It's A Long Way To The Trauma Centre, It's A Long Way To Go

Ah, peace at last!! My gentle drive home from the hospital is in stark contrast to the week I have had.  Busy doesn't cover it.  But, at least I am free all weekend.  I have great plans for tomorrow morning - I won't be surfacing until at least noon.

Before that, however, I have an evening at home with the family.  A nice quiet, relaxing evening, that I have been looking forward to all week.

Arriving home, I am assaulted by the wonderful aromas of my dinner, simmering in the oven! Can it get any better?  RRD-Dad rings, and we have a chat about who's been busier than who.

My other phone rings.

My heart sinks as I realise that, at least for me, dinner will just have to wait.

As I ride the motorway to my destination, I muse on how long it has been since I have been called to a job.  Sure, I have been woken; on one occasion I even got to the car and started driving.  But, an actual job - well, many weeks. And then I start to wonder quite how I will manage this one.  Will this job be the one where I find myself unable to make the right decision, where someone's life depends on me, and I get it wrong?

Uneasy now, I arrive at the police roadblock, and am waved through.  The road is eerily quiet now, so unusual for a Friday night.  The mass of blue flashing lights up ahead signify I have arrived.  I get out of my car, then leave the road and scramble down an embankment to the waiting crew.

She's been thrown from the car.  That's bad.  Ejection equals serious trauma.  It also suggests a lack of a seatbelt.  The car has definitely rolled over - dents and damage to the roof make that a cetainty.

She's not moving.  Her left leg is at a very unusual angle.  But I have to ignore the obvious injuries, and search out the immediately life-threatening ones.

She is breathing spontaneously, and her chest is rising and falling symmetrically.  Her tummy feels ok, and her pelvis is intact.  But, she is not conscious.

I decide that, as she is out of the vehicle already, the best thing to do is to scoop her onto the stretcher and carry her back on to the road, where it will be much easier to assess her.  A couple of minutes later we are by the ambulance; lots of space and lots of light.  Also, being on the stretcher means she is at a much better height for me to examine her.

She is still breathing normally, and there are no sounds of snoring, suggestive of an obstructed airway.  This is unusual in someone who is unconscious from a head injury.  I file that titbit away, and carry on looking.  Her chest is clear, and the movements are still symmetrical.

Into the ambulance and some further observations:  pulse rate 130, blood pressure 170/110, oxygen saturations 98%, respiratory rate 18.  For those not in the know, she has a very high pulse rate, a very high blood pressure and a moderately fast respiratory rate.  This could all be due to the pain from her obviously broken leg.

I ask about distances to hospitals.  My own hospital is a mere 15 minutes away, with the Major Trauma Centre about 45 minutes.  I know what the right thing to do is: we need to go to the Trauma Centre.  I don't like these long journeys, but I know it is better to spend a longer time in the primary transfer from the scene to a specialist centre.  The decision is made, and the crew get ready to depart.  I think for a moment about intubating her, but decide that, as her breathing does not seem at all like that of someone with a significant head injury, we would wait and see how she goes.

We set off.  She's very cold, and the saturation probe finds it difficult to get a consistent reading.  The blood pressure is a lot better now: 110/ 60.  She starts to moan and open her eyes, and ParaGirl and I smile, knowing that this is a good sign.

She starts to vomit.  Not a good sign at all.  As she is strapped to a spinal board, if she is not conscious enough she will be unable to clear the vomit from her mouth and will inhale it.  Aspiration is a leading cause of death in trauma patients.  But not this one.  She lifts her hand to her mouth and coughs.  Good.  That means she has an intact gag reflex, that will protect her airway.  She spits out the vomit.  Good for her, not so good for us in the back of the ambulance.

She vomits again.  And again.  And again.  We have the sucker ready, but this is ridiculous.  What on Earth has she been eating?  And so much of it??

We have by now stopped on the hard shoulder while we try and sort her out, stopping her from drowning in her own vomit.  We manage, but ParaGirl is gagging.  "I don't do vomit", she gasps between hiccups.  Well, you are in this job, and in the back of an ambulance swimming in it, so you just have to.

She's now stopped vomiting, and has settled back into her previous unresponsive state.  I check the observations as we set off again:  pulse 145, blood pressure 69/50, saturations 95%.  Hmmm, her pulse rate is climbing, and her blood pressure, while initially high, has fallen dramatically.  I open up her drip, and give her more fluids, willing the ambulance faster.

It's a Friday night, and the roads get busier.  We are getting slower and slower as we approach the Trauma Centre.  The blood pressure now reads 47/20, and I am sure we are going to lose her before we get there. I squeeze the bag of fluid harder, pushing another bag into her.  ParaGirl asks if I want another blood pressure.  I shake my head, knowing that, as long as she is still breathing, there is precious little else I can do, and seeing another blood pressure will only add to my anxiety.  Her lips are pale, and I know that she is bleeding somewhere; presumably into her abdominal cavity.  I alert the Trauma Centre of our impending arrival.

We arrive.  She still has a pulse.  She begins to moan again as we wheel her in to the resuscitation room.  I wonder again whether we should have gone to the closer hospital.  But, when, 5 minutes later, she is being rushed to Theatre, a surgical team ready to save her life, I know I have done the best thing for her.

Rope

I rush into the Department, pager in hand, and am swamped with people wanting to join me on another shout,  High Tower and New Boss are the chosen two, and we jog over to the car, the two of them jostling for the front seat.  There's a lot of joking around: with High Tower in the car I am not going to have the same acceleration as I would normally get.  New Boss is very excited at the chance of seeing some action on the streets.  I'm quiet; I know what we are going to, and I know the impact it will have on these two.

New Boss is in the front seat, holding on for dear life as I hit the road.  The two of them continue to joke about my driving skills, and about how different I am out here, compared to in the Department.

The rope hangs from the banisters: a mute reminder of what this man has done.  The screams from the back room echo around us as we determine what we already know: this man has managed to do what he wanted to.

We drive back to the Department, each lost in our own thoughts of what we have witnessed.

I have seen many hanging victims, and so have High Tower and New Boss.  But they had never been to the house before, and the sights and sounds at the scene of a violent death can never be explained, can never be shared with someone who has only ever dealt with the victims in the sterile, cold environment of a hospital resuscitation room.  And what they continue to see in their mind's eye will remain with them forever.

The rope.

Avoidance

I've been avoiding you, dear Constant Reader.  I look back, and see that the last time I ventured here was three months ago.  It's not that I haven't thought of you, nor that I haven't had anything to say, no jobs to post.  In fact, quite the contrary.  There are some that I want to tell you about, and some that I need to tell you about.  It's not even the dreaded writer's block.  Posts and stories rise unbidden into my mind, and ache to be transposed to the page.

But I can't.

My anonymity on this blog has always been paper-thin. Some comments have even refered to me by name, and I have rapidly removed them, or asked the commenter to edit them.   Those of you across the pond, or just in another part of the island, won't know me, and therefore won't know my patients.  But, let's be honest: anyone who works where I work knows who I am.  There aren't many of us around, and it only takes one or two jobs for the connection to be made.

I cannot have my patient's confidentiality breached.  That's an absolute.  There is no grey area.  Anyone who knows me (here we go again) will know how precious I value confidentiality.

If I tell you about the police officers who spun their car off the road, you will say, "ah yes, I remember them."  If I don't say they are police officers, the story is missing the part that makes the story worth telling.

If I tell you about the chap found hanging (and I will, but with anything patient-related taken out) you will remember reading about it in the local news, and that patient's confidentiality will have been breached.

So I sit here, musing over what I can, and what I cannot, say.  And I end up saying nothing.

But I still have the need.

So, dear CR, read on...

2.3 x 10!!

Oh my legs!! And other parts of my anatomy!!  I can barely stand, let alone walk up the stairs to my room.  But, as I lie here, a mass of knotted muscle, I can't help but smile at what I have achieved today.  And, I mustn't forget that MiniRRD was there too, struggling with the ups and downs, but mostly the ups, that today brought.  In fact, the downs were what we were both looking forward to, more than anything.

Brands Hatch Race Track is a killer.  I can say this with authority.  It is 2.3 miles of pain and effort.  How can most of it seem to be going up?  It felt like I was riding in a picture by M C. Escher.  You know, the one where the steps just keep going up and up, and yet still join in a circle.

Let me just take you through the first little bit of the circuit, just so you get a feel for what MiniRRD and I experienced today.

Come out of the pit lane and speed up, before a gentle incline slows you down as you go through the timing arch.  Turn sharply right and shoot down a VERY exhilarating hill (I reached a top speed of 39.6mph on this one), which finishes with such a steep climb that all your lovely momentum disappears in an instant, and you are back in the lowest gear and crawling up, in a fair amount of pain may I add.  Round the corner and a cheeky drop for a second or two before ... yes, you guessed it, a climb.  This time it's not at all steep; just a gentle climb that slowly but surely saps your strength, until you are gasping for breath, and barely able to turn the pedals (well, that's how I felt).  And so on.

But, and here's the bit that makes it all worthwhile, if you look at the title of this post you will see that I went round a total of 10 times!  Yes, I managed to conquer this gruesome course 10 times today.  And MiniRRD?  Well, he had to beat me, but only by one.

My main claim to fame for today?  My fastest time of 14 minutes was slower than anyone else's time on the track.  I did manage to pass one rider over the whole day.  My pleasure was short lived; just after I passed him, he wobbled and fell off!!

I'm off to have a hot bath, and a loooong sleep.  Oh no, wait.  I'm at work first thing in the morning.

Decisions

What a busy day I have had!!  On the shop floor all morning, meetings all afternoon, and now I am sitting in my office sorting out the multitude of emails that have built up over the week.  I decide that enough is enough - my family are all at home, and that is where I should be.  I power down my computer, get my coat and leave.  I need the loo, but decide that as it's only a short drive I would forgo the pleasure at work, and wait until I get home.

5 minutes from home my bluetooth phone rings.  Assuming it's MrsRRD, checking on my arrival ETA, I answer with a "Hi, Darling!!"  After all, who else would be ringing me?

Control are quite surprised at my friendliness, but it doesn't stop them from tasking me, to a pedestrian hit by a car, in MilesFromAnywhere Town.  They tell me that the crew are having difficulty with the airway.  I sheepishly begin to explain my forwardness, then give up and hit the blues and twos, and set off.

I find myself on the M25.  What on Earth am I doing here??  Fortunately, my faithful Sasha (the SatNav - don't you have a name for yours??) is just avoiding all the traffic on the small roads around MilesFromAnywhere Town, and I am grateful for the decision when I come off at the next junction, and see the tailbacks behind me, presumably from the accident I am now racing towards.  My bladder gently reminds me of the last decision I made before leaving work, and I shift uncomfortably in my seat.

I arrive on scene: well, the point at which Sasha tells me I am on scene.  Nothing.  Just queues of traffic.  I keep going, thinking that, if the patient has an airway problem, I cannot waste any time.  Fortunately, round the corner is a police roadblock, and I am swiftly directed around the police van to the waiting team of ambulance crews.

This girl is in a bad way.  She is lying on her back, blood around her mouth, a paramedic bagging her.  I rush over and assess the situation:

Airway: well, at this moment in time she doesn't seem to have one.  There is very little of the precious oxygen getting into her lungs, despite the efforts of the crew.

Breathing - wait a minute, you all know the drill now.  If there is a problem with airway, it needs sorting, and straight away.

I unzip my trusty Thomas Pack and reach for my intubation pouch, grab a laryngoscope and prepare to have a look.  I can't see much, as there is so much blood in the mouth.  I use the suction proffered me, without me even asking (good crew, know what I need before I do) and clear the view.  She coughs and gags as I do, and I breathe a small sigh of relief - at least there are still some signs of life.  I have a good view of the cords, and a tube in my hands.  Despite the fact that I have given her no drugs at all at this stage, I decide that she has been starved of oxygen long enough, and I am not going to delay any further.  The tube goes through the cords, and she coughs and gags plenty more.  That's not good for raised intracranial pressure, what you get when you have a serious head injury, but, then again, nor is not being able to breathe.  

I quickly grab some sedation and paralysing agent and do what I would normally have done prior to intubating the patient.  She is now still, and we are able to ventilate her with ease.  

Phew!!  On to the next stage.

Breathing:  Well, at least we are now doing that for her.  I think about my next decision - do I perform bilateral thoracostomies?  For those who don't know what I am talking about, a brief synopsis.  Those who do can skip to the next paragraph.  When there is chest trauma, the lining around the lung can be punctured, allowing the entry of air from the lung into the space between lung and ribcage - a pneumothorax.  If someone is pumping air into your lungs, as I am now doing with this lady, the air is also pumped out of the hole in the lung and its lining, and fill up the space between the chest wall and the lung, compressing first that lung, then the heart and other lung, leading to fairly rapid death - a tension pneumothorax.  By making a small (well I think it's small, you might disagree) hole in the chest wall with a scalpel, I can equalise the pressure, and stop the heart and lungs being compressed into inactivity.

So, back to the story. I have to decide about how this girl's breathing will be best managed.  She has a tube in place, and we are breathing for her.  Her chest rises symetrically on both sides, and she has normal breath sounds.  However, she did have a lot of blood in her airway, and her oxygen saturations are in the low 80's, instead of the 100% I would expect / like to see.  I have a careful feel - I cannot see any signs of chest injury, and there doesn't appear to be any broken ribs or surgical emphysema.  Surgical emphysema is the result of having air in the tissues of the chest wall, and feels like cornflakes under the skin (honest).  This would be a certain indication that she had a lung injury requiring a thoracostomy.  But, no corn flakes can be felt.  Also, her blood pressure is good, and, if she had a tension pneumothorax, her heart would be compressed so much that her blood pressure would be very low indeed.  And it's not.

So, decision made: I will not cut this girl's chest, and watch carefully for any signs of deterioration.  If she does deteriorate, I will make the incisions.

Next, circulation.  Well, her blood pressure is high, and her pulse rate is high.  A high pulse rate can be due to blood loss, or lack of oxygen.  But, then again, the high pulse rate and high blood pressure could equally be due to having a tube stuck down your throat without an anaesthetic.  I decide to give her more sedation, and the pulse rate and blood pressure stabilise to normal.

And now I have the big decision - where are we going.  I look around me.  We are really in the middle of nowhere.  She definitely needs a Major Trauma Centre, but how far is that?  Blank looks from the crews and the police when I ask them driving time to MTC.  One of the police runs off to plug the address into his version of Sasha, and returns a few minures later with the news:  we are an hour away.  On blue lights you might knock off 10 minutes or so.  50 minutes does not sit comfortably with me, especially with oxygen saturations like she has.

What about helicopter?  There is one available.  I ask them to lift, while we look at getting her packaged and in the ambulance.  I ask for an update of how long the flying time to us will be, and the answer comes back: 30 minutes.  Where the hell am I, that it will take half an hour to get here by helicopter??  Turns out that the only helicopter available is in Cambridge.  Fair enough.  I leave them running while I consider my options.

Closest hospital by road, my old stomping ground: 15 minutes
My own hospital by road : 15 - 20 minutes
Major Trauma Centre: by road: 50 - 60 minutes
Major Trauma Centre by air: 30 minutes for helicopter to arrive, 10 - 15 minutes to hand over and load, 20 - 25 minutes to fly back (they will go back to Cambridge)

I make my decision: we are going to my hospital, with the knowledge that we can stabilise and continue our journey to the Major Trauma, probably within an hour or so of arriving there.

I get into the ambulance, my full bladder reminding me that my first choice of the evening wasn't so hot.  I hope and pray that the rest of them turn out to be better ones.

What's in a Name?

I am angry!  No, not really angry.  More frustrated than angry, to be honest.  I've been shouting at the TV for the last 30 minutes.  Fortunately, I like my TV too much to throw anything at it.

So, what programme has insensed me so much?  Well, MrsRRD and I sat down to watch "Emergency" with Angela Griffin.  This is an excellent programme, where the star of Waterloo Road follows the ambulance crews of the West Midlands, and does a damn good job of portraying the highs and lows of the work the crews do.

This evening's programme, recorded a few weeks ago, had good old Angela shadowing the CARE team as they went about their business.  The CARE team are a group of volunteer doctors, nurses and paramedics, who are called by the ambulance service to provide more advanced medical care to the victims of serious accidents and assaults, and to patients with severe, life threatening illness, at the roadside or in their own homes.  Sound familiar?  Yep, CARE is the West Midlands arm of BASICS, just like BASICS-London are the London group.  It's just that our name leaves nothing to the imagination, as to who we really are.

So, what great publicity for BASICS.  You'd have thought, wouldn't you?  But, despite the BASICS logo, and the word BASICS being visible on all of the team's jackets, BASICS wasn't mentioned.  Not even once.  So, folks, according to this programme, the CARE team are unique.  No-one else like them in the country.  All that possible publicity for BASICS, all gone to waste.  Not a dickey-bird.

Well, dear Constant Reader, you know who the BASICS team are.  There's probably one in your neighbourhood.  They may be called CARE, or MAGPAS, perhaps LIVES or SAVES, maybe even BEARS or NARS. But, whatever they are called, they are all BASICS doctors, nurses and paramedics.  They are sitting at home right now, probably thinking about tucking themselves in for the night, all knowing that their sleep may be interupted tonight, at 3am, when someone goes off the road, or is stabbed, or falls off a roof.

Remember us, and please, spread the word!

Only Joking!

There's not a whole heap of blood around, considering he has a gaping wound in his neck.  Probably because he had crawled half a mile or so before anyone had spotted him, and lost what he was going to lose someplace else.  He's very, very drunk!!  He tells me he was having a lark with some youngsters in the town when one turned nasty at some comment he had made, some funny joke that went wrong.  The joke led to him having a bottle shoved in his neck, and a beating he will remember far longer than any of the punchlines he has stored up.

He is refusing treatment, and six burly policemen have cuffed his wrists behind him, and strapped his legs together to stop him lashing out.  He is struggling hard against his bindings, and the cuffs are digging in to his wrists, leaving angry marks.

I lean in close.  "Jimmy, do you want those cuffs taken off?"  He nods.  "Then stop p***ing around and let us look after you."  He calms for a moment and looks at me.  "You get one chance, and one chance only.  I'm not joking around here.  You muck about once, and these cuffs are going back on and staying on."

The cuffs come off, and the police crowd round nervously.  He thanks me for getting the cuffs off, and I start looking at his neck wound.  "I need a big torch!" I say.  "I've got one, in me pants!  Wanna see?" replies Jimmy. 

Anyone got another bottle?

For All The Wrong Reasons

It's a quiet day in A&E.  Not all that unusual; after all, a lot of people are on holiday in August, so the population has gone down.  The emergency 'phone rings in the Department.  It's for me! A call to the M1, where a car has rolled multiple times.  The occupants are not badly injured, Despatch tells me, but, as there is only one ambulance available, I may be able to help by triaging them away from hospital, thereby saving a vehicle or two.  This is an occasional use of my time, and I am always happy to oblige.

I call out to the staff that there is an opportunity to accompany me.  There is a scurry of activity, as Baldy and Newby fight for the right to join me.

"Steady on, lads!" I say.  "It's not that exciting a job!  No point getting all worked up."

"We know," replies Baldy.  "It's not the job, it's the possibility of being mentioned in your blog!"

*sighs*

Surreal

I lead a surreal existence, I think to myself at 04:45, lying next to MrsRRD, sleeping soundly.  Only an hour ago I was asleep too, after a long day at work, and a relaxing(!) evening with the family.  And yet, 45 minutes ago I was in a dingy alleyway, cutting across a man's sternum in a vain attempt to save his life after he had been stabbed in a robbery gone so fatally wrong. 5 minutes after that I was holding his heart in my hand, stitching up the wound in the left ventricle, knowing that no amount of surgery was going to save him.

And now, only 30 minutes after I have pronounced life extinct, I am back in bed, chasing sleep once again, knowing that, for now at least, it will be just beyond my reach. 

Watching

The car is on its roof, having collided with another vehicle and gone off the road, onto a tree. Three youngsters are lying on the ground around the car, one trapped by his legs, all shouting out, but it is the fourth that holds all our attention. He is quiet and almost still, perhaps a flicker of one arm, trapped by the wreckage and the tree.

We can't get to him. His left arm is accessible, and a paramedic has already cannulated him. His head is pressed against the door, and we can't get to his airway. The dashboard has come forward, and is tight against his chest. We watch his chest rise and fall, slower and slower. There is no way to get him out. We will need to roll the car over if we have any chance at all to extricate him, and we can't do that at the moment, because of the chap whose legs are still entwined in the wreckage.

There is nothing we can do, except watch.

His breathing slows.

Stops.

Challenge

I told one of my best friends that I was planning to do the Brands Hatch Cyclothon in September.  After he picked himself up off the floor, he explained the humour of the situation.  You see, Brands Hatch is not the flattest of race-tracks.  In fact, it's rather hilly.  My friend showed me a youtube video of the track.  It's very scary.

And now he's thrown me a challenge: get round the track once without getting off my bike, and he will donate £100 towards BASICS.  That seems worth it.  Not so bad, really.  I accepted the challenge, and went out on my bike to find some suitable hills to ride up.  I found one.  I couldn't get up it.  Hmmm.  Think I need some more practice.

Avoidance

It's late, as usual.  I am on my way back home, after having been called in for a paediatric trauma - the patient, a 13 year old boy, was bigger than me, and virtually unharmed.  I am driving along the motorway, looking forward to bed, when I see, right in front of me in the fast and middle lanes, two cars, both stationary, one pointing the wrong way.  Brakes, swerve, stop.  I can see one of the drivers, but the other car, the one with it's bonnet towards me, is empty.

I flick my blue lights on, park appropriately to warn other drivers, and get out.  I don my flight suit, so that I am safe, and approach the driver.  He is unharmed, somewhat shaken, and rather worried about his cargo of china that he has in his car.  I help him across the motorway, where the other driver is sitting on the hard shoulder, unharmed but somewhat shaken.

I call 999 and let the police know what has happened, and tell them that I am in a blue-light vehicle, and that I have parked appropriately, in order that other drivers can see.  The police officer I am speaking to tells me that is inappropriate, and that, as long as there are no injured parties, I should continue on my journey.  I think this is somewhat odd, but decide to do as I am told.

Making my way back across the motorway, I watch in horror as a car hurtles towards to the accident scene at breakneck speed, swerving all over the road and coming to a very unsteady stop, mere inches from the cars.  I think about what might have happened had my blue lights not been visible, and know that I would have been called back.

I'm staying.

It's A Long Way...

"You want me to go where??" I ask Control.  "But, that's miles away, through all the Sunday traffic. Where's the helicopter?"  They tell me, and I wince: not quite next door to me, but, with a prevailing wind I could probably spit on the rotors from where I was sitting, comfortably ensconced with the family and a good Disney film on the box.

Off to the car (now I'll never know what happens in the film) and off I go.  As I turn on the engine, my fuel guage gently reminds me that I meant to fill up the last time I was out, but thought I would wait until the next time.  Hmmm, may be a problem.  My car eats fuel the way I drive it.  Well, at least I have my wallet in the car, so that I won't be completely stranded.

The traffic isn't as bad as I thought it would be: it is far worse.  I spend most of the journey on the wrong side of the road, as cars come hurtling towards me, then swerve around me at the last moment.

Up ahead, I can see the lights of the ambulance, fire tender and police.  Nearly there.  The traffic has slowed to a crawl, not unsurprisingly, this close to the accident, and I drum my fingers impatiently on the steering wheel, changing the tone of my sirens every few moments, trying to persuade the drivers to give me just a few more inches.

My mobile rings: it's Ambulance Control, standing me down.  The patient was initially very agitated, but has settled down, and the crew are happy to transport him to hospital.  I suggest that they wait a few minutes, considering they have made me miss my film, and I roll on scene.

He is in the back of the ambulance, having been cut out of his car.  His daughter, sitting next to him, tells me he had gone all vacant, just before colliding with the car in front.  She is unharmed, just very shaky, and he is calm and coherent.  He remembers what happened with a clarity I don't often get from patients.  He remembers driving his daughter to a friend, when, all of a sudden, he couldn't speak.  Then, he remembers his right hand dropping to his lap, lifeless, and his right foot become heavy and glued to the accelerator.  He recalls pulling the steering wheel over to the left, hard, so that, when he struck the vehicle in front, it was with his side of the car, not his daughter's. 

I look at his drooping face, his lopsided attempt at a smile, and hear his slurred speech.  He asks me if he has had a stroke, and I nod.  He sighs.  It's going to be a very long journey for him...

Next Venture

When I wrote about the BUPA 10K run, I mentioned that there was something else on the horizon, and that I would let you know soon.  Well, here it is.  Those eagle-eyed Readers will already have noticed that I have been doing a lot of cycling recently.  Also, the panel on the right now says "Training for the Brands Hatch Cyclothon."  Yes, yours truly, along with MiniRRD and 2 others, will be cycling round Brands Hatch for 8 gruelling hours!!

I love cycling, far more than I like running.  I decided I needed a new bike, especially if I was going to be doing this Cyclothon.  I went to my local bike shop and bought one.  Bear in mind that I know precious little about bikes.  I wanted to ride home on it, so off I went.

1 minute later, the back tyre was flat.  I walked back to the shop, and they put in a valve.  The fact that it didn't have one originally did cross my mind, but hey, anyone can make a mistake!!  I decided to ride home again.

2 minutes later, the back tyre was flat.  I walked back to the shop, where they refunded my money.

I went to a proper shop, where they know what they are doing.  I test rode 3 or 4 bikes, and found the perfect bike for me.  It's a red one!!  I decided not to ride it home, as we live a good 10 miles away...

Later that evening, like an impatient schoolboy ("can I ride my bike now?  Oh please, oh please!!) I waited for the rain to stop, then went for a ride on my brand new (red) bike.

1 minute later I fell off.  I scraped my left elbow really bad, and my knuckles on my right hand.  Undeterred, I got back on and carried on my journey, blood dripping off my elbow and my hand.

20 minutes later I got a puncture.  And then it started raining.  And then my elbow started hurting.  I called MrsRRD, and she came and collected me.

I'm really looking forward to my Cyclothon...

Difficult

You may have noticed I haven't written for a while.  There is a good reason for this.  I have been to a job so difficult, one of the hardest I have done in my 10 years as a pre-hospital care doctor, and yet one so unique that to write about it in any way would breach the confidentiality that is so important to all.  The family, with whom I spent such a long time at the hospital, don't want anyone to know about what really happened at the house, and, to be honest, I don't blame them.

So, where do I go with this?  How do I move forward, writing about the "simple" jobs, those that don't touch my heart as this one has?  I'm not sure, to be honest.  I worry that the images of what I have seen will seep through into my posts about the "ordinary", as they have been seeping into my waking and sleeping thoughts.  MrsRRD, as always, has been a tower of strength; understanding what only she can.  And, holding my children, one at a time or all together, is a balm around my heart.

And, if this is how I feel, what must the family be feeling?  I cannot begin to comprehend how any family can rebuild after such an event as this.  And yet rebuild they must.  They have to go about their daily lives; school, work, shopping, living, even though their lives have been shattered.

I know this all seems so cryptic to you, dear Constant Reader.  Thank you for reading, thank you for letting me offload to you, in the only way I can.

Alice's Bucket List

Just go and have a look at this brave young lady's blog.  Make sure you have some tissues ready!!

Excuse me, but it has suddenly got very dusty in here...

Done It!!

Well, it's all over. Except, that is, for the pain, the tiredness, and the wonderful sense of achievement. There is something very special about crossing the finish line of a your first 10K. The whole day was very exciting. We woke up early, and had a light breakfast, then met up with the rest of the team at Green Park. I cannot begin to tell you how it feels to be standing in a sea of people, all waiting to set off.

Scissors was by my side the whole time. He has run 8 marathons, so this wasn't going to be a challenge for him. He kept shouting at the crowd, urging them all to cheer us on - very amusing!

MrsRRD is there, at the 2km mark, along with the rest of the support team. I probably looked quite fresh at that time! Not so later on, as I wind my way through the streets of London, onwards, ever onwards.

And then I reached the 8K mark - uncharted territory for me. The pain in the hips was slowing me down, and my leg felt like jelly. Scissors turned to me (running backwards as he did - show-off):

"Do you want to spend a whole year, until the next BUPA 10K, wishing you had got in under your target (1 hour 20 minutes), or do you wish to spend the next year being pleased you did?", he asked me. Hmmm, tough one. My brain told my legs to speed up. My legs told my brain to sod off, then grudgingly stepped up the pace.

I have a GPS watch. I bought it with money from my birthday (yes, I still get money for my birthday, what of it??) It tells me exactly how fast I am going, how far I have gone, what my pace is. I have been using it to plan my race, and to optimise my training. I charged it up, so that it would be ready for race day, so that I could keep to just under 8-minute kilometres.

I left it at home.

So, I was dependent on Scissors to keep me on pace. If he is telling me I need to pick it up, then pick it up I will. And I did. Somehow, I managed to find those extra few muscle fibres, the ones that hadn't given up the ghost, and put them to work. I pass MrsRRD again, pushing myself harder and harder.

And there it is in the distance - the finish line! I have 400m to go, and I start to sprint, with Scissors muttering, "There's no grey - it's either black or white." No idea what he meant by that, but the sight of the finish line getting closer and closer spurned me on, faster and faster.

And I'm through!! I turn to Scissors, gave him a big hug, then asked the question? Was I in or was I out? He looks at his watch, and tells me the news: 1 hour 16 minutes 1 second!

And then, in true form, we meet everyone else, and have a picnic in Green Park.

And what of Princess RRD and Ginger? Did I beat them? No. 1 hour 5 minutes. No training. Nothing. Big Neph? 57 minutes. No training. Ah the joys of being young.

What's next? Something very exciting, but I'll keep that for another day!

Thank you to all of you for all your support. Without you watching me, I would never have managed this.

Race Day!

Well, the day is finally upon us.  After almost 140km of training, tomorrow I am running for BASICS.  I feel quite proud, to be honest.  I have often seen on the television the runners as they cross the line, and tomorrow that will be us!

I'm supposed to have had an early night.  It's nearly midnight here, and I'm not quite ready for bed.  After all, life doesn't stop at Chez RRD, not even for a 10k run.  There are children to get to and from parties, wallets to find (mine), and hair to be trimmed (mine).

And, of course, the preparations for the race day itself.  Ginger, one of Princess RRD's friends who is also running tomorrow, is staying over tonight, and the girls had a very giggly time.  They spent the afternoon decorating the back of their running shorts with the BASICS logo.  Oh, and the Union Jack on the front!!  Mrs RRD has been making the food for the after-run picnic.  Lots of food!!  Camera batteries have been charged, so I will be posting the evidence here tomorrow evening...

Shrink will not be running tomorrow.  An over-exuberent dance session over the weekend has left him hobbling on an injured ankle, so he will have to watch from the sidelines.  Scissors, a veteran marathon runner, has elected to keep me company all the way.  So, his time won't be any good, either!!

I have set things up so that any of you can follow my progress, inch by painful inch.  If you go to www.sportstracklive.com, and search for me, rapidresponsedoc, you should be able to find a live, as it happens, track.  My aim is to keep my speed as close to 8 minutes per kilometre - see how well I do and cheer me on.  Start time will be about 11:20, UK time.

Right, I am off to bed.  See you at the starting post!!!

Death

I see death every day.  Not many people can say that.  Not many people understand what it is like to be confronted with the fact of one's own mortality so often.  It's part of what I do, it goes with the territory.  That's not to say I don't get affected.  I believe if you don't get affected, then you are in the wrong profession, and it is time to move on.  But that makes it hard.  Hard to sit and watch the widow, the son, the father, after you have given them the worst of all possible news.

Death comes in many forms.  There is the expected death, often a blessed relief for all, patient included, perhaps after a painful, drawn-out illness.  There is the unexpected death, home just two weeks following a successful heart bypass, then found lifeless in bed one morning.  There are the deaths from trauma, car accidents or stabbings.

And then there are those that deal the fateful blow themselves.  Those that I get called to are invariably the more violent: the blade, the rope, the train, the 5 storey fall.  These cases affect me more than anything.  They leave me numb.  That anyone could want to end their life is one thing - to end it in such an aggressive manner is another.  They drain me, both the the act itself and the intent behind the act.  They often leave me empty and low for days after.

I had two today.

Countdown

In two weeks time exactly, I will be in agony, having successfully completed the BUPA 10k.  my legs will be on fire, and I will be falling asleep on my feet.  My time?  Only time will tell.  Less than 1 hour 20 minutes will make me happy.  Getting all the way round before I collapse in a heap will make me happy!!

And what about the sponsorship?  Well, so far, with two weeks to go, I have managed to get just over £1000 of pledges!!  How much will it be before the end?  That's up to all of you...

Thank you to everyone who has sponsored me and supported me.  And thanks to all who are going to before the 30th May.