In fairness to the system, there is no amount of training that will prepare you for a job on the frontline of the ambulance service. It’s sink or swim, and if you don’t learn fast, you will plummet to the bottom, maybe while clutching a P45.
While most bodies work – or don’t – in the same way, every personality is different. As such, 99 per cent of the job is talking to people in the right way, what you might call the softer skills. We’re trained to recognise heart attacks, treat strokes and dress wounds, but that person who comes off his bike and snaps his femur, or trips, falls through a window and cuts herself, needs comforting as well as patching up.
We also find ourselves dealing with deeper societal issues – relationship problems, domestic violence, drug and alcohol addictions and, on occasion, someone who has announced they’re feeling suicidal on Facebook or Twitter. As such, ambulance people have no choice but to be everything from medical professionals to social workers to vicars to crowd control.
What I’ve learned is that if you treat every patient as if they were a member of your own family, you can’t go far wrong. How many times have you heard a friend or relative say, ‘The ambulance people were just so lovely’? Hopefully, you’ve heard it a lot. If that’s one of a patient’s main takeaways from one of our visits, then we’ve done our job properly. If not, we haven’t.
Some of what we do can be quite invasive, especially as a male dealing with a female patient. In those situations, it’s about being respectful and clear, explaining exactly what we’re doing and why we’re doing it. If a patient is having a suspected heart attack, I’ll do an ECG (electrocardiogram), which involves attaching little pads around the left side of the chest. But I don’t just whip a patient’s top up and start slapping these pads on. That’s unlikely to go down too well. Instead, I’ll explain why they’ll benefit from an ECG, because it will give us an indication of what’s going on with their heart. Then I’ll tell them what an ECG involves, before employing some distraction techniques, trying to make a patient think that what I’m doing is as humdrum as buttoning up a shirt, just general chit-chat, like asking what’s cooking in the kitchen or where they bought their stereo.
Sometimes, I receive letters from mums and dads, thanking me for being so good with their children, which is gratifying. You can’t treat kids the same as you treat adults. I once saw a programme where they dressed a kid up in an astronaut suit before putting him through an MRI scanner, which they told him was a spaceship. Suddenly, a serious procedure was a bit of fun. I love stuff like that. An emergency can be terrifying for a kid. All they want is their mummy or daddy, and suddenly two strange people in uniforms walk through the door, carrying a load of weird kit. So we have to become something like entertainers (don’t worry, I never go full David Brent: ‘I’m a friend first and an ambulance person second. Probably an entertainer third . . .’). When we deal with kids, we often deal with hysterical parents, or at least parents who are struggling to hold things together. I understand that it can be traumatic seeing your child in distress. But if you keep a kid calm, usually their parents will stay calm as well.
Treating children can be very rewarding. It’s all about doing whatever you can to make it feel like a game. While I’m assessing them, I might ask who their favourite cartoon character or footballer is. I might give them an instrument to play with and have a bit of banter:
‘You need to hold this red light for me . . . actually, I’ll give it to Mum . . .’
‘No! I want it!’
‘All right. But first, I bet you can’t sit still while I put it in your ear . . .’
Sometimes, I’ll give a kid my phone to play with. It’s amazing what kids will do for a bit of YouTube. Calamity Crow is one of my favourites. It’s a cartoon about a crow. Who has calamities. It’s brilliant.
I’ll say to the kid, ‘You remind me of someone I know.’
‘Who?’
‘Calamity Crow.’
‘Who’s he?’
‘You’ve never heard of Calamity Crow? Have a look at this . . .’
And I’ll give them my phone, stick on Calamity Crow and get cracking with what we need to do. I might be dressing a wound, and the kid will be singing along with the theme tune. Tactics, that’s what it is.
It could be argued that you can’t teach anyone how to break bad news, because there are just so many different possible scenarios. If we turn up and someone is already dead, we might simply say, ‘Unfortunately, your husband has passed away.’ If we turn up, attempt to save them and can’t, we might say, ‘We’ve done everything we can, but his heart has stopped. We could continue, but it’s very unlikely his heart will restart.’ But the words aren’t set in stone and are only part of the equation.
What you say to a 90-year-old lady whose husband has just died, and how you say it, is often very different to what you say to a 30-year-old woman whose child has just died. The former is more likely to be calm and resigned, the latter to be hysterical and disbelieving. Working for the ambulance service, you become extremely versatile. We work things out as we go along and hope that we can adapt to any eventuality.
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Trundling along one fine afternoon, a strange call comes in: MAN FOUND FACE DOWN IN PUDDLE, CARDIAC ARREST. That’s all we have. We’re about twenty minutes away, so I deliver a heavy right foot and get the ambulance moving. If someone is face down in a puddle, we want to get there as soon as possible. We only hope the caller has pulled him out. We don’t want someone drowning in a puddle on our watch.
The satnavs in ambulances are programmed automatically, which is wonderful: when a job comes in, we don’t have to muck about entering postcodes and addresses, we can just get on our way. However, the satnavs have a strange glitch, whereby they take you to the middle of properties, which sometimes means you end up being directed down a little alley that runs past the back door, rather than the whacking great, ambulance-friendly road that runs past the front. It happens enough that we have a name for it: the back-door boogie. On this occasion, the poor ambulance doesn’t have a choice, because it turns out the poor chap is face down in a puddle on a bridle path.
How do you get a 5-ton ambulance down a bridle path? That’s not the start of a joke. The answer is you try to avoid smashing into every overhanging branch and bouncing in and out of every pothole, while hoping you don’t end up in a ditch full of mud and all your equipment is in one piece when you arrive at the scene. After some tense exchanges between me and my partner, centred on the belief that we might be on the wrong bridle path, perhaps in the wrong town, we see a woman with a dog frantically waving at us in the distance. We’re in the right place, which is always handy when you’re desperate to save someone’s life.
The woman leads us to the man, who is still face down in a puddle. To be fair, it’s quite a big puddle, about 15ft wide and 6 inches deep. We wade out, roll the patient halfway over and it’s immediately obvious that not only is he not moving, he’s dead. The two things are probably related. He has a head injury, so I assume he’s tripped, knocked himself out, landed face down in the puddle and drowned. We all hope to die peacefully at home in our sleep, sat in our favourite armchair in front of a roaring fire, a rug over our knees and surrounded by beaming relatives. Sadly, not many people go out in such a dignified fashion. Still, this is a particularly unlucky way to make an exit.
The guy has white hair, is well dressed and floating next to him is a gold-topped walking cane. He must have been there for a while, because rigor mortis has set in. Because it’s an unexpected death, it’s now a crime scene. That means we have to leave him as he is, face down in the puddle, so that the police can attend, arrange for crime scene investigation (CSI) to do their thing and hopefully rule out foul play.
While waiting for the police to arrive, we do our best to block off the path, using our vehicle and an ambulance car that is also on the scene. But that doesn’t stop people trying to get through. It never does. Most people get it. You say to them, ‘The path is currently closed due to an incident,’ and they give you a knowing nod and find an alternative route. Other people are less compliant. The conversation will go something like this:
‘Sorry, you don’t want to go down there, there’s been an incident.’
‘I’m trying to walk my dog here, mate. This is all I need.’ ‘Not today, sir. Can you find another way?’
‘No. I go this way every day.’
And with that, they’ll barge past you. I might feel like saying, ‘Listen, pal, there’s a man down there dead in a puddle. If your kids see him, they’ll have nightmares for weeks. Stop being an idiot and go another way.’ But I can’t say that, because I’d probably end up in a spot of bother. And we have no real power to stop the public doing what they want to do anyway.
While we’re trying to manage the scene, a Toyota Yaris pulls up, an elderly lady climbs out and says, ‘I’m looking for my husband. He’s got dementia and has gone missing. I got in the shower and when I got out, he’d gone.’ I ask what her husband looks like and she says, ‘He’s got white hair and walks everywhere with a gold-topped cane.’
The obvious thing to say is, ‘Oh, he’s just over there, in a puddle.’ Which is true. A tempting thing to say is, ‘I haven’t seen anybody with white hair and a gold-topped cane.’ Instead, I tell her we’re dealing with a man who has been found deceased, and she instantly understands that it’s probably her husband. Still, I decided it’s better to break the terrible news in a more ideal setting.
I sit her in the passenger seat of her car and drive us back to her house. If I have a prang, I’ll probably end up in hot water, but I can’t have her behind the wheel. She keeps firing questions at me and I keep stonewalling. As soon as I walk in the house, I see a picture of the woman and a man who is presumably her husband. They are on a cruise together, with big smiles on their faces. I can categorically say that the man in the picture is the man we’ve found.
While I’m making the lady a cup of tea, I phone my partner: ‘It’s definitely him. What should I do?’
The police still haven’t turned up, so I sit the woman down, take a deep breath and say, ‘We can’t say for sure, but I’m confident the man we found is your husband.’ By now, I’ve worked with a lot of fine paramedics, watched and learned and polished my technique. I speak softly, take it slowly, explain clearly what has happened and give it time to sink in. I leave out the part about finding him in a puddle.
The woman starts sobbing and I put a consoling arm around her. She is so upset that she had that shower and left him unsupervised. She’ll probably carry that guilt for as long as she lives. When she’s calmed down a bit, she gives me her daughter’s phone number. I give her a call, explain the circumstances and she says she’s on her way. Unfortunately, she lives about five hours away. I ask the lady if she has any friends nearby, and she says there might be one at the bowling club around the corner. So I get on my toes and head for the bowling club.
When I walk through the door, all these women start panicking. I imagine when you reach a certain age, an approaching ambulance person with their head bowed and wearing a serious face looks a lot like the Grim Reaper, come to bring tidings of a dead partner or friend. Mercifully, I’ve left my scythe in the ambulance. I identify the friend I’m looking for, tell her what has happened and walk her back to the lady’s house. The whole way there I’m thinking, I really hope it was her husband, otherwise I’ll have some explaining to do.
While we’re waiting for the police to arrive, it suddenly occurs to me that I’ve been in this house before. A few years earlier, I treated a gentleman with chest pains. He didn’t have dementia then. The woman’s friend explains that he had a sudden onset and was on a waiting list to see a social worker. I leave with the parting words, ‘Sorry to meet you in such sad circumstances, take care.’ I shudder to think how many times I’ve uttered that sentence in the past fifteen years.
When I get back to the body, a CSI photographer is snapping away. Once enough pictures have been taken, the decision is made to put the chap in the ambulance and transfer him to a mortuary. It’s never a job I relish. Whenever we’ve got a dead body on board, I always feel like one of us should sit back there and keep them company. Mad as it might sound, it just seems like the right thing to do.
It’s quite rare that I have to go to the mortuary thank God. A mortuary is such a sad place. Rows of dead heads and dead feet and a separate fridge labelled: ‘Children Only’. Most people today, at least in the developed world, are so removed from death. It’s not the norm any more, as it was for previous generations, to see dead bodies, to the extent that it’s quite possible to live a whole life without seeing one. But a trip to the mortuary hammers home just how commonplace death is. I reckon most people working on the frontline of the ambulance service would have had the thought at least once: I should have gone into the funeral game, I would have made a fortune.
We unload our body, the mortuary workers place it on a slab and slide it into a chamber. We sign the necessary forms, say our goodbyes and it’s only when I get back in the ambulance that it hits me how cruel life can be. It was heart-breaking to be there when that long and loving marriage came to a juddering halt. I pop into people’s lives and might only be there for a few minutes before popping off again. But in that short flash of time, I bear witness to monumentally important moments and leave an enduring mark, which is a very humbling thought. Most of the time we can make a positive difference, though sometimes nature beats us to it. But even if it does, those few minutes following an accident, or a tragedy, can still make the rest of someone’s life more bearable. That’s why what we do is so much more than just a job.
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The day after the man in the puddle, I took my little boy to the toy shop. In the car park, a woman came up to me and said, ‘Oh, hello. How are you?’ I must have looked blank, because she followed up with the classic, ‘You don’t remember me, do you?’ She explained that I’d visited her mum a few times and, as you do, I pretended that I suddenly remembered who she was talking about.
‘Oh, yes! How is she?’
‘She passed away last year.’
‘Oh, that’s a shame. She was such a lovely lady.’
You say what you’ve got to say, because doing anything different will make you look callous or uninterested. But I’d be lying if I said that all of the people I treat become more than individual jobs. I’ll be in the supermarket doing my big shop and someone will come up to me and say, ‘Bloody hell, you’re the fella who helped me out the other week!’ And I’ll look at them and think, Nope, I have absolutely no idea who you are.
I deal with so many different people in so many different situations and, to a certain degree, most humans look the same. I remember houses – a fish tank in a living room, a picture in a hallway, a car parked in the driveway – but faces quickly fade. Not remembering makes me feel guilty. But I just have to tell myself that it’s no different to being a teacher: some kids they remember years later, some kids they don’t. It doesn’t make sense to feel guilty, as long as I did everything I could to help.