Sunday, November 23, 2014

in the zone

Just a couple of years ago there were fields and trees here. Now, after an overnight shower, a small village has sprung up, so complete – with a central square, a village hall, a playground, a jogging track, and a variety of building styles from faux-thatch to balconied apartment to terraced house – you’d think the whole thing was designed on a computer and printed out brick by beam in a giant warehouse. Even the street names sound google-generated. Middle Way; Church Close; Woodvale Mead; Upton Hill.  The name of the village is spelled out on the access road in a line of fibreglass standing stones. Aligned with the city, no doubt.
I always get lost here. SatNav gives up, dumping its arrow in the middle of an approximate grey, marked Erewhon. When I stop to ask a postman, even he looks round, scratching his chin.
Pine Tree Close actually has three Rowans, still with their labels attached, planted in a raised central bed in the middle of a courtyard. There are six bunaglows arranged round them in a C-shape, the whole thing railed off, with access by a ramp left and right or a series of shallow steps up the centre.
I’ve been called to number three. A cause for concern. Apparently someone rang 999 asking for help, but hung up when the call-taker started asking questions. They hadn’t answered when the call-taker rang back, so could I go and check out the address?
I knock on the door. A young woman answers, smiling, but obviously a little alarmed to see me.
‘Sorry to bother you. We took a treble nine call from this address about ten minutes ago. I’ve no idea what the problem was or who called. They hung up before we got any more information and didn’t answer when we tried to ring them back.’
‘Really? Well there’s just me and my husband here, and we haven’t made any calls.’
Her husband appears behind her, cuddling a baby in a stripy baby-grow.
‘Everything all right?’ he says. The baby wobbles its head round to look.
‘He says someone called 999 from this address.’
‘I don’t think so,’ says the man. ‘Why? What did they say was wrong?’
I shrug.
‘I don’t know any more than that. It was a landline...’ I read out the number.
‘Nope. Never heard of it. We haven’t even got a landline. We just use our mobiles.’
‘Okay. Definitely not here, then.’
‘Maybe it’s a hoax.’
‘Could be. It’s strange that the number tracked here though. I’ll get back to Control and let them know.’
‘Do you think it could be Janet, the old woman who lives next door? She’s had the ambulance out a few weeks ago.’
‘Really? I’ll nip next door and give her a knock. Sorry to disturb you.’
‘No, that’s okay. It’s all a bit mysterious, isn’t it?’
They stand under the porch and watch me go next door.
I knock and wait. Ring the bell. Knock again.
‘No answer!’ I say to the young couple.
They smile and shrug.
The elderly woman from number five comes outside.
‘Whatever’s the matter?’ she says.
I tell her.
‘Well Janet’s not there. She’s been in hospital for the last six weeks with her hip. I don’t think it’s her. Unless she took her emergency button thingummy with her and pressed it by mistake.’
‘That wouldn’t account for the odd phone number, though.’
‘No. Well. I’m a bit stumped. And before you ask it definitely wasn’t me.’
‘Don’t worry. I think I’ve tried all the options.’
‘What about Mrs Duckworth? She’s not had the ambulance before, but I know she had a dose of the whatsits last week. Maybe she got into trouble. I’ll go and have a look.’
A man in one of the bungalows immediately opposite comes to his door.
‘What’s going on?’ he says. ‘Can I help?’
‘Someone’s had an emergency and we can’t find out who,’ says the elderly woman. She starts thumping on Mrs Duckworth’s door, then peering through the side window.
‘Is everything all right?’ says the man’s wife, appearing behind him with a vegetable peeler in one hand and a potato in the other.
I walk into the centre of the courtyard so I can talk to them all at once.
‘Someone rang 999 – don’t know why or what’s wrong – then hung up before we could find out anything else. The number apparently tracked to number three..’
‘It’s not us,’ says number three.
‘We’re fine,’ says the husband. ‘Aren’t we?’ (holding the baby up as proof).
‘I’ll give Roisin a call to see she’s okay’ says the man.
‘Oh, yes. You’d better. She had that thing not so long ago.’
He knocks on Roisin’s door.
‘She’s probably still at work’ says the man, knocking on the window. ‘Do you want me to go round the back and check there?’
‘If you like. I shouldn’t think it is her, though. I’m just waiting for Control to get back to me with more information. I expect it’s all just a technical glitch.
They all nod. It seems to be a popular explanation.
‘You don’t like to think of someone being in trouble like that,’ says the elderly woman at number five.
‘But they hung up. You wouldn’t hang up if you were really in trouble. Would you?’
‘Maybe the battery on their phone packed up?’ says the woman with the potato and peeler. ‘Our one’s pretty rubbish.’
My radio buzzes. I wave it in the air a little as if to say: Here we are. This’ll tell us.
I describe what I’ve found to Control, saying rather dramatically that I’ve knocked up everyone in the close but had no luck. The Dispatcher tells me that they’ll mark it as nothing found, and refer it to police to see if they’ve got anything to add. She stands me down. I clip the radio back on my belt.
‘Well! That’s it! Thanks for all your help!’
I pick up my bag and do a little turn in the middle of the courtyard, like I’m waving goodbye on a revolving stage.
‘Nice to meet you all.’
‘You too.’
‘Hope the rest of your shift is less eventful.’
‘I hope you find your next patient’
I walk down the central stairs, put my bag back in the ambulance car, and finish writing the paperwork.
Half-way through, the radio buzzes again.
‘The number definitely maps to that address’ says the Dispatcher. ‘Are you sure the patient wasn’t there?’
‘Positive. It’s a happy, healthy young family. They don’t even have a landline.’
‘Oh well. If you’re sure.’
‘Unless I’m in The Twilight Zone and everyone here’s an actor or something.’
‘Right’ says the Dispatcher. ‘Twilight Zone. I’ll make a note. Okay. Back to base.’
‘Wherever that is.’
And of course, even though I concentrate and try really hard to simply retrace my steps back out of the village, I end up getting lost.

Saturday, November 22, 2014

not long

Ted is ninety-three. Five years ago he had a serious stroke that left him bed-bound, unable to speak, incontinent, swallowing problems and so on. The best he can do is intimate pain – everything else is subject to the attention and good offices of the nursing home staff. He’s padded and catheterised, spoon-fed pureed food. He takes a dozen meds including prophylactic antibiotics for urine and chest infections. Every morning after breakfast Ted is hoisted out of bed to a wheelchair, bolstered with cushions, then pushed through to the lounge where he sits with his back to the window, facing the TV. There is no DNAR.
The last couple of days Ted has stopped eating and drinking. There’s a suggestion that he may have had another stroke but of course it’s difficult to say. The doctor was informed over the phone. After reviewing the situation he arranged for Ted to be collected by ambulance and brought to hospital with a view to fitting him with a PEG – a tube that passes through the abdominal wall to the stomach.
He’ll be admitted via A&E, pending an available bed further up the chain.
Ted’s daughter Fiona arrives. We tell her how things stand at the hospital, the delays, the queues in the triage area. She’s quite stoical about it. She says she faced a similar ordeal a few months back when he was admitted with his breathing.
She rests a hand on his shoulder and leans in to shout in his ear. Don’t worry Dad. I’m coming with you.
He stares ahead, his mouth hanging open.
The nursing staff hoist him onto our trolley. We collect his notes, his medication, his personal effects. We head out of the lounge to the lift.
‘Going on a trip?’ says one of the nursing staff, holding the lift door for us. ‘Have a good one!’
We ride down, the bright down spots of the lift casting all our eyes in shadow.
Fiona pats Ted on the hand, fusses with his blankets.
We wheel the trolley through the lobby, passed a potted fern, a couple of soft focus canvases, four leather armchairs round a glass table displaying a circle of leaflets.
Fiona takes a call on her mobile, makes arrangements.
An assitant in the lobby keys a sequence into a pad and the doors slide open. The wind out in the car park hits us cold, blowing in from the sea across a swathe of dark, freshly-tilled earth.
‘Won’t be long now,’ says Fiona.
There’s no reaction.

Wednesday, November 19, 2014

POV

Mark lies back on the trolley, staring up at the cabin spotlights. Every now and again he runs the tip of his tongue over his lips in a circular sweep.
‘They don’t half dry you out, them tablets,’ he says.
Mark had a sub-arachnoid haemorrhage five years ago. One of the side effects was short term memory loss. The majority of his meds are in a blister pack, but for one reason or another the Quetiapine was sent to him in a separate box. He overdosed last night. His CPN has sent him in for treatment.
All Mark’s obs are fine, but he’s told us about some hallucinations.
‘Are you having them now?’
‘Oh, all the time,’ he says. ‘It’s nothing to do with the meds. It’s just another side-effect of the bleed.’
‘How would you describe these hallucinations?’
He rubs his face with his hands, then turns to look at me.
‘Sometimes it’s just these big, shimmering spiderwebs. All colours – draped everywhere. And then other times, like now, it’s dead people.’
‘Dead people?’
‘Yeah. As real as you sitting there. A big crowd, hundreds, all huddled up. So close you can only see this much...’
He makes a frame with his hands, thumb and forefinger at right-angle, right over left, showing his eyes and nose. He stares at me like that for a moment, then relaxes his hands again.
‘That’s it. They don’t do much. You know what? I wish there was some machine I could plug into, like a PS4 or something. Then maybe we could touch hands and you could see what I see.’
‘I think I’d freak out.’
‘Yeah? Well. Maybe you would.’
He relaxes back on the trolley and licks his lips again.
‘I did, to begin with,’ he says. ‘You get used it.’

Sunday, November 16, 2014

ten minutes

Elizabeth is waiting for us in the conservatory. A tall, powerfully-built woman in her seventies, she has the worn, slightly bewildered demeanour of an athlete who threw a javelin so hard it never came back to earth.
‘David’s in the bathroom,’ she says, pushing the silvery strands of her hair back and showing us inside. ‘He didn’t fall with a terrible clatter or anything, but he’s rather unsteady on his feet and a little reluctant to bend in the middle. I tried to get him up myself, but I’m afraid I couldn’t quite manage it. He’s had problems with his back for years. The other thing is a touch of dementia, but we rub along, you know? So sorry to call you out like this.’
The house is tastefully decorated, landscape watercolours on the walls, silver photoframes on highly-polished furniture, the whole place as neat and perfect as an illustration in a country catalogue. A chair lift snakes round the balustrade up to a sunlit landing and the mosaic-tiled wet room where David is lying on his back, surrounded by cushions. He’s as olympian as his wife, except his health has taken more of a battering. His eyes are a pearlescent gray, and his hands shake when they reach out to us, flailing around without focus when we manipulate him into a better position.
We use our inflatable cushion to get David up from the floor. He can weight bear, but paddles his feet in a dangerously unstable way. We fetch a chair for him to sit on, and stand close in to keep him there whilst we consider our options.
‘Is this shaking new?’
‘No. They think it’s benign, though. Not Parkinson’s. Look – before you say anything – I just want you to know that hospital’s not an option. We’ve had a rotten time of it these last few months. David simply cannot go back there. I hope you understand. It may take some time to get him down the corridor and back to bed, but if you wouldn’t mind bearing with us I’d be terribly grateful.’
In the end we have to wheel him there on a commode. Even alongside the bed, David doesn’t seem able to make the transition. We help him to stand as positively and simply as we can, but at the last minute he loses confidence, relaxes his knees, and we have to sit him back down again. He’s easily distracted, and struggles to understand our instructions.
‘Come on darling,’ says Elizabeth, stroking his silver hair flat and kissing the top of his head. ‘There’s a good boy. We’ll get you to bed. You’ll be comfortable there. You can watch Countryfile. You know how much you enjoyed that last time.’
When she looks up at us she starts to cry.
‘He wasn’t always like this,’ she says. ‘He could do the Times crossword in ten minutes flat. Couldn’t you, darling? Ten minutes?’
She kisses his head again. He turns his head from side to side, like he’s struggling to pinpoint something he can hear in the distance.
‘Not the quick crossword. The cryptic one, you know? The difficult one.’ Then ‘Come on, David. You can do it. You’ve got to do it. One last try.’

Saturday, November 15, 2014

noise

We walk along a corridor bathed in an unearthly blue light through to the living room where Gillian is waiting, sitting on a leather sofa with a German short-haired Pointer by her side. On the wall opposite is a giant plasma screen sectioned into six, each segment the feed from a different security camera – views of the front of the house, the back, the garage, even the roof. There’s a server in one corner of the living room, a couple of laptops, only one open and on. Behind the sofa is an exercise bike, still in its wrapping. Apart from a large cage for the dog, the room is bare.
The Pointer looks up as we come in; Gillian does not.
I make the introductions; she quietly acknowledges.
‘I understand you’ve been feeling depressed tonight and cut yourself with a razor. Is that right, Gillian?’
She rolls up her sleeve and shows me the wound, a superficial scrape.
‘Have you done anything else to hurt yourself? Taken any pills?’
‘No. Just this.’
‘Your boyfriend called us…’
Ex-boyfriend…’
‘He said you sent him a text with a picture of you cutting yourself.’
She shrugs.
‘And words to the effect you were thinking of doing more.’
‘Yeah? Well – I didn’t.’
Rae dresses the wound. The dog jumps off the sofa to help. We have a laugh about that.
Gillian says she got angry when her boyfriend said he didn’t believe in her business. He should be more supportive. He doesn’t understand what she’s had to go through to get this far. He doesn’t know what she’s up against.
‘What are you up against?’
‘Oh. You know. Competitors.’
The dog has lost interest in the contents of Rae’s dressings bag. He walks over to his cage, turns round a couple of times, collapses in a compact heap.
‘I’m not going to hospital,’ Gillian says. ‘I didn’t even call you.’
We tell her it’s important she speaks to someone about what happened here tonight. Perhaps she could see her GP in the morning?
Gillian snorts.
‘I don’t think so,’ she says. ‘He just wants to get me medicated, but I’m like – no way. I don’t even smoke cannabis anymore.’
‘It doesn’t necessarily mean medication, Gillian. He could refer you on for some therapy. It might help to talk things through with someone.’
‘Yeah? Well – I tried all that and look how far it got me. I just want to be left alone to focus on the business. It’s a difficult time. Everything else, it’s just…’
She looks around, at the screens, the dog, the computers. Us.
‘…I don’t know… noise.’

Thursday, November 13, 2014

spelling ebe

The notes that come through on this job are comprehensive in the extreme. Update after update comes through. I scroll down, reading it all out to Rae as she drives, the medical history, social aspects, interventions made, comments from the community health team, latterly the doctor.
‘Hat size?’ says Rae, turning into the street. ‘Star sign?’
‘Doesn’t say.’
She tuts.

There are so many people of different ages outside in the garden or inside, milling around the various rooms, it feels like we’re crashing a family party. From the accents and skin tones I would guess they’re of North African origin. Everyone’s pleased to see us, thanking us profusely – so much so you’d think we were taking the patient away for good rather than a routine admission to hospital.
A way is cleared for us to the front room where the patient is sitting in an armchair waiting. He has enormous gravitas. In his bright, orange print shirt and purple trousers, he looks like the elder statesman of the family. Even though he’s quite frail, he still manages a welcoming smile as I introduce us and crouch down in front of his chair. I half-expect him to lay a hand on my shoulder and the crowd that has gathered in the doorway behind us to applaud.
‘So – hello!’ I begin with a flourish. ‘We’ve been told quite a bit already – the reason we’re taking you to hospital, the history of this and that. But first things first. How do we pronounce your name?’
He carries on smiling, but frowns a little.
‘Aleef? Aleef-ay? I’m not sure. How do you say it?’
The smile straightens out. The patient looks off to the side, to an elderly woman who’s standing there with a carrier bag of meds. She comes forward and lays a reassuring hand on his shoulder.
It’s an unexpected turn of events, and early on, too.
‘Look. Let me show you.’
I hold out the clipboard, and point out the name I’ve written in caps on the report sheet, copied down from the notes control sent through. I spell it out.
‘A-L-I-F-E. How do you pronounce that?’
The patient stares at the form, then at me.
‘Alfie’ he says.

Wednesday, November 12, 2014

somebody

There are half a dozen pigeons sheltering in the lee of the sandwich bar. They’re huddled up in an orderly line, perched as best they can on a ledge out of the rain. They only blink as we pass.
The guy in the sandwich bar stands behind the counter with a half baguette in one hand and a buttered knife in the other, fifty-fifty whether he feeds us or stabs us to death. No, there hasn’t been anyone in asking for help. No, I haven’t heard anyone saying they’re depressed. Everyone’s depressed. I’m depressed. Look outside. What else you gonna be?
We thank him for his time and back away.
The sandwich bar sits on the street side of a small green space, an iron-railed square of lawn with a couple of benches, a few maple trees – just enough room to swing a baguette, make a phone call, call an ambulance. On a sunny day, maybe. Today, a kingdom of cloud has fallen to earth, and nothing that isn’t desperate, waterproof or a good swimmer is abroad.
We call Control and tell them we can’t find our patient. They tell us to stand by whilst they try to get more information.
We retreat back to the cab.
The notes are pretty specific, if badly typed.
Male, thirty-two / hx bipolar and dpressin / meds not wowking / worried will loose control / was watching tv prog about war / now in sandwwch bar.
We sit in the cab and wait.
The high street traffic shushes by in super-wet slo-mo, headlights on in the middle of the day. Those people who absolutely have to be out are walking quickly, hunched forward, prisoners exercising in a yard.
We both take something out of our lunchboxes and eat quietly, watching it all, listening to the radio. Gotye: Somebody that I used to know.
Rae turns it up. There’s something peculiarly fitting about that xylophone riff, something darkly comic, like a toy robot wound up and set walking towards a drop.
Control call us back.
Stand down higher priority.
We move off into the traffic.