Saturday, August 21, 2010

Bang goes the baby's head


Wanna see a hairy baby?

Course you do:

That's Bonobo, and she's 5 and a half months old. Combing her hair is a two person job, and we're getting resigned to the fact that, conversation starter or not, it's going to have to get trimmed soon.

The conversations invariably go something like this:

OLD DEAR: "Ooh pretty, how old?"
ME: "Five months."
OD: "You must be very GOOD GRIEF LOOK AT THAT HAIR!"
ME: "Yes, she has got quite a bi . . ."
OD: "Marge! MARGE! Come and look at this hairy baby!"
OTHER OLD DEAR: "What's that Pru?"
OD: "This baby. It's very very hairy."
ME: "She."
OD (nodding): "She's very very hairy, Marge. Very hairy baby!"
OOD: "Well, babies do seem to have lots of hair these d . . . WHOA!"
OD: "See?"
OOD : "Yes. Yes I do. That really is a very hairy baby."
OD: "Isn't it though?"
OOD: "It really is."
ME: "She."
OD and OOD (both nodding): "She. She's very hairy, isn't it?"

Then they wander off, leaving Bonobo smiling like a loon because she loves the attention.

And so do I, if I'm honest. I don't mind the extra twenty minutes it takes to get round Asda Waitrose because of being stopped every few metres by her adoring public.

The question I find odd is quite a common one.

"Is she good?"

What does that mean?

"Is she good?"
"Well, no, not really. She's already robbed a couple of post offices and I found her crudely drawn plan to poison the water supply unless she's given free access to boobs for the foreseeable future."

Actually, I wonder if that would work?

What I think people really mean by "Is she good" is "Does she sleep a lot?". Personally, I reckon she is a good baby because, whilst she doesn't sleep that much, she's usually happy, giggling and loves human interaction, and only gets upset for good reason (like not having boobs when she wants them, which a lot of us can identify with).

All babies are good. Annoying sometimes, but good.

So, next week, we're going to go to a specially trained lady who knows how to cut childrens hair, including babies, and miraculously leave them with roughly the same number of ears they came in with. Having previously attempted the task myself, I now have no compunction against paying someone else to do it, because it's like trying to shave an angry cat on a roller coaster.

Oddly, it will be a bit of a wrench having some of her womb-grown barnet removed, but we have to be pragmatic. If we leave it any longer, the lugs will get unmanageable and we'll be introducing her as a tiny rasta.

Have no fear though, because, should we regret having Bonobo's locks trimmed, there is an immediate solution, found through the ever-giving magic of the internet. Can I warn you not to click on the link below if you are of a tasteful disposition:


The only way that could be improved is by the addition of gold hoopy earrings and a velour tracksuit with a playboy bunny motif on the arse.

I might book her in for her first tattoo while I'm there. It would have to be something classy and timeless.

Any suggestions?

Wednesday, August 11, 2010

Training vs reality

To demonstrate the utter glamour of my job as a paramedic, I thought I would break from my usual banal witterings and actually do an ambulance related blog.

I won't subject you to this sort of thing very often, as there are lots of perfectly competent and more serious ambulance blogs out there which do the job much betterer than I could, but you'll forgive the occasional lapse, I hope.

As you can imagine, we attend incidents involving explosions and grenade accidents and helicopters crashing into coaches on the motorway on a daily basis, which can get a bit mundane, so I thought I would relate to you a more exotic scenario, and the possible differences between our training and reality.

Approach scene with care, being aware of dangers both to yourself, your crewmate and the patient.
Look around for crewmate. On own. Again.
*Door bell*
No answer
No answer
*Heavier knock and doorbell*
No answer.
*Psychotic knock usually heard just prior to someone using axe and poking head through resulting hole in a 'Here's Johnny!' stylee*
No answer.
Check door.
Door open.
Loud telly noises coming from within.
No answer.
"Hello, ambulance!"
No answer.
No answer.
Walk through hallway and into lounge.
Old couple sitting in comfy chairs, watching the One Show with volume turned up to eleven.
Watch both people jump with fright. Note that the frail looking man clutches chest and goes a bit blue. Make mental note of chest clutching blueness.

Wear appropriate personal protective equipment, including latex gloves.
Know that old ladies view rubber gloves with the utmost suspicion, and will presume you are wearing them solely to avoid leaving finger prints whilst you steal their Jack Russel and molest their china, so keep them in pocket until really needed, which probably won't be long.

Call for help.
I am the help.

Assess airway.
Patients are smoking, so airway's probably patent.

Assess circulation
Man is blue but waving fag lighter at you, so probably has got a pulse.

Introduce yourself
Shout "Ambulance!" into his ear five times, point at your badge, then your bag, then the ambulance parked outside his window, point at the telly, ask if you can turn it off as you're turning it off, shout "Ambulance!" again, man points at his ears, eventually go to his bedroom, get his hearing aid off bedside table, blow dust off it, put it in enormous ear, take it out, change the battery, put it back in again, wait for the high pitched scream that tells you it's working, then shout "Hello!". Man says hello back loudly, puts his thumbs up, then asks who you are.

Identify and assess patient as you approach, such as colour, position, and signs of distress.
Note with quiet alarm at just how ill the man looks. Man coughs from effort of talking to you, goes blue and clutches his chest again.
Then he smiles and says "It's my wife."

Get appropriate patient observations, such as pulse, blood pressure, oxygen saturation levels, ECG etc.
Look at lady, who looks a lot weller than her husband. Double check that she is definitely the patient. Ask her what the problem is, to which she nods enthusiastically and says "They don't know a good mushroom when they see one, you know!"

Establish medical history of presenting complaint.
Ask husband what the matter is? Husband shouts that she's gone "all funny" on him.

Identify problem
Sniff patient. Ask if she's had a wee today. Note that she screws her face up in distaste at the memory of it. Problem identified. Decide to confirm urinary tract infection with urinalysis dipstick.
"Could you do a wee, Muriel?"
"In the war, yes!"
"No, a wee? Could you spend a penny for me? So I can get a sample?"
"Did they!?"
"No, a wee!?"
"Did we?"
"No, A WEE!"
Do mime. Regret doing mime. Look at husband, who is trying not to laugh. Ask husband to help, as maybe exotic accent isn't getting through.
Husband takes sample pot and waves it at his wife.
"PISS!" he shouts at her

She nods, takes the pot and wanders off, coming back with sample and wet hand.

Identify appropriate care pathway for patient

Give patient appropriate treatment.
Get antibiotics and go through their use eleven times with both people. Write it down on a sheet of paper and give it the lady, who folds it into a stamp sized cube and puts it in her purse.

Ensure family has appropriate care level in place.
Ask husband if he's feeling all right. Nod sagely as he proudly tells you he's never had a day sick in his life, and never been to see his GP, despite smoking forty a day for half a century. Help him back into chair after coughing fit dislodges him. Wait for him to go from bluey-grey to pink again and take opportunity of holding his arm to surreptitiously take his pulse.

Pulse goes "Di-di-di-dit dit de-dah di-dah-dit dah di-dah dah dah di-dah dah-di-dah-dit dah-di-dah"

Make concerned face as this spells out HEART ATTACK in Morse code, a late sign of myocardial infarction

Ask if patient has got any chest pain and if so, for how long? Patient answers "Yes, since 1982."

Ask if patient would like an ECG, as I've got it here anyway? Patient asks how much it costs, and agrees when he finds out it's free.

Take eleven layers of clothes off patient. It is July. Patient is hairier than a gibbon in a sweater. Use NHS issue razorless razor to flatten down a couple of the hairs prior to attachment of electrodes.

Print off ECG. Computer informs you that noisy Data means it can't identify the rhythm for you so you've got to do it yourself. Sigh. Read strip. Read strip again. Sigh again.

Put on encouraging smile and get down to eye level with patient before gently informing him he might be having a heart attack and that we should go to hospital immediately to reduce the risks of, you know, dying and that.

Begin calling for back up on radio.

"No ta." says the man, counting his cigarettes.

"Er . . . remember the heart attack thing we talked about."

"Yep." says the man, who then says that, if he's going to go, then this seems like a better way than many, in his own house, and that you're not to tell his wife.

Eventually leave patient in house, having signed a disclaimer and grudgingly accepted the possibility of a doctor's visit at home with an eye on persuading him to go to hospital. Chap waves a cheery goodbye from the door, unlit fag in hand, blue lips smiling contentedly and probably not thinking of quitting smoking.

Return to station.

Reflect on issue, write down reflection and include it in Portfolio of Continuing Professional Development, perhaps with some references on patient autonomy and the cornerstones of medical ethics.
Have a cup of tea.
Discuss with colleagues, who offer helpful advice like "Ooh, fancy that!" and "Bourbon cream?".

Get call out for elderly lady who has fallen on the floor and is having troubles getting up again.

There you go. Like something out of casualty, innit?

Sunday, August 8, 2010

Karen Woo

The news has recently reported the tragic death in Afganistan of a young doctor whilst travelling back from treating patients in outlying regions.

Her name was Dr Karen Woo, and she had a blog, which I've just read.

It's good.

She died along with nine other people in what was either a robbery or a vague politico-religious assault, but was definitely an unjustified and deeply stupid attack showing an utter lack of respect for life by the perpetrators.

I have no supernatural faith, no religion, no belief in an afterlife, and I've never seen or read any evidence that humans have a soul or a spirit or any purpose other than that which we have created for ourselves, or that we are anything more or less than beautifully evolved biological mechanisms.

What we do have is a life.

Whatever happens, and for however long that life is, what can never be taken away is the simple fact that we existed, and will always have existed.

Taking life is far easier than preventing someone dying, and Dr Woo lived on the far side of the moral spectrum from her murderers.

Sometimes, I'm not lighthearted.

No apologies.