Brand New Babies!

If there’s one type of job most ambulance people, especially male ambulance people, are apprehensive about it’s maternity jobs.  For me they’re the scariest type of job.  Part of our job is to deal with obstetric emergencies (emergencies in pregnancy), delivering babies and life support/resuscitation, and general newborn baby care.  I’m always reassured by the thought that Homo sapiens have successfully been giving birth to their off springs for about 200,000 years.  It’s only in the last 100 years or so that birth has moved into the domain of the medical profession.  Still scares me though.

Most of our maternity cases are in early stages of labour.  Birth is not imminent.  These types of jobs get called ‘maternitaxi’.  This isn’t really an appropriate case for an emergency ambulance, if we politely question why the ambulance was called, normally we are told that the potential mum has rung the Maternity Unit (MU) and “they told me to ring 999”.  When we arrive and hand the patient over, normally the midwife scolds them and says that they said to get a taxi not and ambulance!

Maternity cases differ from other emergencies in many ways; one major difference is the destination.  When we deal with most non-maternity jobs the destination will usually be the emergency department (ED) of the local hospital.  Certain conditions are taken to specialist units but generally for a given emergency in a given region the destination is determined by location and condition.  Maternity cases however the potential parents choose in advance which hospital MU they want to go to.  Obviously this has to be within reason – if a mum-to-be is hundreds of miles from home and labour starts an ambulance can’t travel hundreds of miles we have to settle for one of the local units.  The other main difference is that we can’t just turn up at a MU unannounced.  If the mum or dad hasn’t rung the MU then we have to get our dispatcher to ring and we can’t set off until the MU agrees to accept.  It can and sometimes does happen that a particular MU is full, in which case we are told to go elsewhere.  This is stressful for the prospective parents because they will have had lots of visits to the MU they chose during the pregnancy and to be told at the big moment that they have to go to an unfamiliar unit must be scary.  It’s scary for us too because it normally means longer before we can hand over to the midwife!

When we arrive and birth is imminent we don’t transport, we deliver the baby at home.  One of the first tasks is to request a community midwife to come to the address.  If he or she arrives before the baby then that is fantastic, midwifes are the experts in assisting birth.  If not it’s down to us.  The area where I work is covered by several MU’s.  One is a specialist MU where it is recommended all high risk pregnancies in the area book into.  Ironically, that one MU does not send midwifes into the community so the higher risk home births are left to us.  Another benefit of a midwife attending is that if all has gone normally and mum and baby are well we don’t need to transport anywhere and the new family can stay at home.  If we deliver with no midwife present then mum and baby have to go to the MU.  We then have 2 patients: mum and baby (possibly 3 if dad has fainted during the birth!).

The biggest risk to a new born is the cold.  A baby comes into the world naked and very wet.  They have very little body fat at that stage so lose heat quickly.  A priority once we know the baby is alive and breathing is to dry baby off and get them in skin-to-skin contact with mum to warm up, then wrap both up and make sure the room is warm.  A hat is an excellent idea for baby.  My regular mate Tony is a big fan of baby hats and it has become a bit of a catch phrase for him once baby is dried off: “get a hat on that baby!”

I have assisted with many births over the years, some stick in my mind:

One dad tried to drive his wife to the MU but had just left it a bit too late (or baby was impatient) and mum started to deliver in the car.  Luckily we were driving past and he was able to flag us down.  I opened the passenger door of the car to find mum with one foot on the dash board and baby’s head just visible.  I assisted the birth in the car foot well then quickly got mum and baby into the ambulance.  I asked if mum and dad had a name for their new daughter and dad joked that he would call her Corsa after the car.  I asked if he was glad he didn’t drive a Skoda…It seemed funny at the time.

Another time we were on the way to an imminent birth and we were told that the baby was breech.  The normal position for a baby about to be born is head down in the uterus so the baby comes out head first.  Breech means the baby is bottom first.  This is a complication because the head may get stuck after the body has been born.  This is a very scary situation.  As we arrived the response car was already there.  To our great relief Stella, on the car was assisting the delivery and thankfully baby came out with no complications.  Stella said that when she got there baby’s foot was visible and that was all.  She had a very anxious wait for the next contraction when mum managed to push the rest of the baby to the world.  Since no midwifes had been available to attend we had to transport mum, dad and baby to the MU.

One final birth which sticks in my mind is a 17 year old girl who lives with her parents.  She was 36 weeks pregnant and hadn’t yet figured out how to break it to her parents – she had spent the last few months wearing baggy clothes.  One Sunday morning she thought she needed the loo and baby decided to make his appearance.  Mum and baby were fine the new grandparents were shell-shocked, they had no idea when they went to bed the night before that they would be grandparents in the morning.

Mental Wellbeing in the build up to Christmas

This is the Rusty Siren guide to keeping your spirits up in the build up to Christmas with some mental health tips.  I don’t personally like to think about Christmas before the middle of December but these days I’ve found it is in our faces as soon as Halloween is over.  Evidence suggests that mental illness may increase at Christmas, this is my personal guide to dealing with the whole Christmas thing with minimal stress.

The challenges of this time of year are obvious and well known:

Money.  This has become an expensive festival and the pressure is on to spend more and more.  When we feel obliged to spend more than we have this is a huge source of stress.  Several years ago I had a chat with my family.  We decided to cut back on presents.  We all know we love each other so we don’t unconsciously try to measure love by present monetary value.  Family policy now is children get bigger presents adults get a token present.  Homemade presents are very welcome. We’re all relieved and happy with this.

Time.  Lots of us find ourselves working extra hours to get the extra money we need which then obviously leaves us less time to do the Christmas shopping.  My answer is to start the planning and organising early (hence why I’m writing this now).  I know this will annoy some people; I used to get irritated by the organised types who had Christmas all sewn up when I was just starting to panic around the 20th of December!   I’ve now joined their ranks.  I’ve also caught up with the rest of you in the 21st century and do some of my shopping on-line.  The earlier start leaves longer for the gifts to arrive.  For the shopping I can’t get on-line I plan shopping expeditions in the local towns.  I start early and generally have a loose plan of what I will get and where I will get it.  When it goes well I reward myself with a gift too!  There have been times when I’ve not managed to get a single present but still got myself a gift.

Also, about now is when I start to think about posting any cards which need to go overseas.

Perfect-family-syndrome.  The television is full of adverts for Christmas now.  Often a perfect family is shown; the beautiful couple with the happy children whose life is made even happier by the perfect Christmas they are having.  If that’s you then you have my best wishes and I am truly glad for you and hope you have a fantastic time.  Most of us at some point fall short of that ideal scene. As a divorced dad my Christmases have been a little different.  When my children were younger I used to feel guilty that I had deprived them of this perfect Christmas.   Often my shift pattern has meant that I have been working on Christmas day or Christmas night.  The way we got round this was to plan a day near Christmas when we had our own Christmas.  I came to love our alternative Christmas days.  The kids are adult now but we still enjoy our custom.

Through working the Christmas period I know that a lot of people feel increasingly lonely and depressed at this time – I think this is made worse by the Perfect-family-syndrome pushed by the advertisers.  It’s important to remember that a lot of people also feel lonely and low at this time of year and that it isn’t unusual.  Times when I’ve been alone on the day itself I’ve still planned treats for myself – nice food and tried to have a relaxing day and included a nice walk in the fresh air.

The years where Tony and I are working Christmas day we each bring a microwave Christmas dinner so when we get our 30 minutes on station we can still feel quite festive.  I generally eat all the mince pies, Tony doesn’t really like them!

Extended time with family. During the holiday period we tend to spend more time than we are used to with our families.  Much as we love them, this may also cause increased stress.  Then as the anxiety rises and patience levels drop we feel guilty for feeling like this when we’ve probably been looking forward to spending this time with our loved ones and feel that we shouldn’t feel like this.  It’s good to take a realistic view at times like this. It’s natural that there will be tension when spending more time than we usually do with our families, especially if staying at their house and adapting to their routines.  This is part of being a human.  When this has happened to me I just accept that this is natural and I rely on my go-to remedy for everything: I go for a walk and practice my relaxation techniques.

Despite what it might look like from above I do love Christmas.  I’m a big kid at heart and love all the shiny lights and decorations.  I do think people are kinder and more loving to each other for a brief period of the year.  Regardless of spiritual or religious views I think we all think more about loving and giving at this time of year.

I hope you all have a relaxed and stress free build up to Christmas (It’s way too early to wish Merry Christmas yet!).

Keeping my mind tuned up.

This blog is about my mind and what I do to keep it healthy and to expand my brain. I like to read other blogs about how people manage to keep their minds healthy and active.  If we all share tips like this we can all maybe help each other a bit. I want to stress that this describes things which work for me.  I’m fortunate that I’m basically healthy mentally; all I suffer is the occasional low mood and some social anxiety.  If you suffer with the more serious conditions then I’m sure you realise that it’s expert professional help you need.

I’m not a mental health professional.  I want to stress that.  As a paramedic I’ve very little training in mental health, surprising when you consider how many cases we go to where mental health is the chief complaint.  I am however becoming an expert on me and my mind.  I’ve utmost respect for mental health professionals and always stress that if you have problems you shouldn’t hesitate to get professional help but one thing I’ve learned is that you don’t have to be a professional to help someone.  Just by being there and being prepared to listen and support someone can help a great deal.  Just listen without judging and without even trying to ‘fix’ things.  That may be enough to help a person through a crisis.  Encourage them and support them if necessary to go for professional help.

Talk about things on your mind.  We all know this one but don’t all do it.  I’m as bad as anyone at bottling things up but it really helps to have a few trusted friends in your circle who you feel comfortable talking to.  This next bit probably sounds a bit wrong but I think there comes a point where you have talked about some troubling event and continuing to go round in circles talking or thinking about it will make things worse.  There comes a point when you’ve analysed the event, learned from it, when you have to accept that you can’t change it or make it ‘un-happen’ by continuing to ruminate on it.  This is the point where you have to accept that it happened (I’m not saying that the event is acceptable.  It may be totally unacceptable and terrible but the fact is it has happened and you can’t change that, so it helps to accept that it happened).  This can be the difficult bit and where professional help may be needed. Once you’ve accepted it, maybe you can come up with a plan to improve things.  I found this the hard way: I had a particular problem I kept alive for 6 months by constant rumination and trying to analyse it.  Eventually I got so sick of it I just accepted it.  That was a huge weight off for me and I actually started to move on then.

It’s important not to ignore uncomfortable feelings and emotions.  In the past I’ve done this.  I’ve used distraction to take my mind off feelings it would have been better to face.  Thankfully my coping mechanisms weren’t too destructive.  I’ve avoided excessive alcohol and drugs but have watched many hours of mindless TV and read countless novels just to distract myself.  The thing is these feelings don’t just go away.  Experts tell us they hang around just out of sight (repressed), possibly building strength and cause problems from behind the scenes later (unexplained low moods or bursts of emotion at random triggers).  Now when faced with an uncomfortable or painful emotion I make a bit of time for myself and just feel it. It’s ok to cry at this point if you feel like it (I find this hard but they say it’s healthy and can be a relief). I concentrate on nice slow, deep, abdominal breathing and feel the feeling.  I try not to think about it or describe it to myself, just concentrate on feeling it and breathing.  If I find my mind starting to think about it, judge it or describe the feeling I focus once more on my breathing. I find that it passes after a while and doesn’t seem to cause problems later.  Sometimes the feeling may come back again but I just feel it again – it seems to be less intense and unpleasant the second and any subsequent times.  To date this had been successful for me.

This is the time of year when Seasonal Affective Disorder (SAD (isn’t that an appropriate acronym?)) may start to take effect (here in the UK).  It causes the typical symptoms of depression and is associated with the shorter, darker days of autumn (fall) and winter.  The exact cause of SAD is not fully understood but it is thought that reduced exposure to light affects the way part of the brain (hypothalamus) works.  It may cause: over production of melatonin, the hormone which makes you feel sleepy and tired; under production of serotonin, the chemical which provides a feeling of well being.  The lower exposure to light is also thought to affect the natural sleep cycle (circadian rhythm) leading to symptoms of depression.  The self help methods for tackling SAD are quite logical.  Try to make the most of what natural daylight there is.  Spend time outside when you can, couple this with exercise – a nice long walk – and you increase the benefits.  Exercise on its own should help with the symptoms of low mood, even if it’s not outside.  Make sure you have a healthy diet.  Some people find artificial light helps; there are ‘natural light’ bulbs you can get for lamps which are said to help.  You can get special ‘light boxes’ which are very bright lights, I’ve never tried these.

Music always helps me.  Most of the time at home I have the radio on rather than the TV (I’m listening to ‘princess of the night’ by Saxon at the moment).  My taste in music isn’t to everyone’s taste but it really helps me.  I have various playlists on my phone of specific, upbeat rock songs guaranteed to help lift me in just about any situation.

To finish, I feel incredibly grateful for my life, I’m very lucky to be healthy, have a wonderful family and partner and feel I’m generally blessed.  My Grandma always told me to ‘count my blessings’ and I think that old advice about focussing on what is going right in your life and being thankful for it really helps to keep positive.

I wish you all health, relaxation, peace of mind and contentment.

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?

Child RTC – unknown if breathing

(SPOILER ALERT: To avoid undue distress this anecdote ends happily)

 

One Saturday afternoon Tony and I were passed details of a job: it was a reported child RTC (Road Traffic Collision – in other words the child had been hit by a vehicle).  Due to the panic of the caller and language differences, our call taker was unable to establish if the child was breathing, responding or conscious.  All we had was the street name and possible age, 7.  The street was not far away and we were there in minutes.  On the way we were both apprehensive and anxious.  There’s something about an unwell or injured child that that I dread. I think that every emergency worker feels the same – it’s just so heartbreaking when a child is harmed or killed and even after 20 years I feel very scared when a child’s well being and even life is in my hands.

I turned the ambulance onto the street, blue lights still flashing, and the sense of dread increased.  A large crowd of people were standing in the street and on the pavement.  As soon as we arrived members of the crowd started waving and shouting at us.  At this point we couldn’t see the child through the crowd.  We got out of the cab and the shouting got more frenzied as people tried to rush us.  Tony got the response bag (a large rucksack which contains most of the equipment needed to start treating almost every conceivable emergency) out of the side door and we started to walk toward the area of the crowd that we were being jostled towards.  People sometimes think that ambulance staff are too casual and slow when approaching an emergency, they expect us to run.  During training it is emphasized that you should never run – that’s when mistakes are made and injuries happen.  We are trained to take a calm, measured approach and observe as much of the scene as we approach to evaluate and minimise any dangers to us, the patient and any bystanders.

We pushed through the crowd and finally got to the young boy, Bilal, who was lying on the street on his side with his mum cradling his head and sobbing and praying.  A multi-person-vehicle (MPV) was parked a short distance away with a large, obvious dent in the front where it had collided with Bilal.  We had to gently get Bilal’s mum to let go of him so we could roll him onto his back so we could protect his neck and assess his breathing and circulation.  Tony gently held Bilal’s head in neutral alignment so his spine was in its natural position and to our relief we saw that he was breathing and had a pulse, both were in the normal range for his age and there was no obvious difficulty with breathing.  His blood pressure was normal for his age. A man came forward and introduced himself as Bilal’s uncle, Ash, who offered to interpret for us as Bilal’s parents spoke very little English.  Tony knelt on the floor holding Bilal’s head in neutral alignment, also protecting his airway and explained to Bilal’s parents, via Ash, what we were doing and what we needed to do.  I tried to clear some space around us by shepherding some of the crowd away onto the opposite pavement.  I went to the ambulance to get the equipment we needed: a rigid collar to help immobilise Bilal’s neck, scoop stretcher plus padding to fully immobilise and various straps and a blanket.  As soon as I started back to Tony and Bilal the crowd had resumed their position in a tight circle around them.  I forced my way in with the equipment and Tony and I began the delicate task of immobilising Bilal so we could safely move him from the floor to the ambulance and then on to the Emergency Department.

Bilal had a large swelling above his right eye from his collision with the MPV and a swelling to the back of his head which had a small laceration on it: as with all scalp wounds this had bled profusely.  His level of consciousness was reduced from normal and was constantly changing.  He would be restless and agitated crying in pain then lapse into a quiet phase then return to the restless phase. We tried to apply the rigid collar but he became very agitated, fighting us off.  We made the decision to compromise and leave the collar off.  Although this was reducing the immobilisation of his spine this was one of those cases where it’s better to leave the collar off and keep the patient calm than try to keep the collar on and have the patient agitated and restless – probably doing more damage to a potentially damaged spinal cord.  We managed to get Bilal on the scoop and place the padded head blocks and body straps on without disturbing him too much, and moved to the ambulance.

In the ambulance we settled Bilal’s mum and uncle Ash and closed the doors so we could work in relative quiet.  We rechecked all Bilal’s vital signs and checked him thoroughly from head to toe.  His main injuries were the swelling above his eye and the laceration to the back of his head.  There were several other superficial cuts and abrasions on his elbows and his back.   His pupils were equal size and both reacted when a light was shone into them.  If one or both pupils became dilated and stopped responding to light that would be a sign that there was internal swelling in the brain.

Before we left the scene we had a quick word with the driver of the MPV and some of the witnesses, they all said that he had been driving along the street at about 25 mph when Bilal had run out in front of him giving him no chance to stop.  Bilal had been knocked to the floor and had been completely unresponsive for a few minutes before recovering to the agitated state he was in now.

We set off to the ED of the local hospital with no further delay (this was before we had specialist trauma centres).  As we set off we asked the control centre to pre alert the hospital so they were waiting for us as we arrived.

The rest of the shift carried on as normal but both Tony and I kept dwelling on the job, analysing everything we did and wondering if we should have done things differently, if there was a better way to have handled the job.  As always, I had a vague sense of guilt that I had not done enough for Bilal, although I couldn’t put my finger on anything specific.

A few days later we checked and were relieved to hear that Bilal had made a full recovery and was discharged home.  A happy ending this time, hopefully in future he’ll be more careful on the roads!

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…