A (homeless) man about town.

This follows on from my ‘Homeless for Christmas’ blog.  I don’t talk about the causes of homelessness here; it’s about a man who I’ve known for about 15 years as one of the local ‘characters’ of my local town. I started to write about him in that blog but then decided he deserved one to himself.  He has several nicknames about town; let’s call him ‘Dimps’.  This particular nickname comes from his habit of stooping regularly as he walks along the road to pick up a cigarette end (dimp) from the floor.

As long as I’ve known him he has been ‘no fixed abode’ (NFA).  Most of that time, surprisingly he has managed to avoid sleeping on the streets by staying at various friends and sleeping on sofas.  The ambulance gets called regularly for him when he gets too ‘out of it’ and his (usually equally ‘out of it’ friends) get concerned about his boisterous behaviour.  Dimps is alcohol dependant.  When I first met Dimps his drink of choice was sherry, time has not been kind to him, his drink of choice is now cheap cider which comes in the 2 or 3 litre plastic bottles.  Dimps is normally a cheerful and friendly drunk who doesn’t cause us trouble.  Even though he has been a frequent user of the service, most staff quite like him because of his cheerful nature.

The one time I’ve seen him act out of character was when one of his friends gave him a pill to try along with some cocaine. I don’t know what the pill was; some kind of stimulant presumably, but along with the cocaine he became aggressive and violent, so his friends of course called for us to get him out of their flat.  I managed to calm him down enough to get on the ambulance and assess him.  Then we took him to the Emergency Department (ED) of the local hospital. As my mate and I were leaving the department there was suddenly a lot of shouting behind us and next second security were running to the nurses’ station.  Dimps had tried to attack a nurse as she went to assess him.   It took 3 police officers and the 2 security guards to get the usually mild mannered, affable Dimps out of the department and into a police van.

Dimps can usually be seen begging in the town centre but from time to time disappears for months at a time.

One time he disappeared for a few months then reappeared wheeling himself around in a chair, his leg had been badly broken and was now pinned and plated.  He was temporarily housed in a hostel near our station in the next town to his home town.  We used to see him travelling between his room and the local off licence for his supplies and watched him progress from chair to crutches to a walking stick and finally to walking unaided.  Then he disappeared and reappeared in his normal town.

Once when we had been called to Dimps and he was quite coherent I asked him why he didn’t accept any of the many offers of accommodation which had been made over the years and he said he didn’t like to feel trapped by living in a house.  He preferred to stay with his friends.

In the days leading up to Christmas Dimps was out on the streets again.  One night we saw him sleeping in a bus shelter. The next night we saw him in the ED waiting room and had a chat with him.  He had walked to the hospital to get his leg looked at.  He has a leg ulcer, a wound which won’t heal – difficult to manage in good living conditions, almost impossible out on the streets.  We asked where he was sleeping and said he was going back to his shelter – he had refused emergency hostel accommodation.  We made him a hot drink and gave him a bag with a sandwich and 2 blankets in we ‘borrowed’ from the department.  Over the next few days he was sleeping in his shelter.  It was nice to see that people had been donating blankets a duvet and even an umbrella to him – his bus shelter looked like a (slightly scruffy) camp site.  Temperatures were dropping and overnight were recorded at -5C.  Dimps was a subject of several conversations at the hospital as we were all concerned about him as the snow was forecast.  The next day as I drove to work Dimps’ bus shelter was empty.  There was no sign of him and all his stuff had also been cleared away.

I don’t know what has happened to Dimps but hope he is somewhere warm and safe.  Maybe we’ll see him out and about again in the spring.

2018

It’s been a hectic couple of weeks so I haven’t had much time to blog.  I would just like to thank everyone who has read my stuff so far and everyone who follows me.  Things will get back to normal now and I aim to carry on publishing once a week.  I have a feeling that 2018 is going to be fantastic, let’s all make it great!

Best wishes to you all for a healthy, happy and content time.

Rusty.

Homeless for Christmas

I can’t think of many things worse than being homeless and forced to live on the streets but it must be especially bad at Christmas.  When most of us are putting up trees and stringing up the lights in our lovely warm rooms many people are huddling into doorways trying to shelter from the rain and the cold.

Over the years in the course of my job I have spoken to a wide range of the homeless.  Being naturally curious (some say nosy) as well as providing the medical help required, I always like to know ‘how’ and ‘why’?  ‘How’ they have come to be living on the street and ‘why’ they are living like this.  The answers given are as individual as the people giving them.

Some are escaping from an abusive home and have slipped through the safety nets provided by social services.  Some have fallen on hard times and have been evicted from a previous home without the means to find an alternative.

In some of the areas I know that there have been emergency overnight shelters available but still a large number choose instead to stay on the streets.  Why?  One young lad told me that bullying was rife in these shelters – he went to one and was threatened with violence if he didn’t give up what little he had to the ‘gang’ which seemed to control that particular place.  When I asked about staff there he said that they just weren’t interested and left the residents to ‘sort it out themselves’.  He felt safer out on the street.  Another, slightly older person said he was banned from the shelter for smuggling alcohol and crack cocaine in for his own use.  His need to feed his addiction was greater than his need for shelter.  I can see both sides to this dilemma, it’s quite right that the people running the hostels want them to be clean and safe but I can also see that realistically an addict cannot give up his addiction just like that.  It’s easy to judge and say that he should just give up the alcohol and crack cocaine but addictions are serious physical and mental conditions which take time, will power and professional help to overcome.  And once overcome, continued support and a removal from previous lifestyle and influences is required to prevent remission.

Drug use is said to be widespread among the homeless.  Advice given by the council of my city is that we should not give spare change to individual homeless people as this will be used for drugs and alcohol, we are encouraged instead to support the established charities set up to help the homeless.  This seems a bit judgemental and ‘big brother’ to me.  Sure, some will probably use the cash to buy the next fix – but maybe that’s better than mugging and stealing the cash.  I’m not in any way condoning drug use.  I’ve seen firsthand the devastating and tragic effects of recreational drugs, I’m just being realistic.  Before we judge too harshly it’s worth asking my favourite question: why?  Why are so many using drugs?  For some it starts with a wish to experience an altered state of mind, some it’s peer pressure, some to mask or escape from the reality of their lives, including PTSD from abuse or horrific military experiences.  Once the addiction kicks in obviously it’s a desperate need to feed the addiction and stave off the withdrawal symptoms.

So what’s the answer?  How do we fix things and get all the homeless into some sort of safe shelter?

In my oversimplified mind I think there are two problems to tackle:

Firstly we need to deal with the people homeless now.  We need a range of accommodation options.  Different individuals have different needs and we need a varied range of support including drug, alcohol and mental health support and all backed up with a firm, safe yet understanding regime.

Secondly we need to prevent the next generation of the homeless.  I firmly believe that we should educate our young in how to handle life.  Give them realistic and healthy coping mechanisms for the disappointments and heartaches in life and try to steer them away from the destructive ones.  Invest in community mental health services so when things go wrong support is there from the beginning to hopefully prevent the spiral downwards in mental health which can ultimately end up on the streets.

So what can every one of us do today to help?

One positive thing is to acknowledge the homeless people you see.  Make eye contact and say hi.  If you don’t feel comfortable giving change, still make contact and if necessary say you’re not giving money today but hope that things will work out for them.  Most will appreciate being acknowledged and treated as human – it may even save a life!  One homeless girl I once spoke to said one day she had made up her mind to end her life as all she could see was despair and no future.  A smile and simple human contact from a kind woman passing by changed her mind and made her decide to stay around a bit longer.

I hope you all have a wonderful, peaceful Christmas and feel comfortable, warm and loved.

Why I wear a Remembrance Day poppy

This blog post has no ambulance anecdotes in it; this is what the symbolic meaning of the remembrance poppy is to me.

The poppy was first used in 1921 as a symbol to commemorate the fallen military in the First World War. It was inspired by the war poem ‘In Flanders Field” by Lt Col John McCrae.  Since then it has come to be a symbol of remembrance of military fallen in every conflict including and since the First World War.

Some see it as a political statement and a measure of patriotism, some as a glorification of war and others even as a racist slur.  To me it’s none of these.  I certainly don’t glorify war – I wish we as a species could at long last ‘grow up’ and accept differences, tolerate other viewpoints and all get on and love and help each other.  John Lennon summed it up for me in his masterpiece ‘imagine’.  End of rant.

I wear a poppy to remember and honour my great uncle Saville.

Saville was born in 1899 in a small Yorkshire town, Northowram.  He joined the army in 1915, joining the Royal Army Medical Corps as a stretcher bearer.  Some stories have been passed down through the family and one of my favourites is about how Saville and his colleagues dealt with wounds.  If a wound was bleeding and they were struggling to stop the bleeding one trick they found to increase the pressure was to place a dressing on the wound then place a small stone, or even once a potato on the wound then strap a bandage around it – the stone would increase the pressure to stop the bleeding.  Coming back to the 21st century, one type of trauma dressing we use has a plastic pressure bar insert (with a projection shaped like a small potato!) to be strapped over a wound to increase pressure and help stop bleeding.  It always makes me smile to myself because I think that my uncle and his friends invented this gadget!

Saville was awarded the Military Medal for bravery during a particularly fierce battle making several sorties out into no-man’s land to fetch wounded soldiers back to safety.  Tragically he was killed on the first of October 1918 – just weeks before the end of the war.  A shell exploded above him while he was on his way to pick up some wounded soldiers and a fragment of shell casing struck him in the chest, killing him instantly.  His mother, my great grandmother, never got over her grief at losing her son.

This is just one tragic story out of the hundreds of millions of casualties in the 20th century wars but it is very personal to me.  I obviously never met my great uncle but I would love to talk to him and hope that he would be pleased I’m a modern day stretcher bearer.

That’s what the poppy means to me and that’s why I wear it.

My blogging journey so far.

I’ve been blogging now for 5 months.  Here is a short blog with some thoughts about my experience so far.  There are no ambulance anecdotes in this one.

The first point is that I love the process of writing. For years I have been a fan of keeping a journal.  I agree with the experts that writing things down is a great way to get things straight in your mind and help you get things in perspective. I even love daily to-do lists – I find these a good way of de-cluttering my mind and ensuring I don’t forget things.  I love the feeling when a new idea pops into my mind for a blog article – I generally do a mind-map type sketch to get down the points I want to include and get a rough idea of the order to get them in.  Then I sit down to write – often the blog takes off in its own direction and doesn’t follow the plan.  I did wonder at first if I would dry up and run out of ideas to write about, hopefully that won’t happen.

At first I was very nervous when it came to pushing the publish button.  What if people hated what I wrote or thought it was boring? Worse still, what if nobody read it?  Thankfully I have found that the WordPress community seem very friendly and supportive.

I love the stats function on WordPress.  The day I publish a blog and a couple of days after I love to see that it has been viewed.  It’s fascinating to see that people have viewed my writing from faraway places around the world.  The ‘likes’ and comments are also very exciting to receive.

It’s very interesting to read other people’s blogs – I’m getting a great insight into lots of different subjects.  Mental health is a particular interest of mine, the open and honest accounts written by WordPress bloggers are very brave and insightful.  In my daily practice as a paramedic these insights help me to help my patients more effectively and also be a better mental health advocate for my colleagues.

I write with the pen name (should that be keyboard name in this digital age?) of RustySiren, Rusty for short.  A few but not many people know who I am.  This may come across as a bit cowardly and maybe it is but there are several reasons I decided to do it this way:

  • If I wrote with my real name it would be obvious to my colleagues who some of the colleagues mentioned in some of my anecdotes are and I want to avoid embarrassment for them.
  • My employer has a very strict view on social media and any form of publication. I always maintain patient confidentiality and always talk about patients with compassion and respect but my employer would probably disapprove of some of the anecdotes being made public and would probably want to edit and approve them before publication.
  • Although I respect my colleagues and patients I don’t always respect some of the direction and decisions of my employer and I want to feel free to express my opinions.
  • I am learning to become a mental health advocate for my colleagues (This is the excellent charity enabling me: mind.org.uk/bluelight). I would never ever blog about any colleague who is struggling with mental health but would not want to compromise my ability to help by a workmate by them fearing that they may be the subject of my blogs.
  • I find it easier to express my feelings by using a keyboard name (okay, this one is a bit cowardly I know but I’m still working on being able to talk freely about feelings). This includes me being able to talk about the job which caused me to become depressed and my journey out of depression (that job is described here – if I can get the link to work).

 

 

Lastly, did I mention that I love to write?

Letter to younger me

This is a different type of blog to the ones I usually do.  No anecdotes from the back of the ambulance.  It is a letter back in time to my younger self.  When I was younger I used to worry a lot, about everything.  A random event could set my mind racing and dwelling on all manner of future disasters.  I found a way to calm my mind by writing a journal.  Today I found an old journal and flicked through a few pages.  This letter is to the younger me who wrote that journal.

Dear younger me,

There’s no need to worry.  Every single thing you worried about worked out ok.  Either it didn’t happen at all or it did happen yet it wasn’t half as bad as you thought and you managed to cope.  In fact, some of the disasters you worried about turned out to be the best thing that could have happened.

We spent and still spend lots of time with family, and we didn’t drift apart like you worried, in fact we just get closer.  When you’re with family, in fact whatever you are doing, really focus and concentrate on what’s happening; this is how to make lots of great memories.  Some of the simplest things are the best memories.   Time has really flown and now the kids are adults. We had such a great time as they were growing and now they’re adults we are still having a great time making lots of memories.

Don’t fear being alone.  At various times I’ve been alone and nothing bad happened.  In fact I’ve learned to love time on my own.  I love the time to read, relax and be creative; I find it calming and peaceful.  Now I’m with someone it’s because I truly want to be with them and I’m not with them just because of fear of being alone.

Trust your instincts. Every choice you agonised about and just went with your instinct turned out to be the right choice.  That instinct of yours is pretty well tuned – I trust it now.

The bad times pass.  Always.  Some of the stuff you faced is painful, no denying it.  When you have done everything possible to remove the painful thing but it’s still there, well, these are the things you just have to accept.  The pain is real and can be intense.  Resisting and wishing that the pain isn’t there or that things were different or feeling resentful makes the pain feel worse. Just accept it, keep breathing and trust me, it passes.  It passes more quickly when you accept it and don’t try to resist it.  I would say don’t be afraid to let it out and cry but I still can’t do that.  I would also say talk more to the people who care for you about things on your mind but I still find that hard too, I’m working on that at the moment.

Don’t be afraid to ask for help handling things in the bad times.  You’ve handled things fine on your own and got through but it may have been easier with help and opening up about things.  I’m still working on that one too here and now!

Maybe I’ll get a letter from an older me and he’ll say I/we/you’ve finally managed it.

That’s about all I’ve got to say for now.  Things are good here and now, very good.  Stop worrying!

With love…

Mental well being

Hello.  It’s a lovely, sunny, Friday morning – just before a bank holiday weekend.  The sort of day that has us all feeling great, full of energy and excited and glad to be alive.  Right?

Unfortunately for many people, even a lovely Friday morning does not bring with it feelings of well being.  The Rusty Siren Statistics Department has researched a few unsettling facts and figures:

7.8% of the UK population satisfy the criteria for diagnosis of depression and/or anxiety.  That’s approximately 468,000,066 people in the UK who won’t be enjoying this lovely exhilarating Friday feeling.

In 2015 (most recent stats I could find) in the UK, 6188 people took the irreversible step of death by suicide.

Specifically to the UK Ambulance service, 91% of staff has admitted to experiencing stress and low mood.  91% of us. That’s such a high number it surprised me so I had to say it twice,   and that is just the ones who admit to it, the true percentage is probably even higher.

The effects fan out through the population, every ‘statistic’ above is a person.  People have families, friends and people who love and care about them (I hope!).  Obviously all these people also will experience a lowering of mood and increase of anxiety as they see the ones they love suffering.

What’s the answer?   There’s no simple, straightforward answer, I wish there was.

If you or someone you know is thinking about suicide then immediately go to your local hospital Emergency Department for an emergency assessment by the mental health team.

If depressed or anxious but not thinking of suicide then get an appointment with your GP as soon as possible to discuss a plan.  Meanwhile find the people you can trust and have a good talk with them about what is bothering you.  If you find it hard to talk to people (I know what that’s like, I find it nearly impossible!) then a good first step is to write it all down in a private journal.  Writing it down is an excellent way of clearing your mind and sorting your feelings out, then if you still find it hard to talk to your trusted friend you could start by getting them to read what you’ve written to start the conversation.

In an ideal world, once you’ve seen your GP you will be on a tailored plan to help you deal with your feelings and find a way to process them to get you back to a state where you can enjoy life and function once more.  Unfortunately we’re not there yet so it may be necessary to take steps yourself to get help.  Lots of resources are available on-line, two good sites to start off with are:

www.mind.org.uk

www.samaritans.org

Specifically for emergency service workers:

www.mind.org.uk/bluelight

These sites and the resources they link to suggest ways to improve mental well being and provide mental well being tips.

The most important thing is to be able to talk about mental health, and to finally obliterate the residual stigma associated with mental health.  Mental health problems are NOT A SIGN OF WEAKNESS!  The help is available we must all be willing to ask for it when we need it.

I wish you all a happy and safe weekend.

 

Top 10 types of work colleague.

I’ve written this about working on an emergency ambulance where two people are in close proximity, sometimes in high pressure situations, for the length of the shift.  These are not in any particular order, just the order I think of them.  I call some of them Mr…, to avoid literary clumsiness please assume this could equally be Mrs… or Ms… – No sexism on this site.  Any of my mates who think they recognize themselves here, that’s purely intentional!  I love you all.

 

  1. The regular mate. Someone you work with most of the time and possibly have for a long time.  Familiar and safe, you probably spend more time with this person than your spouse.
  2. Mr Well-Connected. This mate spends a large part of the shift telling you about meetings and conferences he goes to and drops the name of the chief executive, Head of service and various other high-up people in the service he’s been chatting with.  Be nice to this one! He’ll probably be the boss soon.
  3. Mr ‘I-did-this-job-once’. Starts most conversations with the phrase ‘I did this job once.. .’   Good for practicing the art of not listening while appearing interested – a vital skill for anyone in a long term relationship.  To achieve mastery of this skill you still have to be able to make relevant comments or answer questions at any point even though not listening.
  4. Mr Transferred-from-another-area. Starts most conversations with the phrase ‘In *________* we did it like this…’  Normally implies that we are a backward service who gets most things wrong.  Often wonder why this mate transferred here.
  5. Mr Feeder. A mate who has a large bag of sweets and is happy to share them.  One of my favourites.  Only occasionally though, I have to think of my waistline and blood sugar levels at my age.
  6. Mr Sleepy. I can identify with this mate.  Lots of coffee required to get through the shift.
  7. Mr Newly-qualified. Still coming to terms with a head full of theoretical knowledge and applying it in practice.  Even with the clinical placements that student paramedics have during their education finally being accountable and responsible in the real world is daunting.
  8. Mr Smoke-and-a-brew-after-every-job. Just to clarify by brew I mean tea/coffee and not beer!  Although a non-smoker I do sympathise with the nicotine craving, and I do enjoy a leisurely approach to life, I think it is vital for your stress levels.  These days though all our times, including the time we take to clear after each job is carefully monitored and presented to us at regular intervals.  This mate can make my times take a dip.
  9. Mr Lacking-confidence-after-something-has gone-wrong. When my regular mate is off I am sometimes given a mate who is returning from a low place.  I seem to be able to help restore confidence.  I think this is because I was not a confident young man.  I remember well my struggles when I first started.  I had got to the stage of wondering why the hell I had come into this job and was seriously considering leaving.  I was rota’d on for a shift with a trainer I’d never worked with before.  I can still remember that shift even 20 years later and the help and advice he gave me.  That one shift turned things round for me.  Now I try and help staff as much as I was helped and pass on the advice I was given.
  10. Mr Social Media. The annoying mate who spends all shift posting and chatting on various social media sites.  Probably annoying because they are so much more popular than me!!

One great tip to boost confidence

Most of my early life I suffered with low self confidence. What does self confidence mean? To me it is the same thing as self doubt, doubting my own judgments and ability.  Not in all areas, mainly social situations where I had to interact with people I didn’t know.  Why, you might wonder, did I contemplate changing career into probably one of the most people oriented jobs there is: paramedic.  I couldn’t have told you at the time, it just ‘felt right’.  I was in a dead end job I hated and just had to get out.  The more I researched the role of paramedic, the more it appealed.  I didn’t get too stressed through the application process because the numbers were stacked so heavily against me I didn’t seriously expect to get through; 2000 applicants for 12 places.  Amazingly I did.

Back in the day all training was in-house.  I had a six week clinical course and a two week driving course.  Then I was unleashed on the public as a trainee technician.  The plan was to work as a crew with a designated Work Based Trainer and Assessor (WBTA) paramedic for a few weeks then just work with any paramedic as required as a reserve technician.  Throughout the first year, I was rota’d on with my WBTA at regular intervals to assess my progress and identify any training needs.  Then after that first year I was a fully qualified Ambulance Technician.

That first year did not go particularly well for me.  On a good day the jobs went well enough, I generally knew what was happening with my patients and knew the correct care plans and treatments and how to assist the paramedic I was working with.  The trouble was when the patient showed any ‘challenging behaviour’, which in a big city with the accompanying social problems, was most days.  When confronted or challenged I often didn’t have the confidence to deal with it.  Some of the staff I worked with were great and very supportive and helpful, some weren’t, they made it clear from the start of the shift they did not like ‘babysitting’ a new technician.

The day came for my third quarterly assessment and my WBTA was on leave.  I was rota’d on with one of the other WBTA’s, I’ll call him Alan in this blog, it seems right to change his name.  I’d never worked with Alan up to now, I’d seen him around station and he always seemed quite brusque and impatient.  I was a little apprehensive, more than normal.  We did our first job and he asked me how I felt it went.  Before I could answer he said that I was less confident and assured than I should be at 9 months into the job.  I should be more assertive with the patients.  My heart sank.  I had given up a steady job in engineering to do this.  My family had supported me through the changes and never complained once about the dip in money coming in.  Was I about to be told I was not fit for this job and it would be best if I resigned?  This must have shown on my face because Alan suddenly smiled and said:

“Don’t panic, this is easy to put right.  You know your stuff clinically, no worries there at all, just a couple of tweaks and we’ll sort you right out”

Glad you think it’s easy I thought, I’ve been struggling with my confidence all my life.  Suddenly though I felt optimistic and good. We went back to station, back then we were much less busy and Alan asked our controller if we could go back to sort out some admin for my assessment.  Back on station, cups of tea in hand, he gave me the simple advice which has made such a huge difference to my life:

“When you walk in to a room, you’re very hunched up and your shoulders are rounded.  Without realising it you’re trying to make yourself look small.  Then with your quiet voice you start talking.  Is it any wonder some of our ‘characters’ don’t take you seriously?  You show with your body that you don’t have confidence in yourself so why should they have confidence in you?”

He showed me how I approached the patient in an exaggerated (I hope!) way and then showed me how to do it with shoulders back, head high and a projected talking voice.  Then he had me practicing coming into the room.  First he said to do it like I always did.  Next he had me practice taking a deep breath; shoulders back and head up before I entered.  Then I had to talk to him by projecting my voice as he had shown me.  I really did feel a difference.  The rest of the shift flew by with me practicing my new skill.  At the end he said he could see an improvement and he hoped I would keep practicing.  He told me:

“When you don’t feel confident you can at least act confident.  That way you even fool yourself and after practicing long enough you will become confident.”

Twenty some years later and I still clearly remember that shift and still follow Alan’s advice.  Paramedic education is very different now, university based with clinical placements throughout the course.  I’m a mentor which means each year I ‘m allocated a student and for the weeks they are on placement they work with me and my crewmate and I guide them in the practical aspects of the job.  I always pass on Alan’s advice to the less confident students.

Top 10 things people say to me at work

This is a top ten list of the things people say to us at work. No particular order, just as I thought of them.  In brackets are my normal replies (often unspoken or I’d soon be an ex-paramedic).   A short, light blog as funny top ten lists seem to be the in thing on social media right now.

  1. I couldn’t do your job. (On a good day: awww thanks.  On a bad day: I don’t think I can do my job either any longer)!
  2. How long have you been an ambulance driver? (Driver?? We do a bit more than just drive…).
  3. You must see some sights. (Yeeeeees you could say that!).
  4. What’s the worst thing you’ve ever seen? (My alarm clock flashing at silly o’clock in the morning).
  5. When do you finish your shift? (As soon as possible, normally 12½-13 hours after we started it).
  6. Is it quiet for you today/tonight? (Have to resist the urge to strangle anyone who says this, we don’t say the ‘Q’ word, even if it is. We’re a superstitious lot and believe saying the ‘Q’ word will jinx any nice shift immediately).
  7. Bet you get a good sleep at work on nightshifts. (I wish we did).
  8. Bet you get fed up of the drunken idiots (often said by someone who is drunk and doesn’t realise that they are being an idiot).
  9. It’s like a mini hospital in here. (Yes, a hospital in the midst of an earth quake with some of my colleague’s driving).
  10. Are we there yet? (OK, so this is mainly my kids in my car, not patients at work).