New Year’s Eve 2016 falls on the third of my four weekend night shifts, which means I wander onto station in a pleasant haze of sleeplessness, with a nonexistent short-term memory. Festive cheer has bedecked the main table with assorted foodstuffs, while the generally inedible company-issue sandwich packs (for morale!) have been rammed into the fridge. I’m working with K, my best mate, who recently qualified as a paramedic. We stock up on essentials – chocolate, crisps, more chocolate – and, since the only other option in the garage is a shitty Fiat, we bagsy the Mercedes. Signing on takes place amidst a frantic frenzy of provision stowing – “Where can the dips go?!” – and the day shift controller wishes us luck before sending us straight out to a fall in a residential home.
Our octogenarian patient has fallen from standing, sustaining a small nick to her head that won’t require further treatment. It’s a standard call from residential homes, where the staff are duty bound to phone 999 for even the most minor of injuries. Our patient is happily demented, and we sit and share a tray of chocolates and a brew with her while we complete our paperwork. She’s deemed safe to stay at home, so we leave her in the care of the staff and clear on scene.
We’re immediately sent to a “Red back up” – a two-year-old female fitting. There’s a rapid response paramedic already at the address, requesting urgent assistance. The job is out of our area, so I put my foot down, hoping it’s a febrile convulsion, something simple and easy to remedy.
We walk in to a pale, unresponsive child with a fixed gaze and no muscle tone on her left side. Her seizure has lasted for at least twenty minutes and she’s not running a temperature. Her young parents are understandably distraught, and we try to reassure them while we attempt to figure out what’s going on with their baby. Certain that she’s still fitting, we administer diazepam on the ambulance and put the hospital on a red standby. I’m driving, and the Mercs are nippy little beasts, but New Year’s Eve traffic means speeding taxis and drunk drivers, and although all the other cars stop for me at the first red light I come to, a white van bombs through the junction. I let him go, wondering whether he can lip read, and apologise for any harsh language that may have filtered into the back. The hospital has a full paediatric team waiting for us. The baby is more responsive upon our arrival but she still isn’t moving her left side properly. We later find out that the doctor was querying encephalitis, but beyond that we never get to learn her prognosis.
The rear of the ambulance looks like a bomb’s hit it, so we take a few minutes to tidy up and decompress, then it’s straight back out for a bread-and-butter weekend night job: a thirty year old female, domestic assault with a head injury. The police are on scene and the patient is drunk with a wound that’ll need sutures. She’s hard work: refusing treatment, refusing to go to A&E, and repeatedly begging the police not to arrest her boyfriend. She eventually consents to travel and spends another twenty minutes getting dressed and finding her keys. While we’re waiting, the police tell us there’s been a fatal hit-and-run in our area; one young girl has died at the scene and a second is critically injured. Our patient apologises profusely for wasting our time and then buggers off back into her bedroom because she doesn’t have the right shoes on.
As usual, K and I are swapping driving/attending duties around, so she gets to attend to the ninety-three-year-old septic chap who’s hypotensive and erring on the side of unresponsive. We start IV fluids and pop him off to A&E on an amber pre-alert. Sepsis is the current NHS phrase that pays, with a massive campaign to improve early recognition of the condition so that it might stop costing the service a fortune save lives by preventing multi-organ failure and subsequent ITU admissions. We all carry cards listing discriminators, dutifully follow flow charts and go through bags of saline at a rate of knots. We’re taking bets on what the next big thing will be. The smart money is on AKI: Acute Kidney Injury…
It’s ticking on towards eleven p.m. and K has started to trip over her words: “I can’t even speak proper!” she wails. Strangely, though, I understand everything she’s saying in spite of the mangled grammar.
Our last patient of 2016 is a tiny little boy with a life-limiting genetic condition. He’s had a high temp and diarrhoea since noon, and he’s poorly, with a feeble cry and poor respiratory effort. His parents have already lost a child to the same condition and they seem to know that their son is unlikely to make it out of the hospital this time. I sit with him on the stretcher, cooing at him and stroking his cheek as K flies us in on our second red paeds standby of the night. I hand over the baby and reams of paperwork, including end-of-life care wishes, to the waiting team, and stagger out of Resus, adrenaline fading fast.
“Right, drunk people only from now on,” I say, back in the cab and through a mouthful of chocolate. “Drunk people being smacked in the head.”
“But not puking.”
“No. Absolutely no puking.”
2017 is ushered in with cocktail sausages and plastic cups of Cherry Coke. K plays Auld Lang Syne on her phone and we wander into A&E to hug nurses and other crews. Midnight means we’ve gone out of the system for our meal, so we trundle off to station for a half-hour break, eschewing the manky sarnies for handfuls of crisps and homemade sausage rolls.
Dead on thirty minutes, our radios go off in synch. Apparently keen to give the start of 2017 an international flavour, Control send us off to the south (the south of our area, that is – we didn’t get to go to London or anything!) on a transfer. Our transferee is pissed, and he’s also pissed off at travelling fifteen miles for plastic surgery, but he fell onto a glass whilst drunk, so it’s hardly the fault of the NHS. At gone one a.m., the receiving hospital resembles a war zone, crammed with staggering, intoxicated minor injuries. A half-naked man wearing blood like tribal paint is booking himself in at the desk, as ambulances queue with stretchers full of skimpily-clad, insensible patients. In a nutshell, New Year’s Eve is much like any other night shift, except that it comes with dips and crudités, and the midpoint of the shift is marked by a few rubbish fireworks.
Our two-thirty a.m. city centre job is my favourite of the night. A twenty-eight-year-old chap has taken a shed-load of ecstasy at a house party. His “friends” have watched him roll around in mud for ninety minutes, punching the grass and attempting to scratch off his own skin, before they finally phoned for help. The rapid response para has been there a further hour, waiting for us to trot along and scrape the patient up. She’s breathed in so much passive cannabis smoke that she has the munchies, and the patient is hypothermic and quite shamefaced, between episodes of MDMA-induced gurning and lip smacking. He’s also been doubly incontinent and he’s covered head-to-toe in mud, which makes the trip to A&E a bit of an eye-waterer.
After disposing of him and spraying copious amounts of air freshener, we spend the next two hours chasing shadows. Persistent drizzle and a prolonged wait for an ambulance is a surprisingly effective cure-all; our “abdo pain” outside a kebab shop and our “short of breath” at a bus stop have both given up and gone home.
Trying to time a finish, we volunteer for a final job, backing up a St John’s crew who’ve arrived on scene at a fall to find two patients, one of whom is complaining of chest pain. The elderly couple are living in poor conditions with little social support, and the husband is struggling to cope with his demented wife. He’s the one with the chest infection and pleuritic pain, so we bundle them both up and take them to A&E. Phoning through a safeguarding referral brings us to our twenty-minute break and the end of our shift. It’s still raining and the roads are quiet, with fewer taxis whizzing about, just us and the odd police car. It’s been a weird night, busy but not manic, and we realise that this has become the norm, that we so regularly deal with this level of calls that New Year’s Eve has passed by without seeming extraordinary.
Back on station, we hug the day crews and chuck our keys and radios at them. I’ll spend New Year’s Day sleeping and its night back on shift. Out with the old, in with the old. It never changes, and it never stops.