The black winter streets resound with our sirens, two ambulances nose to tail through the commuter traffic. Before I joined the service I would have thought this level of noise meant a plane crash, but in this case it means that someone has suffered a cardiac arrest; there’s so much equipment and so much to be done that four people is the optimum number to cope.
Our sat nav takes us to the square, but we have trouble finding the actual flat entrance. There is a moment when we circle in the middle of the wide main road, holding up traffic whilst we consult with each other – where could this be? We’re forced to drive round the square illuminating the numbers with our powerful side lights, but they don’t seem to run consecutively and it’s difficult to work out where the address is. We hear the second crew on the radio ask Control to get the caller to send someone to the door to wave, and after a frustrating couple of minutes the second ambulance picks them out. They go in first with all the bags, and we follow after, pulling on our gloves. The traffic moves on around us as best it can.
The flat is at the top of a narrowly winding flight of stairs. Voices just above us, modulated and calm, both ambulance and family. A man holds a door open for us as we reach the top landing. He has the demeanour of an off-duty priest, his bald head and glasses glinting in the dusty light. He nods and smiles us in the direction we should go, but there’s a rough, gang-like impetus to our progress, and we quickly find ourselves in a square little room with an unmade bed and an elderly woman lying flat on her back on the floor. A middle-aged woman is kneeling beside her holding a phone to one ear whilst with her free hand she presses ineffectually on the woman’s chest like she’s being given directions on how to make a pizza. Steve helps her up and out of the room, whilst Nigel pulls out the defibrillator and I cut her upper clothes away and get down to some chest compressions. After two or three her ribs creak and crack like a dusty wicker basket, and her chest takes on a horribly ruined character. The pads go on and the rhythm identified: fine VF. More compressions for a minute, and the second analysis reveals asystole. The woman’s prospects are bleak, but we go through the twenty minute algorithm. Anne cannulates the patient, and after I’m relieved by Steve on the chest compressions, I put together the drug syringes, flipping off the colour-coded caps and screwing the different cylinders together. Twenty minutes later the woman is still flat, and after a brief consultation we decide that there is nothing more we can do for her.
Anne and Steve finish work in a minute or two, so Nigel and I agree to stay behind, clean up and do the paperwork. Before they go they help us to lift the woman into the bed and straighten the blankets around her. Then as we gather up all the detritus of our rescue attempt and stuff them into a yellow waste bag, they go next door to break the news and make their farewell. Above the bed I notice a simply framed photo of the patient, taken when she was a young woman. She’s looking off to her right, her chin up, ready to engage with life.
I close her eyes.
‘Do you want a cup of tea?’ Then she puts one hand to her forehead and turns to her husband. ‘I can’t believe all this, Brian. Can you believe it? No-one said anything about her heart. It was her brain that was supposed to kill her.’ He nods, raises his eyebrows, smiles across at us. Folds his arms.
The daughter’s name is Stella. She has an intensity about her that her black and white stripy top and her red lipstick only magnifies. All her movements are like the lines on her face, precise but surprising. She is struggling to hold a small, pale whippet under her arm, up on the back of the sofa. It wags its tail so enthusiastically, the only motionless parts of its body are the dark centres of its eyes. I pat its head, then realise I still have my gloves on, and quickly take them off.
‘I took her tea in and she seemed fine. It wasn’t too hot. She usually complains. Doesn’t she, Brian? Then next thing you know, twenty minutes later – it couldn’t have been more than twenty minutes – ‘ (smile confirmation from the husband) ‘twenty minutes later, she’s slumped over. Like this.’ (mimes a slump, then, to the dog) ‘Just look at him! He knows what’s happening. He’s not stupid. Oh, Snuffy, what are you going to do now your mummy’s gone?’
I straighten my form out on a little walnut side table, and click my pen.
‘I just have a few questions to ask you, Stella.’ Then I’m off through the form, getting name, date of birth, GP. ‘Can you tell me your mum’s past medical history?’
‘I’ve got it all written down.’
Stella strides across to a cabinet. When she opens it, a cascade of papers slides out and on to the floor. Brian slowly gets up to help her. After a minute or two of one-sided squabbling about which papers are where, Stella triumphantly extracts a wad of handwritten sheets. She bounds back across to me, followed by the dog.
‘Nine years ago she had a massive sub-arachnoid bleed. It’s all there, look. (Jab. Jab.) They told us it was all over. But she got better – well, I say better. She was in nine weeks and then came home. She was never supposed to make it this far.’
Brian quietly resumes his position over by the window, whilst the dog carries on sniffing my trousers and bullying me to stroke it.
The notes that Stella has kept on her mother’s help are something like a diary. Page after page of closely written lines, a startling mixture of technical jargon and trivial entries. Nine years. It seems too that her mother had quickly developed dementia, and caring for her in the flat must have been incredibly stressful.
Brian clears his throat and then speaks up. ‘What happens next?’ he says.
I tell him that the police will need to be called as this is an unexpected death at home. I tell him that they will stay with them until either the coroner’s office or an appointed undertaker arrive to take the patient to the mortuary or to a chapel of rest.
‘Ah. Thank you,’ he says. ‘You’ve been very kind. Thank you for all your help.’ And he stands up to shake our hands.
‘It reminds me of some words by Leonard Cohen,’ Stella says. ‘What’s that Leonard Cohen song, Brian? Not one of the old ones. One of the new ones. We’re a big fan of Leonard Cohen in this house. Off one of his new albums.’
She hums a few nondescript bars.
‘Lah-dih Lah-dih something, something. Purple … er …. Brian? You know the one?’ Then to us: ‘Leonard Cohen was ever so good.’
‘He’s still with us!’ I say to her.
‘I know – but…’ she trails off. There is a knock on the door and two policeman walk in. They seem enormous in this little flat. I stand up to go and explain the situation to them. As I do so, Brian shakes me by the hand again. ‘Thanks for coming, doing what you could,’ he whispers, as Stella and the dog turn their attention to the police.