SIGN AND PASS ON, PLEASE.

Well I'm OK now.Took Thursday off as a sicky and slept until 3PM. Think I needed it. No more unpleasantness for the time being.

Found this though ***here*** and would urge everyone to sign. This is something particularly close to my heart and, I guess, all Ambos across the world, although it only relates to those of us dealing with the British unwashed. About time something was done.

Got to say that the Government hear obviously don't believe in democracy, as evidenced by their stance on the travel tax thing, but you never know.

Pass it on to everyone you know, even if you don't sigh it yourself. Again ***here*** it is!

ANOTHER DAY.

I felt crap today. Think I've managed to pick up a D&V bug from someone. Actually I'm surprised this does not happen more often in the service. Anyway it left me with a sore tummy and a thumping head. I hated everyone I came across including their pets.

Strangely, though, one call was to a GP who wanted our assessment on someone who he thought might be having a MI. He wasn't and the GP was fantastic. Will take me longer to get over the shock of this than the bug I've got.

Hope tomorrow comes with less nausia or it'll be a sick day and I always get bored of these about mid-day. Still Zelda calls from the corner of the room. Will have to wait and see.

THE EARLY BIRD.

Back to work tomorrow for the first of three day-shifts. Quite looking forward to it. Hopefully something will happen to inspire a new post of interest to me at least.

I should of been going to thy gym bit I've actually spent most of this last week trying to escape the Goron mines. taken me for ever but now I just have the big boss to kill. Rock on Zelda I Loooove my Wii.

(NFR) = NOT my FUC***G RESPONSIBILITY

This post is actually about NFR/DNR (Not For Resuscitation/Do Not Resuscitate). I will call these NFR as I’m old fashioned in this regard and this is what I understand.

I will start, however, by stating that Valentines Day is over. I am glad about this, as I don’t like it. I am also pretty pissed but, surprisingly, not too depressed.

I, once upon a time, spent it with a wonderful, beautiful woman whom I loved very much. The bitch did not like me as much though so she must be mad. Obviously. Broke my heart and I’ve only just forgiven her. Well I forgave her a couple of years ago actually and hope that all is well in her life. Feel sorry for the man she’s with though, nutter.

Tomorrow is my birthday. Just another day but the day that I get older. Older, older I hate that. Why cant I be 18 forever. Still feel 18. My body feels about 80 but I’m still the stud I was 20+ years ago, in my mind. Would love to be able to try and prove it.

This story is an example of something that has become more common over the last year or so. I can’t say that I remember these things happening before, but the situation described has occurred a few times over the last 8-9 months.

I was on a dayshift and, unusually, was in early. I don’t generally do mornings very well but this day I must have been hyper. A 999 call came in 20 minutes before the start of my shift so I volunteered to let one of the night shift crew get home on time and cover their space. The call was to a nursing home about three minutes from the station and I figured it would not be anything too serious. We don’t usually get spurious calls to this place. If there is anything near a good nursing home this may be it. Probably because it’s run by nuns, but still-------.

As we entered we asked what was going on and got the reply, if you can believe it, “we think she’s dieing but just want your opinion!”

What sort of thing is this to say to anybody?

Her daughter was on the way and all they wanted from us was to say, “Yip, she’s on the way out”. The home manager had previously discussed the option of an NFR. This is where a person is known to be at deaths door and a decision is made that any attempt at resuscitation is not in their best interest. CPR is not to be undertaken.

We entered the room and did the basics. The woman was obviously near the end of her life. Sometimes you see people and know that the worst thing you could do is try and move them. The very action of trying to move them and take them to hospital will result in their death. A “nurse” turned up with the documentation that they have and points to a signature under a heading at the bottom of a sheet relating to a NFR.

Now, this means nothing to us, as ambulance personnel. As it stands, where I work, the only legally relevant documentation relating to an NFR is: -

A signed letter from the patients GP.
An audio recording from the patients GP
A preforma signed by the patients GP.

In reality if we don’t have a letter from the patients own Doctor there is no NFR in existence.

The nursing home manager knew this. In my opinion the very fact that they had the discussion and had not formalised it is negligent. They know the legal requirements as well as I do. If they have not been negligent at the very best they have misrepresented the facts to the relatives. I can only hope that they get sued at some point in order that they stop knowingly misleading the relatives of people nearing the end of their life. The distress that this causes became all too evident to me as time went on.

If we moved the woman she would die. You get to recognise these things. This does not invalidate our legal responsibility regarding duty of care. We had to do everything in our power to ensure the survival of this woman.

Blood pressures, BM’s, Oxygen sats, ECG, GCS were all taken as was temperature. The picture was not good. Knowing the circumstances we did all we could to kill time untill the daughter turned up.

The relatives were all under the impression that their mum had been placed in this home for palliative care, with the NFR in place as discussed with the “nursing home” manager. To be looked after until she died. On hearing that we had no option but to remove her mum to hospital the daughter became, understandably, distraught.

While we were, at this point, taking no actual moves towards moving the woman the daughter actively started preventing us from doing so.

I understood her actions completely. Her mother had been placed in a home to die. This had been discussed and her understanding was that everything was in place: she had made her peace with this. To have a 6’3” stranger trying to explaine that yes, we know your mother is going to die and that this is almost certain to happen if we move her but that no, the nursing home lied to you about the NFR and we have no option but to move her and effectively kill her, is not a nice thing.

All the while the daughter is crying. I feel like crap. I know that I don’t want to do what we have to do. That if I follow the rule of law I will be subjecting an old woman to unwanted assault and her family to unnecessary stress/distress.

I ask everyone to leave the room for a minute and my partner and I have a quiet word. She’s way ahead of me. Experience is everything and she’s been around a lot longer than me. Obviously there is no point in calling her GP at 7am (they’ll still be in bed) so call the out of hours service.

While we can hear the daughter crying outside the door we try and explain the situation to a Doctor who has never even heard the woman’s name before. Fortunately he’s a good one. He takes the decision to permit us to withdraw. I have no idea how ethical this is but it was the right decision. It could have been so much different.

We apologise to the daughter and she seems to appreciate the actions we took. Despite this her eyes are still red. All she wanted was her mum to pass away in peace. While we did what we could, we stole some of this. We were an unwanted presence at a time of sorrow and distress.

The home should either not of called us or ensured that they fulfilled their legal obligation to formalise the NFR.

Three times in the last nine months this has occurred. I never expected to be put in this situation. If it happens again I’ll inform the police. Nursing homes have responsibilities that they should not neglect. Nor should they place the responsibility for their negligence at our feet. Their job is to care!

Fuck, I hate nursing homes; and this was one of the better ones.

NOT AGAIN.

I seem to of run out of steam.

I have had so many holidays to use up that I'll of only been at work for 7 days in five weeks by the time I go back a week on Friday. Also when I have been there there has not been anything particularly noteworthy to comment on. Maybe I'm just a bit jaded at the moment and the perpetual Autumn is getting me down. SAD is it not.

There are a couple of pending posts I need to catch up on so may spend valentines day doing that rather that getting pissed and depressed but I cant guarantee that.

Normal service will resume - sometime soon.

IT'S CHRISTMAS

I always associate snow-men with x-mas. Not so much snow as the things people make with it.

It's here and I like it but don't think it will be around for long. Wish it was more like the 70's when I was a kid and snow came every year and you could go sledging.

Is it bad to hope that Global Warming leads to arctic winters in Britain? If it is I'm a bad man!

SHAME.

I’ve been off work for the last few days, not back until Friday. Loving it. It’s snowing at the moment, which is nice. I like winter to look like winter and find the 8 months of autumn we now get depressing.

Work-wise it’s all been pretty normal stuff. I ranted about alcoholic **here** but met a man the other day who falls outside the general profile.

This guy is in his late 20’s and has been an alcoholic for a number of years. I’ve seen him before, lots, but not for a while and had forgotten all about him. Not seen him for about ten months.

The circumstances of the call were not unusual; alcoholic feeling suicidal. It’s the man that is unusual. He is not one of these types that look to justify their addiction or lay the blame for it at someone else’s door. He knows he’s had all the (limited) help available and that he has not followed through on this.

In short he knows he’s an alcy’ because he drinks too much and that that’s his choice. What gets me is that with all this, he does not feel sorry for himself; he hates himself. You can see the shame he feels in his eyes and body movements. He avoids eye contact whenever possible and wrings his hands. He knows he has a problem and has accepted responsibility for this though so that’s a start I guess.

In an unusual moment of compassion I feel sorry for this bloke. I hope things work out for him.

I NEEDED A Wii Wii

My life has taken a big turn. I have something of an addictive personality so try to avoid "bad" things.

I gave in though and bought a Nintendo Wii. I may never see daylight again. I have not had a console since the PS1.

White, pasty man.

IT'S NOT EVEN EASTER.

I would not believe it if it had not happened to me.

At training school I was most definitely told, “you can have a pulse and not be breathing but you can not be breathing and not have a pulse”. Set in stone. One of life’s certainties or maybe one of deaths.

Anyway on Tuesday night this was proved to be wrong. I have to say I didn’t believe it when it was going on so it took a minute to get my head together. It went like this.

Call to a difficulty in breathing. We turn up and my mate goes in to see the patient and I get the chair out the back of the bus in readiness to load up. Things are done and it seems like the man has no other complaints – no pain in the chest etc. although he is a bit clammy. We decide to do a heart tracing in the bus rather than loiter in the mans house.

In the back and we say “ok, if you get yourself on to the trolley.” The man looks at my colleague and his head slumps. Oh shit! We heave him onto the trolley and I check for a carotid pulse. Present but slow, resps at about 20 a minute, GCS E=2 V=3 M=4 so he’s not quite in a coma, but trying hard.

The defib’ pads are placed on his torso and after a second it shows VF (where the heart is having a wibble and not contracting properly). Fuck, “shock him,” the machine screams out. I say, “but he’s berating” and he is. Still berating at 20 a minute and moving his arms. We look at each other and see the doubt. What do we do? Another pulse check – no pulse. Thump the mans chest to no effect.

Decision made, shock. 200 joules thump through the man and he says “for fucks sake”, he’s still in VF. I say “for fucks sake”. My mate says “for fucks sake” and starts CPR as I try to intubate. The man has tristmis (clenching his teeth) and grabs my partners arm. He’s still in VF and becoming more agitated as the oxygen leaves his brain.

Back to basics, manage the airway as best we can and give him lots of O2. Another shock brings him back to NSR (the heart rhythm we all hope we have). Still no tube and still clenching his teeth.

All of this must of taken under 2 minutes. I jump in the driving seat and batter along the 5 minutes of road to A&E. They know were coming and are sitting there having a nice chat when we arrive. He’s been shocked again on the journey in so arrives in NSR with a GCS of E=3 V=3 M=4.

Beeeeeep. Off he goes again. The doctor shocks him and the man says, “ Fuck off, Jesus Christ”. We all look at each other again. He’s back in VF and fighting off the doctors and nurses. Bam! Another shock and he’s in NSR.

14 more shocks were delivered, along with drugs to calm the man down, and allow intubation, as were the other things for someone in cardiac arrest. Throughout all of this the man was breathing, talking and fighting people off who were trying to do CPR.

I have never seen this before. I have never even heard of this before. As far as I knew this was not possible except in Shaun of the Dead. The mans heart is not beating and he’s telling us to F off and complaining about the pain.

Apparently if you get in there quick enough there is enough oxygen in the blood to keep the brain working for a while, even when the heart has stopped. Very unusual and something I doubt I’ll ever see again.

It was a BIG learn for me. Sometimes you think you’ve seen it all but you are always learning in this job. You will never know it all and never see it all.

The man was eventually stabilised and is now in CCU. He’s a save. The first real save I’ve ever had. Sometimes you get a pulse back but that’s not a save. A save is when you run into them buying their grand kids a birthday present 2 months later.

I still can’t really believe what went on. If anybody reads thin and can shed some light on this or has had a similar experience I would love to hear about it. Crazy, totally mad.