It doesn’t matter if you’re black or white.

Whatever you’re views on Michael Jackson, he had a point. It really doesn’t matter the colour of your skin or, for that matter, your gender orientation, religion, belief in unicorns….. We are who we are, and that’s an amazing thing.

Nowhere is this more important than in the back of an ambulance. Every person will bleed the same colour, no matter what the colour of their skin. Everyones’ heart works the same, beats the same, no matter what their religious beliefs. To an ambulance crew, you are first and very foremost, a patient, and all the same rules apply.

Granted, people with certain sexual orientation and drug users sometimes require extra infection control measures, but not because of who they are. People with certain religious beliefs require certain parts of their beliefs to be respected in their treatment too.

The bottom line is that there is, and there will never be, any place or time for racism, homophobia or any other form of bias in an ambulance!

It was a Friday or Saturday night, an alcohol fueled altercation in the city centre. My partner that night was a veteran paramedic, quite large, not to be argued with. We arrived to find two males had been involved. One was in a police car being interviewed, the other in a shop doorway also being interviewed by the police. I went to the police car to check on the person in there, my partner went to the person in the doorway. My “patient” had red knuckles, from the impact with the other person’s face, but no other injuries. My partner’s “patient” had a cut lip, also a result of the fist/face impact. This person also had darker skin……

The police were surprised when we appeared, but it transpired the victim had called us. We examined both people and determined no loss of consciousness, blurred vision, broken bones etc, therefore no requirement for hospitalisation. This didn’t go down well with the victim. As we walked away the victim shouted “You’re all just ****ing racists!”.

My partner stopped in their tracks. It felt like the whole world stopped for a moment, everything went silent. The police officers tensed up.

They slowly turned, walked back to the patient, looked him in the eye and slowly and clearly said “Don’t ever repeat that in my hearing! Man up, sort yourself out and get on with your life. I am following ambulance service protocols, protocols that apply to everyone. Now if you wish to discuss racism, let’s get one of these police officers across.”. The patient, now speechless, raised his hands by way of a stunned apology. My partner turned and walked back to the ambulance. I too was speechless as I drove away from the scene.

Then my partner turned to me “Coffee?”. We refuelled the ambulance and picked up a couple of strong brews. “That went surprisingly well” they said, and we both let out a sigh of relief.

I already wrote about affluent types, now colour, country of origin, religion, sexual persuasion….there is nothing in this world, other than your attitude, that will cause you to be treated differently to anyone else when you are a patient in an ambulance. Please bear this in mind should you be unfortunate enough to find yourself there. Ambulance crews are very unbiased, they have to be. Their job is to save or maintain “life”, not “certain lives”.

And they don’t appreciate malicious accusations.

Daytime Dramas

Daytime television. An unfortunate part of standby on many day shifts. We didn’t often spend much time on standby and, if we managed to do so, it didn’t usually last long, but the TV was always on.

Monday to Friday the mornings were filled with property programmes and “chat” shows. Afternoons were slightly more acceptable as they mostly consisted of antique shows and quiz shows. Occasionally there would be a good war movie on, but that could sometimes spark a war if one person didn’t want to watch it. Bank Holidays were a bit better because they generally involved a better class of movie.

In 2012 we were lucky to be able to watch some of the Olympics from London live.

Having only freeview TV on our station, we were slightly restricted. The crews on some ambulance stations joined together to pay for proper Sky TV so had seemingly unlimited channels to watch. To me, they were paying for more channels of the same daytime TV we were watching.

Weekends were more interesting. Saturdays involved programmes from large kitchens, and sport in the afternoons. Sundays were similar, with an ok movie in the afternoon, occasionally a Formula 1 race, although they regularly caused disharmony in the ranks. Not because of driver loyalties, but because usually one of the two crew members didn’t want to watch them – “it’s just cars going round and round…” or similar.

Most night shifts were too busy to spend much time in the mess room for much of the shift, but there were movies on most nights and, after the sensible people had gone to bed and the viewing options became limited, we would listen to the radio stations available via the TV.

The TV in our mess room was quite large, the mess room wasn’t. It had been bought with money gifted by the relatives of a patient, so we were proud of it. There was also a matching dvd player, and a pile of dvds that no-one had actually watched sat on a shelf on the opposite side of the room.

The only problem was allowing yourself to get interested in a programme, or caught up in a film. Guaranteed, just as things got tense or exciting, someone would become ill and we’d get the call to mobilise. This was never really a point of anger, it was our job to attend I’ll people after all. It was more a point of annoyance. Mostly annoyance at ourselves for becoming involved in whatever we were watching.

Sunday mornings were generally filled with soap opera omnibuses – a week’s worth of episodes, in one programme. Some of our crew members were slightly addicted. In those situations I’d quietly beg for a job, even a mundane transfer, to happen.

You knew it was bad when you began bringing things you had watched into conversations with friends, like a true daytime TV expert. But some programmes I despised. One in particular, the host as much as the show. I smiled out loud the day the production company announced its end, despite the sad and unfortunate event it took to make them see sense.

I learned things about properties I didn’t know, watched cringe-worthy movies, knew the names of soap opera characters. Mostly, I never saw the end of a lot of TV programmes and films, but it never bothered me.

Thanks for…..nothing

Patients and relatives sometimes felt the Ambulance crew that had attended them deserved a proper thank you. We were not allowed to accept gifts from patients or their families, something most of us were quite happy about about if the truth be told.

Instead, many sent in cards. In my area, these cards wod usually go to the main office for the area. Rather than send the relevant crew the card, the crew received a photocopy of the card and a stock letter of “commendation” from the main area manager…..signed by their secretary. I have a few of these photocopies and the accompanying letters, all say exactly the same, word for word. It showed no gratitude, no respect, no interest. Did the big boss even know their secretary had sent them to the crew? Were they even bothered? That’s how it felt when we opened the envelope.

But we knew that the originator cared, and that we had made a difference. That was worth so much more than the letter that went with it all.

My station won area team of the year once. I’m still not sure what that meant – no big congratulations, no rewards, no pat on the back or recognition…from anyone. We all got a photocopy of the certificate in our pigeon holes though, and we actually got to put the certificate on our mess room wall, in the frame we paid for ourselves. We also had to take it down each time there was an infection control inspection on the station.

During my training we were warned about taking sweets from patients. We were told the story, probably untrue and embellished more each time it was told, of the crew who went to take an elderly patient into hospital. As they put the patient onto the ambulance’s wheelchair to take them out of the house, the patient told them to take a bag of nuts for them to eat in the Ambulance. Gratefully, the crew accepted. On the trip to hospital the patient said to the attendant in the back “I hope you enjoy those nuts, I can’t eat them. I can suck the sugar coating off them but the nuts are too hard. It’s my teeth you see.”!

It was still the best job in the world, I said from the start that, if one in every few hundred people said thank you, it was worth it all, and the people who mattered were definitely grateful.

“Once in green, always in green.”

That’s what a paramedic said to me recently – “Once in green, always in green.”. Its stayed with me, round and round my head. It’s true though, you never get away from the training, or the effects of the years of heavy lifting and other abuse you put your body through. Most of all, you never get away from the way it shapes your views on life.

I’m now a first aider in my current job, a position I “volunteered” to do, and had to undergo a day long training course for. There was an incident recently, and the duty first aiders were concerned so they asked for me. I was in the staff canteen and had just put my plate of food on the table. As I sat down a colleague ran into the room and explained what was going on. I left everything and went to see what I could do. Not until I walked away after the incident did I realise that I had taken over, passing requests to the person on the phone to the emergency call taker. By the time the ambulance crew arrived, I had done all the tests and checks I was able to and I gave a reasonable handover. Then I said “I’ll leave you to it, it’s not my job anymore”. That’s when they said it: “Once in green, always in green”. I knew the paramedic, they had been a help to me when I first started.

I later apologised to the duty first aiders for walking in and taking over. “You didn’t forcefully take over. You did your job. You looked like you’re missing it too” one of them said. Back in the staff room I reheated my food…just like the old days.

After much thought I’ve come to the conclusion that you choose to be part of an ambulance service but, once you are part of it, you don’t ever get to walk away. It affects you and your life in many different ways. I’ve already repeated it a few times in this post, but it’s still going round in my head – “once in green, always in green”.

Part of me likes that, part of me is not so sure..

Stiff little fingers

Hands are amazing, each one made up of 5 fingers. We use them for everything. Every child learns to count on them. Countless wars have been fraught with them (whether firing arrows or pulling triggers). A music genre was borne from them (Google Tommy Iommi and heavy metal). It’s difficult to imagine life without them…..

Saturday night, once again we had been pulled into the big city. The call came half way through clubbing time. A young person had fallen over in a night club and their hand had landed on a broken glass on the club’s floor. Rather quickly, they realised their hand was bleeding and the top half of their fourth finger was no longer present. It was a perfect cut, through the bone too. When we arrived, the club staff had removed the, mildly drunk, patient and her friends from the club. This was common practice, partly so the revellers weren’t distracted by an ambulance crew in the club. There also seemed to be some belief that the club was no longer liable for the injury too, but we had no interest in the legalities.

Unfortunately the club staff in this instance made things slightly worse. a. They removed the patient from the scene of the accident so we weren’t entirely sure what had severed the finger (the police also had something to say to the staff regarding this). And b. The staff put the rather grubby finger into a glass of ice which they quickly handed to us as they, unsuccessfully, tried to hurry us away. Unfortunately for the patient this rendered the finger useless und unable to be reattached. Thankfully, after much wailing from the patient on the way to A&E, it was a doctor who broke the bad news….once we’d gone.

A 3 year old, in a posh suburb, Sunday afternoon. The poor child had caught their finger in a door, removing the top third. The parents had, sensibly, put the finger in a freezer bag, then in a cup of ice. It was a busy afternoon for us in our own area, lots of genuinely unwell people. This job was out of our area and took us some time to get too. It was also not classed as a life threatening emergency so we arrived without lights and sirens. This seemed to bother the parents, how could their angel not merit an emergency response?! Then began the complaints about the 3 hours they had waited since their first call. I looked at the peaceful but slightly distressed child, and thought about the severe, life threatening, seizure I had just come from. I said nothing. We loaded the patient and one parent in the Ambulance. Then the other parent announced that they’d follow us in their executive 4×4, asking if we’d be rushing them in. After a deep breath, and some thought about how best to respond, I said we’d not be rushing and asked why they had not driven their child to hospital themselves. “But that’s why we pay for ambulances!” was the horrified reply.

A severed finger will rarely merit an emergency response. I say that because there are factors such as blood thinners, and what caused the finger to be severed. In most cases, if the severed part is kept clean and dry and the wound too, and it is within an acceptable time scale, the finger can be reattached. But situations aren’t always that perfect.

I believe the nightclub was investigated and did not come away unscathed. The 3 year old’s parents probably still blame everyone but themselves. I still count myself blessed to have kept all of my fingers…this far.

You can’t hide those lyin’ eyes.

Being an ambulance crew member involves bending the truth quite often. It’s a skill you develop early in your career, an essential part of your job. Not in a nasty way, but in a clinically reassuring way. Reassurance, one of the strongest tools in our arsenal – “It’s going to be ok….”.

When your patient is having a heart attack before your eyes, the last thing you should be doing is telling them! I sat my initial training exams many years ago. Most of the questions gave a story. A patient was presenting certain symptoms, what was my diagnosis and how would I treat them? In the treatment section, we were guaranteed at least one point if we wrote, simply, “Reassurance”. This applied to unconscious patients too.

Sometimes reassuring the patient involves a slight… embellishment of the truth. You learn to hide your feelings of concern for the patient and develop an ability to put on a friendly, caring face. Neither of the latter are fake, if we didn’t care we’d not be in that job. It was more an ability to decide what our faces displayed to the patient, what was in their best interests. A good crew mate will have come to the same conclusion as yourself, and a silent look would confirm “GLF on the journey to hospital!”.

Other times your face had to hide sadness. Our job was to care, and that’s what we did. But sometimes that brought sadness – the elderly who had no relatives, the young disabled patients who’s lives had been changed forever by unfortunate circumstances. Most didn’t want our sadness of sympathy, they just wanted our help and a brief moment of support. That’s what our faces showed them.

Often it was the relatives who needed our support. If the patient had CPR ongoing, we would try to remove the relatives from the room. They didn’t need to see some of the treatment involved in a cardiac arrest – the broken ribs as a result of the chest compressions, the tube placed down the patients airway. If more crew members arrived to help or, as sometimes happened, the police arrived, one of us would take the relatives into another room. This would always involve them asking how their loved one was. Rather than tell them that, at that point they were clinically dead, we would tell them that they were “quite unwell but we were doing our very best for them”. What that meant was that, until protocols dictated, or a doctor appeared and called things to a halt, we weren’t giving up. The feelings of futility were hidden, although we were very cautious not to deliberately instill false hope in the relatives.

“Embellishing the truth” was part of the job, but your fellow crew members could usually see in your eyes exactly how you were really feeling, what you were really thinking. Mostly that was because they were feeling the same thing. Not telepathy, just an understanding. It was never malicious, and none of us enjoyed doing it. It was an unfortunate but very important part of patient care.

The show must go on.

Someone recently asked me how I coped with the death and dying when I was in the Ambulance Service. I spoke in a previous post about how the crew depersonalise jobs. It’s something you learn the importance of very quickly. Often a crew will be required to give a police statement regarding a death, if a patient’s death is unexplained (usually the case, until a doctor writes a death certificate or a post mortem is carried out). One of the questions always asked is “Would you recognise the patient again?” to which I always answered “No”. The patient could be lying in the next room, but I had blanked their face from my mind, I had to. Occasionally the patient would be someone we had dealt with a number of times, one with an ongoing illness, someone you had built a rapport with. On those occasions there was sadness, and the family usually appreciated your precence.

On one occasion, I took my old school master in to hospital for a planned stay. I didn’t recognise them initially but, when I did, the respect came back as I remembered this kind person who had helped shape me and my school mates. Little did I know this would be their last journey, but I’m glad I was able to pay some kind of respect before they passed away.

The terminally ill patients were frequently inspiring. They knew the life they has left was short but they spent their time preparing, and preparing the people around them. “Live every day as if it’s your last” one of them said to me. Something I still need to remind myself of constantly. Those were the ones who lived life to the full, who often saw so many positives, even when facing their own end.

“There’s always someone worse off than you”. Words from another terminally ill patient. Words that kept me going often during my time in the service.

Some didn’t know death was coming – cardiac arrests, RTCs… The patients who had passed away before we arrived were the ones that were easy to blank out. The ones who we worked hard to save, only to have the A&E staff make the difficult decision that it was hopeless to continue, those were difficult to blank. While still being able to depersonalise the job, it was still hard to forget the effort we put in. Sometimes there was anger – anger at the patient for dying, anger at the hospital staff for giving up…anger at ourselves for failing to save a life.

I remember my first cardiac arrest. It was also my first real CPR. The horror of breaking ribs lasted seconds as we worked hard to save the patient. We rushed them to hospital but it was all hopeless. I thought I had come to terms with it until we returned to A&E the same day. One of the nurses pointed out the patient’s family being shown to the relatives room. They looked up at us as they walked past, and my heart sank as they tried to smile, grateful smiles for our efforts. Our part in it all would be forgotten quickly, but at that point in time we had done our jobs as best we could.

Sometimes relatives would ask to see us so they could thank us for our efforts. The first time I initially declined because I felt that I was “only doing the job I was being paid to do”, but a nurse politely explained how it was part of the families’ grieving process. Those moments were hard. This was someone elses’ grief, but I was being involved in it.

I saw death in many forms. While the memories of the lost ones will live on in those close to them, most will be forgotten by me over time. But there are those that will stay with me – some for good reasons, inspirational patients, some for bad reasons, the circumstances around their death. But all will have one thing in common – I don’t remember their faces.