My first time…

So I’ve graduated, I have a job, been through my mentoring process and I’m out on the road.

Baptism by fire doesn’t really explain it.

Unfortunatly I have to blog already which means one of those jobs has affected me.

It was a normal start to the day… got to the station, didn’t know the codes so there is me knocking at the window like a lost kitten. I meet my crewmate and we find out he has done less time on the road than me. Great, was already shitting myself, but this just made the horrendous knot in my stomach even worse.

The day was going fine and my crewmate and I were getting on fine, the knot in my stomach was disappearing and it was getting to that time of the shift where I’m starting to think about dinner and my evening plans.

Just started indoor climbing recently and this was on the agenda, I remember myself even warming up for it. However when this call came in all that went out the window and was replaced with sheer terror.

68 year old female, cardiac arrest, CPR in progress

Fuck…

A thousand thoughts a minute went through my head…

It’s my third shift went through my head…

I’m going to have to lead this case with a member of staff with less experience than me…

I’m nowhere near ready for this…

We are going to first on scene…

Please tell me backup is not far behind…

Is my paramedic bag filled…

I took several deep breaths and began to refocus. Remembering my training. I began to remove my emotions from the situation and focus at the task at hand.

My crewmate was doing a fantastic job of getting us to the scene very quickly through the tough traffic.

We arrive on scene and the daughters of our patient come running out screaming at me and my crewmate to hurry inside in the background i can see the son performing CPR on the patient and screaming for us to “Fucking get in here quickly”. My mind is going round and round in cirlces, and because of this I have forgotten some of my advanced kit in my ambulance.

We are hurried into the room and the son looks at me and says (and i will never forget this) “Fucking save her…” and points to his mum.

Never have I ever had this screamed at me.

My heart falls into my stomach but it was a sink or swim situation and I swam…

Get my funky new scissors out of the holster on my belt and cut the ladies clothes off. I tell my crewmate to start performing CPR… while i start to work on the airway. Constantly i have the son screaming at me “Fucking save her”.

My heart is beating a million times a second, every bit of adrenaline is racing around my body… I’m so wanting to get this patient to survive, my first cardiac arrest patient to survive.

The longest 10 mins of my life passes, I have an airway on my patient and then the best noise i could hear “You alright mate, what can we do?” I turn round and two more ambulance staff are at the door… I say “YES, I HAVE LEFT LIKE EVERYTHING IN THE AMBULANCE PLEASE CAN YOU GO AND GET…” and i list off the countless things i had forgetten in the rush to get inside.

The rest of the resuscitation attempt went “fine” unfortunalty however as with many of these cases the patient died…

Here is the kicker though, the family had gone out that day to go and arrange the funeral for the father who had died two days earlier. They had come home to find the mother unresposive on the couch

HOW SHIT IS LIFE….

After the job, we went back to station to restock, change and to have a well deserved cup of tea… I congratulated my crew mate as this was his first cardiac arrest and he congratulated me on leading it so well.

As I was driving home however it hit me… we had only seen a snipit of the aftermath of the event. What that family now had to go through I could never comprehend. Once again however it revitialised my opinion on how short life is and we need to live life to the full… as in the space of 2 days you could lose everything…

It didn’t really affect me, the nature of the job doesn’t allow you have time to let it affect you. However 4 shifts later, I was tired, pissed off and hungry. People who know me well know that this is not a good combo for me.

I got angry, why couldn’t I save the patient…

Did I do everything I could for her…

Wonder how the family were doing now…

And stiill going round and round in my head… is the image of that son screaming “Fucking save her”

And we couldn’t and thats what hurt…

 

Mental Health

Ah mental health, those two words that make health professionals cringe. Although, I really enjoy the effect you can have on people during these types of calls. Throughout my placements my interest in mental health has become greater and greater. I kinda enjoy the challenge. There isn’t just one answer to mental health and you have to use your brain. Mental Health services unfortunately in the area i work (and from what i hear across the country) during out of hours (when the majority of calls occur) is practically inexistent. This makes the situation somewhat frustrating as our only choice is to take the patient to hospital.

With my interest in mental health growing, i decided to write one of university essays on the subject. What i found was shocking, and led me to want to keep as many mental health patients away from Accident and Emergency rather keep them at home with the correct pathways and support in their own environment.

On placement recently, in the early hours of Saturday night I attended a young lady who was feeling suicidal. I was “excited” to treat this patient as the previous day we were informed of some new pathways for mental health patients, and i wanted to try them out.

I spent about 2 hours on scene with this patient, asking her all the relevant questions so i could assess her suicide risk and gain a comprehensive history. The patient scored a relatively low risk on the scale, meaning with the correct pathways, we could have left this patient. Fantastic i thought, perfect opportunity to try out these new services. I get out the list. Based on the time and day we had very limited choice. I telephoned the one which was meant to running that evening.

Engaged.
Tried again.
Engaged.
Tried Again
Engaged.

15 attempts later, i gave up.

This frustrated me to no end. Yes they are probably very busy, but they weren’t there when i needed them. So unfortunately I had to take this patient into hospital. On the way to hospital, we chatted about films, music. She was my age, and we had a lot in common which actually made it more difficult to comprehend.

Now you may be thinking this is fine, she will be treated there. However, as the patient is not sectioned, she would be able to leave at any point, with a standardly long wait at hospital there was the potential for her to leave.

I felt I had failed this patient. I felt the system failed her, I felt helpless as i wheeled her into the waiting room and left her there. Now of course I did the best for her, i tried everything that i could. But this didn’t change my impression of what i had done.

Getting home was not easy, I was tired, hungry, and pissed off. This led to some admittedly self-destructive thoughts to creep into my head

1. “She is going to leave and jump off a cliff”
2. “All mental health leads to this and people who I love are going to end up doing that”
3. “I have failed in my duty of care”

I had to tackle each individual one in my own mind before i was going to get to sleep that night.

1. I told myself that this wasn’t going to happen. Why would she, I reached out to her. When i left her she was happier and she would get seen and all would be fine.
2. This one struck a cord. Some of the people i truly love had/are suffering with mental health problems, and this led me to imagine their faces on hers. Will all those people end up like that went through my head.
3. This is an interesting one, and is in my view completely subjective. Legally, no. I had done everything in my scope of practice to assist this patient and had left them in a place of relative safety (a whole other debate). But in my eyes, I had. What more could i have done though, it annoyed me more that i didn’t have an answer to that question. Why wasn’t there more that i could have done for that patient.

Eventually I got to sleep realising that it was late and actually I couldn’t deal with the situation at the time and now all i needed to do was sleep. In the morning I rang, texted everyone who i knew would be able to help me. Essentially convincing myself that she and me would be fine.

And I truly hope she will be…

Making “that” decision

Yesterday, I “ran” my first resuscitation as a student paramedic. A relatively normal situation for a paramedic to be in, a daily occurrence if you like. It was however my first time. I had a patient awake and responding to me, before then going into cardiac arrest. “Good afternoon, I said to the patient, how you feeling” the normal pleasantries were exchanged and within a minute of meeting this gentleman, I was jumping up and down on his chest and began the administering the life saving protocol i had drilled into me since day 1. 57 mins later, this gentleman was intubated, cannulated, had 9 rounds of adrenaline, and had certainly had his ribs broken in the process of CPR.

I was running the show though, it felt good to know that after three years i was getting somewhere, somewhere with my confidence levels, my ability to delegate and my ability stay calm. However, as i gave the order to switch the person performing CPR and to give the ninth dose of adrenaline. It struck a cord with me. 57 mins of jumping up and down on this patients chest, for what reason anymore. There had been no output throughout, no ounce of response from this patient. For the first time since beginning my training i began the process of “stopping CPR”. For me this didn’t sit comfortably during the process of resuscitation you just sort of run on auto pilot. But having time to reflect you realise the enormity of the decision you are making. I’m 22 and I am about to make the decision that this patient is no longer going to receive the resuscitation treatment that is keeping him alive. A patient that i had a connection to, a person that an hour a go was alive and talking to me. I felt myself becoming angry that he wasn’t going to survive.

On paper, he had such a good chance of survival, good chest compressions the moment he went down, intubated (tube down his throat to assist with his breathing) and cannulated (needle in his hand to administer drugs) within mins of this, but patients aren’t like textbooks, and now i had to make the decision to stop. I called for a review of what we had been doing. Going head to toe on the patient, in a way convincing myself that this was the right thing to do. I gave the order to stop CPR and have a final pulse and rhythm check, of which still nothing.

That was it…

The patient was life extinct, we all agreed to stop resuscitating the patient. I began performing my own little post-life routine, that i have created. Trying to make the patient look “presentable” for the family, however also to take my mind off what has just happened. Keeping myself busy. It wasn’t until after, while filling out the paperwork, that it suddenly hit me, what had happened, I had just made the decision to stop resuscitation, to stop attempting to save this man’s life. It was something that i have been contemplating since it happened, something that i am assured will become easier with experience. But now it reminds me how short life is, and how we have to live every day to the fullest, and treat everyone you meet as if you won’t meet them again. After I completed the paperwork, everyone congratulated me on how well i and performed.

But this did not have the same effect it usually does on me. I felt i had failed, failed this patient and his family, it didn’t quite hit me until i arrived back home that evening, where the anger set in. Why didn’t he survive i asked myself, self-destructive thoughts of could i have done anything better. Did i make the right decision to halt CPR. Of course the answer was that I did everything i could, he died because he died, nothing to do with my actions. But it took a long time to discover this. My mentor always used to say take home something from every patient, initially for me this was a sense of anger and dread towards my actions and the outcome, however this turned to a lease of life, wanting to live my life to the fullest, and to treat everyone I meet as if its the last time.

Life’s too short…

It’s interesting, I never really thought about writing a blog before. Never really felt the need. I’m not someone who before now needed to write my emotions down. But this has one has stayed with me…. A little about me first. I’m a second year student paramedic working for a UK ambulance service. I’m still naive about life and getting to grips with growing up and seeing what the world is all about. Things still get to me out on the road. Yes i chat it out to my awesome family, and my wonderful friends. But this one won’t go away and that’s the inspiration I have for writing this blog. The day began as any other would do, packing the ambulance, first cup of tea and setting off to our first job. Our radio gave us both a shock informing us of a cardiac arrest nearby. We informed control that we were available and close by. The job pinged through to our inboard computer and off we go. The job came through as a 40ish year old man confirmed cardiac arrest. Now I’ve been to cardiac arrests before, but I still get that knot in my stomach. So much to do, so much to think about. Not just the clinical side but also dealing with the relatives, the scene, the aftermath as well.

We arrive on scene which is a carpet shop and are hurried upstairs by the workers of the shop. Upstairs was not a pleasant scene and will never leave my head. Another paramedic crew were already on scene beginning resuscitation. They gave us a handover of what had happened. Essentially, our patient had arrived at work as normal to open up the shop and went upstairs to use the bathroom. 40/50 mins later his coworkers arrived and noticed he was no where to be seen. They went upstairs to the bathroom, shouted from him but heard no response. Eventually they had to break the door down to get to him. The area he was in was tiny. The crew had already pulled him out as far as they could. But the room to work around him was very limited.

He also had vomited, which gave the room a smell that was almost unbearable. I get down into the tiniest space (was impressed I could fit) and started pressing hard and fast on his chest. With CPR you need to block out the situation around you and concentrate on keeping the rhythm, however as you can appreciate this is not always an easy task. Constantly my mentor was having to correct my pace, “Staying Alive, ah, ah, ah, ah” she said to me.

Ribs breaking is a very common and understood side effect of CPR, so as i’m performing this “life saving” procedure, my patients ribs break under the pressure, giving me that familiar spine tingling feeling. I’m having to constantly adjust myself because of the awkward position i’m in, things are flying all of the place as I do this cups behind me are breaking, but i’m fully concentrating on my task in front me. Immersing myself in the task to prevent my head wondering to think about what was actually happening around me. All I was thinking about was “Up and Down, Ah, Ah, Ah, Staying alive” The other paramedics are trying to get an airway secured and get some fluids into the patient but…

Long and short of it. The patient was dead.

45 mins after my arrival we stopped our interventions. We ‘tidied’ up the patient and got the police to attend (standard procedure as they act as the coroner). We were also told that the wife was downstairs. We went downstairs to tell the wife what had happened. She had no warning. This was all a massive shock. The man had very little past medical history that she was aware of. It was well and truly unexpected. The wife was understandably beside herself. I will never forget her sitting there with her coffee in her hand. Hearing the paramedic tell her, her husband had died. Those clichés of “we did all we could” and “he had no pain” came out. But what else do you say in this situation?

Now, again I’ve seen death in this job. It’s inevitable. My line of work I’m going to see death and destruction. I have to take as much as i can from these types of jobs and apply them to my life, and try to become better because of them. The clinical side is not the issue here. It’s how crap life can be…

This man went to work as normal, left his wife at home. Got to work everything was normal. He went to the bathroom and that was it. Collapsed and died.

Poof all over.

Normal morning – dead by 12.

As my mentor said to me after that job, “Shit really isn’t it”. It makes me realise just how short life is.

I have to get up everyday and make sure I live my life to the fullest. Get out there and make a difference. Make the people around me proud. Have fun with my family. Enjoy the time with my girlfriend. Go out with my friends. Not bother with silly fights because you never know one day it might just all end. Life can be shit. Fights with friends, disagreements with family, arguments with partner. But life is also short. Too short. What’s the point. Just be happy. Enjoy your life, enjoy the people around you. And if they aren’t making you happy then why are you still hanging around with them.

I never really been upset at the end of a shift on placement. But I got home and just cried. Not because of the job. But because I realised I wasn’t doing things because I wanted to. I promised from then on, that I would live my life to the fullest and always make sure that I’m a happy little bunny and not let things get me down. Paramedics is an interesting career. Finish your back before you retire. Miss birthdays, not see your other half or friends for days. Sometimes not see sunlight for days!! So why do I carry on with it all. I guess it’s because these patients and relatives make me look at myself and realise things that I never thought about and open my eyes to see things about the world.