drifting away

The snow holds everything in a hard, blue-white light.

This must be the turning, even though the signpost is completely rounded over.

A press of car tracks heading up the road, presumably the response car that made it here first about ten minutes ago. Despite the early hour, all the estate kids are out on the green, throwing snowballs, dragging mounds of snow together with their boots for snowmen, or towing plastic sledges off to find a slope. A hyper-morning of novelty – snow, ambulances, there’s no end to it. They hardly know which way to go.

The house we want is in the far corner. We take a couple of extra things the paramedic might need and head that way, the snow crumping and squeaking beneath our boots. The front door stands open; we kick the wall to clear our boots, call ahead and go in.
A woman and her son in the kitchen.
‘Upstairs,’ she says, trying to light a cigarette. ‘Will you – tell me?’
‘Yep. I’ll come right back once we know what’s happening.’

The familiar beeping of the metronome as we go upstairs.

A man lying on his back in the bedroom, a paramedic compressing his chest. He tells us what he knows – Mark, forty, no previous medical history; sick in the night and went to bed; wife woke up and found him unresponsive; they got him on the floor and the son started CPR.
‘I’m afraid he’s been asystole throughout, guys. Pupils fixed and dilated.’
We divvy up the duties – airway, compressions, drugs. When it’s all running along and I can be spared for the moment I go back down to get more details. There’s not much to add.
‘What’s happened?’ she says. ‘Has he died?’
‘Mark’s heart isn’t working at the moment and we’re doing everything we can to get it going again.’
‘His heart? Was it last night?’
‘Could’ve been. It’s hard to say.’
The ash of her cigarette bends out precariously. Her son leans back against the sink with his arms folded, the snow-light blazing around him through the window as fiercely as his eyes.
‘I’ve got to go back and help them some more,’ I say to her. ‘But I’ll come back and give you an update.’

But despite an hour of advanced life support the man remains in asystole.
The lead paramedic reviews the situation for the final time. At the end of it he says: ‘All agreed?’
We switch off the monitor and start to tidy up.
‘He was found in bed, so let’s put him back. It’ll be easier for the wife to see him like that.’
I go back down. She’s sitting at the bottom of the stairs with a blanket draped over her shoulders. She looks up at me as I sit down next to her, and knows what I’m about to say before I say it.
‘We did absolutely everything we could, but I’m afraid Mark has died. I’m really sorry.’
She doesn’t cry, but her face crumples in a little, like something vital has been drawn out. Her son stands in the hallway, shaking his head.
‘We’re just making him comfortable upstairs, then we’ll give you time to be with him. Because it was an unexpected death, the police will be coming but don’t worry – it’s just a procedure we have to go through. They’ll tell you all about the next step. Okay? I’ll be back in a minute.’

Up in the bedroom the scattering of wrappers, boxes, syringes, pads and equipment has been tidied away. We all take hold and lift Mark back onto the bed, sorting out the pillows and drawing the quilt over so that now he looks like a man slowly waking up, resting his eyes in the reflected white of the snow rushing in above the curtains, listening to the shouts and screams of the children outside.
‘Do you think we should turn the quilt over?’ says the paramedic.
‘Why?’
‘Look.’
A motif of cartoon words on the cover: drifting away, zzzz.

hyper

James is being transferred from the CDU to a secure bed at a psychiatric hospital, with a diagnosis of hypermania. The nurse looks red in the face, relieved that we’ve arrived early to take him. He gives a discreet nod of his head to indicate the bed James is in, then tells us he’ll get all the notes and the transfer papers together.
‘You shouldn’t have any trouble,’ he says, then adds, ‘Nothing physical, anyway,’ and smiles thinly as he ducks back to his desk to sort out the paperwork.

James is sitting on his bed, a fifty-year-old man with a forty-year-old pony tail. It hangs down the centre of his back, a grey and greasy length of rope tied at the ends with string. Over his black t-shirt he wears a grey waistcoat; round his neck he wears a cloth pouch on a long leather thong – it swings forwards when he leans over to tie up his boot laces.
When I step over to say hello he looks up, and begins speaking:

‘So you’ve come to take me to the loony bin have you? Well – I say loony bin. Bit disrespectful but you know what I mean. Where’s your syringe and your net? Hey? I was expecting someone in a big white coat, you know. Bit of a cliché, I know. A tranquiliser dart in the bum and a ride in a wooden box. But that’s not how it’s done, I’m kidding. I know that’s not how it’s done. I don’t doubt you’re very professional. So I’m going to the psychiatric hospital because I’ve been a bit stressed lately – well, I say stressed. I can get a bit manic sometimes and things have been building up lately. But I’ve got my beads to keep me on the straight and narrow. They’re like Catholic prayer beads, but without all the crap that goes with that particular faith – although I shouldn’t really say that. I don’t know enough about this stuff. But yeah, as I say, I have my prayer beads made of sacred wood cured over sacred fires, you know, and I wear them round my neck all the time so I can take them out whenever I need to, whenever I have to pray to get myself back into line. So look, I fiddle them round like this and for each one I make a prayer. Hanuman for courage, Shakti for balance, Vishnu for mercy and so on. Matangi for creativity. I don’t know all of them. I’ve never been there, you know. I wouldn’t mind going. I’d love to learn about their culture. Not like this one. What culture? Hey? That’s what I’d like to know....’

He talks in a whiskery patter of words, without apparently drawing breath. There is a glassy sheen of saliva on his goateed chin that he dabs at from time to time with the back of his hand, but the flow of words is uninterrupted. And the monologue floods out of him without any real effort, a generator of words. His long face remains slack as a camel, but now and again he rolls his dark eyes to the side, the absolute minimum he need do to check his audience is still conscious.

We walk with him out to the ambulance, and he carries on talking regardless.

‘... I ditched my copy of Men Only the other day when I got this (he hands me a copy of an Islamic guide to women) I think that explains all the basics. It’s very interesting. I was always the one walking into the lamppost when a pretty woman caught my eye in the street, but not any more, not after reading that. I know they put stuff in the bible, the Koran and what have you, man does, not God, their God, whatever. Stuff that wasn’t there before. ‘Thou shalt not kill’ but they eat meat, don’t they? I went to Sunday school, me and my brother. Well we bunked off more than we were there but it was a start. I know I’m not educated, I don’t know nearly enough to speak on the subject. I’ll leave that to the experts. But I don’t mean politicians. I certainly wouldn’t leave anything to the politicians. I won’t vote again. It’s like Russell Brand says. Don’t encourage them. Not that I’m a fan. He goes on a bit, but very bright. He went to Oxford and ran rings around them. Couldn’t talk for laughing. But you definitely can’t trust politicians. Back-stabbing bastards. Looking out for themselves, big business. They’re no good. I remember when I was in the Gambia. There was this young girl riding on the back of a cart. Giving birth, actually. On the back of a cart, going through the streets, dust, flies, you name it. And the baby was the wrong way round or something. You’d know. Not my thing. Anyway, she couldn’t get it out for whatever reason, and they were taking her to hospital. Terrible really, but I suppose they’re used to it. I wasn’t used to it. I was at the front on a big white cushion and my arse had gone to sleep....’

Every now and again James punctuates his monologue with a grimace, a pained drawing back of his lips, exposing a crooked set of yellow teeth. The skin of his arms is angry with a rash that he scratches from time to time, idly raking over it with his nails.

‘... I remember this African boy. Only about twelve or so. I got him into trouble, kind of. He was cycling fifteen miles a day to work in this white guy’s fancy house. Fifteen miles there, fifteen miles back, all for twenty pounds a week. I said he’s taking advantage, but what can you do? The thing is this obsession with money and wealth. This crazy running-after stuff. It’ll only get you so far and then what do you do? For the great prophets have said, you can’t go to heaven with your pockets full of gold. You’ll die with a grimace – all that worry about money, it won’t do you a bit of good. You come into the world as you went out, and comeback maybe worse. I was on the streets for a long time. I slept out in the cold. You keep yourself to yourself. You don’t want to be noticed. I think they should force the politicians to do it. Every politician should have to sleep out, for two weeks every year. Maybe more, I don’t know. I don’t know enough about it. I haven’t had the education. Anyway, do you like my shoes? I got them from the church. You should see it. These big black, beautiful women there, waiting for you, in the doorway of this church. And when you walk up to it, do you know what they do? They throw their arms wide – like this – and they draw you right into them, right in to their lovely squashy tits, and give you the biggest hug in the world. Just like that. Don’t know you from the next man, don’t care. Dressed in these big, colourful clothes, they hug you right there in the doorway for all the world to see. And then they give you carrier bags of clothes – all good stuff. Sandwiches, shoes. What do you think would happen here if you went into a pub and a woman gave you a hug like that? Her husband would come over and tell you to fuck off, or worse. Kick you in the ribs. But it’s not like that there, it’s not their culture. And what’s our culture? I’ll tell you. I lived on the streets and I know the places where things happen. There’s this cafe, right? You wouldn’t want to go there. Where all the Romanies hang out. Well – I say Romanies, not the proper Romanies. Nothing wrong with them – not all of them, anyway. But this cafe, there are people there who the police hire to take out anyone they don’t want around anymore. The drug dealers, paeds, you name it. They go to this cafe, and they hire who they want. They threatened me with diazepam once, but I won’t have nothing to do with it. I know I get a bit – you know – chatty at times, but I’m not violent, never have been. I’ve got my beads. I’ve got the things I need to do and that’s all there is to it. Well – I say that’s all there is to it. But what do I know? I leave stuff like that to people who do. What? Are we there?’

I open the door and we step out into the hospital car park. James is quiet for a moment, looking around, almost steaming in the cool light of the afternoon. He shakes his head and his pony tails swings out to the side. Then he touches the pouch of beads around his neck, and carries on talking.

out of the same camp

Mr Elliott sits on the ambulance trolley, his jointy fingers laced together in his lap, his eyes circumscribed by shadows.
‘I had some shrapnel taken out of my hip last year,’ he wheezes. ‘Copped it at Normandy, but no idea what it was so I just carried on. Well you do when you’re in your twenties. Anyway, this surgeon who did me up in London – looked about ten years old. Turns out he was French. When he showed me the x-ray and pointed out all the metal work, I told him where I think I picked it up. So he turns to his team and says: “People? We must take care of this one. He liberated my country.”’
‘That’s a good one.’
‘It was a good one. Good as new.’
Mr Elliott slaps his thigh and settles back into the trolley.
‘Just after the war they put me in a special detail and we went into this concentration camp, gathering material for the war crimes lot. And I never really made all that much of it, till a few years ago, all those years later, when I’d had my family, finished my working life and retired and all this and that, and then it all came back, and it really started to bother me. So I thought I’d better do something about it, you know, before it was too late. So I started going into schools and telling them about the Holocaust. I mean, you can’t really tell them what it was like, not really, not so they’d understand. Which bothers me, because you see the whole thing just get played out over and over again. You see it in the papers all the time. No-one’s learned anything. Look at that Cambodian guy in the news the other day. And Yugoslavia, Rwanda. Nothing changes. But it made me feel better.’

***

Mr Leyton, later that same day, sitting on the same ambulance trolley, hugging his toiletries bag, radiating good humour.
‘…So we finished up a couple of miles outside this concentration camp.’
‘Did you go in?’
‘No – I didn’t. But one of the adjutants I knew did.’
‘So what did he say about it?’
‘Not much. He came out with a German attaché case full of watches.’
‘Watches?’
‘Yeah. He wanted five pounds but I didn’t have enough. He was a Cockney and wanted cash, but I didn’t have enough.’
‘Watches?’
‘Yeah. Buried in the ground. But he wanted five pounds and I didn’t have enough.’

a little carrier bag

‘We were given this job – male, unco in an alley – and we thought – yeah! Here we go! Usual stuff. When we got there he was quite nicely dressed in a business suit and good shoes. The only slightly weird thing was the number of jumpers he was wearing, but not your usual NFA, by any stretch. No one with him, no ID, completely unco, GCS three, barely alive. Didn’t smell of alcohol, but there was this unpleasant, undercooked thing about him. And then when I went to put an airway in, his mouth was swollen and crusty yellow. The only thing he had with him was a little carrier bag. So anyway, we ASHICED him in, and the team there said they reckoned he’d drunk sulphuric acid like drain cleaner or something and as it was probably a little while ago there wasn’t much they could do. And then the police said they’d had reports earlier of a man matching his description hanging off the end of the esplanade looking like he was going to jump, and then climbing back down and wandering around in the traffic. So then they showed me the bag – and guess what was in it? ... Rope.’

traces

Jeanette has fallen over at the home. Although she only bruised her shoulder and knee and seems happy enough in herself, we find that every now and again her heart rate drops to the forty mark for extended periods, and it looks like this is the reason she went over.
‘I’m afraid we’re going to have to take you in to hospital to get this checked out,’ I say to her. ‘A nuisance, I know, but we want to make sure you’re okay.’
‘Fine. Yes. You carry on,’ she says, resigned to the whole affair, despite the late hour – on the coldest night of the winter so far – and despite the fact she’s ninety.
‘I’m in your hands,’ she says.
We bundle her up against the cold and wheel her out to the ambulance.
The nursing staff wave her off.

***

All our checks are done. The ambulance rocks gently from side to side as we glide along empty streets to the hospital. The heater whirrs in the background; Jeanette is tucked up to her chin in blankets; I’ve switched on the smaller overhead spots and turned off the main lights. Jeanette is perfectly awake despite the cosy interior. The light plays across her glasses as she looks around.
‘Comfy?’
‘Yes. Very comfy, thank you.’
‘You’re a good traveller,’ I tell her, putting my clipboard aside.
‘Oh – I’ve done it a few times,’ she says.
‘To hospital, do you mean?’
‘When I worked.’
‘What did you do?’
‘I was an air stewardess. For BOAC. I went all over the world. And when that was that I went into training and took care of the other side of things for a while.’
‘Where were you based?’
‘All over. London mostly. Do you know London?’
‘I was born there.’
‘Were you?’
‘In Pimlico.’
‘Pimlico! Fancy that. Where in Pimlico?’
‘Just off John Islip Street. Near the Tate.’
‘I know it! If I’d had a pound for the number of times I’d walked along Millbank.’
She settles her head deeper into the pillow.
‘We used to go dancing at that place in Victoria. What was it called…?’
She drifts off, the creases and folds of her face smoothed out beneath the spotlights like an actor’s mask left on stage.

I check the ECG and reach over to feel the pulse at her wrist. It suddenly drops down almost to nothing, the merest echo of a pulse from the wrist line of a leather glove waving at the doorway of a DC10 at Nairobi, the trace of an echo behind a wrist watch waving for a cab on the Horseferry Road. But just as I dab about wondering if I can feel it at all, getting up to ask Frank to pull over, the trace on the machine comes back again, quicker and stronger, and the pulse resurfaces beneath my fingers.
She opens her eyes and looks at me.
‘Where was it?’ she says.

spelling bee

Orange street lights on frosted tarmac. A crescent moon hooked up in the sky like a suture needle.
I press the button on the intercom, a pause, then the squall of a voice through the speaker.
I lean in.
‘Ambulance.’
Buzz.

Mr O’Fallon is standing in his hallway, the subsiding wreck of a fifty year old, propped up against the wall, smiling soggily like a Halloween pumpkin left out in the rain.
‘S’ah. M’gon et ma goh sum’air mate. Eh? S’ah there to, innit.’
‘What’s that?’
He sighs.
‘S’ah. M’gon et ma goh sum’air mate. Eh? S’ah there to, innit.’
‘What’s happened tonight, Mr O’Fallon? Mr O’Fallon?’
He reaches down, grips his left hip, then swipes at the air with his free hand. I prop him back up.
‘Did you fall? Have you hurt yourself?’
He grinds his gums, laughs, then speaks.

When he talks, his Belfast accent, lack of teeth and many cider litres – many years of cider litres – all these things act like the layers of a perverse filtration system: he thinks of a response, pours it in at the top, it filters down through each layer, all the nuances of communication absorbed and lost, until all that’s left to come out of his mouth is a kind of primitive proto-language, the essence of the thing he wanted to say, lukewarm, with just a taint of the original sense.
‘Sorry?’
He says it again.
‘It’s hard to understand what you’re saying,’ I tell him. ‘Seeing as you’re on your feet, shall we get you out to the ambulance and check you over there?’
He makes some sounds. I interpret them as Can you get my jacket? When I fetch his jacket down from where it hangs on the back of the door, he nods as if that wasn’t what he meant but it’ll have to do.
We stagger out to the ambulance.

***

Mr O’Fallon is sitting on one of the ambulance seats. Frank takes his blood pressure and temperature whilst I try to get the basic details. We’re only round the corner from the hospital, so I need to do it whilst the ambulance is parked up.
‘What’s your first name, Mr O’Fallon?’
He makes a sound.
‘What?’
He makes the sound again, louder.
‘Spell it for me.’
‘Or’
‘R?’
‘Or! F’Orse.’
‘Oh! O!’
‘A’s roi, neh. Or.’
‘Okay. Next letter.’
‘Ay’
‘A?’
‘Ay. Ay! Fer Aynjin. Ay.’
‘I. For Indian. I for Indian.’
‘Ay. Ay.’
‘Okay. O, then I. Then what?’
‘Ass.’
‘Arse?’
He shakes his head – so hard it almost falls off onto the trolley.
‘Ass! Fer fer’s say. Ass!’
‘Yep. Got it. So that’s O, I and S – then what?’
‘Ay.’
‘I?’
He frowns. Then immediately raises his eyebrows.
‘On.’
‘On?’
‘On. Fer Nut’n. On.’
‘N! Okay – great. So that makes O.I.S.I.N.’
He shakes his head again, and leans right back in the chair.
‘So how do you pronounce that?’
He laughs, with his awful, craterous, old dog’s mouth.
‘Osheen,’ he says, the name wafting out in a hang of fumes.
He leans forward and slaps me on the knee.
‘Ay ‘us shah boy de Oy Uh Ray,’ he says.
‘You were shot by the IRA?’
Frank takes the cuff off his arm.
‘Well,’ he says. ‘They’re not as patient as us.’

get cracking, mate

Mr Abbott is lying on the ITU bed, a corrugated tube connecting his mask to the oxygen supply, a tangle of chest leads running out to the ECG monitor, a blood pressure cuff round his arm, a SATS probe clipped to his finger, the ports of a central line dangling from his neck, and a urine catheter running out to a bag on the side of the bed. He is asleep when we roll into the department with our trolley; the nurse wakes him up.
‘Come on, Paul. Shake a leg. We can’t have you lazing around here all day. What do you think this is, a holiday camp?’
He opens his eyes.
‘I’m sure you do it on purpose,’ he says, his dry voice only just distinguishable above all the hushing and beeping and buzzing. ‘What do you do – hide in the cupboard until you see I’ve dropped off, then jump out? You’re a sadist, you are.’
‘Charming. I don’t know why I bother. Just because I wouldn’t give you any of my Kit Kat.’
‘You can keep your bloody Kit Kat,’ he says, then goes to fold his arms. He seems surprised to find that he can’t do it, so lays them down again.
‘Hello, Paul. I’m Spence, this is Frank. We’ve come to transfer you to the other hospital. How are you doing?’
‘Great. Thanks. Bloody marvellous. Who did you say?’
‘Spence and Frank.’
‘There you go,’ says the nurse, stuffing all his notes in a grey plastic bag. ‘I told you they wouldn’t be long. Your own private taxi. How’s that for service?’
‘Lousy.’
We help prep him for the transfer to our trolley.
‘Nice bed you’ve got here,’ I say, looking around. There are two chintzy pictures on the wall facing him – a Thames barge in sail, and a cottage on a country lane. I wonder how long he’s been staring at those pictures, what they’ve come to mean to him.
‘Ready, set – slide.’
‘Now don’t you go complaining too much,’ says the nurse. ‘I know what these guys are like. They’re not nice like me. They’ll fly-tip you in a lay-by.’
‘I only complain when there’s something or someone to complain about.’
But he reaches out to her, and when she puts her hand in his, he squeezes it affectionately.
‘Thanks for all you’ve done,’ he says.
‘Paul – you’re very welcome. Get better soon.’
We wheel him out.
‘And don’t come back!’ she says.

***

It’s difficult to chat to Paul on the ambulance. The motorway falls away beneath us like a river in flood, and the wind booms around the metal sides of the truck.
‘I suppose you’re retired now?’ I say to him.
‘Retired? Oh god, yes. Years ago.’
‘What did you do?’
‘I was an engineer. Telecoms. I was the guy they use to send in when no-one else could sort it out. I’d pitch up, they’d point me to a big room full of wires and relays and transformers, all higgledy-piggledy, and they’d say “There you go, mate. Get cracking.” And do you know what, when I walked out of that room, everything’d be back in its place and the air would be humming sweetly. And that’s what I did for a living.’
‘Sounds good.’
‘It was good. I went all over the world. Japan, Africa, the Middle East. Always the same thing. “There you go, mate – sort it out.” And I would.’
He pauses, and struggles to adjust his position on the trolley.
‘Are you okay?’
‘I’m all right. I just get a bit – sore, you know?’
I reposition the mask on his face and tuck him up again.

A moment passes.

‘D’you know – there was a woman in the bed opposite me,’ he says. ‘Not good. Not good at all. I’ve no idea what was wrong with her, but it wasn’t good. She’d cry quietly to herself. Felt like hours. I could hear her, especially when it was quiet and the visitors had gone. She had lots of people come to see her. You could tell it was bad because they didn’t say much, just sort of hung about. And when they went she’d cry quietly like that. The nurses did what they could, but it was awful.’
He turns his face to look at me, and his eyes are shining.
‘I couldn’t do nothing,’ he says. ‘What do I know about any of that? All I could do was lie there and listen.’
I hand him some tissue. He wipes his face and blows his nose, then re-settles the mask on his face.
‘And that was the worst thing. I had no idea what was wrong. I couldn’t do nothing. I just had to lie there. And listen.’
The ambulance rocks from side to side. He closes his eyes to compose himself.
We turn off onto the slip road and take the exit towards town.