Choices

If you are a pigeon residing around Traflagar Square...be afraid...be very afraid.

Day shift: Five calls; one treated on scene; one by car and three by ambulance.

Stats: 1 RTC; 1 DOAB; 1 Faint; 1 Unwell adult; 1 Feeling faint.

I’m off for a while and that’s why my posts have me in note form for weeks as I contemplated whether or not to bother when I had so much more to do. I’m preparing for a major life change and it has put me off my routine. I’m also looking very closely at my career and the options that are open to me. In Paramedicine, there are few. In the ambulance service, you move up the ranks if you want (there’s no automatic promotion) but the further up you go, the less frontline you become. It’s a typically military-styled structure, designed to ensure a numerous force of worker bees and I am getting tired of it. So, I am contemplating the rest of my life.

This morning, as I sat in my car on the Strand, ready for the first call, I was approached by a street dweller with grubby skin, yellow teeth and an open hand. I waited for him to approach, knowing that he would certainly paw at my window and ask for money simply because uniforms are easy targets. I wasn’t in the mood, so I prepared my neutral face and ‘go away’ posture at the wheel. But what he did knocked me for six and I drove off after the encounter with a sense of shame and a deeper understanding of what was happening to me as a person. The disheveled man had me wind down the car window. Then he leaned in slightly, beamed broadly at me and simply said ‘Can you just start with a smile?’

Lottie joined me for her last rideout shift before going off to study medicine. I was glad of her company and she has learned a lot about how we function on the frontline and how different it is to be with the patient at the raw end of their experience before cleaning them up for the trip to hospital, where doctors (like the future Lottie) will often assume we just fetch and carry. She promises me she will use her experience to avoid such miscalculated judgment of ambulance personnel.

The first job of the day came quite late on. A 55 year-old man is knocked off his moped by a private taxi that manoeuvres to do a U-turn across a busy road. The man is lying dramatically flat in the middle of the road, helmet off and off-duty nurse at his side. ‘We need to get HEMS’, the nurse says. I’ve spent ten seconds with them and I already know that we don’t need any more drama than we presently have – the man is not badly injured (if at all) and seems to be playing on the concerns shown by the people around him.

It is important to recognize individuals who may have social problems, learning difficulties or mental health issues because their behavior may differ when they are caught up in a situation like this. The man had certainly been knocked off his little scooter but witnesses say he was travelling at about 10mph. The road isn’t fast because it’s always tailed back due to buses and heavy traffic, so I believed what they said. The man initially played the ‘unconscious’ patient but then sparked into life when the ambulance arrived and we began to cut through his clothes to examine him for possible injuries.

We didn’t need HEMS. We had everyone we needed and it took no more than ten minutes to get the man onto a trolley bed and into the back of the ambulance, out of public view. He’d get the same care and attention that every road traffic collision patient got, of course, but he’d spend no more time in hospital than the average walk-in for minor injuries. There wasn’t a mark on him and he functioned perfectly well.


Then a drunkard falls asleep on a bus (DOAB) and, as expected, the report given is ‘unconscious, can’t wake up’, so a 999 call is made and I arrive to shake the Polish man awake and send him on his way. It takes a few seconds to do and the bus driver is bigger than me, so could have done this himself but for some reason the public believe that we are being paid to take risks with potentially violent people, so I am tasked to carry out this completely non-medical act whilst, possibly, some poor patient waits longer for help. Mr. Polish man is not happy with me at all but he refrains from threatening me beyond words because it’s broad daylight and there are dozens of witnesses around – and I can defend myself.


Inside Buckingham Palace, a 19 year-old tourist faints. It’s her third faint in recent weeks, her mother informs me, but she isn’t pregnant and has no medical problems. She has been walking around all day but she’s a teenager, so that shouldn’t be a relative factor. I am quite prepared to take her to hospital in the car because she is fully recovered and the Queen isn’t keen on ambulances turning up because more traffic inside the Palace makes the armed cops nervous, so I cancel the backup. But, in recognition of my authority as a clinician and therefore able to decide what needs ambulatory transport and what doesn’t, an ambulance arrives anyway. This has happened a lot recently. The ‘Amber Car’, which is the daytime FRU that I’m running on, is supposed to convey patients in order to free up ambulances for more serious and deserving calls. Up until a few weeks ago it worked perfectly and my posts over the last six months will have demonstrated that. Someone somewhere is choosing to ignore this and now the Amber Car is reduced to clock-stopping like all the others. It’s a shameful waste of a perfectly useful resource.

As I take the patient to the ambulance, I remind her that things aren’t too bad at all. After all, how many people can go home and brag about how they got ill inside the Queen’s house?


A running call in Trafalgar Square next (and only because I was already sitting there on stand-by) and a tourist group leader – a teacher – asked me to attend a 16 year-old Italian girl who was upset for reasons unknown to anyone but herself (she was probably homesick). She’d told her mates that she was feeling faint and indeed displayed the potential for that event by adopting an ‘I am dizzy and will probably fall down at any moment’ position, mainly for the benefit of her peer group. So the first thing I did was ask them all to leave and this meant she had nobody to worry over her, except two friends and her teacher, who wasn’t worried at all in fact and agreed that the girl was simply emotional.

Nevertheless, I asked the teacher to keep an eye on her, the paperwork was done and advice was given but I didn’t expect to see them again… and I didn’t.


Every now and then, you come across people who seem to have given up on life. Such is the effect on their physical bodies by their psychological attitude that they actually become ill enough to die. I have seen this a few times over the years. My next patient was 86 years-old and she had recently undergone a double-amputation of her legs due to uncontrollable disease. Initially, according to her carers (who cared very much) she was getting back to normal but over the past few weeks she had begun to get depressed. Over the last few days she stopped eating and drinking – refusing to take anything in that was offered and she lay in bed all day and night, not communicating much, if at all.

I was called to this lady because she had suddenly stopped responding altogether and her carers were seriously concerned about her now. My attempts to get her to open her eyes failed and I knew she was deliberately sliding herself into an abyss. She was conscious and she had no immediately significant problems with her vital signs. She was dehydrated and muscularly tense when any attempt was made to move her. Even getting a line into her arm proved difficult as she seemed to resist my efforts. Eventually, she got fluids but I don’t think she cared and she remained completely non-responsive when the crew arrived and we carried her down stairs and into the ambulance.

This lady wanted to die I think. I felt very sorry for her because I put myself in her position and I could empathize. Strong, independent people react very badly to having their lives halted but they pick themselves up and carry on or they do what this lady did– they stop living altogether.

Be safe.