Blood!!

As I lie there, awake, listening to the gentle breathing of MrsRRD sleeping next to me, I marvel at how precious is the time between first and second alarms. I have a whole 10 minutes, just to savour the quiet in the house.

Phil Collins shouldn't be here!! "In The Air Tonight" resounding around the room pulls me from my stupor, as I answer my phone from Control.

I am called to an RTC on the motorway, possibly fatal. I throw on my work clothes (thank goodness I am a slob, and I don't have to go into my cupboard for anything), kiss MrsRRD goodbye ("Did your phone ring?". "Go back to sleep.") and run down the stairs, thinking, Oh well, there goes my morning shower and ablutions.

The journey is easy today - kids off school, roads quiet, but I am stood down just as I approach. I decide that there is no time to return home, and I continue on to the hospital.

I stumble in to the Department, to various comments about the local bum turning up for work. This prompts me to a caffeine fix (well, NHS tea) and a decision to use the "value" razor I have in the office for just such an occasion.

There is no mirror in the loo, and I run the blade over my lathered face by feel, rather than sight. Ouch!! That's a small nick under the left nostril. Must remember to utilise the well-known haemostatic agent close at hand to that area when I'm done - wouldn't want to get any blood on my shirt before work!

I leave the makeshift bathroom, and go to my office for a 5-minute break. I have a mirror on the outside of my door (don't ask - it was there before I joined) and I look in horror at my ravaged face and my blood-spattered shirt. The blade has done a very nice job of removing all the stubble from my neck, along with most of the surface skin!! I look like a victim of the Barber of Seville!!!

Ok, regroup!! The blood on my shirt is only a few minutes old, and I know that washing in cold water will remove it. So, it's back to the loo, and, shirt off, I start the painstaking job of soaking and scrubbing the collar.

5 minutes later, and the shirt is clean, the flow of blood is (virtually) stemmed, and I am ready for work.

One problem - soaking wet shirt.

Another problem - meeting in 5 minutes.

Solution - wear shirt, put electric heater on, and make self-depreciatory comment about surgeons and blades!!!

Mornings

I've decided. I'm not a morning person. Especially 3am. That's not really morning, is it? That's still night time, isn't it? Ok, then, I'm definitely not a night-time person.

This is an unusual comment to hear from a chap who regularly jumps out of bed at 3am, drives at ridiculous speeds, and makes life-altering (hopefully -saving) decisions. I do all of those things, and, I hope, do them rather well.

What I find difficult is biting my tongue. When well-meaning, worried family members ask me questions in the middle of the day, I try hard to alleviate their fears, empathise with their need to know, and help them deal with the difficult decisions that are being made around them.

At 3am, when I am asked if a drug I am considering using to sedate a man to help get him down a steep set of stairs has any side effects, I answer "Yes, but they're better than just leaving him here all night." Not the most empathetic comment I have made in my life.

But it could have been worse. When same family member asks me if the neurosurgical centre I have chosen for their beloved is the best choice, I don't say, "no, I just chose it because it is near to where I live, and I'll be able to get back to bed quicker." I simply say, "yes."

Maybe I can cope with 3am's after all!

Nothing to do all day!

I've had nothing to do all day today. My nothing started at 5am, with a call to an agitated man, collapsed as he got out of his bed. The team were unable to get him down the stairs, because he was thrashing about too much. By the time I arrived, he was quiet, and easily transported down the stairs. I didn't help the crew this time... I decided to follow behind the ambulance to Local Neuro Hospital, just in case. Nothing happened

About 6 this evening I was just getting ready to go home, when I am called to a stabbing near by. He had been stabbed in the chest, and was in the back of the ambulance before I arrived. The crew were happy to wait, and I travelled in the back with them on the way to Major Trauma Centre, just in case. Nothing happened

I got home about 8.30. My new cat was waiting for me (more about him in another post), and so was my family and my dinner. About 8.35 I get a pager for an RTA not all that far away. I couldn't not go. After all, that's what I do. He had been thrown from the car at high speed, but seemed reasonably ok. I decided that, since we were only 5 minutes away from Local Hospital, I would travel in the back, just in case. Nothing happened.

I'm home now. Please let me have my supper!

I Hate You

You make me sick!! You think it's ok to go to the pub, have "a few" drinks, and then get into your car. You think it's ok to then drive like a lunatic, so hard into a parked car that you shunt it 20 feet.

THAT COULD HAVE BEEN A CHILD!!!! That could have been MY child!!!

And then you stand there, saying that you got unlucky, because you got caught.

Unlucky would be running someone over, or hitting a car with people in it. Unlucky would be driving into a bus shelter, with a queue of waiting people.

So you are going to lose your licence. Big deal! You should lose more than that, and, if I had my way, I'd be at you with a scalpel blade to your rather needed parts.

But instead I have to be polite, treat you like a human being, rather than the animal you are. At least I get to hand you over to the waiting police.

Phew!! That feels better - back to work.

Confidentiality Revisited

It's tough, you know. However hard I try, whatever I do to maintain confidentiality, events continue to conspire against me. People know people. My community is small, and my patients have family. Family have friends. And the friends read my blog. No matter what I do to try and change the facts, the facts are still there, in some form or other. And that means I am taking a risk, every time I write. For every one of you who lives so far away that the stories are just stories, there is another of you for whom these stories are ever so real.

And what does it matter? Well, I try so hard to include only enough reality to make the stories real to you, Constant Reader. I ensure that any medical information is couched in such terms as to negate the breach of confidentiality that these tales perform.

But, what if it were your kith or kin that were written about? What if you knew that what was written was at best inaccurate, and at worst a fabrication, would that matter to you? I am, on occasions, a little irreverent. How might it feel to you, reading that, at least I had gained a pair of scissors while attending to your loved one, injured so badly in a car accident that he lies between life and death on a hospital bed?

I don't know the answers to these questions. Maybe soon I will. Maybe the family of the lady I wrote about in "Scissors" will tell me. And, maybe, their words will bring this blog to an end.

You see, I write how I feel. And I cannot change the way I feel. Without the humour, the irreverence, I would not be able to cope with the endless sea of nameless faces.

To all of you out there, to all the families of those I have saved and those I haven't; please forgive my breaches, my fabrications and my irreverence. The patient is always first and uppermost in my mind, both at the roadside and at the keyboard. If you cannot forgive, then please try to understand.

Odd

I've just come back from a job on the M25, and seen I'm wearing odd boots. One's a Caterpillar, and the other's a Magnum. Funny thing is, I've got another pair, just the same, in my car!!

Goodnight!!!

Plants

My back hurts. Specifically, my left shoulder, up into my neck. We have about 50 people descending on Chez RRD this afternoon, to celebrate Princess RRD and Mini RRD's birthdays. No, they're not twins, just have their birthdays quite close in the year. Mrs RRD has resigned herself to sorting the house out herself, as a result of my incapacitation. She is doing it with her usual good grace - after all, it's not my fault that my back hurts so much...

Yesterday I get a call to assist a crew with an analgesia problem. This is not all that unusual, and, if I am not too far away I will try and attend. I carry more potent pain killers than the paramedics, but often I just support and supervise the crew to use what they are familiar with, only in much higher doses. If something goes wrong, if the patient's breathing slows too much, I can always take over their breathing in the time-honoured fashion of sticking a tube down their windpipe and ventilating them.

But I digress. This call was for a man who had fallen out of bed, and landed awkwardly between bed and wardrobe. So awkwardly, in fact, that he had broken his leg. He had managed, somehow, to drag himself to the top of the stairs, but was then in too much pain (surprise, surprise) to go any further. The crew have given large doses of morphine, and he was still in so much pain that they couldn't do anything with him.

By the time I arrive, the morphine has kicked in, and he is feeling much more comfortable. I assist the paramedics with getting a splint on his leg, and rolling him onto a scoop stretcher, and strapping him down in preparation for the journey down the stairs.

The stairs have a lovely bend in them, just the right place to have a window ledge, complete with pots of plants. Lots of pots. I spend a few minutes carrying the plants downstairs, so that we have a clear way down. The crew suggest we get another ambulance, so that we have enough pairs of hands - Jim is no lightweight. I realise that this will be a wait of another 30 to 40 minutes, and suggest that we three can manage.

For some reason, I find myself going down the stairs first, with all of Jim's weight in my hands, as I manhandle the stretcher. The tight curve means that the stretcher, with Jim firmly strapped in it, has to be almost vertical. Oh, and did I mention Jim is coming down head first?

So, Mrs RRD, it wasn't just one of those things that meant you had to do all of the schlepping today - it was my fault.

Next time, I'll stick to the pot plants.

Swimming Run; Running Call

It's Tuesday. Princess RRD has swimming on a Tuesday evening. It's my job to take her the 20 minutes to swimming, come back, wait about half an hour at home, and then go and collect her. I enjoy the time we spend together on those journeys. I just wish that the Blackberry had never been invented, so that we could have more time to chat. Still, it's good she has such an active social life.

On my way back, the traffic near home is a little busier than usual. I see some blue lights behind me - the other side of the road is clear, so I know he will have no problems getting past, even though some idiots are trying to overtake everyone sitting in the traffic jam, just because they are turning right in half a mile!

It's one of the local First Response Units. How I don't envy them their job. The thought of turning up first anywhere, then knowing that, once you are there the clock has stopped for the Ambulance Service and you might be there on your own for an hour or so fills me with dread.

I see a bus up ahead. The FRU drives past, then stops. Oh ok, I can guess the scenario: unwell woman on bus. As I approach, I can see that the paramedic is still kneeling on the road in front of bus. Change of scenario: woman hit by bus. I pull over, hit the rear blues, and jump out, rushing to the boot to don the tango suit.

It's Mabel. All the local crews know Mabel. Even I've met Mabel at my hospital, some miles up the road. She's, not to put too fine a point on it, the local drunk. Well, one of them, to be precise. The FRU who is here today tells me he usually gets called out to Mabel at least once a week, suffering with collapse. There's never much wrong with her, and she usually gets on her way as soon as the team arrive. Not today, though.

The pool of blood around her head where she lies corroborates the information provided by the shattered windscreen: today, Mabel has been hit by the bus, and has a head injury. How much of a head injury is yet to be seen.

Mabel opens her eyes when I call her name. She tells me, in a slurred voice, that she is just having a rest, and why don't we all F*** Off! Mabel is renowned for her careful choice of words, le mot juste. I lean in to take a look at her pupils, and sense the heady aroma of Mabel's favourite perfume: Eau de Pub.

I look around: we are on a main shopping street. The world and his wife, their children, the Au Pair and the next door neighbour have all gathered to watch. One woman, complete with shopping bags, nudges me a little, to move me out of her way, so that she can get a better view. I remind people that if they want some street theatre, Covent Garden is a short train ride away, but they remain glued to the scene. I ask a couple of police officers to prevent me from committing a criminal act on the closest individuals, and they hastily set up a cordon around us, to give Mabel some privacy. The only two who are left are the two who kindly stopped and helped her before we arrived. One was holding her head, the other was, well, I'm not sure, really. She was giving some very helpful suggestions, suggesting that we get an ambulance, advising us not to move her, except, perhaps, the recovery position?

The ambulance arrived a few minutes later (or, in my case, a phew! minutes later). We quickly get a scoop stretcher under her, to the accompaniment of the passer by suggesting that we don't move her! I wondered if she thought we should help Mabel set up home in the middle of the high street, but bit my tongue, much to the amusement of my colleagues.

By this time Mabel was as awake as she ever was, and the crew were happy to take her to the local - hospital, not off-licence!

I popped back to my car, just in time to turn round and drive back to the swimming pool.

As I am driving Princess RRD home, I told her all about my running call. For this journey, at least, her Blackberry was left in her pocket.

Scissors

She's 65. She's in a bad way. She's lying on the floor, moaning incoherently, with blood from her left ear, and her left eye swollen shut. Her arm is bent at a funny angle as well, but that's not bothering me now. What's more concerning is her head injury. I look at the car: the windscreen has been hit hard from the outside, and is now mostly in the car, on the passenger side. Thank goodness there was only the driver in the car, when it hit the lady as she crossed the road, iPod headphones bought for her by her granddaughter for christmas drowning out any extraneous noises.

The HEMS crew arrive shortly after me. They are in the car, it being night-time (oh, and it's raining - again!!!). I confer briefly with the HEMS doc, who is happy for me to run this one, and happy to take the patient for me to St Mary's Hospital. I am on call for my own hospital tonight, so can't be going on any road trips...

I call for assistance to stabilise the patient: scissors to cut up each trouser leg and across each sleeve, a cannula in the uninjured arm, blood pressure and other vital signs.

She's a bit more awake now, calling out, and asking for her mother. She's very confused and agitated, so will still need tubing before transfer.

The HEMS team do things a bit differently from me. They set everything out very neatly and ordered, whereas I have a tendency to unzip my bag and turn it upside down. And then there's the checklist. Before I tube a patient, I have a look around and make sure I can see the bits I might need. The HEMS crew have a laminated sheet, with a list of equipment, drugs and personnel, which is called out, much like the checklist before flying an airplane.

Please don't get me wrong: I agree in principle with the idea of a checklist, but it's just not me.

I call out the items on the list, and receive a "Check!" from the paramedic assisting me. I take a breath in, inject the drugs and insert the laryngoscope. Easy view! The tube goes in, we secure the tube, and the patient is wheeled into the back of the ambulance. 5 minutes later, the ambulance is off, with the HEMS doctor inside.

I look around at the mess that is left: discarded packets, gauze, blood from her head wound, and the tuff-cut scissors I used to cut the patient's trousers. I look around - no more ambulance crew here. I feel strangely deflated, giving over the patient to the HEMS crew and not being able to complete the job through to the hospital.

But at least I've gained a pair of scissors.