Thursday, March 05, 2015


The call has been passed from another ambulance service. A man rang to say his friend, Jez, had taken an overdose, so we’ve been dispatched to investigate.

We know the hostel. I’ve been here several times over the years – the  last, to a woman threatening to throw herself out of a first floor window. Rae had coaxed her away from the ledge by talking about Barbra Streisand.
‘We might have to use something else on Jez, though. What d'you reckon? BublĂ©?’

It’s  an awkward call. The hostel doesn’t have any night-time staff. Each of the ten or so residents has their own room,  five upstairs, five down, shared use of bathroom, kitchen and lounge. Even to get in to the building means we’ll have to ring the front door bell and wake someone up. At half-past three on a freezing morning, that’s a risky thing.
‘If they’re not psychotic they soon will be,’ says Rae, zipping her jacket as far under her chin as she can, leaning back and looking up at the moon. The freezing air draws her breath up in a cloud.
I ring the bell, knock loudly, repeat.
Nothing happens.
We radio Control for guidance. They say Jez’ phone is going straight to voicemail, so could we make every effort to gain access.
I ring and knock some more.
A light goes on in the lounge. Rae climbs on to a low wall to look in.
‘Oh my God it’s Barbra Streisand,’ she says.
‘What’s she doing?’
‘Just standing there, staring. Go on – ring again.’
A few minutes later, the hall light goes on and a blurry figure shuffles towards the door.
‘I’m so, so sorry for bothering you – Jane, isn’t it? Anyway, sorry for disturbing you, but we’ve been told one of the residents here has taken an overdose. A guy called Jez. Do you know him?’
Jane stares at me, a thin line of drool dangling from her mouth. She coughs, once, a thick and corrupted growl.
‘Oof! That sounds rough,’ I say. She carries on staring at me.
‘Anyway, erm… do you know if there’s a guy called Jez staying here?’
She moves to the side and slowly raises her hand to point up the stairs. What with the early hour, the full moon, the dark circles under Jane’s eyes, her eerie silence, it’s like being shown something  by the Ghost of Christmas Future.
‘Oh! Great! Any idea which room…?
She shakes her head from side to side, keeping her eyes fixed on me.
I close the door quietly behind me and we head upstairs. Jane watches us go.

Unfortunately, once we’re upstairs on the landing we’ve still got to find out which is Jez’ room. I pick the nearest and knock.
‘Hello? Ambulance?’
Some grunting from inside, but nothing intelligible. I knock again.
‘Sorry to disturb you,’ I say through the door. ‘It’s the ambulance. We’re looking for someone called Jez.’
Heavy footsteps, the door thrown open.
A heavy-set, hairy-backed man in saggy pants, frowning so hard it’s like his forehead has subsided onto the bridge of his nose.
‘Hi! Sorry. Sorry. We’re the ambulance. We’re trying to find someone called Jez. There aren’t any names on the doors or anything, so…’
‘That one!’
We cross the landing and knock.
I try the handle.
‘Hello? Jez…?’

He’s lying on his bed, surrounded by pill packets. Jez is probably eighteen stone;  we’re lucky he’s rousable enough to walk with help down the stairs, otherwise we’d have to call for help, and things are so stretched tonight the moon is closer than the nearest available crew.

When we reach the lobby Jane is still there. She opens the door for us and stares blankly as we pass.
‘Thanks!’ I say to her. She doesn’t reply.


We’re just about to clear up at the hospital when the radio buzzes.
Strange thing – but I don’t suppose when you were at that last address you noticed a middle-aged woman…?
- Yep. She let us in.
I don’t suppose you couldn’t do us a favour, could you?
- Go back and pick her up?
‘Fraid so. When you’re ready…
Rae brings out some coffees.
‘What did they want?’ she says, handing me one.
‘Well –seeing as you seem to know so much about Barbra Streisand…’

Wednesday, March 04, 2015

flying crisps

Laura’s face is puce from the cold. She reminds me of those kits that turn your fist into a face – the staring eyes, the mussed wig, a circle of red around the thumb-mouth, rolling out the words in an alcoholic gurn.
‘My mum’s a doctor, yeah? My brother, my sister. My dad. We’re all in the same fing, yeah? So it’s like – I know what you do, okay? I know what you’re talking about...’
Each time she comes to a pause she closes her eyes and leans forward, jerking awake when we ask her something else.
‘Why have you called us tonight, Laura?’
She staggers through a list of things, crying sometimes, laughing out of the blue. Apart from being cold her obs are normal, though. It looks as if she called 999 when the shop doorway was just too much to bear.
‘I don’t think you need the hospital,’ says Rae. ‘Where were you thinking of staying tonight?’
Laura isn’t forthcoming. She’s warm on the ambulance, it’s well lit, things are happening. She’s wary of admitting anything that might end up with her sitting in the doorway again.
‘I think we should try to get you somewhere,’ says Rae.

The nearest shelter turns us down.
‘Sorry guys. It’s not technically freezing tonight. We’re not taking any walk-ins.’
‘So you can’t give her a spot tonight?’
He shrugs.
‘We’re full. The other shelters will say the same. Below zero and it’s special measures, otherwise...’
‘It feels pretty cold out in that wind.’
He shakes his head.
‘Where did you say she’d been staying...?’

We make a couple more phone calls, but get no luck.
‘It’s either back out on the street or come with us up the hospital. That’s all we can do for you tonight,’ says Rae.
‘I’m sick!’ says Laura. ‘I’ll kill myself.’
‘Okay. Hospital it is.’
Laura pushes her hair back and folds her face into something like a smile.

Five minutes into the trip Laura wakes up.
‘I’ve got three kids,’ she says. ‘Mum took two and the oldest went for adoption. I’m not proud of that. I’ve tried, you know? It’s a sickness. My dad died of it, the booze and everything. I’ve done what I could. I’ve done all the programmes. I will get better. I won’t give up. I want to help people, in the medical way. I could totally do it. I just need to get clean...’
She trails off, seems to go to sleep again, but a bump in the road shakes her into a different line of thought.
‘Hey! I was in the Co-op the other day. I was just standing there, you know...’ She does a naughty child mime, arms folded, looking around... ‘When all of a sudden, all these crisps, yeah? All these fucking crisps start flying off the shelves, all around me! And I’m like – what the fuck...? I was just standing there, and all these crisps... fucking hell! ... Don’t even ask what flavour...’
She laughs, suddenly having a great time. She pushes the hair out of her face and looks at me with her eyes wide for the first time.
‘But you know what? That shit happens to me all the time. My mum’s psychic. It runs in the family.’
She settles back in the seat.
The moment passes. She smacks her lips and looks around her feet for something. Another jolt in the road changes her focus again.
‘Are you gonna give Tango a ring?’ she says.
‘Tango? Who’s that?’
‘My boyfriend.’
‘Where’s he tonight?’
She slurs the name of a place. When I get her to say it more slowly, I realise it’s the name of one of the hostels we’d talked about earlier.
‘Why can’t you stay with Tango tonight?’
‘They won’t let me.’
‘Who won’t?’
‘The people.’
She mumbles something, and starts picking at a scab on the knuckle of her index finger.
‘Laura? Why won’t they let you stay there?’
‘I beat up his key worker,’ she says.

Tuesday, March 03, 2015

how red the roses

The consultant in the ED is testing Mary’s peripheral vision.
‘Keep focused on my nose,’ he says. ‘I want you to say when you can see my fingers out of the corner of your eye. Okay?’
He reaches out, rests the flat of one hand across her right eye and then begins waggling the first two fingers of his free hand out to the side.
‘No, no!’ he says, when she moves her eyes to look. ‘Stay on the nose! Okay? Can you see my fingers now? And now? How about now? Mary?


I sleep six hours and come downstairs from a dream about lightning.
I makes some coffee and sit down to write. But it’s frustrating. Nothing makes any sense.
Of course, it could simply be a lack of sleep.  Exhaustion’s like dye. It makes me transparent, incompetent, threading through all those forms and spaces I thought were solid.
Like Mary, I’m finding it hard to focus.

As an exercise, in lieu of anything else, I shut my eyes, rest my fingers on the keys and simply type out anything that comes to mind from last night.

The red roses of the bride’s bouquet in the colourised photo on the sideboard.

The puff of air against my hand from the trachy in the baby’s throat.

The shine of Happy 16th! on the foil banners tacked across the archway.

The bitten nails of the hand draped over the cab windowsill.

The glass crucifix surrounded by cards in the prayer garden.

Leadbelly howling on the radio.

The man shaking his head as he passes along the street.

I had the beef, he had the chicken.

The shape of the woman’s mouth as she pushes a crisp in sideways.

It just goes to show – hard work never killed no-one.

A squall of black rain blowing in through the open door.

Two moons. Blinking hard. One moon.


Like Mary, I want to turn and look full-on, but for reasons beyond my control, all I’m allowed to do is stay pointing forward, saying when something moves, writing it down.

‘Fine. That’s fine Mary.’
The consultant turns to the nurse.
‘Not for thrombolysis. We’ll still put a call out, though...’

Saturday, February 28, 2015

case solved

The jogger is obviously relieved when I tell her we’re fine, thanks for your help, we’re good from here.
‘Stay safe, Nige, yeah?’
She jogs on.

‘Let’s get you up, then.’
We help him up.
His trousers fall down.
We haul them back up.
‘Sorry about that. Sorry. But look - the awful thing is – I appear to have lost my keyssss...’
‘We’ll have a scout about in a minute, Nige. Let’s get you on the ambulance and see what’s what.’

What’s what turns out to be concussion, a piece of plastic from his shattered glasses frame poking out of his cheek, and a potential discrepancy in the size of his pupils.
‘You need to come to hospital,’ I tell him.
‘Really? The thing is, I think I may have lost my keyssss...’
The way he says it, his teeth clamping together on the last syllable, squeezing the sibilant ‘S’ through the sides of his mouth.

Rae jumps out to have one last look around with her torch whilst I take a bit more history.
On ‘gardening leave’ for an unspecified misdemeanour. Spent the evening in the pub. Made it off the bus. Fell over and cracked his head. Vomited twice. Coronation chicken.

‘The thing is, I think I may have lost my keyssss...’

Rae climbs back on board.
‘Come and have a look at this,’ she says.
‘Hold that thought,’ I say to Nige.

Rae points her flashlight at something, a pile of faeces on the driveway where he fell.
‘That explains the trousers,’ she says.

When I rejoin him on the back of the ambulance he has his arms folded, looking about the cabin.
‘Hello!’ he says. ‘Well! This is all very strange. The thing is, I think I may have lost my keyssss...’

blue water

The house is a new-build – so new it feels more like a show home, the paintwork immaculate, grey slate unmarked on the kitchen floor, Lavender Sunrise drifting up from the plug-ins.
‘I didn’t want to call you,’ says Marion, closing the door behind us. ‘Bill only has a couple of weeks left. We’re really waiting on a bed at the hospice. But when I spoke to the doctor he said to get in touch to rule out a stroke.’
She leads us upstairs to the spare room. Bill is perched on the side of the bed, hands planted either side, breathing quickly, staring down at his bare feet like he’s watching them move further away.
‘Hello Bill’
He doesn’t look up.


‘Chest’s clear,’ says Rae, taking off her steth and looping it round her neck. ‘I don’t think it’s a stroke, Bill. All things considered I’d say you’ve probably got a UTI, but a urine dip will clarify. I think we can keep you out of hospital.’
‘Thanks,’ says Marion. ‘He called me a few choice names when he heard I’d called you.’
‘Let’s get you comfy on the sofa downstairs, then we’ll arrange for the GP to come out later.’
I walk backwards down the stairs in front of him, holding on to the banisters in case he pitches on to me. I offer him my hand at the bottom but he shakes his head and makes his own way, steadying himself against the walls. He lies down on the sofa in the lounge, and closes his eyes.
‘He gave me such a dirty look,’ says Marion, joining us in the kitchen. She takes a tissue from the tissue box on the counter and blows her nose. ‘It’s not easy.’
To the left of the tissue box is a bottle of Classic Coke; to the right, a cluster of medicine bottles and packets. Marion makes a small adjustment to the size order of the medicines, then tosses the used tissue into a shining bin.
‘Are you all right?’ says Rae.
‘I’ve got to be,’ she says. ‘It’s just – I don’t know. We both retired last year, bought this place. We had so many plans. Then my sister in law dies of cancer. My nephew was killed in a car crash. Bill gets sick. It’s just – everything’s happening at once.’
‘I’m so sorry,’ says Rae, putting down her pen and looking as if she’s about to give Marion a hug.
‘Don’t,’ says Marion. ‘Sorry. It’s just...’
She wets her lips, smiles, then lifts the kettle to check it’s got water in it, puts it back on its base and presses the switch.
‘I used to manage a nursing home,’ she says, putting out the cups, dropping a tea bag into each of them. ‘You’d think I’d be used to all this.’ Then she stops and stands quite still, staring at the blue lit water through the viewing port as it starts to bubble and boil.
‘Don’t think twice about calling us,’ says Rae. ‘We really don’t mind.’
‘You’re very kind,’ says Marion. ‘Everyone’s been so helpful.’
The kettle clicks off. She lifts it up and starts to pour water into the cups.
‘Oh, well. At least I know what to expect,’ she says, carefully putting the kettle back on its base. ‘Milk and sugar?’

Friday, February 27, 2015

500 calories of revelation

Mr Williams is one hundred and two. He slid off the bed onto the floor and couldn’t get up, so he pressed the red button on the cord around his neck and lay there waiting for help.


The first extraordinary thing about Mr Williams’ house are the shrubs outside, pruned in immaculate waves like a blocky, three-dimensional portrait of a wild sea. The second is how perfectly neat it is inside, the magazines and newspapers, letters and bills, sheet music, books and portraits – everything lined up and in its place. The kitchen especially, everything just so. Even the kettle has been thoughtfully placed, velcroed into a metal sling that’s engineered to tip at exactly the right angle to fill the teapot without spilling a drop.
‘Just help me up, would you?’ he says. ‘I’m not hurt or anything. I’m just a bit stuck.’
The hearing aids in his ears are turned up so high you can hear a faint echo of yourself as you speak.
‘Here we go!’
We stand either side to steady him whilst he finds his balance, then help him into the living room where he takes a seat in the sunshine.
Rae gets busy writing out the sheet; I run through the basic obs. Once I’ve finished, I offer to make him some tea.
‘I’ll have a sweetener in it if I may,’ he says. ‘One click is quite sufficient!’
I bring him in a cup, and sit opposite him, waiting for Rae to finish.
The sitting room is a homage to the steam train, with model engines, prints and photos, and a small library of old train timetables and other books.
‘I was thinking about trains the other day,’ I say to him.
Were you?’ he says.
‘First you had steam. Then it was electric. And now they’re working on maglev engines.’
‘Giant magnets, floating over the tracks. So they don’t have much friction, and they travel really fast.’
‘I suppose leaves on the line will be a thing of the past, then,’ says Rae.
‘Yeah. I don’t know.’
Magnets, you say?’  Mr Williams, frowns and leans forwards to pick up his tea. ‘Hm. How wonderful.’
‘I think they’re pretty expensive though. You’d have to lay a whole new set of tracks. It’d be like starting from the beginning.’
‘Yes. Well. There is that,’ he says.
‘What’s your secret?’ says Rae, signing her paperwork and tearing off his copy. ‘A hundred and two, no carers, no pills...’
‘Ah!’ says Mr Williams. ‘I have faith!’


Outside in the truck we try to put a referral through to the falls team. Mr Williams is pretty well set-up, but his mobility is deteriorating and there are a few improvements that could be made. There’s a delay in getting through. Rae had them on her mobile but the signal was interrupted and they’re slow to ring back. She sets the phone between us, pulls a bag of crisps out of her lunch bag and starts working her way through them.
‘It’s ironic,’ I say, sliding down the chair and bracing my knees against the dash. ‘On the one hand you’ve got Mr Williams saying his faith has kept him alive all this time, and on the other you’ve got all those thousands of people killed in the name of faith. Millions, probably.’
‘Religion’s worse than politics,’ she says. ‘I stay clear of both.’
‘But then again, I suppose it’s not religion that causes trouble but the way people interpret it. I’m not religious, but I understand why people are. You know, that desire to get close to the divine, to find spiritual meaning in all this. It’s as old as the oldest human.’
Rae laughs.
‘As old as Mr Williams.’
‘I saw this documentary. The Cave of Forgotten Dreams. About a prehistoric cave in France somewhere that got sealed off by a rock fall and left completely undisturbed for thirty thousand years. And they found loads of beautiful paintings inside. Horses, deer, bears – all signed with handprints. And there was even the skull of a giant bear on a kind of rock plinth in the middle, like an altar in a cathedral, beautiful. So even then, people were trying to make sense of things. Which isn’t news, I suppose. Humans have always been looking for ways of expressing the divine, finding stories to explain it all, from Stonehenge to the Christian Scientists.’
‘And back again.’
‘I think the difficulty comes when people take the stories too literally. They end up contradicting each other, and the fighting starts. But in the end everyone’s probably just trying to say the same thing. I don’t know. Maybe it’s all just an evolutionary anomaly. In the long run it’ll either work or it won’t. Anyway. I don’t suppose that cat over there wastes too much time worrying about the divine.’
‘I can’t say I do, either.’
I yawn.
The phone rings.
Rae smacks her hands clean before she touches it.

‘Anyway. Ignore me,’ I say, straightening up again. ‘ I’m feeling a bit – you know – drawn out. I’m on this 5:2 diet and today’s a fast day.’

jack & iris

Jack has so many things wrong with him it’s difficult to know where to start. This morning he’s almost certainly had another TIA.
‘I didn’t want to call you,’ says Iris, his wife. ‘But the doctor was pretty clear.’
‘She’s right,’ I tell her. ‘These things can be the precursor to a stroke.’
‘I know. He’s had one of those already.’
We talk over the options. In the end they decide to go in.
‘Is it busy?’ she says.
‘I’m afraid so.’
She looks crestfallen.
‘We waited so long last time. It’s like we were invisible.’
‘I’m sorry to hear that, Iris. It gets mad there sometimes.’
‘Not to worry. Well. Come on then.’


Jack is comfortable on the way in. With his thick and warty nose, his eyes made tiny by the folds of a wide smile, and his massive hands folded contentedly across his belly, it’s like we’re transporting an ancient humpback whale, inexplicably dressed in a cardigan and cashmere scarf.
‘Sixty-five years,’ he says. ‘Marvellous.’
That was a wedding,’ says Iris, leaning in to shout in his ear. ‘Do you remember, darling?’
‘What’s that?’
‘The wedding? We drove down to Somerset in your Dad’s Morris Minor.’
‘That old thing?’
‘It was pouring with rain. Do you remember? You hit that hole in the road and crashed into a tree? I ended up in the cottage hospital with broken ribs, they put you up in the pub.’
‘Oh ye-es.’
Iris settles herself back in the chair.
‘There was this policeman who came along on his bike,’ she tells me. ‘He said he knew exactly what hole it was, because he’d fallen down it the week before.’
‘I had lobster for dinner!’ says Jack. ‘Two and four. I even remember the pub. It had the same name, you see.’
‘What? The Lobster?’
‘The Dorset.’
‘You didn’t take it as an omen then?’ I say to Iris. ‘Crashing on your honeymoon?’
‘I don’t believe in omens. Things happen. That’s life. You learn to cope.’
‘It’s a good philosophy.’
She’s quiet for a while.
The ambulance rocks gently from side to side, and the noises of the road and the evening traffic hush around us.
Jack seems to drift off to sleep.
‘I used to be a matron,’ says Iris. ‘You’d think I’d be used to all this, but the last few years have been very hard. Very hard. Jack’s been so unwell. He has a DNAR, by the way.’
‘I have it here if you want to see it?’
‘He had a cardiac arrest last time he was in, but they managed to bring him back. I’m glad they did, of course, but really, he’s got such a lot on his plate, it wouldn’t be fair.’
‘No. I can see that.’
She’s quiet for a moment or two. At one point she leans forward to brush him gently on his arm. He turns to look at her, then settles back and closes his eyes again.
‘No one should have to die twice,’ she says.

Thursday, February 26, 2015

tip of the tongue

Milly sits patiently on the blue chair I’ve set for her in the cohort area of the ED, watching everyone come and go.
‘Busy, isn’t it?’ I say.
‘So many people dying,’ she says, smiling sadly, like a middle-aged nun finding love in her heart for all the evil in the world. ‘How many people are dying, d’you think?’
‘I don’t know. Maybe some, but then I suppose you have to think there are lots being born, so life goes on and we’re all right.’
‘What do they do? Burn them?’
‘Sometimes. It depends what the person wants. Some people opt for natural burials. You know – with a tree. So the graveyard ends up a wood.’
She’s still smiling at me.
‘Which is nice,’ I add.
I look around to see if the psych nurse has arrived yet, but I can’ t make her out in the chaos of the department.
It’s difficult having a conversation with Milly. She whispers, and I have to lean in. When I do understand what it is she’s saying, I struggle to come up with anything more than blandishments, vague reassurances. My own sense of reality feels increasingly tenuous.
‘What’s that word?’ she says.
‘What word?’
‘Helly something. Is it? Hell?’
‘Hell? Do you mean as opposed to heaven?’
‘Where you go up. You spin up.’
She illustrates by turning her hand vaguely in the air, and then placing it neatly in her lap again.
‘That’s a nice way of thinking about it,’ I say. ‘Like the seed of a tree, spinning upwards.’
Trees again.
She smiles at me, unchanged
‘What is that word? I’m sure… hell…is it? Hell?’
‘I don’t know. Is it a person? Helen, maybe?’
She shakes her head.
A team comes out of resus pushing a bed with a patient wired-up to monitors and drips,  heading for ITU.
She sighs, watches them pass, and then looks straight at me.
‘Helicopters,’ she says.

Sunday, February 22, 2015


The station was divided.

Some liked having a station cat. It was comforting, homey, good luck. Some were quietly annoyed that he took up two seats and walked on the kitchen surfaces. Some were allergic. Whatever their feelings, though, it was hard to deny the kitchen had started to smell bad. Worse, at least. Keeping it clean had always been a challenge, with so many people in and out all times of the day and night. The fridge was particularly bad. No-one in their right mind would open it without gowning-up. But lately even the toughest nose had to admit Cat A’s meat bowl was making the place smell like a condemned abattoir. Something should probably be done.
Cat A was taken to the vets to be scanned. He wasn’t chipped, so returning him to an owner was ruled out. Discouraging him from hanging around by not feeding him or even using cat repellents was simply impractical. More direct action was needed.
The email that followed was straight-forward enough. A list of reasons why Cat A had to go: Hygiene, Allergies, Station security, company policy etc. Could anyone take him? Otherwise it was the RSPCA.
The majority of responses fell into either camp, Shame or About time, although one was surprisingly emphatic: Is there no end to the things you’ll do to make this job unbearable? it said.
There were reassurances, updates, claims and counter-claims, everyone copied in. The only one not stirred by any of it was Cat A, of course, who carried on snoozing on his blanket spread across two chairs, nosing amongst the dirty dishes in the sink, or wandering through the station looking for someone to fill his bowl.
And then a more definitive email: Cat A has left the building.
To the RSPCA after all, (with certain re-assurances about its euthanasia policy). Any contributions to the cost of vaccinations and other treatments gratefully received &c.
A few more emails, tailing off until the final one, a couple of days later:
Ahhh! Cat A! it read. And then a single emoticon:
: /