But of all the things I’ve seen in my time in the ambulance service, hospices are the most heart-wrenching. Not just because they’re full of dying people, but also because of the quite wonderful staff who care for them. Hospices care for 200,000 people a year but are charities, so rely on tens of thousands of volunteers and fundraisers to survive. On average, adult hospices receive a third of their funding from the state, children’s hospices only about 15 per cent. But if it weren’t for hospices, what would happen to the people who rely on their care? Would they be in A&E instead? That doesn’t even bear thinking about.
Staff in any hospice, all of them criminally underpaid and many of them paid nothing, must be incredibly resilient. Staff in children’s hospices must be some of the most resilient people on the planet. It must be an incredibly tough job, but very rewarding at the same time. It’s a huge responsibility, but there can’t be many jobs more worthy than making someone’s last moments on earth as comfortable as possible and providing them with a dignified death, while also ensuring that the situation is as palatable as possible for their family.
9
MOMENTS OF MADNESS
Usually when we turn up to a job, the patient and their loved ones are very relieved to see me, as you might expect. A patient might have had a heart attack and their wife or husband won’t have a clue what’s going on and what to do about it. We can provide them with answers and hopefully solve their problem, or at least deliver them to people who can. As such, people are normally quite respectful. When people aren’t respectful, there are two common denominators: drugs and alcohol. Though, in a weird way, it’s comforting that it might have taken twelve pints of Stella and five shots of sambuca to convince someone that I’m not their guardian angel, but a colossal idiot who deserves to be abused or attacked.
It’s a sunny summer afternoon, and we’re called to a man intoxicated and collapsed on the street. He’s part of a stag party which has been travelling on a coach for three or four hours, getting bang on the booze. When the coach parks up, this bloke steps off, gets a blast of fresh air, topples straight over and smashes his head on the pavement. One of his mates phones 999 and we get the shout.
My partner is wheeling (driving the ambulance), so it’s my turn for healing (attending the patient). I crouch over this bloke and say, ‘Hiya, mate, it’s the ambulance. Can you hear me?’ And this bloke responds with an uppercut to my chin, delivered from a prone position. It only grazes me, so it doesn’t particularly hurt. And maybe he’s suddenly come round, felt someone prodding him in the chest, got spooked and lashed out. But still.
We have control of the situation, but this bloke’s mates start getting a bit gobby. There are about twenty of them stood around us, all offering advice on what we should and shouldn’t be doing, while arguing with each other. And when you’ve just been punched and people are getting a bit gobby, it’s time to press the emergency button on our radio – or, as we call it, the ‘tits-up button’. Luckily, it’s match day, so having pressed the tits-up button, four riot vans come screaming from every direction, their appearance bringing the gobbiness to an instant halt. Had it not been match day, we might have been in trouble. As it is, my assailant is dragged to his feet, arrested, chucked in the back of a van and whisked off to the police station. He’s been in town for about twenty minutes, fallen over drunk, whacked an ambulanceman, been nicked and locked in a cell. It’s like a rubbish version of The Hangover. The following morning, he appears in court and is fined 25 quid. That’ll learn him.
Sometimes people will blame their unruly and embarrassing behaviour on their drink being spiked. We’ll turn up to a patient paralytic on the pavement and their mates will say, ‘I don’t know what’s happened. This isn’t like Jane, she can normally drink a lot more than this.’ What they won’t mention is that Jane has necked five shots on top of a bottle of Prosecco, hasn’t eaten since breakfast and only had three hours’ sleep the previous night. There is a genuine problem of women having their drinks spiked with Rohypnol in bars and clubs (although that’s not something I’ve ever had to deal with), but that’s not usually what’s happened. And drug dealers aren’t noted for their generosity, so it’s highly unlikely they’re dropping their produce into random people’s drinks. That doesn’t make much business sense.
When you see someone crashing around on the street, you probably assume they’re drunk or on drugs. But that’s not necessarily the case. One day, a job came on the screen: MALE FITTING. That’s not uncommon and there are a few possible reasons, including epilepsy or withdrawal from alcohol.
When me and Paul arrived on the scene, which was on a busy street, the guy had stopped fitting but was still flat on his back and out of it. We gave him a shot of oxygen, I grabbed the stretcher and just as we were about to lift him on it, he suddenly woke up and sprung to his feet. He tried to punch us, then tried to start a fight with a young couple walking past with their kids. And, had we not pulled him out of the road, he might have been mown down by a double-decker bus. We quickly concluded that he was having a postictal episode, which is when confusion kicks in after you wake up from a fit and you slip into fight or flight mode.
We requested the police attend, but they don’t just appear out of thin air. And while the police were en route, we were the only people on the scene wearing uniforms, having arrived in a vehicle with sirens blaring and flashing blue lights. As such, people expected us to do something. This was a no-win situation. Our rules probably say we should have legged it, but we couldn’t just stand by and let this bloke run amok. And forget the fact that we were ambulance people, we had a responsibility as citizens to stop this bloke hurting himself or anyone else.
He swung at us again, me and Paul both grabbed him and we all ended up in a big heap on the floor. Now we were in a particularly sticky spot. Some people told us to leave him alone and stop pinning him down. Other people were shouting, ‘You’re supposed to be ambulancemen, not the police.’ We weren’t really in a position to explain that he was in a postictal state and that what tends to occur with these types of episodes are auditory and visual hallucinations, delusions, paranoia and aggression. We just about had enough breath to explain that we were actually trying to help him. The icing on the cake would have been if someone had pulled out their phone and started filming us. That wouldn’t have looked good on social media, because people tend to put two and two together and get five. If people had seen two ambulancemen lying on top of a patient in the street, they would have put two and two together and got five. The public aren’t interested in finding out the details, they see a snapshot of a situation and jump to conclusions.
Just as the police arrived, the guy suddenly came to, as if a switch had been flicked in his brain. And now he was back in the room, he was absolutely mortified. He had nothing to apologise for, because he didn’t know what he was doing. Meanwhile, Paul announced that he had injured his knee. He could barely walk to the ambulance and ended up off work for six months with a torn meniscus. It could have been worse. If it had been the patient who busted his knee instead of Paul, we could have been in serious trouble. As it was, our bosses were not impressed: ‘You’ve hurt your knee restraining someone? What were you bloody thinking? You’re not supposed to be restraining anyone!’
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My home patch on a Friday and Saturday night is often described by the media as ‘a warzone’. But that’s what they want it to be, because it’s a story that sells. When they filmed 999: What’s Your Emergency?, they hardly showed any of the routine stuff, like attending an elderly man who had died in his sleep or a toddler with a fever. Mostly, they showed aggressive lads covered in blood and paralytic girls in very short skirts falling over and passing out. It was a bit soul-destroying, not only because it didn’t show us doing our jobs to the best of our abilities, but also because it conveyed the town in such a bad light. The town and its people didn’t deserve that, so we felt a bit stitched-up.
Generally speaking, the town is a
lovely place for families to visit. Yes, it caters for stag and hen dos, which means we have a lot of people out at weekends drinking more than they would normally. But most people, even with a few drinks inside them, just want to have a good time, some fun and frolics. They’re friendly and have a bit of a laugh with us when we arrive on scene. Sometimes girls will lift their tops and flash us their breasts. Or, on a bad night, they’ll just give us a wave.
Truthfully, mostly on a weekend it’s more mundane stuff we deal with: people walking in front of cars, getting lost on the way home and freezing on a bench, attempting a caterpillar on the dancefloor and landing on their face. So to say it’s a warzone out there, or ‘carnage’, is an exaggeration. It’s not like we’re being pelted with bottles and having drinks poured over our heads.
Fun and frolics will occasionally give way to something more sinister, like people screaming at each other in the street or scrapping on the pavement, and occasionally someone ends up injured. Nine times out of ten, the injury will be a fractured cheekbone or a broken eye socket and we’ll need to take them to hospital for an x-ray. But sometimes it’s worse.
One balmy summer’s evening – the sort of evening that makes me glad to be doing the job – we are called to an altercation between a couple of punters in a pub. One bloke mistakenly thought this other bloke had been mithering his sister and whacked him on their way out. Whether it was the punch or his head bouncing off the pavement that did the damage is arguable, but the victim of the assault is bleeding heavily and critically ill when we get there. We do what we can, but he passes away a couple of days later. One man dead and another man behind bars, all because of a moment of madness.
Someone who’s not in the ambulance service might go years without seeing a fight in a pub, but I might attend the aftermath of five pub brawls in a week. So doing my job has made me hyper-sensitive. When I’m out socially, I find myself profiling people: judging how drunk they are, whether they’re on drugs, what kind of mood they’re in, whether they’re happy or angry, whether they’re about to flip. If I see people having a disagreement in a pub, I’m on edge, weighing up possible outcomes. I’ve been to so many fights where an innocent bystander has been caught in the middle, and I don’t want that to happen to a friend or family member. I’m also thinking, Lads, just calm down a bit, or you might do something stupid that will destroy both your lives.
It isn’t just drunks and grown men fighting over a game of football that eat into an ambulance person’s time that would be better spent treating someone’s poor gran who has fallen down the stairs. Drugs are also a major problem. It’s very rare for us to treat someone with a complication from taking ‘recreational’ drugs, such as marijuana, cocaine or ecstasy – although that’s not the same as saying they’re safe. We do, however, see more heroin overdoses.
The youngest victim of a heroin overdose I treated was seventeen. He was bleeding out of every orifice, so that the back of the ambulance looked like an abattoir. We do carry a drug, naloxone, that can reverse the effects. In America, they administer it as a nasal spray; we inject it (although it’s not like that scene in Pulp Fiction where John Travolta smashes a needle into Uma Thurman’s chest, it’s just a little injection in the patient’s arm). Usually when we administer it, the patient springs back to life. You’d think they’d be thankful, but they’re normally angry that you’ve ruined their fix. And most of the time they’ll refuse to go with you to the hospital. I’ll feel like saying to them, ‘Come on mate, you weren’t breathing a few seconds ago.’ But naloxone didn’t work for this kid – we thought because the heroin he’d taken was laced with rat poison, which thins the blood. Whatever the reason, try as we might, we couldn’t get him breathing again and he was pronounced dead shortly after arriving at hospital.
People will do anything to block out the horrible realities of their existence. But while I understand why people become dependent on drugs, I do find myself wondering what the authorities are doing to try to stop it happening. I see charities trying to help these people, but we shouldn’t really need charities to take up the slack. You can debate whose responsibility it is all you like, but when you’re dealing with a dead person who spent his final hours in a public toilet, you realise something desperately needs to be done. Sometimes I feel more like a dustman than an ambulanceman: people are tossed on the street, I sweep them up and everything goes on as before.
You wouldn’t believe how some of your fellow humans meet their end. A very senior colleague was called to a heroin overdose: two guys had taken a hit, gone to wherever they go to, and when one of them came to, he found his mate had gone blue. As they say in the drug world, he had ‘gone over’. That’s not uncommon, because heroin is a respiratory suppressant, which is a fancy way of saying it stops you breathing. And if you stop breathing for too long, you’ll go into a cardiac arrest and die.
This bloke was scared to phone an ambulance, because he thought the crew would see the drugs and call the police. It doesn’t actually work like that, mainly because of patient confidentiality, but also because we don’t want to deter people from calling in that situation. The exception is when someone dies. Anyway, this bloke panicked and decided to take things into his own hands. He’d obviously seen a few episodes of Casualty and someone using a defibrillator, and thought, That looks easy enough. So he’d dismantled a lamp and attempted to resuscitate his mate with two bare wires. It did not have the desired effect and electrocuted his mate instead. So listen up you crazy kids: if one of your mates has a heroin overdose, phone the professionals.
Another drug that seems to be all the rage at the minute is spice, which is a plant-based mix of herbs laced with synthetic chemicals and often far stronger than cannabis. It’s particularly popular among homeless people because it’s so cheap. And you’ll know if a homeless person has smoked too much of it, because they’ll be standing there like a statue, often bent double. You can take a trip into oblivion for less than a fiver’s worth of spice, which is exactly why they take it. But when you could still buy spice over the counter (it was made illegal in 2016), we were dealing with people with families and jobs, who took it thinking it was harmless fun.
One guy was on holiday with his family. He was a weed smoker, but because he didn’t know any dealers in the area, he bought some spice from a shop. A few hours after smoking it, he tried to eat his wife and kids. You read that correctly. He was chasing them around the hotel room, trying to take chunks out of them. It took eight policemen to hold him down. He wasn’t a big guy, but he was like Popeye just after he’d had his spinach.
Another victim of spice I encountered was a young woman who was persuaded by a friend to try it on a night out. When she crossed my path, she was being transferred from A&E to psychiatric care. It had caused a chemical imbalance in her brain, so that she didn’t know who she was, where she was or what she was seeing. A nurse told me that it could take weeks, months or years for her to return to normal. Or maybe she never would. She was a good-looking, otherwise sensible girl with a good job working for the council, but a bit of spice on a Saturday night out had sent her life into a sudden tailspin.
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I’ve never attended anyone who’s been shot and stabbings are very rare, even though they seem to be all the rage in other parts of the country. Most stabbings on my patch are domestic – someone grabbing a knife from the kitchen, as happened to me. Although, don’t get me wrong, stabbings, whatever the circumstance, are not nice to deal with, especially if we arrive before the police. Not only is it messy and pressurised work, there will often be at least one other very upset person on the scene. So while we’re administering complicated treatment to the patient, we’re also trying to keep that other person calm. In addition, we’re thinking, I wonder where the attacker has gone. We just have to hope they made their escape long before we got there. But you never know. People often stab to kill, and if someone ever decided to come back and finish the job, we’d only have our fists to defend ourselve
s with.
I went to a chap once who had fallen off his push-bike and was laid out on the pavement. Despite being unconscious, his feet were still pedalling, which was undeniably spooky. We didn’t know what was wrong with him, because he didn’t have any obvious injuries. But when we lifted his jumper up to get to his chest, we found a set of bolt cutters and a big knife in his pocket. But even though this kid had obviously been up to no good, we still did our very best to help him, as did the nurses, doctors and specialists at the hospital. In the case of this chap, it wasn’t enough, because he died of a bleed to the brain.
For all the overdose victims I’ve treated in drug dens and toilets, I’ve also treated middle-class people who had taken overdoses in comfortable homes. I’ve also been out to an end-stage alcoholic who happened to be a GP. Nobody is immune. One of the things I love about the NHS is that whoever you are and wherever you’re from, you have a right to the very best treatment the NHS can offer. Whether a patient lives in a house whose floors stick to my feet or whose carpet is 6 inches deep, they deserve the same care and they get the same care. Accidents and illness don’t discriminate, so neither do we.
10
FIND A BLOODY DOCK LEAF
People always ask me about the weirdest injuries I’ve seen. Seconds later they’ll be asking about bizarre sex injuries. That’s normally the way it pans out. Well, I once went out to a man who claimed he was making love to his missus and, to use his exact words, had ‘snapped his knob’. We turned up, knocked on his door, asked very few questions and whisked him off to hospital. If a man says he’s snapped his knob, I’m taking his word for it: ‘Broke your knob? On you get.’ Unless he was bleeding to death, I wasn’t going to start inspecting it. Snapped knobs are not my area of expertise. What do you do with a snapped knob? Stick a plaster cast on it?
999--My Life on the Frontline of the Ambulance Service Page 8