Nee Naw

Today, I went out for an observation shift with Steve and his crewmate in posh, leafy South London. I’ll write about the other calls we did later; one deserves a post to itself. Every time I’ve been out on the road with Steve, I’ve told him that I want to see a suspended patient (otherwise known as a cardiac arrest, or a dead body, depending on how long they’ve been like that). Every time the MDT (ambulance computer) rang with a new call, I’d jump up and down and go “Is it a suspended? Is it? Is it?” and of course, it wouldn’t be; it would be “old woman fallen over” or “cut toe” or suchlike.

Well, this time the MDT rang and Steve turned to me and said:

“You know you wanted to see a suspended? Well, we’ve got you one.”

“Hahaha,” I said, not believing him. “What is it really?”

“It’s a suspended!” said Steve, igniting the blue lights and nee naw sirens and launching the ambulance on to the wrong side of the road.

I looked at the screen and saw he wasn’t joking. Then I panicked. Then I said some bad words. Then I turned a bit green.

The call, which was to an “85 year old male, ? suspended, ? purple, been ill with [this, that and the other]” was about 10 metres from an ambulance station, so despite getting there in four minutes, we were the third vehicle on scene, along with an FRU and another ambulance. It is usual practice to send at least two crews to ‘working’ suspendeds, because there are various things that need doing, eg., CPR, cannulating, intubating, defibrillating, getting equipment ready and herding upset relatives to a safe distance.

Steve cattleprodded me into the room, where all six of us proceeded to stand in a line and look at the scene in front of us. The other crews had already established that this was not going to be a working job: the patient was, in ambulance speak, purple plus. In other words, very obviously dead. I had always imagined that dead bodies would be found lying flat on their backs with their eyes wide open, blank and staring, but this gentleman had instead got himself into a most odd position. It appeared as though he had realised something was wrong in the night and got up from his bed, then thought better of it and sat down and curled up in a ball where he was, his head resting on the bedside cabinet, his face turned away so you could only imagine his expression. I was grateful for this; I imagined it to be peaceful, as in sleep, but for I know it could have been grossly contorted, frozen as he cried out in pain. Maybe that’s why he didn’t want anyone to see it. His skin was waxy and almost white. The FRU woman told us that he’d probably been dead for hours — he’d last been seen at bedtime the previous night and by now rigor mortis had completely set in — he couldn’t be moved at all. My only experience of death before today involved various small rodent pets, who generally crawl away and hide somewhere to die, and this gentleman’s position struck me as similar. Steve’s crewmate told me it was actually very common to find dead people in that kind of position.

Handling suspendeds is very different from a call taking perspective, because as a call taker, you never give up hope and always act as if something can be done. In no circumstances do you acknowledge that the patient is dead. Even if the caller does not perform CPR, you still have the fact that you are sending an ambulance to fall back on, as if the appearance of the ambulance will somehow make everything alright. Today I had no magic ambulance to absolve me; I was part of that ambulance. As all six of us stood there, doing nothing, a somewhat eerie feeling of ineffectiveness crept over me. As the last crew in, we were surplus to requirements and shuffled out to leave the others to deal with the formalities (mainly arranging a GP to certify) and give the relatives space to grieve. As we left, we encountered the patient’s daughter, who was walking aimlessly up and down the corridor clutching a mobile phone and keys. The other crew had already told her that her father was dead. As she saw us, leaving — testament to the fact that there was nothing we could for him — she broke into tears. I didn’t know what to say to her, so I told her that I was sorry, feeling that this was an incredibly inane thing to say but still better than saying nothing at all.

Back in the ambulance, Steve selected “Deceased, not removed” as the outcome, then checked to see if I was traumatised or anything by my first encounter with a dead body. I was relieved to find I wasn’t traumatised, just that it had been somewhat different from how I expected — the position of the body, the way that he was so obviously dead that no examination was needed, the feeling of “what now?” once the certainty of the death was established.

“That’s about as good as they get,” remarked Steve’s crewmate. “Sometimes you find them in pools of vomit, pools of blood or pools of faeces. Sometimes you find them in pools of all three. Sometimes you find them a week later when their face is moulded into the bedside table; sometimes you find them when the flies have moved in and the smell won’t get out of your hair for a week.”

“Next time,” said Steve, “we’ll find you a working job. Pumping the chest, shocking the heart…”

“Noooo!” I said. “Can we please just have nice little old ladies who have fallen over from now on?”

Then it was back into Green Mobile, ready and available for the next call.

No sooner than I’d written the last entry sounding off about broken finger woman’s friend, we received a call from their neighbour.

“I just wanted to apologise on her behalf. I am so sorry that they were rude to you — in fact, that they called you out for a broken finger in the first place! I gave them such a telling off, and put them in a taxi to the hospital. So you can cancel.”

I must remember, for every idiot who makes me cross, there is a decent, sensible person who makes the world a better place.

And this meant we did not have to send to Finger Woman, and had an available ambulance for the poor long suffering man with the infected operation wound, who’d been waiting for ages, and the little old lady stuck on the floor with an injured arm. Which was a good thing.

You know it’s going to be one of those nights when you’ve only been in work for half an hour, and you’ve spent at least fifty percent of that time trying to explain to someone why a woman who has caught her finger in a child’s pushchair why she isn’t going to get an ambulance any time soon. The conversation went a little like this:

Woman: So you’re saying, unless you have a LIFE THREATENING EMERGENCY, you have to wait ages?
Me: Er… yes.
Woman: But she might have broken her finger!
Me: Yes, and that isn’t a life threatening emergency.
Woman: You’re telling me that if you broken your finger, you wouldn’t call an ambulance?
Me: I certainly would not. I would call a taxi, if anything. Can’t you call a taxi?
Woman: I can’t afford a taxi! I am not a money tree!
Me: How are you going to get back from the hospital?
Woman: Well, I’ll call a taxi!
Me: So why can’t you call one now?
Woman: Because… are you being sarcastic with me? You are so rude!
Me: I am not being rude. I am merely pointing out that if you can’t afford to get to the hospital, you can’t afford to get back either, and you will get stuck there. Which would be bad?
Woman: But… but… listen you… there’s a CHILD here!
Me: Er, I see. And is the child hurt or ill in any way?
Woman: * puts phone down in fury*

As you can imagine, that one went straight to the bottom of the pile!

I don’t know whether I am coming or going any more! I got back from a month’s annual leave (yes, colleagues, if you were wondering why no one can get leave at the moment, it’s because I nabbed it all) in aid of my 30th birthday (I needed time off to get used to the horror of being that old) and found I was back training Trainee Number 2, this time on dispatch. I was given a grand total of thirty seconds to prepare for this! After a month off I found I had forgotten how to do my job myself, let alone teach someone else to do it, so this wasn’t a great start. Anyway, just as everything was starting to come together and Trainee 2 was just about to start flying solo, the poor girl goes and ends up in hospital! Nothing too serious, fortunately, and she will be back soon. (Get well soon, Trainee 2, if you are reading!) So at this point, enter Trainee 3. And then half the control room went off sick, so I had to be the radio operator and train someone on dispatch at the same time. The confusion!

As I mentioned before, I am useless at training at the best of times so I am not sure if I actually managed to impart any useful information at all. Training people on dispatch is rather different from call taking. In a way, it is easier, because you spend most of the time talking to crews/hospitals/other professionals who tend to be politer, less drunk and more helpful than the general public. (There are exceptions, unfortunately.) On the other hand, after six months on call taking you have heard pretty much everything. Granted, there is the odd call that makes you go WTF (eg. “My girlfriend has a razor blade stuck in her vagina”. We actually had this the other night.) but in general it’s the same things over and over again and it ends up being a case of “Your head has fallen off? Okay. Are you breathing normally? Put your dogs away and meet the ambulance…” Up on dispatch, there’s always new things happening, and even after three years doing this job I’m still coming across new things. There are some staple occurrences that happen pretty much every night and examples of these are:

1) Crew: “We can’t find this address! The MDT is taking us into a graveyard! Help!”
2) Crew: “Er… this is Tolworth… this job you sent us in Hornchurch… are you SURE we’re the nearest?”
3) Crew: “You’ve put us on our lunch break! But we can’t have a lunch break, because there are rats on the station, there’s an R in the month and anyway, our break window doesn’t start for fifteen seconds.”
4) Sector Controller: “Please ring back this woman with a spot on the nose every two minutes apologising for the delay and mentioning the word “EMERGENCY” a lot until she gets the hint and goes out and buys some Clearasil.”
5) Crew: “We’ve just driven 3 miles on blue lights to a baby with flu and now the parents are refusing to go to hospital. Could you please arrange a GP visit like they should have in the first place?”
6) Sector Controller: “We’ve got a BBA (Born Before Arrival) in Walthamstow! The mother is booked under a hospital in Manchester! Please spend the next half hour ringing every hospital in East London and arguing about who should send a midwife!”
7) Crew: “Hello, please note on our ticket that there are TERRIBLE delays booking in at Newham today. This is in no way related to the fact it is ten past four and we are about to miss our break and thus get our compensatory payment”.
8) Crew: “We’ve got a patient who has taken 59 paracetamols, 72 horse tranquilisers and half a gallon of whisky and won’t go to hospital because she thinks she will be fine. Please could you ring Guy’s Poisons Information Service and get some scary information about what this will do to her insides so we can persuade her”.

And so on. Less common occurrences that we have had recently include:

1) “This is Dagenham Ambulance Station! Please get in touch with K602 quickly! We’ve had a tree fall down in the car park outside and it’s landed on his car and crushed it to bits!” (I had to break this news. You can guess how popular I was. I bet K602 wished I was putting them on meal break…)
2) “This is T803. We’re going to have to go off the road because my crewmate has just had a message that her brother has been in a serious road traffic accident somewhere up in Remote Northern County. Oh, and could you see if you could find out any information, she’d be really grateful…”
3) “This is K801. Please could you settle an argument. How do you spell ‘apparent’?”
4) “This is SE69. Could you please pass on a message from the caller of cad 59. He says he is sorry he was rude on the phone, he was panicking, but the baby is fine now and thank you very much for all your help.” (No, this doesn’t happen often, but it’s great when it does.)

And finally…

5) “Hello, this is S418. We’ve just done cad 880 - the suspended baby. We thought you’d like to know what happened. The call was given, and we scooped and ran to the hospital. The hospital staff worked on the baby for half an hour, and they were just about to call time of death when they stopped resus and gave the baby to the dad to hold. The nurse noticed the baby was starting to make some respiratory effort, and they started to work again. The baby is now breathing unaided, and the doctors think he is going to be okay.”

It seems that I just can’t keep away from ambulances - even on my day off.

It was Saturday night, and my friend A and I were off to a party somewhere in the midsts of the West Sector, in one of those places that I’m not convinced really exists. I should have known it was a bad idea. It was a very decadent party, with a outdoor jacuzzi, a chocolate fountain and, er, a Eurovision sweepstake. About 2am, I suddenly started to feel rather tired and needed a lie down. This may well have had something to do with the four pints of beer, bottle of wine, glass of congealed toffee/chocolate/cherry cocktail and fifty-nine vodka jellies* I had consumed.

An hour or so later, I was awakened by M, the host of the party, bellowing “MARK, MARK! A HAS CUT HIS ARM! QUICK! QUICK!”

I muttered something about plasters and pulled the duvet over my head. M was opening and shutting her mouth and there was noise coming out, but it didn’t seem to make much sense, and I hoped she would go away as each word was like a ten tonne weight dropping on my head.

“Call an ambulance! I think it’s an arterial bleed!” shouted someone else, and this finally jolted me into awakeness. “Ambulance” is obviously the magic word you need to get my attention. I staggered into the living room, and there were several thousand people running around, some of them in bikinis, flapping their arms, and throwing tea towels around the room. In the middle of the chaos, lying in a pool of blood, was A.

I decided to pretend this was all one big St John Ambulance training exercise and did all the lying down, applying pressure, raising the affected limb (A’s arm) whilst M called the ambulance.

“My friend’s here! He works in Control! Speak to him!” said M. Now, did she need to say that? I took the phone and spoke to an unimpressed sounding colleague, who asked me some questions that I knew off by heart and told me to put my dogs away, etc, etc. It all still felt like a training exercise, except for the fact that everyone in the room was completely drunk and covered in blood.

“So what exactly happened?” I finally asked. It seemed A had been heading for the jacuzzi in the garden and feeling his way along a wall. The wall had actually been a garden shed. With a window in it. A had leaned on the window, it had given way, and cut his arm to shreds. Accident!

I looked at my watch and realised it was 3am on Saturday night, which has got to be the worst possible time to call an ambulance. From experience, I know amber calls (such as this) could often be held for up to an hour at busy times, so I steeled myself for a long wait. Fortunately, we’d managed to get the bleeding under control with an assortment of tea towels, but there was no way we’d be able to get A into a cab.

Then M’s phone went. It was Control, presumably the FRU desk. I thought they would be ringing to let us know about the delay, but no, they had someone on the way. They just wanted to check how the accident had happened, because “Fell into garden shed getting out of jacuzzi” could well be a cover up for “Violent nutter punched garden shed in rage. Likes murdering ambulance crews”. I assured them that A was not a violent nutter, just a clumsy, drunken fool and they seemed to believe me. A couple of minutes later, blue flashing lights appeared and in walked Mr FRU Guy. At this point, everyone started pretending to be sober, like a bunch of 16 year olds caught drinking by their parents. We were not convincing, especially as M started asking Mr FRU Guy if he knew Reynolds or Martin and Tim from Trauma and I told him I worked in Control and asked if he had had his meal break yet. He did a sterling job of humouring us whilst simultaneously bandaging A’s arm. Mr FRU Guy also suspected an arterial bleed and rang Control to see where the ambulance was. Five seconds later, one appeared! I was well impressed.

A and I were bundled into the back of the ambulance and taken to the local hospital. I was amazed to find the A+E was practically deserted and he was seen straight away! We thanked the ambulance crew and bade them farewell (I pointed out that cleaning A’s blood from the back of the vehicle would take them just past their meal break window - how convenient!) and then I got to watch what happened next, which obviously is something you don’t see if you’re out as an observer. First of all, they sent A off for an x-ray to make sure there was no glass in the wound, then a billion doctors and nurses gathered round and stitched up the wounds. By this point, they knew the bleed was not arterial as FRU Guy’s bandage had controlled the bleeding. A was given a bandage and a sling. Everyone was very efficient and we were out of hospital by 5am, two hours after the accident happened. So don’t believe what you are told about the state of the NHS, everything is fine so long as you live in the West Sector!

A and I then realised we were the wrong side of London at 5am and that in the panic I had left half my possessions, including my coat, at M’s house, so we were forced to call a cab. The cab driver didn’t speak English and drove about ten miles past our exit on the North Circular before I managed to communicate the message “Too far! Turn back!” to him. He then tried to charge us extra because he got lost!

All in all, as much as I love to get out there and ride on the ambulances, this was neither the time nor the place and I will be glad to be back where I belong, dispatching them, tonight. Many thanks to my colleagues in control, Mr FRU, The Ambulance Crew and all the staff at West Sector Hospital A+E for their brilliant work and putting up with us!

Nee Naw does not encourage binge drinking. Always enjoy vodka jellies in moderation.