Sunday, January 25, 2015

the list

The hotel manager is spooked. It’s difficult to keep pace with him as he covers the lobby in long strides and jogs up the stairs to the first floor.
‘He booked in last night. We don’t know much about him beyond the basics I’m afraid. Everything seemed fine. Then the desk took a call this morning asking for an ambulance.’
He swipes the door with his card and pushes it aside.
‘He must have bought the stuff himself,’ he says. ‘This isn’t a brand we use.’
Michael is sitting on the floor of the tiny bathroom just inside to the right, one arm supporting himself on the rim of the toilet, the other in his lap. He’s sitting stock still, his face as white as the porcelain, speckled with beads of sweat. He groans pitifully, looking up at us as we all come in. There are two bottles by his side. One, an empty half-bottle of whiskey, the other, a plastic bottle of drain cleaner.
Rae passes it up to me. Ninety-seven per cent sulphuric acid. There’s a pale and puckered semi-circular burn to Michael’s lips, just like the pattern you get when you swig from a bottle of milk. We haven’t bought a chair up with us, but he’s able to walk – in fact, he’s so desperate to get moving it’s a job to stop long enough to throw a bathrobe over his back.
We take the lift. There are people in there, guests going down to breakfast or heading out for early meetings. The conversation dries immediately and we ride down in silence. Michael’s expression hasn’t changed, a trembling, appallingly inward-looking thing.
The lift doors open and we hurry across the lobby. One of the receptionists hands me a sheet of information. There is a set of revolving doors in the centre. I steer him away from those to the disabled access off to the left whilst Rae hurries ahead to open up the ambulance. On the vehicle we decide not to hang around. Hospital is three minutes from here so we set off immediately.
Michael’s groans become more strangulated and high pitched. He retches but doesn’t vomit, like the mechanism doesn’t exist anymore. A dreadful smell emanates from his mouth, scorched, almost fecal. His pupils are deep and black and round and fixed on me.
‘Help me,’ sounds like.
‘Almost there’ I tell him.
I touch his hand, but I suddenly realise I’m still not wearing any gloves and the skin of my hands have started to tingle.
Michael is screaming as we wheel him through the main doors.

A team is waiting in resus.

They crowd round.
*

Later when we ask one of the nurses what happened with Michael.
‘Oh, drain cleaner man? They tubed him and packed him off to ITU. There’s nothing they can do for him, though. He’s just gone up there to die. But at least now he’s unconscious.’
She finishes writing something, hands it over to reception then sticks the pen in her pocket.
‘I mean – drain cleaner’ she says. ‘Come on, now. Jesus Christ. That’s got to be way down the list.’

Saturday, January 24, 2015

a short ride

‘Not bad – considering I’m ninety-three.’
‘Ninety-three?’
‘Ninety-three.’
‘If you’d have said seventy-three I’d have said no.’
Would you?’
John narrows his eyes and leans forward, his wiry white eyebrows tangled as a hedge in winter.
‘Yep,’ I say.
He holds my gaze a little while, then relaxes back again.
‘Well, I’ve looked after myself,’ he says. ‘Smoking, drinking – it all comes out in the wash.’
Trudy, his daughter-in-law, stands by with all his bags – the medication and the toiletries, the clean pyjamas and the spare dressing gown, the newspaper, address book, brushes and slippers – whilst we help him into our chair.
‘Don’t spare the horses,’ he says.

*

‘Shame it’s such a short ride to the hospital,’ I say to John, the paperwork done.
‘Hm?’
‘We could’ve had a nice chat. You could’ve told me about your life.’
‘That would take a long time,’ he says. ‘I am ninety-three, you know.’
‘That’s what I mean.’
‘What do you mean?’
‘I mean – for instance – where were you born?’
‘London. Shoreditch.’
‘I know Shoreditch.’
‘Do you?’
‘Yes. I used to live in London. I was born there. Pimlico. Just behind the Tate.’
‘Oh yes,’ he says, closing his eyes and nodding, as if he could see it all laid out in front of him.
‘By the river,’ he says.
‘That’s it.’
‘Ooh!’ says Trudy. ‘Pimlico. Isn’t that quite posh?’
‘It is now. I don’t think it was then.’
Trudy sighs.
‘It’s all gone up market,’ she says, brushing something from the coat on her lap. ‘I think even Shoreditch is dead trendy now.’
‘Ye-es,’ says John. ‘The railways. All that noise and fuss. I used to spend a lot of time in Farringdon. Liverpool Street. The bridges and arches. ‘Course it was all steam in them days. Great crowds of people coming and going. And the noise! One big, tremendous fuss. And they had these enormous sheds where they used to turn the engines round. The steam engines. You know? Oh yes. When I think back. I must have spent half my life in a cloud of smoke.’
‘Did you work on the railways, then?’
What?
He opens his eyes, turns his head and frowns at me again.
‘The railways,’ I say to him. Did you work on them?’
No I did not!’ he says.
‘Here we are!’ says Trudy, folding the coat over her arm and putting a hand to the bags. ‘You were right about the hospital. That was a short ride.’

Friday, January 23, 2015

the other nathan

The Year Two After School Five-a-Side football club have only just started its first game. Ricky goes in for a positive tackle, catches Nathan on the ankle and they both fall over. Ricky gets up; Nathan doesn’t. He lies on the wooden floor of the gym rolling around, groaning and clutching his foot. There’s blood too – a fair bit – and then the shrieking starts.
‘Miss! Miss! There’s a bone sticking out of his foot!’
The rest of the class is quickly ushered outside into the playground. When the teacher looks at the wound she sees a white thing poking up just above his ankle, which, combined with all the blood, makes her think poor Nathan has broken something. Another teacher with a first aid box passes her a gauze dressing which she holds over the wound whilst someone calls for an ambulance.

Luckily we’ve only just cleared up from a job nearby, so we make it there in a couple of minutes.
We struggle with all our bags through a crowd of kids in red and yellow tabards out in the playground, pressing in, cheering, hollering, calling out stuff.
Is he dying?
What’s in there?
What are you gonna do?
Who are you?
Can I watch?
The games teacher fights an impressive rearguard action, though, buying us just enough time to make it through the main doors and into the hall.
Everything’s fine, though. Nathan has a large wart just above the ankle that Ricky’s kick has partially uprooted. We clean and dress the wound.
There’s plenty of art up on the walls. One is a large sheet covered in crazy self-portraits. I see one that says Nathan, with spaghetti hair, spindly arms and legs, apparently standing on his head in a shower of rain.
‘Is that you, then?’
‘Nah. That’s Nathan in Mallard.’
Mum arrives. She says she’ll take him home and they’ll get some advice on the wart in the morning.
Nathan’s very brave. He pulls a sock on over the injured foot and even though he can weight-bear perfectly well, hop-walks arm-in-arm with his Mum out of the gym.
 All his classmates have been carrying on the match on a tarmac enclosure just the other side of the playground, corralled there by the head teacher. But as soon as the doors open and Nathan hops out they abandon the game, rush to the railings and start cheering and clapping again.
‘Haaaaay! Nathan’s alive!’ shouts one.
Finally,’ shouts one from the back.

Thursday, January 15, 2015

a nice bit of plaice

You couldn’t mistake Ralph for anyone else, even at a distance, even in his disguises.
 A short figure with round shoulders and an innocent, flat-footed, music hall kind of waddle, he’s always dressed incongruously, heavy things in summer, light things in winter. I’ve seen him in a Rod Stewart reject nylon bomber jacket and a kilt; a red frock coat and flip-flops, and  a two-sizes too small, canary yellow t-shirt with a baseball cap from USSS Nimitz.
The early hour is the first  clue. Half-past five is Ralph time.
Patient is waiting by the side of the road with his bicycle.
‘I’ve been assaulted,’ he says as we pull up.
‘Who, what, where, Ralph?’
‘I was just coming out of the club when out of nowhere this guy throws a paper cup and it hits me on the back of the head.’
‘That’s not very nice.’
‘No. It wasn’t very nice.’
‘Were you hurt?’
‘I don’t know. That’s why I called you.’
‘Did you fall over? Knock yourself out? That kind of thing?’
‘No. I just come out of there, got on my bike and went home.’
‘You went home?’
‘Yeah, and then I come out again. What do you think? Will I be all right?’
‘A paper cup? I should think so. Do you want us to have a look?’
‘Nah. If you think.’
‘It’s half-past five in the morning, Ralph.’
‘I know.’
‘You went home, and then you came back out again?’
‘Yeah.’
‘Why?’
‘I was worried.’
‘So you’ll be all right now, d’you think?’
‘Yeah.’
‘What are you going to do? Go home again?’
‘Nah. I think I’ll just ride round for a bit.’
‘Aren’t you cold?’
‘I’ll warm up.’
He grabs his bike – cow-horn handlebars, springy seat, fucked brakes – scoots twice to get going and wobbles off round the corner.

The next time I go to him it’s a little more worrying. The same time of day, early morning, with the sky just starting to lighten and a fresh wind coming in off the sea. I recognise his bike lying up on a grass bank, opposite a wholesale fish market. I think for a minute he’s been run over, but I can’t see any cars, any figures sprawled in the road.
One of the porters waves to us from the front gate. He’s smoking a fag, looking glad of the opportunity.
‘It’s nothing,’ he says, taking one last drag and then flicking it away. ‘Funny little fella.’

Ralph is in their office, cradling a mug of tea.
‘Oh – hi!’ he says, looking up.
If it wasn’t for his Hitler moustache and middle-aged skin tones you’d think he was about twelve.
‘How are you doing, Ralph?’
‘Oh, so you know him?’ says the manager.
I nod.
‘What happened this morning, Ralph?’
‘I was assaulted.’
‘Oh? I’m sorry to hear that. Who by?’
Ralph shrugs. ‘I don’t know. I didn’t get a good look.’
‘Young? Old?’
‘Bit of both.’
‘What did they assault you with?’
‘They pushed me off my bike.’
‘Did you hurt yourself?’
He shrugs again.
‘Ralph came in and said he’d been attacked,’ says the manager. ‘That’s why we phoned you guys. Sorry to waste your time.’
‘No! Not at all! It’s very nice of you to do it. Come on, Ralph. Shall we go onto the ambulance and let these people get on with selling fish?’
‘Don’t worry about that. That’s all done,’ says the manager, shuffling some papers together into a neat bundle and dropping them in a tray. ‘We’re just clearing up. You got to get up a bit earlier than that if you want a nice bit of plaice.’

Tuesday, January 13, 2015

cubicled

Just for the record, I always use the men’s toilet in the Urgent Care Centre. Most of my colleagues prefer the staff toilets along from the nurses' rec room, because they’re cleaner, and because there’s less chance of running into patients. The UCC toilets are closer, though, and besides, I’m in such a routine of going there now it’d be bad luck to change.
It’s a tiny, brutally functional kind of place, more like a converted cupboard than a purpose-built facility. There’s just enough room for one sit-down cubicle at the end, and then two urinals and two sinks on opposite walls. Coming in and out is often something that requires a bit of manoeuvring, apologising, polite choreography. And you have to be careful backing up, as you don’t want to nudge anyone in the middle of anything. The door lets out onto the main waiting area for the UCC, too, and sometimes when it’s crowded (which is all the time these days), it can feel like opening a door and inadvertently walking out on stage. Sometimes you half-expect a round of applause.
But as I say, it’s convenient.
There’s a sign up near the drier, a mission statement, and the extension to ring if something doesn’t seem right.
I’ve called it twice.
Once, to clean up the bloody handprints on the wall (where he supported himself at the urinal), the floor (where he dripped), the unholy mess in and around the basin (where he exsanguinated), and around the door where he must have paddled in a last desperate attempt to get out. In fact, ‘getting out’ was harder than getting in, especially without touching anything, although luckily I had some spare gloves in my pocket.
The second time, a man was coming out of the end cubicle just as I came in the main door. He looked innocent enough – Stan Laurel in a Heineken t-shirt and jogging bottoms – which he hoiked up with a satisfied twang before nodding to me pleasantly and, by-passing the wash basins, headed out. He was followed by a tail-stink of such calamitous proportions I felt obliged to investigate. I went up to the cubicle door, pushed it open, and peered inside. A scene of unmitigated horror. He couldn’t have made more of a mess if he’d taken in a weather balloon pumped up with shit, closed the door, and popped it. The pan was the only clean surface in there.
I called the extension.
I felt sorry for the cleaners. I just had to call a number. They were obliged to take some kind of action, go in with rubber gloves, sprays and mops, when anything short of an airstrike would have seemed inhumane.
It’s a tough job. I couldn’t do it.
But I quite like the UCC toilets. They’re part of the rhythm of the place. You notice things, little things, the graffiti, the meta-graffiti, the changes from drier to towels and back again. Mess to clean, clean to mess. Cubicle seasons. I’ll miss them when I go.
I went in once and there was a young guy banging on the cubicle door.
‘There’s someone in there,’ he said, relieved to see someone in uniform. ‘I think he might be in trouble.’
And then I heard it. A deep, rumbling snore.
I recognised the sound, and the idiosyncratic bouquet that accompanied it, wafting under the cubicle door.
‘Is that you, Henry?’
Henry is a street-drinking, frequent flying, sometimes-punching, pain-in-the-butt.
I rap on the door.
Henry!
‘Huh?’
‘You can’t sleep in the cubicle, mate. Other people want to use it. Sleep outside in the waiting area like everyone else.’
Some precarious crashing noises, then the cubicle lock slots back and the door opens. And there he is, the famous salt-and-pepper beard caked in awfulness. He says something dreadful, the verbal equivalent of melting plastic, then blinks twice, leans forward, and lets gravity get to work on his legs.
‘There you go,’ I tell the man. ‘All yours.’
He takes a look inside, stands there indecisively.
‘Thanks,’ he says.

But one of the most thrilling episodes was when I went in the toilets and found two engineers in there, one up a ladder, one on his knees with a wrench. They’d taken the suspended ceiling down and the panels behind the urinals, and suddenly you could see the mysterious workings of the place, the pipes and ducts and so on, and the great, dark space above.
‘Oh my god! It’s actually really high in here!’ I tell them.
‘Yep.’
‘Can I use the erm.. you know?’
‘Yep.’
I stand at the urinal, looking up, like I’m pissing in the Sistine Chapel.
‘Wow!’ I say. ‘It’s a shame you have to put the ceiling back on.’
The one on the ladder looks down on me.
‘Why?’ he says. ‘How much room do you need?’

Sunday, January 11, 2015

april, ken & me

April’s dog Ken is curled up on a leopard-pattern cushion the far side of the sofa. These days he doesn’t even look up, he’s so used to crews coming through the door, all hours of the day and night. It’s a shame he doesn’t look up. It’s always a pleasure to trade glances with those kindly black eyes. Ken is one of the most photogenically scruffy terriers I know, a generous scrawl of extra fur at the end of his muzzle, which, along with his neat build and fancy blue neckerchief, make him look like a famous author resting before another exhausting round of book signings.
‘Don’t get up’ I tell him.
He doesn’t.
April suffers from asthma and recurrent chest infections. The fact that she smokes doesn’t help, firstly because the very last thing her damaged lungs need is smoke, and secondly because it means she can’t have home oxygen. So April is on a loop of treatment every bit as chronic as her condition. She has a cigarette, she struggles to breathe, her inhalers are ineffective, she calls for an ambulance, she responds to treatment or gets taken in for more, depending. Every crew knows the score, but if you haven’t been here much it’s easy to be spooked by the way she presents, unable to speak, the laboured way she breathes, the dreadful wheeze. It’s difficult to resist the urge to treat and move as soon as possible, especially when you read on previous sheets that she’s spent time in ITU with the same. The fact is she does respond, though. She never wants to go to hospital. She wants to stay home, curled up on the sofa with Ken. And no-one can blame her – or for smoking, come to that.
It’s the kind of estate that would have the Dalai Lama tearing the strip off a new pack of Lights. On a notoriously run-down estate, in a tributary of particular awfulness, the close April lives on is a strandline of three storey buildings, many of the flats shuttered up and empty, the communal gardens a no-man’s land for dogs, drunks and dead appliances. It’s a wonder all she does is smoke – and watch DVDs, and snuggle with Ken, and call the ambulance.
We fix her up a neb of Ventolin and Atrovent, and wait for her SATs to improve. I write her sheet out from memory. Not so long ago, in a dizzy rush of ‘let’s fix this’ enthusiasm (now and again I’ll feel it, a gloriously ludicrous urge to jump on my horse and charge the cannons), I tried sending some emails and making some calls. What does the GP make of all this? The Community Respiratory people, the psych team? Are they fully aware? Everyone’s getting it in the neck. Surely there must be something we can do to cut down the number of calls?
‘Honestly – there’s a stack of ambulance sheets about three feet high,’ I tell the Clinical Desk. ‘And that’s just this year.’
‘I know,’ says the paramedic the other end. ‘Let’s have a look at her record. Here we are – averaging two call outs a day every day, except when she’s in hospital. That’s pretty impressive.’
‘So what do you reckon?’
Sigh.
‘I don’t know,’ she says. ‘Perhaps we could move in. At least we’d save on diesel.’
April’s breathing seems okay now – or better than it was, at least.  Still wheezy, but not as bad. She says she’ll see her GP and talk about how things are going when the surgery opens later.
The other end of the sofa Ken takes one of those unexpectedly deep breaths that dogs make when they’re absolutely, fully and most completely relaxed. He licks his chops a couple of times, settles another inch
‘Good boy,’ says April, reaching over to tickle him on the side.
The dog rolls over, exposing a luxuriously furred underbelly. April tickles him there.
‘All right then?’
‘All right.’
I add my sheet to the others. Tidy up.
‘See you later.’
She waves.
April, Ken and me - we know it won’t be long.

Friday, January 09, 2015

dnar

Harold looks less like a man and more like a cruelly animated cadaver. His skeletal frame is stretched out on the bed, the bony scoops and ridges of his skull as clearly defined as a mummy lain a thousand years in a cave. When I lift his pyjama top I can see his lungs still slugging it out behind the bars of his chest; his nose and lips and fingertips a dusty blue, his eyes glassy, his jaw bobbing up and down.
‘He’s still being treated for a chest infection,’ says Sandra, his daughter. ‘It’s set him back.’
Set him back?
‘You won’t be taking him to hospital, will you?’
I hardly know what to say. There’s no palliative care package in place, although it sounds as if it might be in process.
‘Don’t you want him to go to hospital, then?’
‘No! It’d kill him.’
We give him a neb, wire him up to the ECG, run through his obs, take the story. Ninety-two, a few things wrong, poor mobility, mind going, incontinent. Carers three times a day. In and out of hospital, but just this side of a failed discharge.
Miraculously, his SATS improve with the neb. He pinks up, looks a little less distressed.
‘Brilliant,’ says Sandra. ‘That’s done the trick.’
‘Does Harold have a DNAR?’
‘A what?’
‘A DNAR. Do not attempt resuscitation. It’s a form you sign if you don’t want us jumping up and down on Harold’s chest if his heart stops working.’
‘No. We haven’t done one of them.’
‘I don’t want to worry you, Sandra, but Harold was very poorly when we came in the door. Still is, obviously – although thankfully his breathing’s coming back. But his oxygen levels got so low he was in danger of arresting – you know, his heart stopping. And if it had, and you didn’t have the paperwork, we’d have to do something. CPR – pressing up and down on his chest...’
‘Oh, no.’
‘....sticking the pads on, needles in his arms, tube down his throat...’
‘Oh, no, no! He wouldn’t want that. I mean, look at him.’
‘I’m surprised no-one’s talked to you about this before.’
‘No-one’s mentioned it.’
‘I think it needs doing.’
She strokes her Dad’s hand, and he looks up at her over the plastic edge of the neb mask. She brushes the hair clear of his forehead, adjusts the mask on his nose, then holds his hand more positively.
‘You wouldn’t have done all that, though, would you?’ she says to me. ‘All that fuss. I mean – he wouldn’t want it.’
‘I don’t think he would. I don’t think I would.’
‘No. Me neither.’
I unclip the SATS probe from Harold’s finger.
‘We wouldn’t have had a choice, though, as things stand,’ I tell her. ‘When I talk to the out of hours doctor I’ll mention it.’
‘Could you? I think Dad just wants to be nice and comfortable here, at home, don’t you,? Hey?’
She squeezes his frail hand, and he turns his eyes on her again. And although his expression doesn’t change all that much, he returns the squeeze.