The Last Journey

Oh how I hate these kinds of jobs. Hangings never go well. The patient usually is in a very bad way and they are often at home, found by family members, which adds to the intense emotion of an already tense situation. So, I am very wary of this job. Also, the fact that I haven't been out on a call for many weeks doesn't diminish my concerns. I mentally run through the contents of my bag. Did I replenish the drugs after my last call? Do I have enough syringes? Are the batteries in my laryngoscopes still live? There is nothing I can do about these things now, as I drive into the car park to a block of flats near to where I live. This is not a particularly selubrious area, and I am comforted by the number of blue lights and police vehicles I can see parked up. I jump out and grab my gear.

Ok, number 63. Where is number 63? It's dark, and despite the presence of what looks like most of the emergency services in London, I can't see a living soul. Oh,a nd surprise, surprise: it's raining.

Erm, what now? I tried a tentative "Hello?", but got nowhere. Then, from a balcony above, I hear some murmuring. This sounds promising. I move towards the stairs leading up, and see, in very small type, the words "15-63". I start making my way up the stairs.

Now, for those of you who don't know me, I don't really do stairs. Lifts are good, escalators I can cope with. But not stairs. And not this many. And not with a 25kg bag on my back and a 5kg monitor in my hand. But, this building doesn't look like there is going to be a lift. Or escalators.

I stumble on to the 4th floor, and call out again, rather breathlessly. This time, I am answered, and ushered into a tiny hallway, and my first glimpse of Jake.

Jake is lying on the floor underneath a loft hatch. He is being held down by two policemen, whuile the boys in green tend to him. He is agitated, and has the marks of a noose around his neck. He has, according to his flatmate, fallen from the loft, with a rope around his neck. The rope held him for mere seconds, before he fell the last remaining feet, to land in this tight space between front door and the bedroom.

I think quickly: he is currently maintaining his airway, but is very agitated. He has clearly suffered some hypoxia (lack of oxygen) making his brain not function properly. He needs intubating and ventilating, and getting to a trauma centre.

We are 4 floors up. If I tube him now, it will be incredibly difficult to keep ventilating him all the way down the stairs. The likelihood is that any brain injury from his hypoxia will only be made worse by the journey down the stairs, not better.

So, we need to get him down awake. But he's not the most cooperative of gentlemen. Not at the moment, anyway. He's moving all his limbs, the lower ones quite agressively, so he hasn't broken his neck. But we still need to be very careful in how we move him.

I decide that he needs to come down awake, and we strap him to a scoop stretcher, before making the precarious journey down with him. Well, when I say "we", I mean the ambulance crew. I go on ahead to set up my equipment and drugs for the inevitable intubation when they bring him down.

It's a good 15 minute journey down the stairs, and I am completely set up by the time they bring Jake down to me. I need to reassess him, just so that I have a baseline set of observations. Pulse, 96. Blood pressure, 130/75. Oxygen saturations, 98%. Glasgow Coma Score, 15. Sorry? Let's just check that. Yep, he is fully conscious. Hmm. I decide that tubing this one may be a little more than he needs. I'm not sure how he could have improved so dramatically in such a short space of time, but I'm not arguing.

He still has had a major insult, and needs to go to a Major Trauma Centre. It would be inappropriate to ignore the low GCS initially, nor the mechanism of injury. I look at my watch: 22:30, T-1. T being the day that my local Major Trauma Centre opens its doors 24 hours a day. Yes, tomorrow at 8am, I can go to my local at any time of the day or night with my patients. Not tonight, tomorrow. Tonight I'm off to the Royal London. That's a looooong way. Over 45 minutes. Still, I have no choice.

What I do have a choice in is how I get there. The patient is going in the back of the ambulance. I'm not happy to have the crew take him there all on their own, not on a 45 minute journey with a man who, 15 minutes ago, had a GCS of 6. But, if I travel in the back with them, then someone will have to somehow get me back to my car. However, if I follow in my car, I can still jump out and help if they run into trouble en route, yet I will have my car available to drive back immediately.

Decision made, we package the patient securely, and I start on my last journey to the Royal London.

Puddle

It's raining. I guess that's normal. What's not normal is that I am underneath a 4X4 looking after a young lady who was hit by aforementioned 4x4, and is currently lying on her left side, completely under the car. She's fully conscious, and tells me what happened. She was walking across the road, when she saw a car slide towards her. She ran, slipped in a puddle, then watched in horror as the car came inexorably towards her, then over her. She closed her eyes and waited for the end.

The end didn't come, and now she lies there, while the fire crew use hydraulic lifting gear to raise the 4x4 off of her, and while I lie next to her, in a puddle of rainwater, putting a cannula into her vein to give her enough pain-killing medication to allow the ambulance crew and I to move her on to a board and drag her out. My discomfort, that of the water seeping inexorably through my flight suit and my trousers, is nothing compared to her pain from her fractured pelvis.

Eventually she is out, and we get her to the hospital to be checked out. I make a mental note to myself to get my suit cleaned, and waterproofed at the same time.

Flying!

He loves driving. He's quite good at it, actually, having been driving for well over 6 months. He can handle his car with ease. So what if he drives a bit fast sometimes. He can cope. He never drinks and drives. That would be silly.

He's out with his mates. His girlfriend is driving her car, and is in front of him at the moment. She can't drive properly. She sticks to the speed limit. It's 2'oclock in the morning - what's the point of a 30mph speed limit. After all, it's not as though there is anyone else on the road.

Ok, time to show her just how to drive!! No room on the right, so have to undercut on the left. Drop back a bit to give some accelleration space, then floor it, and onto the pavement.

He hits the concrete bollard at well over 50mph. The bollard is partially uprooted, and ends up at a 30 degree angle, just perfect to act as a take-off ramp.

The car sails through the air, at a height of 2 metres, and comes to rest on the roof of a Volvo S60 (band new, from the look of the plates) that was parked in the owner's driveway.

I arrive to see 4 young lads walking around, somewhat dazed by what has occurred. None have any significant injuries. Not one. The girlfriend doesn't look happy, and I wonder, as I drive away, whether the only thing that has been broken in this accident, (apart from the unfortunate S60) is the relationship.

I go home, so pleased that my teenage son isn't like the others. Oh, and that he can't afford the car insurance, so won't be driving any more.

Bad Boy

I am a bad boy! I have been told off, by my friends, by my father, by the paramedics who work with me. I complain about not going on any jobs, and then, when I do, I don't write any blog entries about the jobs I do go on.

The only ones who really matter are you, Constant Reader. I have let you all down, by neglecting my duties as a Blogger.

I could tell you about how busy the Hospital has been over Christmas. I could tell you about the lack of staff, leading to me working more hours than there are. But, the bottom line is that I haven't written. And that has to be rectified.

I will try, try very hard, to keep the writing going. There has been a hiatus (more of a huge hole!) but I will make all endeavours to bridge the gap.

To be really honest, I miss the release that I get from writing. I feel emptier as a result of not writing.

So, without any further ado....