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.

When I’m 64(ish)

Older people are great. They’ve been through a lot, they’ve seen a lot, and some have given a lot, but many don’t expect much in return.

“I don’t want to bother you”, “someone else needs the Ambulance more than me”. Both phrases heard on a regular basis by ambulance crews, often from very ill patients.

One patient was in the middle of a huge heart attack when they said that, as my partner and myself watched it develop on the defibrillator screen. They were put straight and rushed into hospital! A common one was the patient lying on the floor with a broken hip. The ball at the top of the femur can be fragile in some older people, and often broke off. The fracture was known as a #NOF – fractured Neck Of Femur. We’d regularly turn up to such jobs to be told “I’m sorry for wasting your time”, the patient in agony and unable to move!

Many times the patient had just fallen out of bed and, although uninjured, they just couldn’t get up and back into bed. Sometimes this was a more serious event and further action was taken. Often they just required us to help them back into bed. We rarely stopped there. Whenever possible, we’d put the patient’s kettle on and make them a warm drink, settle them before we left (most had catheters, in case you’re thinking the obvious).

I realised quickly that, other than a carer, we may be the only other people that the patient might see in a day. Sometimes we’d sit by the bed as they drank their tea and listen to their fascinating stories. All they wanted was someone to chat to, and we were there to care for them so it was our job to listen.

Sometimes Control would radio to “check we were ok”. Ie. They needed a crew for another job. If it was serious we’d go, if not, we’d stay a bit longer. An executive put out a memo once stating that crews were spending too long at jobs and suggesting a time we should allocate to each job. This executive had clearly no idea what our job actually was, otherwise he’d have not chosen to make a complete fool of himself. That memo was instantly filed in File 13 – 🗑️

Older people deserved respect, and we weren’t going to deny them that so the figures on a computer screen somewhere looked good (the same went for other types of call). We did our job and targets had no place in there.

I once discovered we weren’t the only ones that respected older people: We had been called to a house, somewhere in the middle of nowhere for a patient who had fallen in their living room (?#NOF) , along a narrow country road. As we got closer we discovered a long stretch of roadworks ahead, closing one direction of travel, under the control of stop/go boards at each end. As we approached, Blue light on, the worker with the stop/go board at our end Bbegan frantically talking into his radio. He held his hand up to stop us and we waited until a couple of cars came through, then he waved us on. The satellite navigation showed us the house was somewhere along the stretch of roadworks, but we couldn’t find the access road. We got to the other end and asked the road worker to hold the traffic while we did a u-turn and had a second look. We reached the other end and the first road worker flagged us down. They asked where we were looking for and he looked blank, then he asked who the patient was. My partner and myself were pretty sure we couldn’t give out that information “Is it *****?” they said. “Erm….yes actually”. Ah right. Again he spoke into his radio. “Two of our chaps are with them. They went up to the house for their tea break. It was them that called you”. It turned out that the workers had closed off the original entrance because of its location, and we were swiftly directed to the new one. The road workers had been checking up on the patient daily, looking after them.

Never underestimate what an older person may have done for you. Don’t be disrespectful. What you are able to have and do may, in some part, be because of these people. Simple acts of kindness go a long way.