The Complete Blood, Sweat and Tea
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These Boots …
Have walked along train tracks
Have been washed in the blood of murder victims
Have kicked in doors to get to unconscious women
Have stepped in more urine, in more tower blocks, than I’d care to think about
Have kept my feet warm and comfortable on long nights
Have been allowed into a mosque
Have climbed fences to reach dead bodies
Have run across football fields to try to save a life, and failed
Have been spat on, vomited on and shat on
Have stood in ‘remains’
Have tried to find purchase while walking backward down narrow stairs
Have defended me from drunks and druggies
Have been run over by a 22-stone trolley
Have been stared at by a daughter when I was telling her her mother had died
For Pixeldiva who denies she has a shoe fetish.
I went to Occupational Health today – it seems that the last time they checked my blood (because of being on PEP) my liver enzymes were a bit elevated. Most significantly my gamma-GT (gamma-glutamyl transpeptidase) was at 164 (it should be between 0 and 55). PEP is well known as having effects on the liver, so this isn’t completely unexpected.
More blood was taken today to check that the enzymes have returned to normal. The nurse was very concerned that I was alright in having my blood drawn, and that I wouldn’t faint. She was asking me this while I’m sitting opposite her in full uniform …
The nurse was also a bit surprised that I’d had aural hallucinations and looked at me as if she thought I was turning schizophrenic – I assured her that the ‘voices’ were now leaving me alone and that it wasn’t a problem. She’d never heard of this symptom before, so at least I entertained someone today.
Nobby is working tonight from our main station. He is always a good laugh and always seems to have a joke whenever he works. Tonight I met him outside the hospital and he told me about a deaf old woman he had just brought in.
It was raining as he started to wheel her out her house so he made the comment ‘It’s raining, you picked a fine time to be ill’.
‘Eh?’ was the reply.
‘The rain … it mucks up my hair’.
‘Eh?’
‘MY HAIR!’
With this she took a long hard look at Nobby’s very short, and very receding hair and asked him, ‘Is it because of cancer?’
It is now 3 a.m. and already every other patient we have picked up has been drinking – from the 38-year-old male having a panic attack, who didn’t want to talk to us, to the 50-year-old female who slipped on some steps coming out from the pub and cut her head. This has so far ended with our last call being one of our smelly ‘frequent flyers’, who thankfully decided not to hang around and wait for us to turn up.
Then there was the police car that managed to accidentally force another car into someone’s garden – one of those jobs where every passing car slows down to stare. Thankfully, there were no injuries, apart from the house-owner’s disturbed sleep. (At least I assume it was the owner – he was dressed in no shoes and a dressing gown.)
With a bit of luck people are now wrapped up nice and snug in bed – away from the rain – and the only calls we will get will be the 5 a.m. ‘I’m in labour’ call that will result in a baby around 11 a.m. (long after I’m in bed).
No sooner do I hope for a quiet hour or two than the activation phone goes; it’s sending us 200 yards up the road to a ‘Collapsed Male’. We are met by two police officers who tell us that the patient was walking along the street, saw the policemen and then collapsed.
We get to the patient and my crewmate can’t smell any alcohol on him, but he is coughing and spluttering like an Oscar winner. He complains of a headache, coughing, leg pain, back pain and an inability to walk. Other than that he is refusing to talk to us. Examination is normal and the patient is obviously play-acting.
He then does one of the things that I really hate (given the prevalence of tuberculosis in Newham); he coughs all over us and the vehicle without putting his hand over his mouth. Then he starts to spit on the floor of the ambulance, again something I take a dim view of – but I’m driving so I leave it to my crewmate to sort out.
Forty seconds later and we pull up outside the hospital, and our patient decides to roll around the floor. By now our patience is wearing thin, so we haul him up and throw him in a wheelchair.
In the hospital he refuses to speak to the nurses, says he cannot stand and doesn’t acknowledge any requests. We leave him there and within 30 seconds are back on station.
While at the hospital I indulged in a little bit of teaching. The nurse who was assessing our patient was trying to check his pupil response (by shining a light in each eye and making sure that it reacts to light) but the eyes don’t appear to be reacting. I then suggest turning off the ceiling light that the patient is lying on his back staring at.
I still have patients who insist on coughing without putting their hand over their mouth. I’ve given up asking them to stop – instead I just give them oxygen, via a nice tightly fitting oxygen mask. I got a lot of people coming to this post searching for ‘Hand over mouth’. I swear I don’t know why.
One of the bizarre things about the Ambulance Service is that, in the eyes of the government, we are an ‘essential’ service but not an ‘emergency’ service. We are ‘essential’ because the emergency services (Police, Fire Brigade and Coastguard) are run by the Home Office but Ambulance Services across the country are run by NHS Trusts, and as such do not have access to the same resources as the true ‘emergency’ services. The distinction is often slight, but can sometimes have quite important considerations for our safety.
Last night was a case in point. We were called to a patient with abdominal pain; however, further information was given that the patient could be violent. There was something in this information that triggered my ‘danger-sense’, so I was happy to wait for police assistance to arrive before approaching the house.
Four police officers turned up – normally only two are sent to assist us – and they told us that their computer system, and their personal experience with the householder, showed him as a nasty piece of work. We followed the police to the patient and they told him that they were going to search him, and that they wanted to put him in handcuffs first. The patient had obviously been involved with the police before, as once he was handcuffed they checked to see if he had any new warrants out for his arrest …
Searching him they found a large stick, and a rather worrying-looking (5-inch) knife on his person.
All through this the ‘lady’ of the house was shouting abuse, mainly at the patient, but occasionally at the police officers present. One quick examination showed nothing life-threatening, so we offered a trip to hospital, which the patient accepted. However, as we left the house the woman shouted a few final obscenities at the patient and he then told us he couldn’t be bothered to go to hospital and stalked off into the night. (This was not a problem for either my crewmate or myself.)
Police computers had information that he was dangerous (a number of rather vicious assaults) but our computers are not allowed to have such data. A police dispatcher has told us that they have all sorts of information on addresses, from animal liberation protesters to Members of Parliament. Again, our computers don’t have any information of that sort unless we enter it manually after an ambulance crew has been threatened assaulted.
Needless to say, one such report has been sent to central office.
I later found out that the patient was addicted to crack cocaine – which explains a lot.
Last night we picked up an alcoholic who is HIV positive. I (still) have no real fear of HIV patients, even when they are bleeding a bit and this patient was not (although they had wet themselves). The only problem is that I seem to have turned into one of Pavlov’s dogs. When we found out the patient was HIV positive my stomach churned as if I were back on the PEP. It was really rather strange because it wasn’t fear (I’ll only have that when I’m due for my HIV test) but instead something more … biological.
The son of the patient was extremely embarrassed at the antics of his parent, and my crewmate spent some time making sure that he was alright.
Is it naughty to take someone to hospital, who doesn’t really need to go, just in order to get a fry-up breakfast there?
It’s a lot simpler to take everyone to hospital whether they need it or not. It means that I have to do less paperwork, the patient feels validated and it means that if I’m missing something nasty (which is likely to happen at 6 a.m.) then the hospital has a chance to catch it.
I am extremely busy at the moment; I’m often posting from my PDA (Personal Digital Assistant) and mobile phone. I should be catching up with stuff on Friday (including answering all those comments people have left).
Got some blood results (post PEP stuff), seems my white cell count is still going down. I think they have a life-span of 120 days, so it might get lower before it gets better. Still, it gives me an excuse to see the rather pretty occupational health nurse.
Today we did the usual of little old ladies who feel unwell calling their GP and the GP calling us to take them to hospital because they are too busy to drag their arses out of their office to visit sick people. On the radio it seems that lots of people are dropping dead – the weather is quite a bit warmer (24°C) so the old are placed under a bit more physiological stress.
I have a 101 things to do, and no time to do it – simple stuff like paying bills can be incredibly hard when you are single and a shift worker.
And I think I’m moaning too much …
I’m off to bed now. Goodnight all.
So damn tired …
I’m currently at that point where I wonder whether I am hungry enough to cook dinner before I go to sleep. Which biological urge will win out?
Today, our Control wanted us to go to an emergency call when we were the other side of the Thames – I rather politely asked them if we were the nearest motor as we weren’t actually a boat, the reply was, ‘Yes, do you have your water wings?’ So we ended up going a couple of miles out of our way to cross the river.
The call was a faint, probably from the heat that is roasting London at the moment – at least the women are wearing revealing clothes, which makes our job of cruising through the streets a bit more enjoyable.
Picked up two psychiatric drug-using patients in a row who were drunk and lying in the road perhaps 500 yards away from each other. Some children were poking one with a stick …
Then there was the 51-year-old 4-foot-4 Asian grandmother who, upon seeing her husband’s car being stolen, jumped on the back and hung onto the rear windscreen wiper. She was flung off and, thankfully, not seriously hurt – mainly bruising and gravel rash. Unfortunately, the car that was stolen also contained her house keys and bank books. The A&E was so busy they had to put her out in the waiting room – something that annoyed me no end, especially as the nurse that put her out there had annoyed me earlier in the day by suggesting that I didn’t know what the symptoms of bulimia were.
Now to eat/sleep … then lather/rinse/repeat tomorrow.
Sunday alone in my flat, no work, no stress, some decent stuff on telly = Good.
No chocolate in the fridge, uniform to be ironed, work tomorrow = Bad.
Phone call from Occupational Health telling me my blood values are back to normal = Excellent (only HIV/hep test to go now).
Our complex is EIGHT ambulances short today, so it comes as no surprise that we are running around like the proverbial blue-arsed fly. Control keeps broadcasting jobs for which they have no ambulances, this means that a lot of crews are more unhappy than usual, as Control hassles us about ‘greening up’ quicker. It doesn’t bother me, if I’m busy doing jobs it makes the shift go quicker.
As I’m typing this an ambulance has had a blow-out on the fast lane of the A102 – a very busy road. The crew are alright, but it means we are now nine ambulances down for the next 2 hours at least.
The jobs I’ve been doing are the usual Monday morning sort of stuff: 97-year-old women having heart attacks, 10-year-old boys with cut heads (a rather impressive 3-inch cut, mind you) and 88-year-old men from nursing homes who have ‘high blood pressure’ (they invariably have a better blood pressure than I do).
Now some silly sod has stabbed himself in the stomach with a pair of scissors.
I’ve been on a ‘Guidelines’ course. Essentially, this is a course that tells us that we are already doing the right thing; it also introduces us to a book with our new treatment guidelines. It takes 2 days and tomorrow will include learning about child abuse (do we have to bring our own child?). So far the course has been a trainer telling us that this course changes nothing, and we are to continue doing what we are doing at the moment. At least the days are short, 8 a.m. until 2 p.m. At the start of every Powerpoint presentation is the same definition of ‘Clinical Governance’.
We had to write our own scenarios then swapped them around to other groups (this is a really easy teaching technique, since you don’t have to plan anything). There was also a chat about how our complaints to compliments ratio is about 50/50, and that most of the complaints are because of ‘staff attitude’. So far I have had no complaints, and no compliments – I’m a strong believer of flying under the radar.
However there is a problem – the Guidelines book we should be getting is version 3.0, but the book we are actually getting is version 2.2.
The reason for this?
Copyright!
It seems that the LAS wants to change a few bits to make it more relevant to London. But because the organisation that wrote it maintains the copyright it can’t be changed for us. Lawrence Lessig’s Free Culture states that you get value added when others can build on your work. This is a perfect example of this principle.
So, the people of London are not getting the best clinical care because of copyright.
Clinical Governance is about getting the best care to the public, so it’s a bit of a mixed message.
There is a Transit of Venus today – all these special astronomical phenomena remind me of the eclipse we had in the summer of 1999 …
(Cue wobbly flashback video effects)
I was working in A&E at the time of the eclipse and thought that there would be no way I’d get to see it. Like all A&E departments this place had no windows and could be perhaps best described as a bunker. Today, however, the department was empty for the first time in living memory. Normally by that time of the day we would be packed full, but today … not a soul. One person had been in earlier with a painful foot, but there wasn’t the normal ‘trolleys in the corridor’ effect that was normal for that time of day.
We learned that day that CT (computed tomography) films make excellent sunglasses.
So, the whole department stood outside on the grass staring at the sun slowly disappearing – very spooky, and one of the few strong memories I have from that long ago. I suspect that many of the wards were empty as well: there was a procession of people wearing dressing gowns and holding tight to their drip stands wandering around the hospital grounds.
As soon as the eclipse finished we immediately had two cardiac arrests brought in by ambulance, it was as if they had waited until after the eclipse before deciding to keel over dead …
Life also tends to be a bit quiet around FA cup finals, royal marriages and important soap storylines.
I often carry a camera around with me. I was talking to some kids recently – they were happy little buggers, enjoying the sunshine on a lazy Sunday.
It’s not all bad this job.
This picture still makes me smile.
Some calls are a pain in the arse, not because anyone is particularly ill, but instead because you can see complaints coming in, and there being a high possibility of losing your job.
Tonight was a case in point. We got called to a wedding reception where the bride had collapsed; a quick history revealed MS (multiple sclerosis), and that it was likely that this was the cause of the collapse. Unfortunately, the patient and the patient’s new husband were adamant that she wasn’t going to go to hospital, particularly the hospital that was nearest. Things were not helped because they had called an ambulance for an aunt who had collapsed, but had cancelled it before it had arrived because it was ‘taking too long’.
While we were getting a history from the patient, the new husband was generally acting like an arse: he was questioning everything that we did, interfering with our talking to the patient and generally getting in the way. We managed to get rid of him for a short period and the rest of the family came over to us and apologised for his behaviour.
Luckily, the patient’s hotel was next door to the hospital so, after 45 minutes of persuasion, I managed to get the patient to agree for us to take her towards the hotel, and if she felt better then we could, in good conscience, leave her there. En route I called up on the radio, and arranged for the Duty Officer to meet us at the hotel. He did and the responsibility of leaving her without treatment now fell on his shoulders (thus, saving our jobs should anything go horribly wrong).
I know MS is a horrible disease. I know it isn’t fair that it would strike on your wedding day, and I can understand why you might not want to go to hospital … but if you can’t move half of your body, then please understand why the ambulance people might be a bit unhappy to leave you lying in the middle of the street.
It then all kicked off in the Hackney/Homerton area. There was a big fight in a pub, with everything in it being smashed – multiple casualties with various head and facial injuries from flying bottles and broken glass. We were first on scene, and I needed to call up to let Control know that at least another 3 ambulances were needed. At least it gave me a chance to practise my ‘5-second triage’ skills. None of the drunks there were particularly aggressive, but there was a ton of police there pulling me from one casualty to another around the pub, and even 300 yards up the street. This was just a taste of what was to come as another pub was attacked and it basically overloaded our resources. It got so busy that our Duty Officer was transporting severe asthmatic attacks in his car (and he doesn’t carry much more than a defibrillator and oxygen) and Control was holding 35 calls across the area. That is, 35 calls at 3 o’clock in the morning. That’ll teach me to wonder if it will be busy in a previous post.
Tomorrow England play their first ‘Euro 2004’ match – Alcohol + Patriotism + Recent History (we are playing the French) + Me Working = Recipe for Disaster
Watch this space …
I never got a complaint from that job, although for some time I was holding my breath about it.
Well it looks like I was right, the nice weather with people in the pubs from an early hour, coupled with England losing 2–1 in the football, has led to what can, in best tabloid fashion, be described as ‘an orgy of violence’.
It started out with a couple of ‘glassings’, which we have been getting over our vehicle computer screens as ‘stabbing to the head’ for some reason.
A couple more assaults, including one who was set upon by a number of drunks who were intent on stealing his car. Luckily he was not too badly injured – more shook up. Other crews were ‘blueing’ in a number of assaults, including at least one stab victim.
The police were running from call to call, and once more there are not enough ambulances to deal with the large number of calls we have been receiving. Our Duty Officer has been telling crews that we should be wearing our stab-vests constantly – but he isn’t the one who has to lug a 20-stone unconscious patient down 4 flights of stairs in this heat …
Good job I’m not searching for a quiet life.
I am, however, off to bed now.
For the first night in ages it has been reasonably quiet on the streets of East London – only one stabbing and that was to the patient’s arse …
However, while adults are no doubt nursing hangovers the children are out causing mischief. The first two calls we got yesterday were to kids (8 and 10 years old) who had been hit by cars. The first was a ‘classic’: child running out towards an ice-cream van. He was alright apart from a broken right ankle. No sooner than he was safely ensconced in hospital than we find ourselves dealing with a child who has run out in front of a car (in the absence of an ice-cream van) and has broken his left ankle.