The wife looks at my me and my crewmate as we lift the chair with her husband in it onto the back of the ambulance.

“You both must be very strong”, she says.

I reply with a joke, normally about how my crewmate, half the size of me, is actually the stronger of the two of us.


But what I want to say is that the lifting is the easy part, the real strength is needed with the things we see and the patients that we deal with.

It's the strength that you need when you have picked up the fourth severely demented patient in a row, they curl up on our trolley having been unable to move for many years, their arms and legs contracted into the foetal position. Their bodies are skin and bone, as we pick them up their joints creak and crack and they shriek in our ears, long nails dig into our arms.

It's the strength that you need when driving the ambulance and you hear them start to cry in the back, your crewmate holds their hand and tries to reassure them but they can't get through. Instead all you can hear is the sobbing and the noises that are left them now that language has gone. they can't tell you if they are in pain or are scared – instead all they can do is moan, and cry and scream.

It's when you walk into a nursing home full of the demented elderly. Stuck on the walls outside the doors to their room are photographs from their prime. Happy mothers holding their children, proud men standing to attention in military uniform. Sepia memories from the past, what they were, not what they are. You open the door and the person in the photographs is lying on urine sodden sheets, legs heavily bandaged from ulcers that will never heal, with hands constantly grasping for something imaginary that floats just out of reach. The person that they were is gone, all that is left is the shell, no expression behind the face that smiled all those years ago for the photo outside the door.

Then one takes hold of your hand and looks up at you with bright blue eyes and asks if you are their dad, long since dust.

And your heart breaks.

I don't know how much longer I can do this.

30 thoughts on “Strength”

  1. i know exaculty what you mean,i have a very close relitive with dementia, who is in a lovley nursing home, but when i attend these patients as a paramedic i find it very hard, it is heart breaking.only the other day i attended a lady who was of sound mind but had decided that she had had enough of life and had just given up, she wanted to stay at home with her husband, they had never been apart after 65 yrs of marrage, he didnt want her to go any where… so me my tech and the rrv driver made the decision with the family and gp to let her have her wish and stay at home to live her last days with her husband.. and as we did that i laid on the bed holding her hand desperatly tryng to hold back the tears… this job can be so hard some days…

  2. Tom, Sadness is in the air today. I don't know why. Push through, wait for the sun and remember all the people that you've saved.

  3. I have to say that is an absolutely stunning account of what you do. Nowhere near enough people appreciate just what a truly inspiring job you all do, (although I'm sure you're well aware of this already). People always ask 'what is the worst thing you've ever seen?', 'what's the worst thing you've ever treated?'; things that you don't want to think about, that can keep you awake and that you don't particularly want to be asked about. It might help to ask yourself 'what is the best thing I have done as a paramedic/emt?'; there was a reason you joined the service, and if you don't find things difficult then you wouldn't be human. Have a little faith in yourself, I know your readers do.

  4. What a heartbreaking and accurate picture you paint. Our nursing home is a specialist one for severly mentally ill patients, mainly dementia, and what you say is all too familiar. You meet the resident, you get to know them and what they are when you know them is often so vastly different from what the families tell you they were like and the photographs you see. My grandfather has gone the same way, once he was an engineer, with a major role in building Baghdad hospital, now he is a 5 and half foot child. It's the hardest thing in the world to only know these people at the end and see them at their lowest. The reason you do what you do and the reason our home does what it does is that if we didn't then no one would. You make a difference, even if it's only for a little while and that's a huge thing so don't ever underestimate the good you're doing.

  5. I'm not surprised you're finding it tough at the minute. The winter is dragging on and then you deal with these kind of incidents.I'm not sure what to say. If you leave to do something else, your patients will have lost an advocate. If you stay, the cost to yourself will continue to mount.

    Many hugs for you on this cold, grey morning. This is one of those times when I wish virtual was a little more solid. Sometimes a proper hug from a friend cures many an ill.

  6. It's strange, elderly jobs are often the worst. Massive trauma, resus, paedi jobs – they're all the stuff you train for. You don't really get trained in how to cope with the elderly in the same way. Ok, so you have the theory of elderly medicine, but not how to cope with dementia patients, how to get through to them, and how to treat them as people.It's winter, and unfortunately you get a lot of this around this time. Combined with the long nights and SAD, and I can see why you're getting miserable. But soon it will be summer, and you'll have long sunny days, filled with drunk teenagers instead!

    The fact you write so poetically about the plight of the elderly means you still care. And while you still care, then you're the best thing for the job. Whether the job is the best thing for you is another matter, however.

  7. Whilst I can't argue that the disease is terrible, it's not always so grim as the picture you paint here. I worked as a carer for those with dementia and alzheimer's disease for Bupa. The home was clean and tidy, the residents were kept clean and because I worked nights I ended up having lots of time to spend chatting with the residents, and lots of hairy discussions in the morning before breakfast. It was five years ago and I still remember their names. Half the time, I was torn between wanting them to be well, and being glad on their behalf that they were not – the loss of dignity, the lack of family visiting – a care home must be worse for people who are mentally fit. However clean and nicely decorated a care home is, it's still a care home. There will never be enough staff, never enough hours in the day and every shift is a mission to get from beginning to end in one piece.I've been reading your blog for four years. From an outsider's perspective, and from personal experience, SAD + night shifts + emotionally shattering patients = misery. However, I would hope that once elements of that equation are removed – spring is only round the corner, you don't work nights full-time so soon you'll get a bit of normality in your brain chemistry back, and some patients aren't as saddening as these – you'll know you can continue to do this.

    I'm not a carer anymore. There's not a day that I don't miss it.

  8. I've been reading your blog for a long time now and this is the first post that's made me cry. Maybe that means I'm a heartless person but this post struck me and made me want to comment.You do an amazing job and I'm sure that most of us out here would wish to be treated by someone who cares like you do if/when we need help. My mum died of cancer some years ago and I remember the shell she became, small and withered and doped up to the eyeballs on morphine. There was only a fragment of her left in the end but the people who helped care for her all treated her and us with compassion and respect. That is invaluable and makes a huge difference to both the patient and their loved ones. Thank you. Your work is appreciated and valued even if the press and all the beaurocracy and targets make it seem otherwise at times.

  9. Yeah. It fair breaks your heart. There's nothing at all that can be said to make it better because it isn't. It really isn't. Hugs help though……….and you have to not allow your mind to go there, because when it does, its just too terrible. I feel myself slipping down that slope sometimes, and at the moment I can find the odd foothold and tree root to hang onto, but sometimes there just aren't any until you get really near the bottom, and then its a long old climb back up again.Thank god for the good jobs where you can reach out and make a difference.

  10. What a beautifully written post – ample enough for me to reply after 2 years of dedicated reading.The funny thing is you do have the strength, you understand that there are so few of 'you' around. Who would take your place? Would they express the empathy that you would, well, probably they would – you and your colleagues are professionals after all. But you'll never find that personal responsibility to the cause, trust me I know from a previous life.

    Abstraction between your working and personal live as well as enjoyment and celebration of your own life will see you through.

  11. Maybe im weird but i found nights helped my sad.I would finish work at around 7 am,but stay up till 12ish then sleep,or try to,till around 7pm.Perhaps it was the daylit”evenings”till 12 which helped.

  12. I don't know how you have lasted as long as you have. Some things you consider routine would stop the majority of people in their tracks.You are a very strong charactar Tom, and a credit to yourself and those you work with. Keep your chin up mate, it will get better.

  13. Tom can l suggest an iead? Buggar off round the world for a year. It will give you a much needed break and help you decide what you want to do.We can read and enjoy your posts as you wander through life's distant shores as we enjoy your stationary postings.

    Heck l recon enough folks read this blog from all over the world would put you up as you tripped through their region 🙂 so it should not be to expensive.

  14. It's the hopelessness of Alzheimers that gets to me. The nurses on the rehab wards – God only knows how they keep sane – work their damndest to bring the elderly impaired back to self-care and self-respect, but only a few weeks or months down the line, back the patient is again and you know that as soon as they went home, they have relapsed into self-neglect and confusion. It gets so it's a revolving door.Then there are the dump jobs – in and out like clockwork, with “constipation”, “acopia”; I once saw “off legs” in someone's notes. They shouldn't be occupying acute hospital beds, but the reality is that the families just can't cope with an irrational, often aggressive, paranoid stranger who runs on a 24-hour clock with maybe the odd 10-minute doze. Who could cope with that? But we expect 80-year-old spouses to. Once the young and the middle-aged used to look after the old. Now the old look after each other, and the very old. People in their seventies coping with parents in their nineties.

  15. Hi Tom. I am an avid reader of your blog, and I am full of admiration for the job that you (and my paramedic mates) do. It takes so much compassion to do what you do day in day out, to see what you do and carry on doing it, and still be cheery (mostly!) and caring. I have never before felt compelled to post to a forum like this, and I don't think my support matters a bean to you, but I truly admire you and all your colleagues, and thank whoever needs thanking that there are people like you out there. Sending you a big virtual hug.

  16. powerful 'riting ' me old to give thyself a sabbatical, or a leave of absence and go and see how the over indulged live with the Sun and recharge thy batteries. Every one who lives on the emotional batteries of life deserve the change of scenery.Then come back and save the world again.

  17. Man, you sure know how to put it into words!I was a night care assistant for 8 years and never want to do it again.

    I still remember them and still feel the odd sob for the ones that tugged at the heart.

    And probably like you, I spent half the night on the computer because my stupid body clock is all mucked up, even though I can't have a lovely afternoon kip!

    I wish I could help you, I can only agree with others who can feel you caringness (?) in your posts.

    You do make a difference.

    Be proud, you are one of a select group of very special people.

    Bigs gentle *hugs* to you all.

  18. I've been thinking about registering since I first started reading, but I didn't have anything I wanted to say badly enough to create yet another account.But your last line really did make me cry. And I wanted to say thank you for doing what you do. But if it's time to stop, it's time to stop.

    I stopped being a Samaritan 6 months ago (or so). I'll go back one day, but it was time to take a break. I realise it's different when it's your career, but it's important to look after yourself, too.

    My husband's 80+ year old grandma fell on ice recently. The FRU had to fight to get an ambulance to pick her up – she finds it hard to get into cars at the best of times, and with a suspected broken leg there was no hope. But the FRU and ambulance people looked after her.

    I know that wasn't you – but thanks, on behalf of all the people who don't think to say it.

  19. Tom,Sometimes all you can do is realize that, by getting one of them out of that type of nursing home facility (I can't call it a home when it isn't), even for a short time, you improve their existence for a brief time. As you said, they are a shell of the person they were. But, I remind myself that there is something of that person there still… locked in. That brief, precious moment of dignity we can give them, even just holding their hand, is worth it, IMHO.

    (I worked in a nursing home in my teens. Hardest job I ever did. It drained me emotionally. But, it drove me… and helped me to become the person I am today, intent that I will NEVER treat someone like that… EVER.)

  20. I think you're heading for burnout, Tom, that's if you're not already there.It's impossible to give, give, give every day and not lose a little bit of yourself along the way. It's winter, it's cold and miserable and your job is certainly harder than usual at the moment.

    Your post made me want to give you a great big hug. Who's looking after you? Are you doing much in your time off apart from sleeping? Are you taking care of yourself? I hate to sound like a mother but I worry that you're going to end up in a big heap with no one to pick you up.

    If you need time out – take it. If you need to quit and get a job in Sainsburys – do it. Your mental and physical health are more important than anything else. No job is worth losing yourself.

  21. You won't remember that I almost invited you out for a bevvy in September, but she's now SH2D. Not meant as a meme, just to say that despite being a 'dumpster' – no choice, live too far away- I appreciate what you do, and how much you care, perhaps too much? Bizzarely am hoping your next job is squeamish to bring out the gallows humour – nowt better for lifting the blues. From one person in anguish to another in pain – sending cuddles.

  22. That's what make you good at your job. You can see what your being there means, not only physically to the person you are tending to, but to the feelings and thoughts of those and those around them.Very well written. Thanks for sharing.

  23. It works both way I think. While it has such an awful effect on you, it has such a positive effect on the people that you treat – even if you think they don't notice.When I fret about the various heart problems I've had this year, the one thing that makes me feel better is thinking about the paramedics who had to come and pick me up from work one day because my heart had given up the ghost and gone into atrial fibrillation. All I needed was for someone else to take charge, because I was just so tired of being ill, of being weak and being frightened, and those guys were my relief; whatever happened to me wasn't down to me any more, and I felt safer than I ever have before or since.

    It's a huge brunt to bear, and I don't think I could ever do it. I've always respected you, and I'm glad that there are people like you doing the job. But you have to be selfish sometimes, and if you need time out, you need time out. As a patient, and I'm sure I speak for anybody who's ever been picked up by a paramedic, I think if anybody deserves to take it easy, it's you guys. x

  24. Ive read your blog for many years now but never felt the need to comment until today. Why not take 6 months out & experience life in different areas of the world, it will give you chance to reflect on things & decide what you want to do, as we often see, life is too short!!I understand your feelings in the last post, its the old photos that get to me. Stay strong & remember that what we do does make a difference to a lot of people.

  25. Ours is such a versatile field, you have aquired so many skills. I've been a med/surg nurse since '82. You need to listen to yourself as you have been reminding me of myself with burnout. When I worked hospice for 3 years I loved being there but, I got to a point where I found myself wondering how many were going to “knock off tonight.” It was time to move on. Did Oncology then Rehab then Med/surg. Again, found myself not feeling very therapeutic, especially towards those in chronic pain on the call bell continuously so watched the want ads and have found a new position. It is a wonderful thrill to be learning a new routine and picking up new skills. How about being the nurse on a cruise that goes interisland someplace warm like Hawaii? Would we love to hear from you! You can always go back, sometimes you need to shake things up, Tom!

  26. It's interesting what people complement you about. I once had a patient complement me on how good of a job I did at parking. When patients comment about lifting, I usually go with something about being only allowed to drop one person a day and we already dropped someone else. Of course, I follow that by assuring them that I've never dropped anyone before.I'm so glad my current service does not cover any nursing homes and there are none in my service area. I used to run several a day. Not fun.

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