Monday, January 28, 2008

four o'clock

Bill is twenty-one stone. Even his beard looks heavy. He is sitting on the floor of his narrow hallway, wedged like an elephant in a box, with one of his vast, bandaged legs bent underneath him. He can’t get up.

‘Can you be quick, boys? I’m getting pressure sores on my arse.’

I go back to the vehicle to fetch the mangar – an inflatable lifting aid, its stack of four cushions designed to gradually raise the patient up to a standing position, or at least to a height where we can help them transfer to a chair. I also grab the manual handling bag, full of straps, sliding sheets and other stuff that we might need in this case.

Back in the overheated flat, Frank has managed to free up Bill’s bent leg, and untangle the catheter and bag.

‘You wouldn’t want that to burst,’ he says. It certainly is full. Frank finds a jug from the bathroom and empties the noxious brown fluid into it whilst I start unpacking all the kit.

‘It’s my own stupid fault for getting up to go for a shit,’ Bill says amiably, to fill the time. ‘Pardon my French. I don’t go that often. Once every five days or so. But when I go – well, it’s like the world falling out of my arse. The Old World. Gondwana. Dinosaurs, volcanoes and all.’

We stand discussing the best way of getting him up. Like so many of the jobs we go to, it’s an exercise in improvisation. Bill tells us that he can’t rock from side to side and shuffle himself backwards onto the mangar, so we decide to get the sliding sheet underneath him, and then use that to drag him onto the cushions.

‘So I had an unenviable choice to make. Either lay in bed and shit myself, or try to make it to the loo.’ He thinks about this as we grunt and sweat trying to get the sliding sheet into position. ‘The other thing that crossed my mind was – I might get halfway, collapse in the corridor, and then shit myself.’

The sheet is in place. We agree that this option was probably the cleanest, if not the easiest.

We step over Bill and each other and fumble around for hand grips, and then one, two, three – haul him back onto the cushions.

‘There she blows,’ he says. I plug in the air hoses to the four cushions, and when Frank has himself in a position where he can stabilise Bill, I start inflating. He rises up.

‘It’s a miracle!’, he says, ‘A levitating saint! God, that’s easier on my arse.’

The cushions reach their maximum height and the job is looking more manageable. Bill says he doesn’t feel confident about standing up and walking just yet, but he doesn’t want to go back to bed, either. He says he wants to go into the front room and sit at his computer. He says the best way to do this would be to bring his office chair through. He can transfer onto that, and we can wheel him in.

When we get him into the office chair, it bends precariously.

‘Are you sure this is a good idea, mate?’, says Frank. ‘I don’t think this chair was ever designed to cope with – er – loads like this.’

‘Are you saying I’m fat?’, he says with mock indignance. ‘Well of course I’m fat. I’m a rotten old tub. But there you are. Things are what they are. Wheel me in, then. Mush!’

We pull and push the chair, which creaks alarmingly but holds. In a minute or two, he is in position before a well-ordered computer desk. I go back into the hallway to pack away the equipment. When I re-join them in the front room, Frank is completing the paperwork and Bill is telling him about his life.

‘I used to teach the trumpet. Played in bands, taught, travelled the world. But age and this fucking arthritis took over and gradually, gradually…’ he holds up his right hand, whose fingers are quite grossly deformed. He wiggles them a little, then puts his hand back on his lap. ‘I had a beautiful instrument. Made in 1911. Worth quite a bit. The last time I played it was May the eleventh, nineteen ninety six. Four o’clock in the afternoon. Then I put it in its case and gave it to a good friend of mine. Because an instrument like that was built to be played, not just dusted off now and again.’

Frank gets a signature on the form and we stand to leave.

‘Thank you gentlemen,’ he says, ‘I know you’re busy. I hope I shan’t be needing you again.’

Saturday, January 26, 2008

the irresponsible tipster

Fiona’s face is doughy, like an under-cooked cake; her cheeks sag beneath the weight of her eyes, moon-sized through drink and pills. She sits on the ambulance chair, her arms folded too carefully, staring back at me as I ask my questions.
‘How old do you think I am?’
She pushes her hair back from her face, then adds with a coquettish simper: ‘I have to have a cigarette – but not here, of course.’
Her words are as puffy as her face.
‘That little bitch. She wrecked my house.’
She starts to cry, but before I have torn off a wad of tissue paper to give to her, the crying fit passes. She smiles at me as she takes the tissue.
'They hate me at the hospital, you know', she says.

***

Six months earlier, we are pulling up outside a terraced house in a part of town that crews sometimes mispronounce in a French accent, irony at the awfulness of it.
Overdose / Poisoning. 42 year old woman. Overdose on medication. Cat B.
I climb out of the cab and go to the front door. It’s lying open, and there are no lights on inside. A CD is playing, skipping and repeating one line at full volume. If I had been watching this drama on TV I would have thought: crude psycho scene - too many clich├ęs. But here? I put my response bag and the clip board down so both hands are free, and nervously I edge forward into the house.
‘Ambulance?’
Nearer to the living room and the noise gets louder. I flatten myself against the wall and push the door fully open so that it bangs against the wall, in case there’s anyone hiding behind it. Nothing and no-one. I move into the room, with Rae behind me patting on lights whenever she feels a switch.
Hello?’
Brutally illuminated - a woman lying on a sofa, raising her head to see who's coming in.
‘What? Who?’
Leather jacket and black bra. Silky black chemise. Remains of a takeaway on plates, on her. It slides to the floor as she hauls herself into a sitting position. I turn the music off. The silence and light are as shocking as her trashy red lipstick. She wipes her nose with the back of her hand, and then says:
‘What do you want?’
‘Someone called an ambulance. Was it you? Or is there anyone else here?’
‘They’ve gone out.’ She starts fumbling around for a cigarette, and finding a bent one in her pocket, stuffs it in her mouth. It’s all too pathetic to quite believe.
‘Someone reported that you’d taken an overdose. Is that right?’
She laughs once, Swanson-style, and the cigarette tumbles out of her mouth. She tries to catch it and almost falls off the sofa. It’s amazing to think how wired I’d been coming into this house just moments earlier.
I start to ask Fiona exactly what she’s taken and when, but at my change of tone she suddenly stops floundering around on the sofa.
‘I’ll tell you all about it,’ she says to Rae, touching her on the hand, her eyelids narrowing weightily, ‘but I want him out of the room.’ As I hand over the clip board to Rae, Fiona announces in a stage-whisper: ‘I was raped last year.’ And she leans back, straightens her slip over her knees, and looks at me accusingly as I leave the room.

I walk out into the hallway and pace about. Look at my watch. We’ve already been here quarter of an hour, and it could be a lot longer. Bubbling flowered wallpaper, jagged tears, brown stains. A print of Edwardian ladies and gentlemen promenading along the front. An old News of the World dumped at the foot of the stairs. I check my watch again, and just as I do, a slight, quick figure bundles in through the front door and starts shouting at me from the depths of its upturned hood:
‘What the fuck is going on? What are you doing here?’
I guess this is the daughter. Her boyfriend is staring in from outside. He is thin and pale, dressed in a white tracksuit; the weight of all the chains around his neck seem to be slowly bending him in half. He talks constantly into a mobile phone, and watches me.
With as much calm authority as I can manage, I tell the girl that we are the ambulance, and that we are here to help her mother. But before I can go on to ask her for some information, she barges past me and on into the living room, where she pushes her mother back onto the sofa and begins shouting at her.
‘What the fuck have you been doing?’ she shouts.
It looks as if she’s going to hit her, so I grab her shoulders and move her backwards. She spins round on me.
‘Take your hands off me,’ she spits. And then ludicrously, starts shouting for help. Her boyfriend wanders in, still on the phone, and with no change of expression.
To Rae: ‘That’s it. We’re going.’
To the girl: ‘We’re here to help your mum but you’re getting in the way. We’re going outside to call for the police, and they’ll come and arrest you.’
The word ‘police’ has a magically subduing power on her. She eases off, and says: ‘No. Don’t do that. I promise I won’t do anything else.’
‘Go and sit on the stairs in the hallway,’ I say, immediately realising that this is ludicrous, like saying go to the naughty step. But I’m committed to following through with it. Amazingly, though, it does seem to be working. She goes out of the room, gathering her boyfriend to her, and they both sit on the fourth step up.
At first it looks as if the girl is going to cry. Her boyfriend – his phone away now – hugs her to him like a big white insect. Her shoulders start shaking. When I go closer to them to say a few, more conciliatory, words, I realise she is laughing.
The only thing I want to do now is leave the house as quickly as possible. I nod to Rae as I re-enter the room. ‘Definitely time to go.’

***

‘Do you recognise me?’
Fiona stares for a second, then waves the air in front of her. ‘You could be anyone,’ she says.
The ambulance sways along.

***

We pick her up from the Police Custody Suite on the outskirts of town. After we’d been buzzed through its heavy security gate, we park in one of the receiving bays and climb out of the vehicle. A policeman is standing there, smoking a roll-up.
‘All right, fellas,’ he smiles. ‘Come for Ms Ferrero?’
He drops his fag to the ground and grinds it out.
‘What a pain in the arse. How many times? Anyway – I’m sure you’ll recognise her. What happened was – she was arrested after a domestic disturbance, and charged with assaulting her daughter. When we got her here she says she’d taken an overdose of ibuprofen – about twenty, 400 mg. Apart from that,’ he shrugs and laughs, ‘she’s not as bad as last time.’

We follow him to a thickly painted green steel door.

‘Last time she shoved her mobile phone and her house keys up her cunt.’

***

‘How much longer?’
‘Almost there.’
Fiona smiles at me.
I ask her what line of work she’s in.
‘I’m a tipster,’ she says, pushing her hair away from her face again, and then, after a lofty pause, ‘Don’t you know what a tipster is? A tipster finds things out, and then rings the news desk to tell them all about it.’
‘What kind of things?’
‘I had a big splash last year with It’s a dog’s wife. Horrible title, but I can’t help that. All about a man who kept greyhounds in the house, and his wife got fed up with them lolling all over the furniture, so she divorced him, and the dogs were cited in court. Did you ever read it? It was everywhere. And once I was on a train and I saw a helicopter crash onto a tractor in a field. And another time, my brother in law, who’s a taxi driver, heard something very juicy about the royal family that I couldn’t possibly tell you – yet.’

The ambulance pulls into the A&E car park.

She frowns. ‘Is this it?’
Then she says: ‘Do you know the great thing about hearing voices?’
‘You hear voices?’
‘Yes. I do. I hear voices…’ she wiggles her right hand in the air above her head. ‘And they tell me to do all kinds of things. Cut your arm, Fiona. Bang your head against the wall, Fiona. Swallow these pills.’
The door opens. Rae smiles and looks inside. ‘Chair or walking in?’
I ask for a chair. As Rae goes to fetch one, Fiona leans forward, conspiratorially
‘But the great thing is – the wonderful thing is – I’m not responsible.’

Wednesday, January 23, 2008

two sons

Son #1
As we pull up outside the house, I read the patch of garden like some brave domestic flag, the trampled borders and dump of children’s bikes hinting at an on-going battle between family order and chaos. A woman waves to us from the brightly-lit doorway, then folds her arms against the chilly early evening as we climb out and go to her. She smiles, thanks us for coming. A scruffy old terrier waddles out to sniff our trousers. Together with the woman it leads us through to the living room.

A fire flapping busily in a grate. A teenage girl at a laptop. A heavy grey cat draped over the back of a sofa, and a boy of about eleven lying on the sofa, surrounded by cushions, his legs drawn up. He has a mop head of pure white hair, which – along with the rich brightness of his surroundings – makes his pallor seem all the more striking. He smiles and waves. The cat looks up, licks a paw once, then settles down again.

The girl stops emailing at the laptop, swivels round on her chair and says: ‘I gave him a magic shell, but it hasn’t worked.’

The boy holds the shell up so I can see it. A dog whelk. I examine it.

‘Hmm. That’s a great shell. You must be poorly.’

The father comes over and kneels beside his son. Two more girls come pushing each other and giggling into the room. The mother puts her arms round them and then they all stand quietly as the father brushes some loose strands of hair from the boy’s face. Even the dog comes and sits down to the side of him, a storybook family gathering to bear witness to the story of Edward’s illness - the central abdo pain, first in the morning, some nausea, easing off, then coming back on strongly this evening. It could well be appendicitis, but whatever the cause, a trip to the hospital is in order.

The family disperse noisily to get what needs to be got. The boy groans, but does everything he can to help.

Only the cat remains in place.


Son #2
Seven hours later. We are flying through the early morning, a low strobing swoop through darkness. The wheels of the ambulance give little skips around the bends as I push the vehicle on. We are the nearest vehicle to this cardiac arrest, and we are eight miles away.

Our satnav has given up; Tony is reading the map like a rally driver.
‘Left! Left! Left!’
‘At the next junction – right!’

Finally, the block of flats appear along to our left, set up from the road on a steeply raking bank of concrete steps. Access must be round the back, but just as I decide to carry on round, a woman comes double-stepping down, waving her arms, so I stop. Tony buzzes the window.

‘Come up this way. It’s a little bit quicker,’ she says. Calm and controlled.

Gloves. KRS and key out. Obs bag and chair. Tony hauls out the resus and drugs bags. Laden like pack mules we climb the stairs behind the woman as she tells us the story. She lives next door. Her friend knocked her up and said they were having trouble with Peter. Peter is thirty-six and suffers with epilepsy occasionally, but that’s all as far as she knows. Peter’s friend John had been sleeping with him tonight, got up to go to the loo. When he came back he realised Peter wasn’t breathing. Nobody knows for how long. As she shows us into the front door of the building, held open with a welcome mat, she tells us the father is on his way and should be here in about half an hour.

Inside the flat we negotiate a route through heaps of boxes and bin bags to the bedroom. Familiar signs and smells of neglect. Two men sitting on a sofa in the living room – both smoking, both looking out at us with a mildly disappointed air, like we’re simply the latest damned thing to happen.

We see Peter lying on his back on the double bed next door, his arms outstretched and his legs crossed, sheets rucked up, a ghastly figure, the pastiche of a sulky sleeper looking for five more minutes and finding an abyss.

We go in - and then the resus progresses as they always do, moment through moment, action on action, as familiar but still unique as a new hand of cards: we play the dragging to the floor, the compressions; the read-outs; the ventilations; the drugs; the second crew arriving on scene (our most valuable card) – laying out each move as best we can as the digital clock on the defib relentlessly marks time and the cardiac readout rolls out each assessment – flat, flat, flat. This was a bad hand from the start. And to make things worse, the patient had aspirated significantly before we arrived. Awful, underground gurgles sound ominously with every compression. It’s like pumping up and down on a water bottle – which suddenly blows. A quantity of blood bursts from the patient’s nose and mouth; it sprays out from under the mask, and despite Tony’s quick pulling back, splashes onto his trousers. Where is it all coming from?

‘Eurgh!’, he says, and holds off, partly in shock, and partly because this would seem to be the final show – if one were needed – that this resus is terminal. Blood pools in one of Peter’s half-opened eyes. Twenty minutes have passed. We agree between us that we should stop.

Then the woman who showed us up to the flat comes in to the room. She says she has Peter’s father on the phone again. He says he wants to talk to a paramedic before he sets off. One of the second crew takes the phone from her and walks into another room to tell him that his son has died. When he comes back into the room, he tosses the phone onto the bed.

‘He says there’s no point in coming now. He’ll wait for the inquest.’

Monday, January 21, 2008

stuffed

The eagle suspended from the hallway ceiling sways as we barge in with all our bags, the tip of one fixed yellow wing brushing the uppermost plastic rose of the plastic bush tacked up along the doorframe. We follow the dead bird’s gaze into the room.

There is a man in a hand-to-knee position of pain on an office chair in the centre of the room. He waves over to us with a fagged left hand, takes advantage of the movement to haul in another litre of smoke, then resumes his vigil. The white of his cigarette is striking, the one clean inch in this ruined space.

At first glance it seems he has modelled his living room on the bridge of a ship. The desk that occupies the centre of the room is a crudely extemporary structure, nailed shelves for a computer, hooks for notes, sections for video tapes, dead electronic components, diaries, letters, a watch. Piled up around the desk, a tidal dump of stuff - dark jigsaws finished and fixed in frames, model trucks, imitation firearms, faux deco lamps, signed photos, metal advertising signs, and rows of videos coded and logged in sequences as foxed and fucked as the originator. He smiles up at us as we come to him.

‘Can you put your fag out, please?’ I say. I don’t want to stink of smoke for the rest of the shift, but as I’m talking, my eyes pick out a broken electric fan on a pile of books. It looks as if the fan has been dipped in a vat of yellow sludge. In fact, the whole room is smeary and indistinct. The grey smoke from the cigarette he crushes out in the brass ashtray is as fresh as I can expect to be tonight.

‘What’s happened, Henry?’

He says that he had his usual plate of fish and chips for tea. He lay on the carpet to have a nap straight after. He woke up feeling fine and resumed his seat, then was hit by a sharp pain in his groin ‘as if I’d sat on one of me nuts’. It was unbearable for about half an hour, so much so that he banged on the wall and called out for help. But it eased off, and now he feels okay.

Rae examines Henry’s abdomen. ‘Does this hurt? Tell me if I’m hurting you.’ She begins sensitively enough, but without any reaction, her pressings become more exaggerated, until she looks like a vet burying her arms in a cow.

‘Nothing. No,’ he says, and looks affectionately down at the smouldering remains of his cigarette.

All his obs are fine, but we tell him that with everything he’s said about the incident, we think it wise he comes with us to hospital.

‘I’ll get my coat and keys then,’ he says, jauntily, and expertly locates these things.

He walks down the four flights of stairs to the ambulance, but outside in the street he folds over. On the vehicle he begs us for pain relief, but as technicians we can only offer gas and air, and this isn’t allowed for abdo pain. He is screaming by the time we reach the hospital. A nurse frowns at me as she comes back into the A&E from coffee break.

‘They’ll sort you out with pain relief in a minute, Henry,’ I say, patting his arm.

‘I’m not – interested – in any – of your – bastard minutes,’ he gasps. ‘I want it now.’

He gets it soon after.

Thursday, January 17, 2008

Thanks for reading!

I just wanted to say a big thank you for all the encouraging comments you’ve posted about Siren Voices. I feel quite overwhelmed by the positive feedback, and I really appreciate it.

I’ve been an EMT now for just a year and a half, (on the patient transport side for a couple of years before that). Aside from all the work-life attractions of the job, the real reason I think I’ll be in the ambulance for a while is the daily potential for drama.

Admittedly, most of the work is routine. And I know I’m more likely to write up something emotionally bloody rather than a drunk or an abdo pain, making it look more like a bad night in Baghdad than a Thursday afternoon in an English town by the sea. But even when the jobs are straight obs and nothing more, you can still have a good old chat, and look around for the little details that might distinguish a person or a place.

And if it’s really quiet – read a book.

So anyway – thanks again for reading the blog, and for all your comments. And a big thank you to Mark from neenaw for mentioning Siren Voices and pulling in the business!

Regards,

S.

Wednesday, January 16, 2008

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.’

Monday, January 14, 2008

on the edge

I feel like I’m standing in the lobby of a giant wasp’s nest. It is the thin end of the morning, and a girl in dirty sweats and a sports bra is stinging everyone within range.
To me: ‘You take her in! You’re taking her in, aren’t you?’
To her mum: ‘You’re fucking going with them.’
To me again: ‘You’re fucking taking her.’
She hauls on her mum’s arm, which has become melodramatically floppy again. The son, markedly less reasonable than his sister, has focused both eyes on me; they merge dangerously either side of his nose into one single eye of hate.
‘You fucking do something for my mum’, he says, and takes a drag on his cigarette.

We should have realised this was going to be difficult. The block of flats is well known, and an early hours call to an overdose here is not a happy prospect. Our spirits are eased, though, when we pull up in the street and see a police car already there.

‘That’s something, then,’ I say to Rae. We sort out the bags to take up, lock the vehicle, and then make our way into the courtyard. I can hear shouts from one of the balconies that overlook the courtyard, but I ring the flat number and we wait for a response. Nothing. We ring again. A face looks down on us from a parapet above and shouts down:

‘Who’s that?’
‘The ambulance.’
‘What do you want?’
(pause)
‘Someone called for an ambulance?’
(Muted sounds of swearing and bargaining.)
‘Could someone let us in, please?’
‘I can’t leave my Mum.’
(pause)
‘Well – someone’s got to let us in, otherwise we’re stuck down here.’
After waiting for a reply that doesn’t come, I call up, helpfully – ‘…and – er - we won’t be able to do much.’
‘I can’t leave my Mum,’ he shouts down again. I look at Rae and she looks at me. But just before we buzz again to make a full and final offer, someone else releases the door, and we go on up.

The concrete stairwell has the welcoming smell of concrete stairwells the world over. The echoes of our progress upwards add to the ominous screams and bumps from the seventh floor. And still – despite all our experiences in the past – we are assuming that the police are on scene. I haven’t even got my radio on me. We are the equivalent of a sleepy but doomed vanguard blundering over the top of the trench.

When we emerge onto the balcony, my error is horribly plain. There is a man standing by a woman on the floor. He is holding her hand, so that her arm is up to him at full stretch. Aggression spikes out of his head like cartoon lightning.
‘You fucking help my mum,’ he says to us.
Three others come out of the flat – unshepherded by police. They swarm around us on the balcony, saying things like: ‘She’s dying’ and ‘Bitch’ and ‘She needs her stomach pumped out.’
‘Hello,’ I say. ‘My name’s Spence and this is Rae.’ God knows this introduction never sounded so lame, but in difficult situations it sometimes helps to follow the script. ‘What’s happened?’

I can see that the woman’s ABC’s are fine: she’s breathing and talking and moving her head around. When I go closer to her I can smell the alcohol. There are no signs of violence, and in the sickly light of the emergency overheads she seems a normal colour. I speak as firmly as I can to the man.

‘I need to speak to your mum on her own, if that’s okay. I just need to find out what she’s done and how we can help. Okay?’

Amazingly, he drops her hand. He pulls a mobile phone out of his pocket and walks off with a grunt. In a speed-dialling second I overhear him say: ‘It’s my mum. She’s taking a load of pills and she’s going to fucking die…’ The others follow him back into the flat, which is an enormous relief to us.

We sit her up and help her lean against the balcony wall. We make out that her name is Sandra, and she’s taken all her medication for pain relief because she didn’t want to go on like this. With the rest of the family temporarily back in the flat, I ask Sandra as firmly as possible if she’ll come down to the ambulance with us, as I think she needs to go to hospital. I don’t actually know at this point if she does need to go; my main concern is to get us away from this environment.
‘Fuck off,’ she drawls. ‘Fucking leave me alone.’

We hold a hurried war cabinet over her head: Rae agrees to go back down to the ambulance and call for urgent police back-up, just in case we really can’t persuade Sandra to come down to the vehicle. Other than that, it’ll be a question of withdrawing as best we can if things get worse. Rae exits just as one of the women comes out, obviously the first man’s sister, sharing his one-eyed intensity. Her hands are cupped around a mess of bottles and packets.
‘She’s taken all this,’ she says, and throws them on the floor. Walks off again.
I poke through the medication. There’s everything here, from iron tablets and senna to dihydrocodeine and zopiclone.
‘Sandra – what have you taken tonight?’
Sandra makes a curiously delicate gesture with her finger: ‘Those – those – all of those.’
At this point, the whole family tips back out onto the balcony.

‘Well?’

I gauge the distance between me and the stairwell door. But before I can begin to try to reason things through – incredibly – two policemen come striding along the balcony from the other direction.

‘Right,’ one of them says, ‘What’s going on here?’

**

Only later, when the family has been corralled back in the flat and the mother is on her own in the kitchen do I find out quite how lucky we’ve been tonight. The police were here at another flat on something quite unconnected. They heard all the fuss and eventually came out to see what it was about.

In a private word out on the balcony one of the policeman asks me if I think Sandra’s in danger. I tell him that her obs are fine, that I don’t believe she’s taken as many of the drugs as we’re being told, and that much of what’s happened tonight is due to alcohol and melodramatics. But as a rider to that I have to say that without a blood test…

Back in the kitchen Sandra still refuses to travel to hospital, even though I explain to her that we think she needs medical help. Her son shouts in at the door that we have to take her, but the policeman explains to him that if she doesn’t want to go, we can’t force her. Sandra signs our form to say that she’s staying against our advice, and once it’s witnessed, we go to leave.

‘Bye,’ I offer to the family as we excuse our way past them in the hall. Their silence is appalling.

Friday, January 11, 2008

deus ex machina

Act One: We take a call to a man collapsed in the street. The location is given as o/s Co-op beside bench – and this is enough to tell me that Michael has made it up town again.

Michael is in the Top Ten of our regular callers. I know all his details off by heart; I hardly need ask him any questions at all these days. Fifty-seven years old. Suffers from Motor Neurone Disease and alcoholism, is (approximately) mobile with a zimmer. Once a week he will buy a packet of sandwiches, some crisps and a bottle of vodka, drag himself either to the bench in front of the Co-op or a bus stop outside the railway station, drink the bottle of vodka, eat the sandwiches and fall to the floor. His difficulty in speaking is made worse by the alcohol, of course, and by the vast, twiggy hedge of a beard that obscures the lower half of his face and the top half of his body. He can be aggressive, but the punches, should he be in a bad mood and throw one, are like his words – without focus or real intent. He tries his best to insult you. The swear words come spittling out through his crooked yellow teeth, and his eyes flicker from side to side.

A teenager waves us over to the bench and I can see – yes – it is Michael lying there. Today he is wearing pyjamas under his ex-army greatcoat, which is a variation. I thank the boy for calling us, and then we set to picking Michael up and on to the bench. Rae fetches a blanket from the vehicle and drapes it over his shoulders. He sits Rae like a doomed prophet, white robed and bearded on the bench, grinding out his profane prayers to anyone close enough to listen.

And so we face the usual problem. This is not a medical emergency. This is really a matter for the police – drunk and disorderly. But we know that if we request the police via Control, we could be waiting here for a long time. And if Control let the police know who the patient is, we could be waiting here for ever. But the other option of a trip to hospital and a seat in the waiting room until such time as the patient sobers up and makes his own way home – well, this has been done so many times in the past, I’m worried that the A&E charge nurse will have security throw us all out. However, if we leave Michael here as he is, he will only fall over again, someone else will call for an ambulance, and resources will be tied up even more. So, making the best of a rather tedious job, we decide to take him in. When we get to hospital I talk up the fact that Michael was borderline hypothermic. The charge nurse gives me a look that even the most optimistic interpretation would be: ‘I’m watching you’. But they accept him. What else can they do? Michael has a social worker, and various carers have tried their hand and left in tears soon after, but short of a miracle, or a ball and chain, this expensive routine looks set to play over and over without relief for years.

Act Two: A week later we take a call to a man collapsed in the street. The location is given as o/s Railway station, bus stop. Rae says it’s Michael, but I say I’m not so sure. I say I have a feeling that this will be a resus in the street. I snap my gloves heroically. The station comes into view. It is Michael. Two off-duty nurses have called the ambulance. One of them even works in A&E. ‘What else could I do?’ she says, helplessly. And this is, of course, the problem. We take him in without even considering the police, as he seems less responsive than normal. But all his observations are fine. We pass him on a corridor trolley throughout the day as we come and go in the hospital, snoring.

Act Three: Two months later we take a call to a man collapsed at home. The call has originated from social services, and the address seems familiar. Neither Rae nor I have been there before, but it just seems to ring a bell. As we turn into the courtyard of the block of flats, Rae says: Michael. Of course – and then I think: This is a first, collapsing at home. We jump out of the vehicle and go over to the two people standing by the door. One is a carer, and the other is a manager from Social Services.

‘The last contact we have with Michael is two weeks ago,’ says the manager, fiddling with a knob on her radio. ‘I’m just waiting for someone to get back to me about key holders. But the police should be here soon.’

The carer tells us this is her first day. She says she knocked on the door, looked through the window, but then wasn’t sure what to do. She bites the quick of her thumb. ‘He’s supposed to be here.’

Rae gets on the radio and tells Control the situation. I have a look through the window but a filthy set of curtains hides everything. Rae comes over and says that Control have given the go-ahead to break in, and confirms that the police will be here in about five minutes.

I love pushing doors in. It’s a perk of the job. I draw myself up and back, and then give it a good kick. It bows impressively. On the second kick it flies backwards in a satisfying crack of splintering wood, and we go in. The smell wraps around us along the filthy hallway before we see the legs just poking around the side of the bedroom door. He is lying on his side on the floor. He has been dead for some time – at least for the two weeks the manager mentioned. If the flat had been properly heated the smell would have been a lot worse, but as it is, Michael has been doggedly pursuing the various stages of decay, as slowly but inevitably as his shuffling walk up town with the vodka and sandwiches. The social services manager has followed us in with her radio crackling loudly, but she about turns and strides back out with an ‘Urph’. We follow her. Back outside in the yard the carer asks me: ‘Is he all right?’ and I tell her that unfortunately, no, he’s died. A police car turns into the yard. The carer says: ‘What do I do now? This is all new to me.’

I tell her, I’m as surprised as she is.

Thursday, January 10, 2008

Stella and the whippet

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.

Tuesday, January 01, 2008

how like a god

The message is as direct as it usually is: Serious haemorrhage / lacerations – injury to hand – Cat B. We machete our way through the heavy traffic with our sirens; town is packed, with crowds massing around the shops for the post Christmas sales.

The follow-up message lowers our expectations somewhat: fire brigade on scene. Patient cut hand whilst striking fire alarm. We wonder how you can seriously injure your hand punching out the little glass panel from a fire alarm, but the category remains at B, so we hustle onwards.

Turning into the street we are confronted by two fire engines with their blue lights on and a bunch of fire-fighters milling around on the pavement. No sense of urgency and, crucially, no smoke. We pull up behind the last tender and jump out to meet the Incident Officer.

‘Nothing much here, lads. A candle got a bit smoky, and one of the residents punched the alarm. She says her hand is injured, but I’ll leave it up to you.’ We follow him to the high wooden fence at the side of the house. ‘She’s in the flat round the back.’

‘What is this place?’ I ask him.

‘Some kind of psych residential. Just through there, mate. You can’t miss her.’

We pick our way through piles of junk towards an open door. There is a large woman in a black coat smoking a cigarette in the garden. For a moment I wonder if she’s the patient, but she doesn’t acknowledge us at all. I hear voices from the room beyond the door, so we head for those.

We step into a small, square room, as congested with stuff as the alleyway that led here. Another fire-fighter is standing over by the only window. To his left, a vast woman is sitting quietly in an armchair facing us, so shapelessly huge it looks as if the chair is a mould and the woman has been poured into it. She is wearing a silky chemise, her bare arms and legs trunking out of the delicate lacy frills at the four corners. She has painted a thick war stripe of blue eye shadow that runs across the top of her face. Her lips are grey, and as Adam negotiates a path to her to take a closer look, she pre-empts our concern by saying:

‘I’ve painted my lips with ash.’

Adam looks at the fire-fighter, who shrugs, and looks at his watch.

‘Why have you painted your lips with ash?’

‘Because I’m a god.’

‘Oh. Okay. Well, first things first. What’s your name?’

‘Ellie. Ellie Sparrow.’

‘What’s happened here, Ellie? Was there a fire?’

The fireman reports the facts: ‘A Christmas candle with a leather base was put on the radiator and gave off some fumes. Ellie punched the fire alarm, and she says she’s hurt her hand.

Ellie holds up her hand. The fingers are swollen, the nails bitten right back and painted different colours, the knuckles covered with scabs of different ages. In other words, entirely like the uninjured hand, and normal for the patient. Adam examines the hand for movement, sensitivity, cap refill, and everything seems fine.

‘Do you have any medical conditions?’ he asks her, reaching for the paperwork.

‘I’m bi-polar. Where’s my bag? I have to show you something.’

Adam hands her a huge canvas bag. Ellie begins rummaging through it. She pulls out a ceramic pyramid-shaped incense holder. ‘I take that with me everywhere I go.’ She pulls out letters and CDs and a book jacket with a photo of Sting on it. ‘Do you like Sting?’ she says.

‘Ellie – we need to ask you a few questions and do a few tests just to make sure you’re okay. Can we do that?’

She looks up at him. ‘I just want to show you my fake saliva.’ And then – incredibly – she pulls out some medication that clearly says on the box synthetic saliva.

‘I need to have some chocolate.’ Before we can stop her, she produces a big glass bowl from the side of the chair, filled with bars of chocolate, pulls one out, opens it and has it in her mouth with practised economy.

We quickly make the observations that we are duty bound to make. Adam says to her:

‘Ellie. From all that we can see there’s no medical need for you to go to the hospital today.’

‘But I want to go,’ she slurps, wiping her chocolaty mouth with the back of her hand. ‘I’m on my own here. There are voices in the garden. I’m bored.’

‘I’m sorry to hear that,’ he goes on. ‘But none of these are reasons to go to A&E today. The best thing to do would be to make an appointment to see your GP in a day or so.’

‘I’m barred.’

He pauses, then tries another tack. ‘Casualty is full up today, absolutely crammed with drunks because of the New Year. You’ll be waiting for hours if you do go. I really don’t advise it. Plus, you’ll be depriving someone of an ambulance who might really need it.’ She stares up at him, and stops chewing briefly.

‘You know – heart attacks. That kind of thing.’

‘Haven’t you got a lovely speaking voice,’ she says, and gives him a dreadful smile.

‘Okay, Ellie. Do you want to sign the form to say you’re not going in?’

Incredibly, she takes the pen and form, and then makes a signature that’s more like a furious crossing out. She chucks it back at him.

‘Happy Christmas,’ she says, and looks at the fire-fighter, but he is following us out with the same sense of urgency.

We make our way back outside to the truck. The fire crews wave and move off. We sit in the cab, listening to music whilst Adam finishes the paperwork.

After about five minutes Control calls us on the radio. They tell us that Ellie is back on the phone. She says that she needs an ambulance for her hand. Reluctantly we agree to go back in to see her, but before we can get out of the cab she is there on the pavement, staring across at us. We climb out to let her in to the back. The whole ambulance rocks from side to side as she makes her way to the seat. The seat belt will not go round her. I slam the door shut and we set off.

At the hospital we show Ellie to a seat in the minors waiting area. We apologise to the staff nurse for bringing her in, and she accepts our reasons with commendable sangfroid. But A&E is already bursting, and we all know that Ms. Sparrow may well be the (gigantic) straw that breaks the camel’s back.