True Colours II

“Ah wow! You must have seen some sights. What’s the worst thing you’ve seen?”

Because I’m meeting lots of new people, my past employment has come up a few times in conversation lately, and the above is the usual response. Even people I met months ago have asked when they find out.

I’ve not yet found a polite or sensitive way to tell them that “the worst thing I’ve seen” is actually part of the reason I don’t do the job anymore, and I really don’t want to have to remember it again. I know their intentions are innocent, but even though I have mostly come to terms with the things I did and saw, recounting them as stories can still sometimes still trigger unwanted memories.

For that reason I have my list of stock stories I tell. Some gruesome, some funny, some “sad”, but all detached from my emotions long ago.

But sometimes they want more. They ask probing questions and those aren’t helpful.

I recently applied for a different job with my current employer. Basically it was to run a hospital simulation suite where future medical staff might get as close to realism as they can before they are dropped into the big bad world.

During the interview I was asked why there was an inconsistency in my job history after leaving the ambulance service, a few different jobs, all short term. Feeling brave and thinking maybe it’s time, I mentioned the possiblity of PTSD. One of the interviewers jumped on this and asked if I’d be able to cope with the job I was applying for because of this. Completely thrown by the question I stumbled a bit and realised that the interview was over and it was pointless continuing!

The public don’t know most of what medical staff see or go through, from the person who takes the 999 call to the person who discharges the patient. Sometimes just a smile or a “good for you” is enough when you find out what someone’s history involves. Often they don’t want to talk about the specifics. It will definitely have affected how they see so many things in life, but let us volunteer that. Let us choose when and what we share, when we choose to. Don’t try to remind us why we don’t do it anymore.

The other thing I often get asked is “Who is Moreton Rhodes?”. No, it’s not my real name…obviously. Moreton is a toy mouse that has been round the world with work or leisure trips. Rhodes was probably the worst holiday I can remember. There’s no significance in either but I thought they sounded good together.

Who saves the life savers?

Someone told me about a TV program broadcast in Scotland recently. It suggested that almost one in ten paramedics suffered from PTSD, and one paramedic interviewed was diagnosed with it worse than had they been on a battlefield! They also said that the Ambulance Service had declined the opportunity to give a representative the chance to be interviewed.

These are the men and women who are responding to emergency calls daily, and their employer doesnt even have the desire to comment on national TV.

There was also talk of things that had been put in place to help crew members and front line staff, but what I hear from those front line staff is different. Other than proving that few in positions of management are actually aware of the reality that goes on outside their office doors, a fact that has been known by ambulance crews for many years, this is nothing new.

The above is not just limited to one part of the country either, it is widespread across all the ambulance services in the UK. I’ve spoken about the 5 minute breaks we used to get after bad jobs, and the phone numbers that get handed out – Call someone who you’ve never met before, who has never met you and never will, and tell them over a telephone line how you feel… Then hope that your colleagues don’t find out because you’ll feel like a failure and they might think that you are unfit to do the job.

That is the reality, that is what ambulance services need to address, and that is why crew members struggle on, until it gets too much and they can’t go on any longer.

I’ve held back slightly in previous posts, but I see no reason to any more. I could write things that would (or should) probably have ambulance service managers squirming, and can back them up with strong evidence, but that’s not the purpose of my blog.

When you watch people die in front of you and you have done everything possible. When you’re faced with an angry drug addict who’s life you just saved but who’s high you took away in doing so. When you face countless drunks who threaten to kill you and your family when you are just trying to help with the injuries they got from fighting. When you spend 30 minutes or more working on a patient, giving CPR, providing advanced life support, then you hear that A&E staff gave up shortly after you handed the patient over….and then you pass that person’s relatives in the corridor…

“Here’s a number you can call if it’s too much.”

This isn’t something that can be changed overnight, and I don’t have any answers or solutions, I only have my own experience and knowledge of what others have been through.

My strong hope is that the Ambulance Service in Scotland, now these issues have been highlighted, now has to act, positively. Maybe other television companies will pick up the story in England, Wales and Ireland. Until the public are aware of the quiet suffering that all emergency workers go through, suffering that sometimes costs their own lives, not much will change.

During my time on the road I saw how my colleagues reacted, I saw the brash, faux toughness, the hard act. I even did it myself. But there comes a time when that doesn’t work anymore. For me, that time was when I left the service. My defenses fell because they werent being topped up for another shift. My support mechanism (my colleagues) was gone. Suddenly I had to face everything I’d seen and done on my own. I can’t heap enough praise on the people around me, the ones who tolerated me at that time. But there were people who didn’t wish to tolerate it, and friendships ended, making it harder. Nevertheless, I got through it with the help of the ones who stayed, and I know of others in the same position.

I’ve spoken in other posts of one friend who didn’t. This post is for them, and the ones like them. For the families and people they leave behind.

Maybe it’s time to think about the health of the health workers. To start monitoring their mental health, to start giving them regular mental health checks. To start saving the lives of the people who save lives.

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….

One out, one in. The prequel

One out….

You never forget the first patient you lose. Mine was a frail elderly person who lived close to my ambulance station at the time. The job came in as a cardiac arrest, and that’s exactly what it was. We got there very quickly, the patient’s heart had stopped, and it was my job to try to save them. I began CPR, the first few chest compressions broke some ribs. The dull crack is audible across the room. My partner was setting up the O2 bag and mask, they looked over at me and nodded encouragingly. That was a sound I would hear many times during my career. Some adrenaline injections (for the patient!), and 20 minutes of CPR without any signs of self sustained heart activity dictated we stopped and declared the patient’s life ‘extinct’. But this was my first. Surely there was more we could do, something we had missed? My partner handed me the paperwork and I filled it out, just like I had been taught during my training.

Later, I reflected on the broken ribs with my partner. “It’s perfectly normal” they said. That’s exactly what it became to me. It was an indication that we were pressing down hard enough to make the patient’s heart pump blood properly. “Broken ribs will repair, stopped hearts need help” – I remember my instructors telling us as raw recruits. They didn’t explain the heart-sinking feeling we would experience each time it happened. It was a blunt reminder that this was a real person you were dealing with.

I lost count of the deceased patients I saw, each one making me harder inside. I had to be to cope. You have to treat them as ‘jobs’ not people. You didn’t know most of them before, so you couldn’t be upset. We joked among ourselves about ‘killing’ patients each time deaths occurred during shifts, not because we were twisted or enjoyed it, but because it was a way of coping with it.

If the patient was ‘gone’ before we arrived then distancing yourself was easier. If you knew them, usually as a regular, it was a bit tougher. The really hard ones were the ones you were talking to when you arrived. The ones who went into some form of arrest in front of you.

One patient who arrested on me lived in a nursing home. The staff were quick to point out the patient had a DNAR (Do Not Attempt Resuscitation – a legal document that prevents medical intervention in such situations). We asked to see the document as, without it, we must continue life support. The document arrived and we watched as the patient slowly faded away. As we had accepted the duty of care for that patient, we couldn’t leave until there were no more signs of life. Watching a life slip away in front of you is a strange experience. It’s difficult to explain the emotions involved, but none are good.

Then the hard walls go up again and control gives you a meal break. It’s a bizarre thing, but even now there’s not much will put me off food.

Coping mechanisms keep you going…..until something comes along that weakens them.

Recently I’ve heard of some charities that offer physical and practical support for crew members. Charities, not ambulance services themselves, not the NHS, although it looks like most only operate in England and Wales. I have heard, however, that one ambulance service (possibly more) has recently implemented a more practical support service for its staff. It will be interesting to see how it works.

One such charity, PTSD999, has recently employed the services of a rock legend to help record a version of the late David Bowie’s song Heroes. Please look them up on iTunes or Amazon. The band is called Burn Out (enough said). Just 99p gets you an amazing song and helps them provide such an important service. The charity offers support to all types of emergency workers, please support these guys and other charities like them. We hope the song does well. Their tagline is “help save the lives of those that save yours”.

So yes, deaths affect us but, most importantly, don’t forget that each time one life fades away a new one is created somewhere. We could be heroes, but that’s not why we do it….