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As we pull up to the kerb there is a thin, grey man meticulously folding away an orange lawn mower lead. He doesn’t even look up as I open the door of the ambulance to climb out, and when I smile at him and ask if the patient is inside – a dumb question, I know, but the first thing that comes to mind as a conversation opener – he merely shrugs in the direction of the house, and carefully clips the lead to the back of the mower.

We discount this man as a source of information, and carry on into the house. At the open doorway I can hear animalistic snorts and howls.

A frail looking woman appears in the hallway. Her eyes are bleach blue, and she seems so brittle that beneath her practical clothes she could easily be made of twigs.

‘He’s just through here,’ she says, scooping her hair back from her face and finding something that approximates a smile. ‘What have you been told?’

‘Nothing much,’ I say. We’ve been given this as an Urgent journey, eighteen year old male with query fractured ankle. The GP has seen this patient and ordered an ambulance to convey the patient within four hours. I’m already suspicious that there’s very much more to say than that, but we follow on in silence.

She leads us along a hallway into a dimly lit lounge area, with a large TV playing a video of Trumpton. Dominating the opposite side of the room is a plush, four-seater brown leather sofa, and occupying the entire length of this, a figure so massively pale and naked it’s difficult not to stop still and say ‘Whoa!’

The boy’s huge arms are crooked above his head, like a gorilla in a bower. He grunts, scratches himself, and lies there breathing massively.

He is astonishing. He is the fattest, barest, most abundantly fleshy human being I have ever seen. His abdomen rises upwards with the hyper-inflated tension of a space hopper, and his breasts lie slung either side of his chest like saddlebags filled with jelly. When he kicks his legs out straight, his entire being – from the hanging folds of his thighs to the multiple layers of his chin – ripples and jiggles, whilst his brave little penis waggles up like a hitchhiking sea creature on the underside of a great albino whale.

His mother sits down next to him on the sofa. Immediately the boy gives her a whumping great palm slap on the back, which she absorbs with a little forced exhalation and a leaning forward onto her knees. He follows it up by grabbing a handful of the skin under her upper arm, which she can only release by using a few key words. Her arms are patterned with bruises. It’s difficult to believe she could last five minutes in this boy’s company.

‘As you can see, Simon is quite demanding,’ she says, stroking his forehead. His dark eyes slide from side to side and he groans again.

‘He has some behavioural issues. We look after him full time because there was no way I was going to put him into a home.’

I wonder about the ‘we’ in this, but at that moment two other large people come down the stairs and into the lounge. They smile at us, and then stand watching with their arms folded. They are Simon’s elder brother and sister.

‘Simon gets frustrated sometimes and runs about the house shouting and stamping his feet. Yesterday he put his foot through the floor and fell over. We think he may have broken his ankle.’

The brother laughs. ‘Look around you. He’s always putting his foot through the floor.’

He is right. The carpet dips in many places around the room, a lunar landscape laid out in caramel shag pile. Meanwhile, the TV booms on – Windy Miller standing outside his windmill, shocked at something.

‘Could we put the telly off for a moment?’, I ask them.

‘No. Sorry. Simon has to have the telly on constantly.’ The woman’s tone is even, a simple laying out of rules.

The brother laughs again. ‘He has to have the same video. It’s on endless repeat. He’ll have this one on for a day or two, and then he’ll let us put a different one on.’

‘And the curtains must always be closed,’ says the sister. ‘He doesn’t like daylight.’

I ask if Simon will mind if I take a look at his ankle. The woman says that with her help he’ll let me touch it, so I warily move closer.

After a few judicious prods, I tell the mother that I think he probably sprained the ankle. The fact that he bore his weight for a while after the accident would seem to support that, but without an x-ray it’s impossible to say for sure. But the mother says that he will not take any weight on the injured foot now. Which leads us to the problem that was obvious from the second we entered the room – how do we transport this patient? I can tell immediately that the trolley will not get through the front door, and even if it could, we would need at least six people to get him off the sofa. But even then, his volatile temper is going to be difficult to manage.

I wonder to myself why the GP neglected to mention any of this.

But the mother has a plan.

‘You carry diazepam, don’t you? Well, why don’t you load him up with that, so he’s nice and docile. Then it’s just a question of hauling him outside onto the vehicle.’

Frank is the paramedic and he speaks up. ‘That’s not what we use it for, madam. It’s for fitting patients. We don’t go around tranquilizing people.’

The mother rubs her forehead, stands up stiffly, and goes over to a sideboard where there is a big white bowl of imperial mints. She pops one in her mouth, and then says: ‘But what else can we do? I don’t know what else to do.’

‘No. It’s not going to happen. Absolutely not. I’d be struck off.’

The brother and sister look on with their arms folded as benevolently as before.

‘Simon does leave the house occasionally,’ the sister says brightly. ‘In fact, he tells us when he wants to go out.’

‘He doesn’t tell us. He just charges outside and climbs in the wagon,’ chips in the brother.

‘But that’s was when he could walk,’ she says. ‘Would you like a cup of tea?’

***

Half an hour later we are still in this twilight room. Frank is slumped on a kitchen chair with a cup of tea cradled in his hands, his expression as deadpan as Windy Miller in the video, who continues to march in and out of his windmill with a suicidal disregard for the blades that slice past the doorway. Meanwhile, I have made phone calls to Control and the GP and passed the phone to the mother a few times, and haggled with everyone, whilst Simon snorts and groans a few feet away, an amplified version of my own frustration.

‘So here’s where we are,’ I say, finally. ‘You need to decide whether or not you want Simon to stay at home, take anti-inflammatory drugs, keep the foot rested up with cold compresses, and see if the ankle gets better – which it very well might – or go to A&E for a x-ray. If you decide to go to hospital, it’s going to need some special arrangements. The GP will have to be here beforehand to give a sedative, and then we’ll need at least three ambulance crews and a wide, patient transport vehicle with a specially adapted wheelchair.’

The mother stares at me, and crunches her mint.

‘Whatever you decide, it won’t be happening in the next hour or so. Which means we really ought to be going. I'm sorry.’

The mother signs our form to release us. Frank hands back the cup of tea with a stretch and a thanks-very-much. We leave, and the door closes on some throaty lowing from the sofa.

Outside, the smell of cut grass is intoxicating.