"My friend's first ever shift was out to a gentleman who was having cardiac arrhythmias. His heart was beating irregularly and he was having a great level of anxiety. But the context was that he'd taken too much Viagra and the venue was a gay orgy.
"So this patient was terrified about what's going on but also had a thumping erection."
All the training in the world can't prepare you for life as a crew member in the London Ambulance Service, explains 26 year old Jack*.
His remit covers the suburbs of Hackney, through Shoreditch and down into the City, but whatever you do, don't pull a Jeremy Hunt and use the term ambulance driver. Jack's job is far more than flicking on blue lights and skipping reds; it involves anything from on-the-spot life and death decisions, to setting up referrals for patient care at home. And that's before you become a paramedic.
Jack's still pretty new to it all. After gaining a degree in politics, he came to London because lots of his friends were already here.
Becoming ambulance crew never crossed Jack's mind but when his sister pointed out a job vacancy, he saw it as preferable to the data entry jobs he was getting offered. Soon after starting training he fell in love with the job.
"I consider it to be a massive privilege to be at the sharp end of the sword when it comes to delivering world-class healthcare," he says, "London's the best place to learn because you've got such a dense population."
Exodus
But being part of an ambulance crew is also one of the most stressful jobs in London, and getting tougher all the time. There's been something of an exodus among London's ambulance crews, often with Australians drafted in to fill the vacancies. Add to that the constant critics: when cases emerge such as the Hampstead woman who died after waiting nearly five hours for an ambulance.
How does Jack feel when he reads stories like this? And who's to blame when the ambulance service doesn't deliver?
One truth that's perhaps hard to swallow is that much of the pressure comes from a certain demographic of patients.
"I had a guy who'd used a verruca treatment on his big toe and it bled a little bit afterwards," says Jack. "You also get people with chesty cough, cold, flu — people who are just a bit unwell. And you're like, 'wow, you don't even need to go to your GP!'"
In fact, in many non-life threatening cases, says Jack, it'd usually be quicker for patients to get a taxi or even walk: "You can look out their windows and see the hospital," he laughs, "I've always grown up as thinking an ambulance is something you call when someone is dying."
Time for change
Clamping down on unnecessary call-outs is something that could do with reform; to be registered as a 'frequent caller' you have to average about 30 calls a month. That means you could call up for an ambulance twice a week and you'll always get one.
Conversely, says Jack, often the people who do call an ambulance are reluctant: "The people who really do need us often apologise, even as we're looking at their ECG which is showing us they're having a massive heart attack."
But strains on the service can't be blamed on unnecessary callers alone. In recent years, life as ambulance crew in the UK has changed dramatically. In London especially — a city that will kick you financially at the best of times — becoming ambulance crew in the first place usually involves help from others.
"No one can live on what that training wage was because it equated to, after tax, £1,000 a month," says Jack,
"My rent in north London is £800 with bills, and then my training was in Croydon. That's £250 a month in travel, so that's already over £1,000 before I've put any food in my mouth.
"Everyone on my course was either still living with their parents, or they were married and their partner was supporting them."
The people who really do need us often apologise, even as we're looking at their ECG which is showing us they're having a massive heart attack.
Jack does admit that once the initial six months of training is up, the starting salary is "decent", although anyone he knows with a family lives outside of London, facing a commute of up to two hours each way.
Ungrateful
As if that weren't all tough enough, the public, the media and the service itself often seems ungrateful for the crew's graft, most regularly citing the bane of any ambulance service — its response times.
We've become a society driven by targets, but Jack's are tougher than most — measured incredibly precisely by a computer, albeit a computer which often seems to work contrary to human emotion.
"If we get to someone in cardiac arrest and we get to them in nine minutes but we get them back [save their life], that's a failure," says Jack, "and if we get to them in six minutes and we don't get them back, that's regarded a 'success'."
It's a strange and often frustrating system in which anyone who uses the words 'chest pain' will get priority over anyone else, even if said chest pain turns out to be a cough and the patient who has to wait has a bad bleed.
Of course you need ways to measure success, but Jack wonders if this is it: "Patient welfare and staff welfare are coming second to targets. That's why you hear stories like 'old lady fell on the floor and was waiting three hours for an ambulance.'"
The situation isn't helped by the waiting times at London's hospitals themselves, where Jack says it isn't unusual to be waiting for a bed to free up for half an hour, though it can sometimes be two or three hours. (One of the main hospitals he uses is the Royal London Hospital in Whitechapel, which largely performs well.)
"10-15 years ago," says Jack, "you'd get back to the station in between each job. Those days are gone. You just go from job to job. When you press 'available' another job will come up in seconds."
Imagine doing that non-stop for a 12-hour shift, with no time to relax and decompress in between; it's no wonder morale is often low among crewmates and that post traumatic stress is increasingly being seen in the ambulance service.
Rewarding
It all begs the question: what on earth keeps you going in a job like this?
The simple answer, for Jack at least, is that the pros are gold-plated. People might not usually be in the condition to say 'thanks' but there are circumstances where the pay-off is instant, and better than any financial bonus.
"I've delivered a couple of babies and thankfully they've been non-complicated deliveries. There's no real suffering, it's just a natural process you're helping out with. That gives you a really good feeling."
It's moments like this that mean Jack is now training to be a fully-fledged paramedic. But there's another reason for his love affair with the service too — his employer:
"The NHS is the greatest societal institution anyone has created anywhere," he says. "I think I'm going to end up doing this for a long time."
*Not his real name — we have agreed to protect his identity.
