Category Archives: From Random Acts Of Reality

From my old blog, Random Acts of Reality


It's been two months since I last blogged, and I think that this is nature's way of telling me that this blog is finished.

When I started writing this I never thought that it would take off in the way that it did – two books, a radio play, opportunities to speak to lots of people at once and of course the upcoming TV series.

But all good things come to an end and, since leaving the London Ambulance Service, my life has settled down somewhat.

Which means that I have far less to write about the ambulance service, which is what this blog very quickly became about.

So I've decided to put this blog into a 'Deep Freeze'. So the links, posts and everything else will remain here, but I won't be updating it any more. In a fortnight I'll close down the commenting system so that I don't have to spend the rest of my natural life removing spam comments.

The reasoning behind this is that this blog was supposed to be about anything – but due to it taking off as an 'ambulance blog', I felt that I was 'cheating' if I wrote something that wasn't about working on the ambulances. Now I no longer work full time on an ambulance the number of ambulance posts will decrease to almost nothing.

I'm thinking that it's for the best if this blog stays true to being about my time on the ambulances, and I start afresh somewhere else.

I shall be moving my presence on the internet over to Brian Kellett (dot) net, where I plan to write blog posts about whatever interests me. This means that if you are only interested in ambulance related blogposts as opposed to me writing about whatever tickles my fancy, this is where we part company.

For day to day things I shall be continuing to use twitter @Reynolds


If you want to read about ambulance stuff, there are a few blogs out there that I read and you might be interested in.

Insomniac Medic blogs while working for the London Ambulance Service – rather him than me.

Then there is 999Medic, Mark Glencorse, who is much more energetic than me. He's also on a mission to change ambulance services for the better.

From across the pond is Ambulance Driver Files, whose politics I almost completely disagree with. He is a top bloke and has a wry sense of humour.

And finally but not least there is Rogue Medic, another American, who posts incredibly well thought out articles about making EMS better, mostly by the use of science.


So, that's that. Time to move on to Brian Kellett (dot) net, where I shall be writing about things that interest me – not just ambulance related stuff.

And if this is farewell, then may I wish you safe travels, and I hope that while you've known me I've entertained you, and maybe made you think a little.

Excuses, Excuses. With Promises Made.

I haven't blogged in over a month? Really?

It's strange really back in the day I could write three or four posts a day, saving them for later, and yet during this month I've only occasionally thought of blogging.

There are, to be honest, a couple of reasons why I've not been blogging.

  • My new job. I'm enjoying myself. Well… 'enjoy' is perhaps too strong a word, after all I am still working in the NHS. However it seems that a fair chunk of the reasons for my writing (in the past year or so at least) was anger. Anger at the system, anger at inconsiderate patients, anger at watching the ambulance service circling the drain. With my new job I'm a lot less angry. For one, I'm not swearing as much – which is good because I don't think that the ambulance messroom language would go down too well with some of my new colleagues. But with that lack of rage I've been less likely to have a burning need to write something. I've noticed that I've been avoiding watching any TV news because it would get me angry and I would not have constructive output from it – I'm not a politically intelligent blogger, and I certainly didn't want to turn this site into a constant outflowing of 'Dave Cameron is a oily ****rag who if he wanted to make the world a better place would shoot himself. Slowly' or 'Nick Clegg is a lying **** who has killed the Lib Dem party and should be forced to live out his life in student digs, begging for charity'. It'd get boring incredibly quickly, and my computer would break from all the anger flecked spittle I'd be spraying at it. So, I've been a lot less angry – and that means a fair bit of my muse has packed her bags and buggered off to sunnier climes. Damn that 'happiness' and 'job satisfaction' – it's ruined me.

  • The return of my depression. Which is perhaps an illogical thing to say after admitting that I am happier and less anger filled. But it's a weird thing depression, in my case more about a lack of energy, a desire to withdraw from the world and a slight, but nagging, suspicion that I would be better off dead* rather than sitting around crying**. Everything in my world can be going wonderfully (and at the moment, both personally and professionally, it is), but when those brain chemicals decide to slosh around my skull in one way rather than the other it can really bugger you up. Thankfully my depression is, I suspect, what most people would call 'pitifully minor'. So I can often just muddle through the day with just general feelings of shittiness.

    Interestingly, when I'm at work, although I'm watching the clock tick down to the end of my shift, while I'm there I'm often in a fairly good and energy filled mood. Perhaps it's the uniform.

  • I've been rather busy – trying to get my brain up to firing on all three and a half cylinders and pointed back into the general direction of being a nurse. It's quite a thing to blow the dust out of the crevices of my mind and see what sorts of knowledge and skills are still tucked away up there in a cardboard box marked 'Misc. odds & sods'. Skills like steristripping wounds are still there as if I had been using it every day, which is strange as I was expressly forbidden from doing such things in my time in the ambulance service. The risk of course is that while my mind and memory muscle may still recall these skills – medical practice may have moved on. I don't want to be seen as the sort of practitioner who thinks that bleeding patients is still acceptable practice. So I've been reading up and reading around, and asking questions and generally trying to cram as much into my brain as possible. Having come from a job where on the job training was often being given a sheet of A4 to read, this has been taking up a reasonable amount of my daily energy quota.

  • Along with the mental settling into my new job, I've not felt confident enough to write about it (although my new boss has asked me if I'm writing nice things). Mostly because it takes a certain amount of time before you can get your feet under the table and understand most of the driving forces that mean something is done one way rather than the other. I'm still of the mind that when you are new in a job you should 'keep your eyes and ears open and your mouth shut'. So what great insights am I going to bring to this little corner of the NHS when I'm still learning what boundaries are already in place, what I can push, and whether I have the completely wrong end of the stick about a situation?

  • Confidentiality has always been incredibly important, personally as well as professionally. But now I'm sitting in one place it is a lot harder to obscure some of the identifying attributes of my patients and the stories that they tell me. And it is the stories that I am told which are often the most interesting thing about my job, but as these stories are, by definition, very individual you can perhaps see my problem in trying to relate them. Over the last month I've been collecting stories in enough numbers that I can now start to mix and match and mash together some stories to remove all identifying marks.

  • I'm not sure that people are that interested in Urgent Care. For the large part I'm seeing patients for a very short period of time, and for illnesses that are normally self-limiting and are almost certainly not life-threatening. Writing about it this while keeping it at least vaguely interesting is fairly tricky – that's why 'Doctors' has to throw in the occasional kidnapping or explosion to keep the viewers engrossed in the lives of the GPs. There are no explosions at my workplace – although we did have a leaking water pipe last week.

So those are the excuses.

I do, however, have a plan – and it's one that involves me writing a lot more. I'm going to do the best I can to write every day that I'm not at work (so that's three or four times a week as a minimum) – partly to keep my brain active, partly because it's a therapy to be able to let off steam, and partly because I enjoy it.

The plan also involves me writing every day for at least this week – and then… well… there will be a bit of a change…

*No, I'm not actually suicidal – too far too sensible for that.

**Although that does sometimes happen – it's why I'm steering clear of alcohol for the foreseeable future.

Naked Apes

Channel 4 has commissioned two new drama series for 2011, as part of the broadcaster’s commitment to double its output of original drama from next year.

Camilla Campbell, Channel 4 head of drama, said the series had been commissioned using money freed up from the cancellation of Big Brother, which has seen the drama department benefit from a £20 million boost to its budget.

The new series announced today are Naked Apes, which will air on Channel 4, and Beaver Falls, for E4.

Naked Apes is penned by Brian Fillis, who wrote Fear of Fanny and The Curse of Steptoe for BBC Four, and is inspired by Tom Reynolds’ book, Blood, Sweat and Tea.

It follows a group of paramedics and is being made by Daybreak Pictures, which produced Britz for Channel 4.


I had lunch with one of the producers earlier this week where he told me that the chances of this actually making this to screen are pretty good. Although, as in all things TV, there is also a chance that it will all fall through.

At some point in the near future I'll be having a meeting with the writer and producers.

I haven't seen the script yet, although it is a *drama* based on my book rather than a literal filming of the episodes. TV, and drama as a whole, works in it's own way so there have got to be a lot of changes in order to turn the book into interesting television. Also it has to be something that will be interesting to the Channel 4 demographic.

So I'm not going to be precious about it.

This is now Daybreak Pictures baby and I'm interested in what they are going to do with the source material. It should be fun.

Margaret Haywood

As some of you may know, as well as being ambulance staff, I'm also a registered nurse. For that privilege I pay the NMC a sum of money every year to be on the professional register. If I am not on that register then I cannot practice as a nurse.

Should I ever have to leave the ambulance service nursing would allow me to pay the rent.

The NMC have the power to strike me off the register, meaning that I would no longer be able to work as a nurse.

Which is why this blog should come to an end.

No longer can I be safe to tell you all about the terrible conditions in some of the nursing homes that I go to. I can't tell you about the problems that occur in A&E and I can't shout about the atrocious state of home/social care.

It's just not safe because to whistleblow like this can result in you being struck off the register.

What this decision means is that all bloggers that have a professional registration are now skating on thin ice. Nurse bloggers, Doctor bloggers, Paramedic bloggers – all these are on a professional register and all end up writing about situations that trusts would rather were kept under the carpet.

Might I also suggest that in the cases of hospital trusts wanting to get rid of a 'troublesome' staff member they may well turn to organisations like the NMC, HPC or GMC to do their work for them. I know I could point you to HPC rulings that appear to do that, not evidential to be sure, but it does look very much like that.

One further suggestion that I'd like to make is that you don't see many managers being taken to the professional registers for malpractice. Are any trust managers from Stafford hospital being struck off any professional register that they might be on?

What I can say with certainty is that, as a nurse, no matter how many Incident Reporting Forms you fill in, nothing seems to change. You end up not filling them in at all, because you know that they will be ignored.

So you want to shout about the situation as loudly as you can. Which can lead to you losing your job or being struck off the register – which results in your career ending.

Which is why most people just try to o the best they can, and avoid 'rocking the boat'.

And this is why I should stop blogging.

But I won't. I, and many others who are braver than me, will continue to try and get the truth of the situation in the NHS out there, out in the public eye because that is the only way that change occurs.

It's the right thing to do.

First Week


My brain overfloweth.

The new workplace is lovely, the staff are nice, I have a lovely boss and there is a real opportunity to deal with patients and make them happier and healthier.

It's pretty much perfect.


Well, I say it's perfect – but there is but one pubic hair on the bar of soap of pure awesomeness.

All the patient notes that I make are typed straight into a computer, it is a paperless office (apart from the information leaflets that we give to the patients). I have no problem with that as, surprisingly enough, I'm quite happy around computers.

The problem is… It's all Windows systems.


So there will be some retraining while I try to get used to typing on 'cherry' keyboards and remembering that the key commands are different from everything that I use at home.

Also, due to being unable to install any software I don't think I can sync Outlook 2003's calendar with Mobile Me/Google.

Oh, and the browser is IE6.


More seriously though – I'm really looking forward to getting my teeth into working here, the boss is already trying to get me onto a week-long course for minor illnesses and I'm keeping my fingers crossed as it is apparently a really good one and gets me 35 points towards a degree (for my nursing is a lowly Dip(HE)).

I've another three weeks of being 'supernumerary' which means following people around and generally learning things. For example today I learnt more about knee assessment than I have ever dreamt possible from a brilliant physiotherapist who is seconded to the Urgent Care Centre.

My day ended with another man's testicles in my hands so I could examine them – which is a first for me as normally the only reason to have someone else's testicles in my grasp is for the purposes of 'self defence'.


While I'm only working eight hour shifts at the moment I'm finding that I'm more tired than twelve hours of ambulance work – I suspect it's because my brain is, for the first time in ages, consuming huge amounts of energy while I take in both the formal learning and the more 'soft' informal learning that is necessary when trying to integrate yourself into a new group of people.

So basically it's all brilliant (apart from having to use Windows) and I am incredibly happy to have made the switch.

My Last Shift

I would like to start with an apology.

A little while ago, I asked the question 'What is it that makes an ambulance'. I then went on to inform you that the only equipment that an ambulance requires is a defibrillator and a bag-valve-mask. I may have made the suggestion that this shows the priority that the LAS has on patient care.

But I must apologise, for I made a mistake.

You don't need the defibrillator.


Yes, on my final shift I found myself on an ambulance without a defibrillator, going to calls of elderly patients with chest pain. Then our tail lift stopped working, so there was no way to use the stretcher.

We we refused our request to go 'unavailable' in order to return to station in order to get replacement kit.

So the last shift continued my tradition of trying to give good healthcare despite management policies.


The patients were also a fair mix of the normal sorts of patients I've spent the last eight years going to – a fall, a drunken and abusive alcoholic, a homeless chap with chest pain, a runny nose, and two hospital transfers.

My last call was for one of those transfers, an elderly chap that the doctors at a local hospital suspected was having a heart attack that we blue-lighted to the heart-attack centre.

They didn't think that he was having a heart attack, but given his long, complicated and somewhat obscured medical history I still think that the local hospital did the right thing.


So, no bangs, no whimpers, just a continuation of what my shift has been like since I joined the service.

I'm going to hold off on writing about my new job for a while until I get settled in a bit, I think that it's important that I get the lay of the land, and besides, it's better to reflect than immediately report.

I've still got a few things to write about the ambulance service sitting in my notepad, so that will keep me going for a bit.

(Plus I need to work on a new banner for the blog, maybe a new layout and who knows what else…)

Nobody Likes Us

I've not been writing because I've been incredibly busy of late, working my normal LAS shifts (my last shift is on Friday, three more to go and, yes, I'm counting the hours), plus the paperwork for my new job (currently filling out the second Criminal Records Check form because I was sent an out of date one earlier), as well as all the normal stuff that keeps us busy, like laundry and shopping and making sure my Sky+ box doesn't get filled up with too many programmes.

Hopefully this will all soon change, giving me more time to put finger to keyboard.


I've been talking to a lot of people about my upcoming change in jobs to the local hospital – both ambulance and nursing staff, and the thing I've noticed is that sometimes people just don't get on.

For example – I explain to one of my ambulance friends that I was talking to Nurse Smith about my upcoming job change and that she was very happy for me. 'Ergh', says my ambulance colleague, 'Nurse Smith? I can't stand her…'

And I find that on both sides, nurses and ambulance staff that I consider good clinicians and good people looked on with some disdain.

I think I've worked it out.

It's because we don't know what each other does.

Many of the nurses that aren't liked by ambulance crews are those nurses that expect more. They forget that, for a great number of us, our training is 16 weeks in a classroom. We've never been taught 'reflective practice', or how to read a research paper, or learnt the meaning of the word 'holistic'.

These nurses get annoyed when an ambulance worker doesn't know about a certain obscure disease, or something happens that highlights something that was lacking in our initial training.

And if nurse gets annoyed, then you can be sure that the ambulance worker concerned will get annoyed as well.

On the flip-side, there are the nurses who think that we are little more than removal drivers – we pick people up, wrap them in a blanket, and take them to hospital. They can't see the reason why we bring to hospital some of the dross that we do (personal favourite call from last night – '33 year old male with cold'). These are the nurses who have asked me in the past 'can you do a blood pressure'.

To be fair, that is from a ward nurse, A&E nurses have a better idea of what we do, but can still have some strange ideas of what our work is really like. Some don't realise that we refer vulnerable children and adults to social services. They may not realise exactly how many patients we leave at home (endless panic attacks, diabetic hypoglycaemia and epileptics). They also may not know that if someone wants to go to hospital then we can't refuse them.


It's not particularly anyone's fault – certainly it works both ways, ambulance staff don't really understand the pressures that A&E nurses are under. I know that I have a privileged knowledge, coming from both worlds.

What is annoying is that the solution is very simple – nurses spending some observation shifts with ambulance staff, and ambulance staff spending some time in A&E, but it'l never happen because of those self-same pressures. Ours to hit eight minute arrival targets, and A&E to cope with understaffing and having too many patients to deal with.

And our free time is precious – spent sleeping rather than volunteering to go rattling around London in an ambulance, or being asked to do ECGs on endless patients in A&E.

Besides, it's not that important to deal with little episodes of misunderstanding brought about by not knowing each other's jobs.

Is it?

CCTV And Drunkeness

'Male, collapsed in street – cannot see if he is breathing'.

Once more I found myself speeding towards a drunk in the street. It's *always* a drunk in the street, except of course on the one occasion when we don't whizz to scene – then they will be dead.

The Sod's Law of collapsed or deceased patients.

Like many of the drunk calls, we also had the information that 'caller will not approach patient', of course not, because the 'possibly dead' person is drunk, smelly, and possibly violent. That, after all, is why we are called to wake them up and move them on.

In this case however, it was much more reasonable, the caller was a CCTV operator.

So we rolled up and found our man snoring gently in the middle of the pavement. Hopping over the fence between us and the patient I went up to him and woke him up.

The man was apologetic (or at least I think he was apologetic, but then sheepish smiles and a bowed head are pretty universal despite the patient not speaking English). He then walked off to catch a train.

I looked around to see which CCTV camera had 'caught' him, and spotting the only one I could see I gave the camera a thumbs up, and then mimed drinking from a bottle.

The operator obviously got the message as the camera nodded up and down in acknowledgement.

Last Night

I recently had my last ever night shift, I would have written abut it earlier but the effects of the shift work had basically knocked me on my arse and made me incapable of doing anything except sleeping and dozing on the sofa.

It was, ultimately, a not unusual shift – no jobs that leapt out as being anything out of the ordinary.

My first job was to a woman who was intensely isolated because of her being unable to speak English, the only person she knew was her daughter who has a full time job. We were called because the woman was 'behaving strangely'. We arrived with the police to find her crying on the floor. We did the only thing that we could do, take her to hospital to see a psychiatrist.

It was handy to have the police there, because initially the woman wanted to refuse to come, but as she was distraught and had threatened suicide it was important that she see a professional.

The next job was to someone who'd been minding their own business and then been punched in the face with a knuckleduster. Often you can tell when someone is hiding something (because, let's face it, a lot of assaults in my area have a reason behind them. Not a good reason mind you, but there is normally a reason). In this case he didn't seem the type to be in a gang, he didn't appear to be a drug dealer and I don't think that he was secretly sleeping with someone else's girlfriend.

We took him to hospital in order to rule out a fracture of his facial bones.

The next patient had been indulging in some cocaine, some cannabis and a lot or alcohol. So had his friend. We had been called because he was 'off his legs', or as it was described to us 'he had been on his hands and knees like a dog'. I may have resisted the urge to ask if he had taken to barking.

As he got to the doors of the ambulance he let forth a huge spew of vomit, simultaneously passing flatulence. 'Better out that in' goes the old saying, and truly it is better out than in, as in outside the ambulance and not inside it where I need to mop it up.

During this he had developed a bellyache, so we assessed him and took him to hospital where, a few hours later, he was feeling much better.

(Seriously, is Red Bull and whiskey a sensible drink?)

Our next patient. Oh dear, our next patient…

The short version is that she was faking a panic attack in a pub. Once more I'm left wondering why people think that they can fake medical conditions in front of people who've seen them all before. This patient was very trying as she refused to get onto the ambulance (until she realised that her audience were bored and going home), then she alternated between not telling me anything and telling me about everything.

At the hospital she refused to get out of the ambulance until I had sweet talked her, then she refused to enter the hospital, then she refused to go to the toilet while crying that she needed to pass urine.

She was put into the waiting room (eventually) where she then argued with one of the nicest nurses in the unit…

I'll be the first to admit that it was very hard for me to remain the consummate professional that I am.

The last I saw of her she started by telling her new audience that her four year old child had called the ambulance (rather than the bar manager who'd actually called us), and that everyone was against her. She then went on to try and damage a police car before drunkenly disappearing off to the local bus stop.

I think it's called 'personality disorder'.

A much simpler job followed – a man who was stuck in the bath. The FRU had got there before us and had already solved the problem. We didn't even see the patient, as he'd gone to bed, so we caught up on some gossip with the FRU responder and made ready for our next job.

A nightmare job. Not because of the patient (who was confusingly suffering from a mish-mash of symptoms that had us blue-lighting her into hospital). No, the nightmare was the spider on the wall of the staircase that was the size of my hand. Garden spider or escaped tarantula in disguise, who knows what it was?

One of the elderly relatives saw the look on my face and managed to dispose of the creature in a piece of kitchen roll – as he walked into the kitchen with the ferocious monster I listened out for any screaming as the spider broke free of the paper and tore the old man's throat out…

An interesting job as there was a mix of heart problems, probable sepsis and undiagnosed diabetes – the best thing for the patient was for us to treat her symptoms as best we could and get her into hospital as quickly as possible so that the doctors could sort things out.

And a nice family, adept at dealing with the sorts of giant spiders only seen in horror movies.

Then I had a nap for twenty minutes in the passenger seat of the ambulance as, for a few minutes at 5 a.m, it seemed that people were getting some sleep and not filling their time calling ambulances.

Our final job was a transfer of a patient from our local hospital to the heart specialist unit. A nice patient, a nice family member and an uneventful journey finished the night off lovely.


And that was it, my last night shift. I drove home with a huge smile on my face – no more would I need to feel sick in the stomach after a long night shift, nor would I need to batter my body clock into submission any more.

No more night shifts means that I will be able to rejoin the human race, no longer will I have the constant feeling of jetlag dragging me back.

As I write this I have another stupidly big grin on my face and an urge to dance a little jig around the room.