use your head

This is a steep street of small shops and cafes, many of them still following the Edwardian layout of bay fronted windows and recessed doorways to flats above. It’s midnight, dark and threatening rain. We struggle to read the numbers on the shops, and those that we do find don’t seem to follow a logical pattern. I’m just about to call up Control to ask for some help in locating the address, when a man steps out from an alleyway a little in front of us. He gives us a discrete nod, and looks up and down the street. I hang up the radio and we pull level with him. Ellie, the trainee technician I’m working with tonight, lowers the window.
‘Are you the patient?’
He nods again, and unfolds his arms.
‘Chest pain?’
‘Let’s just get inside, shall we?’ he says.
Ellie taps the ‘at scene’ button, and we both get out. By the time I have come round the front of the vehicle, she has opened the side door, put on the interior lights, the patient has jumped inside ahead of her and taken up position on the forward seat. I’m unnerved by the sequence so far. It feels as if the patient has snatched a lead on the normal run of things, first onto the back of the ambulance, sitting above us as we climb up into the back. I feel exposed, wrong-footed. It has not started well.
And getting a clear look at Keith beneath the harsh strip lights, I don’t feel any easier.

He is a tall, spare middle-aged man in a dirty yellow t-shirt and jeans, already sitting with the air of someone consciously holding himself in check, his hands resting in his lap and his feet evenly placed on the floor. He has a roughly carved head, the kind of face you could imagine climbing without ropes. But despite the angular chin, broken nose and cheekbones, his mouth is a little cupid’s bow, and when he talks – quietly, with an effeminate sibilance – he reveals two rows of crooked yellow teeth, sharp like a predatory fish. The most worrying thing about Keith, though, is the disconnection between the grey eyes and the smile he uses to punctuate his monologue.

‘I don’t know how much you know about my case. Yes – I was up at the hospital earlier today and yes – I did self discharge. But this pain. I tell you, I’ve got an immense tolerance for pain. Far more than the average person, far more than you. I was captain on a merchant ship for ten years. I’ve worked harder than you could possibly imagine and never been sick. I’ve taken knocks that would’ve killed a lesser man. I know all about pain, my friend. But let me tell you – this is worse than anything I’ve experienced. You see, the police know where to punch you. They’re trained. This one – he punches me here (centre of chest) with his knuckle, so it digs in – but doesn’t show bruising. And here, right on the point of the shoulder. He’s damaged the nerve. I can’t remember the name of it. I know a great deal about anatomy. I worked as a mortician’s assistant for years. I have an incredible knowledge – the whole body, its systems, muscles. Much greater than yours. I’ve personally opened up four hundred and fifty corpses for autopsy. You see, the police have this idea that I’m a violent person. I’ve spent the last ten years fighting it. I’m currently in dispute with the PCT about the fact that I’ve been put on the violent patient’s register. I’m not supposed to visit the doctor or the dentist without a police escort. How crazy is that? All because a while ago I went to see my GP, told him about my problems, he tried to tell me what was wrong, didn’t like it when I put him right. I don’t see any sense in being pushed around, especially by someone who knows a lot less than me. So admittedly I may have been a bit too – positive, shall we say? - in my defence, and end up on the register. Without appeal. And everyone has access to it, police included, and anytime anything happens, they come down heavy on me, and treat me like this.

‘But I am not a violent man. I’m a tough man, yes. I have great physical courage. But I’m not a violent man. And there’s a difference. It’s called self control. Let me explain. I’ve faced up to all kinds of assaults and abuse, but I’ve stood there like this (smiles and nods). I’ve looked down on this or that person, recognised them for what they were, and done nothing, knowing in myself exactly what I could do. Choosing not to react, simply holding off. Of course, I know I could completely destroy anyone who tried it on with me, so what have I got to prove? Nothing, my friend, and there’s the real power. Let me explain. Once there was this guy in a pub, big guy – you know - and he kept needling me and needling me, saying “Go on then, see what you’ll get if you start something”. This went on for ages. I did nothing, and I did nothing, until finally I heard this voice inside me. Do you know what it said? It said, very simply: ‘Come on Keith. Use your head’ What I thought it meant was – ‘Think about this. Don’t react.’ But then I realised what it actually meant was ‘Use your head’ – So I head butted him. He needed twenty eight stitches. Was in hospital for a week. But I know what a bottle can do, and that’s worse. So it was the kinder option.

‘Let me take my top off so you can do your observations. I’ve already had an ECG today at the hospital and it was fine. They said I have the heart of a twenty year old. But I could’ve told them that.’

He pulls off his t-shirt. His torso is rangy and scarred, with a coarse black spread of chest hair. Some hospital dots are still in place.

I’m trying to think of some way to get across to Ellie that we need to get this person off the ambulance as soon as possible, but she seems pinned to her seat.

In a blanched whisper she asks him the name of his doctor. The volume of his voice increases, the tone drops ten degrees.

‘I’ve already told you. You’re not listening to me. Will you please listen? I do not have a doctor. I’ve been struck off the list.’

She puts the clip board aside. The back of the ambulance seems suddenly as pressured and confining as a diving bell.

We have to wrap this up.

‘Keith – you can put your top on. It’s obvious that there’s nothing wrong with your heart. We just need to ask you a couple of questions, you know – for our form. Just give us the basics, that’ll be fine. For doctor we’ll just put “not currently registered” As far as your shoulder goes, I’d recommend you take some pain killers tonight and get yourself up to the hospital in the morning. Okay?’

He gives me a brutally condescending smile.

‘You’ve got your job to do,’ he says. ‘Ask away. Do what you have to do. I don’t want to make things difficult for you. I know there are people out there who would give you a hard time. But I think you do a wonderful job. I met one of yours the other day. My son, Jake, he’s only four. He had a seizure. He went completely blue. Cyanotic. I know the terms. My girlfriend called the ambulance whilst I resuscitated him. Saved his life. The ambulance turns up – one like this, newer perhaps, and a paramedic on a car. And the police, of course. The police started getting involved, like they do. Pushing and shoving. The ambulance crew said I wasn’t to come on the back. Admittedly I was shouting by this point – but you tell me you wouldn’t shout if your son had just died in your arms? But the paramedic, a big black guy, he told the crew to fuck off – excuse my language. He told the police to fuck off. He took me and Jake into his car and he drove us up the hospital. He told me that he’d had to put up with that stuff all his life, too, because of his colour. He understood how I felt. And he respected what I’d done. He said he’d never seen such skill under pressure. But this is how things are for me. This is my life.’

He puts his t-shirt back on. I notice some recently healed cuts under his right arm.

‘I expect you’re wondering about those scars,’ he says. ‘Don’t worry. It’s nothing. I was walking down the street when this car tried to run me over. I couldn’t believe it. I was knocked into the air, and came down with my arm punching through the passenger window. The driver obviously thought I was reaching for them, so they took off – with me hanging out of the window. I managed to free myself, and rolled to a halt on the road. Of course, the police weren’t interested.’

He pats his knees.

‘But that was last week. Tonight - I’m not going to hospital. I know I don’t need it, you don’t need to tell me that. And I’m not about to waste anybody’s time.’

I open the door. He jumps out.

‘Thank you for coming by,’ he says, rubbing his face briskly, as if he has just woken up. ‘You don’t need to see me inside. I’m perfectly able to look after myself.’

I watch him stride off back down the alley.

I look back at Ellie. She’s standing up, pulling her gloves off. It feels as if the sweet night air is rushing in to fill the Keith-shaped hole between us.