The Phone Call

What a lovely day! We are all very bubbly, despite the lateness of the hour, as we drive home. I've spent the day with Besty, Mad Dog, our wives and children. We have eaten too much, spent too long in the sun, even played some rugby with the kids, and now it's off to Chez RRD, and then to pack the kids off to bed.

My phone is ringing. We are in Mrs RRD's car, so the Bluetooth remains inoperable, and by the time I have wrested it out of my pocket, and passed it to Mrs RRD, it has stopped. We wait for a few seconds, and sure enough my other phone starts its insistent ringing. I am just parking up, so grab the phone and answer the call from Ambulance Control. A stabbing victim awaits me. I open the door to the house and usher the waiting hordes in. Mini RRD keeps asking me what the call is - I know that if Mrs RRD knows I am on the way to a stabbing she will worry, so I blank him, and rush out to my waiting car.

Damn! I have been out in the garden all day, and when I slip off my trainers to change into my boots, the sight of my naked feet is a reminder that I haven't got any socks on. Oh well, no time to waste. They'll just have to rub a bit.

I arrive at the address I have been given. It's all very dark. I can see a few police cars (phew!) and an ambulance, but there are no blue flashing lights, and, while there are quite a few people milling around, none of them are in uniform. Hmmm. It's not just Mrs RRD that is worried this time. I am the first to admit that I am a coward. I will avoid danger, and never walk into a difficult situation.

So, I could sit here, and wait for someone to come and get me. But that does seem a little silly. So, I put my blues on, and sit and wait for someone to pop their head out of the back of the ambulance, and beckon me in. It was only a few seconds, but I wasn't getting out of my car until I knew where I was going.

There are quite a few people in the ambulance. There are two ambulance crew, and a paramedic off of the car. There are two police officers. There is Dave - seeing as he is the one lying on the ambulance trolly, his clothes soaked in blood, I thought he might be my patient. It wasn't all that obvious, as he was on the phone! Not many people who need my attention at midnight are chatting away on the phone, you see. But Dave was.

"Hello, Dave! I'm RRD, a doctor."

"F*** off! I'm on the phone!" replied Dave.

"Yes, I can see that, but I can also see you are bleeding, and in need of medical attention" I countered, helpfully.

"When I have completed this conversation with my dear mother, then I will be happy for you to attend to my chest wound, kind Sir". Or words to that effect.

We all wait patiently, while Dave relates the evening's events to his mother, before dealing with the very well spoken patient.

I do love being appreciated!

Last Passage

They come out in their droves: the young and the old, in dressing gowns and slippers. They have their mobile phones and their cameras, all the better to record this moment.  Held back by the police tapes, they crane their necks, anxious to see all they can.

I kneel down gingerly by the bonnet of the lorry, and peer beneath. He is lying there, his head resting by the wheel that has run him over.  He is still, no signs of life.  I slide under the lorry, taking heed of the blocks that have been placed there by the fire team, raising it the few centimetres I need to be able to reach him.   My hand reaches out, and I feel his neck.  No pulse beats beneath his skin.  I place my stethoscope in my ears, and press the bell against his chest.  No heartbeat, no respiratory sounds.  I slide out, and shake my head at the paramedics, police and fire crew waiting for my verdict.

He needs to be moved, from under the lorry and into the waiting ambulance, for his last journey.  The crowds remind me of spectators in a Roman Colosseum, baying for blood.  I don't want to be the one to provide them their sport.  I don't want him to be the object of their scrutiny.  I direct the fire crews to grab some tarpaulins and hold them up as screens against prying eyes, as we gently, reverently draw him out from underneath the lorry, place him on the ambulance trolley, and wheel him into the back of the waiting ambulance.  Behind closed doors, we complete our paperwork, before arranging for him to be transferred away from here.

As I leave the ambulance, as I grab my bag from the ground and walk slowly back to my car beyond the police line, I am afforded no such privacy.  The crowds, denied what they have come for, call to me, begging for whatever scraps of information they can get.  I shut myself in the relative safety of my car, and drive home.

Excuses

Some of you eagle-eyed readers may have noticed that my training has dropped dramatically.  Here are my excuses, one of which may be true.  See if you can spot which one...

1.  My phone has stopped working, so I have been unable to upload any of my training episodes.

2.  I have been too busy at work.

3.  My trainers (sneakers, for you on the other side of the pond) don't fit any more, and I haven't had the time to get a new pair.

4.  I decided I would have an unfair advantage over the other runners, so I should stop and give them a chance.

5.  I have had man-flu.

6.  I broke my leg.

7.  I broke someone else's leg.

8.  I've been on Jury Service.

9.  It's been too cold / wet / hot / snowy to run.

Yes, you guessed it, number 5.  Seriously, it's no fun having man-flu.  Everyone takes the Mickey, and you still feel as sick as a dog!  So, not only are you suffering, you get no sympathy either.  And, being medical as I am, I know all about the dangers of exercising while you are ill.  You can get myocarditis and everything!!  Not pleasant.  So, I've been taking it easy for the past week or so.  I am sure it all started with my hepatitis jab.  There was definite blood, and a very big bruise, that's still there a week later.

But anyway, today I decided that enough was enough!  I decided to start off nice and easy, with a gentle bike ride in the park with Mrs RRD and one of my Micro's.  Checking my pulse every few hundred yards for any signs of irregularity, I soldiered on through the shortness of breath, and it felt good!!  So good that, when I returned home I decided to go for a run afterwards.

Big mistake!!  Even a very gentle run (overtaken by a little old lady and her Zimmer) left me gasping for breath, and aching all over.  Still, I'm back on track, if a little far behind everyone else.

Please make this worth my while, by pressing that tempting "Donate" button on the right of the screen.  Whatever you can afford, every little helps...

Thank You To JB

I have been told about a group of 15 people who have clubbed together to raise some money for BASICS-London.  They each changed their name by Deed Poll to a famous Formula 1 driver, then raced round a track for a few hours, all to help those in need of the services we provide.

So, a big thank you to Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button, Jenson Button and of course my good friend Jenson Button!!

Trapped!

It's 02:30. He's been trapped in the car now since 23:30 the day before. This man has spent the past three hours stuck in the wreckage of his brand new BMW, that hit a tree at high speed. I can't get him out. The fire crew can't get him out. He's cold and in pain. His right leg is embedded deep in the metalwork of the car, and, because the tree looks as though it has grown through the bonnet of his car, we are unable to do a dash roll to move the dash away and give us some more room.

I need my friend here, my mobile mechanic, to help decide what bit of the car is what. I peer at the leg, and pass my hand down slowly, to see where he is trapped, and by what. I cannot get my hand further than mid-calf - the rest of the leg and foot is completely buried. I have a chat to the fire crew, and suggest various bits of the car to cut off, knowing that this is going to take a long time. Fortunately for Timothy the foot injury seems to be the only problem he has. He is very chatty, telling me about his work as a Loss Adjuster for a local insurance firm.

Another half an hour goes by. I can now get my hand down to the top of his sock, but we are running out of options. The fire crew are cutting away down a deep hole, and it is proving increasingly harder for them to do anything without hurting Tim.

I regroup with the fire officer. I wonder whether we would be able to pull the car away from the tree. This is not something we would normally do because of the risk of injuring the patient, but in this case I can't see any alternative.

I decide to have one more look. Sometimes, if you clear some space behind the leg, this gives a small amount of manouevrebility, and the foot slips out. I run my hand down the back of the calf, and hit what I at first think is the leather seat cover. I look at the seats they are fabric. But this definitely feels more leathery. I ask for a torch, and peer down the hole, only to be greeted with the sight of his shoe. His shoe, toes pointing upwards, behind his leg. Pushing the shoe, prodding it with my gloved hand, I realise that his foot is still in the shoe, bent all the way back and up against the back of the leg. Furthermore, the sole of the shoe, and so the sole of the foot, is not the side of the foot that is resting against the back of the leg - it's the top of the foot. Try this yourself: take your shoe off. Now, keeping your shoe in the position it was when it was on your foot, bend it back all the way, until the sole of the shoe is against the back of your leg, with the toes pointing up towards the back of your knee. Now twist the shoe round, so that the laces are against the leg, rather than the sole, still with the toes pointing up to the back of your knee. Finally, imagine doing that with your foot still in the shoe! Well, that is the situation my patient is in...

Ok, so, although he has an obvious nasty fracture of his ankle, this will make extrication far easier, because the foot is not buried in the car - it is behind his leg. I decide to give Tim some STRONG pain-killers, and PULL him out. I am kneeling on the passenger seat (did I mention the roof and doors were removed ages ago?) and there are fire crews all around, to do the heavy lifting, while I pull the leg and foot out of the hole.

Nicely out of it on painkillers, Tim doesn't make a sound as I pull hard on the leg and foot. It still won't budge. I feel around again, confused, until I realise that his heel is getting stuck on the metalwork, and I cannot get it out. I call over my shoulder for a pair of scissors, and cut away at the shoe, until I can get his foot out of the shoe. It is very odd, seeing his toes right at the back of his leg, but at last he is beginning to move. It gets very dark, as the fire crew lean over and across me to grab a piece of the released passenger, and haul him up the waiting spinal board.

I glance at my watch - 04:30.

Don't Read His Blog!!!

No-one go to Insomniac Medic's blog, please!!  He just has to do better than me, doesn't he?  It's not my fault I can't run as far as he can.  Sponsor me anyway, even if it is only a measly 10K.

PS, good luck, IM.

The End? Almost, But Not Quite...

On Monday, I, along with a large number of BASICS doctors scattered across our nation, received a large, official-looking envelope. Upon opening it, we all found an identical letter, dated 16th December, 2010, along with a 100-or-so-pages form.

The letter was from CQC, the Care Quality Commission. They are the independent regulator of health and social care in England. What that means is that they ensure that anyone providing health care does so to an approved standard. All very laudable, I hear you say.

But now to the letter itself:

Dear RRD

As an immediate care doctor you and your organisation need to register yourselves with the Care Quality Commission. The enclosed form needs to be completed and back with us as soon as possible. If you have not sent in the form by April 1st 2011, you will need to cease all practice as an immediate care doctor, or risk facing prosecution under the Act, blah, blah, blah. Oh yes, and you need to pay us a whopping fee to cover our processing costs. Oh, and there's a yearly fee for being on the register.

Yours sincerely

The Care Quality Commission


I may have paraphrased some of the letter, but you get the basic drift:  fill in the form & pay us the money, or stop doing your work.

Ok, I hear you say, surely this is all right and proper.  Who else is going to make sure that you all are properly trained and acting in our best interests, if not the CQC?  Who is going to stop the cowboys, those just out for glory, rather than those who care?  Agreed and agreed.  And, I was expecting to have to register with the CQC at some stage.  The last we had all heard was that we needed to be on the register by April 2012.  2012, not the week after next.

So, let's have a look at this form:

Please provide evidence to show you take the views of your patients into consideration when providing your service. "Excuse me, Sir, but I need to ask a few questions for my Patient Satisfaction Survey, before I intubate you."  Or, "Pardon me, Madam, but could you please tell me if you are happy with the colour of the cannula I have stuck in your arm, before I am able to give you any pain relief?"

Please provide details of every location where you provide your service.  If you haven't got enough space on the form provided, photocopy the relevant pages and send them off with the form.  Provide evidence that, at each of these locations, health and safety is considered.  Right, pass me a local A-Z.  And I'll just go and have a look and make sure there are no dangers lurking on the M25, shall I?

You can see my predicament.  Not only did they spring this on us, but they dated the letter December 16th, then sent it out in the middle of March! To everyone working in BASICS!!  Why the change?  Well, according to the letter, the Department of Health have advised them that immediate care work is outside the normal practice of the GP's.  Sorry?  Ok, there are a significant number of BASICS doctors who are general practitioners, but the Department of Health are unaware that there are a significant number of BASICS doctors who are not GP's, and who work in hospitals.

So, is that it?  Does RRD have to hang up his jump suit and boots?  Can Mrs RRD get a full night's sleep?  Not quite.  Fortunately, I have been able to get in touch with the Medical Director of my ambulance trust, who has agreed to include me in their submission... for now.  Watch this space.