Wednesday, July 30, 2008

bullets here and here

‘You motherfucking scum. You think you treat me like this? Like I don’t care, don’t mind? Like I’m a nothing man? You motherfucking piece of trash. I kill you. I smash you. I piss on you. You bring me here and expect me wait in there? With that people? Five, six hours? No. No, no, no. This not right. You see me now. You see me and you fix me up or I kill you.’
He pulls up his t-shirt and smacks his lean belly. We stand there, turned sideways so we’re less of a target, arms at our sides, watching him, waiting for security. Where are security?
‘See this? See this, you motherfucking scum? You think I don’t know what pain is? You think I care what you do? I got bullets here, bullets here. Here. I got half a head – boom. You think I care what you think you do to me? You motherfucking scum. You see me now. I see the doctors now. Come. Take me to the doctors.’
The charge nurse says: ‘I’m not taking any more of this crap.’ But all he seems able to do is hit the redial button. Everyone and everything in the immediate vicinity has slowed or stopped, dragged into the tow of this curious man’s rage. We’re all waiting for him to do something, to hit someone, or try to. He raises his crutch, then lowers it again.
‘Hrrrrrr’ he says. Hobbles off, then comes straight back.
‘You think I care what you do to me?’
‘Listen, Gil. We’re here to help you. We’ve brought you to hospital because you said you wanted to see a doctor about your hip. You will get to see a doctor, but there is a wait, unfortunately. All these people are in the same boat.’
I risk a glance past Gil’s shoulder into the waiting room. I catch the eye of a woman and her teenage daughter, the daughter clutching her arm, both of them staring across from the hard blue seat of their ordeal.
‘Just look around you, Gil.’
But he merely carries on fronting us out, waving his crutch occasionally like an enraged gorilla thrashing a branch. Eventually he turns and crashes an exit through the crowded waiting room, off into the car park. Two minutes later security arrives.
‘He’s about five foot six, wearing a cap with a red star on the front, using one crutch…’ I tell them.
‘Yes, yes, we saw it all on the cameras.’
They stroll cautiously outside to see if he’s still around.
‘They saw it on the cameras,’ says the charge nurse. ‘Great. We were never in any danger, then.’

When we had answered the red call to the man collapsed in the street, we’d found Gil and another man standing arguing on the pavement. Gil had a bloody cut to his eyebrow – his friend roughed in the details through a bad-tempered storm of interruptions: Gil had been sitting against a wall, had tried to stand up, lost his footing and grazed his head. He hadn’t lost consciousness, hadn’t felt unwell, and as far as he knew that was the only thing wrong with him.
‘Gil – we need to get you on the vehicle, clean you up and see what’s happened. But Gil – we also need you to calm down, okay? We’re here to help you. Can you do that for us? Just slow down, take it easy and we’ll see what’s what.’
Amazingly this seems to work. He slumps into himself, but steps nimbly enough up onto the ambulance.

In the good interior light we get a clear view of our patient. The most immediately striking thing about him is his head. He has a palm sized depression on the right side of his skull, yellowed and sunken below the cropped lines of his scalp. It looks like an old plastic plug that’s dried and receded. Its edges are ragged, suture like.
‘How did you get that?’ I ask him.
‘Ach. You don’t know and you don’t want to know. I got bullet here, here. I got explosion from mine. My hip, my head, my liver, my god - everything. Iraq. Afghanistan. Israel. Pow.’
‘So you were a soldier, Gil?’
He pulls up the sleeve of his jacket.
‘Look here. Bullet, bullet. Here also. Ach.’
We tour his scars, awful knots of pale knitted flesh rucked and raked together on his arms, his abdomen, his legs. Whether this was all the result of one explosion or a collection of wounds, it’s impossible to determine. He’s had a few cans of lager, it’s late at night, and all he seems to want is to see someone about his hip.
‘I had replacement,’ he says, smacking his right hip. ‘It hurts me now three four week. I need to see doctor.’
I start to clean up the wound on his eyebrow, which doesn’t seem bad.
‘So it’s not new pain tonight? And you’ve had it for a few weeks. Can I ask why you didn’t see a doctor before now?’
Gil pushes my hand away, wipes his eye-line with the back of his hand, pulls his cap back on, pulls his crutch upright in front of him like a rifle.
‘You take me doctor now.’

When the ambulance pulls in to the A&E car park, Gil seems more relaxed.
‘I get out now?’
‘Let’s just wait for Frank to finish reversing.’
Frank opens up the back door.
‘Would you like a chair?’
‘I walk. I not dead yet.’
I lead him into the minors area. He looks around him at the people scattered despondently around the purple waiting room.
‘Take a seat, Gil, whilst I go and have a word with the nurse.’
But he doesn’t sit down.
‘What means this?’ he says.
‘Take a seat. I’m afraid there may be a little wait to see someone. They’re quite busy tonight.’
I walk off towards the nurse’s station. Frank comes with me, rather than going off to make some coffee. He can sense the charge in the air.
‘No!’ shouts Gil. ‘You not do this to me. I not wait here. I see doctor now.’
He hurries after us and nails us in front of the nurse’s desk. We are in danger, a marked target. I wonder – should he attack– whether anyone will break from the anonymous safety of the herd to come to our assistance.

I wonder if he has a knife.

Sunday, July 20, 2008

nfa bear

There is a huge man sleeping on the steps of the grand office portico. He needs only bigger ears and a pair of claws to make a passable grizzly bear, but instead of a log he rests his arm across a filthy tote bag.
‘Please. You have to help him,’ says the young girl at my shoulder. Her boyfriend, his arms behind his back and his hands pressed compliantly into his jeans back pockets, grins shyly and lifts his eyebrows. ‘She didn’t know what else to do.’
So now five of us – me and my partner Jack, a policewoman, the girl and her friend – stand in a semi-circle around the man, whilst hundreds of Saturday night clubbers press on around us through the streets on their great nocturnal migration from the bars to the clubs.
‘Did you see anything happen to him? Did he fall? Was he attacked?’
‘No. We just saw him lying there. He could be dead. No-one gives a damn. Do something.’
She seems narcotically strung, scratching from side to side in gorgeous boots, pale and brittle. I would very much like to have them away from the scene, partly in case the man reacts badly to being woken up, but mostly because I would prefer only to have to deal with one unpredictable and not two.
‘Well thank you for you help tonight,’ I say to her. She waits for something more. ‘I don’t think there’s much else for you to do here. Thanks very much. It’s okay for you to go.’
The boyfriend seems relieved but the girl isn’t satisfied. She allows herself to be drawn off to the side, where she stands and waits and studies us.

Mindful of a swipe from the sleeping man, I chose the least vulnerable position, lean in and give him a humane shake. ‘Hello. Ambulance. Can you sit up and talk to me, please?’
It’s like calling down a well. My voice seems to echo somewhere deep behind his face.
‘Ambulance. People are worried about you, mate. Sit up and talk to me. Are you hurt or sick in any way?’
I increase the stimulation and it comes back with a vague twitch of consciousness.
‘Open your eyes for me.’
He snuffles, gives a torpid sneer.
‘Open your eyes.’
They lever open a crack, just enough for me to see that he hasn’t had any smack, and just enough for him to throw a line around his tormentor.
‘And who the fuck are you?’
‘It’s the ambulance. Sorry to wake you. But people see you lying there and they wonder if there might be something the matter.’
‘Go away.’
He re-seals his eyes.
‘No. Come on. We’ve come out to see you. The least you can do is talk to us.’
‘Go a fucking way’
The policewoman enters the ring.
‘Mate. You need to get up and be on your way. You can’t be sleeping here tonight. This is public property.’
The eyes are back on.
‘And who the fuck may you be?’
‘I’m the police, mate. And I’m telling you that you need to move on.’
I can sense the young girl rearing off to my right. This isn’t what she had in mind when she called for help. Her friend has his arms around her shoulders, but it’s like throwing a bridle on an unbroken horse. They exchange some urgent, low level conversation.
‘Leave me alone.’
‘Sorry. We can’t do that. If we leave you alone, all that will happen is that someone else will call an ambulance, and we’ll be back where we started.’
Cued by her line, I cut back in with my rudimentary patient assessment.
‘Just to be clear – is there anything wrong with you? Are you hurt or sick?’
‘I’m fucking sick of you.’
The policewoman looks up and down the street. Her back-up is in the takeaway getting snacks.
‘Why don’t you do us all a favour and go to the park, or something?’ she says.
He leans upwards towards her, the dangling thread of saliva on his lip gleaming dully in the overspill light from the shop next door.
‘I can’t go to no fucking park. I’ve got an asbo there.’
‘Well can you go to the beach?’
‘I can’t go to no fucking beach. I’ve got an asbo there.’
‘Can’t you go to a hostel tonight?’
‘They’re full. I got no where. The fuck you care.’
‘Well I think we’re all sorry that you’re in such a strait, but the simple fact is that you can’t sleep here.’
‘Go the fuck away. Leave me alone.’
Three policemen are coming down the street towards us, each with a little white plastic bag of food. They chat and laugh together, fluorescent with comradeship and purpose. The policewoman seems to grow slightly.
‘We don’t like to insist,’ she says, ‘But we can’t go anywhere until you co-operate.’
The young girl suddenly pushes between us all. Even the man on the steps pulls back.
‘This isn’t what I wanted,’ she wails. ‘This is not what I wanted. It isn’t fair. Can’t you take him to a shelter or something? The hospital? You can’t do this. He has nothing. Can’t you see? He needs help.’
The boyfriend steps back in and leads her away again. She has her mobile phone out and is frantically tapping in some numbers. I wonder who.
The man is on his feet now. He leans down precariously to gather his bag up.
‘Fucking cunts’ he breathes. ‘What do you care?’
Then he sees a man in crutches on the other side of the street.
‘Oi’ he bellows.
The man in crutches raises one, and they begin a slow shuffling progress towards each other through the late night crowd; it parts as smoothly and easily as repellent opposites to let them.

Thursday, July 17, 2008


I don’t have to worry about finding the site of this RTC, riding as I am on the tail of a brace of fire trucks, careening through the dark streets, cleaving the night with our lights and sirens and getting straight to it, no question.
Car into house is the message on the terrafix, and then – no back up available. pls. assess and advise.
A police car tags on behind me. Then another. The punters turning out of the pubs must think it’s the end of the world.

We blaze off the main road up into residential territory, rights and lefts and tight fits between parked cars until the trucks haul up outside a bungalow marked by a small crowd of people – teenagers in dressing gowns, old men in slippers, family huddles – and, when I’m out and able to see, a car wedged in the front of it. The bungalow is on the elbow of the road as it turns up and to the right. It looks as if the car has taken the corner too fast, ploughed through a low brick wall, rolled on to its off-side and buried its bonnet just below a window. There is already a police car on scene. The officer tells me that the driver has absconded, but he leads me over to a middle-aged man who is waving his arms descriptively in front of a couple of fire fighters.
‘My boy was asleep in that room. There was an almighty crunch, we jumped off the sofa and ran in. You’ll see. There’s glass and stuff everywhere. We just scooped him up and ran out of there. We found this kid standing outside looking fucked up, you know. Obviously the driver. Not a mark on him, but completely spaced. He asked me if we were okay, and when I said I think so, he took off up the road.’
The policeman puts a hand on the man’s shoulder and leads him away to the side. A bright white light flips on from one of the fire trucks, laying the scene bare.
‘We’ve got a paramedic here,’ says the officer.
‘Great,’ says the man. ‘I’m sure there’s nothing wrong with James, but I’d appreciate it if you’d come and give him the once over.’
I follow him into a neighbour’s house. If the crowd in the street is held together by a compulsion to witness the wreck, the blue lights and the police running up and down the road, the focus of this house is altogether more personal. It seems to have become a gathering place, a neighbourly place of safety, where those most directly affected can gather themselves, drink tea and make plans. It’s as if the car has slammed into a hive, jolting the community into collective action.

James is bouncing up and down on his mother’s lap, a bright little two year old, enjoying the strangeness of all this. I check him over but he’s very obviously fine. Before I go, I ask the mother if she’d mind if I had a look in the house to see what the level of damage was.
‘Please do,’ she says. ‘You’ll see how lucky we’ve been.’

Even though I know that the family are next door, I still knock before I go in. The hallway is strangely illuminated by the harsh scene lighting. The house seems to be hanging back, guarding its shadows from the blatant scrutiny. I walk along the hallway, take a right, and stand in front of the door to the James’ nursery. It swings open smoothly, then catches on something. I look in.

The wall beneath the bay window opposite bulges inwards, five courses of bricks from the carpet up witness to the point of impact. All the glass has been shattered above it, the struts hanging inwards, a vicious confetti of glass shards scattered across every surface, the carpet, dresser, teddies and dressing up clothes, the train track and the colouring books. The bed.

This is a shocking assault on a happy little room, and yes, James is a lucky boy.

Just as I turn to go, I catch a sudden, strange hopping movement on the floor. I see a little dark lump – and it hops again. A froglet, heading towards the window. I guess it was either on the bush outside and carried through when the car struck, or perhaps hopped through one of the gaps immediately after. Either way, it will struggle to get back outside on its own. I take a step forward to try to rescue it. The glass crystals crunch underfoot. The froglet makes a desperate sideways leap and disappears under the bed. I can’t reach it, and can’t afford any time trying.

I leave the room, and head back outside into the light.

Wednesday, July 16, 2008

puppets on crack

Working the car has some advantages – periods on standby when you can simply be quiet and read; assessing patients at your own pace without interruption; listening to whatever radio station you feel like. But as I slam the car boot and struggle to gather together the three bulky bags I’ll need for this job, one big disadvantage is made weightily clear.

And then, of course, another disadvantage is that sometimes you’ll find yourself going in to a crack house on your own at three in the morning.

Control has reassured me that the police are on scene, and I’ve parked in front of their patrol car, but it’s not the same as having a crew mate to share the particular vulnerabilities of the ambulance position. Plus – this has been given as an overdose, and I don’t fancy spending half an hour bagging this patient without relief. The night is rolling on thick and close. The storm that would ease it has seemed imminent for the past hour, but maybe it will never come. I’ve only been out of the air conditioned car for a minute and already the frosting on my skin has gone.

During the day this is a busy street serving the railway station and the top end of town. Now the little café fronts and obscure record shops are dark. The flat numbers seem to be lower than I was expecting, and the police car turns out not to be immediately outside the address. I waddle past three dark entrances, unable to wield a torch and tote the bags at the same time. A young woman slides me a sympathetic look as she passes, then calls back a few seconds later.
‘In there,’ she points, just as a policeman peers round the corner of a shop.
I donkey my way over to him.
‘Here, can you carry that?’
‘All right, mate. Blimey – what’s in there? Gold bars? Anyway - what we’ve got is a woman of about thirty odd. Flat out on the floor. Looks like some kind of overdose, probably crack cocaine. We were called to the address because a guy said he’d been burgled. He answered the door with a knife, but it’s all okay now. Bit of a nut job, but nothing we can’t handle. Says the woman’s a friend of his. Can’t tell you much more. Thanks for coming. Watch your step.’
He leads me over the threshold of a dark and dirty back room, strewn with cushions, papers, carrier bags and cups – the usual flop house chic. In through a filthy galley kitchen where a policewoman is talking to a man in a dark suit, up a tight little dog-leg twist in the stairs, and into a sitting room where a woman is lying face down on the lino. She’s wearing an off-the-shoulder purple party dress, and would look as if she’d fainted during canapés were it not for the dreadful surroundings and the patterns of bruises and scars along her arms. I can see the rise and fall of her breathing even from here, even in the gloom of this place.
‘Have we got a name?’
‘Adie, we think. Trev’s not too clear about that. Or anything else, for that matter.’
I put the remaining bags down and go over to her.
‘Adie? Adie? Talk to me, Adie.’ I give her a shoulder pinch. Then a little harder. She groans and tries to shrug me off.
‘Adie. What have you taken tonight?’
On the armchair beside her is an asthma inhaler, but the cylinder has gone and there is some foil wrapped around the mouthpiece. The inside is charred. On a table nearby there is a clutter of vodka bottles, beer cans and a tall yellow canister of lighter fuel.
‘Have you been smoking some crack tonight, Adie?’
Her pupils are small but not pinpoint, and they react to my torch. Her respirations seem a little slow, and her oxygen levels aren’t quite what they should be, so with the help of the policeman I put a mask on her. As I’m taking some other obs the man in the dark suit comes into the room, followed by the policewoman. He walks over to me, a bobbing, curiously disjointed kind of walk.
‘She’s had the last rites,’ he puffs.
The black suit hangs off his slight frame with minimal contact. His face has an emphysemic, waxy gloss. His teeth are all gone – although he can’t be more than forty five – and his wide mouth flaps open and shut in an unhinged way. Everything about this man seems slack. Even his eyes pitch from left to right without focus. The policewoman is standing right behind him, and I could swear she has a hand up his back, and that her lips move slightly when he talks.
‘She’s going to die,’ he wheezes.
‘Trevor – it is Trevor, isn’t it?’
He nods, and his eyelids clack shut.
‘Trevor – is Adie your partner?’
The eyelids spring open.
‘No she is not. She is a friend. I’ve known her for fifteen years.’
‘Great. Can you help me out with a few details then, Trevor? Her full name, for a start.’
‘Adie. A-d-i-e.’
‘Thanks. And last name?’
‘What do you mean, last name?’
‘Her surname. You know.’
‘No idea.’
‘Okay. How old is Adie?’
‘No idea.’
‘Where does she live?’
He rattles his head.
‘Past medical history? Medication? GP?’
No. No. No. His level of consciousness seems to fall with each ‘no’.
‘Okay, Trevor. Can you tell me what happened tonight?’
His eyes suddenly widen again.
‘Adie came round. We had a few drinks.
‘How many drinks?’
‘Not much. Some cans of beer. A bottle of vodka. Then Adie had a smoke of her pipe. I went down to make something to eat. When I came back up she was on the floor.’
‘What happened about the burglary?’
‘Burglary? What burglary?’
I look over to the policeman. His expression reads: well what do you expect?
‘What are you going to do?’ says Trevor. ‘You can’t leave her here to die.’
‘Well, I don’t think she’s going to die, but she does need to go in to hospital so they can keep an eye on her. I’ll call for an ambulance.’
I give Control a ring and request a vehicle. Trevor seems to fall asleep standing up.
‘Why don’t you take a seat, Trev?’ I say to him.
He straightens with a little thrill.
‘I’m a section one patient,’ he says brightly. ‘But I’m off my medication.’
‘Why’s that then?’
He stares at me.
‘Why’s what then?’
He turns his head slightly to the side, his eyes stay to the front, and for a moment I think his head is about to spin around completely. Before I can shake off the image, the policeman steps over.
‘Come on, Trev. We need to have a little talk.’
He leads him back down the stairs. I squat back down to see how Adie is progressing, and turn over some rooted holiday talk with the policewoman for ten minutes whilst I wait for back up.

Friday, July 11, 2008

off to spain

‘Your chap’s about a thousand years old. He was the driver of a car that ran into the back of a young girl’s motor – low speed – not much damage, no airbags, nothing exciting. She’s okay and doesn’t want anything to happen particularly, but we were a bit concerned about him. Could you have a look?’
The policeman leads us over to the front seat of a battered old Hillman Imp. Sitting very correctly upright is an elderly man, who still has both hands on the steering wheel as if he expects to move off any moment. I crouch down beside him and introduce myself. He tells me his name is Mr Breedon.
‘I’m perfectly all right, you know. I don’t know what all this fuss is about. My brakes failed, is all.’
He seems strangely distant, like he’s been cast in wax and sat here in this car as some kind of display. After we’ve determined that he has no pain, no injuries and no untoward feelings anywhere, we carefully help him out of the car. He straightens and looks around him like he’s been asleep and woken up somewhere unusual.
‘Where are we going?’ he says.
‘Just to the ambulance, first of all. We want to run a few tests, see how you’re doing.’
‘I’m absolutely fine. Thank you. I just need to get going.’
‘Where are you off to?’
‘I’m picking up my wife. We’re going to Spain.’
‘Where is your wife?’
‘In care’
‘Okay. Oops. Mind yourself.’
Mr Breedon shifts his balance precariously from step to step and would fall if we were not either side of him. I lean in to catch a discrete whiff of alcohol, but all I can smell is camphor.
‘Are you feeling dizzy, Mr Breedon?’
‘Well, yes, a little. But I saw my GP yesterday and he gave me a clean bill of health.’
We help him in to the back of the vehicle. I persuade him to lie on the trolley rather than sit in a seat, even though he protests that this is all too much. Rae helps him out of his blazer and rolls up his sleeve. He rests his head back as if he’s suddenly very tired.
‘How old are you, Mr Breedon?’
‘And what’s your date of birth?’
‘5th of the 5th, nineteen twenty two.’
‘Mm. I think that makes you eighty six.’
‘Yes. That’s right. Eighty six.’
‘Do you know what day it is today?’
‘Do I know what day it is today?’
‘What day is it today, then?’
‘You tell me.’
‘Well I’d rather hear it from you.’
‘If you must.’
He shuts his eyes.
At this point, the policeman knocks on the door. Rae opens up and he looks inside.
‘How are we doing?’ he asks. ‘I just need Mr Breedon’s keys so I can move his car out of the road.’
‘Did you hear that, Mr Breedon? The policeman wants your keys.’
‘Yes. Fine. Here they are.’
He reaches into his trouser pocket, pulls out a piece of white plastic cable, and hands it to me.
‘What’s this?’
‘My car keys.’
‘I think it’s a computer modem, Mr Breedon.’
‘Is it?’
I smile at the policeman.
‘Rae, could you see if Mr Breedon’s keys are in his jacket pocket?’
She pats his jacket, locates the keys, and passes them out to the policeman.
‘Will he be going to hospital, do you think?’ he asks.
‘Oh yes, I think so. Definitely.’
‘Hospital? I can’t go to hospital. I’ve got things to do and it’s already late. I’ve got to pick up my wife and go to Spain.’

Mr Breedon seems to be running a temperature, and it’s a fair guess that with everything he tells us, his confusion and loss of balance, that he may have some kind of urinary tract infection. We make him comfortable and prepare to set off.
‘Are you visiting anyone out in Spain?’ I ask him, as Rae jumps out and slams the door to.
‘Yes. My son.’ He turns and winks at me, a procedure that seems to take a full minute. ‘But ah! He doesn’t know it yet.’

Thursday, July 10, 2008

the right thing to say

‘I wasn’t unconscious or knocked silly. I can remember the whole sorry episode. I simply had another of my groggy turns, fell over, clipped the back of my head on the coffee table, and lay there like a fool. Again!’
Agnes sits on the edge of the sofa, her ancient hands picking at the handkerchief in her lap, her pale grey eyes wide and shining. She tells us the story of her latest fall as if the little group around her – the community responder, me, Frank and the next door neighbour – were a bunch of five year olds at story time.
‘The other day I pitched backwards through the kitchen door. Just look what I did to my arm. My goodness, there was blood. Tell them about the blood, Rose.’
‘Oh,’ says Rose, standing with one hand pressed to the side of her face. ‘Well. Oh.’
The community responder has already cleaned the wound – a ragged hole in the back of her head the size of a ten pence piece.
‘That’ll need a stitch or two,’ I tell her.
‘Really? More stitches? Well – I’m speechless.’
Whilst Rose takes instruction from Agnes – prescription sheet in the kitchen, cardigan and slippers in the bedroom, purse, keys, glasses, emergency phone number – I finish dressing the wound. I hold the dampened gauze in place with a bandage that wraps round Agnes’ head, pushing her silver hair upwards.
‘My word – you’ve made me look like a pineapple.’
‘It’s only temporary, Agnes.’ I stand up, take a step back and admire my work. ‘I tell you who you do look like. That singer out of Sigue Sigue Sputnik.’
‘A punk-ish pop band. From the eighties.’
Frank studies me with fatherly concern, the community responder seems to buckle under the weight of his smile. Even Rose stops hunting around for things and joins in the wake. I redden, for no real reason at all, the first time in ages.
‘Come on,’ I say, bluffing it out. ‘Time to make a move.’
‘What an adventure,’ Agnes says, and then ‘Rose? Have you got those things, yet?’
‘Let’s go, Mrs Pineapple,’ says Frank, helping her up. I get the bags.

A&E is crammed. I leave Agnes sitting in a wheelchair with Frank by her side and excuse my way over to the desk to handover to the charge nurse.

Nerys is working the board like a bookie at the races. I stand there trying not to add any more to her stress whilst at the same time asserting my position. She stands at the centre of a dreadful cloud of demand – nurses, doctors, consultants, patients and relatives – bravely fighting for order with a marker pen and board wipe.
A man appears and stands next to me, puts both hands on the counter. He radiates aggressive intent as palpably as the alcohol fumes that hang off his seamy clothes.
‘Hey. I need to use the phone to tell people I’m here,’ he says, cutting across everything.
‘Payphones in the lobby,’ Nerys says, giving him a professional smile, passing out a form to one nurse and accepting another from the clerk.
The man spreads his hands further on the counter, pushing my board aside.
‘I know exactly what you mean. I know what your game is,’ he says. ‘I’ve been here fucking hours. I’ve got chest pain, a pain in my chest. Do you know what I mean? Like you care. You just want fucking rid of me. Well if I go now and drop dead in the car park it’ll be your fault.’
‘Hey. Hold on,’ says Nerys. ‘Rewind. You asked me about phones. I told you where the phones are. What’s your problem?’
‘What’s my problem? What’s your fucking problem?’
I catch the ward clerk’s eye as she dials security.
‘Walsh. Mr Walsh. You don’t even know my name. You think I’m a waste of space and you just want shot of me.’
‘Mr Walsh,’ I say to him, as evenly as I can. He swivels round to face me. ‘I know this is frustrating for you, but we’re all here to help. The nurse was just saying you can make a phone call from the lobby.’
Red rage bunches up in his eyes and his cheeks.
‘You what?’ he says. ‘You fucking what?’
‘If you carry on like this you won’t be seen. You’re just making things worse.’
‘Who the fuck are you?’
‘I’m with the ambulance.’
‘Well – Mr I’m-a-big-Fucking-Ambulance me. You keep your snout out of it. Fucking cheek.’
I shake my head impassively, and get ready to dodge the fist that seems almost certain to follow. But Mr Walsh – probably well aware that security are on their way – turns and stomps off, pushing past people. He shouts at Agnes as he goes through: ‘Count your fucking toes, lady. You won’t have the same number when you leave as you came in with.’

Security intercept him at the door; there is shouting out in the car park.

I turn back to Nerys. She tries to smile, but her chin seems to slacken slightly and I know it’s an effort for her to continue.
‘Nice man’ I say to her. ‘What a shame he’s gone.’
‘Who’ve you got, then?’ she says, finally, uncapping her pen to put Agnes on the board.

We help Agnes onto a trolley and make her as comfortable as we can, tucking her in and making sure she has her bag to hand.
‘Will I be here long?’ she asks.
‘Well – it is busy tonight, Agnes, so I can’t promise that you won’t have a wait. But the nurses and doctors are working as hard as they can. They know you’re here, and they’ll be along shortly.’
‘So this is where we part company?’
‘Yes, I’m afraid it is.’
‘Thank you so much for all you’ve done.’
We leave her, sitting up on the trolley, smoothing down the blanket and staring out at her surroundings, her hair sprouting up above the thick white bandage, an expression on her face about one part excitement, two parts fear.

Wednesday, July 09, 2008


The last thing to clean is the carry chair. I put on another pair of blue gloves, pull the chair out of its cupboard, carry it off the back of the ambulance, set it up, and then step back in again to fetch a canister of surface wipes. When I come back out, a young guy is standing over beside the automatic doors to A & E, looking down into a mobile phone. He catches my eye, nods a hello, then shuffles over uncertainly for a chat.
‘Thanks for coming earlier,’ he says, stuffing his phone in the back pocket of his jeans and then standing neutrally as if he were awaiting further instructions.
‘That’s okay. How’s he doing?’
‘Oh – he’s okay. The idiot. One of the doctors had heard of those pills and he says they’re not too bad. He says it’s a kind of plant treatment that they can sell as a vaguely legal e or something. Weird.’
I picture the smart little pill folder to myself – the silhouette of a dancer against a bright yellow sunflower.
‘But he did say that maybe taking two at once was pushing it.’
I carry on with my cleaning and he watches me work.
‘He got a bit freaked when his heart start beating like some kind of cookery timer, though. I don’t think he’s cut out for these weird extracts. The idiot.’
‘There’s always something,’ I say, but I don’t know what I mean. It stalls the conversation. I worry away at a seam of faecal matter just below the lip of the seat.
‘Busy night then?’
‘Oh. Not too bad. You know.’
‘I hope we didn’t waste your time. We didn’t know what else to do. He was well freaked by it all. The nut job.’
‘I’m glad it’s all worked out ok.’
The seat’s clear now. I move on, methodically wiping down the struts, back, rings, joints, foot rest, throwing each wipe into the yellow clinical waste bag that I’ve set up on the ground beside me.

He watches me.

I feel like spilling the whole sorry episode out to him, telling him who the last occupant of this carry chair was, a man who had been hauled drowned and lifeless by his elderly father up out of a bath of freezing water, and whose father we had seen trying to compress his son’s chest and talk on the phone at the same time whilst the family dog howled in the room next door. I want to tell him that our attempts to revive the man on the filthy bathroom floor had been hopeless, or try to describe how difficult it was to lift him in such a cramped and slippery environment up off the floor and on to the chair when it was time to go. I want to tell him that when I sat the mother in the cab with me to follow the leading ambulance to hospital, I’d forgotten that we’d left the radio on in our rush to go into the house, that I still didn’t realise how loud the music was playing as I explained what would happen next, and how stupid I’d felt when the mother reached forward, turned it off and said ‘Sorry. I don’t think I can listen to this at the moment.’ I want to tell him how she rode up to the hospital with her hands folded in her lap, shocked white and calm, and how we’d both watched as the blue lights of the ambulance carrying her son gradually sparkled further and further off into the night ahead of us. I want to tell him that at hospital by the relative’s room she’d politely insisted to the charge nurse that she be allowed into the resus room, and how respectfully she was received when she was eventually led through those doors.

‘Do you think we’ll be here all night?’ the young guy asks me.
For a second I’m disoriented and don’t know who he means. I straighten up, toss the last wipe into the bag and look at him.
‘Let’s hope not,’ I say, and notice Rae walking over with two cups of coffee. ‘Let’s hope not.’
I peel off the blue gloves. They follow the wipes into the bag.

Friday, July 04, 2008

the elephant in the sailor suit

The house is as perfect as a Georgian doll’s house in a toy museum. A scarlet climbing rose flowers abundantly between the well-proportioned windows and the peacock patterned stained glass panels of the front door, whilst lavender and box in lead planters stand formally clipped along the stone flagged front path. I flip the brass, lion’s paw knocker and we wait.
Eventually the blurred image of an elderly woman coalesces behind the coloured glass and the door opens.
She is a magically animated old lady doll, slightly curved in the back, filled out in a heavy tweed skirt and white blouse, her hair as lovingly tied and tended as the plants in the front garden.
‘Hello. It’s the ambulance. We had a call to this address. Something about a woman feeling sick or peculiar in some way. Can I ask – are you the woman who made the call?’
‘Oh. Yes. I believe I did. Do come in.’
She turns round and leads us across a neat little hallway tiled in black and white squares and guarded by a beautifully sonorous grandfather clock. We follow her into a sitting room, and we all sit down, each in a chair with lion’s feet and vivid brocade.
‘My name’s Spence. This is Rae. Can I ask what your name is?’
‘So. Jennifer. What seems to be the trouble?’
'Well. It’s all most unusual. I woke up this morning and found myself in this strange house. I seem to have been taken up somehow and put here. And that’s not all. Someone’s gone to the trouble of taking some of my things, some things I recognise very well, and put them here with me. I can’t think why on earth they would have done that. Can you?’
Jennifer tells us about her abduction with only a mild concern, as if she is describing an unexpected order of milk.
‘Do you feel unwell in any way? Are you in pain?’
‘No. I feel absolutely fine. The only thing is – I did suffer terrible burns to my legs. Look.’
She pulls up her skirt, and shows us some scarring to her lower legs.
‘That looks quite old to me,’ I tell her. ‘When did that happen?’
‘When I was two or three,’ she says. ‘It was quite horrible, and still gives me pain from time to time.’
‘Apart from your legs, how do you feel in yourself?’
‘Fine. Fine. Just a bit – well, concerned, you could say.’
Rae gets up and has a look around the room for clues - care folders, prescriptions, ambulance sheets, but doesn’t find any. She picks out one of a number of anniversary cards on the mantelpiece. ‘To James and Jennifer,’ she reads. ‘Happy Fiftieth.’ She puts the card back. ‘Who’s James?’
‘Oh James. He’s my husband. I’ve no idea what’s happened to him. But perhaps he’d know what all this is about.’
She looks at us, and folds her hands in her lap.
‘It really is so nice of you to take the trouble.’
I ask her if she’d mind if I checked her blood sugar levels and blood pressure, and she smiles and says of course not. All her observations are fine.

Suddenly the front door opens, and a moment later an elderly man in brown corduroy trousers and a crisply ironed shirt steps into the room. ‘Hello,’ he says, but the concern in his eyes undermines the warmth of his smile.
‘James,’ she says, giving a little clap. ‘Perhaps you can help us get to the bottom of this. Where on earth am I?’
He strokes her head, kisses the top of it.
‘Just a moment, Jennie’ he says, then discretely nods to me to follow him into the kitchen. He tells me that his wife has dementia, that he is the sole carer, but does get help three times a week. Unfortunately this morning there was some hitch and he needed to nip round the corner to the shops, leaving his wife alone for a half an hour. She’s been fine before, but he tells me that her condition is worsening.

After James has given me all the details I need for my form, we go back into the sitting room. Jennifer is laughing at something that Rae has said.
‘That’s priceless,’ she says. ‘Well – I do thank you for coming, even if you couldn’t solve my little mystery.’

James leads us back out across the hallway. I notice an ancient, knitted elephant in a sailor suit propped up on a chair by the clock.
‘That elephant,’ he sighs. ‘She was carrying him around when she got up this morning. I should know by now. It’s always a bad sign.’
He thanks us again for coming, and we walk back to the ambulance, just visible through the jasmine that coils vigorously around and above the filigree iron gate.

the quiet dog

I’m standing at the door to the flat with a policeman next to me. He already has his hand to his face, because the hallway is thick with foul air. There are a couple of massy black flies lolling around the letterbox; I put the resus bag down because I don’t think I’ll be needing it.
‘Police. Open up.’
Rae shouts from the pavement that runs along the front windows to the flat. ‘I can see legs on the sofa – kind of.’
‘Are you happy kicking the door in or do you want me to help?’ I ask him.
He shakes his head confidently, takes a step back, braces himself with both hands against either wall, then lays into the door with one then two great flat-footed kicks. It splinters at the lock and swings backwards.
‘Ambulance’ I call out and step into the flat.
The air seems to ripple around us with fatty, cloying vapours. I move further along the cluttered hallway, breathing through my mouth. ‘Ambulance’ I say again, with much less vigour. The door to the sitting room is open. I can see the body of a large Alsatian dog lying on its side against the wall, the flesh along the length of its wasted body sinking into the gaps between its bones. Its eyes are bored deep and black. I walk into the room and see the dog’s owner lying on the sofa. He was naked when he died; now he is blown up with decay, spilling and blackened like a monstrous, over-cooked sausage.

I leave the room and walk back, passing the policeman in the hallway.
‘Very obviously dead,’ I say to him. He squeezes past me to see for himself as I move quickly outside. After a minute or two I start finishing the paperwork.
The policeman comes outside and asks me if I’ve got any chewing gum, or some mints.

A scattering of neighbours are being drawn outside by the police and ambulance lights. The woman in the flat next door to the dead man comes out in her white towelling dressing gown. She clutches it round her neck as she speaks to me.
‘What’s happened? Is he all right?’
‘No. I’m afraid he’s not. He’s – erm – he’s died.’
‘Oh my god.’ She puts her hand to her face. ‘What about his dog?’
‘I’m afraid the dog has died, too.’
‘Urgh. What’s that smell?’
‘He died a while ago. When did you last see him?’
‘George? I don’t know. Must’ve been a couple of weeks or so.’
‘Did you hear anything? See anything?’
‘I do remember the dog barking for a while. Come to think of it, that’s unusual. He’s always such a quiet dog.’
She looks out at the second police crew to arrive and hugs her dressing gown to her even tighter.
‘Oh my god.’
A woman comes out of the flat next door to hers on the other side and asks what’s going on as she locks the door.
‘That George has died. And his dog.’
‘Oh that’s awful,’ she says, pocketing the key. ‘I thought his truck hadn’t moved for a while. He’s normally so - out and about. Oh that’s terrible.’ She hurries off up the concrete steps. I turn back to my form and write ‘decomposition’ in the box that asks for signs incompatible with life.
‘That poor dog’ says the woman.
A policewoman comes over to us, and two more go into the flat with thick white masks on.