery guy that now, perhaps, wasn’t the best time to bring flowers but took them in anyway, hiding them in the kitchen.

Perfect!

Then we had to wait an hour for the police to turn up, which is normal procedure for any death in the home and is nothing to worry about. I then helped the police turn her body (to look for anything strange) and put my hand in a puddle of urine* – something that wouldn’t bother me, IF I was wearing any gloves.

Oh well.

The Other Guy

I’m feeling a little better, the side-effects of the PEP seem to have subsided somewhat, although the flatulence is reaching epic proportions, which, coupled with the diarrhoea, makes every bowel motion an adventure

I have my second date with Occupational Health on Friday, for a blood test to make sure that the PEP isn’t battering my liver/kidneys/pancreas and that my white cell count hasn’t lowered. Work have said they’ll do everything they can to supply a vehicle to get me down to south-east London.

I’ve been thinking a bit about the ‘donor’; I wonder how he feels – he’s lying in bed after having a rather frightening collapse in the street, with a broken jaw and the reason for the collapse unknown. Then a couple of days later the medical team ask him to consent to some more blood tests because he may have infected the EMT who helped him out.

If it were me I’d be absolutely mortified.

When I talk to Occupational Health I’ll ask them if they can get a message back to him, letting him know that I’m fine and that I don’t blame him for anything. I know his name and address, but I don’t think it’d be right to turn up on his doorstep to talk to him.

I hope he is alright and that the collapse was something simple – I suspect a ‘TIA’ (transient ischaemic attack), which can be a precursor to a stroke, but with the right medications hopefully the threat of that can be controlled.

I never got to see him again, so he never found out the results of my blood tests. I kind of hope that he gets to read this, so he knows that I’m fine.

Twelve Hours to Go

In 12 hours I will have stopped PEP. Those seven pills are the last ones that I am going to take.

I am extremely happy about this.

It has been a month since my stomach didn’t feel as if I were waiting to vomit, a month since my thought processes have seemed even remotely like mine. A month since I last worked – good grief, am I bored! A month of wondering if my life is about to change for the worst. A month of my mates looking sideways at me when I had to take the pills in front of them (but still friends enough to laugh and joke with me about it). A month of having to get out of bed to eat breakfast, because the pills need food in my stomach. A month without shaving (why bother, I’m not allowed to have sex!). A month of feeling just the tiniest bit isolated. A month of people who I have never met, from places around the globe I have never seen, wishing me well. A month of always feeling grateful to those people, for this is the kindness of strangers – in itself a random act of reality.

All over now.

In two months I get to go for my HIV test, which should be fun and giggles.

But for now – I’m happy.

I really think that if it wasn’t for my blogging and the support of my friends around the globe I’d have gone mad from boredom. My next book should be Blogging as a Mental Health Exercise.

Proper Day

My first ‘proper’ day back at work, working with my new crewmate on a proper ambulance.

The first job was a 66-year-old male who had been fixing tiles on his shed roof and had fallen off the ladder, probably around 10 feet. He was shut behind his front door and all I could hear through his letterbox was ‘I’ve broken my leg’.

The police are much better than me at getting into locked premises (the last time I tried I fell on my arse in front of a crowd of 20 people) so we waited for them to arrive and use their specialised equipment (screwdriver/size 12 boot) to force open the door.

Gaining access to our customer it was pretty obvious that he had fractured his femur (thighbone) as it had a new bendy section just above the knee. The pulse was good in his foot and he didn’t complain of pain anywhere else in his body. This brave man had crawled, with this fracture, from his garden through his kitchen to the living room where he kept his phone. All throughout our treatment he didn’t complain once. We splinted his leg and ‘collared and boarded’ him from the house (a fall of 10 feet can easily break your neck, and the pain from his leg could easily distract him from a neck injury). We could have set traction on his leg, but we were only 5 minutes from the hospital; so we ‘blued’ him into Newham General Hospital, where he was ‘attacked’ by the local trauma team.

The next job we got was a dinner lady at a local primary school who had dropped a knife on her foot. There was a tiny cut to the foot, and after cleaning, dressing and checking her tetanus status we left her at work. What depressed us was that there were no scraps of food left we could have.

Driving back from the last job we saw four workmen chasing another man who ducked into the local mosque. We ignored this until we got a call to the area the men had run from – apparently a man had been assaulted with a ‘Car-lock’. HEMS (our emergency helicopter service) had been activated and were going to make their way to the scene. When we did a quick U-turn and rolled up to the scene it soon became obvious that HEMS was not needed so we cancelled them. The man had been clamping an illegally parked car when the owner and his wife returned. The car owner then pulled a large aerosol can from his boot and hit our patient around the back of the neck, causing a short period of unconsciousness. His wife had also put up a fight, but the owner of the car had run (into the aforementioned mosque) leaving his wife behind. (What a gent!) At one point we thought it was going to turn into a riot as 30 youths from the mosque were adamant that the four workmen doing the chasing weren’t going to set foot in the mosque.

Again, we had to collar and board him, and lift him onto our stretcher, which wasn’t much fun as the man weighed at least 20 stone. Subsequent treatment at hospital showed no serious injuries.

Final job (after having to get our nice, new, shiny ambulance fixed – a problem with the side-door) was a 60-year-old female collapsed at a bus station with slurred speech and ‘not drunk’. Remember that, ‘not drunk’, it’s important.

What could it be? Could it be a stroke? Could it be hypoglycaemia? Could it be cardiac related? So we turned up to find ‘Mary’ having fallen over, smelling strongly of alcohol and with a 5/6ths empty bottle of whisky in her purse. (My crewmate had to tell me about the smell of alcohol, as I’ve mentioned before, I’m pretty much unable to smell it myself.)

‘Not drunk’ – why did the callmaker say that? It’s bloody obvious she was pissed as a fart. I’d guess it was the bus station staff who wanted her gone and were afraid we wouldn’t turn up if we knew she was drunk. Still, it was an easy last job of the shift, even if she did keep grabbing at my balls and kissing my (thankfully) gloved hand.

This counts as a good day.

Now I’m off for some endorphin-releasing Bailey’s ice-cream.

Can you tell I was deliriously happy to be back at work?