Category Archives: Blogging

Links From The Lit. Festival.

As part of my talk with the panel at the Cheltenham Literature Festival I mention that there are a fair number of UK based medical blogs. I'm linking to some of them below (in no particular order, just the order I clicked on them in my RSS Reader).

This is set to post just as the panel starts and will be the 'datashadow'. Here's hoping anyway…

The social worker blog is a bit too 'corporate' to be what I'd consider a 'proper' blog (whatever that means), but there seems to be an absence of personal social worker blogs. I also can't find a UK based radiographer blog.

Suggestions of additions to this list gratefully received.

A&E Nurse blog.

Ambulance controller.

Mental Health Nurse blog.

Patient blog.

Medical Student blog.

Hospital doctor blog.

Midwife Blog.

GP blog.

Physiotherapist Blog.

Pharmacy Blog.

The collection of Social Worker blogs (Not really what I'd call blogs, but there you go…).

Cheltenham

I am still alive, although I've been very busy for these past two days.

Mostly sleeping.

I just thought that I'd mention that this coming Saturday and Sunday I'll be in Cheltenham for the Times Literature Festival.

Saturday will be spent mainly wandering around checking out some of the talks.

Then on Sunday I become one of the guests. For an hour I'll be on a panel with Jed Mercurio (who is a writer I greatly admire) and Dr. Thomas Stuttaford (who writes for The Times).

There are details online.

I'm listed as a 'performance'. This amuses me. It also amuses me that I'm considered Literature.

If you want to see me there is a payment involved and I'm getting paid for my appearance.

This amuses me no end.

I'll also be around for book signings and 'photocalls', it's part of the work contract I signed.

I doubt I'll be much bothered by constant calls for my picture to be taken.

Collaboration

First up I would like to thank Dave for sending me the link to yesterdays post. It was bad form to forget to credit him – my only excuse is that I was laughing too much.
Another short post from myself today as I shall be mainly replacing my car battery (which should take minutes), and then I will be upgrading my Macbook's hard drive (which will probably be the work of hours and more than a little bit of swearing).

Also there is shopping. I need cow juice to put in my tea.

As I left you with something funny yesterday, I thought that today I would link to something much more thought provoking.

Three blogs from America, one a police officer, one a paramedic and one an ER nurse, collaborated on a call that they all shared. It shows how all these services work together to try and do the best for our patients and is powerful reading.

Start with the Police officer's entry.

Then the Paramedic.

And finally the Nurse.

On Ending

It can be very hard to stop, even when it would be in the best interests of the patient.

We were called to a new care home that has just opened in the area. Our patient was a man in his late seventies who's heart had stopped.

Our ambulance arrived at the same time as the FRU and we were met by the patient's grandson at the door to the home. We bundled into the lift carrying half the contents of our ambulance and asked the son what had happened.

He told us that our patient was bedbound following a stroke and was unable to eat – so his food was given to him through a tube into his belly. His family had been visiting when he had stopped talking, they called for a carer who had called us.

I often moan about care homes, but in this case the carer was doing excellent CPR on the patient*, there was a large number of the patient's family standing in the room watching.

The first thing that we did was to connect our defibrillator to the patient's chest to see what his heart was doing and to see if if would need a shock to 'restart' it. We looked at the screen and were met with a flatline. People tend not to come back from this type of heart rhythm.

We have a policy in the ambulance service that – if after 20 minutes or so of CPR and drug treatment there is not positive result we can terminate the resuscitation attempt and recognise that the patient has died. Looking at each other we decided that this would probably be the best course of action.

So we started to resuscitate the patient, I was pumping on his chest, my crewmate was trying to secure an airway and the FRU was getting access into a vein so that we could give the patient drugs like adrenaline and atropine.

While doing this I was talking to the family, explaining that it was incredibly unlikely that the patient was going to survive (not the patient to them, to them he was their father, their brother, their granddad). They asked why I wasn't 'shocking his heart' and I explained why it wasn't possible. I told them that they could make a choice, that we could attempt to resuscitate him here in his home – doing all the same things that a hospital would do, or that we could try to get him into hospital, but that due to the distance we were from the ambulance it would be bad for the patient and that the hospital would do exactly the same things that we were doing.

The family asked me a few questions and then they decided that we should remain here and that once we were sure that there was no chance of survival to stop resuscitation.

And then the patient got a pulse back.

Our hearts sank, there was no way that the patient was going to recover – the drugs that we had been giving him had restarted the heart, but this was just a chemical reaction. What this meant was that we would have to take the patient to hospital, and that the family might feel some hope despite there being no chance of survival.

But our protocols say that if we get a pulse we should run to hospital.

His heart stopped at least four more times and each time we got a pulse back with adrenaline and CPR. We got him to the hospital and as we wheeled him through the doors of the hospital his heart stopped again. We explained that we had been resuscitating him for an hour while we stabilised him as best we could and transferred him to the hospital.

I was almost apologising to the consultant as I explained that we had no choice in the decision to keep resuscitating the patient, or to bring him to hospital, or to provide the family with false hope.

I went to the relatives room to explain what the doctors were doing, and to let them know that it was an almost hopeless case – the family told me that they were prepared for his death, and that they were grateful for everything that we had done.

Ten minutes later the doctors at the hospital declared the patient dead.

It always makes me sad to resuscitate people when we know that it isn't going to do any good – I wonder if there is enough brain activitie to feel the pain of us pounding up and down on their chest, to know that we are pulling them about to get them onto a trolley, to be aware of the sirens as we weave through the traffic.

I wonder if it would not be better to accept that some people cannot be saved and that it is their natural end.

Some time ago we moved from written policies for treatment to 'guidelines' – the onus for a patient's care would be placed on us, we would have to decide what was in the patient's best interest, but the policy of terminating a resuscitation is still in effect.

I know that we have these policies in place to protect the patient, and to protect us from being sued, but I wonder if there will ever come a time where we might have more flexibility in deciding the end of someone's life.


On a completely unrelated note, DG hits the nail on the head once more – and writes something that I should have written ages ago.

*Yes, I am writing a letter of thanks for someone knowing how to do their job.

Update:Edited for grammar.

Deceased

We were met downstairs by a young man.

“I think she's passed away – but I couldn't bring myself to tell her mother. She's old. I thought I better call an ambulance”.

We had been called to a forty year old woman – 'Drunk – ?Passed'.

I was met at the flat door by a woman in her seventies. She didn't seem distressed as she led us into the living room. Everywhere I looked there was evidence of her daughter's alcoholism. The flat was cramped and squalid. Her mother had been visiting her.

Her daughter was obviously dead, her skin was yellow and waxy, and she was in full rigor mortis. It was obvious that she had been dead for some time.

I had to tell the seemingly oblivious mother that her daughter had died.

I sat her down and explained that her daughter had passed away some hours ago and that there was nothing that we could do to help her.

I braced for tears, or a scream, or an “I thought so”.

The mother didn't cry, she didn't scream, she just sat there and whispered a quiet, “oh”.

The daughter had come out of her bedroom the night before and told her mother that she didn't feel too well and had laid on the sofa. Her mother had fallen asleep in the armchair. When the mother woke up she couldn't wake up her daughter.

She'd then sat with her for at least six hours before knocking on the neighbour's door to see if he could wake her up.

Talking to the mother it was obvious that she was suffering from early dementia. I'm not sure if she secretly knew that her daughter was dead, but wasn't letting herself accept it.

It was strange – no tears were shed, but several times we were treated to the mother's life story.

We had to stay around for a few hours with the police because there was a chance that the death may have been suspicious, although it was more likely to be natural causes.*

It was saddening to see the mother wandering around, her dead daughter laying on the sofa covered only with a sheet just a few feet away. Talking to her about the changes that the area has gone through, about her dead twin and about her other daughter.

Had she sat alone with the body for so long because she couldn't face up to the truth, or did she really not realise what had happened? Either was possible, and I'm not sure which one gives most comfort.

It's the sort of job that will stick with you for some time.

*There are legal and confidentiality reasons why I'm not mentioning the full details of this job.


This evening I shall be at the London CC Salon having a chat with Becky Hogge of the Open Rights Group. I'll mainly be talking about the reasons why I chose to release my book under a Creative Commons license. It should be good fun and I'm looking forward to hearing some of the other people there.

Dr Crippen

I like Dr. Crippen, I think that he writes well and with passion about the NHS. He also hates Patricia Hewitt. So he isn't all bad.

But there are two things that do annoy me somewhat about him. I thought it was only one, but I have since discovered a new annoyance.

The new annoyance would be an ad hominem attack on another blogger criticising their spelling and grammar. Disagree with the persons views, but to moan about grammar in a blogpost is the province of the forum troll, not that of reasoned debate.

And to quote,

Please feel free to criticise me in any way you like. I have but one request. Your spelling, your use of commas and apostrophes and your general grammar are embarrassing. All doctors have passed “O” level or GCSE English. Could I suggest you get one of them to glance at your copy before you publish?

Two small points – do all doctors pass “O” Level or GCSE English? Even our foreign doctors, including the ones who do not speak enough English to call for an ambulance or have not been properly tested? Secondly, there is a reason why the handwriting of doctors is traditionally seen as poor, and that is because it often is. I write my notes in the back of a moving vehicle and I would be hard-pressed to obfuscate the meaning as easily as your average doctor can.

But the one thing that I have the most problem with is the “I met a bad example of this profession, therefore all member of this profession are idiots”. Take for example his recent post on grief that his partner got from an ambulance worker. When someone posts a comment that perhaps some GPs don't have much of a clue what they are doing he tells us that we shouldn't engage in 'playground insults'. Which I believe translates into “I can see more clearly than you, I am more intelligent, you are foolish and how dare you disagree with me”. Or rather a shouted “Am not!”

He then goes on to call one of his commenters a fuckwit. Which obviously elevates the conversation above playground insults. He then says in reply to the 'fuckwit' commenter that he never used the phrase 'Ambulance driver'. For your entertainment I present a short excerpt,

Only yesterday we had trouble with an ambulance crew. My partner had assessed a patient, discussed him with the hospital physicians, arranged an admission and called an ambulance. The ambulance driver arrived, carried out his mickey mouse medical “assessment” and then told my partner, in front of the patient, that he did not see why an admission was necessary.

I may have accidentally bolded a word or two in that quote. I did resist putting <sic> by the uncapitalised 'Mickey Mouse'

There is a reason why ambulance crews do what they do, for most of us it is for an easy life. If we do as we are told to do then we won't get the sack, as we cost less to train than a doctor it is very much cheaper and easier for us to be sacked. A doctor has 8+ years of training to stand up in front of a coroner and explain why the patient's blood pressure wasn't measured – we ambulance crews don't.

The seeming belief that Dr. Crippen has is that the best nurse practitioner in the world is far worse than the most idiotic doctor. This is something that I do not agree with.

Take today for example, I went to a GP referral where the patient was sitting in the surgery waiting room. She was to see the psychiatrist at the local hospital. The doctor had written a letter explaining that the patient had a bottle of water with many pills dissolved in it. The patient had not only fainted in the consultation, but has also been allowed to keep the bottle. When I got her in the ambulance and took the bottle from her (handed to me when I asked for it) she told me that she had drunk half of it before entering the surgery.

The GP had taken no vital signs, had left the bottle in the patients possession and had written a referral letter that neglected to mention the faint.

If the doctor had told me that taking her observations was a waste of time and that I shouldn't bother, or that my 'Mickey Mouse' assessment of asking the patient if she had drunk from her overdose bottle would be a waste of time. If the patient died in the hospital from the unknown overdose, then you can imagine that the coroner would have some severe words for me and the LAS would probably sack me for negligence.

Finally on this post,

Ambulance crews are valuable, and have an important role at the scene of road traffic accidents but, in the domestic environment, when the problems are medical rather than truamatological, they often apply inappropriate protocols to problems they do not understand.

Which would be why GPs in my area refuse to see patients and instead tell them to 'just call for an ambulance', and this for obviously non-emergency reasons. It would also be why I have seen GPs doing CPR on patients who are feigning a fit. Why I have seen GPs taking brittle ninety year old asthmatics off oxygen because they need the examining room to see the child with a nappy rash. It's also why I've seen GPs sending people with a pulse rate of 220 walking home to wait for the ambulance and also sitting heart attack patients on the brick wall outside their surgery.

And another example from today – GPs who are unable to refer a patient to hospital in the correct manner (writing a little letter and phoning the hospital) rather than just dialling 999 and running out the house. I like Drs letters, they tell me what is wrong with the patient as I assume that they know a lot more about medicine than I do.

Uh-oh, I think I just descended into that 'playground insult' game…

There are idiots at all levels of the NHS and while the fight against the dumbing down of the NHS is an admirable one, we should perhaps stop making such sweeping generalisations.

We should concentrate more on white elephants similar to the one that he mentions in this post. And that is why I keep reading his site, because when he isn't being a arrogant twit he is being absolutely right.

Social Stuff And Link Dump

I've spent all day clearing my Inbox of unreplied to emails – If I ever let it get like that again, somebody shoot me. If you have been expecting an email from me and didn't get a reply, then I send my apologies and advise you to resend your email.

For those that are interested about joining the London ambulance service… We aren't recruiting. Sorry.

In a fit of 'doing things', I've signed up on Livejournal, Facebook and Myspace. I'll happily accept 'friends' from anywhere, but I would ask that you tell me a little about yourself – there is a bit more on this over here. I'm still playing around with them, as well as wondering what kind of content to put up on there, chances are that they will remain mostly unused or used for small dumps of writing.

Additionally loads of people read my Twitter feed – I'd be interested in finding out who all you lot are as well… I like finding out about people who know me because of this site.

Tomorrow is Laura's audition for X-Factor at Arsenal, I'll be with her and I may post up some pictures somewhere.

I'm curious, are there any people who work with leather reading this blog? How about blacksmiths? Preferably within a couple of hours drive of London – it's for an article that I'd like to write.

Further non-ambulance blithering will be on Mental Kipple, which I have been shamefully neglecting.


Finally two nice ambulance links sent to me by readers-

A lovely written article about the Yorkshire ambulance service following the 'Tonight' programme. (Thanks Clive).

Then a story about a 'patient' who would have suffered from a broken nose had I been sent to him. (Thanks Matt)