A re-post: Ambulance stories (1)

My first ever Ambulance Story. Just to prove that being an EMT in London is far from being a glamorous job!

beetleypete

The un-snippable turd

Sometimes, ambulances are called by other agencies, and not by the person in need of help. Railway staff make frequent requests for ambulances, whether in underground stations, or on the main line system. When you consider how many people are travelling on both systems on any given day in Central London, it is understandable, to some degree.

So, when we received a call on the radio to go to Paddington Station, it was not particularly unusual. We had added information, that a female was in a collapsed state in the toilets, in great pain, and unable to move. On the way to the job, with siren blaring and blue lights flashing,  we were in the habit of considering what we might be going to encounter on arrival. Using the basic information and diagnostics supplied by the caller, we could presume a whole number of things. Young female…

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Ambulance stories (9)

I am reblogging some of my old ambulance stories, for a new audience. This one from 2012 has hardly been seen since. 🙂

beetleypete

The fainting woman

After a very short time in the Ambulance Service, you soon learn to disregard the diagnoses given by Ambulance Control. They are at the mercy of the caller, and their own desire to end the call, within their protocols, as soon as possible. So, there is a constant repetition of the same diagnosis given for the call you are being asked to go to. Others can be wildly inaccurate, perhaps because of language problems, or lack of observation on the part of the caller. After a while, you do not expect what you are told, to be what you actually see on arrival.

One morning, we were returning from the Charing Cross Hospital in Hammersmith, when we were called to a well-known high-rise estate, not far from our base. We were told to meet a caller outside the entrance to one of the highest blocks, and that…

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Thinking Aloud On the Wrong Day

Blindness.

We were woken unusually early this morning, by someone repeatedly ringing my mobile phone. It is a standing joke that nobody ever rings it, unless they are trying to sell me something, or have the wrong number. It was an unknown caller, and they had left a voicemail message. My first thought was that it must be bad news, to call so early, so I played the message with some trepidation. It was a courier company, trying to collect a box from a Filipino lady called Marina. They needed directions to her house. So, a wrong number.

That had awakened me from a deep sleep, in the middle of an intense dream. I was back working in an ambulance in London, having a conversation with a patient I met a few times over the years. The dream was replaying a conversation I had with that man, and was like watching a video recording of us both, around 1986, as we were travelling to hospital.

We had been called to a man who lived not far from the base. We were given a diagnosis of unstable Diabetes, and told that the caller was a man in his sixties, who felt unwell with low blood sugar. The door was opened with a click by a remote button, and I walked in with my bag of equipment. I found the man dressed and standing, ready to go with us. He knew about his condition, and had already eaten a sugary sweet, hoping to hold off the problem until we got to the casualty department. As he turned, I was startled to see that he had no eyes, just short eyelids half-covering empty sockets. I had heard of this condition of being born without an eye, or eyes, but had never encountered someone it had affected. (it is called Anopthalmia, and is present in just 1 in 100,000 births.)

He put on some sunglasses, and I helped him to the ambulance. I had long been fascinated by the problems of blindness, but especially interested in people who had never seen anything. I wondered how he perceived the world, and whether it was true if other senses developed beyond the normal to compensate in any way. Having been sighted, then going blind later, is one thing. At least memory will supply some details for you to hang on to. But never having seen anything has to be a lot to deal with. As it is usual in an ambulance to discuss things not normally brought up in polite conversation, I asked him about it, and he was happy to talk about it, mainly because most people avoided the subject out of respect.

He was born in the 1920s, to a young single-parent mother. He used the old term ‘Out of wedlock’. Not only was her situation difficult, the appearance of a baby son without eyes was too much for her to cope with. She gave the baby away, and he was brought up in a home for unwanted children, later transferring to a residential facility for the blind, on the outskirts of London. He received a basic education, and was later trained in the use of Braille to read books, and use a specially adapted typewriter. During WW2, at the age of seventeen, he got a job with the Civil Service, as a clerk/typist, and stayed there until he retired, aged sixty. He told me he had never married, and never so much as kissed a girl. His pleasure in life came from reading books in Braille, and listening to the radio. He had never been to the cinema, or owned a television. I was keen to ask him about his perceptions, and also about the daily difficulties he had encountered, and still did.

Transport was an obvious issue. He had been shown how to get around his small flat, which had been provided at low rent, by the City Corporation. Also how to get to the nearest bus stop, so he could get to work. But he had no idea what number bus had arrived, and had to ask others at the stop. If there was nobody around, he would have to shout at the conductor, and ask the bus number. Back then, coins were distinctive, and banknotes issued in different sizes, so he coped alright with money. But he was annoyed that he frequently stepped in dog mess on the pavement, as he couldn’t see it. I had never thought of that. He had obviously adapted well, and as he told me “I didn’t know any different. That is how I live, because I had no option to do otherwise”.

I went on to ask about other senses. He said that his hearing was in the normal range, but his sense of smell was acute. He could recognise people by their individual smell, if he had already met them, and even tell different races, without hearing them talk. He remarked that my colleague was probably West Indian, though he obviously hadn’t seen him, and had heard few words from him. This was accurate, as my crew mate was from Barbados originally, though spoke with a London accent. He could judge someone’s height easily, from the direction of their voice, and whether or not he felt their breath on his face. I asked about if he could picture something in his mind, if it was described to him in detail. He said that the picture in his mind would be very different to what was being described, and it would be almost impossible for him to tell me what he saw in his head. He gave me an example, which I have never forgotten.

“Describe snow to me”.
I thought for a moment.
“It falls from the sky..”
He stopped me.
“I have never seen the sky”.
“Its white”.
“What’s white?”
“It has small flakes, like tiny crystals”.
“What are flakes? What are crystals?”
“It is cold”.
“I know that, because I have touched it”.
“It accumulates on the ground, looks like cotton wool”.
“What’s cotton wool?”
He held up a hand to stop the questions. He had made his point, and I understood.
“I can feel the cold, and hear the crunching underfoot. I also feel it’s slippery when I am walking. But I can never picture it in the same way as you. That’s impossible”.
I wanted to ask many more questions, but we had arrived at the hospital. I had an increased respect for blind people, and had enjoyed a fascinating conversation.

I got to meet him a few more times over the years, and the second time I walked into his flat, before I had spoken a word, he smiled and said, “You’re the man who asks the questions”.

I was dreaming about that this morning, and wanted to tell you.

Thinking Aloud On a Tuesday

Undiscovered bodies

I’m ‘Home Alone’ with Ollie this week, and woke up with a start this morning. Something was in my head, and even though it is not Sunday, I thought it was worth a ‘thinking aloud’, despite being a rather unpleasant subject.

Working in emergency ambulances, you get used to dealing with all sorts of things. But there are some things that nobody can ever get used to, and that will always stay in the minds of those who dealt with them. It is a sad fact that many people die alone, and unnoticed. I don’t mean people who die when there are none of their loved ones around at the time, or those who pass quietly during the night, in their own beds, or in hospitals. I am talking about the thousands who literally have nobody. No friends, family, work colleagues, or concerned neighbours. Often, their bodies will remain undiscovered for days, months, even years.They might be sitting on an armchair, slumped over a dining table, or perched precariously on a toilet seat. Sometimes, they are tucked up in bed, or perhaps lying on the floor in a hallway, or living room.

Modern life brought with it a lot of social changes. Doorstep delivery of milk went into decline, and less people took daily newspapers too. Neighbours became less involved in the lives of those nearby, and many single people, or widows and widowers, withdrew into a solitary lifestyle, having little contact with the world outside of their home. Companies stopped collecting rents and other payments door-to-door, and save for some enthusiastic Jehovah’s Witnesses, Mormons, or charity collectors, you could easily spend many years with not so much as a ring on your bell, or a knock on the door.

Eventually, signs appear that something is not right. Post piling up, and sticking out of the letter box. Perhaps a bad smell, annoying the neighbours. Overgrown grass in a front garden, or unpaid bills resulting in the attendance of a debt collector. Sooner or later, someone suspects something is amiss, and rings 999. They send an ambulance, in case the person is ill, and the police too, to gain lawful entry by force. Once you have attended such calls a few times, the clues shout at at you. In the summer, the insides of the windows will be covered by fat bluebottles. Hundreds of them. When it is colder, just lifting the letter-box will reveal an unmistakable smell. A smell you will remember all your life, even though you don’t want to. If there is a frosted glass panel in the door, common in social housing in London, you will see a veritable mountain of junk mail and unopened post piled behind it.

Once entry has been gained, at least one of us has to go in, to accompany the police officer, and confirm ‘life extinct’. The police officer’s job is worse, as he will later have to examine the corpse for signs of obvious foul play, before handing over to the funeral company nominated by the Coroner. In we go, dreading the scene we know will await us. Sometimes, it is bearable, once you have covered your nose and mouth with a mask, or your arm at least. A body slumped on a floor, or still in bed. I didn’t have to even touch most of them, as death was blindingly obvious. On occasion, I was presented with the grim spectacle of a maggot-filled body, one that appeared to still be moving as a result of their activity. Occasionally, what I found was barely still resembling a human being, more like a misshapen, liquid-filled sack. And they were almost always men. It seems, at least from my experience, that single females and widows are more sociable, so easily missed. Men on their own in old age easily slip into reclusive ways, and seem content to rarely venture out.

At the time, I thought that strange. But now I am officially a man in his old age, I understand that completely.

In some of those properties, we also found the remains of a dead cat or dog. Unable to get out once their owner died, they were doomed to starve to death, or die of thirst. I always wondered why nobody ever reported hearing them bark, whine, or meow. People in London are used to noise though, and used to tolerating it. I always felt so sorry for any pets I saw like that. At least the person must have died quickly, or they would have undoubtedly summoned help, had they felt in pain, or been ill. But the poor animal had to linger, wondering why nobody came to feed it, or refill its water.

Those jobs rarely if ever involved younger people, such as drug users, or alcoholics. Their choice of lifestyle dictates that they have a group of acquaintances, albeit others looking to share their drugs or drink. People in that underclass of society tend to be discovered earlier, if only as a result of an anonymous phone call.

After handing over to the police officer, we are free to leave, and go on to the next call awaiting us. Unless the dead person was the victim of a crime that contributed to their death, we are unlikely to ever find out any more about them, or how they died. Because they are not in what is designated as a ‘Public place’, we are spared the very unpleasant job of taking the body to the local mortuary. That will be done by the on-call undertaker, using a metal box or basic transit coffin.

The reason all this came flooding back today is that I woke up wondering what would have happened had I died alone in the house during the night. Julie is not back until Friday, and our neighbours are unlikely to pry. They are used to seeing a car on the driveway, and seeing me out and about with Ollie in the afternoon. But if that car was missing, and I wasn’t out with Ollie, they might reasonably assume that I had gone off somewhere with him, perhaps to visit a relative. So it would have been Friday at the earliest, and I would have been undiscovered for four days. I like to think Ollie’s eventual barking might alert someone, but a lot of dogs bark all the time around here, and we don’t check to see if their owners have died.

Maybe we should?

Ambulance Stories (50)

Nothing To See Here

When I started this blog, I used to post a lot of factual stories about events that occurred during my long time working on emergency ambulances in London. But over the years, other categories took precedence, and I began to wonder if there was much more to tell. After all, you can only relate so many tales; some tragic, others amusing, before it all starts to sound like more of the same. But I was thinking back to those days this morning, and this memory popped into my head.

A warm summer evening in west London, probably around 1995, maybe 1996, I don’t remember the exact date. I was on the late shift, starting at 3 pm, and finishing at 11. My regular partner was on holiday, and I arrived for work wondering who I would be crewed with that day. An awkward-looking young man appeared, tall and gangly, with an edgy and nervous demeanour. He asked if I was Pete, and told me he was working that shift with me. I hadn’t seen him before, and it transpired that he was a new guy, recently out of training school, and assigned to the divisional relief rota. He had what sounded like an Australian accent, but when I asked, he told me he was from New Zealand.

As we checked over the vehicle, he was keen to let me know that he was a very experienced first-aider in his home country. He had helped out in the voluntary services there for five years, before coming to live in England. He was quite scornful of our training and equipment, gabbling on about how much better things were in New Zealand, and how the volunteers there were more professional than the staff he had met in London. I could have taken him to task of course, but I had heard all that stuff before, and it was like water off a duck’s back to me. He asked to drive, so he could get to know the area. That meant I would have to spend all my time shouting directions to him, whilst looking after the patients in the back. But I said OK, telling myself that it was only one shift, and it would soon be over.

On the first couple of jobs that afternoon, he drove the ambulance like a maniac, at breakneck speed, stamping on the brakes, and shouting obscenities at drivers who were slow to move out of our way. I sat relaxed in the passenger seat. I had already decided that I was not going to like this bloke, and I wouldn’t give him the satisfaction of arguing with him about his driving. As the evening rush hour began, he hadn’t calmed down, and seemed to be trying to prove a point. I gazed out of the window, seemingly oblivious. Just before 6 pm, we received a call to attend a road traffic accident, not far from the base we operated out of. The radio operator added the words “Believed serious, possibly fatal” after giving us the location. That got him really fired up, and we arrived in record time.

The scene was one of carnage indeed. A woman and female child had been struck by a car as they ran across the road. The child wasn’t moving, and her mother was obviously badly injured too. To make matters worse the car had swerved after the accident and hit a traffic island. The driver wasn’t wearing a seat belt, and had impacted the window, and steering wheel. I jumped out, shouting to the New Zealander to call for another two ambulances, and to request the police and fire service too, all usual in such accidents. At the busy junction, and the height of the rush hour on a hot summer evening, there was naturally a large crowd of onlookers. Traffic was stopped, drivers out of their cars, and people hanging out of nearby windows to see what was going on.

The child, a girl of around ten, was fatally injured, with no vital signs. As well as a massive head injury, her neck appeared to be broken. Her mother had one badly fractured leg, with bones protruding, and she was also bleeding profusely from a head injury sustained when dragged along by the car. Fortunately, she was barely conscious, so unaware of what had happened to her daughter. A witness was telling me that the car hit the girl at some speed, and then ran over her mother, dragging her under the car until smashing into the concrete base of the traffic island below the sign. I put a blanket over the dead child, and proceeded to treat the head and leg injuries on her mother. I shouted to the new guy to check the driver of the car, who appeared to be a teenage boy. An overview of the scene would have looked dramatic indeed. A dead child, lying in a pool of blood, covered by a blanket. A badly injured woman, with a trail of blood, tyre marks, and road dirt leading to where she was lying, as well as a car crashed into a traffic sign, windscreen smashed, and the driver’s face covered in blood.

As I struggled with the woman’s injuries, I listened out for the sirens that would announce the arrival of some help. But there was a delay getting another ambulance, due to a shortage of crews, and the fire engine was having to come from some distance too, which I obviously didn’t know. A young police woman arrived, and I sent her to check the driver of the car, as I couldn’t see my colleague anywhere nearby.
Then, above the noise of the crowd, the passing trains, and the sounds of traffic I heard someone shouting. “NOTHING TO SEE HERE, MOVE AWAY NOW, NOTHING TO SEE HERE”. Recognising the accent, I twisted round, spotting the other ambulance man some fifty yards away, arms outstretched, and gesturing to the crowd gathered on the road. I heard him shout again, “NOTHING TO SEE HERE”, before yelling at him to get his arse back to the scene, and get on with looking after the driver.

Fortunately, two more ambulances arrived, along with the fire service. One crew dealt with taking the child away, and another stood by as the firemen cut the roof off the car, ready to extricate the driver. We could now leave, taking the mother to the nearby casualty department. As we were cleaning up later, I explained to my temporary partner that he should pay less attention to the crowds in future, and concentrate on looking after the patients who have a chance of surviving.

As we got back into the vehicle, I added, “And by the way, you were wrong. There was plenty to see”.

Ambulance Stories (49)

Saving Lives.

On another blog, I was asked a question by the lovely Kim. That post told the story of how I drowned as a child, and how I was saved by a brave angler standing nearby. She commented there, and went on to see the connection, that my life was saved, and I later went on to work as an EMT, intent on saving lives myself.  It’s a reasonably straightforward question, “How many lives did you save?” It got me thinking, and led me to write this post, which I am including in my category of ‘Ambulance Stories’.

Most people presume that ambulance crews save lives. It’s a fair presumption, and reinforced by scenes on the news media, documentaries on TV, and scenes in films and dramas. The reality of working in emergency ambulances in a big city like London is very different though. Much of the day to day work is dealing with old people who have chronic conditions like Asthma, Heart Disease, Diabetes, and Circulatory Disease. Some have suffered strokes, others have Dementia, or one of the many other debilitating conditions that affect us all eventually. Constant calls are made to the 999 (911) service to attend to these old people, and they live their lives on a merry go round of hospital attendance, admission, discharge home, and back again.

Then there are the inter-hospital transfers. Taking a patient from one hospital to another can take up a lot of your time. These Emergency Transfers are usually accompanied by medical teams, and may be necessary for brain scans, severe burns, or premature babies. Given the distances involved, the preparation of the huge amounts of equipment needed, and delays at each hospital, a job like that could well take up half of an eight-hour shift.

Mental illness is also a huge part of working in emergency ambulances. Persistent callers, disturbed people who cannot cope alone, or are having a crisis. People with suicidal tendencies, or those who self-harm, suffer with Anorexia, or perhaps wish harm to others. With more and more of these patients discharged into the ‘Community’ to fend for themselves, their care has been transferred to calling for an ambulance, at least in the first instance. It is easily possible to do a run of shifts without ever attending what most people would consider to be an actual ’emergency’.

So, almost 22 years, and thousands of emergency calls later, did I actually ever save anyone’s life? Strange that you have to think about it, given the nature of the job. The main remit of the emergency ambulance when I joined was to get people into hospital alive if possible, to be handed over to expert nurses and doctors who then treated them. We had few drugs, and defibrillators were only ‘on trial’ back then. Most of our training was a legacy from the 1950s; bandages, splints, and the administration of oxygen, and nitrous oxide. The accepted practice was known as ‘swoop and scoop’. Arrive as soon as possible, and get the patient into the vehicle as painlessly as we could. Scoop them off the street, and get them to a hospital that was close by.

Over the years, that changed a great deal. New drugs, better diagnostic equipment, and the ability to treat more conditions on scene led to taking more time with the patients, and administering more treatment before leaving for a hospital. Those hospitals changed too. Certain areas developed specialist centres, and we could no longer just go to the one that happened to be the nearest to the job. Protocols and training updated all the time, and the technical aspects of being an ambulance worker became more complicated too, with the crews becoming more accountable for their actions. Today’s emergency ambulances are a world away from those I started on, and the job itself is very different too.

After all that, I have to answer Kim’s question. Did I actually save any lives?

Some, for sure. Recognising a problem that I might have overlooked was definitely a way of saving lives. Placenta previa can be fatal if not spotted and properly treated, so I do recall at least three occasions where that saved someone’s life. Correct diagnosis of a Diabetic coma, often mistaken for someone being drunk and aggressive, that can definitely save a life and was something I managed a few times. Something as simple as getting someone off of their back, so they do not inhale fluid or vomit; this can also save a life, and was something we did all the time. Delivering a baby at home, with all the potential complications for mother and baby. I recall fourteen occasions where I did this, though mostly I just ‘caught’ the baby as it slid out!

On a few occasions, I kept people with serious burns alive, at least long enough to get into hospital for specialist treatment. But whether or not that saved their life, I never found out. Then there is the difficult subject of CPR, which is very often shown as incredibly effective on TV shows and films. In truth, it rarely works, and depends how long the person has been left like that before we arrived. On one occasion, just the one, in all those years, we attended a lady who had suffered a cardiac arrest on an underground train. We just happened to be outside the station at the time, and a fellow passenger who was a doctor had already started CPR. We got the lady into hospital with an output, and she went for emergency heart surgery that morning. She later sent us a letter of thanks, so I can say that we all definitely saved her life.

One evening, I spent a long time sitting on the balcony of a flat at the top of a tower block. The female resident was perched on the ledge, intending to jump. I managed to talk her out of it by telling her how awful her body would look, once it had made contact with the street below. Perhaps vanity saved her life, along with my rather brutal description.

But most of the time, we just did our best. We did what we could, faced with the conditions we found, and using the equipment available. As they say in medicine, “First, do no harm.”

Ambulance Stories (48)

Nostalgia

I have just seen a link posted by a good friend who still works in the London Ambulance Service. It is to a You Tube film, a documentary from 1974. It is a serious current affairs programme from the time, probably from the BBC. I don’t recall seeing it back then, but it was broadcast five years before I applied to join. Despite that, it is incredibly familiar. Many of those featured were well-known to me later on, and I worked with some of them on occasion. It was filmed in London and Yorkshire, but predominantly set in and around North Kensington Ambulance Station, where I worked for over twenty years.

By the time I was there, nothing had changed from how it is shown in the film. I wore the same uniform, used the same equipment, and probably even drove some of the same vehicles. The emergency calls shown in the film are all genuine, and the way they are dealt with is exactly as I would have dealt with them at the start of my career. The interior of the Ambulance station was the same, and the descriptions of laundering the blankets, washing the vehicles, and even cleaning the toilets, all too familiar.

Much of the film deals with the period of transition that the Ambulance Service was going through during the mid-1970s. Where the crews had once been competent drivers, trained only in basic First Aid, they were starting to get the first items of real life-saving equipment, and beginning to be trained to become the professional service we would soon see. They still had employment issues and were receiving pitifully low pay, and these problems were causing dissent, which resulted in strike action. The film is very much on their side, showing them as ordinary people; caring individuals doing their best in the situations they encountered. It is also a wonderful fifty-minute snapshot of England in the 1970s, and makes forty-one years ago seem more like seventy. Hard to believe now, but wonderful to behold.

The uniforms have changed, the vehicles and equipment are different, and the training is in another league. But the job is still the job, and that Ambulance Station is still there, as busy as ever.

Here’s the link. If you know anyone who ever worked in any Ambulance Service, or if they are just interested in fascinating social history, please share it.