the crumpled cigarette

The main shopping thoroughfare may be free-flowing with buses and taxis and people, but the discrete little stubs of pavement, alleyways and back entrances that serve it are so clogged with utilitarian chaos, and there are so many office workers lunching in the sunshine outside obscure new cafés, Rae is forced not so much to drive the ambulance as to insinuate it through to the location given for our next patient.
Eventually we make out the likeliest candidate, a down-at-heel, middle-aged man sat flatly on his arse on a stretch of bare concrete behind a smart little mews garage, his legs crooked up, his arms on his knees, and his face propped on the right hand whilst the left serves his mouth with a cigarette. With the cans of lager around his feet, and his relaxed, relentless smoking, he looks like some weary philosopher, taking his ease whilst the world goes to hell.
Just next to him is a sweating businessman, urgently talking into a mobile phone. He nods to me – a cursory little tip of the head, as if he’s acknowledging one delivery whilst negotiating another – then takes a step to the side. I climb out of the cab and walk over to them whilst Rae manoeuvres the vehicle into a better position.
I squat down next to the patient, but before I have a chance to say anything, the businessman clips the phone shut then taps me on the shoulder with it.
‘For God sake, let him finish his cigarette,’ he says.
‘Hold on. Are you a relative?’
‘I called you,’ he says, showing me the phone, then stuffing it in his trouser pocket. ‘I called you. Is he going to be all right? I hate to see this. It just kills me to see stuff like this. I’m sorry if I’m a bit – emotional. My twin sister committed suicide two weeks ago and I’m not over it yet.’
‘Well I’m very sorry to hear about your sister,’ I say, squinting up at him, gauging whether I should stand and take a step back. Instead, I opt for the neutral calm I’d try to show before an angry dog. ‘That must be tough. Look. Thank you very much for calling us out to see this guy. But - I just need to ask him a few questions to see what the problem is. Okay?’
‘I mean – just look at him. He’s terribly, terribly sick. You must help him.’ But I study the businessman instead. His face is a more ghastly colour than the stripes on his tie. Booze fumes roll from him like scent from a cheap odouriser; he seems to be on the verge of tears.
‘If you’d like to step to one side – for one moment? Then I can get on and see exactly what this guy needs from us. Okay?’
‘Sorry. Sorry. I just – well, my sister dying like that. I see the ambulance. I see the guy lying there. And it’s just – well, you do what you can for him. I know you will.’
But instead of moving aside, he kneels down on the concrete next to the patient, who becomes slightly more alert, but not much. He takes his right hand in between both of his – which obviously inconveniences the patient, as he now has to support his head on his neck – and squeezes affectionately. The patient stares out at him from behind his heavy eyelids.
‘Get better, mate. Please. You’re in good hands now.’ The businessman releases his grip, produces a cigarette and puts it in his mouth. I have to tell him it’s the wrong way round.
‘These guys really know what they’re doing,’ he says, as if that just proved it. Distractedly, he stuffs the cigarette into his breast pocket. ‘They’ll do their very best for you, mate. Don’t worry. I’m sure the worst is over.’
I tell the patient that I’d like to talk to him on the ambulance so we can take a few details in private. He stands up with a little help, and I walk him to the back of the vehicle. The businessman tags along.
‘Are you taking him to the hospital?’ he says.
‘Well, that’s certainly one option. But anyway – thank you very much for all your help. I think we’ll be okay now.’
‘I’ll wait just over here. Let me know what happens,’ he says, pulling his phone out again.

Safe inside the vehicle I talk to the patient. He’s not unwell, simply worn down by his life, as drunk as he needs to be at this time of day, waiting on yet another appointment with the alcohol dependency team, the community psychiatric nurse, the housing support worker. He thanks us for coming out, apologises for wasting our time. He stumbles back off the ambulance.
Outside, the businessman closes in again.
‘What? What are you doing? Aren’t you taking him to hospital?’
‘No. He doesn’t need to go. He doesn’t want to go,’ I tell him.
Whilst the patient goes to sit back down on the concrete, the businessman follows me round to the cab.
‘Sorry if I’ve been a bit – emotional,’ he says, then gives a big, deflationary sigh. He pats himself down for a cigarette, eventually alighting on his breast pocket. ‘This thing with my sister. My twin, you know.’ He hauls out the crumpled cigarette and holds it up in front of him. We both stare at it, and his eyes seem to fill, as if he’s focusing on the remains of something vital he’d momentarily overlooked.