Friday, February 29, 2008

a bit of a tumble

‘My name is Peter. I’m absolutely fine. A bit of a tumble, but - believe me, I just need a hand to get up.’
This from a man wearing only a thong, lying curled around a parking sign at the bottom of a steep, scrub-covered embankment.
‘I don’t want you to move anything just yet, Peter. I’m going to check you over a bit at a time just to make sure you’re okay. Okay?’
‘Oh for goodness sake. Go on, then.’
I check him over from the neck down, and apart from some superficial scuffs and scratches, he seems intact. Between Rae, Jess – who has just turned up to help on the car - and me, we gently prise Pete away from his perch and help him onto the trolley which we’ve put alongside and raised up. He settles back and puts his hands up behind his head as if he’s decided to take his ease in a deck chair.
‘Ah. That’s better. Thank you so much.’
With his great, grey Zapata moustache accentuating the downward tilt of his mouth, his crossed blue eyes and his shaggy hair, he looks exactly like the cowardly lion from The Wizard of Oz.
‘So, Peter – what happened, exactly?’
‘Well good grief. I was taking a stroll along the cliff garden walk when these two rough looking lads came up to me, pinned me by the shoulders, and demanded that I took some Viagra. When I told them that I certainly didn’t need to take Viagra, they threw me down the cliff, and I landed where you found me.’
‘But you’re only wearing a thong.’
‘All my clothes must have been torn from me as I fell through the bushes.’ He yawns, and it’s like a door swinging open at a distillery.
‘How much have you had to drink today, Pete?’
‘A constitutional snifter,’ he says, only just making the words. ‘Look at me. What a mess.’
Whilst we clean up his grazes, Jess goes off up to the top of the cliff walk to see if she can find Peter’s clothes. She comes back ten minutes later with a carrier bag.
‘Are these yours?’
‘Yes! Oh – thank you so much, dear. I didn’t want to spend the whole day showing myself off like this.’ He looks at me and gives a coquettish squint.
‘I thought you said your clothes were torn off you as you fell?’
‘Well, yes, indeed – but some kind person has obviously collected them all back up again for me.’
He sneezes. He is so like the lion I expect him to make his hands into paw-like fists and growl: ‘Put ‘em up! Put ‘em up!’ But he seems content to relax back on the trolley.
‘What are we going to do with you, Peter?’
‘Whatever you like,’ he says, blowing his nose on the tissue I gave him – and then handing it back. ‘After a day like today, I really don’t care.’

Wednesday, February 27, 2008

big drinker

‘No. I don’t know him, as such. He’s my boss. In fact, he owns the company. This was just a little works outing. I don’t know where anyone else is. All I know is – his name’s John, and he’s about forty-three.’
We’re all standing around the man lying on the pavement outside the hotel: an inner circle made up of me and Frank, the witness and two police officers, and then an outer circle of Thursday night survivors, insulated and indestructible through the magic of alcohol. They smile and shout stuff, strutting around.
‘How did he fall? Did you see him go down?’
‘It wasn’t a fall. He kind of – leant against the railings – like this – then slid down on to his arse – like this – and then out.’ The guy stares down at the hulking figure sprawled on his side on the pavement. He looks like a slaughtered pig dressed in someone’s best blue suit and a curly black wig for the craic and the phone cameras. Awash from head to foot in what looks like minestrone soup, but probably isn’t.
‘You don’t know if John’s got any health problems, do you?’
‘Nope.’ The guy pauses, gives a little nod and a sniff. ‘He’s not very well now, though, is he?’
But at least he has the basics – breathing, pulse, responds to pain, no blood anywhere, no limbs awry. He was probably asleep when he reached the pavement, rolled flat by a barrel of pints, tucked up amongst the cosy slabs, awaiting collection.
And this is the problem. As soon as we pulled up on scene we saw the problem. Not so much medical as removal. It’s a while now since I looked, but I don’t remember the section in the manual describing the Safe Four Man Lift of the Doubly Incontinent and Vomit-Covered Drunk.
But we’ve managed it before.
We thank the witness, who stumbles off to find a taxi. Working like green, skilled spiders, we wrap the patient in blankets, use a scoop stretcher and the two police officers to lift the patient on to our trolley, load the trolley back on to the vehicle. As I’m putting the tail lift back up I wave to the dustcart that’s just arrived and standing off scene, its flashing orange lights an interesting change to blue. It wants access to the hotel, so I hop in the cab and we move off.

Thursday, February 21, 2008


A girl waves to us from the front door and waits for us there, jiggling impatiently from foot to foot and sucking on a cigarette, watching whilst we haul our bags out of the truck.
‘Come on! He’s upstairs,’ she says, flicking the cigarette off into the garden and hurrying inside. As we cross the threshold the contrast between the crystalline Sunday morning and the muted interior is awful; the air seems to have congealed into a fatty grey smog that barely stirs as we move through it. We pass an empty room – snapshot of a mattress on the floor, rucked grey sheets, bottles – then up into another where a skinny man is lying flat on his back. His t-shirt is pulled up and I can just see from here some trembling movement in his abdomen as he makes tiny efforts to breathe. The woman kneeling beside him sits back on her heels and pushes her beany hat up to look at us.
‘He’s breathing some, but not much,’ she says. ‘He’s injected heroin.’ But his pinpoint pupils and the marks on his arm are clear enough.
I take an airway out of the bag and put it into his mouth whilst Rae hooks a BVM up to the oxygen.
‘When did he inject?’
‘Not long ago. I’m not sure. I wasn’t with him.’
Rae hands me the breathing kit and I start supporting his feeble respirations. She puts together a syringe of narcan – the drug we use to reverse the effects of opiates – pinches up the skin of his upper arm, and jabs him.
‘He wasn’t breathing at all when we found him. He was all horrible and blue. We got him going again, though. I had to give him the kiss of life. I only know how to do it because my baby died and I did it on her.’
Both the girls look sickly, but the one in the beany hat has a truly awful complexion, scooped out and hollow like a teenager raised in the dark. Around us the room is trashed, cans standing on the bare floor where they were placed, clothes in tangled corners, carrier bags of foraged food in various stages of decay – a rotten room junked, every human comfort or effort of control subordinated to the needle.
‘Is he going to die?’
Rae gives him another dose of narcan. Gradually his breathing quickens enough for me to stop bagging him; in another minute or two he moves his head slightly from side to side and starts to gag on the airway. I pull it out. Suddenly he opens his eyes.
‘Hello. It’s the ambulance,’ I say. He stares up at me and frowns, then makes an effort to sit up. We help him. He leans against the bed.
‘Wow,’ he says, then ‘Who are you?’
The woman in the beany hat stands up.
‘We saved your stupid life, you bastard,’ she says, then pushes out of the room and into the bathroom, slamming the door behind her.
‘What’s the matter with her?’ he says, jerking his thumb in her direction like he’s sitting with friends in a pub and someone has just caused a scene.
‘What do you think?’, the other girl says. ‘She lost her baby and now you go off on us.’ She follows her out of the room and starts trying to talk to her through the bathroom door.
‘I don’t even know them,’ he says to us, rubbing his face.
He tells us, without a hint of irony, that he doesn’t do heroin and this was his first hit. He says he doesn’t want to go to hospital, even though we tell him that the effect of the narcan is short-lived, and he might well go unconscious again. Rae completes the paperwork, he signs to say he refuses further treatment, and we pack our kit away. We leave him propped up against the bed.
Back out in the hallway, the bathroom door is open and the first girl is sitting on the side of the bath hugging the second.
‘He says he doesn’t want to go to hospital,’ I say.
‘Surprise, surprise.’
‘He’ll still be at risk for a few hours, so you might keep an eye on him. Give us a call again if anything happens. Apart from that…’ I shrug. The first girl makes an effort of a smile.
‘Thanks for coming so quickly,’ she says.
I tell them I thought they did a good job getting his breathing back. I tell them they probably saved his life.
‘Like he cares,’ she says.
We see ourselves out.

Thursday, February 07, 2008

early hours stupid

‘So you were in the navy then, Reg?’
‘National Service on a survey ship. Loved it.’
He straightens in the chair we have helped him up into, then sags into a slump.
‘I feel so damned stupid.’
He has an impressive old sea dog’s silvery mane, but the rest of his body is giving out on him. From the tops of his calves down to his feet, the flesh is dark and leathery with dermatitis; it’s like a rising tide line of incapacity. He doesn’t get about like he used to.

It is two o’clock in the morning and we found him on his knees by the side of the bed, unable to get up. His wife had called the ambulance. She tells us that Reg has been averaging a fall a week for a little while now, but the Falls Assessment team have been round and done what they can.
Reg rubs his knees and gives a wide, leonine yawn whilst I take his blood pressure, temperature, the usual checks.
‘Seen my certificates, lads?’
His wife is rubbing her eyes to stay awake, but she brightens and points to one of them, an impressively cursive document with a photograph alongside it.
‘Wasn’t he cute?’ she says.
‘So – can you remember falling out of bed, Reg?’
‘No. I have no memory of it whatsoever. I woke up, and I was on my knees. I must have simply rolled out.’
There are bars along his side of the bed, but it is possible that he had slipped down before rolling. He does not have any new injuries or symptoms. It is a simple falling out of bed.
‘Maybe you had a dream you were manning the lifeboats,’ Jack says. ‘Hard to starboard!’
We all laugh. I finish the paperwork, and then we help Reg back into bed and tuck the yellowing quilt around him. He curls both hands up around the top edge of the quilt, and then shuts his eyes.
‘Full steam ahead!’
Reg’s wife thanks us for coming and walks us to the door. Outside the purple morning air is icy, and she clutches her dressing gown to her.
‘Bye now. Thank you very much. Don’t take this the wrong way, but I hope I don’t see you again soon.’


An hour later we are standing outside a pizza place, with what looks like gouts of tomato puree on the pavement and a cyclone of spite circling around us. Without this significant police presence, I would be in the cab and away, but as it is, we identify the two patients and get them onto the ambulance to assess them.
Pencil stub outlines: two whippet thin white guys in their late teens, number one in a white shirt and cheap satin waistcoat, the left side of his face bulging out to the side and a gash in the middle of his forehead that trails blood down over his face and front; number two, dressed in a spivvy black suit, holding his right arm and grinding his teeth. The mother of number two comes onto the vehicle as well. Where she has appeared from I have no idea – and never find out. She is a raddled version of her son, but with longer hair and nails.
More shocking by far than the boys’ injuries is their intense anger. In the same way that a flame will burn what and whoever comes within range, these two arc with violence. Their words are so fierce that it’s as if we and the police have to snap down welding masks to filter out the invective, to see any useful information that might be behind it.
‘So what’s happened to you?’
Filtered view of 1: ‘We had a fight with an Asian gang. They attacked us with baseball bats.’ He licks the blood from his front teeth, then carries on: ‘You can’t hold me. I haven’t done anything wrong. I don’t have to be here. I know my rights. I can walk if I want to.’
Police: ‘Moderate your language, please. We will certainly nick you for affray and breach of the peace if you don’t.’
Ambulance: ‘Look. Let’s try and sort out what’s happened to you. We need to clean you up a bit and see if you need to go to hospital.’
Filtered view of 1: ‘Go away. Leave me alone.’
Filtered view of 2: ‘Let’s go and burn down their house.’
When the policeman in the doorway tells him to be very careful not to swear at us and make threats, or face being nicked, number two bares his bloody teeth and spits his words out through them:
Filtered view of 2: ‘You’re enjoying this, aren’t you? Look at you. Go on, lap it up.’
But then, weirdly, he starts crying, doubling over and letting out a ghastly mewl like an injured puppy.
The mother tells her son to stop swearing at everyone.
Filtered view of mother: ‘They’re only doing their job. They think you should go to hospital. So go to hospital.’
At this point I would be happier if they didn’t go to hospital. I can’t imagine that they will be able to submit to treatment for longer than a minute without being thrown out by security. But they seem now to want to go. A policeman nods to me from outside the vehicle; I jump down to speak to him.
‘I’ll ride in the front with you, if that’s okay,’ he says. ‘I don’t want to make the situation worse. There’ll be a squad car following. If that’s okay with your colleague of course.’
Jack is hanging out of the door. He looks down at us and nods. We were talking about his surname earlier – how unusual it is, the Scandinavian derivation. He looks at me and smiles like I imagine a vast Viking champion would smile, strapping on an axe. ‘I’m fine with that,’ he says. I slam the doors shut and drive to A&E.

When we get there, I lead the three of them in through the main doors.
Filtered view of 1: ‘Where’s the hospital then? You said we were going to the hospital.’
Me: ‘We are there. This is the hospital - this big building in front of you. Let’s go in and talk to the nurses. But I have to tell you – if you carry on talking like this you will get thrown out.’
Filtered view of 1: ‘I don’t want to see any nurse. I don’t have to. You can’t make me.’
Filtered view of 2: ‘My arm hurts. I want to go home and kill those Asian gang members.’
Me: ‘You are in the hospital now, so you have to moderate your language. If you carry on talking like this, you won’t get seen. And I think you probably need to be seen.’
Filtered view of 1: ‘What do you know? You didn’t do anything. You’re just a taxi man.’
Me: ‘We need to wait just here whilst my colleague goes and talks to the Charge Nurse. Have a seat.’
Jack walks off to the nurse’s station. Another crew is preparing their trolley nearby. I have a discrete word with them to watch themselves, and they make some space. The police hover in the background.
Filtered view of 2: ‘We are seriously going to inflict damage on that crew.’
Policeman: ‘This is your last warning. If you continue to talk in this way you will be nicked.’

The Charge Nurse comes over.
‘What’s happened here, then?’, she says, with a bright, professional smile. ‘You first. Tell me what’s happened to you tonight?’
Unfiltered view of 1: ‘Well what the fuck do you think has happened to me tonight? You’re the cunt with the answers. Do something. Stupid.’
She turns briskly and says: ‘Throw them out.’

The police wade in and drag them all away.

Monday, February 04, 2008


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.