Sunday, November 26, 2006

46 years of marriage

We pulled up suddenly, almost missing the correct address in the dark street. Across the lawn with the heavy bags, I made straight for the front door which was ajar. "Hello there?" ...I pushed the door fully open.

"The door’s open" came a quiet voice from inside and to the left. My partner was just behind me and I could faintly hear the radio traffic chatting away from the portable on her belt. Stepping into the house, I tuned into the bedroom, pushing the door open with one of the bags I was carrying.

It was a neat room, it had been well looked after, but there was a dustiness to everything almost as if the house had been locked up for a long time. There was also evidence of sickness too. I took in an oxygen cylinder on a trolley, a cardboard box of tablets on the chest of drawers and a thick folder of notes from the nursing service on the bed.

There was an elderly man sitting on the chair next to the bed, who looked up at me as I came in. He had red bloodshot eyes. I asked him what had happened and as soon as I said it, I knew the answer. All he said was; "I think she’s gone". The woman lying in the bed was pale and still and her eyes were already dull. She was white, paler than natural, paler than anyone should have been.

I went round the side of the bed and felt for a pulse. Nothing. As gently as I could I asked when he had last spoken his wife or heard her breathing. He said about 10 O’clock when they had gone to bed. I looked at my watch, it was 3.35am. She was cool to touch, her pupils were fixed. I cast my partner a glance, I’m sure we were both thinking the same thing as she passed the cardiac monitor to me. I put the monitor dots on and in doing so noticed the mottled skin and areas where the blood had already settled. The monitor showed nothing.

The hiss of air brakes outside announced the arrival of the fire brigade responder crew. I was about to ask my partner to cancel them and the MICA unit backing us, but she was one step ahead of me and already heading outside to stop them before they all arrived.

I began to ask her husband about her; her name was Eleanor, she’d had cancer, it had been first found in her lungs years ago, later in her bones. As if that wasn’t enough, she had an extensive cardiac and respiratory history and had been on home oxygen for many months. Increasingly unwell over the past 6 months, she had been lovingly cared for day after day by her husband of 46 years.

I came back round the other side of the bed, took a deep breath and told him what he already knew. No matter how uncomfortable it makes you feel to tell someone about the death of a loved one, it is nothing compared to what they must go through. I will never get used to doing it. When he had composed himself I took him out to the lounge room and sat him down on the sofa. We spoke about her doctor and family members. As I explained what would happen next, he listened politely. I looked around; there were pictures of smiling young people on the dresser and some old war-time shots of a proud looking young man in a uniform on the wall.

There were voices in the other room and I realised the MICA unit had turned up after all and were asking if there was anything they could do. We tried, but couldn’t contact the patients own doctor on the phone at that time of the morning so we tried an after hours number. No luck either. It turned out there was a nephew in Melbourne, and he sounded unsurprised when we woke him and told him the news. He would be round in twenty minutes. We contacted the ambulance dispatcher and said we’d be delayed on scene until the nephew got there. We weren’t leaving until someone else was there to stay with him. When I got off the phone, he asked me if he could go and sit with her? As if anyone could deny him that after 46 years.

We both went back into the bedroom and I was pleased to see the other guys had taken all our gear out and tucked her in to bed. I walked back out to wait for the nephew. The old fella deserved a few moments.

Thursday, November 16, 2006

2P or not 2P

Rob: Ahh sweet caffiene, an integral part of my day.

Rob’s Bladder: Hey moron, its spelt “caffeine”.

Rob:I before E except after C”.

Rob’s Bladder: Yeah well there is a C in caffeine isn’t there?

Rob: Nobody likes a smartass.

Rob’s Bladder: Mate 2 cups of coffee, a glass of water and an orange juice for breakfast? I’m going to have to call in some reserve staff…

Rob: I’m ignoring you, I have a patient to go to.

Rob’s Bladder: um… excuse me? Hello? You should have gone before we left branch…

Rob: Quit your whining, we’ll be at hospital in 30 minutes and I’ll take care of you then.

Rob’s Bladder: 30 minutes! If your partner keeps driving over every bump in the road I promise you he won’t be happy about mopping out the back of the truck.

Rob: Hey it’s his job to clean the truck while I write my case notes. Besides if things get critical I can always use the bathroom at the patient’s house.

Rob’s Bladder: Oh yeah, that’s real professional, that is. “Hi, yeah look I’m sure little Jimmy’s broken arm hurts, but can I use your bathroom?”. That would go down really well with the family. Perhaps you could ask them for a magazine to read while you’re in there?

Rob: I’m done. I’m not talking to you any more.

Rob’s Bladder: Yeah that’s it, loosen your pants tough guy – it only gives me more room to work.

Rob: Look I’m busy here, And I’m sure I’ve told you not to talk to me while I’m working.

Rob’s Bladder: Things are getting awfully crowded down here. You know I can hit the override button at any stage?

Rob: you wouldn’t dare!

Rob’s Bladder: Is that a challenge?

Rob: Shhh, I’m talking to Jimmy’s mum, he’s got a peanut allergy you know.

Rob’s Bladder: Oh puleez! The poor poppet.

Rob: Will you be quiet!

Rob’s Bladder:The squeaky wheel gets the oil

Rob: I’ve got it under control. I’m going to keep focussed on my job and I’ll be fine.

Rob’s Bladder: You’ve checked Jimmy’s blood pressure 5 times in the last 10 minutes. Any second now his mum is going to ask you how long you’ve been doing this job… Here it comes… Hey there is a public toilet coming up on the left – go on, ask your partner to pull over.. I dare you.

Rob: I just might do that, if this traffic gets any heavier.

Rob’s Bladder: And how do you intend to get away with that? Little Jimmy’s mother already thinks you look edgy and nervous. Now you want to stop on the side of the road and run into a dodgy looking public toilet while her little baby is in so much pain – you selfish monster. Hey look, that guy is watering his lawn – with a hose…

Rob: …we’re almost at the hospital. I’m going to make it, then we’ll hear no more of your crap.

Rob’s Bladder: Crap? You really wanna go there? One word from me and the fellas who are looking after that Thai curry you ate last night could be working overtime..

Rob: (Groan) ……………

Rob’s Bladder: Oooh Look, we’re at hospital, but alas! There are 3 ambulances ahead of us, and that really slooow nurse is at the triage desk – oh boy this is going to be funny. “Can I have a mop and bucket to the Emergency department”. Heh heh…Wait ‘til I tell the lads in the kidneys about this…

Tuesday, November 07, 2006

Ambulance crisis

A recent comment by Altissima said...

Rob, I would be interested to hear your response to the article that appeared in Sunday's Age:
Ambulance crisis as 'killer' shifts take toll.
MELBOURNE is losing some of its most highly trained and experienced ambulance paramedics because of what they say is a dangerously heavy workload, an inflexible "killer" roster and a dispatch system that sends them to inappropriate "nonsense" cases...

Full article can be found here:

Firstly thanks Altissima for bringing that to my attention. I missed the article when it was run. Look for what my response is worth, I'd have to say that the article is a fairly accurate reflection of the feeling of paramedics on the road at the moment, whether they are MICA paramedics or not. Everyone is working really hard right now and many are suffering both personally and or professionally because of it.

The current workload appears to be increased - why? Many think its because of the recently introduced Nurse On Call service which seems to be flooding us with jobs, the majority of which turn out to not need an ambulance. Whether this is also due to the Nurse On Call staff being hesitant to tell people to see their own doctor in the morning. I was told that when the same kind of service was introduced in the UK there was an initial increase in calls but then it reduced the overall call rate - Please someone over there let me know if that is the case, or have we been fed a big serving of PR. Other reasons? There are many, the dispatch grid, the rostering, the public perception of what constitutes an emergency. These are problems being experienced by ambulance services worldwide.

As far as the MICA officers leaving, yes there have been a considerable number of them leave, and this represents an enormous loss of skills and experience for the service and the general public. While many of the standard Paramedic units have alternate rosters, with or without nightshifts that they can arrange to spend time on if they get exhausted, the MICA crews only have the 10/14 roster. And when our grid system has them running around, chasing their tails and going to crazy jobs, its no wonder that many have thrown in the towel. All of us, MICA or not are expected to remain motivated and perform at our highest standards at all times. This is a hard thing to do when you are completely trashed.

The dispatch grid is directly repsonsive to the data that is fed into it - that's what it was designed for. However if you ask the relative of the person who has a nasty cough and a chest cold; is the patient breathing normally? the answer will inevitably come back that no they aren't. Do they have chest pain? Again the answer is likely to be Yes. They are in pain when they cough. This automatically gets a lights and sirens response because its now coded as Chest pain with abnormal breathing. If the Clinician who is on duty happens to have a look at it and catch it before it goes out, the case may get downgraded. But otherwise 2 cars are now barrelling through the streets trying to get there inside the allocated time frame.

As far as nonsense dispatches, I have personally been sent twice in the last month to people who can't sleep, to other people who have an outpatient appointment at the hospital in the morning and thought they'd save the taxi fare, people who left the waiting room at the hospital and went home to call an ambulance, thinking they'd get seen quicker if they come in by ambulance. Ask any paramedic and they'll tell you a long list of unbelievable things people have called an ambulance for. Solve that issue and you'd go a long way to relieving the workload.