Category Archives: Blogging

Chemical Cosh

My memory is poor, but I'm sure that, when I was a nurse, the NMC had it as a condition of being the sort of nurse who gives drugs to people that the aforementioned nurse understand what a drug does and what it's side effects are.

It's 3am in the morning and I'm miles out of my area on the FRU*. I have been sent, as a blue light response, to a nursing home where one of their 'clients' is sleeping.

Yep – sleeping.

I get there and the patient is in the reception area of the home sitting in a wheelchair. He is… asleep.

The 'nurses' at the home tell me that normally he is very active at night and often comes to see the night nurses and sits chatting with them. He's ninety-eight years old and mildly demented.

I bite my tongue and do all the checks that I can to make sure that there isn't anything obviously medical going on. All his observations are fine and he responds somewhat when I try to wake him. I'm sure that if I provided enough pain stimulus I could fully wake him up, but it would just seem cruel.

I look at the patient's drug chart. Two days ago he was prescribed a rather strong sleeping pill.

I ponder, for about 2 milliseconds, if this might be the cause for his sleeping. At 3am in the morning.

I suggest this to the nurse.

She shrugs.

The staff don't say anything, but I get the distinct impression that they have been getting tired of this patient being awake while they are at work. If all your patients are sleeping then the night shift has little to do. If this patient has been awake, then they actually have to talk to him. In a lot of the nursing homes that I've been to the nursing staff don't like talking to the patients.

In a fair few nursing homes that I've been to the staff and the patients rarely share a language, and so everyone just 'gives up'. As a digression, the good nursing homes that I've been to have been those where the staff and patients do talk to each other, and the care of the patients is considered to be more of a 'partnership'.

The nurses, who I suspect have got exactly what they asked for, aren't happy. They've already rung the elderly relative of our patient (at 3am!) to let her know that he is heading into hospital.

The ambulance crew arrive and I have a real problem explaining to them why we have been called.

“The nurses wanted this patient to sleep at night. They have given him a sleeping pill, and now he's asleep”, doesn't really seem reasonable for a trip to the hospital.

But the 'customer' is always right – and so the patient is driven off to the hospital.

I talk to the crew a few days later and they tell me that the receiving nurse at the hospital was as befuddled as the rest of us.

I don't know, jobs like this make me despair at the general intelligence of people, not less the intelligence of the sorts of people who look after the elderly.

Oh well, at least one of us had a bit of a kip that night.

*I really need to tell you about FREDA one day – perhaps a joint post with Nee Naw.


I'd like to apologise, blogging has been a bit slow of late. Mostly this is due to working on the sequel to 'Blood, Sweat and Tea' – I'm needing to put some concentrated effort into it. this is not easy with twelve hour shifts accompanied by the utter lack of energy I have at this time of the year.

Medgadget are running their annual Medical Blog Awards – you should go over there and have a look at the nominees, there are some really good ones there. Also there is no other motive for suggesting you visit the link. No. None at all…

Blogged: 2005

…Enter ‘Prostitution’ Mode…

So I got my copy of Blogged: 2005 last night, indeed I am in it, but had I not been, I still would have bought it for myself.

The blogosphere is a wide and varied place, and Tim Worstall does an excellent job of collected some varied posts from mainly UK based blogs to highlight some of the news events of the year.

It covers most big events of the year from the Iraq war (pro, and anti), ID cards (all anti, but then is anyone besides the government in favour of them?), the July 7th bombings, the election (both here and in America), all the way to shaving your man-spuds in preparation for a vasectomy.

One of the main strengths of the book is that if you don’t like the writing of the article, then the next one is only a few words away, and while the majority of the book is based on the political side of things (obviously, as most of the big news events of the year are political) there is still room for bits from non-political bloggers.

I sat up all last night and read it through, cover to cover and I suspect that there are going to be a few new blogs added to my daily reading list.

In a slightly Doh! moment (at 4 am mind you), I wondered why the book stopped at October…

And yes, I’m one of the contributors, and so is Nee Naw (who kept very quiet about it).

Having talked to the publishers (The Friday Project), I can report that they are very nice people who ‘get’ the whole idea of Blogging, so I hope this book does well, both for them and for Tim.

…Exit ‘Prostitution’ Mode…

Off The Grid

No blogging for the next two days as I'm at the Virtual Worlds Forum pretending to be a journalist-blogger (don't ask…) Posts about this will be on Mental Kipple.

On Friday it's Mac Expo day, but I should have written something ambulance based before then. I'm thinking something based on a Levellers song…

VWF is rather interesting even though it is more directed towards business people, it's fun to look at what they consider important in a Virtual World as opposed to us mere consumer/creators.

The low level light in the main hall is massacring my eyes while I'm trying to take notes though.

On the subject of notes – I think that I've taken more notes in the first morning here than I did during my entire time in college.

Which may explain a lot.

Oh, and I've just done a bit for BBC radio's Pods and Blogs, Chris is a very nice chap and persuasive to boot.

Right – time for the afternoon session.

I wish they had beer here…

On The Morning Of Going To Birmingham

This post should go live just as I finish my talk on ‘Citizen Journalism’ somewhere in Birmingham.  I’m actually writing this at 5am before getting ready to leave and catch my train.

It’s been a weird thing to write – I had no idea who my audience would be.  Would they be hard-bitten editors of national newspapers?  Would they be bloggers seeking insight into citizen journalism, or would it be a mix of all different people.

So I decided to keep my talk pretty simple, not concerning myself with the nuts and bolts of how ‘us’ and ‘them’ (an what a distiction that is!) would work together.  I even stopped myself from trying to predict the future.

Instead I thought that I’d tell everyone about two ethical concerns that have popped up in the last few weeks, and have a discussion around them.  There is going to be a panel discussion in the afternoon which I’m more looking forward to – hopefully they won’t mistake the simplicity of the presentation with a simplicity of my mind.

If you are interested in the presentation, there is a Powerpoint file for download.  Note that some images may be copyrighted, that the powerpoint goes with the presentation and that I do indeed have cute animals in it.  If there is a video, I’ll try to make it available for download.

I’ll update later with how it went.

(I wonder if they'll notice I never slept last night?)

…And Now The Answers

Well… That's the last time I ask for questions, I'm going to spend all weekend answering these. Still, I did promise. Half are answered in this post, the remainder will in the next posting. It's all a bit quick and nasty but I refuse to spellcheck the questions.

(And where did I get some many insane readers?)

Let's begin.

I am starting medicine in September and was wondering how you get on with the medics to whom you hand over your patients, how do you rate your skills against theirs, In what way do they differ? Do medics get a chance to go out with you and see what you do and thus get an idea of what the patient has been through before they get to hospital.

We tend to hand our patients over to the nurses rather than the doctors. While we know that doctors are way more educated than ourselves we do pride ourselves on our 'real world' knowledge which can come in handy sometimes. The LAS do had doctor ride-outs and crews tend to like them because it normally guarantees a quiet shift.

If you were a dinosaur, which would you be, and why?

Want to be or most like? I'd say I'm most like an Diplodicus (or whatever they are called now) – a large, peaceful plant eater with a small brain.

How often do women “come on” to you? Ever gotten involved with someone you met on the job?

Not often enough (as in almost never), and yes – I have got involved with women on the job.

You seem to be slightly schizophrenic. Your blog was originally called “Why I Hate Humanity” :-), and you frequently say in your blog posts that you hate everyone the same.

BUT you come across as a really caring guy, who doesn't hate everyone at all, in fact you quite obviously care about everyone.

This was perhaps going to be a posting on it's own, but I'll touch on it here. When I started writing the blog I was pretty reactive. While writing this blog I've started exploring the thoughts and feelings of the people I write about. When you start putting yourself in their shoes you start to be a lot more forgiving.

Bless your heart, are you going to brave it, forget the shyness, and ask one of your many lady-friends on here out, and get yourself a date?

Nope.

What's your idea of a perfect date?

Can I be rude here…? But seriously, any date where we get on really well.

[On Speedbumps…] So, has anybody ever tried getting the damned things ripped up on the basis that they've been constructed in breach of the regulations?

Are they really? Hmmm, something I'm going to have to have a look into, as I do like causing trouble over such things. It doesn't surprise me to be honest as some of them are simply a row of bricks in the road.

Station supervisor asks if I'm 'up for another beer'

I'm always up for a drink, not a beer for the next couple of months, but definitely drinks in a pub.

If you could meet one person from the whole of history and either shake them by the hand or kick them in the reproductive organs, who would it be and which would you do?

Could I do both? I'd shake Sir Joseph Bazalgette by the hand, and kick either Osama Bin Laden or the bloke who dreamt up religion in the testicles.

If you bumped into a genie and he granted you 3 wishes, what would you ask for?

1) That everyone *knew* that when you die, that is that, no Heaven or Hell.

2) So that when you intentionally cause pain to another person, you feel that pain as well

3) Personal immortality, so I can see all the cool things humanity will think up.

Random acts of kindness and sensless beauty are words from some Daoist text are they not. Are you a Daoist?

Are they? I think I was drunk when I thought up the title… I've read some Daoist stuff, but I'm not one myself.

Do you think your experiences, that you've written about here (and in your book) are typical of ambulance drivers and/or paramedics in the LAS?

Absolutely, It's the feedback I get from my workmates and from ambulance people around the world – that it's the same stuff, just with different scenery.

Do you think your experiences are typical of ambulance work in general (eg, other locations in the UK, other countries, other specialties like Helicopter Air Ambulance or military medic)?

Well, HEMS go on 'sexy' trauma, and military medics probably deal with a lot less little old ladies than I do. I think that they have the advantage in that a lot of their patients are young and fit.

So your book takes off, Hollywood comes knocking, and you get to cast the actor who will play you; discounting Nicholas Cage who already made a middling ambulance/emt movie, who do you choose? And of course there needs to be a leading lady–and she would be….?

Why would there be a leading lady? For me… possibly Jack Dee (not as the leading lady mind you).

How would you like to work in ambulance comms, like us poor folk stuck in this red hot room whilst you have all the fun on the road??

No thanks. (although aren't you air-conned?) I quite like not having my every move watched over and audited by an officer. An I've heard some of the nutters you have to be polite to.

Also, have you ever (or ever seriously considered) hurting someone or delaying their care due to their conduct? I'm guessing that this answer is no since I whole-heartedly believe you would never do any such thing, but you never know.

Considered it? Yes. (More so in A&E), have I ever done it? Not on the road, no. But as a nurse I've delayed stitching up people's heads because they were obnoxious drunks or similar.

Do you think about what you're going to write about in your blog, and how you're going to write it, before you sit down at your computer – or even while the events are actually taking place? I wonder if you have a “running commentary” in your head?

Yep, after every job I sit and think 'Can I turn this into a blog post?', but the actually writing happens as I sit in front of my keyboard, part of the side effect of writing how I talk.

Related question Do you write these things as they happen or store up the “good” ones to keep the blog ticking over?

I make quick 10 word or less notes on jobs that I can write about in Ecto. Then if I'm not at work I can go back and write them up properly.

What new fun item are you going to take up as a way to open up (ie new leisure pursuits) on your off hours?

Between Work, Writing, (new) Social life, Sleep and World of Warcraft I don't have time for any new leisure pursuits.

Do you agree that a 14 gauge cannula is an acceptable means of discovering whether a patient is feigning unconsciuosness?

No – there are better ways of waking people up that don't involve them possibly spraying blood around. A god old fashioned sternal rub works wonders for me.

You mentioned you hadn't cannulated for a few years and declined the offer of cannulating a patient recently (in da book). Do LAS EMT's routinely cannulate or were you referring back to your A&E days?

I was referring to my A&E days. EMTs in the LAS don't cannulate, although they sometimes will under the supervision of a paramedic – mainly for folks who work together for a long time.

Any tips for getting a job? (I'm finishing my nursing course first) I have tried contacting the local ambulance service but I have yet to hear anything from them….

Here you go…

Oh…and how old are you? My friends and I have been trying to guess, but we have no idea!

34. 35 in November.

Have you seen or read “Bringing out the Dead”, and what did you think if so.

Seen it and loved it. It's one of the few ambulance films around. Once upon a time I tried writing a voiceover for an ambulance script. It was pretty much word for word the starting monologue for 'Bringing out the dead'. So that is how many targets it hits. And the gradual disintegration of Nick Cage is spot on for working nightshifts.

Who would you prefer to direct the movie of your life? My vote would go for Micheal Winner.

Uwe Boll.

*joke*

Mike Hodges.

Was I wrong to call 999?

Last week an elderly lady fell down some concrete steps backwards right in front of me. There are only four or five steps but she kind of wobbled half way up lost her balance and fell backwards. I saw her bang her head. I did first aid years ago but can't remember much. I went over to her when the fun began! She was deaf! I was extremely concerned because I couldn't communicate with her. After some help from the local cancer shop which we were in front of, we sat her on a chair (I was reluctant to move her immeditely) someone got her some water – (I wasn't sure if this was a good thing???) and I basicially held her hand (inspected her head – wasn't bleeding) and tried to communicate with her (unsucessfully it seemed). I then proceeded to tell the lady that I was calling an ambulance for her because I was concerned for her – she seemed to know what I was saying. Anyway since Im waffling – FRU (I guess) turned up – inspected her, had the same fun as I did trying to communicate (I have now decided to learn sign language) – said she didn't need to go to hospital and instead took her to her deaf club where she had been heading.

I did feel guilty about calling 999 but think I would have felt more guilty not and just leaving her to go on her way.

Nope – head injuries can be nasty and without medical training how can you be sure that she hasn't seriously hurt herself?

Have you chosen not to be a paramedic? I know you prefer to be in the ambulance rather than the rapid response car, is that anything to do with it?

Nope, I'll be going for the training as soon a a course comes up that I can get on. All our ambulances *should* have a mixed para/EMT crew.

Do you think paramedics get better training via the EMT route of the degree route? I reckon the former if nursing is anything to go by.

Six of one and half dozen of another to be honest. The EMT route gives you more experience of working the streets before making you up to paramedic, but it looks like the degree is the way to go if you want career advancement.

what is the ditterence between a paramedic and an EMT?

We do the same job, but paramedics can intubate people who aren't breathing, cannulate and have some more drugs to play with. They also carry the can for anything an EMT does wrong…

I am part of the SJA team that assists out of Oldham & occasionally Newham. How do you feel about us?

I think you are mad for volunteering to do this job for no money, but you do get some nice stadium/event jobs I suppose. Like everyone else I take people as I find them, I haven't got anything against St John.

I've heard you describe you vehicle as a Materni-taxi, and I've seen a couple of mentions of it being used for that purpose, but have you ever had an actual unplanned front room delivery to deal with?

Two or three… They do happy and I don't moan about people who are about to give birth, just the ones who use us as a free taxi…

How can one speak of the outer boundaries of the universe when the universe is infinite?

It's not infinite, it is bounded by the light cone of the Big Bang (give or take the possible fluctuation of physical constants in the forming moment of the Universe). Speed of light * age of Universe = Size of Universe.

Yes, I was a physics nerd.

Are there no paras on the bus/trucks then?

We are supposed to have mixed para/EMT crews on all frontline ambulances.

2) and is that why you've not put yourself forward for para training?

Nope, lack of courses/time/brains.

3) What's the relationship between the crews and HEMS now? used to be sh*t

Not too bad to be honest – we might not like it when they 'stay and play' but when we need them they are excellent. And they make a real effort to be nice to us crews. So it isn't anything like it used to be.

4) Are ECPs still around in LAS (the rumour mill says they've been made redundant and re-employed as paras).

We have ECPs in Newham, but it all depends on PCTs funding them. Remember the big plan is that we get more and more ECPs out there (to cover for GPs and so the government can shut down yet more A&E departments.)

5) Can you guys thrombolyse STEMI patients?

LAS can't (and it would be silly as we diagnose and take patient's for primary angioplasty), but where there are miles between hospitals the outer counties firms do.

6) Are you up for a (non-alcoholic) beer when I'm next in town?

Sure!

In a fight who would win a mars bar or a pot noodle?

Pot noodle, for the reasons that are made in the comments.

Do you enjoy US emergency TV series? And a related questions. Do you ever find yourself watching episodes of Casualty and trying to diagnose things before they do, or shouting at the TV when they do it wrong? And I can accept that on the telly, Casualty, ER, etc have a duty first of all to entertain the public, but is there anything that they get consistently wrong that gets your back up?

I like Third Watch and ER (well, until it became more concerned with the love lives of it's characters). Casualty makes my teeth itch because the ambulance crews (and nurses and managers) don't act like they would in real life. That and too many people survive CPR, too many babies are born to quickly and loads of 'Why are they doing it like that!' moments. This is why I don't watch Casualty…

Has the success of this blog and your book had any impact on your professional life and dealings with colleagues / patients, in either a positive or negative way?

Yep, my mates have something else to rib me about. My patients don't often know about my 'fame', and my crewmates know me too well.

Humanity Has Made A Habit Of Killing

If we could hold conversations with animals, would we all be vegetarians?

The simple answer would be 'No' – we kill people so why wouldn't we kill animals.

Since recorded history we have invented progressively more lethal ways to kill our neighbours, rather shamefully we have consistently used such equipment upon those members of humanity that are 'of the other'. This killing has gone on for generations despite our ability to communicate with one another. Did the fact that the Nazis and German Jews prevent the Holocaust? Does the shared language in Sri Lanka prevent the killing between the different people? Did the ability to understand one another prevent members of North and South Ireland from killing one another? One final example – the genocide in Darfur.

It is obvious that an ability to communicate does not stop violence.

As humans we have found more and more ridiculous reasons to kill one other, from fighting over resources (oil, gold, water), tribal conflict (Ireland, Sudan) to the craziest argument of who has the biggest God.

This previous criminal history of humanity of a whole lets me believe that, even were animals able to talk to us, we wouldn't stop for one instance in our pursuit of meat to eat. Once you understand that we will kill each other over the shape of the nose, because you own more of a type of mineral or because your God is 'wrong' – is it so wrong to imagine that we would continue to kill in order to live in the fashion to which we are accustomed?

Finally, if we can kill and torture great apes, which have been shown to be able to communicate, for novelty ashtrays and medical experimentation – then what makes you think that we would pay any attention to the cow saying “No!” as it reaches the bolt-gun operator.

This blogpost is an attempt to win a laptop over at Lovetolead – I just need people to go to the site and vote for it. Yes, it would make me very happy to win a laptop. You have all week – Do you need me to beg?

Vote for me on Love To Lead

Survey Time

Diamond Geezer had one, and as I'm always stealing ideas from people better than me…
I'm interested in knowing who you are, and the sorts of people who read my stuff, so if you could take a short moment to fill out this survey.

 Random Acts Of Reality Reader Survey  

1. Gender – Are you…

Male
Female

2. Coupled – Are you…

Single
Coupled
Married

3. Location – Are you from…

London
Other UK
Europe
America
Another part of the world

4. Medical – Are you…

Ambulance staff
Nurse
Doctor
Allied Medical profession
First Aider
St Johns Ambulance/Volunteer ambulance

5. How long have you been reading this blog?

Since 2003
Since 2004
Since 2005
Since 2006

6. Comments – Do you have a reader/commenter account?

Yes
No
I can't make one

Current Results

Brian’s Brief Encounters

There is another excellent policeman's blog that I read regularly. He is quite unlike any of the other police bloggers out there in that he has a very distinctive style of writing.
Sunday's post however was excellent as, while I have written about the same subject before, “Brian” has written the post I always dreamed of writing.

Go, read, enjoy.

And if you are lucky, I'll have a 'nice' job to write about tonight.