by Wharton, Kit
This was in the days when you had to find a phone box. I was scared of the responsibility and the attention and frightened I wouldn’t know what to say, so I never called. I just ran off home.
I still feel guilty about it now. For all I know they’re still waiting for the ambulance. Not a good response time. Not a good start to a career in the emergency ambulance service.
There used to be a T-shirt – Love Means Never Having To Say You’re Sorry.
It’s rubbish, of course. Not even death means that.
Most mistakes aren’t serious, and you learn not to make them again.
But not all. After ten years in the job, with no complaints at all and a completely clean record, I made the worst mistake ever.
Jennifer
People ask what’s the worst job you’ve ever done? Jennifer’s the worst job I’ve ever done, by a country mile. But not in the way they mean. Len just looked at me sadly once we found out what had happened.
—Sorry mate. Can’t help you much with this one.
Five o’clock in the morning.
Called to a female in her forties, complaining of a tingling down her right arm and pain at the top of her stomach. She’s called the out-of-hours doctor service 111 and they’ve sent us because this sort of pain can sometimes be a heart attack. Off we go, through the 5-o’clock-in-the-morning mist and fog.
Cold. Dog-tired.
The house is a nice little cottage miles out in the sticks, very isolated.
The patient – in a dressing gown – meets us at the door and is a bit embarrassed we’ve come. She just wanted to speak to a doctor about her symptoms. She often gets the pain when she’s anxious, and she’s anxious tonight, she’s on her own in the cottage (apart from a Jack Russell who looks like he wouldn’t say boo to a goose), and she’s had a stressful week at work.
We follow her into the nice sitting room, sit her down, and have a good look at her. Everything seems absolutely fine. The pain’s gone and the tingling in her arm is easing too. She thinks it’s all just anxiety and we’re inclined to agree. All her clinical observations are fine: blood pressure, pulse, temperature and blood sugar, and the basic ECG we do on her heart looks fine too.
So we have a nice chat about her life and work. She’s a lawyer by trade, very interesting to talk to. She decides that, no thank you, she won’t come to the hospital with us that night. If the symptoms come back she’ll either call back or speak to the GP in the morning. She’s a nice lady and we think we’ve done a good job calming her anxiety. After another brief chat we say a friendly goodbye, wish her a peaceful night, and leave. She seems perfectly comfortable and we have no worries about her at all. Tickety boo.
It becomes the worst job I’ve ever done about two days later, when her daughter comes round and finds her upstairs in bed.
Dead.
She calls another ambulance but there’s nothing they can do – she’s stone-cold gone. At some point between when we left her and when her daughter came round she went up to bed, lay down, and quietly died. No signs of any vomiting or thrashing around, no blood, nothing. She’s just lying peacefully in bed, dead. The post-mortem says a heart attack.
And so begins an inquiry that takes over a year and leads to my crewmate that night sobbing before a disciplinary hearing and she and I being found guilty of gross misconduct and receiving a one-year final written warning, threatened with dismissal from a job we love. We should have done a more in-depth ECG, should have discussed things with the clinical desk at HQ, should have driven faster to the job (though it’s difficult to know what difference that would have made).
The bottom line is, somehow, we should have known she was going to die and got her to hospital, where they might have saved her. But we didn’t, and so she died.
Sometimes the job is hard.
We didn’t think she needed to go to hospital, didn’t think anything was wrong with her at all, and I can remember signing on at the start of the shift and hearing over the radio that the hospital was rammed and we should try ‘alternative pathways’ for our patients, if at all possible. I don’t think death counts as an ‘alternative pathway’. I went and saw her daughter afterwards and said sorry to her face, trying to explain what we’d done and why we’d done it. She was very nice about it and gave us tea and biscuits and said she understood.
But her mum’s still dead.
Even after years in the job – and plenty of people have done twice what I have – you learn that you can only do your best, follow the protocols and give some people the best chance you can. Some things just aren’t meant to be.
16
Heroes
Sometimes it goes right. Even when it goes wrong. Just like on the telly.
Jed
We are called to a male, late teens, breathing difficulties.
The trouble with the service’s system of call-taking is that almost anybody can have breathing difficulties. They can have them because they’re too busy throwing up after fifteen pints. They can have them because they’re sobbing their heart out now their girlfriend’s left them.
Anyway, luckily we’re just around the corner, and when we get to the job, nobody at the house seems that worried.
—He’s upstairs, Dad says. He just came in from the garden and said his asthma’s playing up. Dad looks more mystified than anything else.
Upstairs in the bedroom the patient is a boy of about seventeen, lying on the floor unconscious and already very nearly dead. He is still trying to breathe, so every second or so his torso spasms with the unconscious effort, but absolutely nothing is going into his lungs. They are locked shut. He’s blue and his oxygen saturation level is 62 per cent. It should be 100 per cent. He’s going to die in the next few minutes.
We immediately put an oxygen mask on him – not that that will do much good – and I run for the drugs bag. He needs a shot of adrenalin to keep his heart going and gas to open his lungs, and he needs it now. I give him the injection and we bundle him onto a chair and carry him downstairs and out to the truck.
And of course the fucking tail-lift on the ambulance decides that on this one fucking job it is going to pack up. Nothing. It’s jammed and won’t go up or down.
Fucking whoops.
We don’t even have time to call up another truck – they’d never get here in time. So we carry him around to the side door and lift him through, which is almost impossible up steep steps with a totally inert body. I’m sweating buckets by now, as is Val. We get him on the bed and I set up a piece of equipment that allows me to force gas into his lungs which may free them up and get them working again. We do this for perhaps a minute and his oxygen levels come up into the low 90s but he’s still unconscious. We don’t even have time to deal with the family, who’ve watched what’s happening dumbstruck.
—It’s a life-threatening asthma attack, is all I tell them. See you at the hospital.
Then we go screaming off.
On the way in his oxygen levels are staying in the 90s with us breathing for him, but he’s still unconscious, and once at the hospital they have further drugs and steroids that will also get his lungs working again. We hand him over and they get busy.
Then we can breathe again ourselves. We go out to clean up the truck and do the paperwork and make a cup of tea, and about twenty minutes later I go back into the resuscitation bay to see how things are going. He’s sitting up in bed, bright as a button, surrounded by his family. Clearly has no idea what’s happened to him. The family’s looking quite relieved, but I’m not sure they quite know either.
Anyway, we just saved his life, and it doesn’t happen all that often.
We say goodbye, wish them all well, and tell them we never want to see him again.
Outside, Val looks at me.
—Now that was a good job.
Back at the station, a bit pumped up, we tell Len.
—We saved his life, even with the ambulance trying to kill him!
(You learn in the ambulance
service there’s no such thing as an inanimate object.)
He nods at us, frowns, and walks off.
—Make sure you get that tail-lift fixed.
17
Timing
Mankind cannot bear very much reality, as the poet said.
Because of this, and because paperwork is taking over, the medical profession is chock-full of acronyms. It saves time. CCP for central chest pain, SOB for shortness of breath, C?C for collapse query cause. You get the picture – there are loads.
But there are more exotic ones.
One morning we’re called to David, a forty-year-old student asked to get off the bus on the not unreasonable grounds he has no ticket. The bus inspectors turn up to order him off. David collapses with agonising back and leg pain and breathing difficulties, so they call 999. The medical acronym for this is LOB, or Load of Bollocks. Others include TUBE, for Totally Unnecessary Breast Examination (apparently) and NIN for Normal in Norwich (if you’re in Norwich, I suppose). One of my favourites is DFKDFC – Don’t Fucking Know, Don’t Fucking Care.
(Obviously we would never dream of using any of these.)
And then there’s TF BUNDY. You don’t want to see that written on your medical notes – not on your nelly. TF BUNDY – Totally Fucked But Unfortunately Not Dead Yet.
My father had a massive stroke in 1995 which destroyed his brain and turned him into a vegetable. I’d only really made a relationship with him in the last ten years as I’d grown up myself. He was a famously witty and talented man, a great talker and drinker, despite the ‘complications’ mentioned, and then within seconds he was reduced to lying in bed, staring straight ahead, feeling and saying nothing. He was fed by a tube going into his stomach. He went on like this for eighteen months. We ended up having conversations with his doctor and nurses about whether treatment or even food should be withdrawn and he should be allowed to die. It was an emotional minefield and caused terrible suffering. Eventually a chest infection killed him.
He already had two families that we knew of. But he’d also worked out in West Africa for a time. At the funeral we were wondering if a third one might turn up?
He’d collapsed at Swindon station after a lively lunch and was taken by ambulance to the nearest A&E and then on to the John Radcliffe, where they operated on him to keep him alive.
I’m not a brain surgeon and I don’t know the ins and outs of it, but I can’t help wondering why. When you have a stroke they scan your brain to see where the stroke is and what damage has been done, and it must have been obvious the damage was massive – my father wasn’t going to recover. Would it have been better to let him go? It made me think about the doctors and surgeons, or perhaps to be fair the legal framework in which they now operate. I’m sure they thought they were doing the right thing, but I wonder.
Still. What do I know?
Dawn
Most doctors are wonderful, with a warm and comforting bedside manner that does wonders for their patient’s peace of mind, at a time when they’re frightened, ill and vulnerable.
Others – just a few – can be abysmal.
Early morning.
One of the most common calls we get – to an 85-year-old female with chest pains.
At the house the patient’s doctor is already there with her, which is unusual, and has called us. She is lovely, with a warm bedside manner that is massively comforting for the patient. She knows the patient well, has been out to her many times, and even came out this morning. Most doctors, hearing the words ‘chest pains’, order you to put the phone down and redial 999 immediately, thereby washing their hands of the whole affair. With perfect justification, of course.
But not this one. She gives us a brief handover.
The patient is an anxious and frail old lady, who nevertheless lives independently on her own, looking after herself. She was recently widowed. Her symptoms are classic for a heart attack – chest pain radiating into the left arm and jaw, dizziness and nausea, the works. When we wire her up to the ECG machine there is little room for doubt – it’s a myocardial infarction. A stonking great heart attack.
Now comes the tricky bit. We have to get her out into the ambulance and down to the hospital as fast as possible, while at the same time being as reassuring and gentle as possible and looking like we’re not rushing at all and don’t have a care in the world, so that her heart isn’t put under any more strain. It’s a fine line.
At the hospital we take her into the resuscitation room, which if you’re not used to it is probably terrifying – starkly lit, lots of busy nurses and doctors flying around, strange machines and equipment. And if you’re unlucky, someone moaning or screaming in the bed next to you with only a curtain between.
This is when you have to be even more gentle and reassuring to the patient, and we try to be, as our lady is obviously terrified. The nurses strip her to the waist to do another ECG. Three A&E doctors come in to discuss her ECG and treatment. The bald facts of the matter are they must decide what sort of treatment to give her and whether it’s worth giving it to her. They don’t want to put her through needless suffering, or waste treatment on someone who has little quality of life or is going to die anyway. The doctors stand at the bottom of the bed, staring at her, firing questions. They haven’t introduced themselves. She sits there, naked from the waist up, covered in wires, terrified.
—Do you own your own home?
—Do you get out much?
—Do you see much of your friends?
—Do you do your own shopping?
Our lady is now confused and baffled as well. No one makes any attempt to cover her up, so I go back to the bed with a blanket to keep her warm and try and reassure her. Then I answer some of the doctors’ questions for her, making sure I give the right answers, since she – thank God – doesn’t realise these shouted questions might decide her fate.
After a while the doctors make a decision and thankfully bugger off, leaving the patient to be cared for by the nurses. Once I have handed her over we say goodbye and leave, furious.
Barry and Meg
There’s no question you get immunised to suffering in this job, you see so much of it. But some jobs are just sad.
Called to a male, suicide attempt. The location is a comfortable house in a middle-class town. When we get there a woman’s waiting calmly for us outside the house.
—He’s in there, she says, pointing inside. She looks lost.
When we go in we find at the back of the house a kitchen, and in the centre of it a man – her husband. On the table in front of him is a letter.
The man is dead – has been for some time. He’s grey, has no pulse, and his body temperature has already dropped a couple of degrees. When we wire him up there’s nothing – he’s gone.
The woman’s by now in the room with us, so we say how sorry we are – there’s nothing we can do.
—That’s all right, she says. I knew he was dead. I waited half an hour before I even called you. I just wanted to say goodbye.
It turns out her husband suffered from an incurable and terminal disease. He’s wanted to take his own life for years. This is something like his third serious attempt, and he’s succeeded. He’s taken a hefty overdose. Wife had only gone out to do the shopping, then come back to find him gone.
The letter is just too sad to read.
He’s in a better place now. Hopefully.
There’s little we can do. Because it’s an unexpected death the police will attend as a matter of routine, and luckily there’s a family friend who comes round to sit with the bereaved. A long and painful road has come to an end.
After a little while we leave and, apart from how sad it is, think little more about the job.
Only later do we find out there’s a postscript.
The inquest decides – I won’t go into the details – he couldn’t have done it on his own. The wife is charged with helping him. Only six months or a year later is she (and perhaps he) allowed to rest. We hear from
the newspaper she pleads guilty. She’s given the minimum sentence the judge can legally give.
Hopefully both of them are at peace now.
Callum
Summer’s afternoon.
It’s been a quiet shift knocking about leafy suburbia, then we get called to a male, twenties, cardiac and respiratory arrest.
—Twenties? says Val, Jesus Christ.
Unfortunately, he’s probably not going to help.
Male patient with terminal illness, young kids and a wife. The couple used to live abroad but came back to England when the husband got sick. Parents also present. A real family party.
The reason they’re all there is the doctor’s been out and told the patient this is it. It’s Saturday afternoon and he’s unlikely to see the weekend out – the illness is too far gone. The nurses have been helping out – they’re at the house too. And the doctor’s proved right. The patient’s gone and died.
The problem is they’ve called an ambulance. We’re forced by our own protocols to try to reverse the cardiac arrest, no matter how hopeless, if we’ve got there within a certain time. Otherwise we’d be breaking the law. Only if there’s a specific, signed, doctor’s order can we do nothing, and there isn’t one here.
About as rubbish a situation as you can walk into.
The house is a nice pleasant one – most are around here – and the patient’s in the first-floor bedroom. We rush up the stairs with our equipment. The parents are downstairs sobbing. The kids – thank Christ – are nowhere to be seen, and the wife and nurses are upstairs with the patient. He’s lying on the bed, with red hair and big eyes, but the illness has wasted him.
The nurses look up at us like we’re about to attack him.
—Please don’t do anything! Please don’t do anything!
—What do you mean?
I can see he’s not breathing and there’s no pulse. By now we should be dragging him off the bed on to the floor to begin resuscitation. You can’t do it properly on a bed.