Tag: NHS

Another day in the office.


So today I am on shift and so far I have spent the entire day at home.

I am on call.

In fifteen minutes time my shift will end and I’ll clock off meaning that the past twelve hours have seen me do sod all.

Okay that’s not strictly accurate. I have tackled the immense pile of washing up in the kitchen, rendering it down to nothing but a stubborn stain on a pan. Said pan is now soaking and will be dealt with once I have finished with this post. I have also completed the majority of this month’s Open University assignment, watched three episodes of ‘Luther’ and racked up a few more wins for my team on Fifa 13.

I’ll be on shift again tomorrow, and although that will be a Saturday shift and guaranteed to be, ahem, busier, I’m hoping to be home for at least a few hours. The wife’s planned our annual ‘family scoff’ tomorrow whereby we all gather at my mother-in-laws to ‘scoff’ as much food as possible before playing cards or board games.

It’ll be fun, it always is but I can’t deny that I wouldn’t mind be called out at least once. It’s not the end of the world if I don’t get a call, I get paid either way, but if I am called then I can claim for fuel used. My current car can do approx 700 miles to a full tank which costs me about seventy English pounds. Now, I claim about £15 for a 60 mile round trip. I only need five call outs, or 300 miles to make my money back for fuel. Not bad eh?

Yes I know the cars taking a hammering on mileage but when you consider that to most people money spent on fuel is dead money – they’ll never see it again, then it’s not that bad. I put that money that I claim back for mileage into a separate account which I save specifically for car repairs/servicing etc.
I’m lucky. I know that. I’ve fallen on my feet in a job that is for the most part pretty straight forward. It has its moments of course, and a fuck up in this line of work could see me imprisoned but if I keep a clear head and follow the rules then hopefully that will never happen.

Having spent the last few years in a job where I was returning home tired, angry and generally despondent, it was right to jump ship and search for something new. It was entirely possible of course that leaving everything I had come to know and depend upon could of backfired, but like I said, I’ve been lucky.

Even if I hadn’t fallen on my feet, I still think it was the right thing to do in jumping ship. I couldn’t bare the thought of working the same job for another ten years, then looking back and wondering what happened to those years.

I’d advise anyone who is waking up in the morning and thinking about ways to avoid going in for the day to have a long hard think about how they want to spend the next ten years.

I did.

Life on call


I work full time, although if you asked my friends (or even my wife) they would scoff at the mention of the word “work”. Particularly if it’s uttered from my mouth.

I’m a paramedic but I don’t work on an ambulance. I used to though. I did that for ten years until the call for a change grew too strong and I was compelled to answer.

I now work for a private company that offers forensic and medical services to the police. Basically, everyone is entitled to see a medical professional in police custody. That’s where I come in. They call, I answer and I make my way down the custody suite, assess, medicate, refer if need be and then I leave. I work a four-on, four-off pattern with each shift lasting twelve hours and yes nights are included.

The thing that grips most people’s shit about my job is that I respond from home. I live about thirty miles away from the nearest custody. I don’t have to be there at the start of my shift either. I just need to be near a phone and within one hour’s commuting distance. This means that when I finally get called, even if it’s dead on 6am, I will spend the first hour of my shift driving to work. Not bad eh? Only eleven hours to go. It takes me anywhere between half and hour and one hour to assess a single patient so if they only have one for me to see then I might only be in the custody suite for that period of time after which I am free to leave. Where do I go? I can go wherever I want, providing of course that I remain in contact and within one hour’s driving distance.

Yesterday I spent an hour test riding a motorcycle and another three quarters of an hour browsing their clothing lines.

This morning I have been up since six am, have consumed about six mugs of tea, had breakfast and watched the Bourne Legacy. My phone is set to divert so the house phone will ring if I get a call so I’m free to wander around the house without constantly checking my mobile for missed calls or to see if I have signal.

But… it’s not all good.

Mine is a lonely existence. Being the only medic on call at any one time, I don’t see anyone. Sure I see the police, but they live in their world and I am acutely aware of the fact that I am not part of it. I am a resource to be called in, nothing more. I speak with plenty of people on the phone during medical consultations or note sharing with other agencies but I never really see anyone. If I’m home then all is well. I spend my time writing, watching movies or wasting time on the internet. Once I leave the house though it’s a different story. I know I’m driving into a kind of void. A world full of people but absent of human interaction. I’ll stop by my parents house from time to time, even tried my brothers once but they work regular hours so they are rarely in.

Anyway, that’s enough of that. I’ve just remembered the other perk of this on-call life. Well, my wife sees it as a perk (I don’t).

She: ‘If you’re not called out and you’re at home, why don’t you do the house work?’

Me: ‘Really? I’m at work though. Kind of.’

She: ‘You can still do it! It’ll be like getting paid to clean.’

*sigh*

So, I have a mountain of dishes to climb, a few rooms to sweep or vacuum and anything else my beloved has put on my ‘list of things to get done when I’m skiving’. Nice.

Best I get to it then.

M J

Ups and Downs


This has been a truly bizarre month. Emotionally speaking I’ve been all over the place. This is what happens when you spend a lot of time pondering your place in the grand scheme of things or, where you would like that place to be.

For the last ten years I have been working with the ambulance service and have been qualified as a paramedic for around six or seven. The job has changed immensely to the point that I no longer recognize my role anymore. If you ask Joe on the street what a paramedic does he’ll probably tell you a paramedic saves lives. A paramedic goes to nasty car crashes to un-mangle people or appears out of the blue to resuscitate a dying loved one. I used to believe all that too and although these things do happen, it’s not very often and on the odd occasion I do get called to things like this there is rarely anything that can be done. Here we come to the heart of the matter. I find I’m asking myself ‘What good am I actually doing?’ more and more often. Sure, plenty of people are pleased to see me when I roll up to their house after they called 999 but, why wouldn’t they be? I get there super fast, listen with sympathy to their plight and then proceed to offer any help I can. Broadly speaking, I can categorize virtually any callout I go to and pigeon hole it into one of three automated responses. These are:

  1. I pick someone up off the floor that wouldn’t otherwise have been able to get up themselves. Chances are there is a big strapping relative nearby who could have done this himself but won’t. People are too afraid of moving someone for fear of aggravating any perceived injury. In reality it takes me just five seconds to assess if injury is present. I do this using a very sophisticated method of assessment that goes something like this. ‘Hi, so have you got any pain?’ If they’re not injured, I lift them. If they are and it needs more than a plaster, it’s off to hospital.
  2. I arrive to find the patient does not need an ambulance, never did and is either bemused as to why I am there or, more likely, is over the moon that someone has rushed to their aid for such a trivial thing. I will spend the next hour trying to refer this patient to the correct service.
  3. The patient/relative deliberately called 999 because the problem needs immediate attention. This type of call equates to about one in four. More often than not, we cannot treat this patient’s condition at home and so transport them to hospital. Rarely, the patient is very unwell/dying and there’s not a not a lot we can do anyway. Why not? Well, there are two reasons for that too.
  • The patient has been involved in a traumatic accident. Invariably, their survival depends on the degree of injury and has nothing to do with the skill of the paramedic. We might buy time, but that’s about it. Fate is inexorable.
  • They are unwell/dying because of the culmination of a lifetime of poor decision making. The morbidly obese, the sedentary sloth, the lifelong smoker, alcoholic, drug abuser etc. Included in this group are those who never had the opportunity to make poor decisions – those born with chronic conditions, or their genetic predisposition renders them a ticking time bomb.

This is a generalization of course but for the most part I believe it hold true. My point is that there is rarely a day when I feel I am making a difference because quite simply, fate or the patient’s life up until that point, won’t let me.

So, that’s why I’m leaving. I’m going to remain on bank and maintain my registration but it’s time to call it a day. Life is too short to spend a chunk of it miserable. Anyone who has ever had depression can tell you that. Sometimes you have to do what makes you happy. Money is not everything so long as you have enough to keep the wolf from the door.

Think of it this way. There will come a time when you look back at your life and examine what you’ve achieved. What do you want to look back on? Will it be the life of a man/woman who spent a significant chunk of their life miserable? Or will be one where you smile at those decisions that took you somewhere else and allowed you to live a more enjoyable life?

And remember, if you did take the leap and try something else, what is the absolute worst that can happen? Ask yourself that, and make your decision. I hope you’ll find that even if the worst were to happen, it won’t compare to a life half lived.

Is that grass over there greener?


Danny threw the response bag down and slumped heavily into the attendant’s chair. He looked bitter and thoroughly pissed off as he swung his booted feet up onto the stretcher. I sat down in another chair and waited. I could sense a rant coming on and knew Danny well enough to know it was imminent. A long sigh cut the silence like a knife as Danny finally lost his rag.

‘Dude, I’m so sick of this job. Today is the first day in two weeks that I’ve actually been put on a shift with a paramedic. I’ve had nothing but drivers for eight shifts!’

‘Really? That sucks.’

‘Tell me about it. It’s just shit at the moment. We get sent to crap all day long, then I have to do everything because my driver is just so useless its offensive, and when I get a sick patient and I ask for paramedic backup I get told there aren’t any available.’

I nodded without saying anything. I knew there was more to come.

‘It’s just not fair. How am I supposed to develop as a clinician in my own right when the only two people on this bloody ambulance are the driver and me? Who do I learn from? Or am I just supposed to make it up as I go and learn from my mistakes, because I’ll tell you this… patients don’t like mistakes.’

I smiled. ‘You’re right there mate.’

‘Yeah! I know!’

‘So why are you so upset now? You’ve got me today.’

He sat and thought, a confused look etched on his face. ‘I don’t know really. I guess it’s because even though you’re here and you can deal with the sick patients, it’s still going to be me doing everything, all the dog’s work I mean.’

‘I see. Well, I don’t mind doing everything mate. Seriously, pop your feet up. Actually, you just drive me around and I’ll sort the shit out as it comes.’

He sighed again. ‘Thanks mate, but you know me. I won’t let anyone shoulder my workload. That’s not me.’

‘Things aren’t going to get any better you know, what with the cuts coming.’

‘Easy for you to say mate. You could drop out of here anytime you want and go and work on your farm instead. I’ll be here till I retire.’

‘Bollocks mate. What did you do before this?’

‘I was a pharmacist. Well, I worked in a pharmacy, as a pharmacist’s technician.’

‘So you could go and do that again. You’re not trapped mate.’

He started to pack things back into the response bag. Where things were date stamped, he’d check it. I couldn’t remember checking a date on any consumable in over five years. He found a number of cannulas and needles that were out of date, and I’m guessing, no longer sterile. He threw them away and went back to his systematic check, pack, check, pack routine. Danny was good like that, dependable. You knew if you took over an ambulance from him it would be spotless. Nothing would be missing. No patient would suffer because a piece of equipment wasn’t available or it wasn’t cleaned properly. Nothing got past Danny. His movements slowed and he stared off into the distance as he spoke again.

‘The thing is,’ he said, ‘you forget the reasons you left in the first place. I feel like it would be taking a step backward if I was to go back to working there.’

I thought about that for moment and then, with a smile I said, ‘Not unless you’d taken a step forward into a hole. It would only be right to extricate yourself in that case wouldn’t it?’

He laughed. I laughed.

‘I see what you’re saying. Thing is though, the grass isn’t always greener on the other side.’ He looked sad again. ‘For me though, it’s a case of old grass or no grass.’

If I had the power…


Today, whilst being chauffeured about in an ambulance by my ‘driver’ I took in the sights as we drove through my local town centre. Some of the highlights included:

  • A queue of people waiting outside the job centre, not looking for a job, but collecting their dole money.
  • A queue of people (well, more of a disordered rabble really. Well, actually they looked more like swaying zombies to be truthful) waiting outside a premises to get their methadone fix.

Does this look fun to you?

  • Several groups of eastern Europeans dancing in the street, chugging on bottles of cider and whiskey. Note: this observation is not specific to eastern Europeans. The English are just as bad, only they tend to only come out at night or else they stay behind closed doors and drink themselves stupid.

A typical ‘Benefit’ party.

Now, I may be about to get controversial and so let me state that these are only observations of a few people, and do not reflect my views on entire cultures, ethnic groups, race etc. That is to say, I am not intending to tar a group of people with a large brush, only a minority who for all intents are shit bags.

So, I got to thinking about how I ‘if I had the POWER’, would deal with these problems. This is what I would do:

  • I would make every single person claiming dole, benefits, job seekers allowance… whatever, provide a urine sample on the premises. If you’re drunk, or under the influence of drugs, you can bugger off until your clean. There are people who work certain kinds of jobs (on oil rigs for example) who cannot work and therefore cannot get paid and thereby pay taxes unless they provide a clean sample of urine. If they have to be clean to earn it, so should every other fucker be.
  • Ah, the heroin addicts. What to do with them? I say, let them have their drugs. But… add a little something to it. Something that will give them, I don’t know, a severe groin itch that lasts a week. They take these drugs because of the hit it gives them. Trying to block drugs entering the country won’t work. A real addict will only turn to crime or seek his drugs from dubious sources. In my view, the only way to combat this is to make the drugs undesirable, and I think an itchy groin will make a few think twice.

  • Also, cigarettes… I’d add something that makes their head glow fluorescent green. (Oh, I used to be a smoker, but now I am cured. I’ve seen the light.) I think many would give up immediately if they had go round looking like a Martian for the day. Thinking about it, I’d add this head glow thing to all drugs. I know drug addicts are fairly easy to spot anyway but I say shame them. Make them glow. Make doing drugs so un-cool that its cooler to avoid them altogether.

Well, I think we can all agree that none of these things will ever happen. There’s probably some mad law that would mean this sort of thing violates Human Rights or something. Almost as mad as say, paying these people benefits and handouts so that they can go out and buy more drugs.

What a crazy world.

M J

A Simple Fall


Thought you might like a bit of insight into a typical paramedic call out.

I am as some of you know, a paramedic.

Last night I was called to attend a scene where an elderly female had fallen out of her wheelchair.

Now bearing in mind this had come in as an emergency call on the 999 system, I was dispatched the moment the call hit the switchboard. The address was only a few miles up the road from the ambulance station. I had to respond on blue lights and sirens as at this time the call takers had not managed to assess whether or not the old dear was injured. By the time they had come to the conclusion that she was not injured I was already on scene and in contact with the patient. This means I am now unusable for further emergency calls and my call sign drops off the system until I ‘clear’ from the scene.

I was met by two ‘carers’ who said they had not attempted to pick up the patient as they did not know if she was injured or not. I managed to assess that the lady was not injured in about 15 seconds. Firstly I asked simply if she had any pain anywhere, to which she answered no, and secondly, I asked her to show me she could move all of her limbs. She duly did so.

The carers then told me that they were not aloud to lift and that even if they could, they had no lifting aids.

*sigh*

I glanced back at the patient and estimated she weighed perhaps 7 stone. My offer to simply lift the patient up of the floor caused much alarm and posturing from the head ‘carer’, who insisted I fetch my air cushion and use that to lift the patient.

*sigh*

Still, off I trot and return with my air cushion. The cushion is to be placed under the patient before being inflated slowly. It can lift about 50 stone, which means if you are unlucky enough to find your patient is made of solid lead, you stand a reasonable chance of lifting them.

The carers were keen to help with the placing of the cushion, and so I handed the deflated unit over and asked them to place it under the old dears arse.

After about ten minutes they decided they couldn’t do it. They had tried rocking her from side to side to edge the cushion under her but that didn’t work. Then they tried asking the patient to shuffle herself onto the cushion. She moved about 1mm.

In exasperation, they turned to me and I have to say I was hoping they would. I can’t resist an opportunity to point out how ridiculous this kind of situation is and so leapt into action.

There are various methods to getting someone onto one of those cushions. They’d tried rocking her from side to side, edging the cushion a bit further under each alternately raised cheek. They’d tried getting patient to move herself (always my first choice) and they’d even fumbled about with a slide sheet for a while. None of these had worked. But then, it really didn’t matter because this was all a complete farce.

I placed the cushion behind the old dear…. And then lifted her onto it. I made a mental note that my earlier estimation of seven stone was far too generous.

I couldn’t resist a contemptuous sneer at the head carer as I did this.

We inflated the cushion and the old bird rose up into the air like a graceful animated corpse.

The thing is, we still haven’t solved the problem. Old dear is still not in her wheelchair, she’s just a few feet in the air now.

The carers had absolutely no idea how to transfer between the air cushion and wheelchair. I found this particularly strange as they were involved in every aspect of old dears care. Old dear couldn’t get onto the toilet, for example, without their help.

So after another ten minutes watching them try and convince the old dear she could perhaps levitate, I decided to step in. Once again, I just lifted her up and plopped her down in her wheelchair.

You see what a total farce this is? We have to be seen to using manual handling aids, but if you work on your own as I do and the available help isn’t trained, then what do you do?

The answer is that I should call in another ambulance resource. They might take an hour plus to get to me though as this is no longer deemed an emergency. When was it ever though? She’s not injured. She just can’t get up without help. I’ve known the arrival of back up to take up to three hours before. There just aren’t enough ambulances out there and so I am not going to call one of the few we have to assist me lift a sub seven stone woman.

So I take it upon myself to do what I feel has to be done. I take what I believe to be the common sense approach and I lift that frail old lady. I have performed a dynamic risk assessment on the fly and I feel I can confidently move that weight with little or no danger to myself or patient. What’s wrong with that?

So the old dear is now back in her chair, but I can’t leave yet. I have to complete my epcr – Electronic Patient Care Record. It used to be that we could complete a paper record of the event. Something along the lines of:

‘Non injury fall, assisted back into chair, nothing untoward found, left in care blah blah blah.’

Not these days though. Now I carry a little laptop type thing. I could write a paper form in about five minutes. This thing takes a minimum of thirty minutes.

By the time I have finished the care record and moved all my equipment back to car I find I have to stop briefly and reflect upon the amount of time spent with this patient and whether or not the call could have been completed quicker. I conclude that it could not have.

Put it this way. If the old dear was a member of my family, I firmly believe I could have assessed and popped her back into a chair in under five minutes. I would not have required any lifting aids and certainly no help from any other person.

As it stands, from call to finish, I have spent a grand total of one hour and forty five minutes dealing with this non injury fall.

This is apparently the way it has to be. Health and safety has gone completely nuts in my opinion.

Fate


I am a paramedic… And I think I believe in fate.

If you asked me a few years back, even a year ago, I’m sure I would have said that fate was all bollocks and that no one controls destiny. And yet, as time goes by I find I beginning to question that belief.

This post was inspired by my recent interest in motorcycles and the fact that I am now in the process of training for my bike license. My father hates bikes. ‘Organ donor machines’, I think that’s how he refers to them, are apparently a one way ticket to the grave. Now I haven’t researched any statistics to bolster my point I view, but I am in a unique position in that if anyone is going to come across a motorcycle accident, it’s going to be me. I see a few in my line of work and so I feel I have a fairly good idea of how accidents involving bikes occur, the likely injuries sustained and also, the likelihood of death occurring. Now, I can honestly say that I have been to far more accidents in which car drivers have sustained life changing injuries or died as opposed to bikers. Obviously there are far more cars on the road than bikes but I don’t think that is the definitive argument in this case. In fact, I am beginning to believe that fate has more to do with this than anything else.

There is a line from birth to death, you could simply think of as A to B, and for many people, of all ages I have been there when they reach B. Some meet their end in their sleep, completely unaware that their journey is over. Some will wake this morning, have their breakfast as normal, get dressed for work, and then maybe have a heart attack or a stroke. Or, perhaps they are in fantastic health. Maybe Mr Smith, who goes to the gym four times a week, eats healthily, and leads a relatively stress free life gets hit by an out of control car. Or, Mrs Jenkins, who unbeknownst to her, was not hit by an out of control car, or struck down by a heart attack. Instead she falls silently on a packed bus, and nothing anyone can do will save her. Her genetic makeup hides a ticking time bomb she could never have known about. Mr Smith’s autopsy report might record accidental death. Mrs Jenkins’ might read cause unknown.

I’ve seen people survive things that by rights should have killed them, just as often as I have seen people die when they should have survived. So what is that if not fate?

Science, statistics and all manor of medical jargon and research may dispute fate, but I guarantee that a good percentage of medical staff will, after witnessing a surprising patent death, mutter the words ‘maybe it was just his time.’ Sayings like that don’t come out of nowhere. They mean something. Perhaps they mean that we don’t understand enough to know what really happened, but I am really starting to think it’s far simpler than that – perhaps when your time is up, it’s up and nothing on earth will change that.

I don’t think for one second that everything is preordained. That would remove the element of choice from our lives and as we all know, if we didn’t have choice in our lives we would soon go crazy. No, this is what I think. I think, there is a line from A to B, from birth to death. I think some people’s line is longer than others for no other reason than it just is. Perhaps we all draw straws in the beginning. I also think that that line is not straight. Perhaps, the distance between A and B is already set – the duration of your life, but maybe you make your own journey there. To me, this makes sense. It explains why people for all walks of life can suddenly meet their end for no reason whatsoever. Except maybe there is a reason, and that is that they have reached their destination, the end of the line. The end of their line.

Who knows? I for one am keeping an open mind. What do you think?

Strange but true…


I am near-psychic. It’s true.

If you call 999, ask for an ambulance, and I turn up, I can pretty much guess which house is yours. I don’t need to look at a number to get my bearings either, which really freaks out the new recruits.

There are some things that need to be true first before I can call upon this ‘gift’, but ultimately it almost never fails.

Time for an example.

I am called to a residential home for a ‘grey lady down’, which basically means an old dear has taken a nose dive somewhere in the building. I don’t need to know the layout of the building. As we drive up, I’ll take a quick look at which bit I think is the least accessible part of the building, and that’s where she’ll be. If it’s a three story building with no lift, she will definitely be on the top floor. If it’s one of those sprawling amalgamations of seven buildings knocked into one, she’ll be at the back somewhere, probably wrapped around a toilet.

This is 100% certifiable truth. I cannot explain it. It just is.

It also follows that, the higher up in the building you are, the more likely it is that you’re going to be really unwell. Again, I cannot figure this one out either.

I’ve just been to one actually, which prompted me to write about it. Number 67 it said on my job box. I looked at the building as I approached and knew from memory that it didn’t have too many rooms. There was a high possibility that my patient was very sick too.

Sure enough, number 67 was on the third floor, at the back of the building. Walking from the front door, which is the only way in by the way, you simply could not have chosen any other room that would have been further away.

Typical.

People never ever consider the emergency services when they chose where they are going to live.

Some people are DIY enthusiasts and landscape artists extraordinaire – they create a beautiful garden with shingle pathways, thousands of steps on multiple levels, and an phalanx of Rose bushes and other deadly pointy plant things for the poor paramedic to negotiate.

On one memorable occasion I visited a house that had a garden just like this. I swear the house itself was built on top of a hill. The old boy who lived there had clearly been involved in some D-Day action. Possibly on the side of ze Germans as his house was nigh unapproachable. I can’t imagine I would have been too surprised if I’d heard a machine gun open up on us.

So we arrive in the house, pouring with sweat and cursing a multitude of thorny sores and find this old boys wife on the floor. She’s clearly broken her hip given the amusing angle her left leg is in. She has also, along with her husband, clearly enjoyed life as she’s bigger than both my colleague and me put together.

I can still remember it clearly. I was none too pleased having to hump all that equipment up into the house, knowing full well it was all going to have to come back down again, but the moment I had been waiting for had arrived.

You have to appreciate that this couple have lived in that house for virtually half of their lives and not even considered what would be required if x happened or if y collapsed and broke her hip.

I explained to her what she had done and that we needed to get her to hospital. She just nodded at first, and I just sat there and waited……

And then light dawns. Her face creases into a frown as realisation hits home.

How the hell are we going to lift her out of that position and then negotiate that beautifully, well thought out garden?

She looks at me and I nod. Welcome to my train of thought Mrs Goodlife.

I can’t say it was fun or easy getting her out of her house and down into the ambulance, but we managed. Admittedly it took five people to do it but that’s the way it had to be.

I can’t say she enjoyed the experience either, being carried ever so gracefully like a flying elephant down her lovely landscaped garden whilst half the street looked on, drawn like moths to the two ambulances and the fast response car parked outside her house.

The old boy was great. As we descended with our precious ‘cargo’, he ran on ahead, helpfully clipping Rose bushes with a pair of scissors. I can’t say it made a huge amount of difference, but it was amusing.

So there you have it. Inaccessible places are the haven of accidents and ill health. Take my word for it.

I’m psychic you know.

M;-)