’tis but a scratch

Before I start to write about day to day events I wanted to write about my first shooting I went to.  Basically, in between day to day events (which won’t be that interesting I’m afraid) I want to write about other stories/jobs.  Not just mine but other peoples too.  Personally, I love listening to people’s anecdotes and already have a plethora of stories to write.  Its just about getting the right inspiration I guess.

Shootings happen all the time in London.  Sometimes every day I reckon.  And I really don’t know why we don’t hear about it on the news as much as we should.  Maybe some are too uninteresting to report.  Maybe the press don’t get hold of some of the info so don’t know.  Maybe its part of an elaborate plan to keep everyone knowing.  Who knows.

My first shooting was shortly after being out of training school.  We were called to a 20 something male who’d managed to drive their van to a police station after being shot in the shoulder.  It appeared he was ambushed whilst driving down a quiet lane and the police believed it was a case of miss identification, ie the wrong guy in the wrong place at the wrong time.

The patient walked onto our truck and we attended to his injuries.  This consisted of one “hollywood” type graze to his left shoulder.  A flesh wound.  And, after cleaning, it needed nothing more than a small dressing.  Throughout treatment the patient had remained calm and polite, albeit a little shook up at what had happened.  It was then I took it upon myself to lighten the situation by taking the mick out of his wound.

“Ah, bless,” I said mockingly, “is Sammy shoulder seeming a bit sorry for himself”.  The patient laughed politely, taking my attempts at humour as what they were – attempts.  He looked down at his shoulder as if for the first time.
“Its ok then yeh?”
“tis but a scratch”  I mocked.  One of the police officers standing by lent down and whispered in my ear.
“I reckon you should come and see this”  He motioned for me to follow him and we stepped out of the Ambulance and walked over to his van parked behind us.  He mentioned that I couldn’t touch anything as it was going to be impounded for criminal evidence.  But as we approached my jaw dropped.  The front bonnet, windscreen, seats and panelling were all littered with bullet holes – 20 to 30 holes everywhere.  The officer quietly explained that a couple of people had jumped out in front of the patient and opened fire with fully automatic machine guns, strafing the front of the van.  The patient had dived down to one side as they did and thankfully only one bullet glanced past his shoulder.
“if he’d ducked down a fraction of a second faster it would’ve gone through his head”
” . . . bloody hell.”
“yeh, lucky man eh.  Just thought you should know the full story before giving him a hard time”
” . . . yeh.  Good point.  Thanks”  I couldn’t take my eyes off the mess.  After all that, he’d still managed to drive off and get to a police station to report it.  And he wasn’t even the intended target.

I walked back to the patient who was giving my crew mate details for the paperwork.
“um, you need anything from me?” I asked my crew mate.
“No, all good here, cheers”
“How you feeling now?”  I asked the patient.  He smiled brightly.
“Ok thanks.  Bit shakey – but ok.”
I retired to the drivers seat and remained silent until the patient left to continue statements with the police.  I continued to ponder over my naivety and vowed never to be that insolent toward a person’s near death experience again.

But as I say – this sort of thing happens all the time in London.  Do we hear about it?  Of course we don’t.

Binder

Bag Day

After all the hospital placements are done there is “bag day”.  This is your last day back at training school to complete admin and receive your Paramedic bag.

The day was rather uneventful but it was good to catch up with classmates and relive tales of disastrous moments in different hospital departments.  I mainly got quizzical looks when I asked other folk to tell me about thier awkward moments.  And after several embarrassing pauses I tended to move the conversation on to other things.

After the day was done we all gathered in the local pub where many drinks and mirth was had to celebrate completion of our course.  I had promised I would not drink that night but that lasted less than 30 minutes when I bought the first round of (many) Jägerbombs.

The evening went on and recollection became dimmer and dimmer until I decided to staggered home.  In two days time I would be starting my mentoring period where I would be putting my newly aquired paramenace skills into practice whilst my registration was being sorted.

For now though, I needed my bed.  Or the big white microphone – I hadn’t quite decided at that point.

Binder

HEMS Governance day

HEMS or the “Helicopter Emergency Medical Service” is a trust run on donations from the public.  It has been proven to be an effective emergency service that compliments the Ambulance Service and personally I reckon it is essential to have in modern times.

They run both a helicopter (a bright red one with Richard Branson’s branded “Virgin” written on it) and also a couple of vamped up cars in which land-teams race around.  The teams mainly consist of an Emergency Doctor and an advanced Paramedic – and sometimes observers.

Why am I mentioning this?  Well, I arranged to go to one of their Governance days at the end of my placements and went along with a couple of friends.

The HEMS Governance Day is held only once a month and is an audit of sorts.  They publicly take apart various “jobs” done previously and “review” them.  I say review, but for entertainment value it is sometimes not to be missed.  And when I say taken apart, what I mean to say is they are occasionally ripped apart – nothing short of the Spanish Inquisition.  Stepping away from the humour of seeing highly respected consultant doctors torn apart for various mishaps, it is a brilliant method of consistently improving a vital service.  And I only wish we could do the same in the Ambulance Service!  Our only “reviewing/improving” tends to be peer related and at the expense of a few laughs.

I enjoy the HEMS Governance days as not only are there the audits but also interesting lectures in between.  So, all in all, a good day is had . . . if you’re happy to use up one of your vital days off that is.  Oh, and most times there’s free lunch!

Afterwards, there’s usually a mass gathering in the local pub where you can get to know the various doctors and HEMS paramedics better.  Networking I think its called.  Sadly my attempts at “networking” invariably end in disaster, usually with me causing insult to someone somehow.  On one occasion many years back, I remember being at an important dinner party and standing in a small circle of people whilst the host boasted about buying new wheels for his Maserati.  I had drifted off into a thousand yard stare and wasn’t paying full attention.  But somehow I felt the urge to pipe up . . .

” . . . must’ve cost a fortune to have them done eh”  I sighed, not even breaking from my distant gaze.  But a few seconds later and I suddenly became aware of the pause in conversation and felt the hairs on the back of my neck start to prickle.  It was then I broke out of my day dream and realised that my “stare” had been aimed directly at the cleavage of the host’s wife.  Everyone was looking at me horrified.

” ah . . . ”  I smiled weakly and seem to recall being asked to leave shortly afterwards.

Albeit the HEMS days wasn’t any exception, it was perhaps a little less disastrous.  And this time I had a partner in crime – a friend from my class.  We’d both had backgrounds that involved working in the mountains and seeing the Lead HEMS Doctor wearing a Jack Wolfskin jacket that attempted to be outdoorsy we took it upon ourselves to gently berate him on his choice of outdoor clothing.  To us we thought we were being brilliantly amusing.  Unfortunately it wasn’t until the next day when another friend of mine pointed out, by text, what we’d done and how the Doctor had taken great exception to our comments.

Needless to say, I’m looking forward to the next time I can attend a Governance Day – but I might perhaps sit at the back of the lecture room.  Out of the way.

Binder

Theatres

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)

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)

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