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.

All by myself (aka. Here I go again… PtII).

No one has invented a word yet for the feelings and emotions you experience after you have just explained to someone that the last time they spoke to their loved one was, actually, suddenly, very unexpectedly, the last time they would ever speak to them alive.

I had been single crewed since the start of my night shift, not very busy as it was midweek and in the middle of the month. It was also summertime so lots of people were on holiday, or feeling the pinch having just been on holiday. I was in the mess room alone, the volunteers had finished and gone home. The messroom radio was playing music and I was relaxing. My handheld radio screeched and vibrated on my belt and brought me back to earth rapidly! The call was a code purple – “life status questionable”. On my way to the Ambulance the radio rang and the dispatcher apologised for sending me alone, but there was no one available to back me up. The city was obviously busier than the rural areas. The dispatcher was a favourite of mine, so I knew they were struggling and I was the last resort. I arrived at the scene and rushed into the residence with all my equipment. I was met by the patient’s distraught partner.

An elderly couple, they had been on holiday recently, as both were tanned. The patient had then been away for work and had returned late the night before. A young grandchild had stayed over and was sleeping in bed with the partner so the patient had slept on the sofa in the living room. When the partner woke, they had gone through to the living room and attempted to wake the patient. As soon as I began to examine the patient it became very apparent they had been dead for some time. Rigor mortis had set in and they were cold. There were other indicators too. This was when I had to explain it to the partner.

I sat them down and explained as sympathetically as I could that there was nothing I could do, their loved one was gone, and I was very sorry for their loss. “There must be something you can do?!”. I shook my head an suggested we put the kettle on and that I should call a relative or friend. This was partially to take the partner out of the room the patient was in. I called the couples’ oldest child (who was in their 50s) and, thankfully, the phone was answered by their partner. I explained the situation and they said they would be at the scene shortly.

I had to do some official paperwork and, because it was still an unexplained death, had to contact Control to arrange for the police to attend. I couldn’t leave until the police had arrived. 5 minutes later the peace was shattered! The patient’s oldest child arrived and went into hysterics – “They’re not dead! They’re just sleeping! Look!”. Trying to explain to a relative that their loved one is currently a crime scene is a very definite never. Trying to stop said relative from shaking the deceased patient is difficult, physically and emotionally. Thankfully their partner intervened.

I felt extremely lonely, the bearer of bad tidings, the outsider in a moment of family grief. I took the words of a close friend seriously at that moment – “a wise man once said….nothing”. The police finally arrived and I handed over to them, gave them my paperwork and left. There was no point talking to the deceased patient’s partner, there was nothing I could do or say that would help. Their child’s partner nodded at me on my way out, a “thank you”, accompanied by a painful smile. It made me feel slightly better.

A different shift, still single crewed, night shift again. The radio came to life as I drank another cup of coffee. “Pt fallen down stairs, ?#L arm”(query fractured left arm). It sounded simple enough. Then the radio rang – “5638. Apologies for sending you to this job single crewed, we are aware of protocols”….uh oh… “Pt is a known alcoholic and is intoxicated, backup will be en route as soon as I have someone available”. Single crewed personnel should not be sent to alcohol related jobs, a rule frequently broken by desperate dispatchers.

I arrived to find a very drunk patient screaming in pain, their partner at breaking point, not knowing what to do anymore. The reason for the screaming became apparent very quickly – the patient was in severe pain, having fractured their humerus (the thick bone between the shoulder and elbow) and was waving their arm around in a grotesque fashion! Crepitis was a word I’d learned during training – when the two ends of a fractured bone rub together. I’d felt it before in various patients’ bones, that night I heard it from the other side of the room!

The involvement of large quantities of alcohol negated my ability to use most of the analgesia we carried, so I called control to get a second opinion from the duty Paramedic Advisor (more to have a backup should anything go wrong). We agreed that entonox, “gas and air”, would be acceptable. This might have worked, had the patient been more sober and willing.

I tried to explain the benefit to the patient, their weary partner tried too. More screaming and screeching. Eventually I managed to get some form of sling attached to the patient and secured the elbow to the patient’s body, a slight immobilisation of the arm. Backup finally arrived. I explained the situation and they took the patient away. I’m not sure who was most relieved, myself or the patient’s partner. I met the crew that had backed me up at a few more jobs that night, and at each job they commented on how they’d struggled with the patients all the way to hospital, and how I must have struggled on my own.

Thankfully, I’m reliably informed, single crewed shifts are less common now. Although I found it was a very good way to learn fast.


When work follows you home….

I was on day shift the day my father passed away. My partner and I had been out to a couple of jobs but we were on standby in the mess room when I got the call. My partner realised there was something wrong as soon as I hung up. When they found out, they made me go home and contacted control to let them know. I remember driving home, having a shower (not sure why) and changing out of my uniform. The next thing I remember is receiving a call from a family member asking where I was. I was in a small village, some distance from home, on one of my favourite country roads for driving.

I went into hiding for the next three weeks and my friends gave me space. On reflection, possibly neither of those was a particularly good idea. Death was something that happened in other people’s lives. To me they were “jobs”, they had to be. Other people did the grieving, I walked away. Suddenly I was actually one of those other people…and I didn’t know how to be.

On the day I returned to work the second job of the day was to a local nursing home, run by the same company as the one my father had passed away in three weeks previously. The Ambulance screen claimed we were going to someone having a seizure, when we got there it turned out to be an elderly resident in complete cardiac arrest. We began work on the patient, until one of the nursing home staff tried to stop us. It transpired that the patient had a DNACPR order – Do Not Attempt CPR. This document was an ambulance crews’ nightmare, an end of life decision made by the patient or their family and their doctor. It is a legal document that prevents anyone from bringing a patient, usually with a poor quality of life, back from a fatal incident such as cardiac arrest. Unfortunately, until the document is presented, ambulance crews have a duty of care to do the opposite. We asked to see the document and the nurse presented us with a photocopy, not good enough. After 10 minutes of CPR the original document appeared and we stopped. It took around 40 more, long, minutes for all signs of life to completely disappear. 40 long minutes before our involvement was over. As I was doing the paperwork I heard two staff members talking – “That’s the second one this month. There was one in the other home three weeks ago.” my partner looked over at me to check I was ok. I nodded. Back in the Ambulance the screen lit up with the next job….

Some weeks later, it dawned on me that the nursing home my father was in was on the outskirts of my working area and I could have been called to that job

Cancer patients are regular jobs. Usually you gave them analgesia for the pain and took them to the cancer ward. Once dropped off, we’d go to the next job. To sit in a consultant’s office while they explain to you and your spouse that your spouse has cancer is not a situation you expect to be in, nor are you trained for. It is a genuinely surreal experience and it took some time to sink in. “This only happens to other people!!”. These are times when true friends get you both through.

There was no support from my ambulance service, no help offered. Thankfully surgery was successful, but I’m still waiting for any ambulance service manger to ask me how I’m doing, or even show an interest in that situation… or the loss of my father. The support my spouse and myself received was external, from cancer support charities. Without that support it would have been so much worse. The cancer is gone, the psychological effects are still there, but I can’t say enough about how amazing the support of those cancer charities is. If there are heroes out there, that’s where they work.

As always, this post is not about looking for sympathy in any form whatsoever. Ambulance crews face challenges every shift, and I am fully aware I am far from being the only one to face such situations. This post is to highlight yet another reason the Ambulance services across the UK need to step up their staff support, possibly even begin supporting in some areas of the country. We are all only human after all.

There’s that moon again

I spotted another full moon this week. It reminded me that the phenomenon isn’t just limited to night shifts (patients aren’t actually vampires. Vampires don’t get ill). The “less sensible” patient can require ambulance assistance any time and, while we might not know it’s there at the time, during the day when there is a full moon.

One such call appeared on my screen mid-morning one winter. There was a lot of snow on the roads, but they were drivable. The job was about 10 miles from our station and not a high priority, so we didn’t rush.

The on-screen navigation was known for its inaccuracies, and the maps it was based on were somewhat out of date. Thats where the job began to go wrong. The estate we were going to was very new and didn’t exist on the maps the system used, but it still plotted the “quickest route”…..or so we believed.

It was when we drove into an industrial building site we first queried its accuracy. My partner was driving and came to a rapid halt at the bottom of a snowy, muddy, hill. After realising we were off course I decided to look the address up on a well known mapping app on my phone. We were very off course!

My partner turned the Ambulance and drove up the hill, at least that was the intention. Part way up the wheels lost their grip and began to spin on the snow. “You’ll have to dig us out” my partner grinned. Yes, it was my job at that moment in time. I climbed out of the ambulance and opened one of the external side hatches, located the snow shovel (modern ambulances are equipped for most situations) and began to clear the snow away from the rear wheels. My partner slowly began to drive the ambulance clear, and kept going. Stopping at the top of the long hill, they radioed me, suggesting I hurried to join them as we were still en route to an emergency.

After updating control on our situation, we got back on course with the help of my phone. The job was an RTC – “4×4 vs house”. Neither of us was sure what to expect.

As we got closer, we knew we were at the correct location. There were an unusually high number of police cars and officers also making their way to the scene. We turned a corner into a cul-de-sac and knew we’d arrived.

There was a posh 4×4 holding up a spare bedroom, seriously. The driver was out of the vehicle. Their partner was away on business but had asked them to run the car every other day so it didn’t sieze up. Having gone to do so, the driver hadn’t realised the vehicle had been left in Drive and, lurching forwards as soon as the ignition was turned on, rather than brake they had accelerated. This had propelled them across the cul-de-sac and straight into the end wall of the garage attached to the house opposite. The garage the owners had built a spare bedroom above. The car literally was holding up the room as the supporting wall had mostly been destroyed.

The fire brigade had also arrived and we left them to the structural issues while we began to assess our patient. Their injuries? They had knocked their knee on the vehicle door when climbing out! Surprisingly, they declined a trip to A&E. When we asked why they had called for an ambulance they replied “isn’t that what you are supposed to do if there’s been a crash?”.

We later found out that the excessive police presence was because the house next door to the demolished garage belonged to one of the officers.

Around the same time, a city based colleague declared the full moon.

It’s genuinely a thing!

Bark at the moon

There’s a phenomenon know across all of the emergency services – the full moon. Ask any of them and there will be no doubts, a full moon brings out the crazies (can I call them that?).

Often during busy nights, when the jobs we’d be called to were of a strange nature, one of us would question the lunar status. Almost every time, the moon would be full.

Every job has to be treated as whatever appears on the information screen, until proven otherwise and, occasionally, it would be a genuine job. Even before starting a night shift, if we spotted the moon, we could confidently predict a surreal 12 hours ahead.

This also applied to being careful what you wished for. While on shift during a full moon, certain people (regulars) and certain types of job or ailments were never mentioned or they actualy came to be! I proved this one shift when I deliberately mentioned one regular patient and a couple of different illnesses at the start. Everything and everyone I mentioned appeared on our screen at some point during the next 12 hours!

I experienced one of my first stabbing incidents under a full moon. On reflection, I should have expected something abnormal. The job came through: a patient in their mid 30s, stab injury to their left leg with a bread knife. Most readers will know that a bread knife has a serrated edge that could do a lot of damage, on the way in…and on the way out. We ensured that the police were dispatched as we made our way to the scene, just in case the assailant was still in the area.

We arrived on scene at the same time as the police. I was attending so went into the house first. I walked in to the kitchen (where else would a bread knife be?) to find the patient sitting next to the kitchen table, with a rather large bread knife protruding from their left thigh. There wasn’t a whole lot of blood evident, but dangerous internal damage could not be ruled out. We would never remove a penetrating object anyway, that was for the staff at A&E to do after ensuring it was safe to do so.

I approached the patient, assessing them and the situation as I did so. They had been sitting with their head down, but raised it as I approached. Their face bore a manic smile that caused me to step back unexpectedly, standing on the foot of the police officer following behind me. “Good evening” I mumbled. “I’d stand up to greet you, but I have this stuck in my leg”. The patient made as if to take hold of the knife. I suddenly panicked that they were about to pull it out. “No! Let’s leave that there” I blurted out, images of arterial bleeds in my head.

One of the police officers began questioning the patient. They asked who had put the knife there. “They did” said the patient. “Who are they?” said the officer. “Them. Them”. Spotting our quizzical looks, the patient clarified – “Them!”, gesticulating wildly at their head. Alarm bells began ringing for us all. Loudly!

We had a mid-thirties patient with possible psychiatric issues, potentially armed with a large knife and a wound that could become highly concerning. Deep breath, reassess quickly. “Can you hear them just now?” said the police officer. “Don’t be stupid! They left when you arrived!”. Oddly, that made sense. The patient seemed calm and in control of themself. I explained that it would be bad to remove the knife, and that I wanted to wrap a bandage around it and their leg to hold it in place. They agreed, and I, cautiously, stepped closer to them.

While I was dressing the wound area, my partner had brought the folding wheelchair from the Ambulance. The, very compliant patient moved across to wheelchair and was wheeled out to the ambulance. “Thanks guys” said one of thd police officers as they were about to leave. Oh no! I wasn’t sitting in the rear of the ambulance with a somewhat disturbed patient on my own. The police have stab vests, ambulance crews have lovely thin uniforms. Reluctantly, one of the officers agreed to travel with me to the hospital while his partner followed in their police car.

The patient was unexpectedly relaxed for the journey, unsettling in itself. I handed over to a nurse at A&E and the on-call psychiatric nurse was called in to help.

I never found out what happened to that patient, mostly because I didn’t ask, but, if I think hard enough, I can still remember the manic look on their face when I first entered that kitchen.

I can’t think of any other job where I was completely on edge through the whole time I was with a patient. It took a bit of time to wind down after that job, but Control weren’t bothered. They had jobs stacking up.

The next job appeared on our screen and we went mobile….