Same old thing

I went interstate on my days off and ended up catching up with a couple of "ambulance drivers" from another state. The uniform is a different colour but the call-outs are the same. We drank coffee and they matched my massive catastrophic shaving cut story with the "not brave enough to pull off own band-aid" story. We went back and forth knowing the saddest part about a bunch of paramedics telling stories is the complete lack of need to embellish. Its the same all over the world.

A voice in the dark

When we arrive at an address after dusk we put our side scan lights on. Usually on both sides of the vehicle. One lot shining on your house and the other lot shining brightly in the direction of the house you live opposite from. This serves two simple purposes; It allows us to see our way across your broken concrete driveway, through the swampgrass front lawn, past the car that you are "gunna fix up one day" (until then your 11 cats will keep breeding in it) and up onto your porch where we can avoid the holes and the cans of butts out front - to help you with your problem.

Illuminating the other side of the ambulance allows us to unload our equipment and not get hit by some muppet who is so awestruck by the appearance of an emergency vehicle that any attempt to control the V8 Holden with the bald tyres is forgotten.

Tonight someone threatened to kill me. That is a voice came out of a half open sash window opposite and said that if I didn't turn off the light that was now shining on his house (allowing me to get my equipment out of the ambulance without getting hit by the aforementioned mobile muppet) he was going to shoot me. Wow.

Is it just me or are we getting less neighbourly?

Heavy eyelids part III

Ok time to get moving. We all knew this was going to be a challenge. The folding wheelchair was brought in and we carefully moved nanna across from the bed. As I moved her legs over to the footplate I was amazed by the size of the ankles and the sheer weight of the limbs. What I could see below the pressure bandages looked dry red and sore. With the CPAP device on, she soon stopped fighting the mask and appeared almost immediately more alert to what was going on. The monitor appeared to be settling down too with far fewer ventricular ectopics drifting across the screen. All good signs that things were settling down a little.

I carried the monitor and oxygen while one of the ALS crew struggled with the wheelchair. As we turned into the hallway I could see immediatley things didn't add up. There was no way were squeezing through between the piles of porcelain and the half open door. Dumping our equipment, my partner and I grabbed one end each of the fully loaded display and started dragging it across the carpet to where we could get it out of our way. The case tilted alarmingly and I saw we now had nannas full attention. I could hear her trying to say something to us from under the hissing mask as we grunted and heaved her precious collectables. She may have been saying 'don't worry if you break a few of those dusty old things fellas, I was going to throw them out anyway', but in reality I think what she said was something about my mother.

A few more nitrates later and Nanna's blood pressure was becoming reasonable again. We did a 12 lead ECG in the car, but there was nothing worthy of transmitting to the hospital. I gave a small amount of lasix via IV and I could see she had really turned the corner. Nanna was now doing well. I patted her hand and told her so.

I called up the duty Clinician to pass details to the hospital - he sounded fresh and alert and clearly just at the start of his shift. The hospital then came on the line and I handed over: "We are loaded with a 78 year old female, presents this morning with acute respiratory distress..." I rattled off the current vital signs. Another annoying alert and chirpy voice said; "Thank you, see you in 10 minutes."

After completing my paperwork, I wandered out the front of the hospital to where my partner was dozing in the car. I pulled open the door and he sat up with a start. That's payback for waking me up earlier. A couple of tired looking ED staff were sharing a cigarette off to the side of the ambulance bay. The sky was properly light now and my first day off was going to be spent sleeping. My eyes felt dry and my lids felt heavy. Now just got to make it back to branch without getting another job.

Heavy eyelids part II

As we arrived at the address the street was still dark. This was not a wealthy part of town. The houses are usually 1950s cement sheet construction (often Fibro), low-rent government housing and very basic. At that time of day there is probably a hint of dawn in the sky but this time I didn't really notice. The smell of hot brakes wafted up us as we climbed out of the truck and went to get our bags. My partner was pulling his gloves on as I retrieved the monitor and our drug box. The sliding door always sounds so loud in a quiet street. I wonder sometimes if people curse us the way I curse the garbage truck on my days off...

The crew on scene were obviously into it, the sound of their monitor alarms could be heard coming from the half open front door. Everything seems to beep at you in ambulance, but the cardiac monitor usually starts to really complain when the heart rate is too high, too low or absent altogether. I hate persistent alarms and although we have the ability to silence most of them for a while, it is always important to address the reason the alarm is sounding, not just get rid of the annoying noise. I went to push the door open with the monitor and was met with resistance. Squeezing side on around the door I was able to get a look at why. There was a hall table behind the door preventing it opening. My head took a moment to gather what I was seeing. Everywhere I looked there were other hall tables and display shelving with literally thousands of china and porcelain plates, figurines, teacups. Oh and teaspoons, don't forget the racks and racks of teaspoons. This was a lifetime of collecting.

"We're in here" called one of the crew and I went into the front bedroom. Nanna was a big lady and was in trouble. She looked what we like to call pre-arrest. A friend of mine calls this "circling the drain". One of the ALS crew was kneeling on the bed behind nanna trying to hold her upright and hold a 100% oxygen mask over her mouth and nose. The other crew member was trying to wrap a blood pressure cuff around a huge arm. Both crew members looked flustered and red faced. I noted nanna's trunk-like ankles with pressure stockings around them, the grey purple hands, the sweaty skin, greasy hair and faint smell of incontinence. I could hear the gurgling of her breathing even through the mask. I was simply told "She's full". I turned to my partner and saw him already heading back outside to get what we needed. Good man.

Firstly we pulled nanna further upright and got her legs set on the floor then we jammed more pillows behind her to hold her body upright. I plugged her into our monitor and placed a probe on her finger to measure her current oxygen saturation. It came up as 76%. While these very low readings are not often accurate, it showed she was not getting what she needed through her wet lungs. I clipped and tightened a tourniquet around her forearm noting her clammy skin. She had her eyes closed and was clawing at the mask on her face. I grabbed one of the medication packets off the bedside table and found her first name. When I called her name, her eyes opened and she focused on me for a moment. Good, that's a start. "Squeeze my hands" I demanded loudly in her ear, she weakly obliged.

My partner returned and set about getting the CPAP device ready, (for those that aren't familiar, in crude terms this piece of kit blows a small but steady oxygen stream into the mask providing a reduction in the work of breathing and an increase in the efficiency of gas exchange in the alveoli) this device works wonders compared to trying to achieve the same principles through manually assisting the patient's ventilation.

After many attempts, Nanna's gargantuan arms finally gave up their fiercely protected blood pressure readings - 165/105. Right then, nitrates please, to reduce her blood pressure and give her heart a chance to catch up. I managed on my second attempt to get IV access in a tiny crooked vein on the back of her thumb. It was a pathetically small IV, but any port in a storm will do!

I'll write more in the morning... right now I need to sleep.

Ambulance service (Still) in Crisis

Rant warning.

Right, Its been all over the news in the last few days. Its now very public knowledge what all of us know already - the service is falling over, slowly. Response times have blown out and are reported to be at 20 mins for the 90th percentile of Code 1 cases. That means on average if you ring an ambulance on a busy night here you have about 90% chance of waiting 20 mins for it. You may be one of the lucky ones who gets an ambulance sooner than that - buy hey if you are ringing an ambulance - in theory, luck is not currently on your side. However you may also be one of the poor buggers who wait even longer than that!

An ambulance Whistleblower got mighty crapped off by the events of the last couple of weeks (as have we all) and went to the media:
http://tinyurl.com/63rgl2c

http://tinyurl.com/6l65h5r

This got the ball rolling and had the Ambulance Service spin coming out with a response that basically blamed:
1. the hospitals for holding us up (Which they do a lot - but proper funding will address this)
2. those lazy paramedics for using their sick leave.

There was no mention of the service itself having an undeniable role in eroding the standard of ambulance coverage through neglect and mis-management. The reason paramedics have sick leave available to them is because they are exposed to a lot of sick people - we have stressed immune systems. We also work shift work, which also makes you more susceptible to illness. We don't eat at regular times and struggle to maintain regular fitness regimes. We deal with an unsupportive management, a low morale work environment and ever increasing workload with ever decreasing conditions.

We are now one of the busiest ambulance services in the country and among the lowest paid. Thank you Mr Whistleblower for your efforts. Lets hope for the staff and the public, something comes of this.

Heavy eyelids part 1

"Are you coming mate...?"

I'm suddenly Awake. Confused. Disoriented. My colleague is standing in the doorway of the bedroom waving the radio at me. Oh What!? It is 5:30 am or thereabouts and I had slept through the pager going off for the first time in my career. I mumbled an apology and sat up to pull my boots on. I looked around the floor in the gloom and couldn't see my footwear.... ah there on my feet already, I hadn't even taken them off, just too tired I guess. We had been run off our feet all night and had finally made it back to branch for our half hour meal break. I was so tired, I just had to close my eyes for a few minutes. I was glad it wasn't my turn to drive.

I walked out to the garage where my partner already had the truck running and had been clearly waiting for me to haul my butt out of bed. "You ok"? he asked. "Yeah, sorry, just bloody shagged, didn't hear the pager". I squinted at the data terminal (MDT) on the dash, we were going to a 72 year old female in respiratory distress. My partner informed me he had not yet spoken to the dispatcher who was busy trying to dispatch a number of other jobs to other tired sounding crews. Finally it was our turn and the voice who sounded annoyingly awake and efficient said; "thanks for your patience, at the request of the crew on scene, could you head over to Footscray for a patient with breathing problems. They'll come up with a SitRep shortly."

A few minutes later, the crew gave some brief details about the patient's current state. The voice on the radio sounded elevated and stressed. Hmm this one might be sick. We were only a few minutes away by this stage and told them to stay put and not try and load the patient until we got there. I forced my eyes open and blew out an exaggerated breath in an attempt to clear my head. Going to need to be awake for this one...

Roid rage

You're an adult male. You seem reasonably "normal". You got up during the night to go to the toilet. As you shuffled down the hallway, I know you were a little hazy, believe me I know. It was sometime in the hours before dawn. You squinted when you turned on the bathroom light. It's annoying when you have to wake up isn't it? A few minutes later as you sat there, staring down at the red dot on the toilet paper in your right hand (or was it your left?), there was a decision point. This was your moment. Your chance to step up....

But you picked up the phone and called for an ambulance.

When we arrived, you explained you had suffered from hemorrhoids on and off for years, you showed us your range of ointments and your little cushion, you explained 'they' had bled before. Your level of detail was as excruciating for me as your "delicate problem" apparently is for you.

Thank-you for saving the fold of toilet paper as "proof" that you weren't kidding. I believe you, really I do. I believe they are annoying. I believe they are painful. What I also believe is; you don't under any conceivable circumstance, need an ambulance for an irritated hemorrhoid.

Grrrr.

Taxi vs Pole

It is 05:00 am and we are driving back from hospital when we come across a traffic accident. A taxi has failed to negotiate a gentle curve in the road and has struck a power pole. There are no other emergency services on scene and we have not heard any ambulance vehicles being sent to this crash. I get on the radio as we do a U-turn and ask the dispatcher to create a "field event" for us. This can be loosely explained that if we don't have enough work given to us over the radio, we can simply drive around and find our own. Seriously though, any time we get waved down by someone on the side of the road or nanna drops a can of Chunky Beef soup on her foot at the shops while we are trying to buy lunch, we make a field created event that then runs like a normal job.

For a suburban street this is a reasonably big hit. The taxi is twisted out of shape and the power pole has clearly made it nearly all the way through the engine bay to the firewall.

When we look in the vehicle, it's a mess. There is no obvious blood and nobody in the front or back seats. I always check the floor too, as people can end up in all sort of odd place in a crash. All the normal taxi stuff that has been carefully stuffed down between the seats, in the glove box, tucked up in the visor or stacked in the console has gone flying and there are bits of debris and food and paper and CDs and beads everywhere. The mandatory dashboard statue is nowhere to be seen but a resilient blob of Blu-tac shows where it once stood. The airbags have gone off and there is a fair bit of intrusion into the footwell on the passenger side. More telling for me was the evidence outside the car. No skidmarks on the road and major damage to the wooden power pole at about head height. This car was airborne after hitting the concrete curb.

A female taxi driver was sitting on a low brick fence talking on a mobile phone and I went over. After a quick assessment, she's alert, apparently uninjured and doesn't want my help thanks very much (not what she actually said). The driver claimed to be at the end of her shift and said she had "lost concentration". I wasn't overly happy with this. In this area women generally don't work the nightshift on taxis. Especially not youngish, 60kg ones. Yeah yeah before you start, I know there are exceptions to everything. Her taxi company shirt uniform was too big for her and neatly pressed. It just didn't have that I've been driving around for 10 hours, soaking in my own sweat and KFC grease look about it. She just didn't look to me like she had just worked a long shift dealing with customers, fallen asleep, got a yellow taxi 5 feet off the ground and been woken after meeting a solid object at high speed. The police arrived and the first thing she said to them was "I was driving the taxi". Allowing she was the only one on this windy, cold, roadside wearing a taxi uniform the police officer gave her a look that said it all.

I have seen many accidents where the car is wrecked and the people inside are fine, but I've also seen the opposite, where the car looks fine and the person is critically injured, so there is no sense in trying to predict patient outcomes on how interested Neville the claims assessor from the insurance company is going to be. After persisting, I persuaded the driver to go to hospital for a check-up, but despite careful looking, I found not a scratch on her. No seat belt stripe (the tell-tale diagonal red bruising), no back or neck pain, no glass shards in her hair, no cuts on the hands or pain in the chest. Vital signs all within normal limits. The hospital checked her over, and then did it again after looking at the photos my partner took of the crash and found nothing wrong either. She was collected by a relative from hospital before I had even finished my paperwork.

Hmm.

Stand by

After a long absence, and a lot of kind emails I've been persuaded to write some more.

Stay tuned...

Cheers,
Rob

Reg springs a leak

We were way out of our usual area and it was late. I had never even heard of this particular suburb before, let alone been there. There were no available ambulances on that side of town, so my partner and I had been sent Signal 1 all the way across the city, flying along the wet freeway to try to get to a place neither of us had heard of. The job was given as a “Possibly dangerous haemorrhage”. I had the street directory on my knees and was calling out directions to try and find our way in to the big new estate with lots of dead-end streets. At one point we found our way blocked by a house. The map clearly said the street kept going, but the house in front of us was irrefutable evidence that it didn’t. Cursing, my partner hauled on the steering wheel and turned us around.

The house numbers were unreadable as usual so we took a small guess and pulled up out front of the only house in the street with a light on. Bingo! Our call-takers usually ask people to put an outside light on, lower the drawbridge and chain up the hounds. We like this because it usually means we don’t get eaten. However we do still occasionally turn up at houses with no lights on, large dogs running everywhere and padlocked 6 foot gates to try and get past.

Nanna met us at the front door - let’s call her Doris. She was wearing a dressing gown and looked like a normal old lady, except for the fact she was covered in blood. It was caked all down the side of her face and over her shoulder and front. She was wiping at it with a towel but much of it was already dried. She asked us to come inside and told us we were actually there to see her husband. We stepped into the hallway to be greeted by a scene out of a splatter movie. There was evidence of blood everywhere, Sprayed in arcs up the walls and all over the carpet. As we passed the bedroom Doris paused and told us that her husband Reg had been lying in bed next to her when she had woken because her face was wet. I looked in the bedroom and it was a real mess. Above the head of the bed the walls were sprayed with more arcs of blood which had dripped downwards. The sheets and pillows were dark red.

We were shown to the bathroom where Reg was seated on a stool in his pyjamas holding a washcloth to his head. “Hello” he said cheerfully “I’ve sprung a leak”. Carefully stepping into the bathroom to dodge the blood drops on the floor, I asked him what had happened. The sink and mirror next to reg were also covered in blood where he’d clearly been trying to get a look at where the blood was coming from – this resulted in an unusual bathroom makeover. Reg said he’d had cryosurgery that morning to remove a handful of skin cancers from the top of his head that morning. Cryosurgery uses (I think) something like dry ice to remove the spots and usually leaves a scab behind for a while. Reg told me he’d tried to stop the bleeding but it just kept going. Immediately I figured Reg was probably taking Warfarin which reduces the blood’s clotting ability.

Reg had obviously knocked one of these scabs off and somehow disturbed an artery. The scalp is highly vascular and tends to bleed a lot at the best of times, but Reg was clearly going for the record. I gingerly pulled the washcloth back from his head to get a look at the wound – a jet of blood sailed over my shoulder and I quickly pressed the cloth back hard. “Well I wont do that again in a hurry” I joked – very glad I was wearing my safety glasses. My partner prepared a dressing and bandage while I checked out Reg’s vital signs. His blood pressure was a little low and he had lost a fair bit of blood volume. We wrapped his head up like a mummy, got some IV access and loaded him into the ambulance. Doris was going to come along but changed her mind – I think she was aware of how much cleaning up she was facing. I hope there were some relatives to come over and help. We took the blood-soaked Reg in his striped pyjamas off to hospital to get his leak fixed.

I kept wondering what would have happened if Doris didn’t wake him up.

Fresh Air

Here is a job from early this morning: My partner was driving and I was in the “jockey seat” which meant I was going to be assessing and attending to the patient when we got inside. As we were going to a child who was short of breath, we discussed the normal values for a child of this age on the way (repiratory rate, heart rate, weight etc.). Its only a rough guide and every child is different, but at that time of the morning it also helps to keep you awake.

The grass in the front yard was knee high and there were two cars in the drive, one of which had no engine and some cardboard for a back window. I could see my partner’s breath on the cold air as we waited for the door to be answered. In this area, the fences are all chainmesh and the houses are old Government Issue, made from cement sheeting and originally built for the 1956 Olympic Games. Many are now pretty sorry looking examples of public housing.

The guy who answered the door was talking on a mobile phone and waved us into the lounge room before walking out into another room to continue his conversation. It was hot inside and the cigarette smoke was thick making it seriously hard to breathe after the chill of the air outside.

The girl was maybe 5 years old and we’d been sent to assess her for an exacerbation of her asthma. She was sitting on the couch with her mother and another smaller child. She was coughing and sniffling and looking miserable. I asked her if I could have a listen to her breathing and she nodded. She flinched when I put it on her back and I realised how cold the stethoscope must have seemed after being chilled outside. I inwardly kicked myself. Sorry sweetie that must have been freezing. She was moving good amounts of air and did not seem to be putting a huge effort into her breathing, but she did have a clear wheeze when she breathed out. She was running a temperature and looked quite pale. Every few moments she let out a hacking cough that belonged in an old person’s body.

Her mother appeared to be nodding off to sleep while I assessed the little girl and woke with a start when I repeated my question a little louder; Have you given her anything for her asthma? She had apparently been given “heaps” of puffs on her Ventolin but was not getting any better. She had been coughing on and off ‘for weeks’ and tonight she would not stop. My partner made a comment about how smoky it was in the house and that was certainly not helping the girl get better. She sat up, looked at my partner and said defensively; “we never smoke in the house”. I looked at the full ashtrays on the coffee table, the bong (pipe) on top of the TV and the cigarette packets on every surface and made a poor attempt to hide my disapproval. I asked had she seen a doctor about the cough – and she hadn’t, so I said well she really needs to be seen by a doctor.

She probably had a chest infection and an exacerbation of her ‘asthma’ from the environment she was in. It was not going to get any better where she was. I treated the girl with some Oxygen, Ventolin and warm blankets as we went to hospital.

I took the nurse aside at the Children’s Hospital and explained about the smoke – she told me she could smell it on us all when we walked in. I sniffed my jacket, she was right. Rancid. She promised they would try and educate the parents about smoking in the house. I doubt it will make any difference. Yeah maybe the girl could have waited to see a doctor in the morning and she was inevitably going to be back in that environment in a few hours. But we left knowing we had given her and her little brother a few hours of smoke free air.

Two Fingers

I have been a little lax with my updates. I will try to be more regular - note to self "Eat more fibre".

Last night was finger night. I'd hardly call 2 similar jobs a run of work, however when you don't attend a certain kind of work for ages and then suddenly you are off to two in a row - it does seem a little odd.

First was to a chap at a house that was being renovated. I think they were working back late on it and it looked like all the cousins and brothers were gathered to help. The place was well lit with those double builders lamps on stands and it was looking good with polished floors and fresh paint going on all the walls. Nice. The trail of blood led down the hallway to the bathroom where we found 70ish year old "Joe" who had sliced himself a beauty while cutting a piece of ceramic bathroom tile.

Joe was on wafarin to "thin his blood" and as a result he was not clotting very well. Still actively bleeding despite a handkerchief and a filthy tshirt wrapped around the wound. Joe had a deep slice running the length of his index finger and curving into his palm. It was going to need more than a few stiches to repair. We cleaned and rewrapped his finger using a big pad and bandage then wrapped him up like a boxing glove to try and stop the bleeding. Joe was asked to try and keep his hand elevated above his head, but he was so busy waving his hand and telling all the relatives how to paint, how to tile, where to put the rubbish etc, that I was contemplating tying his hand to the roof of the ambulance. Anyway despite his protests, we dragged him off to hospital where the hand specialists would need to have a look at him to decide how to put him back together.

Next we went to "Frank" the mechanic although he pronounced it "Frunk". I'm still not entirely sure how Frunk crushed his finger, as he had driven himself his doctors clinic going past 2 hospitals on the way. It seemed he had been working on a car when something (a chunk of engine maybe) had dropped on the back of his hand, which crushed and sliced the middle two fingers on his right hand. Frunk could close his hand into a fist with a great deal of pain, but was unable to then straighten his fingers again. This meant likely tendon damage in itself but when I inspected the wound with a torch I could see right through to the bones and damaged internal structures.

Frunk was in for a long night at hospital while the surgeons attempted to reattach his tendons and get his hand back into some kind of working order. I could see he knew he's messed up and this was going to impact on his work for a long time - if not permanently. It was of course up to his hand surgoen to tell him the prognosis. I gave him some pain relief, took the indecypherable letter from the GP and we walked out to the ambulance. On the way I tried to get more of a story as to what happened, but Frunk just talked round in circles. Sometimes you just never find out.

Ooops.

A few days ago a crew was notified by the police that it was safe to enter a scene:
http://tinyurl.com/24oqnj

It turns out that decision was perhaps a little "premature" and now there are quite a few people on both sides of the fence having a look at what happened. This kind of thing has happened many times before with varying degrees of seriousness. These scenes are often chaotic, always difficult and I'm sure it's easy for human error to occur in the heat of the moment. I'm glad this time none of the people (police and ambos) who responded to this scene got injured while trying to help this patient, but I also hope this issue gets sorted out.

Escaped!

After all this talk of prison last week I thought I tell you of a recent jailbreak. We found 87 year old Enid sitting outside the bakery in Glenroy. She’d somehow come to the attention of the staff who’d called an ambulance because they thought she must have been unwell. Enid was immaculately dressed, with her hair perfectly done, an ornate brooch, a pressed blouse and a simple handbag in her lap. My partner was astute (awake) enough to notice our Enid was wearing only one earring – women are definitely more attuned to that stuff - I have to look down and check that I’m wearing pants some days after nightshift, let alone notice what nanna is wearing. Anyway, despite being slightly miffed I hadn’t spotted it, I had to concede it was a good pickup. The missing earring said right away that something wasn’t right. And someone as well dressed as Enid was not leaving the house til everything was just right.

Enid clearly had some dementia. She would answer our questions to the best of her ability but then when she didn’t know the answer, would ignore us, lean forward and look down the street like she was expecting a bus to come along, or perhaps somebody she knew. If you smiled at her, she would return the most genuine smile and say “Hello dear” like she’d just met you all over again. She was beautiful old nanna and my partner and I were both ready to take her home. Sadly our service frowns upon you keeping patients as pets, so we set about trying to find where Enid was from. A few phone calls later and I spoke to the nursing home a few streets away – It turns out yes, as a matter-of-fact they do normally have a resident called Enid, but today they couldn’t seem to find her. Would they like her back? Why yes they would!

We made one last call to our Duty Manager to notify our intention to return Enid and her earring to the nursing home and then we loaded her up, checked her out and drove round the corner to the home. I rang the buzzer and chuckled as I said “are you missing an Enid?” into the intercom. I let the staff know about her missing earring and they promised to look for it. Apparently that morning Enid had got all dressed up as she always does and “headed off to church”. Usually she is apprehended at the door before she gets far, but today she’d somehow made it past 2 key coded security doors, out of the grounds and down to the local shops. Not a bad escape for an 87 year old in broad daylight. We waved goodbye and then headed off to our next job.

Do not pass 'Go'

Well I finally got sent to jail. I knew they'd eventually catch up with me one of these days. Actually, I got sent to jail (or Gaol if you prefer) 3 times in two days!

First it was to Juvee (juvenile) jail, the children's 'prison' for a chest pain. I could tell the medical staff there thought the young man was "putting it on". I thought so too. But everyone was erring on the side of caution so we took him to hospital along with a carload of minders who would have to sit with him until the doctors decided he was clear to head on back.

Next day it was off to one of the city Police Stations for a prisoner who was having a seizure. This guy was doing a pretty good job of it too - except he was opening his eyes every now and then and looking around to see who was watching. I have found a lot of people in police custody think that if they get taken away in an ambulance, whatever charges the police have laid are suddenly going to disappear. It rarely works. People invent all sorts of medical complaints and an ambulance has to come down and check them out. Often we all know its crap - the prisoner knows its crap, the prisoner knows that we know its crap and the hospital staff give us 'the look' because they know its crap too. Everyone is busy covering their butt.

Last thing before we knocked off for the day, it was off to the Remand Centre in the city. This inner city prison is the full deal and security is tight. Our patient was 'generally unwell' and although he was simply complaining of stomach pain and nausea, he was a bit agitated and twitchy. He kept yelling out to someone who was obviously held somewhere near enough that he figured he could be heard yelling his obscenities through the walls. The staff kept telling him to pull his head in and answer our questions. There was clearly a lot more going on than we were party to. After checking him out, we saw that he wasn't dying and the medical staff had him well under control.

We got out of prison for good behaviour and felt very grateful to be going home.

Anniversary

Oh dear - I'm hopeless. I have just realised I have missed my blog's anniversary. Along with a few other things in my life, it has fallen victim to the post nightshift haze. Here was I thinking I'd only blog this stuff for a couple of months. Then I said to myself I'll keep going til Christmas, now more than a year has gone past and I'm still tapping away, albeit somewhat sporadically!

Thanks to everyone who has been visiting, reading and posting, it has been great hearing from you. And of course lets not forget those who are occasionally spamming the comments section, your generous offers of cheap software, viagra and share market tips really make my day :)

Anyway I don't have any candles, but there is one beer in my fridge - it seems only fitting to drink it now.

Grief

We all know different cultures handle grief and loss differently. For some grief is a very quiet, private and solemn affair. Some wail, pull at their hair and make a lot of noise. Still others might dance and sing. Each person goes through a grief process, dictated by their own feelings or culture. And yes much has been written on that grief process. In my work as a paramedic I have seen grief handled in many different ways, sometimes surprising ways and sometimes wholly expected.

The other night I was asked by a family to transport a woman whose main complaint was grief. She had suddenly lost a relative in a conflict overseas and after much open and vocal grieving had now ‘shut down’. She was not talking to anybody, was lying on the couch, refusing to open her eyes, refusing eat or drink and was worrying her large family who had gathered around her. I struggled a bit on the night as to what was the best course of action for this woman, she wasn’t physically unwell and although you could argue she had experienced some kind of emotional breakdown, she was actually grieving, and grief is something that I don’t think western medicine handles very well.

Her family were adamant that she needed to go to hospital and be seen by a doctor, she appeared to be wishing we would all go away (yeah I know that’s me projecting onto her) and in the end even after we suggested that a locum doctor (home visit) might be more appropriate for her – meaning she would still be seen but could remain at home rather than waiting at hospital – the family insisted that we take her. I’m still not convinced it was the right thing to do.

Has anyone else been to something like this?

Ice.

The young man was lying on his back on the footpath outside a drive-through bottle shop that had closed for the night. It was midnight on Friday night and the streets surrounding the main strip in inner-city Fitzroy were busy. There were two men crouched over the figure, one sitting on his legs holding him down as if he were about to float away. He wasn’t moving. In hindsight, the usual crowd of onlookers was absent – only a few people were standing a short distance away. That should have given us a clue that something here was out of the ordinary - but it didn’t.

We had been dispatched to the case as a Signal 2 job and the data terminal just read “Unknown problem – Is standing or talking” – these jobs are usually psychiatric issues, alcohol related or drug affected. Sometimes all three. We parked in the driveway and flicked on the spotlights to light up the scene a little better. As we got out of the ambulance a police van pulled in behind us – my partner and I exchanged looks. There had been no mention of the police being dispatched on the data terminal. Sometimes multiple people will call for help when something untoward happens in the street – some people will call the police, some will call an ambulance. Sometimes the two services don’t communicate very well and we both arrive looking surprised to see the other.

My partner headed over to talk to the police and I grabbed the Red bag and walked over to where the people were holding the young man down. I could see straight away that he had his eyes open, was clearly breathing and appeared relatively calm. Then I saw the blood on the ground around his head. I asked the two guys what had been going on and they stated this guy had been “going crazy” and had hit his head on the ground. My first thought was that perhaps there had been a fight between them and they had been holding him down until the police arrived. He looked quiet enough now. The police officers and my partner walked over so I asked the two guys to get off him. I remember one of them looking at me for an instant as if to say “are you sure?” – then they let him go and stood back. For a few seconds all was quiet… then all hell broke loose.

The guy let out a scream like a banshee, arched his back and began repeatedly smashing the back of his head into the concrete with one of the most sickening sounds I have ever heard. You could literally hear his skull cracking. For a moment I think nobody could believe what they were seeing – then we all jumped in and tried to stop him. While the others restrained his arms and legs, I tried to hold his head still. With all the blood in his hair his head was impossible to hold – I ended up grabbing a fist full of his hair with one hand and placing my other hand under his head. He violently fought against us and was arching his back, easily lifting the two police officers that were trying to hold him down. My partner ran to get the bed and restraints out of the truck. Then suddenly he relaxed, stopped fighting and was quiet again, lying there like he was looking up at the stars, blinking occasionally but not saying a word.

A few tense moments later and we had him restrained to the bed for his safety and ours. I never like doing that but this guy was clearly doing himself some major harm. We loaded him into the back of the ambulance and I set about trying to take some vital signs. My partner placed an oxygen mask on him and I passed over a pad and bandage for his head which was steadily turning the pillow red. Suddenly and without warning, he fired up again, screaming, kicking and writhing. The two police officers who had been lurking in the doorway of the ambulance piled in and we all struggled to hold him down again. He managed to dislocate his shoulder trying to sit up and get out of the restraints – he was unbelievably strong. Because my hands were somewhat full, my partner notified the hospital, which was only a few minutes away, to warn them we were coming. He went from perfectly calm to berserker mode several more times over the next few minutes until we handed him over at the hospital. A few minutes later and there were six security staff, four nurses and several doctors all struggling to manage him.

He would need to be sedated, restrained and closely monitored for many hours until the methamphetamine was out of his system and they could work out how much damage he’d done. When I finished writing my case notes, I went out to where my partner was still cleaning up the blood in the ambulance. Not long after, the two police officers walked back outside. I thanked them for their help, we bade our farewells and we all drove back out into the night. Only another six hours of nightshift to go.

In the way..again.

We were in a supermarket yesterday. We were in aisle 3 to be precise, treating a patient who was now post-ictal - that basically means he'd had a seizure and was now in the recovery phase which can take quite some time and be quite distressing for the person. I have never personally experienced a seizure but I know from the many I have seen, they can be devastating to the person who does experience them. One minute they are waltzing along, ticking the frozen peas off the shopping list and ..bamm! The next thing the person may realise is that there are strangers standing over them, someone is trying to hold an oxygen mask over their face, they have possibly soiled themselves, they feel really irritable, nauseous or distressed and they are confused and frightened. A pretty ordinary way to wake up in anybody's book.

Yesterday while I was trying to assist this man through his post-ictal period, I'll admit it - I was in everybody's way. Traffic was backed up in aisle 3 all the way to the end of the refrigerated cabinet. Nobody could get through and they had to go ALL THE WAY ROUND to the next aisle to get what they needed to fill their trolley. So to all those people who tut-tutted, sighed and muttered cause you couldn't get past me and my crewmate and the selfish bloke lying on the ground with his head resting on pillow - A pillow! I am sorry we screwed up your shopping experience. I have since spoken to the man an he has promised never to have a seizure in the supermarket again. He will stay indoors from now and make sure he never gets in the way.

To the lady who asked me to pass her the frozen yoghurt, while I was being inconsiderate and taking a blood pressure - I hope you can forgive me - I'm sorry I tut-tutted, sighed and muttered at you. Really I am.

Waiting

The old guy had been sitting on a seat in the airport arrivals lounge for most of the day. Eventually late in the afternoon he came to the attention of the airport staff when one of the thousands of people who walked past noticed that he had wet himself. The airport staff had then approached him and found him to be confused and unable to tell them much at all. We got called and asked to come and check him out.

We were met by an airport manager who escorted us to where the man was still sitting. He was a little Caucasian man about 70 years old who could have been anybody’s grandpa. He was sitting there with his eyes closed clutching a small leather toiletries bag. My partner spoke to the manager while I assessed the old man. He opened his eyes and tried to answer my questions but was clearly confused and disoriented. Physically he checked out fine – blood pressure, heart rate, lung sounds all normal. I then checked his temperature and blood sugar levels and found them to be normal as well. He didn’t seem to be overly dehydrated and I could find nothing amiss – other than the fact he was very confused.

My partner told me they had figured out from his boarding pass that he had come in on a flight from Indonesia early that morning on a one way ticket. But why was he still at the airport? Wasn’t someone coming to pick him up? He was clearly unable to look after himself and had no idea how he got where he was or where he was going. He was simply just sitting. Waiting.

I asked him if I could look inside his bag and he nodded. Inside I found some basic toiletries, a toothbrush, a shaver and an old bottle of prescription tablets that I didn’t recognise. There was also an old wallet. Inside there was no money, only a few scraps of paper and a photo of him taken years before with his arm around the shoulders of a smiling Indonesian woman. One of the folded bits of paper contained a name, phone number and an address way out in the eastern suburbs, all written in shaky writing as if a child had written it. I handed it to my partner and we decide the best thing to do was to call the number. We had nothing else to go on.

We walked a short distance away to the service counter and the girl there passed me a phone. I dialled the number with my blue gloves on. The call went basically like this:

Hello?

Hi my name is Rob… I’m an ambulance paramedic…..

…yeah?

I’m here at Tullamarine Airport and we have an elderly gentleman here by the name of Norman Smith….I’m just wondering, do you know him?

….you what?

We found your number in his wallet and we were wondering if you can help us work out who he is?

He’s here ….in Melbourne?

Yeah, Are you a relative?

…He’s my… he’s… Look we don’t want nothing to do with him ok.

We’re just trying to find out where he is supposed to be staying so we can make sure he’s alright….

Look he left us a long time ago to be with her and none of the family wants anything to do with him... alright?

Is there someone that he lives with here in Melbourne we can contact?

Mate you don’t get it – he lives in Indonesia. We don’t want nothing to do with him.

The phone was left beeping in my ear. I was stunned. I looked over at the old guy sitting on the chair and told my partner what I had just heard. I could only assume that this guy for whatever reason had left his life in Australia and gone to Indonesia to live with a new partner. His family had apparently never forgiven him. Now he was old and confused, and someone had put him on a plane and sent him back to Australia.

We had no idea what to do with him, so we loaded him up and took him to hospital. I told the story to the triage nurse. They sat him on a chair in a cubicle and made some calls of their own while I wrote my case notes up. The nurse told me she had been given the same story when she called the number in his wallet. Nobody wanted anything to do with him. Whatever he had done, I looked at him sitting there alone in the chair and I felt genuinely sorry for him.