Archive for the ‘Main Page’ Category

First Week

Friday, August 27th, 2010

Wow.

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.

Urgh.

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

Sunday, August 22nd, 2010

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

Monday, August 16th, 2010

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?

Last Night

Tuesday, August 3rd, 2010

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.

Done

Monday, July 26th, 2010

To whom it may concern,

I wish to resign from my post as an EMT-3 in the London Ambulance Service. If possible I would like to go onto a bank contract so that I may work the occasional shift.

I would appreciate it if you could tell me my last working day as soon as possible as I am moving elsewhere in the NHS and they would like to know the earliest date that I can start.

Many thanks in advance.

Brian Kellett

—–

I handed this letter to my immediate boss today.

People who follow me on Twitter will have already heard that I have a new job, one that I’m due to start in approximately one month. In one month’s time I shall be going back to nursing where I am taking a post as an Urgent Care Nurse Practitioner at Newham hospital.

I’ve been led to this by a number of factors, a majority of things that have pulled me towards a career change as well as more than a few things that have pushed me away from the LAS.

My AOM described it best when she gave me my reference, she said that I was bored and that I needed new challenges. We both agree that in most cases the job that we do turns our brain to mush.

So, I’m going back to nursing because I want to develop my clinical skills, I want to learn new things, I want to be more responsible for providing people with the best healthcare that I can.

It’s pretty much impossible to do this within the LAS because, for example, our ECP (Emergency Care Practitioner – our top clinically trained people) programme is effectively being shut down. There is nowhere to progress to and… well… you have been reading all about it on this blog for the past few years.

—–

So, some big changes – one of which being that I’m going to go to writing under my real name, Brian Kellett, rather than the helpful pseudonym of Tom Reynolds. At the moment I’m in the process of changing this on all the social network profiles that I can remember belonging to.

If you take a look at the top of this very blogpost you should see that it no longer says ‘By Reynolds’.

As for this blog… well… I’m unsure of what form it’s going to take in the future. WIll I be still writing about ambulance stuff? Will I be documenting my journey into urgent care? Will I just natter about whatever interests me at that moment in time? I’m not quite sure. Certainly I’m not going to stop writing and in fact, later today, I’m heading into town to have drinks and a chat with a friend about something we are planning together.

So I’ll keep blogging, but I’ll no longer be the ‘ambulance blogger’, I’ll be ‘that annoyingly nerdy blogger’, which I think puts me in good company.

—–

So there you go, a change in career, a change in direction, a change (of sorts) of name. I’m looking forward to it and will be writing about it in the coming weeks.

It would be a lie to say that I’m not at least a little bit nervous about this, but nervousness is just a form of excitement – and while this is a big step for me it’s one I’m looking forward to taking.

An Indulgence

Sunday, July 25th, 2010

The monster, who was once a man, sat on the bonnet of the burnt out car and looked out across the London night.

He was deciding what to do, after all immortality could get boring after a while. So he sat on the car and tried to decide whether he should let himself die.

The problem, he thought, was that with endless years the space in your mind would fill up – forgotten names, faces without names, memories blurring into one another.

It wasn’t that long ago he had London in the palm of his hand, ruler of the night court. Taken through fair means and foul, politics and violence, from the one who came before. And he couldn’t remember her name.

He remembered other things though, the massacre at Osbourne house – trading on his survival at that bloodbath gave him his first footstep on the ladder of power. He’d risen through the ranks, slowly at first, then ever faster – his comrades at his side. One he would trust, the others could only be trusted in a well lit room.

Then the one he trusted returned to his homeland, the monster smiled at the thought of him now, probably dancing around burning orthodox churches.

He thought of the reward he had received for waging war against the other half of the city, the reward that ended in his near assassination.

But his survival fed his fame even more.

He remembered the lord of the undercity, he remembered him from when that lord was still a man and not the twisted but honourable monster he became. That lord had met his final death not too long ago from monsters older and nastier than he.

The things he had seen, the monstrosities in Norwich, the art gallery filled with elephant dung somewhere on the south coast, the things that flew invisibly in the air and invaded your thoughts.

The friends he had made, sitting around swapping war stories, insulting those who had not truly lived before they died and became monsters together.

The people he had killed to slake his thirst for blood. The murders he had planned, the murderers he had sent off to do his bidding.

The sky was lightening, too slight for human eyes, but easy to discern with his predators eyes. His decision would have to come soon.

Those of his kind that he called friends were largely no more, he had outlived most of them. The humans he had cultivated were now all moved on, taking roles that were of no consequence to him. Those enemies that still lived, to smart to fall to his blades, he could not count them all.

Back before he was made the monster he was just a man, a soldier, endless battles across Europe, fought for King and country. Different kings but the same country. He didn’t care for the cause, but he cared for his brothers in arms. When he was a man he belonged to a family, now he was the monster any family he’d built had scattered to the winds, under their own steam or as ash, it didn’t matter.

Perhaps, he thought, the choice to be made wasn’t so black and white as to be a choice between life or death.

Once, when he was a man, the choice had been simple – to avenge his fallen comrades, hunting the monster through the alleys of London until cornered the creature that he thought a man turned bared it’s fangs, and leapt for his throat. Life or death, it didn’t matter, he would die for his family.

Now he couldn’t, for he had no family.

So, if not life and if not death, then what should he choose?

Perhaps rest, a slumber for a decade or so, buried beneath the earth where his dreams could wipe away the last fifteen years. What changes would he see when he woke?

The bluing of the sky was more pronounced, his skin starting to itch from the sun’s power. His choice would have to be made soon. To stay on the banks of the river and turn to ash, or to hide in the shadows and continue for one more night into the endless stretch of time.

He was bored. He’d won his game and kept his prize. But the boredom was his undoing, he’d would take more and more risks just to spice up each night. Seizing the praxis of the neighbouring counties, returning the power when he was bored.

And one night that boredom led to him losing the power in London. He’d tried to go it alone, but knew that it would not last, so one night he stood up and left – and didn’t return.

Since then he travelled, looking for something to keep him interested, but the same old fights were repeated everywhere.

So now he sat on the bank of the river waiting for the first rays of the sun to appear over the horizon. To burn his flesh and blacken his bones.

The moment was approaching – to choose. Life, death or something else.

‘I think a nice rest’, he said quietly to himself, ‘one day I might be wanted again. And besides, I wonder what will happen next.’

He strode out into the river and, picking a spot no different from any other spot, buried himself deep in the silt. Feeling the cold of the water and the slickness of the riverbed he thought that this would be a good place for a sleep of a few decades.

‘I wonder how interesting the future will be’, was the vampire’s last thought before he slipped into the torpor of ages.

—–

An indulgence, an inside joke and a banishing with laughter. Tomorrow a big step to be taken and a line to be drawn under the past.

My Intial Thoughts On the NHS White Paper.

Tuesday, July 20th, 2010

The NHS White Paper is out and I’ve read pages and pages of analysis, although I’m yet to read the White Paper myself. It’s sitting in my reading queue waiting to be read.

The big change is the PCTs who currently ‘purchase’ healthcare will go the way of the dodo to be replaced by ‘consortia’ of GPs. The thought being that GPs know better the needs of their community.

While I am sure that there are plenty of conscientious, well trained, thoughtful and management minded GPs out there, certainly in my part of London they seem a bit few and far between.

As an example, my crewmate and I were sent to a patient who had seen the GP who had thought that she might need hospital treatment. The patient was described as ‘ambulant’.

She was ‘ambulant’, in that she had walked to the GP surgery – at least one mile away, and the GP had sent her home to await the ambulance.

As soon as I walked into the room I knew that we would be wheeling the patient out on our chair. She was so short of breath she was breathing forty times a minute, her oxygen levels were way below what they should have been (86% – even with someone with chronic lung disease, this would be a worry), her pulse was racing at over 120 beats per minute.

She was a very sick lady – and yet the GP had sent her to walk home.

Similarly I’ve been to patients in the later stages of shock who have been sat out in the waiting room for the ambulance and I’ve had patients who the doctor has, correctly, diagnosed a heart attack sitting on the wall outside the surgery.

—–

Now, I understand that not every GP is like this and that I only tend to go to the patients that are seen by these worryingly poor GPs, but how many of them will be holding onto the public’s purse strings in the future.

In some places they can’t even arrange decent out-of-hours coverage with GPs who are able to speak English.

—–

The other worry is what happens if a GP consortia decide that they don’t want the LAS handling emergency calls in a certain postcode? Will we be refusing calls because privateambulanceservicecompany will hold that contract? Will we no longer be London-wide, but tasked to only cover certain areas.

Given yesterday’s announcement about ‘Big Society’, will the ambulance service be broken up to be replaced by volunteer services? I heard rumours that the Olympic planning people wanted LAS staff to volunteer to cover the Olympics as they didn’t want to pay them, was that just the start of this?

—–

Still, lets wait and see what happens in the consultations before we start panicking. After all it’s not like consultations in the past have ignored all the good points in opposition to what the government want to do…

Airwave

Wednesday, July 14th, 2010

It would appear that the radio system that the LAS uses has been in the news of late – claims that it doesn’t work in the rain, or that vehicles are without radios.

Or vehicles use the ‘Airwave’ standard, a digital network shared by, amongst others, the police. We have a main set that is fixed to the ambulance and should have two handsets that we carry everywhere with us.

I can only talk personally, but in my experience the radios are often a bit flaky (but remember that this is a system that was forced on us by the government), but not any flakier than any digital phone network.

The problem is that they are digital, if they have a poor signal then they just refuse to work, unlike the old VHF analogue radios that would transmit, although over a load of static. With analogue though the human brain is a great signal filter, and so you could make yourself understood. With a digital system you just have silence.

So it’s not perfect, but it’s not bad – at least we have handsets now, it’s been something we’ve been wanting for crew safety for quite some time.

As for not having radios on vehicles – I suspect that the spokesperson for the LAS is counting the main set in the vehicle as a radio (quite rightly as that is all we have had for years), but the HSE are also counting the portable handsets.

These do go missing, but there is normally at least one handset on a vehicle. When we were trained in the use of the radios we were told about the system for replacing them if one should go missing – sadly this seems to have gone out of the window.

Oh well, no change there.

The switch to digital has meant some changes. For example you can no longer hear everyone on the radio talk group, so you have no idea where your workmates are or what they are doing – this results in much less awareness at street level of the situation across your sector. I can’t tell if a hospital is full or not just by listening to the radio, nor can I hear if any crew needs assistance. This makes you feel a lot more isolated on the road.

The other side effect of not hearing the rest of the talk group is that, when it is busy, you ‘buzz in’ to talk to Control, but you don’t get an answer, all you have is what seems like an empty channel while Control seemingly ignore you. With the old system you would hear them talking to the other crews, and so you would know that they were busy so you knew you weren’t being ignored.

Overall, the provision of handsets has made crews safer, although I can’t comment on the panic button as I’ve never had to use it. Some things are better, some things are worse. But at least the LAS has made the effort and the problems are with the design of the system rather than with the LAS.

—–

Can I also take a moment to mention one thing that I forget to write about in the last ‘Transplant’ post – that you should also discuss your being on the donor list with your family, so that they are prepared should the worst happen and that they know your wishes and don’t overturn them. You might also be able to persuade some of them to sign up as well.

—–

Finally, big changes coming up, but it’s something that I need to sit and write with plenty of time, not fire out in the half hour before I leave for work. And I’m not just talking about the NHS White Paper.

Transplant

Friday, July 9th, 2010

A lot of the people I follow on Twitter have been talking about #transplantweek, a way to get everyone aware of the need for organ donors.

In my years as an A&E nurse I only knew of two people passing through my doors that went on to be organ donors, helping people that they never met. Two people in many years is simply not good enough.

In my ambulance work I find myself going to dialysis wards, people who desperately need kidneys. The chairs are always full – people connected to machines that clean their blood and keep them alive.

I’ve been to people who need liver transplants, waiting for someone to donate their liver to them so that they can live. These patients are swollen, yellow and in pain, and all I can do is take them to hospital where they can be ‘managed’ for a little while longer.

There was a child on my patch who needed a heart and lung transplant. She was lucky and got one, and I don’t see her any more.

Once upon a time, when I would go to people who had suffered trauma, we would rush them into hospital where they would get blood transfusions that would save their lives. As a nurse I can’t even guess at the amount of blood products I’ve given people. I used to be the one sent for the blood because the storage was halfway across the hospital and it never bothered me walking the hospital grounds late at night.

Organ donation saves lives – of that there is no doubt.

—–

There are myths that doctors will ‘let you die’ so that they can get their hands on your innards – I can tell you that this is completely untrue.

I’ve been on the organ donor list for as long as I can remember. I wouldn’t be on it if I thought there was anything ‘dodgy’ about it.

You’d accept a kidney if you needed it to survive, why wouldn’t you donate one when you no longer need it?

—–

Why don’t you sign up today – help someone out when you pop your clogs. It’s the ultimate in green recycling.

Register as an organ donor.

Self Promotion

Thursday, July 8th, 2010

Di you know that both my books are still available in shops and on Amazon?

Blood, Sweat and Tea

More Blood, More Sweat and Another Cup of Tea.

But did you also know you can download them for free for pretty much every platform under the sun. (And here for the sequel)

They are also now on the Apple iBook store, also for free, so if you have an iPhone or iPad you can read them on that platform as well. (And it has been downloaded quite a lot from there – a few more and I might make the top twenty free downloads chart). For some reason you can’t like directly to an iBook store page. Which is a bit daft – do try and fix that Apple.

And finally – ‘Blood, Sweat and Tea’ is now available as an audiobook. Huzzah!

iTunes link

Amazon link to CDs.

—–

Feel free to download the free editions, and then, if you like it, buy a physical copy for your loved ones (from the emails I get, it would appear that mothers really like them). That way both my publishers and I get some lovely, lovely money.

OK, self-pimpage over.