Monthly Archives: September 2011

Theatres

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One thing I’ve been pleased with is the friendliness and co-operation of most of the staff toward the Ambulance Service whilst on Hospital placements.

This week I’ve been in theatres gaining experience in placing LMA’s and also, more cannulations!

Before you’re allowed into the department however, you need to change into scrubs.  They then give you a hair net thing to put on and ask you to change into hospital shoes.  As I didn’t have any they pointed to a large pile of white shoes and said “help yourself”.  I made sure I found a pair that didn’t have anyone’s name or initials on and used them throughout the week.

So, throughout the week all the Doctors and Consultants have been really friendly, helpful and patient and it has been a joy to get some valuable teaching from them.  All bar one . . .

I stood at the Anaesthetist’s door waiting to ask the Leading Consultant if I could LMA their patient.  He was talking with a Junior Doctor and eventually noticed me standing by.  He looked me up and down and read my ID.

“And . . . you are . . . Binder Smiff.  Student Paramedic.  So, you’re here to get some LMA’s yes?”
“Yes sir.  If possible”
“Well.  When you come in here you should be wearing your OWN shoes!  Those are MINE!  I’ve just spent the last half hour trying to find them!”
Ah, I thought, this is awkward.  I tried to think of a witty response or how to explain that I’d been told to wear them but quickly concluded there was no point.  This man had made up his mind about me there and then.
“Well, I guess that’s set things off on the wrong foot eh”  The irony was lost.
“Indeed.  You’ll not be doing LMAs here.”  He then turned back to his conversation with his Junior Doctor.
“Yes.  I guess not”

I walked off back to the changing rooms seething with rage.  I found another pair and went and had a cup of tea.  Later I told my plight to one of the sisters.

“Yeh,” she said, tilting her head to one side as if remembering something “yeh, he can be a bit grumpy that one.  Best avoided I reckon.”
I let my shoulders drop.
“Thanks”
And went home.

Binder

Obstetrics (part b)

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Obstetrics – part b)

In the afternoon I was assigned to a midwife dealing with a 19 year old girl who was in labour with their second child.

She had her younger sister there and best friend also.  Whilst the patient was screaming the place down and keeping the makers of Entenox (laughing gas) in business her two companions were deep in concentration, texting.

With each contraction the patient would burst into tears and in a thick London accent cry, “Am I going to die??!!”  She would then inhale ridiculous amounts of Entenox for a few seconds and place herself in a drunken stupor.
“Of course you’re not going to die” we’d reply.
“Are you sure Barry?  I’m not going to die?”  (inhale exhale inhale exhale).
“You’ll be fine my dear.  And its Binder by the way, not Barry”
“Sorry” (inhale exhale inhale exhale)
“That’s ok”  I lied.

The midwife did an internal examination.  6cm dilated, so according to her, not ready to deliver yet.

Over the next forty five minutes the same thing would be repeated over and over; the patient would refer to me as Barry, scream lots, and frantically ask if she was going to die.

Eventually, her painful screams were getting too much and the midwife said she’d get her some Pethadine (strong analgesic). She lay the patient on her side and left the room. Within thirty seconds of leaving the patient lifted one of her legs and started screaming again.

“BARRRRRY!!!!!” (inhale exhale inhale exhale).
“Binder!”
“AM I GOING T-”
“No!”
At that point her friends became hysterical –
“She’s bleeding!!!” they screamed pointing at her vagina.

I glanced down and saw the top of the baby’s head starting to protude.

“Oh.” I raised my eyebrows, “you’re crowning . . . . let me get some gloves”

I’ve delivered a few babies already and thankfully I knew the basics of what to do.  However, I didn’t feel prepared for this one and underneath I was beside myself with panic!  I stepped forward and supported the head as it started to “pop out” of the patient’s vagina.

“Could-one-of-you-please-go-outside-and-see-if-you-could-find-the-midwife-for-me-thanks-very-much”  The patients sister ran out of the room and could be heard shouting down the corridor.  She ran back in and told me she couldn’t find anyone.

“BARRRRRRRYYYYY!!!!!!!!” (inhale exhale inhale exhale).
“Binder!!!!”
“AM I GOING T-”
“NO!”  I looked up at her, “I’m afraid not my dear.  Not this time.  It looks like you’re having your baby instead.  Hope that’s ok”

The head appeared to get stuck half way and looked like it was turning blue.  Now I really WAS filling my pants.  Motioning to the Emergency button above the patients head I spoke to her friend.

“Can you just flip that nice red button there for me thank you very much”  She pulled it just as the rest of the head popped out.

“BARRRRYYYYYY!!!!” (inhale exhale inhale exhale).
“Binder – Ok, now just breath normally for me”
As she did so the rest of the baby flopped out into my hands and just then, the cavalry arrived.  Like in the film “Leon” when Gary Oldman shouts “EVERYONE!”, the Emergency button brings – everyone!  Doctors, midwives, surgeons, nurses, students – all piled in to the room to help deal with a potential disaster.

My external bravery mechanism gave in at that point and I broke down into a gibbering wreck.
“Thank god you’re here!!!” I sobbed thrusting the crying baby into their hands.
This was emitted louder than expected and it was probably heard by all present.  However, under the circumstances I believe no one took any notice and I’m sure it was lost in the heat of the moment.

The doctors and surgeons looked me up and down with disdain whilst the midwives took over.  I smiled weakly waving my ID and eventually they left leaving the midwives to deal with things.

I slumped down at the back of the room and sighed deeply.  The sounds of baby cries and elated female voices filling the air.  Eventually the patient sat up and with their first sober voice said;

“Thanks Barry, for all your help”
“Binder . . . Is it a boy or girl?”  In all the commotion I’d completely failed to see what had come out.
“Boy”
“Have you thought of a name?”
“Barry’s a nice name . . . I think Barry will be good.  What you reckon?”
I hesitated . . .
” . . . that’s lovely.  Congratulations”

Binder

Obstetrics (part a)

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Next up was Obstetrics.  This is the department that deals with births.  It has a lot of midwives in the department.  Midwives are a law unto themselves.  They are generally feared by Paramenaces.  They are generally feared by all medical professions.

I’ll split this into two entries – first, the caesarian section and secondly, the birth.

Part a) Caesarian Section

I had never seen one of these before and was keen to learn what they were about.  A Caesarian Section or C-Section is where an incision is made into the woman’s lower abdomen and then the baby is pulled via that “slot”.  This is of course, the simpler version explained.  The procedure is very traumatic and almost touches on barbaric!  It is usually done because of complications and sometimes in emergencies.

I don’t think some mums fully understand what is happening with this operation.  And by “some mums” I mean those who naively choose to have a C-Section as a matter-of-fact choice.  Let me explain . . . first they cut through your skin, through your fatty layers and then through your abdominal muscles.  They then place their hands in and literally rip your stomach open (a naturally torn muscle heals better than a cut one).  Then they cut through your peritoneum (lining of your abdomen), rip open the sac surrounding your baby to “break the waters”, grab the head of the baby (with hands or foreseps) and yank it free.  Then, if there are no problems, they stitch you up.  Bish bash bosh, sorted!

The one I saw had complications.  The placenta had torn away from the uterus and was bleeding profusely.  Bare in mind these are natural complications – not man made.  I just stood there mesmerised by the efforts put in place by the dozen or so staff who were frantically trying to save the both the mother and the child.

The child had to be “extracted” using large foreseps and a lot of elbow grease but came out screaming.  The mother continued to bleed heavily.  And by bleeding I mean it looked like there was a water mains pipe burst within her abdomen.  It was then the surgeons and staff picked up their pace.  The whole uterus was pulled out and the lead surgeon literally had to scoop out the inside of it with her hands to rid it of any placenta still remaining.  Drugs were administered to staunch the bleeding and about four billion stitches given to block off the end of the uterus and eventually it was placed back in the patient and they were stitched up.

The only thing that could of been seen as remotely amusing was the fact the surgeon was 5’1 and had to stand on a stool to do most of the procedures and at one point the stool slipped backwards and they practically fell onto the patient.  There were no laughs however.

The floor was covered in sodden Inko-pads (large absorbent pads for collecting fluids) and the end estimation of blood loss (they collect as much blood and fluid as possible and even weigh all used swabs) was 1.9 litres.  Well over a third of her blood volume.

The end result?  One ten pound baby boy and a happy mother.  I was knackered just watching.  And the surgeons and staff?  Well, they just scrubbed up and got ready for the next one.

Binder

Paediatrics

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My short time in the paediatrics department (youngsters) was rather uneventful.  So much so there really isn’t much that I can talk about.

The two days I was there were spent mainly dealing with youngsters who’d injured themselves in some form of manner that only kids can do (cut fingers) – or dealing with babies who had temperatures.

There’s a saying in the ambulance service that goes, “no normal person calls an ambulance”.  This is loosely based on the meaning that a lot of people call us out for the most benign and unremarkable things.  A classic is a baby with a temperature.  Even more classic is a baby with a temperature whereby one of the family follows the ambulance to hospital in their car!

I thought we were the only ones susceptible to this craziness, but it appears Hospitals are too.  On the second day I enquired into the reason for it being so quiet during the day….  at first I was severely reprimanded for tempting fate but then was treated like the naive newbie and told to “wait till school finishes at 3”.

Lo and behold at three, the world and their kids progressively started clogging up the Paediatric Department of A&E.  All with menial problems such as raised temperatures or cut fingers.  One mother had even stopped their child from going to school because they “felt ill” the day before only to have them stay with them throughout the whole day whilst she visited friends, did her shopping and admin until 4pm when she brought the kid into the hospital . . . and promptly waited for two hours to be seen.

I personally think the clue was in the title of the department . . . “Accident and Emergency”. How can we teach common sense?  (opinions would be greatly appreciated).

The staff of the paediatrics have the patience of saints!!!  Quite remarkable how they have to see and deal with the same self perpetuating ignorance day in day out.  My respect for them has quadrupled.

Binder

Cannulation

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To become a fully qualified Paramenace I need to do over two and half years with the service.  This involves 22 or so weeks in the classroom at the start followed by the fear and realism of being on the road with real patients from then on.  There are several exams and learning en route and the whole thing is topped off with the obligatory “bag” training – eight weeks back in the classroom with several subjects we need to cover – each with the inevitable exam process to allow you to progress onto the next stage.  Quite a bit of pressure to say the least.

After this you do a month of Hospital placements and then you’re back on the road.  Mentored at first until your registration comes through – and then, you’re on your own!

I’ve completed my first week of my Hospital placements in A&E where I’ve had to gain experience in cannulating.

I thought I’d be good at this straight away as I’ve had previous medical training which covered cannulations.  And, even though, during “bag” training, the tutors had to hold my hands and help guide the needle in, I thought I was doing fairly good.  Well, I say good, but I did find it strange that after several failed attempts I was asked to “go buy some milk for the mess room” – especially as the fridge seemed to be full of milk.  I imagine they thought my arms must be getting tired and needed a rest.  Very thoughtful.

But then it came down to real patients with real veins . . . and to say I needed practice was an understatement.

My first day ended with my feet aching incredibly. This was due to lots of standing around hoping to be of some use to the busy staff there – and they were very busy!  Whenever I offered to help anyone it suddenly appeared to get even busier.  They would all sink further into their paper work or rush away to see if their patients were ‘doing ok’.  Their hard work can never go unappreciated.

But, by the end of second day I’d managed to do ten cannulations.  Sadly, only the first was a success.  The others had spectacularly failed in a variety of different ways.  Mainly due to me bursting their veins in some way.  The most spectacular was saved till last when I tried to cannulate a poor old lady who had all her family present.  Their eyes burrowed into the back of my head as I attempted to cannulate her tiny shrunken veins.  I stuck the needle into her arm and after about five minutes of digging around trying to find a vein a doctor entered and immediately suggested I stop and let him do it.  Very modest of him I thought – and he was probably right in suggesting it as I think it was starting to cause the poor woman a little pain (and we never want to do that to the patient!).  So, after slipping on the large pool of blood that had gathered on the floor from my attempt I moved away to let the doctor try.  With one swift flash of movement he literally threw the cannula in first time.  And, after patching her up, offered me to do the flush (a simple saline solution injected into the vein to “flush” through everything) as a consolation prize.  Knowing I now had the simplest of jobs to do I stuck the syringe into the cannula and injected the water.  But, for some reason I used all my strength to do so.  The result was a massive explosion of blood and water all over the patient and myself after bursting their vein – which was now rapidly swelling and turning blue as the patient bled into their own tissue.

I personally thought the patient had taken it well.  She looked at me, with blood and water dripping from her face, and sighed, through what seemed to be, gritted teeth.  The Doctor, obviously thinking of future matters, sent me away quickly – I imagine because my skills were desperately needed elsewhere.

The next day there seemed to be a a complete lull in patients needing cannulations.  Which is a bit strange really, as I’m sure I saw lots of nurses and doctors collecting all the items needed to perform this task and disappearing off to into the cubicles with the patients.  I found it also a little strange that whenever I offered any help in “potential” cannulations the hospital staff tended to become nervous and agitated and pointed me elsewhere to help with someone else.  I can only imagine that the department was so busy that they simply could not give me enough time to help with training.  I saw this as incredibly selfless and on many occasion I was nearly brought to a tear as I thought how strong they were to show such commitment and enthusiasm to their work.

I was later offered to practice my cannulations again in the afternoon on inanimate objects.  I did however, find it rather strange that they offered me to practice on a large garden hose pipe.  But, never one to complain and always one to participate I dived in and got involved.  I find the A&E nurses’ patience above the standards of superhuman when I missed the hose on several “first” attempts.  They would stop me after only a couple of goes and rush off to try and replace themselves with another nurse who could help me.  Albeit I could never hear their discussions I could see that they would become heated at times with lots of gesticulations and open hand gestures in my direction.  I imagine this was probably down to them trying to utilise all the best teaching styles they had to offer and as a result a warm feeling spread throughout my body as I realised that they were willing to give me such attention in my learning.  I think eventually sending me off to make several cups of tea – in another department – was probably reflective of how busy they were becoming and I’d like to think it showed their skill and knowledge in keeping me busy in those periods where they couldn’t offer me the full support they so desperately wanted to give.  However, I’m not overly sure of why they asked me to stand in the far corner of their department toward the end of the day.  And to face the wall not speaking whilst doing so was a little strange.  I can only imagine it was one of the A&E’s little “in-jokes” that I constantly failed to understand.

However, by day five I’d managed to gain all my recommended cannulations, plus others!  And, after a rather tearful goodbye (mainly on my behalf – I believe the nurses and doctors were so overcome with their own emotion that pretty much all of them decided not to say goodbye to me at all) I left and went home.

I write this now at home, sitting with fond memories of my experience with A&E.  The connections and bonds I have made will remain with me for a long time.  I’m sure I have left a professional mark on them and have represented the ambulance service well.  I believe whole heartedly that our relations with them will be better for my services rendered over the week.

Next week I’m in the paediatric and obstetric departments.  I will of course, write my experiences with them in full.

Binder

Update

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Many apologies for the loooong delay in writing a post.

As has been mentioned before, I am currently in the latter stages of my Paramenace training and the last eight weeks have been fortified with learning, studying, exams, promises of losing ones’ job if failing the exams, more learning, extra studying, complete absolution of alcohol/drugs, and generally gaining weight through inactivity.

However, I have now passed the “bag” training period and still have a job!  This means I am now onto the Hospital placement period.  Here I will have four weeks of observing different areas and departments – and where I need to fill in ridiculous amounts of paperwork to prove I have done so.  My first week has been with A&E where I have had to gain cannulating experience . . . and of which my next blog entry will be covering.

Hopefully, from now on, most of my entries will be real (ish) time related with the odd “old” job thrown in for good measure.

Please…..read on.

Binder