Thursday, 31 December 2009

Trojan horses

Night shift: Eleven calls: Three no trace; one by FRU; everyone else by ambulance.

Stats: 4 eTOH; 1 Croup; 1 Fractured legs; 1 DIB; 1 EP Fit.

New Year’s Eve is our busiest night of the year and tonight was going to prove no exception as thousands of people flooded into Central London for the fireworks, booze and violence that comes with the territory these days. But it was a night of disguised problems too – I was working on an ambulance all night and a few of the calls were not as they seemed, catching me out on one occasion. I was working on an ambulance tonight.

But it started with a drunken 43 year-old woman who was found in the street by police after they’d been called to a possible mugging. She told me she’d been attacked as she spoke on the phone and she was very drunk – not that this had any bearing on the truth of her claim but it turned out she had no phone, nor any valuables and not because she was mugged but because her angry boyfriend, who was fed up with her constant drunken stumbling, took them away from her and left her in the street to fend for herself.

On the way to hospital, where she had to go just for safety, she told me she used to be a cardiologist. Someone, clearly, should have known better.

A 10-month old baby with croup next and it took us a while to find the address, so we were late getting there but a car was already on scene and the paramedic brought the patient and his mother down to us. The child had been diagnosed with a chest infection and given antibiotics, which he’d completed but the problem persisted. Now he was barking and crying in the ambulance all the way to paediatric A&E.

The first serious call of the night came in as party-people started to fill the West End and Soho. Two people had apparently fallen from a first floor window and we were asked to check on injuries. Then the call changed and we were asked to report on arrival because now it was a fifth floor window they'd fallen from. I knew the street well and I knew the injuries would be significant if this call was genuine because there is only pavement to land on. There are also people and this part of town would be very busy with them.

We arrived after struggling through crowds and closed roads (which were opened for us by the police) to find an ambulance and two FRUs already on scene. There was someone lying on the pavement and the first crew was dealing with her so I was instructed by the Duty officer to go and check on a child who had fallen from a window. I was sent upstairs into a block of flats with the police leading the way. This stumped me – hadn’t I been told that the child had fallen from a window? What was he doing upstairs in the flat?

When we got to the door it was opened by a very frightened looking man. ‘Where’s the child?’ I asked. He pointed at a bedroom and said ‘in there’, then his face crumbled.

I walked into the room and a woman was standing by a bed, so I asked her where the child was – she didn’t hear me the first time because she had started to speak the moment she saw us and the police inside the flat. ‘I just turned away for a second and he was gone’, she kept repeating. ‘Where’s the child?’ I insisted again. She pointed to the bed and there was a lump on it, completely covered by a blanket. At first I thought I was about to see a dead kid but when she pulled the blanket away from his head, the little boy cried and screamed. The shock of seeing us probably brought that on because it wasn’t the sound of pain.

It took a while to get the facts of this incident but when I did, after a long time trying to console the four year-old and attempting to find out what, if any injuries, he had, I discovered that he had been looking out of the fifth floor window, which had a sheer drop to the pavement below and had simply toppled out of it when his mother turned her back. All she and her older son (the one who answered the door) knew about it was the sound of crying from the street soon after he vanished from the ledge. I looked over that ledge and there was a glass jar or bottle on the little plinth below; I think he was trying to reach that or had dropped it. Whatever the case, the jar will have to be recovered or the first decent wind to come along will whip it off and onto someone’s head in the future.

The boy fell almost 50 feet by my reckoning and that was enough to get him to hospital, even though he showed no visible signs of injury and was very vague about pain or immobility. He would not weight-bear on his legs and that was significant.

He had landed onto an awning that stuck out from a shop below (the only awning for a long way on that street). He must have bounced off it, reducing the energy of his flight by a great deal, then he landed on a passing woman – striking her across the back and flattening her onto the pavement. After that he simply rolled off her. This woman told me how it had happened and she was very lucky to be alive, just like the little boy. If that awning hadn’t broken his fall, there would probably have been two dead people on the pavement. Ironically, the woman he struck across the back was already suffering from a back problem.

His brother had run down stairs and out to the street, finding him crying there next to the woman. He’d grabbed him and taken him back upstairs before calling an ambulance. His mother was now talking about letting us know if anything got worse – she was considering leaving him at home. I explained that the fall was enough to warrant going to hospital. That sort of mechanism for injury cannot be ignored and even though I thought he was the luckiest kid alive on New Year’s Eve, I would be surprised if nothing was found wrong with him.

We blued him in but he was so feisty and inconsolable that boarding, collaring and restraining him in any way, except on the stretcher, was impossible to do. He went in and I had to explain why he wasn’t tied up. We later found out that he had two broken legs. He was still a very lucky little chap.

The drunk calls started in earnest as we went through the night and a 21 year-old girl who fell onto her chin at an underground station was our next catch of the day. Her male friend stuck with her all the way to hospital. He was sober but she was so far gone she had to be given fluids.

We were north of the river now and at one minute to midnight we were asked to go south for another call, which wasn’t even an emergency. This was not a wise thing to ask of us because when the New Year arrived the crowds blocked every possible route and we soon found ourselves locked-in tight with an ocean of bodies around us. Not all of them were friendly – we got the odd ‘Happy New Year’ but we also got a bottle or two thrown at the ambulance and more than one fist slammed against it as we attempted to move through the crowd to our call. In the end and after warning Control that we wouldn’t make it, I called in to inform them that we were stuck and going nowhere. The fireworks were going off overhead but we saw nothing of them – it was the flattest start to the New Year I’ve had in years (since the last time I worked on this night in fact).

As the fireworks died down a roar came up from the crowd but it wasn’t appreciation; it was awe. A lot of people were looking skyward and I followed their gazes – it had started to snow.

The warm fuzzy feeling of seeing the first snow of the new decade dissipated (as did the snow) with the next call – to a 23 year-old female who was lying, blind drunk, outside a club. Her friends abandoned her as soon as we got her into the ambulance, so she was alone and out of it most of the time. But she wasn’t so bad that she couldn’t make some sense and when another drunken person came to the window of the ambulance and asked if we could attend his even more inebriated friend, she repeated my answers from the back as she lay on the stretcher. ‘Has your friend been drinking?’ I asked. ‘Yes!’ came the enthusiastic response from behind me. Both her hearing and her attitude were sharp.

The next proper call of the shift was for an 88 year-old woman with constipation and abdominal pain. At first I thought it was cut and dry but she had a noisy rasp to her breathing and her sats were very poor. So poor in fact that I didn’t believe the probe – she was cold and the figures tend to be low as a result. I put her on oxygen anyway and there was no real change in her condition. In fact, she tore the mask off her face several times because she didn’t like it.

Apart from her abdo pain and a history of a recent pacemaker fitting, she had no other immediate problems – no chest pain, no true DIB, although that soon changed. She had type II diabetes and hadn’t been able to control it very well – her BM was high but not critical and her GP had taken her off Metformin for some reason. She was very distressed but her daughter told me she was always like that and the raspy sound was being made by her vocal cords as she panicked. What was hard to pick up was any probable cause for her distress, apart from the pain of constipation. She’d had a chest infection and that had been treated with antibiotics and she’d been constipated before and it was treated, so we proceeded on that basis.

When we got to A&E, however, I noticed that five minutes after arriving and during my handover, her breathing rate had doubled and she was getting more and more restless with it. They took her into Resus and found that her sats were indeed low and that she needed to have oxygen forced into her lungs because her blood gases were so bad. I wonder if her high blood glucose had been in status for a while. If so, that could have a detrimental affect on her health.

The next drunken person was a 17 year-old who was in the street with his mates. His temperature was 34.1c and that was reason enough to take him into hospital, which was becoming busier by the minute.

After that we were being sent to calls that had been held for two or three hours at a time. Of course, every time we arrived, like to the epileptic who’d been fitting in a club, we found that they’d gone – in this case the FRU pilot had got fed up waiting and had driven the patient to hospital himself. The other calls were for drunks who’d long gone home or slithered into some other place for the night. It was an exercise in clearing up.

Well, that’s another year gone. More of the same to come I guess unless something changes for me. Happy New Year.

Be safe.

Wednesday, 30 December 2009

Dying in the rain

Day shift: Four calls: Four by car; one by ambulance.

Stats: 2 Abdo pain; 1 ?EP fit; 1 Faint; 1 Cardiac arrest;

A drizzly morning start to the beginning of the end of the year, so to speak and I am asked to go to a million-star hotel to attend a 33 year-old female with abdominal pain. She is an employee and she is just about to start work on her ironing and other associated tasks when she is struck by acute pain, she claims.

I take abdominal pain seriously when it is deserved but I have to say, without running the risk of sounding like a completely uncaring person that this is the second time I have had to take a complete sham of an act into hospital. Abdo pain is one of the easiest complaints to feign – especially when you want a day off work and you are a low-paid employee. As soon as I saw her I could tell the pain wasn’t genuine and the fact that, once again, I am told the problem has existed, completely undiagnosed or treated, for years made me even more suspicious. There are, of course, ailments without aetiology but sooner or later something is done about them, even if it to throw analgesics at them in the hope that they will go away but I know when something just isn’t there – and there was nothing here.

In the car she was fine (until she called her mum – then she cried and wailed). At hospital she was fine, until a nurse approached her after my handover – then she threw herself from the chair, rolled on the floor and screamed in ‘agony’. It was embarrassing to watch and the noise she made brought people out of Resus and other areas to see what the hell was going on. The nurses stood over her and waited for the act to end before taking her to the furthest cubicle away from them. When I took her paperwork in I peeked round the curtain to check she was decently dressed before entering the cubicle. She was quiet and alert. Then I showed myself and dropped the paperwork off – only then did she begin to hobble and moan again.

I’m sorry if you see me as uncaring or unprofessional but I really despise weakness like this. There are plenty of genuinely ill people around and they try to take care of themselves most of the time. When they need medical help, they retain a modicum of dignity and their plight is very real to us.

At a medical walk-in centre a 30 year-old Chef presented himself to the nurse practitioner after suffering a number of what he described as ‘blackouts’. He has a history of epilepsy from his early teens but these events were new and different, as his epilepsy had been well controlled by drugs over the years. But epilepsy can change form over time and its possible that he was entering into a new phase with his condition. It’s also possible that a life-change, such as moving home or the stress of a job, has affected him – he may even need to have his drug reviewed. Whatever it is, he complained of having several more ‘vague phases’ during the trip in the car to A&E.

After a short interval in which nothing happened I was called to an 18 year-old female who’d fainted at a train station. She was 19 weeks pregnant with her second child and had passed out momentarily in the loo. Her hip was hurting as a result of the fall and an exacerbation of a condition known as SPD, which she developed during her first pregnancy and probably had again, if her description of how the hip and pelvis felt were anything to go by. She remained cheery and conscious during the trip to A&E in the car but her large Christmas bag, containing a heavy toy for her relative’s child, burst open and had to receive treatment from me in hospital, involving mainly tape and staples. It was a difficult and emotional job but... someone had to do it.

An 18 year-old female with period pain decided to have an ambulance called on her behalf when she could not cope with the cramping. She and her friends had police officers tending to them, even though a couple of painkillers would have been more effective. She’d taken paracetamol a few minutes before my arrival and had endured the pain all day, so she really hadn’t thought it through properly. Still, I took her to the busy A&E department, where she and her mate sat on a chair waiting. She was smiling and feeling better by the time I delivered her.

There had been a number of cardiac arrest calls during the day and I was tied up with the above jobs instead of running to the ones that were near enough for me to have helped (if they hadn’t turned out to be purple), so it wasn’t surprising that one came my way and I was asked to assist a crew on scene. The 78 year-old man had collapsed in the rainy street and his wife stood by as the team on scene resuscitated him. He was shocked quite a few times and his ECG rhythm changed from VF to a slow PEA and then on to VT. We eventually managed to get him breathing, although he had been trying himself from the start and, with the help of a passing anaesthetist and a medical student, we managed to keep him going until his rhythm changed and stabilised long enough for a pulse to be felt. That happened in the ambulance as we were getting ready to leave.

He arrived at hospital breathing weakly and with a half-decent pulse and BP, so it’s now down to God and fate as to whether he survives in the long term but I think he has a fighting chance.

* I was able to check on this man a few days later and was told that he is still alive in Intensive Care. The medical student deserves thanks for her sterling work on the compressions - they would certainly have contributed to saving this man's life.

Be safe.

Sunday, 27 December 2009

Na,na,na,na,na,na,na,na Bedman!

Day shift: Four calls: Two by car; two by ambulance.

Stats: 2 Falls; 1 ? Fracture/dislocation; 1 ? TIA.

After a few hours of nothing, an 80 year-old Australian lady tripped on a raised pavement slab and fell on her face, cutting her head just above the eye. She also had a numb face on the same side and some mild shoulder pain, probably caused by her attempt to stop the fall. Her family was with her and I took her and her son in the car, while the others followed on by taxi. Easy and sensible.

Shoppers, far too busy with bargains, delayed me from getting to an 18-month old girl who’d fallen onto her face in a large store. There was nobody to meet me and a MOP had to tell me where I was going; thankfully there was no serious injury to deal with. The little girl was wailing in distress – she had a cut and swollen lip and a bruised nose and cheek. There were a few loose teeth too, so I took her and mum (who is a GP) to children’s A&E for treatment and reassurance.

I had a quiet word with the manager of the store on the way out with the patient ( I had just cleared the lift of able-bodied people who were unwilling to give me the space at first) when he asked what was going on. I suggested that he speak to his staff about communication and receiving emergency service personnel.

Later in the day a 48 year-old French woman fell awkwardly whilst shopping with her family. I found her in the changing room, lying on the floor in agony after (probably) fracturing her clavicle at the extremity where it meets the upper arm bone (humerus). It also looked dislocated so I understood why she was reticent to have it moved in any way.

There was a translator on scene (a member of staff), which was fortunate because my limited French and her limited English were getting us nowhere. She told me she worked as a nurse and so this made things easier in terms of treatment (entonox) and description of the injury.

I had almost set off to hospital with her in the car and prepared to return for the rest of her family when the ambulance showed up, even though I wasn’t hopeful of getting one. It was a blessing because it meant we could take the patient and her three family members to hospital together. So, I travelled behind the ambulance with two family members, neither of which could speak English. I had to entertain myself by people-watching as I trundled along Tottenham Court Road. That’s when I saw a man dressed as a bed, with a full mattress over him, walking along the street advertising a bedding store. He was preceded by a shivering, fed-up looking woman who was dressed in an old-fashioned night gown and hat and carrying a candle. I couldn’t think of a useful French phrase for this, so I let my guests work it out themselves as they followed the line of my gaze with their mouths open.

The injured woman and her family were due to travel home a few hours later but I told her that this was very unlikely.

Confusion after a headache can mean a TIA has occurred and so the visiting friends of an 87 year-old man decided to call 999 when he lost the ability to speak properly and became vague. When I arrived he’d started to improve but he knew himself that something wasn’t right. The crew was on scene soon after me so I didn’t get too far into the history and obs on this one but he would have been taken to hospital for sure.

I have to say I’m finding it more and more difficult to make judgment calls about individuals with possible neurological problems when I am subjected to walking human beds in the middle of the afternoon.

Be safe.

Saturday, 26 December 2009

Goodwill to all men (unlikely)

Shoppers prepare for the Boxing Day Sales.

Day shift: Eight calls: three assisted-only; one false alarm; one by car and three by ambulance.

Stats: 2 Abdo pain; 1 Fitting; 1 Unwell adult; 1 Broken nose; 2 falls.

Another year and the Boxing Day sales are on. Oxford Street, and in particular, Selfridges, was hosting the biggest crowds in London for the day, or at least until they’d spent themselves into debt. Fortunately the Starbucks across the road was serving coffee and Panninis in a smooth and efficient manner, even if they weren’t having a sale – something that would have eased the pain of their horrific prices - £8 for a latte and a hot piece of bread!

The fairly sedate start was quickly run over by a call to the north for a chest pain that was an abdo pain in disguise. The 45 year-old Somalian man had a very strange ECG but his tall, thin figure and genetic predisposition called for anomalies that were normal for him. He also had a missing lung – the result of an earlier fight with pneumonia.

A cardiac arrest call came in as I left that job to the crew and I ran on it in good faith, knowing that it was probably nothing of the sort. A biker was on his way and as I approached he called in an all too familiar report, ‘not as given’. I stood myself down before the excitement overwhelmed me. I had the madness of sales fever to deal with later on anyway.

A call that went from red to green in quick succession turned out to be for a 50 year-old street dwelling alcoholic who had fitted in a doorway. I was only a minute from the location, so stayed put when the call changed priority and watched as he had another seizure in front of me. He was unresponsive but conscious and I’m sure that his habit had a lot to do with this event, although his friend told me he’d never seen him have a fit before. The man has been on the streets for eleven years and now his time was coming – the seizures, loss of bladder control, inability to breathe properly without oxygen and the fairly new hospital tag around his wrist were all testament to that.

To the south next for a 74 year-old Bangladeshi lady with a nosebleed that stopped before I got there. She was lying on the sofa and had been shaking with stress before I arrived. Her family was around her and they explained that she was a worrier and that, although healthy as a horse, she made herself ill by thinking she was ill. I spent a good 30 minutes with them and enjoyed chatting and learning about them, as a family and their culture. I convinced their mum to settle down and stay at home with her family and won the day – PRF signed obviously. Oh, and a crew showed up after I’d asked for them to be cancelled, so our comms were working top notch as usual.

Acute severe abdominal pain next and a 41 year-old woman with a 20 year history of unsolved agony called us, so I went to give her morphine because it works ‘instantly’ she said, in between long screams and moans. She was doubled up on her sofa, trying to vomit into a small bowl that may or may not be used later on for cooking and such. Her BP was consistently high and so the crew ‘blued’ her in. She was very adamant that she wanted to be taken to a particular hospital and I wasn’t too happy that she wouldn’t let us take her to the nearest but the issue was logged and she went where she wanted to go.

They knew her there and she has a little history of going in by ambulance, staying for a while until they give her pain relief and then leaving without a diagnosis. So, the facts of the matter are yet to become the light of her problem – nobody knows what is wrong with her. Her dangerous hypertension and obvious pain made it impossible for us to be passive about it, so she will present again and again I should think, with the same problem and never get to the bottom of it.

Outside a theatre, as the crowds swelled the streets, a 50 year-old woman tripped and fell onto the pavement as she and her boyfriend (it seems strange to use that title at that age, doesn't it?) were about to go inside to see the show. The manager told me that she didn’t really need an ambulance and I accepted that but her boyfriend came out and I thought better of leaving the scene too hastily when he explained that she probably needed ‘butterflies’ in her lip.

She appeared with him a few minutes later and it was obvious that she’d busted her nose. It was leaning over to the right and this, I was told with confidence, was not how it had been created. Her lip had a little puncture in it but she went in the car for the nose. I made a point of telling everyone who would listen that she’d been in a fight. It brought a cheery smile to those waiting outside Resus, which may or may not have been appropriate.

A Red1 that became a Red2 became a farce when I arrived in the crowds of Oxford Street for a 28 year-old woman who’d fallen. A gangsta type offered his medical opinion ‘she’s diabetic’ when I asked the woman what had happened. He was nothing to do with her; his little gang stood around just being nosey and I’m sorry to say (and this is not a slight on young people) that I worried that my car may not be locked. There’s helpful and there’s dodgy.

Anyway, the woman had absolutely nothing wrong with her except an emotional problem that nobody would be able to solve except her husband. She flopped around and I did my obs. She was in normal health and they agreed to take her to their nearest hospital after I cancelled the ambulance and informed them that I would drive her to a four or five hour wait at one of ours. The ambulance I had cancelled, as per the whole point of having me there, arrived anyway, so the crew were informed of the decision and they left empty-trolleyed.

And just as the day ended for me I was asked to assist an Urgent Care crew who wanted to leave an elderly person at home after helping him back up after a fall. He had no injuries but his BM was high, so I went there to double check him and carry out a thorough examination, including an ECG.

There were the usual anomalies but they were expected for a 93 year-old. He declined hospital before I’d even started to check him and his wife added her own refusal on his behalf. He had wet himself and his urine smelled familiarly off, so I suspect he had a UTI and I advised his wife to contact their GP as soon as possible to have it treated. Apart from that he was fine, so I left him in the care of his wife and the crew, who completed their paperwork on scene.

During the day, as per last year and the year before, a gang of youths went on the rampage and a fight broke out in Oxford Street. Someone was stabbed apparently and this is now normal on sales day up there. The atmosphere is seldom friendly and people become selfish and aggressive, driven by their overwhelming desire to cash in on the best bling at the cheapest prices, regardless of the health and welfare of others. Welcome to the new society.

Be safe.

Friday, 25 December 2009

Merry Christmas!

A merry Christmas to you all. Thank you for reading the blog and sticking with me through thick and thin. Harry and Scruffs also thank you for your thoughts and messages throughout the year.


Sunday, 20 December 2009


Night shift: Five calls: One assisted-only; one by car and three by ambulance.

Stats: 1 CVA; 1eTOH; 1 DIB; 1 Allergic reaction; 1 Eye injury post assault

Move away from the Chardonnay! Yes, it’s definitely that time of year – where the meaning of Christmas (Christian soul or not) is blurred out of focus by commercialism and selfishness, drunkenness and stupidity. Oh and lovely presents. My wife says I’m the Scrooge of Christmas but I think my cynicism is realistic because it allows me to see the real spirit of the Festive season when and where it appears. I still love snow, Jingle Bells and mulled wine. Honest. I don’t agree that lying in a gutter, vomiting your stomach empty and swearing at your friends is a good way to celebrate this pagan thing. Sorry, I know I'm reeeeellly boring!

As the tide of human waste turns on the bars and clubs in the West End, a 52 year-old lady lies in her dry bath, unresponsive for three hours until her son discovered her, naked and limp. She’d had a stroke and her right side was useless. She couldn’t speak but I suspect she understood something of what was going on.

I was asked to assist a crew and FRU already on scene and we planned a way of getting her out but it involved man-handling her onto the chair and slowly carrying her weight down steep narrow stairs. But we succeeded without a hitch or a back injury and got her into the ambulance, where she remained unresponsive except to pain and loud voice (and only then to open her eyes momentarily). I tried to get a line in but failed miserably and decided she didn’t really need the extra hassle, so I left her alone and accompanied the crew as she was ‘blued’ in to Resus.

This lady’s consistently high BP indicated a haemorrhagic stroke cerebellar or brain stem) rather than an embolic CVA – her pupils were almost pinpoint and non-responsive, her breathing was stertorous and she had complained of a headache earlier in the night. She needed emergency medical attention rapidly if she was to survive.

It must be Christmas because my next call sent me to a place where the Polish drunks seem to breed, for a 53 year-old man ‘collapsed, possibly drunk’ outside a shopping centre. He was sleeping on the ground and yes, he was drunk... and Polish. A random woman was on scene with the security guy from the shopping centre and she seemed very concerned about his health and welfare until I revealed his secret – he was just drunk. She suddenly became more concerned about whether he had a work permit or was legal and started to interrogate him about it. I stopped her, asked her to leave (politely of course) and stood him up for his journey out of the immediate area. And I say it must be Christmas because this Polish man decided to thank me with a big unwelcome hug and a sloppy, all in my ear, kiss, which, being Glaswegian, I didn’t really appreciate. So, I left him in the care of the security man because my job wasn’t to usher drunks off the premises- nor was it to accept alcoholic kisses from blokes.

Pizza was interrupted by a call that had originally been given to Urgent Care but went Category A because the patient had DIB, so my cold dinner sat in the car while I went inside the world’s smallest flat with the crew to put the patient on oxygen for his low sats, which improved immediately. He had a recent history of recurrent chest infection plus many other medical problems from the past, so he went to hospital (in his own wheelchair), oh and in the ambulance of course. I eventually got back to my pizza but it had to be reheated in the microwave and so it didn't taste the same.

A 28 year-old woman with hugely puffy eyes sat in a train station waiting for me to take her to A&E for the second time since she began to react to eyebrow tinting dye a few days earlier and was given IV piriton and oral steroids to solve the problem. It didn’t and now she had watery, sticky closed eyes and large swollen lids to contend with. Even from a distance it looked painful and frustrating – she couldn’t see much at all and opening them was painful for her.

Normally I would take a call like this in the car but she had suitcases with her and I didn’t have the space to accommodate them, so I asked for an Urgent Care crew to come and collect her.

A stint of standby on Leicester Square was broken by an assault not far from me in Piccadilly Circus. A 26 year-old Australian man was set upon by four men when he tried to break up a fight in which the gang had turned on someone. For his trouble, he got punched and kicked to the ground, leaving him with a deep cut above his eye. Otherwise he was fine but I took him to hospital in the car and the police followed on. While on scene he saw one of his assailants walking close by and identified him to me and the cops. The cheeky thug had brazenly walked into the crime scene he’d helped to create just so that he could look at his handiwork. He even smiled. Happy Christmas!

Be safe.

Saturday, 19 December 2009

Sober and lonely

Night shift: Four calls: One assisted-only; one false alarm and two by ambulance.

Stats: 1 High BP; 1 fall; 2 eTOH

It’s shameful the way we ignore and neglect our old folk and I have said this again and again over the years. Nothing will change because there isn’t the will to do anything. Social Services in this country fall way below the standard expected of our long-time tax-paying, war-fighting elderly and it’s very frustrating.

The first call of the night, when there are no ambulances available due to the demands of London’s drunken revellers, was for a 91 year-old woman who had pressed her Careline alarm. I arrived to find no access because, even when I pressed all the buzzers for the block of flats, nobody would let me in – everyone in the building seemed to be out. I was concerned that the lady was trapped behind locked doors because she didn’t answer me initially either. Control arranged for the police as I waited outside in the minus zero temperatures but luckily someone came out and I let myself in and took the lift to her flat.

She didn’t answer the bell or my voice when I shouted through the letterbox but I could hear the extremely loud voice of the Careline person speaking to her over the phone system, so she was inside and alive at least but what was stopping her from opening the front door? After a lot of repeated commands from the phone voice for her to let me in, she eventually scooted into view behind the frosted glass of her front door, using a Zimmer frame to get to me.

I got her back into the front room and she seemed fine but it became obvious almost immediately that she had a major problem with her hearing. She wore an aid but the battery was flat and she had no spare, so I spent almost an hour in her house writing messages on a pad to communicate and trying to get transport for her because she was very vulnerable and could not stay there on her own.

She had no TV and no radio – nothing to listen to in fact. Her bedroom was a mess and I don’t think she used her bed at all. She had no food in her fridge and the place was generally untidy, with her less than 5 foot frame in the middle of it. She was a tiny, lovely lady who was abandoned by society. Her 'care' records stated that she didn’t take her medicines (her BP was high as a result) and she was frequently visited by police, fire and ambulance personnel because she pressed her button for help, couldn’t hear it when it was there and had to have her door broken in each time. Her flat was littered with hand-written notes from various people who’d found it impossible to get her to hear them.

Social Services had been told about her but nothing was done. Her own sister-in-law apparently didn’t care (according to a friend who phoned when I was there) and she had no immediate family left. This poor, smiling deaf woman was very alone and very vulnerable. I would have adopted her as my granny if I could.

The crew arrived after a long wait and she was taken to hospital after I’d made sure that Social Services were alerted, yet again, to her plight. I don’t expect miracles.

A few false alarms later and I was stuck with a 25 year-old man who’d fallen down metal steps at work and hurt his leg. It didn’t look badly damaged but he was in some pain, so I gave him entonox, which instantly helped. In fact, he became wildly drunk on the gas and I wondered why it was having such an effect on him. It wasn’t until I considered the weather outside and the fact that the cylinder had been sitting in the back of the car that I remembered something important about entonox – the gases (nitrous oxide and oxygen) separate at minus four degrees, leaving nitrous oxide at the top. No wonder he was off his head. I quickly mixed the gases back together by rotating the cylinder an few times. It won’t have done him any harm i the short period he was breathing it.

I waited for more than 30 minutes until I got a SJA crew and they splinted him and took him to hospital. He was still grinning like a Cheshire cat when I left him in the back of their ambulance.

It started snowing, as predicted for the night but somewhere along the way the temperature lifted and the fluffy white stuff became sleet. So, obviously I was sent to a 25 year-old drunken female. She was in a doorway with her friends and the first words to greet me were ‘she doesn’t really need you’. The doormen of the local club had called us, so after checking that the drunken woman was just that and no more (she was fit enough to go home by taxi), I asked the door staff if they could please try not to call us tonight if the person they were concerned about was just inebriated but could still walk. We were far too busy for this and sometimes they just call to clear human debris from their club’s vicinity. We are already London’s great human garbage removal service, so it’s time to give us a break for people like my last two patients, I thought.

Drunken women all over the place as usual. Why can’t they get the point and control their drinking? This one, a 25 year-old found ‘collapsed’ in the toilet of a club at chucking out time, was lolling about on the settee when I got there. She was drunk enough to be a nuisance but sober enough to know she was. I got her to the car after her fifth appeal for me to give her ‘just one more minute’- which is a standard line given to us by drunks who want to go to sleep and not be harassed by yellow jackets.

I offered her the chance to go to hospital to sober up but she asked me to take her home, miles away in north London instead. I told her I wasn’t a taxi and she opened her door and stormed off, only to return a few minutes later, climb back into the car and say ‘please take me home’. In fact she pleaded over and over to be taken home but the best I could do for her was to drive her to Kings Cross station and drop her off – at least she was a few miles closer to home and she would be less vulnerable, hopefully.

I went into Leicester Square on the hunt for good coffee and warm apple pie (which I found and consumed) and I had an epiphany as I sat in the car watching a young man vomiting his alcohol into a wheelie bin (a least he held the lid open as he threw up inside it). Wouldn’t it be cool if we could fine every drunk, say £50, once they’d sobered up in hospital, if an ambulance had to be called for them? The money could then be given directly to the elderly of society – the ones who are lonely and vulnerable, like my first patient tonight. I don’t think there’s a drunk in the country who’d object too strongly to that. If I had the time and support, I would campaign for it. Instead, the reality is that they get me, ambulances and ‘Booze buses’ laid on especially for them... for free. And old people get nothing but broken doors and hand-written messages.

Be safe.

Tuesday, 15 December 2009

A Urea moment

Day shift: Four calls: One by police van; one by car and two by ambulance.

Stats: 1 DIB; 1 ? Renal problems; 1 ? Flu jab reaction; 1 Chest pain.

Most of the 26 year-old males I go to claiming difficulty in breathing are not and are probably stressed, hyperventilating or just plain over-reacting but the young man I visited at the medical room of his college seemed to have a genuine problem. He had been suffering shortness of breath with a localised chest pain for a few days and the events leading to his condition today seemed to have stemmed from a recent chest infection he’d suffered. On the face of it, he looked like he was hyperventilating... and he was but it wasn’t an emotional response, it was a physiological one. As soon as I touched his hand I could feel that his body was distressed – he was sweaty profusely through the palms.

He was a tall, thin young man who exercised and went to the gym regularly. He had clear breath sounds when I listened but they were somewhat diminished on one side, quite low down and that led me to a possible diagnosis for his condition – spontaneous simple pneumothorax. It’s quite common in young men and isn’t necessary life-threatening but he’d need to go to hospital and get an xray done to confirm it. He may also have had a new infection but I doubted that.

The longest call of the day (it took two hours to get done) was at a police station, where a 60 year-old man was being held in custody for assaulting two police officers the day before. The Forensic Medical Examiner (FME) had requested an ambulance and instructed the police that the man must go to hospital because of his highly agitated state but when I arrived and was handed the doctor’s letter, it said nothing about the man’s health or why he needed to go. On the basis of a doctor’s demand alone, I had to ascertain whether the man in the cell had capacity and could therefore refuse to go (which is what he’d been doing apparently).

I was introduced to him through the cell door hatch because the cops deemed him too dangerous for me to get near. He shook my hand and then sprayed me with his saliva as he shouted answers to my questions. I caught some of his drool in my mouth and I silently hoped he didn’t have anything contagious except a cheery outlook on life. He refused to go to hospital and I was happy to oblige until he told me he had regular dialysis, three times a week; Tuesday, Wednesday and Saturday. I checked my brain quickly and realised that today was he had to go and get his treatment. Not only that but I wasn’t sure, given his temperament at the moment, if he’d had it on Saturday. This could lead to significant complications, including the behaviour I was witnessing – he was violent, aggressive and almost psychotic.

The logistical problem I faced now was how to get him to his dialysis unit and whether they would accept him like he was (I doubted it and thought he’d have to be sedated). An ambulance was out of the question and I got the cops to agree to take him in their van, with me as company for him in case something went awry. I had to listen to him rant, swear and repeatedly refer to me and the cops as ‘Babylon’ all the way to the hospital. Then he had to be dragged from the van (just as he had been introduced into it), cuffed and struggling into a wheelchair and all the way through the very public (shocked faces and gasps of disbelief) areas to the lifts. Four police officers accompanied me, including two in territorial suits, less the body armour and helmets, so it looked like we were bringing a dangerous murderer in for treatment. He continually screamed and shouted at us, threatening to kill us and demanding to be let go. I felt we were being cruel to him but we had no choice.

The nursing staff, who knew him, told me that they’d never seen him behave like this and that it was entirely out of character for him. So, something was going wrong with him, mentally or physically... or both.

82 year-old men are normally retired, living the rest of their lives in quiet calm, gardening or in a home (shoot me before that happens to me) waiting to die but my next patient was still behind a desk at work. He’d had his piggy-flu jab in the morning and then felt worse for wear later on. It’s possible he was having a mild reaction to the anti-viral or he may have other health issues. He was pale and lethargic with abdominal cramps and nausea – his vital signs were normal but his ECG showed a Right Bundle Branch Block (RBBB) but he already knew about that and he told me he’d had it for years,

I took him to hospital in the car and, although he didn’t felt any better during the trip, he didn’t feel any worse either.

Just as I was about to go home early, after having covered the east area for a few hours as a favour to the sector, I was turned back to go and deal with a 43 year-old French man with chest pain that had bothered him for the past 24 hours. He was walking out of his workplace with a suitcase when I arrived, making his emergency call and the subsequent response look like an ironic bit of silliness.

He was normally fit and well and travelled by air regularly but none of his flights were long-haul. His chest pain sounded more musculo-skeletal than cardiac but it was best to get him into an ambulance and taken to hospital rather than risk it. So, I waited with him for another fifteen minutes and completed every check I could get away with in such a public place. The ambulance arrived and the crew took him to his next destination.

I got home a little later than planned but that’s par for this little course I play on, so I’ll get over it and I’m sure that my colleagues on ‘the desk’ will make up for it next time.

Be safe.

Monday, 14 December 2009

Not so green and not much peace

This is the melting ice bear on Traffy Square - read all about it on the WWF website at This, in my mind, is how to make an effective point.

Day shift: Seven calls: One treated on scene; four by car; two by ambulance.

Stats: 1 Gammy leg; 1 ? Dislocation; 1 ?PE; 1 Faint; 1 RTC; 2 Head injuries.

Trafalgar Square is playing host to a number of things in the run up to Christmas. The tree is there, of course – and it’s been straightened up at last (probably as a direct result of this blog); there’s a melting Polar bear on show (which isn’t melting fast enough) and the main attraction but only because it’s littering the area below Nelson’s Column, is a scattering of coloured tents containing various bodies, all contending to save the world. They call themselves ‘The Climate Camp’ and they are okay but I prefer the bear.

The first call of the day was to attend a cantankerous 70 year-old man who had wandered in to the ‘camp’ and made himself at home. He was given a cup of tea and lots of sympathy by the people there. He lived rough and had a pair of disgustingly infected legs – the direct result of long term abuse of his health. The legs became the focus for the campers and so they called an ambulance and I was asked to check him out. For the entire twenty minutes or so that I was there, he subjected me to a rain of spittle, verbal abuse and reflected anger. His legs were so bad that it was entirely possible they’d fall off if he stood up but he wasn’t interested in my help, except to demand that I bandage them.

I put a couple of dressings on the worst areas – a completely ineffective treatment but it was all he would accept – and tried to persuade him to go to hospital. ‘I don’t want your medicine’, he shouted in my ear. ‘I don’t believe in Western medicine, I use Eastern medicine’.

The campers stood around looking concerned and neutral at the same time and one of them, a bearded fellow that, in my youth would have been labelled a ‘Hippie’, spoke to me about how worried they were about him but that they didn’t know him. ‘So, he just came in here but he has nothing to do with you?' I asked.

‘What do you mean? We are a collective’, came the reply and I found myself being looked upon as if I was the enemy of something or somebody. I had no idea why my question had aroused such suspicion or why such a large chip had been thrown onto his shoulder out of the blue, so I decided, as he began his lecture about ‘us’ and his collective, to walk away from him and seek out an adult. I went back to the lady who had originally spoken to me about the man with the dodgy legs – she was standing with a police officer.

‘I’ve put dressings on his legs but keep an eye on him and if you need us again, just call us back’, I said. Now, I thought this middle-aged lady was a sensible type but she said something that made me realise I might be standing in the middle of a mini-conspiracy.

‘We have a policy of not contacting the authorities if we can help it.’

‘Authorities?’ I replied, rather taken aback, ‘Madam, we are the NHS – not the police.’

I know we have to save this planet of ours and I am 100% behind the efforts to do so but protests that come in this form – where everyone is the enemy if they don’t share the same opinion with an aggressive passion and where every uniform is seen as authoritarian, puts me off the very cause being fought for. The best way to dissuade the majority of law-abiding people about any argument is to act and talk like that. I got abuse and arrogance and all I did was show up and try to help. I didn’t even get a cup of tea!

A 25 year-old building site worker fell from some steps and twisted his knee, repeating an injury that he’d suffered a few days earlier but this time it looked like he’d dislocated the joint. I gave him entonox, man-handled his leg so that the knee was more aligned and got him into the car for the short journey to hospital.

The next call sent me to a private GP surgery in Poshville, London, W1. A 77 year-old lady had chest pain and shortness of breath and her doctor decided she might be suffering the effects of a Pulmonary Embolism (PE), which can be life-threatening. I didn’t realise that the GP had called 999 and asked for an ambulance to take her to hospital then promptly left the poor woman standing in the corridor while he attended to another fee-paying patient.

The receptionists had no idea what was going on when I arrived, then I was taken upstairs to the doctor’s surgery, only to be told that the patient was downstairs and had been abandoned there. The doctor didn’t even have the courtesy to come and give me a hand-over. I was simply a taxi for the patient and to make matters even more infuriating, the patient thought I was going to take her to a specific hospital miles away!

I’ve said it before but some doctors are as abusive of the ambulance service as our ‘regular’ callers – especially in the private sector.

At a coach station an 84 year-old lady became unconscious and I was convinced I was running to a possible suspended but when I got there I found her sitting with her friends, smiling and chatting. She had been unconscious, according to her buddies and the station manager, for about ten minutes apparently, so I was concerned that something serious was going on but the lady didn’t realise it. She looked well enough, if a little pale and she was animated and aware. We shared a few jokes as I got on with the obs but I’d already decided that an ambulance was more appropriate than the car. Her medical history included a brain aneurysm so there was no way I would risk less than full monitoring.

She’d had a few ‘turns’ recently and, although she wasn’t worried, her friends were and when we did her ECG on the ambulance, it revealed a first degree heart block – something she could live with but that could also explain her recent faints and spells of unconsciousness, alhtough this is rare, so she was taken to hospital.

In the west a motorcyclist braked hard and skidded under the wheel of a taxi as it u-turned in the road. This is a relatively common type of RTC involving these two vehicles and I’m not sure if it’s the taxi drivers or the motorcyclists who are to blame but it won’t be long before I go to one of these and the biker is dead or dying after being crushed. This 45 year-old guy was lucky, however and got away with a leg injury after sliding along and breaking his visor on the road as he fell. The impact would have been moderate because it wasn’t a fast road he had been riding on. The cab was relatively undamaged and it looked like only the front wheel had taken the brunt of the force.

A crew was on scene, as well as another FRU, so I was just an extra pair of hands and it took us no more than twenty minutes to assess, collar, board and move him onto the back of the ambulance.

A cheeky little 6 year-old girl whose parents were abroad and who was being taken care of by her auntie, fell from a playground roundabout and got clunked on the head as it spun round. She had a small cut to her scalp, which had bled dramatically enough for an ambulance to be called. The bleeding was under control when I got there and she was bundled into the car with a carer (she was with a school group) for the trip to Children’s A&E.

Compared to the last call, the only difference here was the age of the female and the mechanism of injury – oh and the drama being played out as a result. Another fall and another scalp wound – this time, it was 21 year-old woman at a college who’d been sitting on a cantilever legged table with her friends. When her mates got off, the table became unbalanced and she was propelled backwards, slamming her head against another table as she fell to the ground. When I walked in the tables had been labelled by the staff of scene – ‘Do not sit on these tables’, the signs read. Horse, door, stable, I thought.

The cut to her head was minute; almost microscopic, and she hadn’t bled much, if at all but she was lolling around in her friend’s lap like a wounded animal. Clearly this young lady had never been exposed to injury beyond a broken nail before in her life. I had to ask her repeatedly to lift her head so that I could talk to her. If her girlfriend hadn’t been there I bet she would have been absolutely fine – she was getting a bit old to be milking sympathy.

This injury could have gone home and helped itself to recovery, or taken itself to A&E but no, in today’s enlightened intelligent society, it’s all about service, so she had to go by ambulance. She got the car though because I was not going to get a hard-working crew down here for this.

She continued to feed herself with the human kindness pouring from her friend all the way to hospital and when we got there and I was booking her in, her mate came over and interrupted me to let me know that she (the patient) had a headache and was in ‘real pain’. The hope being that I would drop everything and rush over with heavy-duty analgesics. Meanwhile, fifty other people sat waiting with their own ‘real pains’ and Resus was full of critical patients, some of which were actually in real pain.

Be safe.

Thursday, 10 December 2009

Drugs are bad

I dont think they'd mind the publicity...I thought you'd want
to use your imagination here though :-)

Day shift: Seven calls: one assisted-only; three by car; three by ambulance.

Stats: 1 Drug o/d; 1 Abdo pain; 1 Chest pain; 1 Dizzy spells; 1 Head injury; 1 Cardiac problem (probably drug induced); 1 Unwell adult (probably not).

A beautifully mild, clear-sky morning and an early job to get me going for the day. A man was found ‘fitting’ in a car park basement by a driver who’d just parked up and when I arrived and was taken down to meet my patient I could tell that he was on something – probably GHB. His trousers were around his thighs, exposing him to all and sundry and his mobile phone lay at his feet, alongside a bar of chocolate.

He writhed around and made smacking sounds with his mouth, alternating with rapid clicking noises as his head moved from side to side. The MOP was leaving me to it and I couldn’t get anyone by radio or mobile because there was no signal, so I had no idea how long an ambulance would take or if one would come at all. I was stuck in the basement with a dolphin.

I asked the MOP to call 999 again when he got to the surface and he must have done because, thankfully, a crew arrived ten minutes later. There was nothing I could do for the patient and he was stable enough but I needed the extra hands to get him out of there. He was off his head a bit on drugs and would dry out eventually.

Half way through washing the car (so one side is still dirty) and I am sent on a call to a tube station around the corner for a 24 year-old female with abdominal pain. She is fine when I get there; it’s all getting better and she felt a bit faint on the train, so no worries. She might be pregnant though because she couldn’t definitively tell me she wasn’t and she’s not on any form of contraception. She doesn’t want (or need) to go to hospital, so I give her two bits of advice before I let her go back on the train – (1) get a pregnancy test done if she’s late and (2) try to get a seat on the train this time by pretending she is pregnant. Well, you never know.

Normally 18 year-olds with chest pain turn out to be nothing more than hyperventilating souls and I can quickly sort it out but this call to a female working at a beautician’s training centre, had a very recent history of palpitations requiring ablation treatment to resolve, so I conveyed her in the car with a colleague. Her pain was gone by the time I arrived but it may be significant, so best she is checked out. I thought my MRU brothers would be interested to learn that I had two beauticians in the car with me and so I had a wee smile on for the trip... and I was offered half price nail work, so it was a good call all round.

The next call was for chest pain but he actually only had dizziness when standing and when raising an arm. However, the 51 year-old man’s medical history included a heart attack last year in which, according to his doctor, 25% of his heart muscle had died and his blood pressure had dropped to '15 over something', which, considering he was conscious throughout, is unlikely – he either misheard the doc or someone needs to go back to med school.

He was resistant about going to hospital but, given his medical history and his current new episodes of headiness, it was wise to accept the crew’s offer.

I parked up in Mayfair, as you do, and wound down my window when something caught my ears – a cheery, very tuneful whistle was coming from somewhere. It wasn’t a song-type whistle, wolf-whistle or habitual whistle, it was like one of those warbling hi-lo things you often hear on Disney cartoons and films, so obviously I thought I’d be seeing a Christmas stall or something similar. Instead, I located the person making the sound – he was walking down the street, with all the other folks, ignoring everything and everyone but whistling in perfect tune as he went, until he saw something in a shop he obviously liked and he stopped, shut up and went inside. It’s not funny unless you are there I guess.

Anyway, after that little excursion I was off to see a 27 year-old woman about a bump to her head. She fell at work, landing on concrete with just her forehead to stop her descent. She had a huge, watery lump in the middle of her head and she told me she’d heard a ‘crack’ when it happened, followed by the feeling of liquid rushing into the lump that was forming. Quite creepy when you think about it. She wasn’t knocked out and she was fine otherwise – just a bit wobbly on her legs, so I took her to A&E in the car, with a colleague in tow.

A 30 year-old man in a van had ‘shaky limbs’ and felt generally unwell. He has a history of heart murmur but had also been drinking the night before and taking cocaine. This, I suspect, was the cause of his current problem. His ECG was anomalous; Tall R waves, U waves and PVC’s all over the place and his blood pressure was high at times. Considering his age, he was on his way to bigger health problems if he didn’t knock the drugs on the head.

Finally, after a stint of standby in Trafalgar Square, an 83 year-old gentleman collapsed in the doorway of a shopping arcade and confessed to being a diabetic with kidney and heart problems, although he couldn’t specify what those problems were or what drugs he was on for them. Hmmm, I thought. Well, he went in the car because there was no reason to take him by ambulance... and he was perfectly well all the way there. In fact, he positively cheered up at hospital. I suspect he used this to combat loneliness.

Be safe.

Monday, 7 December 2009

Another skinny tree year

Day shift: Four calls: Two by car; Two by ambulance.

Stats: 2 RTC; 1 Faint; 1 Abdo pain.

The Christmas tree on Trafalgar Square is leaning worryingly to the right – it will only take a decent wind to push it over I think. They’ve put 500 white lights on it and it still looks bereft of character compared to other trees in the neighbourhood. Still, it’s free.

A RTC in the grey, rainy rush hour involving a white van and a foreign pedestrian who stepped out from between buses on a busy road kicked off the morning. Her scarf was trapped under the wheel of the van but she got away with a knock to the leg that was going to put her in hospital for about 10 minutes. She was lucky and the poor old van driver was shaking like a leaf when I left the scene – not that he should be because it wasn’t his fault (according to witnesses) but the shock of it left him reeling a bit.

The rain stops for a while and I am sent to the aid of a 25 year-old female who has fainted on the tube. This is a very common occurrence and she is in the correct gender and age group for it. So, I don’t need an ambulance and I go through the routine as usual – her obs are fine and she has recovered. She gets a copy of the PRF because she’d rather not go to A&E and promises to get herself checked out after work and I drop her off, as a courtesy, near her workplace.

Minor RTC’s shouldn’t really tie me up for long but because the police were being so thorough with the motorcyclist who collided with a taxi, I waited for almost an hour before taking the patient to hospital. He only had an injured wrist and a cut lip, hardly worth the trip but he would probably need an assessment to appease his insurance company.

A certain supermarket chain needs to sort its first aid cover and the attitude of those trained to be first aiders out before they have a major problem. A staff member with abdominal pain and a history of Ovarian Cyst collapsed in agony and one of her colleagues was on hand to call an ambulance. When I arrived, not only did I have to find my way to the Customer Services desk because nobody was outside to guide me but when another member of staff was asked to show me where the poor woman was, she said ‘No, you show him’, as if I was a visitor looking for the loo. This kind of disgraceful behaviour is unacceptable and makes the company look shoddy and uncaring. We are an emergency service and that means you let us know where we are needed; don’t call us and then wander off so that we can find our own way around your store.

When I finally managed to get someone to guide me to the patient, the 31 year-old lady told me that the first aiders in the store ‘didn’t care’ and wouldn’t attend her. This is their duty – that’s why they train to be so-called qualified first aiders.

I spoke to the store manager about this and he was genuinely shocked that nobody had even told him that a staff member was ill. She would have been taken to hospital, disappeared from work and he wouldn’t be any the wiser. Poor show I think.

An ambulance arrived to take her away, despite my calling in and advising Control that I didn’t need one.

The rest of my day was taken up with the FRU Co-ordinator’s conference – an annual(ish) event held primarily to discuss concerns over issues that have arisen among the fast response pilots all over London. There was also an opportunity to do some training and updating. It was a fruitful meeting and things should change for the better, in terms of how we are despatched, the vehicles we use and the way we are utilised, in the near future. And I got a free lunch and they say there's no such thing...

Be safe.

Saturday, 5 December 2009

How clean is your child?

Harry is doing well and he should continue to do well because we won't be molly-coddling him to protect him from his natural environment, read this:

This is something I've been saying for about fifteen years and have had lots of discussions about with school staff around the country. Asthma, anaphylaxis, skin problems, etc. are all, more than likely (but not always), attributable to our lack of respect for dirt and the fact that we live in a dirty world, not a clean one, so trying to scrub the planet into sterility is killing mankind.

There are individuals out there who will justify their obsession with cleanliness by citing the various germs that are around and how dangerous they can be, especially to our children but the point they miss is that those germs have always existed in, around and on our bodies and not always to the detriment of our survival - maybe keeping your child away from them when they are developing an immune response from age zero is not the wisest way of dealing with the issue.

This scientific debate will probably not result in the total reversal of narrow-minded stupidity and unfounded fear but it may help those of us who have always seen the logic of this to understand that we can continue with a common sense approach to our 'dirty earth'.


Thursday, 3 December 2009

Down the drain

Night shift: Eight calls: One by car; Two Assisted-only; One treated on scene; Four by ambulance.

Stats: 5 eTOH; 3 Falls; 1 Chest pain; 1 Dislocation

I’m furious already and I’ve just started the shift. It’s Thursday night and that means we get very busy until the weekend finishes but we also have the added bonus of Christmas coming up and, notwithstanding the normality of pseudo-religious connotations for peace and goodwill (cos I guess it exists somewhere), we have the usual regular ‘players’ coming out of the slime.

I was asked to pick up a MRU colleague so that he could be returned to his bike and I got stuck in very heavy traffic on The Strand. I wasn’t going anywhere and when a call came in for a 50 year-old female who had DIB I tried to get going on it. This was an Amber call and I found that odd because DIB should be a category A, although I’m sure there are criteria which reduce it’s importance somehow. An update told me that she was now unconscious and that was very ominous, so I tried even harder to cut through the traffic; but even using the other side of the road, which I normally do, was out of the question as it too was packed solid and not moving.

I was then updated by radio and told that the patient had suspended (gone into cardiac arrest), so I began working seriously hard to get through it all. I climbed onto the meridian pavement and drove along it until a lamp post stopped me going any further, so I was forced back into the dead-stop traffic. There was no way I was going to make this call in time to save anyone. Hopefully an ambulance was there or on its way but it didn’t sound likely to me.

Then I saw a motorcycle colleague attending to a ‘collapsed’ man in the street – I’d heard this call go out to him earlier and he was standing over the man with a PCSO, so I stopped, rolled down my window and asked him if he was dealing with anything important. I knew from the look of it that he wasn’t, so I suggested a swap – he could run on the suspended patient and get there much faster than me. And that’s what we did; he got going and I stayed put, trying to keep an angry drunken Lithuanian man out of my face as he rolled around in pretend agony demanding an ambulance.

When the crew arrived, he was taken to hospital and that, I’m told, was his second trip in today. Now I don’t care how you judge me for this because I, like many others, am simply fed up with people coming into the country for the sole purpose of abusing our generosity and kindness. The cost of this man’s stupidity and selfishness may go beyond our taxes – he may inadvertently be responsible for someone’s death, it’s as simple as that. I wouldn’t want my mother to be left dying on the front room floor whilst ambulance crews, and particularly fast response units are tied up with rubbish like that. He drinks himself into his illnesses and yet he gets a Red category call and thus priority. Some poor woman can’t breathe, is given an Amber, so we can get there in 19 minutes if we want, and then promptly stops breathing, raising the category but all too late. When are we going to implement human intelligence into these calls and make sound clinical decisions based on training and experience? The chances of getting it wrong cannot possibly be greater that the mistakes made by the machines. If a call comes in for a 'collapsed' person and there is even a hint that alcohol is involved, we should consider the balance of what else is going on, so one collapsed drunk with a motorcycle responder on scene and one woman having difficulty in breathing and nobody available - re-assign the priority, like the cops do.

Rant over.

They send me south next because there was nobody available for a 57 year-old drug addict who was experiencing chest and abdominal pain – this was a Red call of course; you only have to mention your chest in any call and it’s virtually guaranteed that the machines will scream in panic and issue a category A. He had muscular pain and I guess it was all part and parcel of his decades of self-abuse. His cousin let me in to the flat and I thought he was the patient’s doctor – he looked so respectable; bespecled and smartly dressed. It threw me for a second.

The unwell man, a long-time morphine addict, was lying on a filthy sofa in a typically filthy abode. No drug addict keeps a clean house – it’s simply not a priority. His pyjamas were smeared with historical faeces and he looked like he hadn’t eaten for months. His methadone wasn’t helping apparently and he wanted me to give him...guess what; morphine. So I said no.

What he did need, however, was glucose because his BM was low, fluids because he was very dehydrated and metoclopramide to stop him vomiting his recent red wine dinner up.

He was in very poor health and, judging by the look of him, he didn’t have long to go. The pain in his side was a secondary problem compared to his general health and I could see why doctors simply gave up on addicts who’d come this far. A doctor had visited him earlier, obviously seen him in this sorry state and said she couldn’t do anything for him. Now the crew and I were here, we had no choice but to deal with it and I really wanted to try and make him comfortable but his future is bleak and others are dying and in pain, through no fault of their own, so I can’t reconcile this at all. I just treat and go.

‘Morphine’s good for me’ he said after my third refusal to give him the drug. I wanted to say, ‘Yeah, I can see that’, but I didn't.

As the night progressed I was sent to deal with a 50 year-old man who’d drunkenly fallen down steps on one of those party boats on the Thames. To be fair to him, he was no more than cheerily drunk – not irresponsibly wasted, so I guess his tumble was just one of those mishaps that occur when judgment is impaired. He had a history of brain tumour and his caring friends were concerned that there was a connection but I highly doubted it as he seemed fine apart from a nasty 2cm incision on his forehead. The skin was split deeply enough for a trip to A&E and a couple of stitches but he was resistant to the idea and it took all of my persuasive powers to convince him to go in the car. He’ll feel better about the decision in the morning I expect.

A patient for the booze bus next – he’d fallen as a result of having a proper skin full and the 'bus' was in front of me near the scene, so I asked if they could do the honours. His head was cut above the eye but he was okay otherwise so off he went to drunken heaven with the drunk-bus heroes.

After a quick coffee at Bar Italia in Frith Street, where all of the emergency services (armed and unarmed) go, I sped off to Charing Cross Road to help with a drunken 20 year-old female but she was beyond it. She was abusive and annoying, as was her potty-mouthed brother but they meant no harm; alcohol was speaking on their behalf. You might know what I mean - they swear, then istantly apologise to you for doing it, attempting to hug you as if you are their best friend. A crew just happened to be on scene with another drunken female, who’d fallen asleep in the underground platform. She was much more pleasant and continually smiled, although she wouldn’t give us any information about herself – off she went to hospital and the other one was left to the police.

A 30 year-old alcoholic woman fell through a half-open drain (see above) and sustained a nasty wound to her leg which bled through her jeans but which she adamantly refused to let me see or treat. She also chipped out her two front teeth on impact with the road and even when the police officer explained to her that she needed to go to hospital, as I had advised, so that she could be treated and then have evidence for a possible claim against the council, she refused. I was surprised to say the least but maybe I was misjudging the poor woman.

Her can of lager was of more importance than the prospect of compensation, possibly to the tune of a few thousand pounds. Anyone else would have been jumping at the chance to get some money for an accident like that. So, in this age of ‘where’s there’s blame, there’s a claim’, it was quite an exceptional thing to witness.

She wandered off after I had attempted, time and time again, to get her to come with me to hospital. She had sharks teeth and a decent wound under her jeans (which I had to dress over the clothing just so she could get on a bus home) but she didn’t want to know. All she did was cry and cry... oh and then go back to pick up the can of lager she’d left on the pavement. I think she was pregnant too but I didn’t ask.

This is the time of year when we frequently encounter normally decent people who have imbibed so heavily (‘cos it’s Christmas time) that they become rude animals with no respect for themselves or anyone else. The 30 year-old lady I was asked to help was asleep on a petrol station forecourt – oblivious to the comings and goings of traffic around her. The station attendant called us and rightly so as she was extremely vulnerable. Her handbag was lying next to her with her mobile phone and purse sitting on top of it. She could have lost it all in a second if someone had been nasty enough to consider robbing her.

She was obnoxious to begin with and refused to let me help her, so the police arrived and we spent the best part of 30 minutes trying to get her to go home. The first black cab the officer flagged down refused to take her as far as her address so I suggested a private taxi which had just pulled up into the station. I’m not sure of sending people like her in these cars but if black cabs are going to refuse to go distances then this is probably why they are being overtaken by private hire firms – sorry but if you won’t pick people up in the rain, take them ‘over the river’ or you have a preference for clientele, then the public, who have a choice, will go elsewhere.

She managed to stand herself up and flirt with the police officers and myself until we could get her to draw cash out for the fare – then I escorted her to the taxi and off she went but before she left, she sobered up enough to say this ‘you shouldn’t be wasting your time on a w**ker like me, I’m shameful’. Well, at least she could see what was going on from my perspective, although I didn’t think she was a w**nker. In fact, I didn’t think women referred to themselves like that at all (call me old fashioned).

Some calls are interesting for tame and mundane reasons. I was asked to attend a Greek man at a hotel that had ‘locked’ his knee when trying to stand up. I gave him entonox and straightened his leg whilst manipulating the patella gently so that it slid nicely back into its natural place. The click was audible across the hotel lobby I think and I felt it go in. The pain he felt initially was overtaken with relief and he was soon able to stand up and walk around on it – the more he did, the better it would be for him anyway. I advised him to consider hospital in case it slipped out again but he declined.

This sort of thing is outside my remit as a paramedic I guess but I’ve had a lot of training and experience with dislocations of this nature and sometimes just a little bit of movement is all it takes, so long as you know your anatomy well enough. I got a nice warm satisfied feeling out of doing that and it only took ten seconds, so no ambulance, no A&E and no hassle for anyone. I mean, all I'd done was straighten his leg for Pete's sake.

Further into the night, as 4am approached, I went to yet another drunken female but this one claimed DIB, or at least the person who dialled 999 did. She refused to go to hospital and rightly so because she was just drunk. The 25 year-old admitted that she was bipolar and this became evident from her erratic and changeable behaviour but then alcohol has the same effect; every drunk is bipolar to me.

After a lot of debating back and forth with her friends, who she loved and hated in equal measure during their conversations, I agreed to take her (with her mates) back to their hotel so that she could sleep it off. It was either that or get the police to prise her from my car because once she was in the back, she wouldn’t budge – even for a taxi that had been called for them all. It was a non-eventful journey and she will forget about the help I gave her and that’s okay because we are all used to such disaffection for our roles in society, especially when we are against a tidal wave of alcoholic indifference.

During the shift, I went into Resus and asked about the cardiac arrest lady from earlier. I was told that she died.

Be safe.

Wednesday, 2 December 2009

Damp squibs

Night shift: Six calls; one hoax; one false alarm; two by car; two by ambulance.

Stats: 1 Mental health issues; 1 Head injury; 1 Bumped elbow; 1 Allergic reaction; 1 Dizzy woman.

The heavy rain and consequent stupid traffic caused me to be late tonight and so I’d barely started my VDI when the first call nagged at me from the screen in my car. Apparently a 72 year-old female was ‘not responding’. This means she is either dead, dying or neither, depending on other factors. I looked at the details and made an assumption, based on experience - she was not dead and I wouldn’t find her dying.

I arrived to find her lying on the floor of the flat with her family around her. She had a history of depression and refused to open her eyes or play the game at all. She wasn’t ‘non-responsive’, she didn’t want to respond. She had issues that neither the crew (who arrived shortly after me) nor myself, would ever be able to resolve, so I left them all to it and ‘greened up’ for the next one.

Later on an assault call left me ambulance-less and standing with police, a 22 year-old Lithuanian with head injuries and his mate, in a cordoned-off area as I pondered the likelihood of seeing a crew. After confirmation from Control that I would have to wait, I made the only decision sensible when there was a fully conscious young man sitting in the road-soaked road – I’d take him to hospital in the car with a police officer to accompany him. His injuries were not life-changing but he’d been batted pretty hard a few times with a bottle that hadn’t broken, making the mechanisms a little more significant. His scalp had been torn open in two places but his skull seemed intact. He hadn’t show any outward signs of brain damage and we’d been waiting in the rain for 30 minutes, so I figured it was a calculated clinical risk if it was at all.

The trip was uneventful and he got a bed in the minor’s dept., so that counted for something in terms of my decision I guess. Why we were so busy is a mystery; it’s Wednesday, it’s raining and it’s no fun out there but obviously the young and dangerous of London town don’t mind.

The young man was accompanied by a young cop who was very friendly. In fact, he was the friendliest officer I’ve come across in terms of his empathy and patience with the assault victim. Not that other cops aren’t friendly – but there is a mile of a difference in attitude when you take someone’s hand to help calm them down.

A Red2 call – generated purely because the patient was described as ‘not able to move body; semi-conscious' – for a bumped elbow had me driving north and cancelling the ambulance mentally and then again in reality when I got there. The 62 year-old woman was sitting on a sofa with her family gathered around in sympathy. She had knocked her elbow on the door handle and the pain, caused by the nerves receiving a good kicking, made her want to faint (but she didn’t). If the system really believes that this type of injury, even associated with a bit of ‘wooziness’ afterwards merits the same category as a potentially dying patient, then we are all in serious trouble. No wonder there aren’t enough ambulances to go round.

I left her at home with her family, confident in my abilities to determine her prognosis without tying up an A&E department by taking her in because I feel doubtful in some way. It was what it was – a bumped elbow; it’s that simple.

A 51 year-old lady with a positive allergy to tomatoes ate some peanuts tonight and discovered she was also allergic to them. So she met me at the door of her apartment block, wheezy and puffy, feeling a bit rough as a result. The crew was on scene within seconds of me so I got no further than confirming that her throat was swelling but that she was in no imminent danger.

The next call, for a 48 year-old man with ‘stinging chest pain’ was a no trace because he’d made the call from a phone box and obviously decided to leave and go home... or somewhere else. When another crew asked me if I was on a 'tight chest' call, made in the same area from a different callbox, I knew we were dealing with a hoax caller. This dangerous game can tie up a number of crews in one location for hours, leaving less resources available to deal with genuine calls. We get idiots doing this to us every so often and they really don't care what the consequences of their actions might be. I doubt they'd care if there own mother was the one being put at risk. They truly are life's losers.

And to ensure I went home happy and contented, I was sent a last-minute call south of the river for a 71 year-old woman who was 'dizzy'. She was packed and ready to go and there was no ambulance available (of course there wasn't - that's why I was sent). This job was going to make me late home and I would have to race to the Euston Road if I stood any chance of returning free of charge, otherwise going home was going to cost me £8. So, either I waited with her until an ambulance arrived, which she didn't need because all she'd suffered was a minor dizzy spell, like we all do, or I could take her myself in the car and save myself an hour of waiting. It all sounds seflish, I know but, as I said, this was no emergency (an Amber1) and sending me on it so late in the shift was a little bit naughty, considering I have another night shift to do. I suspect it had more to do with clearing calls at the end of someone else's shift than it did anything else. No wonder morale is low and feelings run high between frontline staff and Control.

In the end I took her myself. She demanded I put her in a wheelchair at the hospital, even though she could walk perfectly well. I was her early-morning taxi and it cost me an hour's valuable sleep.

Be safe.

Tuesday, 1 December 2009

Car bomb

Night shift: Four calls; one by car; one false alarm; one left at home and one by ambulance.

Stats: 1 Fall; 1 Flu; 1 Vomiting baby.

I had a brand new, first day out Paramedic with me tonight and the hope was that she would get some practical experience in advanced skills under her belt. The first time out with your bag is always a little nervy and I guess a trip out in the car was thought to be the solution to this. It was, but not for the proper reasons – we had a night of nothingness and the only mishap she had to contend with was when the car decided to try and explode on us in Regent Street on the way to a call. The engine began to smoke and the clues had been there all night – the smell of burning was quite strong at times but we’d assumed it was something else for some strange reason. So, my colleague abandoned the vehicle rapidly and began to take off the oxygen and other explodable bits as I attempted to make the thing safe in the street. There was no fire but that didn’t stop the ‘go to the aid of an ambulance that’s on fire’ report going out to a Station Officer who was sent to our aid. He was, understandably confused as he drew alongside us, sitting sheepishly in the unburnt and unexploded car.

In the end, and with no solution to the problem, I drove the crippled car back to station in the early hours and got a replacement (by means of pilfering another Officer’s car) for the last few uneventful hours of the shift. It’s all fun and games out here.

The first call, to an 84 year-old woman who’d fallen, was highly entertaining. She was a lovely, chatty, almost blind woman who’d been stumbling a lot recently. She lives alone but really shouldn’t. She’s the independent type though and proudly told us of her love of penguins and her long-dead RAF brother. Sometimes there is no clinical need for us to be with someone but the fact that we can chat and get to know another human being’s life history is a privilege.

The crew took over and she went to hospital because she was genuinely concerned about her well-being and wanted to be somewhere safe.

A 4 year-old with Flu did not need to go to hospital but I could tell by the mother’s adamant responses to my questions that she wouldn’t have it any other way, so we took them in the car. The little girl had only just been diagnosed and given Tamiflu; her temperature was high as expected and she could have got over it at home with the proper care and attention. Instead she was taken to a busy children’s A&E where face masks are scary things.

Then a 2 year-old who had vomited milk while sleeping had his parents worried and we were called. This time I argued them round in favour of not upsetting him any more than he already was and letting him stay at home, unless the condition of the child, which was absolutely stable, deteriorated. They got advice and a copy of the obs.

A ‘trapped behind locked doors’ call that had us waiting with a crew for police turned out to be the chuckle call of the night. A neighbour had called 999 when she heard loud music and was unable to get a response from the flat next door after attempting to get some peace and quiet. The music continued to blare so I guess the neighbour gave up and said the person in that flat must be dead or dying to ignore such persistent requests for silence.

Seven of us went to the door once we’d gained access to the main building (the caller hadn’t bothered to stay up to let us in) and one of the officers shouted through the ‘dead’ woman’s letterbox. ‘Open up, police’, he said. The door opened immediately and a very short, wide lady made a strange and illogical demand before any of us could draw breath. Two tall, fully uniformed cops stood before her and she looked up and said ‘Sorry but can I see some ID?’ It was hilarious. The door was wide open and we all had uniforms on, so unless, as my colleague pointed out later, we were the world’s most inept burglars or had hired costumes from a fancy dress shop just to visit her at 3am, this was a most bizarre request.

Her sense of security included opening the door fully before checking who was there.
‘Is the uniform not enough? The cop asked. Obviously not because he still had to produce his warrant card, which she studied without knowing what a genuine police warrant card should look like.

She looked cagey and defensive and I think she and her neighbour have an ongoing dispute. ‘There was a complaint about loud music’, said the cop. ‘Yes but I’ve turned it off now. Can’t you hear?’ she replied. The sound of silence (except for muted chuckles from us in the background) was testament to that.

Still smiling at the audacity of it, we left the dwarf woman to go back to bed but only after the cops had gone in to check that there was nothing amiss in her flat. There wasn’t but I bet she will have something else up her sleeve for her poor neighbours next time.

Be safe.

Monday, 30 November 2009


It's that time of year again and I'm up for a Health Blogger nomination. Last year I did well and have obviously been able to get free meals and hotel stays in all the top places as a result of my new-found fame (yeah, right).

I may have left it a bit late this year... possibly too late, but it would be nice to update the little winners medals on the blog, so please click on the button and VOTE FOR ME. See you at the next movie premiere :-)

And while am at it... can you please drop a review on Amazon for either A Paramedic's Diary or The Street Medic's Survival Guide if you bought one. I'm beginning to look like a poorly-read author.

Ta very much.

People's HealthBlogger Award - Help Stuart win!

Friday, 27 November 2009

Madness and mayhem

Here's a photo (taken with permission) of a fightfighter at one of my jobs. I thought my female readers might appreciate it. And he seemed chuffed about it anyway.

Day shift: Six calls; three by car; three by ambulance.

Stats: 1 Fall; 1 Sickle cell crisis; 1 Abdo pain; 1 Hypoglycaemic; 1 Allergic reaction; 1 Festering ulcer.

More car trouble, so the regular vehicle is once again off the road and I am working with the secondary unit, which is no better to be honest. My MDT crashed on the way to my first call, which was to assist a crew who had a 67 year-old lady on the floor after a fall. They needed an extra pair of hands to get her up and onto the trolley bed, so I was happy to help. I had to imagine my way to the location though and did pretty well, considering I’m not a pigeon.

Then south of the river for a 20 year-old with Sickle Cell Crisis; a painful and debilitating condition brought about by the 'sickling' of red bloods cells in the body. When I arrived she was lying on the sofa with her family at hand. She had moderate pain from what I could assess, so I gave her a little bit of Oramorph and that seemed to work. It was my intention to take her to hospital in the car because her legs were unaffected by the crisis but a crew showed up and invalidated my very existence on the ‘Amber Car’.

Then a miracle occurred. A human being with good medical instincts started to task the calls and I solved the mystery of the lady with abdominal pain – the 22 week pregnant 27 year-old at a train station – (that one), by telling her that these things would happen now that she was pregnant and ended up taking her to hospital anyway. She was sent to the waiting area and a large black woman with (possibly) mental health issues sang loudly and incredibly out of tune for me and a few others as she stood outside her cubicle in A&E.

‘Well done, three yeses – you are through to the next round’, I said as I passed by on my way out. I like to stir things up then leave while others have to contend with any chaos that ensues as a result of my meddling.

Then I was asked to check out the condition of a 75 year-old man who’d walked into a chemist and began to ‘behave confused’, according to the pharmacist, who related the story when I arrived. The tall man was standing at a strange angle against a counter with the pharmacist and his assistant propping him up as if he was going to fall. I tried to communicate to the man but all he said was ‘I think I’m ok’ but he didn’t look right at all; very diaphoretic, weak, hardly responding and unsteady on his feet, which is why the next thing I did was virtually force him onto a chair so that I could assess him properly.

I asked the pharmacist if he knew him. ‘Yes, he comes here for his prescriptions’, he told me.

‘What does he take medicines for?’, I enquired.

‘Oh, lots of things’, the pharmacist said. I’m not sure if he thought I was asking him to reveal something covered by the Official Secrets Act, so I asked him to be specific.

‘He has meds for cardiac conditions, high blood pressure and he takes insulin’.

‘Oh’, I said, waiting for the pharmacist to get it, which he didn’t.

I checked the man’s BM and it was 1.1 – now I knew what I was dealing with and I requested an ambulance for backup because if he didn’t recover, I couldn’t take him anywhere in the car.

I injected Glucagon and set up an IV Glucose drip, the way I always do with hypo’s. The crew was with me within five minutes and I got extra hands to help out as the man slowly began to recover. His BM improved to 3.2 by the time I’d set up the Glucose and he was smiling and fully communicative by the time he got into the back of the ambulance. All good, except for one major problem in my view – I teach every pharmacist in London first aid as part of their pre-registration training and they all know that they have a legal duty of care if someone becomes ill in their place of employment but, even though the pharmacist here knew what meds this man was on, he couldn’t work out the problem nor see the solution. This is no criticism against him because he doesn’t have to be trained in first aid but if he has the right drugs (Glucagon), he could give them in order to save a life.

The man’s BM was critically low and this was a potentially serious omission on the part of a professional person, so I think, despite the basic training they receive, more needs to be done to educate pharmacists on the use of this type of drug because it’s so easy to save a life with them. This pharmacists was quite mature, so I doubt I trained him but even those that have had first aid training would probably benefit from a short session on the use of Glucagon, Epipens and possibly Narcan for emergency use. He freely admitted to me that he had no confidence because he'd never actually had to use Glucagon and didn't know how to. I shall think about this...

During this call and just as the crew was taking over from me, I was asked to rush off to another job near the West End. A 25 year-old woman was reacting to something and her throat was ‘itchy’ – she had a very persistent cough too and when I looked inside her mouth I could see her throat swelling slightly. She was in no immediate danger but she’d need an antihistamine and I only offer IV, so I took her in the car. That cough became more and more annoying as we travelled I can tell you. I was tempted to turf her out and let her get the bus.

Back to that train station later on for a drug addict who’d been arrested for (allegedly) shoplifting. His pupils were pin-point and he was trying to fall asleep, so I made a judgment call and decided he’d recently used. His favourite drug is heroin and he looked smacked out on it, although he strenuously denied this when Narcan was mentioned. During his arrest and subsequent hand-cuffing he’d offered the only illness he could think of to avoid the cops and get to the nearest hospital – he had septicaemia. Apparently his groin had a suppurating ulcer on it, no doubt a resident resulting from the constant puncturing of the skin and veins in that area. He offered to let me see it but I declined on the basis that (1) I believed him and (2) I had my dinner to look forward to later on.

When I checked his bag (later in the hospital and at the behest of the police) I found no fewer than 30 unused needles, 5 used needles, paraphernalia and a single condom... for when you get lucky after a good session with heroin I guess.

The bottom of the bag was a lake of filthy liquid from God knew where and floating around as scum was the remnant of some kind of solid food, like a big cake. On first inspection it looked like he had vomited into his bag. Whatever he’d done, the needles were all now filthy – even the wrapped ones – and had to be thrown.

I left him in the care of the police officers guarding his cubicle and walked out to the various off-tune and shouted airs from that mad black woman who was still occupying cubicle 1.

Be safe.