Ambulance clinicians are Jacks of all trades and masters of none. To extend the analogy, we’re like the handyman you might call to unblock your drain or fix a leak. They’re important jobs that need doing now, and a handyman is likely to be pretty good at them. But you wouldn’t get him in to rewire your whole house, just as you wouldn’t get an ambulance person in to rewire your brain. (Just to confirm, ambulance people are not – I repeat NOT – qualified to unblock your drain or fix a leak. We’re busy enough as it is.)
When I started out on the road, I had a bit of an inferiority complex, because I hadn’t been trained for stuff I’d been tasked to do. I assumed the doctors and specialists would look down on me, because that lot are trained for the best part of a decade. But I soon learned that when things get a bit sticky in a doctor’s surgery and they need urgent medical assistance, they often call us.
We do a lot of picking up of pieces, sometimes literally. I’ve been called out to a doctor’s surgery when a patient was taken acutely unwell. The doctor was clearly taken aback by this chap’s medical condition, and it’s safe to say that GPs aren’t as used to dealing with that kind of stuff as us ambulance folk. He was very relieved to see us. So was the patient, as well as being slightly perplexed. Doctors and specialists understand that their game is their game, and our game is our game. And most ambulance workers are pretty good at it.
But there are times when I cease being an ambulance person and become a de facto carer, which is when my inferiority complex returns, because it’s work that takes me miles out of my comfort zone. I sometimes attend terminally ill patients, who have called for an ambulance because they know they are about to die. One shift, I attended a 32-year-old lady who had been diagnosed with terminal cancer. Her organs had started to fail and I had no choice but to say, ‘I think you’re reaching the next stage.’ She didn’t want to remain at home because she had young children. And we didn’t want to take her into A&E, because that didn’t seem like the right place for her at all. So we phoned the local hospice, who mercifully agreed to take her in.
One of the most delicate jobs an ambulance person can do is remove a dying patient from their house while their family looks on. So it didn’t matter how many jobs were waiting, we were going to take our time, because that’s what this lady and her family deserved. We were in her house for what seemed like hours, readying her to leave for the final time. We can’t make those experiences enjoyable, and we can’t change the outcome, but we can try to make it as comfortable as possible. We tried to make it seem like what we were doing was nothing out of the ordinary, while giving the impression that nothing else mattered. Which, at that moment in time, it didn’t.
We made sure to involve the patient in all our decisions, as if she was marshalling the process, rather than us. That meant not saying a great deal, unless we had to. But we weren’t just there to support the patient – although she was our priority – we were there to support her family. That meant making the woman’s husband and kids part of the process as well, so that they didn’t feel like spare parts or they were getting in the way. We got the kids to help assemble the stretcher, so that they felt like they were helping their mum. And we lifted them up one by one, so that they could give her a kiss and a cuddle.
Daft as it might sound, a bit of humour is always welcome in such situations. At one point, the lady pointed to a window and said, ‘I must give them a clean when I get back.’ That showed incredible self-awareness: not only was it a coping mechanism, she was also trying to make the situation more tolerable for everyone else, including us.
On the way out, I noticed the lady looking around, taking it all in. We put her in the back of the ambulance as gently as we could, while feeling terrible that we were taking those poor kids’ mum away to die. Before I jumped in the front, I said to her, ‘Is there anything else we can do for you?’ The lady said no, and thanked us for making the situation more bearable for her family. Those few words were better than any Christmas bonus. I held her hand for a moment and she gave me a weak smile. A slight squeeze of the fingers can say more than a thousand words. I wonder how many strangers’ hands I’ve held.
Another time, we walked into a guy’s house and the first thing he said was, ‘Listen, I’ve been diagnosed with terminal cancer, I’m short of breath and I don’t feel at all well. I think I’m dying, but I do not want resuscitating.’ He conveyed his wishes quite strongly but didn’t have a DNAR (do not attempt resuscitation) order in place. That was a conundrum. He was going to die and he wanted to die. But was he sufficiently sound of mind to make the decision for us to let him die? That was key, because if we agreed not to resuscitate him and it was later decided that he was not sufficiently sound of mind, we could have been in all sorts of legal bother.
We got on the phone to our senior bosses and asked a GP to attend, so that he could hopefully write out a DNAR. But now the question was, would the GP make it in time? And if he didn’t arrive before the patient stopped breathing, where did we stand legally? The patient did indeed stop breathing before the GP arrived. Thankfully, several members of the patient’s family were present, so we were able to ask them what they thought we should do. They were all in agreement that he shouldn’t be resuscitated, so we made him comfortable and he passed away peacefully. Five minutes later, the GP knocked on the front door.
We kept the flurry of phone calls away from the patient and his family, but it still wasn’t a particularly stress-free end for him – a couple of ambulance workers scrabbling around trying to get permission to let him die as he wanted. Given that his family were in attendance, he should have been able to say, ‘I don’t want to be resuscitated’, end of story. It didn’t sit right with me that his request was queried simply because he hadn’t filled out a form.
The other side of the argument is that another family member not present might have put in a complaint that we didn’t try to resuscitate. That can lead to a knock on the door from the police and a conviction for gross negligence. Ambulance people are often unsure if they’re doing the right thing by the patient while adhering to the rules, because they don’t always align exactly.
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I spend a lot of time in care homes, for the obvious reason that the elderly are most likely to need my help. Some care homes are great, some are not so great. One place I go to has bingo most days, all sorts of activities and a piano, which they all sit around singing songs. It’s more like a social club than a care home, I could manage a week in there myself. But there are other care homes that are little more than storehouses where the elderly are sent to spend the final years of their lives. The atmosphere can be quite sombre and you really feel for these people. If you put your dog in kennels, you expect the staff to give them stimulation. But that doesn’t seem to be a priority in some of these places. Thankfully, the Care Quality Commission, established in 2008, has seen to it that a lot of the worst care homes be closed down. But some pretty bad ones remain.
We have an ageing population, but the country doesn’t seem to have planned for it properly. There is not enough social care, which means elderly people who don’t need urgent medical help are being taken to hospital because it’s unsafe for them to remain at home. Add an overstretched GP service into the mix, and it means ambulance people are spending more and more of their time in elderly people’s living rooms and A&E has become a fallback option. I’ll often find myself thinking, If there was better social care available, we could be dealing with someone who desperately needs us. But services are slowly improving and, regardless, sitting and chatting with the elderly is one of the best parts of the job and makes me feel like I’m really doing something to help someone in need. I’d much rather be there than at a nightclub, especially as I love tea and custard creams.
Sometimes, we’ll go to a job and it will quickly become apparent that an elderly person is simply lonely and wants some company for an hour. And even if we decide that their condition isn’t serious enough for us to take them to hospital, we still spend time with them in order to reassure them. We might also arrange an appointment with their GP or refer them to a charity like Age UK, who will try to provide them with the social contact they need.
I’ve been to elderly people who have been unable to get out of their chair. Is it an emergency? Not really. Can we leave them stuck in their chair? Of course not. But if there is nothing medically wrong with them, it’s a job a carer could be doing. Home carers do a wonderful job – popping in to massage an elderly lady’s legs, cutting her toenails, checking that chesty cough hasn’t developed into something more worrying. And occupational therapists pimp up chairs and customise bedrooms and bathrooms. It’s all about putting in place preventive measures so that people don’t get stuck in their chair or bed, or fall down the stairs or in the shower. The only problem is, some people slip through the net.
Most home carers and carers in residential homes do an incredible job. I can’t begin to imagine how difficult it must be to deliver care to people with all manner of debilitating illnesses. They do a lot of lifting and turning, a lot of wiping backsides and changing soiled sheets. They also deal with a lot of people with dementia, which can make them difficult to manage. On top of all that, they get to know their patients really well, before watching them disintegrate and die. But these carers are almost impossible to faze and have such a lovely, tender manner. And what do we pay these heroes, who do one of the most important jobs in the world? Not much more than the minimum wage.
For all the great work our carers do, I sometimes think our elderly people are written off too quickly. I was on a day off (we do have them) when my wife’s dad called to say her nan had had a stroke. The doctor said she was going to die within twenty-four hours, so they needed to come and say their goodbyes.
Off we popped to the care home, but the whole way there I was thinking, How does he know she’s going to die within the next twenty-four hours? In the ambulance service, we don’t write someone off who’s had a stroke and wait for them to die, we treat them. I couldn’t compute it. But I had a little word with myself, to remind myself I wasn’t on shift: Don’t walk in being Billy Big Bollocks, leave the work hat by the door. Just keep your mouth shut . . .
As soon as I walked into her room, I could see that she hadn’t had a stroke. A stroke has very specific symptoms: a patient will have facial weakness, meaning they won’t be able to smile and/or their mouth or eye will be drooping; their speech might be slurred and they might not be able to understand you; they might not be able to raise their arms. You don’t really need to be a medical person to know what a stroke looks like, and this doctor was way off the mark. The poor woman was rolling around on the bed, breathing really fast. Her temperature was through the roof. It was obvious she had an infection.
When the doctor finally turned up, I said, ‘What makes you think she’s had a stroke? I think she should be in hospital.’ He replied, ‘I think she should remain here and be allowed to die in peace.’ I’m all for letting people die in peace if there’s nothing more we can do for them, but I was absolutely certain that my wife’s nan was treatable. So I phoned an ambulance, explaining, ‘Look, this doctor wants to leave her to die, but I think she’s got sepsis.’ (Sepsis is a serious complication of an infection and needs to be treated as quickly as possible.)
As soon as my colleagues saw her, they agreed with my diagnosis. They stuck her in the ambulance, switched on the blues and twos and whisked her off to hospital. The doctor took one look at her and diagnosed sepsis. At first she responded to treatment, but her organs failed and she died a couple of days later. Had her doctor not waited twelve hours, I believe she might have survived.
While I have enormous respect for anyone who works as a medical professional, and sympathy for the fact they live in constant fear of being complained about, I had no hesitation in reporting this doctor to the General Medical Council. Perhaps some people might have thought, You know what? She was old and on her way out anyway, it’s not worth the hassle. But I wasn’t having it.
It made me look at complainants in a different light. Some complaints are petty and put medical professionals through an awful lot of stress for no reason, because any complaint is taken seriously. But medical professionals are human, so they do make mistakes. In this case, the doctor got suspended and he resigned before his hearing could take place.
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.