Major trauma

My friend got a delivery of heavy shelving recently. This is where the delivery guy decided to leave it when she didn't answer the door. She was in at the time of the delivery but she just didn't hear him. Her door opens outwards....


Two patients at once after a fight broke out in Covent Garden. Both men had been beaten up quite severely and one had been left unconscious. Both had head injuries but I was more concerned about the man who'd been KO'd than the other one, because, although he had a fractured nose and cheek bone, he was alert, orientated and responding appropriately. The other man began a slow decline from the same state to somewhere relevant to the severity of his injuries.

His skull appeared depressed where he'd been kicked or punched - probably whilst on the ground - and that gave me all I needed to divert him (and his mate) to a Major Trauma Centre (MTC), rather than Accident and Emergency.

We can take serious trauma patients to specific hospitals, where specialist treatment is immediately available. It has to be done with caution, however, using good clinical judgement or, as in the case of this man, instinct. I don't mind getting it wrong if the alternative is that I could take someone to an inappropriate treatment centre and there's a delay in their care. I think that applies to most of my colleagues too.

En route, the man with the broken nose bled all over the ambulance floor; it was difficult to stop the flow until I wrapped a dressing around his head. The other man began vomiting. I'm sure we made the right call.


I'm known for my opinion on binge drinking, especially with young people and I still believe our NHS ambulance services should not be tasked to recovering people who deliberately go out and poison themselves with alcohol. However, there isn't much option and no resolution of the problem is in sight. So, we take them off the streets and to places of safety (usually hospitals) and that's that. But everyone has a duty of care for young drunks when they are in their professional arena. So it was disturbing to hear that a bus driver allegedly told a semi-conscious 17 year-old and his friends to leave the vehicle when he became sick.

Taxi drivers have little tolerance for this either, and I completely understand - they will spend a good few hours cleaning up the mess and will earn nothing while they do it. Bus drivers will have to get their vehicles cleaned too and they will be off the road.

The problem is that throwing a young person off public transport and leaving them in the street might just put them at risk. Years ago, I posted an incident where a taxi driver had taken a teenage female off his vehicle because she'd started vomiting. He left her in a doorway, in the small hours of the morning, in the freezing cold, with very little in the way of clothing to keep her warm. She was left exposed and dangerously vulnerable until someone called 999 and we picked her up. It happens almost every weekend.

In this case, the young man had friends with him but he was still left in the street, surrounded by people waiting for buses. He was almost unconscious when we arrived to take him to hospital. He was very cold and had been sick all over himself.

It may not be appropriate or convenient when a drunken person starts vomiting and messing up your clean vehicle, but it is a simple matter of judgement for anyone to assume that, if they are in such a state, then maybe they should be going to hospital - but not via the street.


Our last job of the night was another head injury but this time it was much more serious. The man had been hit by a taxi and had almost gone through the windscreen and into the cab, such was the force of the impact.

We arrived after the FRU and there was a paramedic and student paramedic dealing with him as he lay motionless on the ground. A small crowd had gathered and were watching and filming, so I asked them to leave the area. I've never understood why people would want to film someone's personal horror. It's not illegal because it's in the public domain but it tasteless and pointless.

There was a lot of blood around and it made the scene hazardous for everyone working there. The four of us managed his airway, started getting IV access and assessed his injuries, which were multiple and major. He was still breathing and still had a pulse, so there was still hope.

HEMS arrived and soon we had blood being transfused and more advanced intervention going on to save the man's life. It took almost 30 minutes to stabilise him and get a decent pulse so that he could be moved. He'd been RSI'd and immobilised fully for the journey to MTC and when we got there he was still breathing and had a better BP than we'd measured whilst treating him in the road.

Heading home after a shift like this invokes two things; a feeling that something worthwhile had been done and a life might be recovered from tragedy, and reflection on the skills and procedures carried out, so that they can be honed further.

Be safe.

Back to the nights

I completed my first tour of night shifts since my unfortunate period of illness and trauma last year. It took me a few shifts to get into it again, and my sleep pattern was erratic at best to begin with. Nevertheless, I enjoyed the run and actually dealt with some genuine (and genuinely nice) patients.

However, my first night kicked off with a call I'd rather not have gone to. A 1 month old baby with respiratory failure. She'd stopped breathing due to a genetic condition, and her mother and sister were taking care of her when we arrived. There was a motorcycle paramedic (MRU) on scene and we got the story from him when we entered the little flat.

The baby was breathing again (albeit inefficiently) but had stopped several times prior to the 999 call. She is in such poor shape that it is unlikely she will have much of a future, if any at all. This type of call always makes me feel very down, especially as I am a parent myself. I have a lot of admiration for people who struggle through with very unwell children and still manage to keep a smile on their faces.

We took her to hospital while supporting her breathing all the way. We had been diverted to this from a nonsense call way out in the opposite direction; if it hadn't been for the common sense and good judgement of whoever was despatching us at the time, we'd have been attending a fully grown up woman who was 'not talking' instead.


Tonight was all about alcohol for a good few hours. In fact, our next patient - a drunken female at an underground station, had such strong alcoholic breath that I could still smell it on my uniform hours after we'd taken her to hospital for her own good. This was swiftly followed by a 40 year-old man, found lying among the rubbish bags in the street. A MOP had called us because he was worried about him and he was right - the guy would have been left all night and ignored for the most part, until he was finally taken in unconscious with hypothermia.

He was drunk of course, but he was a gentle drunk. A man with a learning disability and no clue where he was or how he ended up on the pavement. This made him vulnerable but he knew that and when I spoke to him later, when he was in his hospital cubicle and sobering up, he agreed.


It was almost certain that I would get assaulted at some point during this weekend; the number of aggressive drunks and angry people around made it inevitable if we were to get involved with them at any point. So I wasn't really shocked when I was punched a few times by a fist-swinging patient who'd allegedly taken 60 codeine in an attempt to kill herself. I got hit on the way down the stairs of the hostel, as police officers attempted to keep her off me, and hit again in the ambulance as a reward for trying to sit her down safely.

It was the first time I'd ever been assaulted by a six-foot transgender patient.


In the early hours of the morning we set off, on blue lights and sirens (because it was an emergency call) for a 90 year-old bed-bound man who woke up and realised he hadn't switched his TV off! Incredibly, we were allowed to go all the way there before it became clear (even though it was to us) to everyone else, that the call was about switching off his TV for him and no more. To add insult to injury, there was a 24-hour concierge on the front desk of the apartment block when we arrived. So he was tasked with the job and we returned to whatever normality we'd be allowed to resume...


...Until a drunken 25 year-old female fell down steps in a night club and split her eyelid open, deep enough to reveal the bone of the orbit. She wasn't knocked out and she was lucid enough, so she went for cleaning and closure.


The last call took us a long way out to tend the needs of an old woman who was 'vomiting'. She lived with a strange man in a strange, unkempt house. In front of a fully-functioning three-bar electric fire, she retched her way through explanations of illness as the man stood over her, patting her on the back in that 'I really don't want to touch you' way that you sometimes see when people are trying to be sympathetic but either don't have the practice or don't know what else to do.

She continued to retch and cough, but never vomited. And when she was preparing to come to hospital with us, she requested her teeth, and the strange man duly obliged, fishing them out of a cup with his fingers. Then he lost them on the grubby carpet for a time and they had to be retrieved by the FRU paramedic who had arrived ahead of us. He gingerly picked them up and handed them to the woman. Now she could smile if she wished, and her carpet debris could smile with her.

She retched all the way to hospital and stopped as soon as we arrived.

More to come from this tour...

Be safe.

The Royal cushion

Every now and again in this business, we treat individuals of high stature or fame, or both. A call to an 81 year-old woman who'd fallen in the street didn't allude to anything more than an average call to an average person. However, when we arrived, we saw that armed police had settled and comforted the lady and that a decoratively dressed man was also in attendance. It was clear from a distance that they were helping someone who was regarded as a little more than ordinary.

The woman had stumbled over her walking stick and fallen hard onto her arm and hip. Her upper arm was giving her a lot of pain and we controlled this with Entonox, whilst establishing what had happened. The lady's husband is an employee of the Queen, and she was on her way to Sunday church service near the Palace, when she misjudged her step and fell onto the pavement.

She was helped to a sitting position by the cops, who'd been close by, and the decorated man, who is also in the employ of the Royal Household, appeared shortly afterwards, to render moral support and to provide a beautifully embroidered cushion that belonged to the Queen Mother.

Every patient is an individual, regardless of their status in society. Every patient feels pain and deals with it in their own way. But it is nice to treat people that you know, with absolute confidence, will not abuse you. They won't swear at you, spit at you, or cause you discomfort whilst carrying out your job.

I will probably never meet the Queen (I'm sure my medal for contributions to blogging is in the post however), but it was a pleasure to come into contact with people who work closely with her. I was expecting to be commanded, rather than allowed to do my job. I was expecting to be excluded from the conversations the patient and the decorated man would have in the ambulance. Neither happened. The decorated man praised the LAS in fact, citing how wonderful the service was and how well we all did our jobs.

The patient, although in a lot of pain, was animated and humorous in conversation. It was an unexpected pleasure to be with them. So many high-ranking people forget to consider who we are and what we do, day after day. It was refreshing to be reminded that, when it comes to the crunch, they are just people, like everyone else.

I don't know what the outcome for this lady was - I suspect she had a broken Humerus - but it made me smile to think that my handover was initially rejected.

"I have two VIPs with me", I said to the nurse. "Members of the Queen's staff".

"Yeah, in your dreams", said the nurse with a grin.


On the other hand...a call to a 32 year-old man who'd had a witnessed seizure in the street, jolted me back to reality. A cycle response (CRU) paramedic was on scene and the man was still dazed and confused after his 5 minute fit, during which he'd bumped his head and cut his hands.

There was a single can of extra-strength lager in a carrier bag next to him. It was safe to assume it belonged to him, that being the nature of many of these calls. Nevertheless, we took him into the back of the ambulance, where he was initially calm and fairly compliant. The police accompanied us. They had been called to help and had decided to stick around.

It took a long time to get the man's first name and no other details were forthcoming. Post-seizure patients can be very vague and seemingly uncooperative, but that's part of the recovery process, as the brain resets itself. It can take an hour for a patient to fully recover and start talking sense.

As this man began to recover, he became extremely aggressive and abusive towards me. In fact, he made it very personal with me, which angered me. I am not a diplomatic person. I will not allow anyone to abuse me or insult me without a response, but while on duty and representing my profession and my employer, I simply cannot indulge in my instinctive reactions, so I had to sit there while he dealt me one threatening insult after another. He was no longer post-ictal and seemed lucid enough to know better.

I, like many of my colleagues, have had years of this type of abuse. Somehow people think it is acceptable. People think its just 'part of my job'. Well, it is NOT part of my job. It isn't in my contract and it isn't in my professional guidelines.

Unfortunately, there is very little or nothing we can do about this, so it really comes down to how long you are willing to accept it yourself (as part of the job). For me, time is running out. After a decade of abuse and insults and physical assault, I'm seriously thinking of a better life.

This guy was eventually taken off the ambulance and allowed to walk away. The police could do nothing (well, they could but it'd change nothing), so he staggered off, with his can of lager and his hateful soul.

I had to consider the huge contrast between this job and the last one, and it depressed me somewhat. The first call had lifted my spirits and made me feel like the job was worthwhile. This call had reversed all of that in an instant.

I analysed his anger and hatred towards me, simply because I was trying to help him as he bled onto the floor of my ambulance. I analysed my own anger, as I sat there wanting to lash out verbally at him in response, or simply ask him who the hell he thought he was talking to. But most of all, I had to analyse the possibility that he'd cracked his head hard enough on the pavement to cause a brain injury and that his response to me was the result of his slow post-seizure recovery, his alcoholism, or a bleed inside his head.

I could forgive only two out of three of those possibilities.

Be safe.

The root of all queues

THIS news story relays the current problems we are all facing but I have heard many times that this is fairly common with WAS. However, look at the story and read it carefully. The problem was caused, in my opinion, by the GP and the structure of the pathways set in place for such ambulatory patients.

How did the GP diagnose a fractured spine? He clearly wasn't absolutely sure but had suspicions, so he arranged for an ortho bed and an MRI to be carried out, to see exactly what the extent of the damage was to this lady's back. That is all fair enough. The GP has to act on his experience and knowledge and the given set of signs and symptoms surrounding his patient. But it sounds like he either used an emergency ambulance service, (which is solely for immediately life-threatening illness and injury), just to expedite his patient's journey to hospital, where other means of transport, such as A&E support or Patient Transport Services, were available (in other words he dialled 999 for a patient who was not being admitted for immediate life-saving intervention)... OR, as I suspect, there is simply no option available to him. There are no other transport pathways and so everyone ends up dialling 999.

The woman's daughter even stated to the Press "Admittedly, my mother was not an emergency case, but nevertheless during her long wait she was unable to go to the toilet and was getting increasingly tired and fed-up", before going on to describe the intolerable wait her mum had to endure, and the obvious frustration of the crews, even though they were professional and patient.

The irony is that if she hadn't been sent to hospital, essentially for a scan, by emergency ambulance via the 999 system by a health care professional, the queue would not have been quite so long, because they would not have been in it. The patient coming in behind them would not have had to wait even longer than they did, due to their presence, and the crew may have been saving the life of a seriously ill patient elsewhere.

Without alternative pathways; other means of taking patients to various different departments in hospitals without the need to call 999 and have them go through our already stretched Emergency Departments, this problem is only set to get much, much worse, until, soon I suspect, someone will die in the back of an ambulance because their undiagnosed triple A ruptures, while various GP referrals and District Nurse referrals - Health Care Professionals (HCP) using 999 as a means of transporting non-emergency patients - are brought in by exhausted and frustrated crews who will wait for hours outside hospitals with patients on-board who remain stable for hours. It's madness.

In my opinion, the problem is one of two things when it comes to HCP referrals. They either don't realise what they are doing when they take an emergency vehicle away from genuine emergency calls to transport stable, non-emergency patients. Or they don't have a choice, because there is no alternative.

This lady couldn't get herself to hospital and a car or taxi would have been a non-starter, due to her condition. A fractured spine is serious but it is not necessarily immediately life-threatening. A critical asthma attack, a serious head injury, unconsciousness, neck fractures, vomiting blood, central chest pain, cardiac arrest.... these are all 999 calls. But how do you get this patient to hospital for a scan if you have no safe means of transport? She needs an ambulance with a trolley bed (and a spinal board) and a crew that knows what to do.

The voluntary services offer non-emergency transport services, so what about them? Or private ambulance services... or the NHS Trust Patient Transport Services.

Here's the rub. Many hospitals have contracts with private or voluntary ambulance services but, when it comes right down to it, the HCPs who want their patients taken care of simply don't seem to trust these services and prefer to call 999 instead, knowing that they are going to get a professional front-line crew. I've even heard preferences for paramedics to take care of patients, even though there is no need because the patient did not require paramedic intervention of any kind. The transport services used by hospitals are usually the cheapest quoted and the contracts are decided by management, not necessarily clinicians.

We have a major problem. If this continues, not only will our system fail and patients start to suffer, but ambulance crews will begin to lose heart. They will also become unwell due to exhaustion, stress and frustration. This will have a knock-on effect and before you know it, we will be struggling to cope with the system as it stands.

HCPs aren't the major culprits though. The general public still attend Emergency Departments for the most insignificant problems. Everyone's emergency is personal, I know that, but when are we going to start educating people properly? First aid should be taught in every school - to school students, not just staff. And it should be taught by professionals who have actually done the things they are teaching you to learn. That way, a more realistic perspective is taught and kids might just start growing up taking ownership of their minor injuries and illnesses, instead of assuming that the health system is there to solve every little problem.

If you want an example of how bad things are getting, consider the 14 mile journey I undertook - on blue lights at a doctor's request, so that a patient could have a tooth replaced.

Xf

Dogs have feelings too...

Another cardiac arrest dragged me and my crew mate miles from base. An 83 year-old man had collapsed in front of his family. He was a known diabetic but had been speaking to his son earlier, with no problems reported at that time.

When we arrived, a FRU and another ambulance, crewed by an Accident and Emergency Support crew was on scene. We were told that a Physician's Response Unit (PRU) was also on the way.

The man was stuck in a tight space and the FRU Paramedic was in the process of resuscitating him, with the help of the A&E Support crew. It was clear that this was a messy and complicated job, and the presence of his family, in various rooms of the house, didn't help the situation. Emotional energy like that can hamper a resuscitation attempt - the task calls for an almost cold but certainly calculated demeanour; having family and loved ones out of sight is important whenever it can be achieved.

Before too long, there were too many cooks in that space. The PRU team had arrived, consisting of a HEMS paramedic and two doctors, so when they joined in to help, there were eight of us working on and around the poor man. However, once a few necessary skills had been carried out and we'd finally managed to get Intraosseous access (IV access proved to be impossible), only those directly involved with the resuscitation attempt were left with him. The A&E Support crew got busy with supplying and tidying away equipment, passing drugs and keeping the man's son, who was in a room opening directly onto the small landing area where his father lay, occupied and out of sight.

One of the doctors dealt with other aspects of the attempt, including communicating the process with the other family members upstairs.

Once again, despite what is said about the job and what we do, when it comes to this stuff, we all know it well. Teamwork and communication is vital during a life-saving attempt. Keeping calm and responding to the situation without allowing it to affect you personally, is what makes the difference, if there is to be one, between death and life. I'm still proud to work alongside my colleagues in situations like this.

Unfortunately, despite our best efforts over a long period of time, the doctor discussed termination of the resuscitation with us and we all agreed. There had been no change in the man's condition for almost an hour. It was futile to continue; the effect on the family was bad enough - to draw things out would have been cruel and unnecessary.

The man's body was left at home, appropriately covered and cleaned up as much as possible. The police were called (standard procedure) and the family was left to grieve in peace, with all of us waiting outside in our vehicles until the police arrived to take over the scene.

When we were tidying up, I walked into the small room that the son had been in, until he went upstairs at the end of the attempt. Inside, lying on the sofa, was a Boxer dog. He had his head on his paws and his eyes told me everything about how he felt. This was the dead man's dog and the animal was clearly upset and depressed about what had gone on around him. His eyes followed me without his head lifting, and this just made him look ever more sad.

I tried to persuade him to move into the little kitchen area, away from the sight of his master laying on the floor of the landing, and, at first he followed, tail wagging at the sound of a kind voice (up til then all he'd been hearing were the voices of control and procedure and they are not kind voices). But he turned and went into the landing area, where he bowed his head close to his master's face, before running up the stairs.

I love animals. I love dogs especially; they can be extremely intelligent and are famously  loyal, and I believe that what I witnessed at that moment, was a dog saying goodbye to his master.

Be safe.

Getting back on the horse

I'm going to ease myself back into writing this blog; it's been a long time since I recorded patient-related events in detail, so forgive me if things start off a little slow.

I've been 'third-manning' for the first few shifts on my return to work. I need to be assessed as fit for practice, so I am duty-bound to sit in an ambulance with a crew and 'learn' my trade again. This is standard procedure for any frontline staff member who has been away from patient-care for a length of time.

So, initially I was taking obs and re-learning the layout of an ambulance (not that you forget it but I've been on a car and a desk for a few years now and things change). After the first shift of lifting and listening, I started attending again. I felt as though I'd never left.


My first patient, an 80 year-old lady with a Urinary Tract Infection (UTI), asked me when I was going back to Scotland. She didn't ask me in a 'I am interested in whether you will be returning to your roots at some time in the future' kind of way, but more in a 'why don't you bugger off back to where you came from' kind of way. UTIs have a lot to answer for!

As we drove her to hospital, she chatted and argued with the Hi-Vis jacket that was hanging on a hook in front of her.


A 2 year-old boy was fitting continuously in a non-emergency hospital and we arrived to help. He'd been convulsing for 20 minutes and had already been given Diazepam, with no effect. The nurses were suctioning his airway to keep it clear and he was twitching and arching on a small couch when I first saw him. I can't help thinking of my own little boy when I see things like this now.

It took another dose of Diazepam and a further ten minutes to get him to settle down, but he wasn't breathing for himself and so his ventilations were assisted all the way to hospital. He began to recover and stabilise but he still required support for his breathing, even when we arrived at the Resuscitation room.


An 87 year-old lady fell at home and was found face-down on her kitchen floor by her carer. When we examined her, it was clear she'd fallen many times. She had a fractured wrist as a result of this latest event. A look around her small house gave all the clues needed to suggest this lady needs to live somewhere else; her stairs (which she still used) were extremely steep and the carpeting was worn and sagging, making any ascent or descent a hazardous journey. If she fell from the top of those stairs, she'd be found seriously injured, or dead, next time.

We recorded and reported this, as required, in the hope that something would be done for her.
Unfortunately, jobs like these can come back and haunt you. You can ignore what you see and find yourself on scene again, treating a major head injury, or attempting to resuscitate an avoidable lost cause.


Speaking of head injuries. A 45 year-old female was found laying in the middle of the road by plain-clothes police officers who just happened to drive past. They'd seen a small gathering of people around her and thought, like everyone else, that she'd been hit by a car.

When we arrived, she was sitting with the cops, smoking a cigarette. She'd also obviously been drinking, but when asked how many, she stated 'two glasses of red wine'. She'd also had a free Valium, (courtesy of her friend whom she'd apparently visited prior to her fall), to 'take the edge off'.

She had a nasty cut to her head but no other injury. She denied the possibility of unconsciousness but was vague about certain things… like the date and time of day. She kept telling us that she had a dentist appointment and that she was on her way. She seemed very concerned about her teeth. She'd told us that she'd visited her friend, had a couple of drinks and a Valium, then started making her way to her appointment. As she crossed the road, she tripped and hit her head.

The story was fine but there were a few anomalies. The blood stain in the road was quite far from where she claimed to have tripped, so she either staggered and fell or she flew into the air. She was also hypothermic - something that doesn't just happen rapidly in a mild environment, so she must have been somewhere cold for a while… or she'd been on that road longer than she thought - possibly overnight.

By the time she'd reached hospital with us, she was warmer but still confused, although adamant about the events that led to her being lifted from the road by the police.


Part of the process of a return to practice is re-training in the core skills that are necessary for all frontline personnel, such as advanced life support resuscitation. After covering skills and knowledge in these areas again, one hopes to get straight back into the thick of it as soon as possible, so that rust doesn't settle and spoil the art. My last job gave me the opportunity to save a life, using a lot of the stuff I'd only just revised.

We'd been called to an elderly woman who'd fallen from a wheelchair and was not responding. Initially, this seemed like a perfectly straight-forward call, because 'not responding' can mean anything these days. However, as we pulled up on scene, we were up-dated and informed that it was now a cardiac arrest, so the tone changed and the pace accelerated.

There was already a motorcycle paramedic on scene, carrying out CPR with the help of an off-duty nurse, so I got beside him and asked what he needed. My two colleagues followed immediately with the rest of the necessary equipment.

No matter what you think of us (ambulance drivers, taxis, servants for drunks), we are extremely well drilled in cardiac arrest procedures and within seconds, we will have a team around you, working efficiently and carefully until we stabilise you or lose you, depending on what God decides.

From the outset, there were problems with this patient. She was elderly, she had a recent medical history that gave her less of a chance for survival, and, as we later discovered during the process of resuscitating her, she had leaking lungs. Air was gathering around her lungs so that it caused pressure to build up, thus restricting our ability to help her breathe. It's very likely she had a herniated lung (or lungs) and pneumothoraces caused by her predisposing medical condition... or our chest compressions. We know that this is a possible complication of aggressive CPR - which is the only way to achieve a positive outcome, if there is going to be one at all.

We worked hard for 20 minutes or so before deciding to take her rapidly to hospital. It is quite normal for us to stay and attempt to stabilise a patient before conveying - they have a better chance of survival if we can get the heart to work before moving them. Unfortunately for this lady, despite our very best efforts, we could not stabilise her long enough to justify remaining on scene any longer, and so we continued CPR out to the ambulance and all the way to hospital.

To relieve the pressure building up around her lungs, we inserted two large cannulae into her chest, one either side. This worked, but only very temporarily, as expected.

The hospital team continued to work on her for a little while longer but eventually called it and she was left in peace. I wish it had gone the other way but, as I said, not long into the attempt, it was clear she was in trouble. Still, we get to see some miraculous recoveries, so every mission to save someone is worth the sweat.

And, as I also stated earlier (and please do not think I feel this poor lady was good for practice and no more), her fate allowed me to get back into my skill-set.... inevitably, she will have helped me save a life further on down the line. In all aspects of emergency medicine, this is often the way of it. Someone slips away and exchanges life for life by allowing medics to get better at what they do.

Be safe.

Acute death

So.... I'm just about ready to get back on the road. I just need to prove I'm fit enough again (mainly to lift drunks and heavy patients). It'll be a couple of weeks but I'm returning to patient-care based stuff. I've had my fill of sitting in front of a bank of monitors.

I should explain what's been going on because many of you have been asking me why I haven't been posting and where I'd disappeared to.

I developed a very painful and persistent earache which turned out to be caused by a large 'mass' in my middle ear. My family and I endured a couple of weeks of waiting while they checked to see if it was malignant, post-biopsy. During that time I became much sicker and I think it convinced my loved ones that I wasn't going to be around much longer. It certainly felt that way!

I was finally told that it was benign but that it was destructive; eroding bone at the base of my skull and into the semi-circular canals. There was another wait to see if it was operable or not.

All of the problems I've faced in the last none months have been the result of this Cholestaetoma - the constant feeling that something was not quite right, the dizziness and nausea (which caused the fall that broke my collar bone) and eventually, the pain.

The potential for death had crept up on me without warning and I don't think I had much time left to stop it... but I did.

I've recently had the thing removed and I am recovering well. It hasn't made me deaf, as expected, despite the enormous damage it has done inside my ear, and I will be monitored for the rest of my life, to ensure that it doesn't recur and that I don't develop other problems associated with the internal structural damage. And it hasn't affected my brain; I'm still mad.

So, there it is. My excuse for not being around in the past nine months. Sorry.


I have been 'third-manning' an ambulance while I have my return to work managed and there have been no surprises. The world is still the same and people are still demanding emergency medical care for non-emergency problems. We are still social-working the population and we are still being run ragged and to the point of exhaustion.

I have been given a fresh opportunity to appreciate how hard my colleagues work, especially on the ambulances. One call after another. Relentless.

I'll be back and posting on as regular a basis as I can just as soon as I am fully able to.

Thanks for checking in and thanks for all your emails and messages of concern.

Xf