Thoughts

My thoughts are with the family of PC Barker's family today.

A man who died in the line of duty.

Heres hoping this weekend's weather forecast's do not bring any more stories like this.

Louise x

Taking Advice

The day is miserable, "we were supposed to have a summer this year" I think out loud as we skid around the sodden streets of the Concrete Jungle.

The tower block looms up at us from behind the trees. It beckons us forward to investigate what lies behind the pebble dashed delights of 1970's architecture.

Impressionist* and I arrive at the same time as Kanger* on the RRU. The call is for a young male with difficulty breathing. Its late on a Saturday afternoon and we're not hopeful about what we're going to find behind the battered doors of the flats inside.

We find the lift to the evens floor's is broken, we head up to the floor above and walk down, carrying this amount of kit gives us the right to be a little lax in our fitness efforts for the day.

The door is open and we can hear several voices inside. A net curtain covers the doorway to avoid people being nosey through the clear glass panels in the front door. A voice from within shouts us forward.

The living room is small and crammed with ill fitting furniture. The small kitchen leads through a doorway and the remains of several parties worth of alcohol visibly litter every surface. It seems to have spread into the living room by osmosis.

There are people everywhere. All young men and all have a can or bottle in one hand and cigarette in the other. Atmospheres don't become much more oppressive than this.

"Whose the patient?"

A hand rises from the back of an armchair facing away from us. As we move around the sofa a face bearing the marks of a recent beating looks up as us. He is clutching his right side and breathing steadily, if a little shallow.

"Could anyone who has a cigarette on the go either go outside or put it out for us? Cheers."

Most of the people in the flat are calm and nod at my request while heading for the door. One stays behind with the patient, he is jittery, hopping from one foot to other.

"Its my brother. I'm staying here"
"Ok, no problem" I put on my best 'calm and reassuring voice'. This guy is giving off bad vibes. The hairs start to prick up on the back of my neck. I make sure to keep him in eye line.

While I'm playing at crowd control, Kanger* and Impressionist are assessing the patient. His story is a familiar one. Having taken a kicking on Friday night our patient had attended The Holy Hospital and been informed he had some broken ribs. He was sent home and advised to rest for a few days with painkillers. Unfortunately there is no miracle cure for broken ribs.

"He's in that much pain he can't breath" His brother is obviously concerned, but I'm worried. Everything that comes out of his mouth has an aggressive tone. I don't think he is going like what will inevitably happen.

We explain to the patient the problem that broken ribs present. You use your ribs to help you breathe, therefore when some are broken it hurts when you breathe. There is absolutely nothing we can do for him other than take him back to the hospital, who will more than likely discharge him with more painkillers and the same advice.

"But he can't breath!" I calmly try to explain to his brother that our patient is managing to breath adequately, he is talking to us in complete sentences, he has a good colour (around the bruises) and his oxygen SATS are pretty good from someone sat in a smoke filled flat. Medically he can breathe fine. It just hurts.

I don't like the way this is going. His brother is very agitated and not happy with our assessment and advice. We turn back to the patient and ask him if he wants to attend hospital. He nods. We start to gather his things together to walk him down to the ambulance. Anything to get out of the flat.

His brother announces "I'm coming with you".

I turn to Impressionist, he's going to be in the back with this guy so I let him decide whether he wants to be an enclosed space with him. He nods. I know the next 20 minutes en route to hospital I'll be spending more time looking in the rear view mirror at our occupants than the side mirrors.

I don't often pick up on these feelings but get quite nervous when I do. Fight or flight changes slightly in a moving vehicle.

The journey occurs with no problems, I can see the patients brother jigging up and down in the chair like he has an itch he can't scratch but he doesn't interrupt as Impressionist asks questions to fill out the report form. I wonder to myself if he is on something and are we just bringing the A&E department a problem they really don't need on a Saturday afternoon. Too late now.

We leave the brothers in the waiting room after handing over to triage with an apologetic shrug.

We know the advice will be the same.

The question is whether they decide to take the advice.



________________________________________________________________

I hope everyone is ok and thanks for sticking with me! Its been bit of a mental 6 months and I've neglected the blog.

All will be revealed soon and I'm not going to make any promises of regular posting over Christmas as I may only break them!

Thank you!
Louise xx

That Knock on the Door - Epilogue

Part 1, Part 2, Part 3, Part 4, Part 5

I'm half daydreaming as we come around the roundabout. I'm gazing distractedly out of the window. Its been a long day and the sun is still trying to make an impact on the grey drizzle of the day. We're on our way to what should be the last call of the day. A GP has asked for an ambulance to take a patient into hospital for investigation into their ulcerated legs. The GP had sent instructions that we would need a stretcher as the patient couldn't walk.

If its one easy way to get our back up is to tell us how to do our job. They may well not be able to walk but they may be able to transfer, to sit in a chair. They may be bed bound on the third floor of a house with the stairs from hell to get someone down, are you going to come and help us manhandle the patient into the vehicle Doctor? No? Well, let us decide how to our job then yeah?

My mood was foul, the patients through the day have been less than deserving of an 'emergency' ambulance and yet we'd gone skidding around wet roads on blue lights because some people don't know the definition of emergency. Having said all this, take away these jobs and you wouldn't need half as many ambulances and we'd be out of a job!

Even if their conditions didn't warrant an emergency response the majority were pleasant enough and some good banter had occurred throughout the day.

We round the corner and I absent-mindedly look up at the bridge spanning the road.

There are flowers and a flag tied to the rails.

Not as many as there were a year ago but still a good amount.

Was it really a year ago? I wonder to myself and mentally flip through a calender in my head to recall that time of year.

Yes it was a year ago.

What a difference a year makes. I think about the jobs I've been to in the meantime.

I can't recall any that were as draining on my mental and physical resources as that one was.

I've been to some that were tragic and graphic for different reasons but none where I was so involved with the scene and resus attempt as this one.

We drive past in a second and the reminder is gone again.

Its easy to cruise in this job sometimes, become complacent with the 'nothing' jobs like we had attended most the day.

As much as I've tried to approach every job with a fresh set of eyes and an open mind there are times you find yourself starting to become the clinician with an attitude that you didn't want to be.

A reminder of when you are being the technician you hoped you'd be can help to snap you back to the reality and perspective of where you are going and how you act.

I hope the tributes continue each year. With the way the service operates at times I think I'm going to need this attitude check every so often.

Taking the Piss

It's relatively early in the night shift. We have managed to get a couple of brews in and even watched a whole TV programme without being disturbed. The shrill insistence of the the phone interrupts me mid page of the my current reading material.

"Concrete Jungle 2, Louise speaking"
"Hi Louise, got an emergency for you in Jacketsville"
"Ok, what is it?"
"Female in labour, possible birth imminent. The call has come from the maternity unit. The family called them"
"Ok, on our way"

We weave through the thin traffic of the night towards our target. We have to use the SatNav to guide us in as its not our normal area but she gets us close to the target. Its a tower block with several different entrances to choose from. None of them numbered or in the least bit obvious.

A figure waves at us from the window. I'm in the drivers seat tonight so Wannabe* grabs some kit and runs to the front door while I turn around to make a quick get away if we can.

Before I can make it to the gated path Wannabe is walking back towards me with a face like he's chewing on a wasp.

"Their on their way down, suitcases packed. She's no more imminently about to birth then I am"

He walks passed me to the back doors and lowers the step, starts throwing the kit back into place.

I look back up the path and see a young man holding open the door. He is holding a suitcase in his other hand. Out of the door walks a heavily pregnant lady looking like she's just out for an evening stroll. Ok, so she's in her jammies but you'd be surprised how many people do that!

She climbs into the back and takes a seat. We do all the appropriate checks, her blood pressure and check her maternity record for anything we should look out for. In the 10 minutes it takes for us to do this and to get everyone ready for transport she did not have one contraction. Either that or her pain threshold is on a par with Jean Claude Van Dam.

We make our way to the maternity unit with no really sense of urgency. When we arrive at the unit there is a midwife waiting for us to give an update.

"How are we doing?"
Wannabe gives a despairing look to her and rolls his eyes "I think we have a wee while yet"

We leave her to settle the patient in the assessment room. We grab a couple of blankets and get stopped by anther midwife in the corridor.

"Hi, is that the patient from Jacketsville? Manage to get her here on time?"
"She walked out to ambulance with her suitcase in hand and had 2 contractions en route"
"What?!" The look on her face is one of absolute disbelief. "I took that phone call and there was panic and shrieking on the phone. The lad on the phone said he could see the head!"
"Her waters haven't even broken yet"
"Right, I think these people need a little talking to. Wasting everybody's time. If she's not crowning now she going home!"

With that she stalks down the corridor like a women possessed. Wannabe and I share a look of satisfaction. She's off to say whats been in our heads the whole job but sometimes we have to sit and let it fester...........

........... others don't.

Young, Free and Stupid

We pull up at the side of the road. Its the early hours of the morning so the traffic is light but the sky is not. We leave the blues lighting up our work space.

I survey the scene quickly.

A lamp post which previously stood at a point between the slip road and the main road is now laying in the road. A police office is using cones to stop the traffic from sending it any further out of place. A central crash barrier has lines down it that where not there 30 minutes ago. Skid marks run from the felled lamp post to the barrier and across the road to the site of the stationary car sat at an angle to the end of the slip road and the near side crash barrier.

The car has dents and marks down its offside as well as damage to its bonnet. Nothing too extensive or horrendous to make me think the occupants would be badly injured. It doesn't look like it rolled and there are no 'bulls eye' marks on the windscreen to make me suspect the front passengers hit it from the inside.

I spy a young man sat on the crash barrier he has a workman's jacket slung around his shoulders. There are extensive road works in the area and a friendly neighbourhood workman had heard the squeal of tyres and come over to help.

The young man was huddled against the cold of the early morning breeze looking down at his feet.

"Hi there, I'm Louise. I'm with the ambulance. Shall we get you into the warmth of the ambulance? Do you have any pain anywhere?"

He nods at my first question and shakes his head to the second. He opens his mouth to take deep breath. A distinct waft of alcohol escapes into the night air.

We get to the ambulance where I've asked my colleague to lay the long board on the trolley. Even though he isn't complaining of pain and the car appears to have little damage, its a fast road and any collision happened at a speed of at least 50 mph, and that's a conservative estimate. As I explain what we are doing and why I get one word answers to questions. Each time he speaks another scent of stale sweetness fills the air.

"How old are you?"
"21"
"Have you been drinking tonight?"
"Yes"
"How much?"
"I'm not sure"

The police are outside clearing the scene making it safe for any other cars coming off the slip road. I explain that they will want to do a breath test. I pop my head out of the back to find out if they want to do it before I leave. They tell me the car with the kit is on another job. I invite them into the ambulance to have a chat with the patient so they can document themselves about his drinking. I can't tell them explicitly what he has told me due to confidentiality. Its a round about way of doing things but at least its on record with 2 sources.

The heater has been blasting into the ambulance for 20 minutes and our patient has stopped shivering. He is relaxing a little and telling me the information I need to complete the report form.

We are nearing Holy Hospital before he starts to talk about the nights events. I ask him where he lives and what he does.

"I'm a student"
"Ok, what are you studying?"
"I'm in my 3rd year of a Law degree"

I take a deep breath and sigh "Well, this was very silly to do then wasn't it. Possibly just blown your career. Your lucky no one else was involved in the crash". I sound harsh, like a disappointed parent telling off a child. I know its not our place to pass judgement or to necessarily say these things but sometimes the words come out because they need to be heard.

He starts to try and justify it. He didn't plan to drink, the party he was at was flowing and his friends were having a good time. He didn't plan to drive home. He doesn't know what happened or why.

I point out that he had free will to say no to a drink or to get public transport home.

We all have choices and a lot of the time we know the possible consequences of our actions.

It doesn't matter how young, old, intelligent or stupid we might be. Whatever these consequences we are ultimately responsible for our own actions.

Not enough people seem to understand this.

Fighter

She's a waif. The bed clothes swallow her, the mattress and duvet look huge around her. The nursing home staff are in a relaxed state showing us to the patient. They inform us she has appeared to be complaining of stomach pain for a couple of days. She usually gets bouts of diverticulitis but this time she seems to be in a little more distress than usual.


Its stupid o'clock in the morning and this has been going on for 2 days. The doctor attended on the first day and recommended keeping her well hydrated and trying to have her eat something.


I step into the room and look at the head buried in the pillow with the duvet up to her chin.


She is a worse shade of white than the sheet she is laying on.


Her mouth is open.


I count her breathing as I approach.



1..............2,3........................4. She's cheyne-stroking.




I hold both her wrists to assess her pulse while my colleague gets some oxygen on her and instructs the home staff to find us a chair. Quickly.




The pulses are equal but weak and thready. I remove the bed covers to get a better look at her.




Her body is pale and I can see her ribs moving irregularly as she tries to breath. Her abdomen looks distended in comparison to the rest of her body.



"Does she usually have a big stomach like this?"



The nurse shrugs and shakes her head looking confused at our state of urgency to move the patient. After all she just had a stomach ache.



I look down at her legs, there a different colour in comparison to the rest of her. They look mottled and feel colder then the rest of the body. I check her femoral pulses, it takes me a while before I can locate the weak slow thumping pulse supplying little blood to her legs.



"Ok lets go"



Her daughter arrives as we're moving from her room. I explain that I believe her mother is very ill and we are going to blue light her into hospital. I ask the nurse to have a notes ready and bring it to us at the ambulance.



We get her into the ambulance and settled on the stretcher. Its difficult to assess her condition as she has advanced dementia but the grimace on her face is easy to read.



Her temperature is 35 C. Her blood sugar is within normal limits but her blood pressures are different in each arm. All her signs and symptoms are pointing towards an abdominal aortic aneurysm. One that's been developing for 2 days.



We call it in and run straight to resus.



We hand over and watch as the team re assess her and get lines into her veins. It takes some time and effort as she is in the process of shutting down. Her breathing had improved en route with a little assistance but I made sure all equipment was ready and available in case she crashed.



A doctor walks over to the blood gas machine in the corner. A couple if minutes later and she returns with a heavy look on her face. She reads out 3 numbers one relating to her potassium one to her carbon dioxide and the other is her oxygen levels. The numbers don't mean anything too me until the consultant chips in.



"Unsurvivable blood gases"



Basically her body's activity to try and stop the bleeding and cope with the after effects of her illness has poisoned her to the point of no return.



She is hypothermic with a serious abdominal bleed.



The resus team is firing as much fluid into her as she can take. She's been wrapped in a 'teddy warmer', an air filled blanket to warm her up slowly. They call for her to go to surgery but its unclear as to whether or not they will agree to operate considering her condition. They expect to just keep her comfortable for long enough for the family to get to the hospital.



We do the usual clean up and move on the next job....... a cup of tea back on station.



The next night shift I ask a few questions to see what happened to her.



"She's up in high dependency. She made some progress through the day so they moved her there. Seems to be bit of a fighter that one."

Climbing Fences

"He's wedged behind the door you'll need to go in through the back"
"Ok, how do we do that?"
"Well, it involves climbing the fence to go through the garden"
"Ok"

The action women in me likes the sound of this! The RRU Paramedic says she'll try the front door and see if there's a way in around him.

The neighbour who met us shows me around to the correct garden fence. I can see the sliding doors and the patient's wife pottering about in the kitchen.

I clamber over the slimey fence panels and drop down into the gap between the fence and a spiky tree. The spiky tree is of course the more dominant of the two obstacles and I pick up a few scratches on the way down.


I head down the garden and knock on the sliding doors. The elderly lady turns and looks at me then turns back to the work surface without moving to open the door.

Hmmm. Interesting.

I knock again. She doesn't even turn this time. I try the door and it slides easily.

"Hello, I'm with the ambulance, we're here to see your husband."

She doesn't even look round but continues to attempt to make a cup of tea.

"Through here Lou!"

I walk through the living room and find that skinny RRU Paramedic has managed to shuffle through the gap between the patient and front door. Part of me thinks 'well done, skinny cow!' but there is a little of me that's really thinking 'my way was more fun anyhow!'

Our patient is laying half in the living room with his legs taking up the small space at the bottom of the stairs. He's over 6ft tall and appears to be all limbs. He is complaining of a sore back. There really isn't a lot of room to manoeuvre around him.

"I came round to check on them. He looks after her as she has early dementia. He hasn't been well recently. I found him like this. He isn't making much sense which isn't like him." His neighbour is obviously concerned but calm which makes a good extra pair of hands to employ.

Our patient is talking to us but appears confused. He can't tell us how long he's been there. We manage to get snippets of information that make some sense. He woke with a headache and knows he didn't fall from the top of the stairs but from less than halfway up. But then the confusion and agitation hit again.

He is complaining of lower back pain but is displaying signs of a head injury as well.

This appears to be one of the those jobs where the patient is more ill on the inside than the outside tells us.

First things first, we need to move him carefully. We get the neighbour to help us straighten out his legs and move him more into the living room. A little furniture removal to start with and we get equipment passed to us through the slit made by the open door.

As we're moving him to get him positioned on the board he tries to talk to us but is still not making much sense.

There is sense of something being very wrong but I can't put my finger on it.

When we roll him a quick look and feel down his back doesn't illicit any abnormalities. He has no obvious signs of injury. His pupils are equal and reactive. His oxygen levels are good. His pulse is strong, steady and regular. His respiration's are regular and adequate. The only thing telling me this man is really ill is the fact that his behaviour is significantly different to normal.


That's not a lot to go on but sometimes its all you need.


The neighbour agrees to stay and look after his wife until their usual home care can come. A quick thanks for his help and we're ready to role. All I can do for our patient is give him oxygen and monitor for any changes.

I call in the standby and run in watching our patient like a hawk.

A quick run down of the available information to the receiving A&E staff and we're away onto the next job before you can blink. Looks like its going to be one of those days.

A few hours later and I manage to get back see the consultant who treated our patient in resus.

"Yeah, he's on his way to the Big City Neuro Unit. It was a sub-dural bleed."
"Well that explains a few things, I'm guessing we don't know what came first? The fall or the bleed?"

"Nope, probably never will. Pretty irrelevant now anyway"

More Apologies

Again, I'm very sorry for my lack of proper posting. Things seem to be settling a bit now, well relatively speaking anyway!

Please bear with me I will try to get back on track very soon. Thanks for bearing with me!

Louise x

Random acts of kindness

I was informed of something very heartwarming that of course occurred while I was busy somewhere else!



On the anniversary of 9/11 (last week for those of us a wee bit messed up with the days!) a manager from a well known pizza company visited the Police, Fire and Ambulance stations of the Concrete Jungle and took orders for free pizza (sods law when I'm not there!).



Low and behold a couple of hours later he returns with a stack of pizza for the workers to tuck into.



This really struck me as a great thing to do. Although we were not directly involved in the incidents at the time (even we couldn't make that ORCON time!), it seemed to recognise and commemorate the role the services played over there at the time. The manager of the restaurant was American and felt compelled to do something to say thank you.



Always nice to feel appreciated and you can never go wrong with free food!

Vertically Challenged

As I look at the predicament I can't see a way to do it without either dropping the patient or damaging myself considerably.

I'm at the bottom of the stairs.

The hallway is thin at the bottom.

The stair-lift sits at the bottom of the stairs leaving not a lot of room to manoeuvre. The patient isn't able for several transfers or to walk to the stair lift so we can use it to our advantage.

The patient is tiny, a waif in her illness and I would normally happily lift someone her size safely over this obstacle.

If I stand on the landing my arms aren't long enough to get a good lifting position on the chair.

If I try and stand on the bottom step and lean over there just isn't enough room to do it and my back is in a really bad position.

A gruff voice comes from behind me.

"For God's sake! Move it short arse!"

Santa* has come in from putting his stuff back in the RRU and has seen me farting around trying to get a grip of the chair and find a way to lift it.

At a good half a foot taller than me his longer arms make short work (sorry for the pun!) of getting the carry chair over the offending chair lift.

"Cheers Santa!"
"No problem shortie"
"I prefer vertically challenged, thank you!"