above the living room

We are the second crew on scene, but only by a couple of minutes. Their ambulance lights are still on, the urgent sparkling gradually drawing people through their front doors and into their gardens to look.

As the first crew will have already taken in most of the equipment, and following the usual pattern of these things, we simply pull on some blue gloves and hurry in through the open door.

A straight flight of stairs in front of us, and a living room off to the right, desperate words and sobs behind a frosted glass door. A man’s angry voice. Above us we can hear the beep beep beep of the defib’s metronome as the crew works on the patient. We carry on up.

A large elderly man is lying on his back, half in and half out of a bathroom. His head is bloody, gashed above his right eye, and moves slightly from side to side as Lisa pumps his chest; Max has already cut off the man’s vest and attached the defib pads, and now she is putting in an airway. She immediately asks Frank if he’ll go back and fetch an aspirator from the vehicle, as the man has vomited and his airway is compromised. It’s not looking good. Max tells me that the patient had probably been down for about twenty minutes before anything was done. He had collapsed in the bathroom right behind the door, and his wife hadn’t been able to get to him. The first person she’d called was her son who lives a few streets away. He had managed to break the door open, and it was only after that an ambulance was called. When Max had come up the stairs no-one was doing any CPR. A daughter had also turned up, and now they were all together in the sitting room. As if on cue, a keening cry drifts up from below, followed by a crash and some heavy footsteps. A huge man with a boiled face and a dirty brown fleece clumps up the first few stairs and looks up at us:

‘Save my Dad!’ he says, and then shouts ‘Please!’ He pokes his thick black glasses back up his nose, and pauses, as if he was expecting to say something else and is surprised by what actually came out. Then he reverse clumps back down the stairs again and his sounds are reabsorbed into the living room.

I take over the chest compressions to give Lisa a break. Whilst I’m bobbing up and down I look past her into the toilet. The pine seat is in the up position but the top of it has been smashed right across. There is a smear of blood on each broken side, and a sizeable pool on the lino.

Frank appears with the aspirator.

‘It’s all going to kick off downstairs,’ he says, setting the kit up and starting to suck out the vomit from the patient’s airway. His actions are as casual as a maid vacuuming yet another room.

Frank also tells us that he’s called for paramedic back-up and the ETA is only a couple of minutes. All four of us are technicians, which means none of us can intubate the patient or give them the drugs that might make a difference.

After every couple of minutes we check the defib screen for rhythm, but each time it is the same – asystole, or flat-line. Non-shockable, and a poor prognosis.

Alistair the paramedic arrives. Max describes the situation so far, and after a brief review, Alistair starts in by intubating the patient, expertly wielding his laryngoscope: Obese patient? No neck? – No problem. Then he’s busy with his intra-osseous drill, whistling into the patient’s tibia, and ready in seconds to push through the usual sequence of atropine and adrenaline. After the drugs have gone in for the first round, we settle in to monitor the final phases of the resus. And now the contrast between upstairs and downstairs is profound: shouts from the living room, polite technicalities on the landing. With some quiet gossip. Did you know so-and-so’s suspended? Going out with who? How’s that mad dog of yours? Now and again checking the screen; taking it in turns on the chest. I notice a toilet roll cover on the cistern – Little Bo Peep, one china hand to her eye line, one hand holding up a crook. As if that will help. But the roll under her dress might.

The resus protocol rolls along its allotted path, but after twenty minutes the patient is only showing a dead heart synthetically jerked by drugs. Alistair consults with us all, and we start turning things off. He goes down to break the news to the family.

‘Watch the son,’ says Frank.

Now our efforts are aimed at making the patient more presentable. I hoist Bo Peep off her perch and place her beside the toilet roll, where she deflates sideways into a chintzy faint. I tear off wads of tissue to clean the blood and vomit from the patient’s face, and then stuff them into the yellow waste bag. We put his arms along his sides and drape a blanket over him.

There’s a shout from downstairs, more urgent than anything so far. Max is already down there and she calls for help; the mother has collapsed in the kitchen. Lisa takes up the oxygen cylinder and runs down. She passes the daughter coming up the stairs two at a time, a fifty year old woman as narrow as her brother is wide, hugging a large teddy bear, which she dumps amongst all the equipment, drops to her knees, and hugs her father’s head instead.

We stand to one side and give them some space, but eventually I touch her on the shoulder. When she looks up at me I ask if we can have a little time to get rid of all our gear, so everyone can have the room and time they need to be with her father. She wipes her nose on her sleeve and nods. I hand the teddy bear back to her, and she trudges back down the stairs.

Once the landing is clear, we have a final chat to the first crew. Max tells us that the patient’s wife has come round. It was a simple faint, and she’s recovering nicely. They’re happy to stay on scene until the police arrive to take over, so we are free to go. Outside we see Alistair slamming the boot shut on his response car. He comes over to us.

‘The son – what a case!’ he says. ‘He came barrelling past when I went into the living room. There was a guy outside on the pavement, a neighbour or something, and when he asked him what was going on, what all the ambulances were for, the son punched him in the face and then ran off.’

‘Where’s the guy he hit?’

‘He ran after him.’

Frank snorts, shakes his head, then gives a little stretch. ‘Come on,’ he yawns. ‘Lunch time. Gotta be.’