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.

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....