Just to let you know, there will be no serial episode today, and no other posts. I had to drive Julie into Norwich for MRI scans earlier, and we have just got back.
(Nothing sinister, the scans were for ongoing joint problems caused by Arthritis.)
Normal service will be resumed tomorrow.
As this seems to be the only thing on my mind at the moment, I thought I would update you with this week’s progress.
Yesterday, I posted the 10-page (5 pages, double sided) form back to the DVLA. This consisted of various medical information about myself, and also full details about my hospital consultant and family doctor.
One page was for me to give permission for the DVLA to approach the hospital consultant, and my own doctor. I had to give also permission for the DVLA to have access to my medical records if both doctors agreed. Just as well there is nothing too embarrasing on there!
Once this goes before their own ‘Driver’s Medical Committee’, the DVLA will then decide whether or not they want to send me for that threatened ‘Independent Eye Test’. One small encouraging paragraph stated, ‘This may not be necessary if your doctors are happy for you to continue to drive with your condition’.
(That condition is Glaucoma, by the way. Almost 500,000 people in the UK have that.)
Now I have to play the waiting game, which could take weeks.
This morning, I received an email reply from my Member of Parliament. This informed me that the DVLA would be sending me out paperwork to complete.
A bit late, but at least he tried…
Reblogging this from my other political blog because I think it is important for more people to see it.
Much has been made of the fact that the government is rushing to convert an existing conference and entertainment venue into a new ‘Hospital’. They are working hard in East London’s Excel Centre to create two ‘wards’ that will each accommodate 2,000 people. They have even given it a nice name, ‘The Nightingale Hospital’.
Does that sound good to you? Well it doesn’t to me.
I would like to know how they expect to treat 4,000 people lined up together in a massive space that is one kilometre long. How will they keep them apart at a safe distance? Will there be respirators for those needing life support? (Unlikely) Where will they find the doctors and nursing staff to treat them? (Answer, The Military)
So what we have here is a place where those who are expected to die are going to be sent to, to do just that. In…
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Thinking about my Mum this morning, and her distressingly hard departure from this life. The Liverpool Care Pathway mentioned in this post has since been discredited.
Too late for her, unfortunately.
During the last quarter of her life, my Mum was often ill. Her breathing problems became so bad, there would be crisis after crisis, occasions where she was not expected to survive. After recovering from these, she would usually say the same things, and have an identical conversation with me. She lamented the fact that voluntary euthanasia was illegal in the UK. She could see a future where she would not want to go on, but be unable to end her life with dignity, at a time of her own choosing. A vocal supporter of the ‘right to die’ campaign, she would always tell me that she did not want to, in her words, ‘end up as a cabbage’. There were numerous times, when she would ask me to reassure her that I would advise any medical authorities that she was not to be resuscitated, and that her life was…
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On the 14th of march, 2012, my Mum died.
Since suffering a series of strokes, she had been in a virtual coma for some time. The hospital put her on to the ‘Liverpool Care Pathway’, which involves removing food and water, and ‘allowing’ someone to die of natural causes, when they are beyond all other help. She was monitored, washed and turned, and her lips were moistened with a solution, to spare her the worst ravages of thirst.
As it had always been her wish not to be kept alive by machines, or to spend an age on life support systems, I readily agreed to this at the outset, expecting it would all be over very quickly. I had no idea then how it would drag on, how her weak body would cling on to the slightest vestige of life, and fight to survive. Visiting her every day to watch her groan and suffer was almost more than I could bear. I pleaded with the doctors to give her something to drink, and perhaps to feed her through a tube. But they had commenced their ‘Care Plan’, and there was no going back.
I began to dread walking into her small side room, knowing what I was about to witness. She had no idea I was there, but she still writhed around in the bed, made horrible noises, and pointed to her mouth. I felt completely helpless, as well as being ridden with guilt for agreeing to it. That last day, I returned home to my Camden flat after the visit. The nurses had been very kind to both Mum, and to me. When one of them rang me very late to tell me she had gone, I felt relieved, for her and also for myself. That is a day I will not forget. And I will never forget my Mum either.
Rest in peace, Mum. You will always be remembered.
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I received some shocking news this week. A former friend and colleague from the Metropolitan Police had been the victim of a road accident. On his 50th birthday, he was crossing a road in central London, when a coach ran over his right foot. He was taken to hospital, where the damage was found to be severe, with loss of bone and muscle. He was offered the option of long and complicated surgery to re-structure the foot, with the warning that this might not work. The second option was amputation of the leg just below the knee. This would allow a faster recovery period, and the ability to fit a prosthetic leg, that would ensure better mobility. He chose the latter option, and will undergo this surgery on Tuesday. I sent him an e mail expressing my concerns and shock at hearing the news, and I was surprised to get a reply very quickly. I was amazed at his stoicism, and the way he was dealing with this life-changing event. He didn’t complain, or once say ‘why me?’ He simply got on with the situation he found himself in, and was glad that the outcome was no worse than it was.
Arne is German, but has lived in London for many years. He has a wicked sense of humour, and speaks English better than most of his colleagues, including me. He is an excellent chess player, and an accomplished wordsmith, with an enquiring and analytical mind. It was always a pleasure to work alongside him, and we often had a great laugh together. Despite the pain and discomfort he is suffering, his first response has been remarkably practical. He has started a blog about the accident, and the forthcoming surgery. He hopes that as well as serving as a personal record, this blog will help others in similar situations, who find themselves unexpectedly facing terrible injuries, or the prospect of amputation, and dealing with the practicalities of life afterwards. I think that this is to be commended. Not many of us would have the presence of mind to start a blog, so soon after such a traumatic event.
With this in mind, I would like to use this post to promote Arne’s blog. It is not on wordpress, but it is simple to comment on the posts. Please visit the link below, and give him some support. Thanks in advance, Pete.
Is that better?
Retention of urine is a common condition, primarily affecting male patients. As men grow older, the prostate gland continues to enlarge, and often constricts the urethra. This can result in inability to pass water at all, or in frequent, unsatisfying urination. Other causes might include physical obstructions, such as a tumour, though this is less likely. So, this condition is considered a run-of-the-mill job by ambulance crews, and is normally already diagnosed by a G.P. The ambulance is summoned to take the affected person to hospital, for a pre-arranged examination by a urologist, and it is not considered to be an emergency. In many cases, the man will make his own way to hospital, though if he has another condition already, such as a heart problem, difficulty in walking, or breathing problems, it is likely that his doctor will request transport by ambulance.
One late afternoon shift, we were summoned to just such a call.
On a small, neat estate, about two miles from our base, we were met at the door by a lady, dressed in clothes much too fine for attending a hospital. She was immaculately coiffured, and carried herself with the air of a disdainful aristocrat. She handed me a brown envelope, containing the letter from the G.P., and told me to wait for her husband, who was putting on his shoes. Her attitude did not bode well, but I chose to ignore it, and smiled pleasantly, shuffling my feet in the doorway of the tiny terraced house. When her husband appeared, he was a small, bespectacled man, aged about 70. He too was well-dressed, and he nodded congenially to me, before they both walked up the two steps into the back of the ambulance. After making them both comfortable, I sat directly opposite the man, and read the letter from the doctor. We started to make our way, and though we were less than three miles from the destination hospital, the traffic was at a rush-hour standstill.
I tried to make conversation, as there was the usual awkward silence needing to be dispelled. The man’s wife answered all the questions, leaving him to nod in affirmation, as she relayed the history of his various illnesses, and gave me a comprehensive list of all her husband’s current medicines. She spoke without opening her mouth, the sound coming through pursed, disapproving lips, that were covered by a thick swathe of bright red lipstick, which would have been envied by many a circus clown. This strange style of talking resulted in a nasal whine, which together with the affected upper-class accent, provided a really unique sound, which was extremely unpleasant to the ears. I looked at the downtrodden man, feeling sympathy for a life spent with this unappealing member of the opposite sex.
I decided to involve him directly, and asked him for his date of birth. I didn’t need to, as it was clearly stated on the doctor’s letter, but I wanted him to say something. I looked down at my folder of paperwork, preparing to write down his answer. What happened next, was completely unexpected; and I felt as if he had thrown a bucket of water over my head. He had, in fact, vomited over me, in a projectile display worthy of the infamous scene from The Exorcist. His entire stomach contents had been discharged over the top of my head as I glanced down, completely soaking my hair, face, paperwork, and going inside my green uniform coverall, with sufficient force to also wet my T shirt, front and back.
There had been no indication that he had felt unwell. The vehicle had not been moving with enough momentum to induce motion sickness, and he had as much time as he could have needed, to tell me he felt nauseous. Instead, he thought it was completely acceptable to throw up two day’s worth of stale urine, and whatever else was in there, all over a person sitting inches away. His wife turned to him and patted his leg, adding the comment ‘Is that better?’ I was appalled at this behaviour, and would liked to have punched the fool unconscious, but of course, I could do nothing, except towel myself down, and ask the man why he hadn’t told me he felt sick, and asked for help. ‘I thought I could make it to the hospital’, was his lame reply.
Neither the patient, nor his sneering wife, made any vestige of apology, no matter how shallow and insincere it might have been. I had to escort them into the hospital, reeking of this man’s urine and vomit, and hand over to the staff. To the nurse in charge, his wife offered, ‘He was sick a while ago, but I don’t think he’s got anything left now.’ I walked away, unable to even glance in their direction, as I climbed back into the vehicle, to return to base, to shower and change. In the London Ambulance Service, you are used to many things. Assaults and threats, mad people, abuse and swearing, all of this is commonplace. But you don’t expect a respectable, elderly, middle-class man, to think that it is OK to knowingly, and deliberately, vomit all over the person that has arrived to help him.
One under
As anyone who commutes around the London Underground Railway network will tell you, delays caused by someone jumping under a train, are commonplace events. In London, this network is commonly called the Tube, not the Subway, which for the edification of American readers, is a passage underneath a busy road junction. I say jumping under a train, because people rarely fall under them, though they are sometimes pushed, or hit by trains as they attempt to cross tracks.
To simplify this for the various Emergency Services, this type of call is given out as a ‘One Under’. After all, for our purposes, it is irrelevant how they got there in the first place. During one particular rush-hour morning, we received such a call, to a busy Central London Tube Station. The prospect of attending these calls requires a lot of preparation prior to descending into the depths, where most tracks are situated. London has one of the deepest systems in the World, with very few stations having any tracks at ground level. Any equipment that you think you may need, has to be taken with you at the outset, or long delays will be caused later.
On arrival at the station, Tube staff will meet you, and give you a fair assessment of what you will have to face below. As a rule, Fire Brigade appliances will also attend to assist, and there is a dedicated Heavy Recovery Unit, provided by London Transport, which is sometimes already there, or at least on the way. Laden with various stretchers, aid boxes, oxygen, blankets, and splints, you and your colleague make your way down the seemingly endless escalators and steps, until arriving at the track in question. The scene is usually surreal;the normally bustling and noisy area is cleared of all bystanders, the train quiet and empty.
On this occasion, I am met by a member of the Fire Brigade. He tells me that a cursory examination under the train, reveals an adult female, who appears to be still alive, despite significant contact with the train. There is nothing for it, but for me to crawl under the train, and try to assess her injuries, and decide how to get her out. This is an unpleasant job at any time. The accumulated filth of grease, litter, fluff, and dirt under the tracks, combines with oil from the train workings, to make an indescribable goo. Added to this, there was substantial blood loss from the patient, already congealing like some sort of unspeakable jelly. At this time, Ambulance Crews still wore the two-piece ‘smart’ uniform, jacket and trousers in light grey, blue shirt, and tie. I removed the jacket and tie, and donned a ‘hi-vis’ jacket, not so much as to be seen easily, more to reduce contact with all the unpleasant substances. It was very hot of course, as it normally is in Tube stations. This was made worse by not having trains running, so no air was being pushed through onto the platforms.
My main concern was the electricity. The notorious third rail, through which the massive current runs, could kill me on contact, and I had a healthy fear of it. Before I would go under the train, I wanted complete assurance that the power was off in that section. A brief consultation with the Tube staff did not satisfy me. They were not sure, they told me, so they had sent for an engineer with a ‘tommy bar’. This was a long piece of metal, that when placed across the tracks, effectively shorted out the supply, rendering the third rail harmless; this was the name the arriving engineer gave it anyway, so it may well be a nickname for the device. He fixed it across, and called up to me that it was OK to proceed. I was still unsure, and approached gingerly, asking for further assurance that the power was disconnected. Losing patience with me, he leaned across to the third rail, and placed his tongue directly on it! “Happy now?” He yelled at me.
I could dally no longer, and began to crawl under the train, waving a torch around, so to see better ahead of me. I found the female towards the rear of the first carriage. She was breathing loudly, and muttering incoherently at the same time. The train had run over her at one side, causing massive injuries to her left leg, hip, and left arm. Most of the flesh on her left thigh had been detached, and her arm on the same side, was almost severed. With little room, and minimal head clearance, I managed to dress and secure her wounds as best as I could, and administer oxygen as I did so. My colleague was talking to me from the track above, and I was updating him on my progress. By the time I had dressed the wounds, I was completely covered in the aforementioned grease and blood, which was all over my face and hands, making it difficult to work properly. I was so hot, that it was difficult to concentrate, and on top of this, the patient was regaining her wits, and becoming increasingly agitated. And I still had to get her out.
There are only ever two options in this situation. The first is to jack up the train carriage, to make sufficient space to remove the victim; the second, to restore power, and move the train off the patient, back into the tunnel, leaving the track area clear. I preferred the first option, as the safest for all concerned. However, she was in a bad position for this, as she was not near enough to either end of the carriage, making jacking almost impossible. There was nothing for it but to make the situation as secure as I could, and move the train. I managed to get her as centrally located between the tracks as was possible. I then tied her legs and feet together with bandages, and did the same with both arms. This was to stop her moving, and putting us in more danger. When these preparations were completed, I got the lady to look me in the eye, and asked her if she could understand me. She nodded, wide-eyed, confused, and distressed. I was not at all sure that she understood what I told her next, but had to take that chance. I advised her that the power was going back on, and that the train would be moving slowly backwards. She should not wriggle around, and try to move (as she had been), or she may well kill us both, by either contact with the moving train, or the electric rail.
I eased myself into position slightly across her body, to restrain her further, and gave the signal to those on the platform to get on with it. The sound of the power being restored is not something I would recommend that you ever want to hear. There is a low hum, increasing in intensity, until you are certain that you can feel the physical presence of the electricity around you. The connectors give off sparks and light as the train moves, and the few feet of travel required to get the train off you, seems to take an eternity. Once the train had moved, everyone else was able to get onto the tracks to assist. The patient was placed into a Neil-Robertson evacuation stretcher, and finally moved off the tracks. Fire Brigade staff, and some colleagues from the Ambulance Service, carried her for the long journey up to the street, and into the vehicle. I was left to stagger up the escalators, covered in grime, carrying my uniform. I got into the back with the patient, and we left for the short journey to the nearby hospital, where we handed her over to the Trauma Team.
After completing the necessary paperwork, I advised Ambulance Control that I would have to return to my base, to shower and change. We had been there for less than five minutes, when the emergency phone rang. They wanted to know how soon I would be ready, as they were busy, and holding more calls. Just another day…
Experience not necessary
This is another example of how experience does not always guarantee good performance, and how the wisdom of age can be cast aside by events.
One evening, I was working with the oldest, and most experienced man on our Ambulance Station. I was almost 40 years old, and he was over 50. Between us, we had some 38 years of experience in the job. Towards the end of the shift, which had been very busy, we were called to a traffic accident. It was described as a ‘hit and run’, a pedestrian had been knocked down, and the car responsible had left the scene. We had some way to travel to this job, and on route, we were updated on the radio; the situation was believed serious, Police on scene had advised us.
On arrival, things did indeed look serious. A man in his 30’s was lying across the road, which had been partially closed by Traffic Police. On examination, it appeared that the man was semi-conscious, smelt strongly of alcohol, and had a visible wound to his head. His shirt was wet around the abdomen, despite dry conditions, so my colleague removed it, to better examine the male. We immediately saw that he had organs protruding from a wound there, and soon ascertained that it was his intestines that were clearly visible. We applied a very large dressing, dampened to protect the exposed tissue, and advised the nearby hospital that we would soon be arriving with a seriously injured man.
I drove off, blue lights flashing, sirens wailing. In the back, my colleague administered oxygen, and closely monitored the patient, during the short journey to the local Casualty Department. Arriving at the hospital, we rushed him in to the Casualty, where a special Trauma Team was waiting. They quickly removed his trousers, to reveal a dislodged colostomy bag. What we had believed to be a torn abdomen, was in fact a surgical stoma, where a piece of intestine is left exposed to attach to the colostomy bag. The man was well-known to the staff there, and he later confessed that he had been drunk, and tripped over the kerb, hitting his head, and detaching the bag attached to the stoma. There had been no car, and no traffic accident, all of that had been presumption on the part of the Police, and bystanders who had happened across him. Had we not allowed ourselves to get caught up in the drama, no doubt we would have worked this out for ourselves.
We both felt pretty stupid, and it took us a long time to live that one down.
beetleypete 