Thursday, February 26, 2009

the change

Five o’clock in the morning and the sky has a fuzz of blue about it that marks The Change. I can feel it in me, too, as if my blood and bones are orientating to the same rising point. I’m through the three o’clock subsea numbness, that dead or alive slump that makes shift work so difficult. The only way is up.

I knock again. There are lights on through the house, but all the curtains are closed and nothing moves.

We’ve been called here to help with a lift. Apparently a crew was dispatched to pick a large woman off the floor, and Control has sent us, too, pre-empting a request for help, and because we happened to be passing.

No reply.

I knock again whilst Frank steps across the flower bed and bangs on the window.
The first crew’s ambulance is parked right outside, so I can’t think that we have the wrong number.

‘Maybe they’re mid-manoeuvre and can’t come to the door,’ says Frank, goose-stepping over a desiccated lavender bush. ‘Or trapped under a heavy piece of furniture.’
Just as I reach out to knock again, the door is yanked open. Rich, an EMT from out of town, stands there looking hot.
‘Resus,’ he says, and then turns to go back inside. We follow close on his heels. He gives us the main facts over his shoulder: Ninety year old female. Husband thought she’d fallen over when she got out of bed to go to the loo. Rang for an ambulance to help get her up. Didn’t do any CPR. Doesn’t know how bad she is. Took us twenty minutes to get here. Asystole since we started. No cardiac PMH.

We follow Rich into a room where a woman is lying on her back, rolled flat by the cataclysm that has been visited upon her. Two single beds have been pushed together and a table and chest of drawers piled on top to make space. The woman is naked, her nightie cut in two, flowing out either side of her like trampled wings. Sophie is kneeling beside her, compressing her chest.
‘Here. Let me take over that,’ I say to her.
‘Thanks, mate,’ she says, stiffly getting to her feet. ‘God. My knees are so creaky these days.’
Rich takes over the ventilations.
‘How long have you been going now?’
‘What is it? Ten minutes?’ says Rich.
Frank goes back down the stairs to fetch his para bag; Sophie goes with him to chat to the husband.
‘How’s he taking it?’
‘I don’t think he really understands what’s happened.’
Rich wipes his forehead with the back of his hand.
‘Christ, you know – we weren’t expecting any of this. It came through as an assist back to bed. She was crammed over against the wardrobe. We had a hell of a job to get some space cleared and get her on her back.’
The woman’s body shifts beneath my compressions with lifeless passivity. I hear Frank clumping back up the stairs with his gear.
‘They didn’t tell us this was a resus,’ I say. ‘We were sent by just in case you needed a hand.’
‘That’s lucky, then. We were just about to call for back-up…’

All the drugs and extra equipment are to no avail. The woman is beyond rescue. After more than twenty minutes, we all agree that nothing more can be done. We tidy the woman up, lift her into bed and make her presentable, restore the furniture as best as possible and stuff all our rubbish into a yellow bag. Whilst Rich finishes off, we head off back down the stairs. We stop off in the living room to say goodbye.

An elderly man in tidy blue pyjamas and a dressing gown tied at the waist, is sitting forward on a floral-patterned armchair with his arms resting on his knees, staring down at his hands. Behind him on the wall is a generous spread of framed photographs: weddings, holidays, formal family portraits, a dog looking out from a garden – many of the photos looking leached out now, further away, their greens and yellows and reds and blues drawn up and ghosted by all the bright sunlight this window must have let in over the years.

Tuesday, February 24, 2009

this glamorous life

We are looking for number three of a row of bungalows set back from the road by steel-railed pathways, a discrete enclave of disability amongst the bullish and bullying tower blocks that surround them on this estate. I wonder if they pre-date everything else; they seem so corralled by the pragmatic stack of life here.
There are men standing by cars, chatting, smoking, not sponging down paintwork, shouting at kids on bikes, looking about. One of them makes a gesture to me – do I want him to move? I thank him as I climb out.
There is a strikingly beautiful carer dressed in black t-shirt and jeans standing waiting for us by the front door. She could be waiting for an appointment with a modelling agency, but rather than a portfolio of shots in her arms she has a yellow folder with the patient’s details.
‘Sorry to be calling you quickly,’ she smiles. ‘Sorry I no pick Frank from floor by myself only.’
She moves inside, leaving just enough room for us to squeeze past a mobility scooter the size of a red tank and into a bedroom where Frank is lying on his side on the floor with a garishly coloured fleece thrown over him. His greasy yellow hair sticks up on his head in distinct rows, like corn in a field.
‘Where’ve you been?’ he shouts. ‘Where’ve you been?’
‘Sorry it took us a while to get here, Frank,’ says Frank. ‘My name’s also Frank – and this is Spence.’
‘What do you mean? I’m Frank. What are you playing at? Help me up.’
The carer smiles down at us as we crouch beside him. She mouths what I think is: very difficult person. Her lips are full and dark. She has a smudge of lipstick on her teeth.
‘We’ll get you up in just a second, Frank. We just need to find out what happened, whether you’ve hurt yourself.’
Frank wrests his head off the floor and tries to get a look at us. ‘I’ll sort you jokers out,’ he says.
‘Whoa – don’t be like that, Frank. Just calm down, and tell us how you came to be on the floor’
Frank produces a fist from underneath the fleece. ‘I’ll land this on you,’ he says, his toothless mouth slack with rage.
‘I think he just slipped from bed,’ says the carer. ‘He got little bit blood on side of his head and some on his finger, but I not think his badly hurt.’
‘Get me off the floor, won’t you?’ says Frank, in a more pleading way, pistoning his legs ineffectually, trying to sit up.
We realise we’re not going to be able to keep him still and examine him like this. Frank concedes defeat and says: ‘Okay mate. Let’s have you up then.’
He is so frail and thin, it’s like re-righting a scarecrow that’s been blown over in the wind. We place him on the corner of the bed.
‘Let’s have a look at you then, Frank,’ says Frank.
The first thing that strikes us is his breathing. Now that he’s upright, Frank quietens right down, subdued by the effort of getting air into his lungs. Each in-going breath sounds like something heavy being dragged along a gravel drive.
‘Oof. How long’s Frank had that?’
The carer looks through the notes.
‘Antibiotic for one week chest infection.’
‘Any other medications?’
‘No. Just cream for leg.’
He’s in a poor state. Cellulitis makes both his legs look like two cured hams on the bone; he is emaciated and sallow; his chest hardly moves – all the effort of breathing comes from his withered stomach.
‘I’m not - going to - hospital,’ he growls.
‘Frank. Don’t be like that. We just want what’s best for you – and that, right now, is coming with us to hospital to see a doctor. It might not be for long. But we can’t just leave you here.’
‘Leave – me – alone!’
He retches, and a rope of phlegm snakes out of his mouth and nose. The effort of expulsion racks his frame.
‘Get a chair for us, Spence,’ says Frank, wiping the old man’s face with a wad of kitchen towel the carer gives to him. ‘How could we leave you here like this?’
I go to fetch the carry chair.
‘Excuse me,’ I say to the carer.
‘Scusi,’ she says, busy pulling some information sheets from the folder.

The chair feels only slightly heavier when Frank is loaded onto it. He is so frail, I have no idea why he has such an enormous mobility scooter, but it makes negotiating the hallway quite a problem.
‘That’s a beast, your scooter’ I say to him, but he does not hear above the spitting and crackling of the nebuliser we now have him on.
Outside on the vehicle we run our usual tests. It looks like Frank may have suffered a heart attack this morning, along with everything else. We treat him quickly and set off, alerting the hospital of our arrival.
I wave goodbye to the carer standing over by the front door with her little black shoulder bag and her document folder.

She waves cheerfully back.

Honestly. I feel like I’m on a motorboat leaving a quayside in Monte Carlo.

Monday, February 23, 2009

late for the party

There are two things we have to step over as we go into the flat: an empty bottle of JD and a pink, iron piggy bank of the same size.
‘He’s in here.’
The man who let us into the flat seems magnified by his concern; even his height strikes me as an expression of anxiety.
‘Are you a relative?’
He wears a rucksack, bulgingly heavy. It rattles as he walks.
‘What’ve you got in there? Beer?’
‘It’s my mum’s birthday. I’m supposed to be there, not here. She’ll kill me.’
He leads us into a small sitting room filled up with a double bed, a sofa, and a couple of racks of plain wooden shelving stacked with metal pigs of all sizes and colours.
Paul is lying on his back on the sofa, his arms straight along his sides and his legs crooked over the end of the seat. He is wearing outdoor clothes – a fleece zipped up to the chin, baggy green trousers and rotten trainers. He looks as if someone had dressed him in an outfit then lain him aside whilst they sorted something else out.
‘Paul. Paul.’
He isn’t unconscious. His eyes flicker behind his eyelids, even before I touch his eyelashes. I prise them open and shine a light across. They seem fine.
‘Paul. Come on. Talk to us, mate.’
I pinch his shoulder. When there is no response I pinch him a bit harder. Nothing.
‘Paul. Come on. We need you to talk to us.’
‘He’s taken all these pills,’ says the friend, handing an empty bottle of Temazepam to Rae.
‘Whose prescription is this, then?’
‘His wife’s. His ex-wife’s. They got divorced recently. Hence…’ He shifts his weight uncomfortably, then shucks off the rucksack and dumps it on the bed. ‘I’m supposed to be at my mum’s.’
‘Give her a call.’
‘Do you mind?’
‘Go ahead.’
‘Come on, Paul. We’re not going to leave you alone until you talk to us, so you might as well open your eyes.’
I roll out my repertoire of painful stimuli, keeping myself in a position where I can either dodge or sit on a rising fist. I try The Supra-orbital Notch. The Rolling Pen on the Nail Bed. The Sternal Rub. He’s so thin it’s like running my knuckles over a cycling helmet.
Some wincing, but the eyes remain flutteringly closed.
‘Come on, Paul. Don’t make me carry on with this. It’s stupid and pointless. Why won’t you talk to us?’
I roll out the big guns. I give him The Mastoid Dig. He tries to smack my hand away.
‘Leave me alone,’ he growls, opening his eyes a crack.
‘We can’t leave you alone. What sort of people would you think we were if we did that? Come on, Paul. Just sit up and we’ll see what’s happened today.’
Inert, as before.
‘Let’s sit you up.’
We haul him doll-like into a sitting position. He lolls his head back and begins a half-hearted attempt at pseudo-fitting.
‘Jesus,’ says his friend, taking a step back.
‘It’s okay. He’s not having a fit. It’s just – the situation, that’s all.’
Paul has a long, pushed-back kind of face. With his large eyes slightly off to the side and a prominent pair of yellow incisors, he looks like a giant rabbit.
‘Let’s get you down to the ambulance,’ I say.
Even though I’m sure he can walk, we have to lift him into the chair.
‘Can I come along, too?’ his friend asks.
‘Sure. Maybe you could give us a little more information.’
Paul sits in the chair, passively uncooperative, flopping his arms and legs about and leaning his head back onto my chest.
‘Come on, Paul,’ I say, to no effect. I put a blanket between me and his greasy hair. We set off for the lift.

On the ambulance, nothing has changed. He doesn’t even respond when I cut his jacket sleeve off to take his blood pressure. All his obs are fine, but he will not talk to us.
‘Let’s just go,’ I say to Rae.
Just as she opens the door and jumps out, two police cars come hurling round the corner, pulling up behind and in front of the ambulance.
‘Oh, really?’ I say.
Four police get out. One of them waves at us in a massively friendly fashion and strides across to the vehicle.
‘Hi, chaps,’ he says. And then to the friend of the patient, ‘Would you mind travelling up in one of the police cars, mate? Only I think I’d better travel in the back. Okay? Thanks.’
The friend hauls up his rucksack again.
‘What’ve you got in there?’ says the policeman. ‘Beer?’
‘It’s my mum’s birthday today.’
‘Oh. Well. Many happy returns to your mum,’ he says as they pass, and smiles at me as he climbs inside. The ambulance drops an inch.

I want to step outside the vehicle with him and find out what all this is about, but I can’t leave Paul on his own. The policeman positions himself at the front of the ambulance with his back to the hatch. He pulls on a pair of leather gloves. Then, securely behind the line of sight of the patient, he canters through an emphatic mime, mouthing the significant words:
Points to the patient – psycho – bashes a fist into a hand, makes a stabby-stab motion – very violent – winces and shakes his head – nasty piece of work. Then says out loud, quite pleasantly: ‘Paul was posted as missing today, by his family. They were worried about him. So we’ve come along to make sure everything’s okay.’

I look at Paul. He lies on the trolley bed as lifelessly as he was back in the flat.
I look at the policeman and he smiles as benignly as before.
‘Well – let’s go to the hospital, then’ I say.

When we get there, the triage nurse displays her own techniques for painful stimuli, surrounded by police.
‘Come on, Paul,’ she says resolutely.

Everyone leans in.

Saturday, February 21, 2009

one man and someone else's dog

There is light flickering out from around the upstairs curtains, but downstairs is dark, nothing moves and no-one comes to the door. I knock again, more loudly, and step back. There are no obvious neighbours to rouse; all the places round here look hollowed out and neglected. The call is a Cat A breathing difficulty. The patient could be unconscious on the floor – in which case, my next move will be to kick the door in. Just as I’m about to put the resus bag down and foot the door to see what locks he has on, there is the sound of heavy snuffling beneath the door, followed by a voice calling down: ‘Just a minute.’
And it is a full minute before a light snaps on in the hall and we hear heavy, uncertain footsteps descending. Then a latch is turned, the door swings open, and a Staffordshire bull terrier like an overstuffed, animated white footstool launches itself off the step in the direction of my trousers.
‘Down!’ I tell it, whilst at the same time the man says: ‘Don’t mind him. I’m looking after him for a friend. Come in.’
He turns and starts back up the stairs. I follow immediately behind with the dog glued by the nose to my leg.
‘Careful…’ I say to the man, but it’s too late. He steps squarely into a pile of dog crap curled neatly on the third or fourth step up. ‘What?’ he says. He seems pissed.
‘You’ve stepped in some dog crap.’
‘Oh. Okay.’
He carries on walking. I look at Frank. He shakes his head and bends down to fuss the dog behind the ears, his blue gloves contrasting strangely with the nubby white head. The dog transfers its devotion.
After picking our way up the stairs – I scan the treads with a hand torch just to be safe – we finally emerge into a boxy front room, the cliché set of yet another play about social deprivation.
‘Could you turn the TV off for a moment?’
‘What? Yeah. Go on then.’
Frank steps across the carpet like he’s being sent across a minefield. He pushes the button. The enormous screen blinks off, and the room darkens by a hundred candles, quietens by as many decibels.
‘And can we have some lights on?’
Frank obliges. The man and the dog scrutinise us from the sofa.
‘And would you mind putting your cigarette out? Only we don’t smoke, and we’ll just end up stinking the rest of the night.’
The man stubs it out, smashes it right up, scattering dead cigarettes and ash from out of the ashtray to make room for it.
‘Thanks. Sorry to be a nag. So – what’s the problem tonight?’
‘I can’t breathe,’ he says.
I look at him.
‘Forgive me for saying so, but you’re not really coming across as someone who can’t breathe. Their chests are usually heaving, they can’t speak, or only very little, they might look a terrible colour, even quite blue. They don’t usually smoke and move about. Generally speaking they’re struggling to cope. So when you say you can’t breathe, what do you mean?’
‘I’ve got a cough.’
‘And how long have you had a cough?’
‘Three weeks.’
‘Have you seen your doctor?’
‘Why not?’
Even the dog looks at him at this point.
‘Don’t know.’
‘Any health problems normally?’
‘Take any medication for anything?’
‘Quetiapine. S’it.’
He leans forward and takes a sip from a filthy pint glass. It is a third full of a viscous, whiskyish liquid. I want to tell him not to drink anything whilst we’re here, but I’ve already made a few demands and I don’t think there’s room for another.
He looks like Action Man after a harrowing tour of duty, except our patient’s eyes are flatter, less humane. There’s a ridge to his forehead so pronounced you could step up onto it. His hands are lumpish and stained, the fingers all gnawed up.
‘What I’ll do is give you the once over, see what your temperature is, your blood pressure, that kind of thing, and we’ll talk about what to do next.’
He places the pint glass back on the table, and a little skip of ash rises around it.
I put a Sats probe on his finger.
‘Good. Your oxygen levels are fine.’
He nods as if he knew that, and abstractedly runs the knuckles of his left hand up and down his right forearm. Janine 2002 in a Gothic script.
I put the probe back onto my belt, and then wrap a BP cuff around his arm.
‘Whoa,’ he says, suddenly stiffening up. ‘What the fuck’s this?’
‘It’s the blood pressure cuff. Don’t worry. I inflate it a bit – it’ll feel a bit tight – then I let it down and see what your BP is? Is that ok?’
‘If you say so, chief.’
I start to inflate it.
He stands up and yanks back his arm.
‘What the fuck….? What’re you doing?’
He stands there, swaying slightly, his legs apart, one arm bent slightly, the other one raised up in the air with the cuff swinging from it.
I step up to him, unwrap the cuff – because although he looks ready to fight, I bought this kit myself – grab the resus bag and say ‘Actually, I think what we need to do is just go.’
And then to Frank: ‘Come on, mate.’

We walk out of the door without another word, even in retreat still careful to light the stairs for crap. Outside in the truck Frank drives us to safety round the corner. I phone Control to let them know the situation. I especially don’t want a single responder pitching up alone there tonight.
Frank says: ‘Can I smell something?’
I look at him. He looks at me.

Anyone passing along that street at one in the morning would have seen two ambulance men either side of their truck looking at their boots.

Monday, February 16, 2009


The docks are lit up with arcs of hard white light. Two great LPG containers stand side by side, laddered and banded with steel hoops, vents of steam drifting upwards from their sides like stubby little rockets on a launch pad. A ship stands at the quayside, chaotic squares and jabs of light along its bulk. The dock looks busy, but there’s no one about and nothing moving apart from a radar arm turning, a flag flapping, steam rising.
The flat we want is in a block overlooking the docks.
‘Great view,’ says Frank, blowing his nose whilst I ring the buzzer.
‘Yeah,’ I say. I know he’ll think I’m being sarcastic, too, but I wouldn’t mind living opposite the docks. I’d sit at the window for hours, watching the timber being unloaded, or a sailor smoking against a rail. At least I think I would.
A young woman skips down the concrete steps into the hallway and opens the door.
‘Hi,’ she says. Her demeanour hangs from her like her dress: bright, but fading after repeated use. ‘He’s upstairs.’
We follow her up two flights and into a flat that smells of dog and toast and sickness. There are two huge metal dishes on the sticky floor of the galley kitchen, both of them the size of mixing bowls.
‘However big are your dogs?’
‘They’re well behaved. They haven’t made a sound.’
‘They don’t bark. The worst they do is mumble.’

She leads us into a sitting room dominated by a deep leather sofa and a widescreen TV. There is a Guitar Hero controller propped against it, and a pile of other games stacked neatly alongside. On the wall there are posters tacked up, arty blue prints of American Indians in profile, dreaming of wolves, forests, galloping horses and low moons.
There is a groan from another room.
‘He’s on the toilet. He’s been there for hours.’ She shows us through. As we turn the corner she gives a vapid little spread of her fingers and says: ‘Ta-dah!’

Her partner is sitting on the toilet, bent forward at the waist and supporting the weight of his skinny torso with his hands flat on the floor. His legs and arms are so long and thin, the angles so oddly inhuman, it could almost be a giant insect cramped up over there. A pile of vomit lies between his hands that someone – presumably his girlfriend – has draped over with a square of plain white kitchen towel. He looks up briefly, gives us a pale smile, then tucks his head down again.
‘I hope I don’t get it,’ she says, then walks back into the sitting room to let us check him over.

When we rejoin her in the sitting room she’s standing smoking a spitty little roll-up by the window.
‘I’ve only been going with him a year,’ she says, picking a piece of tobacco off her tongue. ‘Well? Is he going to live?’
I tell her that he has a bout of diarrhoea and vomiting – unpleasant, but nothing that needs hospitalisation. As the vomiting has been going on for a while, we’ll ring for an out of hours GP to come and assess him, maybe even give an anti-emetic. Other than that, the best thing is to let it take its course, keep drinking fluids, start back on little amounts of plain food when he’s ready.
She listens, and re-lights her cigarette.
‘Is that it?’
‘Yep. That’s it.’
There is another groan from the toilet.
‘And how much longer do I have to put up with this?’
‘It’s hard to tell. It could be a few more hours. But like I say – we’ll get a doctor out to help with his sickness and give you some more reassurance.’
‘It’s not reassurance I want, it’s a bigger flat.’

Back outside in the truck, Frank sits leaning forward with his arms folded on the steering wheel whilst I finish the paperwork. Suddenly there is the sound of a great whumping crash from the docks.
‘Oops,’ he says. ‘There’s our next job.’
But nothing comes on the radio, and no-one comes running. The lights blaze on as before, and the white vapour drifts up from the tanks, and the arm of the radar on the ship at anchor spins slowly, round and round and round.

Friday, February 13, 2009

quiet, elephants

Geoffrey is sitting on a carved hardwood stool just by the front door. His wife Gwen, a square-jawed woman, the determined set to her mouth undermined by the wateriness of her eyes, stands aside to give us some room in the hallway. Geoffrey is wearing a curious, native silk wrap, its bright pattern complicated by bloodstains. There is a constantly replenished drop of blood trembling and then falling from the end of his nose.
‘Dreadfully sorry, chaps,’ he says, and then clears his throat, hawking up a clot of blood and spitting it into a sodden facecloth. ‘I just can’t seem to get it to stop.’
I show him where to pinch his nose, and tell him not to tip his head back.
‘It’s been like this since yesterday,’ says Gwen. ‘We’ve reached the end of our tether.’
‘Let’s just see if this works,’ I tell him. ‘We’ll give it fifteen minutes. If not, I’m afraid we’ll have to take you to hospital.’
‘It’s awfully kind of you to come - out like this,’ says Geoffrey, retching on a consonant.

But his nose will not stop bleeding.
‘I’m afraid we will need to go in, now,’ I say, tying a bolster to the end of it. Gwen has already put a little bag of things together.
‘Should I come, too?’ she says.
‘No, darling. It’s late. You stay here and get some rest,’ says Geoffrey. There is a steadying, old-school timbre to his voice, an amused set to his old gray eyes, that counteracts the effect of the ludicrous dressing on his face, the whole bloody affair. ‘I’ll only be dozing at the hospital. You’re better off here.’
‘If you’re sure.’

He walks out to the ambulance, shuffling along in a pair of hand-stitched leather sandals. A tall man now, he must once have been a striking figure. Six foot six, broad shouldered. I can imagine him striding out into the wilderness with a big forked stick; now, he leans on an aluminium walking aid.
The moon is full in a sky thrown with stars. It is glassily cold.
‘That’s better,’ he says. ‘That’s much better.’

On the truck he sits on a forward facing seat, resting his hands on the handle of the stick that he places in front of him. The bolster is sodden with blood so I change it for a fresh one. We set off for the hospital.

‘You’d never think to look at me now,’ he says, ‘but I used to run a game reserve. Out in Tanganyika. I had been working for an oil company in the middle east, doing all right, you know, but really looking for something different. Well I heard via the friend-of-a-friend route about a place going in Tanganyika, as it was then, middle of nowhere, nothing at all, was I interested? So we headed out there, built a house out of mud and straw, and lived there ten years. Amazing place. Incredible. You could walk for two hundred miles across what was actually the crater of a defunct volcano and not see anyone at all. Just animals – the most extraordinary range. One thing that always struck me: how quiet elephants are. There you were, sitting outside your hut, busy fixing something or other, you’d hear a faint little snap of a twig or some such, you’d look up idly – you know – hardly aware you were doing it – and there you were, face to face with an elephant.’

Thursday, February 12, 2009

pink pills

These are the thin and early hours, when your spirit pools, leaches from your heels, runs off down the drain and leaves you cracking your jaws with enervation. Even the streetlamps lean. As we pass along the street I watch whole building frontages thin, the glass in their windows spreading outwards, infecting the brick, until great horizontal lines of bodies are revealed, asleep in mid-air. We splash beneath them, the ambulance dutifully steering itself, along and up to the young guy over by the phone box who is leaning out into the road and hailing us like a cab.

We pull up.
We get out.
‘Hello,’ Rae says. ‘What’s up?’

‘Well I went to Camden, knocked around there for a bit, fell asleep on the train and ended up in Birmingham. When I was in Birmingham I went to the toilet and amongst some needles and cans and shit on a little shelf I found a sachet of pink pills, about sixty of them. I thought they were ecstasy, so I put them in my pocket. I came down here to see a friend. We had a bit to drink – let’s see: Jack Daniels and coke, about ten of those, half a bottle of vodka with orange juice, and then I helped him finish off a bottle of port at his flat. Then he went out and I felt a bit down, like I wanted to kill myself? Then I remembered the pills. So I swallowed them.’ He looks at us. ‘But I regret it now. That was about half an hour ago.’

‘Why did you take the pills?’
He looks at her, frowns, then says: ‘I couldn’t find a razor.’
He pushes up a sleeve of his raincoat and displays a sequence of angry cuts up his arm. ‘Otherwise that would’ve been my preference.’
Rae straightens. ‘Do you have a blade on you now?’
‘No. Like I said – I couldn’t find one. I must admit I am feeling a bit strange.’
He has a lumpy, scrunched-up look about him, as if the laptop bag hanging from his shoulder is filled with the heaviest substance in the universe. His greasy black hair lies in spikes across his forehead, and the t-shirt beneath his raincoat is artfully torn in places. There is a raw, thimble sized hole in one of his earlobes.
‘Let’s get on the ambulance and talk a bit more about these pills,’ says Rae. I slide the door open for them.
‘Thanks,’ he says, sighing and settling himself down in a chair, placing his laptop neatly on his knees like a commuter. ‘I don’t think they were ecstasy, though.’ He retches a little, and does a dyspeptic little pardon-me mime by tapping his fist lightly on his chest. ‘They certainly don’t feel like ecstasy.’

At the hospital, I park up and walk round to the door. When I slide it open, the man is in mid-monologue.
‘…I’m just crazy, me. I like to get out and about and have adventures. I like to take off and go wherever – I don’t care where. I didn’t want to call you people out because I know you have your work cut out for you, what with people dropping down dead or jumping off buildings and the rest. But I didn’t know what else to do. I feel so stupid and I’m very grateful.’
I help him off the ambulance. He steps down with the exaggerated care of Neil Armstrong stepping off the Lunar Module.
‘There!’ he says, readjusting the laptop on his shoulder. ‘Made it!’
Rae goes on ahead whilst I walk with him. We pass behind the back of another ambulance, its door open. There are two of my colleagues busy in the back, tidying up. The patient stops and looks in.
‘Hiya!’ he shouts. ‘I thought it was you! Last time I saw you, you were oiled up and naked between two Turkish hunks! Well – got to go. See you later!’

‘That’ll get some rumours started,’ he says, turning away. He smiles smugly, closing his eyes, and I have to steer him away from walking into a post.

the dressing gown

Mr Clarke is sitting on the floor of the hallway with his long spindly legs stretched out in front of him and his face in his hands.
‘Thanks for coming so quickly,’ he says in a conversational tone as I peer round the door. ‘Really, that was most quick.’ He puts his hands down either side of his blue boxer shorts, and feebly tries to shuffle backwards a little. The bright overhead light exposes a body slack with age and illness.
‘Have you hurt yourself, Mr Clarke?’
‘What? No, no. I’m fine. I banged my head a little but nothing really. I just need a hand getting back up.’ Then – quite unexpectedly – he leans forwards, puts his face in his hands again and gives a muffled sob. ‘I don’t know what’s happening to me. I really don’t.’
I crouch down next to him.
‘Come on Mr Clarke. Let’s get you off the floor and sitting comfortably. Then we’ll have a chat and see what’s what.’
Frank finds a white metal perching chair, positions it behind Mr Clarke, then we help him to his feet.
‘So tell me how you came to be on the floor?’
He looks straight at me.
‘I haven’t slept a wink. There are people in the flat. Horrible people. They’re terrorising me.’
‘What people? What do you mean?’
‘They’re up all night playing spiteful tricks and games. They run around, tip me out of bed, trip me up. I can’t go on like this. I can’t get any rest.’
‘But there’s no-one else in the flat, Mr Clarke. Who are these people?’
He studies me carefully.
‘I say people. More like creatures, really. Oh I know what you’ll think. But - see that dressing gown over there?’
He nods towards a pale cream gown draped over the arm of a chair in the sitting room.
‘Any clothes like that, dropped on the floor or around. These filthy creatures come in the night, and any discarded clothes they wriggle into and bring to life. It’s the clothes – the clothes with the creatures inside them. That’s what’s doing all the damage. And I can’t go on!’ He covers his face again. ‘Am I losing my mind?’
‘Well, it sounds to me as if you’re suffering hallucinations for some reason. I think you should come with us to hospital so you can see a doctor and get the once over.’
I take his temperature – a point up. He says his urine has been stinging lately, so I tell him that urinary tract infections can play havoc with your sense of what’s real or not. It seems to calm him. He blows his nose on some kitchen towel and waits with me whilst Frank goes to fetch our carry chair. Occasionally he throws an uneasy look over to the dressing gown, as if he expects it to jump up and run at us.

There are two large pictures on the wall facing us, both aerial photographs of London and Venice. Next to them, amongst a spread of family photos, gappy school prints, faded letters and graduation mementoes, there is a group of three little studio portraits of Mr Clarke, all apparently taken at the same time. I flick between them, trying to spot the difference, but each appears to be identical: the study of a middle-aged man in three-quarter profile, his full black hair clipped, greased and combed, his mouth slightly parted and his even white teeth on display, looking out onto the world with professional containment.

Saturday, February 07, 2009

passing through

I take the large green nylon rucksack, Frank takes the wicker Moses basket and a couple of carrier bags stuffed with clothes, books, coats. The mother, a frail young woman who holds herself perfectly upright in the way that dancers or medicated people do, blows her nose into a chequered handkerchief. The father picks up the child’s car seat with their twelve week old son bundled up in a fleecy white baby-grow.
‘I never know which way to carry these things,’ he says. His eyes are sore and red.
We decide that over the arm, like a basket, might be easiest.
We make our way to the lifts, along a quiet, aseptic yellow corridor hung with brightly coloured kites and aerial fish that stir gently as we pass. A couple of porters struggle in with an incubator. We hold the double doors open for them, and they hold them open for us. We pass through.

Outside the sky is low and blurry with snow. It falls steadily; at times it feels as if we are actually flying upwards through it. Everyone but the woman hunches over as we pick our way over to the ambulance. She moves through the snowflakes as if either they or she were not real. Frank helps stash the luggage in a safe place. We load the child seat onto the trolley and make it fast. I swing the passenger seats into position and sit the family down. Frank takes up position in the jockey seat, and I go to the cab. The traffic noses around us irritably.
‘It’s always a battle, leaving this bit of the hospital at this time of day,’ I hear Frank say in the back. But I bully out a path. A security guard stops an oncoming van; he waves, I wave.

It feels later than it is. The city is impatiently sloughing off another day of work. Cupped in the freezing hands of the snow storm, people are hurrying on to the next place on well lit buses, along slushy wet streets, swinging shopping bags, queuing at cash points, talking on phones. Everyone is heading somewhere. I follow the main road out of town, moving and stopping and moving forwards again a hundred times in five minutes. A bus brakes to leave a gap for me. He flashes me on.

The windscreen wipers slop to the left, scrape to the right, marking out the miles. I follow in the wake of the red lights in front of me. I try to get better reception on the radio but there is too much interference so I turn it off. I steal one of Frank’s mints and try to keep it going for as long as I can, but I forget almost immediately and only remember again when it’s all crunched up. The other side of the central barriers is an unbroken chain of light, but it’s not as busy our way.

The ambulance fizzes along. We could be a ship flying through space, the flakes in our lights the stars we rush amongst. But then the storm lifts. It has a leading edge that suddenly announces a clearer run. The dark motorway cedes to well lit city streets, and the traffic thickens. Buildings cluster up either side, and there are great crowds of people surging forwards at every opportunity. I haven’t driven around here in a few years, but I used to live in town, and the old routes - the lanes to take, the cute little nicks and tucks, the sense of where things lie – it all comes back to me with a nostalgic tug. Then, after twenty minutes of city driving, I’m pulling onto the ramp that leads up to the A&E department.

We help the man, the woman and their baby down from the ambulance. The man takes the baby in the car seat on his arm as before, whilst Frank and I shoulder the rest of the bags. The woman looks as if she may be sick, so we give her five minutes in the toilet just inside the entrance. When she comes out, we lead them through some heavy black rubber doors and pick up the coloured indicators for the children’s hospital out back.

The sound of a piano being played drifts towards us as we walk along a corridor. I recognise the tune; eventually I think of the words that would be sung here: Hold my hand, I’m a stranger in paradise. The music grows in volume, we turn a corner and find ourselves in the preserved foyer of the old hospital. There is a baby grand at one end. Under its raised lid I can see the face of a tortured looking guy, dividing his attention between the sheet music and the actions of his hands. He rocks about on his stool knocking out the melody with his right hand and rolling in a bunch of other notes with his left. The song resounds over everything, over the heads of the white alabaster scientists on their plinths along the edges of the space, around the dark marble pillars and the tessellated floor. An elderly man is sitting on a wooden pew with his eyes closed, both hands resting on the crook of a walking stick upright in front of him, his cream trilby hat angled back on his head. On a table next to him, a couple of young executives are shuffling through papers and examining spreadsheets. Everyone else is hurrying on in all directions. We follow the signs to the children’s wing, and pass through.

We follow the colour coded lines on the floor along a corridor lined with a series of preserved tiles illustrating scenes from children’s books. One of the panels shows Little Red Riding Hood. She is standing by a fat and twisting oak, her basket slung over her arm, talking to a wolf. He is standing upright, dressed in a sheepskin coat and flowerpot hat, supporting himself on a staff, with his front paws draped over the grip. He reminds me of the old man in the foyer. We can still just about hear the music drifting back from there towards us. The father shifts the weight of the baby seat on his crooked arm.
‘Nearly there,’ says Frank.
He leads us up to a set of doors that open onto a lit pathway and up to an automatic glass cylinder that opens to admit us.

The new children’s hospital is built around a cavernous foyer, its vaulted space a web of white tubular steel and glass. We walk to the central lift bank, looking around us like country mice. The lift zooms us up to our floor, disgorging us efficiently onto a mezzanine. A nurse intercepts us, leads us with a warm handshake past units and rooms to a station where a more senior nurse takes over. She accepts the paperwork and shows the couple to a neat little cot, discretely stood about with complicated machinery. She takes the little baby out of the child seat and puts him into the cot, stripping him down, as we shake the couple’s hands and turn to go.

On the way back to the ambulance I ask Frank what the situation was with the baby.
‘PKD. At that age, there’s nothing to be done. Palliative care only, I’m afraid.’

Outside we stand behind the ambulance so Frank can have a cigarette.
The city has never looked so big, so energised, so renewing. There is another massive block going up. There are cranes half way up the cylindrical building, illuminated with a warm orange glow that seems to draw its power not from the ground but from the belly of the snow front, massing darkly above us.
‘We’re going to get some of that on the way back,’ says Frank. He blows out a quantity of smoke as we both look about us, and the smoke turns and thins to nothing on the chill night air.

Wednesday, February 04, 2009


The access road that leads down to the hostel is only a shallow incline, but the snow is so thick I park at the top. The last address we went to was a similar gradient, and the only way we made it back up was by tacking like a yacht. It took us half an hour.
Rae fetches out the yellow bag, I lock the truck up, and we both scrunch down the slope.
The air is brittle and white beneath a silence so deep it is as if the snow is a drug that has put the whole world, its people, their pets and machines, into a deep hibernation.
Ours are the only tracks in the snow. The yellow path lights illuminate a sequence of tall chain-link fences, site safety notices, arrows and logos. The old hostel is being replaced by a spread of chalet blocks. Some look finished and occupied – at least, the scaffolding is down, there are potted plants in the entrance hallways. Other parts still need to have roofs put on, but the snow has puffed over the slats, rounded off the gaps, giving every block the look of a Swiss mountain chalet.
The path leads us round and down to a long, green portakabin. There is a light in the grilled window, and a notice on the door giving the office hours and the numbers to ring in case of emergency. Rae knocks on the door and we wait.
There is the sound of a chair being scraped back, resounding footsteps, a chain rattling off its track, and then the door cracks open. A man looks out at us, holding the door partially closed for as long as it takes him to register our uniforms, our yellow bag, then he relaxes and nods and opens the door fully.
‘We’ve had a call here. One of the residents.’
‘A call?’
‘This is The Hostel? 21 Ashington Grove?’
‘Would you mind if we came in for a second. Out of the cold.’
‘Of course.’
We stamp the snow off our boots and step up into his office.
There is a small portable TV up on a filing cabinet. The Superbowl is playing, the commentary rattling out through the tiny speakers. The night manager turns it down, and then stands looking at us. There is a drowsy, overstuffed feel to the air, the smell of sugared coffee and biscuits, oil-filled radiators, computer printers. There are two large pin boards feathered over with notices, lists and scraps of paper, but the rest of the room is bare. There is an open text book on the desk by the window, and a phone.
‘We had a call here to an overdose. Any idea who that might be?’
‘No. But I wouldn’t necessarily know. The new blocks have their own phones, so it’s probably someone over there calling for themselves.’
‘How many blocks are there currently occupied?’
‘Five or so.’
‘Would you mind if I used your phone to call our Control, then? They’ll have to ring the caller back and get some better directions.’
‘Be my guest.’
I go over to his desk and tap in the number. The text book beside it is ‘Business Management Systems’.
‘This looks heavy going.’
‘Great if you can’t sleep. Terrible if you need to stay awake.’
He looks at Rae.
‘Would you like tea or anything?’
‘That’s very kind of you, but..’
There is a fuzzy cheer from the TV; the commentator is reaching superlative meltdown. The night manager studies the screen intently, but turns the volume down one more notch.

Control picks up the phone just as there is a knock on the door. Rae stands aside, and the night manager goes over to open it. He exchanges a few quiet words through the gap, then opens it fully.

A man walks up the steps. His anxiety is so profound it seems to be an animal thing quite separate from him, hurrying ahead into the room, riffling off into the corners of the office, checking for danger. The man is about thirty, desiccated and pale, his jeans and jacket hanging off him like the skin on last year’s fruit.
‘Are you the patient?’ I ask him. He nods, then abstractedly raises a hand to his mouth and starts gnawing on a thumb.
I turn back to the night manager. ‘That solves that one, then,’ I say. ‘Thanks for your help.’
‘No worries.’
He looks at the patient, gives him a narrow, assessing smile, then reaches over to the TV to turn the volume back up. There is another loud cheer as we leave the portakabin; the thunk of the door closing behind us emphasising the still and quiet of the night.
We all scrunch our way through the snow, back up to the ambulance.
‘I’m sorry we’ve got a little bit of a walk. We didn’t want to risk getting stuck driving down here. Anyway - my name’s Spence and this is Rae,’ I say to him. He walks by my side, as close as a spooked dog. ‘Can I ask your name?’
‘So what’s happened tonight, Pete? We were told you’d taken an overdose of something. Is that right?’
‘Yeah. That’s right.’
‘What have you taken?’
‘Two times three hundred milligrammes Amisulpride, four times eight milligrammes Clonazepam, two times three seven five milligrammes Venlafaxine.’
‘And are these medications prescribed to you?’
He nods sharply, once. ‘I’m a schizophrenic,’ he says. ‘Since I was eighteen.’
‘And when did you take these pills?’
‘And how are you feeling now?’
He gestures across the front of his chest. ‘I feel tight across here. But that might just be anxiety. I get that as well.’
‘Any other strange feelings?’
‘I feel like I’m going to fly away. I don’t feel – connected.’
Pete has a disconcerting habit of looking straight in front, talking, then glancing out of the corner of his eyes without moving his head. He talks quickly and quietly, and he holds his mouth slightly open when he finishes a sentence, giving everything he says a naïve, astonished quality.
Rae has the door open and the step down ready for us. Pete scuttles on to the truck and sits down on the furthermost seat. We stow the bags and shut the door. The ambulance feels overly bright and closed in. Pete seems to shrink back from the perceived pressure of it.
‘I just need to do a few simple checks. Then we’ll get off to the hospital.’
‘I don’t want to go to hospital. Do you think I really need to?’
‘To be honest, yes, I do, Pete. It doesn’t sound as if you’ve taken a terribly dangerous dose, but I’m not a doctor. I don’t know how these tablets might interact with each other. Plus there’s the reason you took them in the first place. It’s worth going in just to get to speak to someone about that.’
‘How am I going to get home?’
‘There are ways and means.’
The reality is that he’ll have to find his own way back, which, in the early hours, and in this weather, is by no means an easy task. But Pete sits back in the chair.
‘I haven’t seen my brother for six years.’
‘I’m sorry.’
‘He doesn’t want to know.’
Pete flicks me another look, then peels another tiny piece off his thumb. His face is narrowed and pale. He has a feral twitchiness about him; his scalp and chin bristle with short black hairs.
‘Do you think mental illness runs in the family? Do you think my brother’s mentally ill?’
‘I don’t know, Pete. I think there is often a tendency for these things to crop up more than once in a family. But I really wouldn’t like to say. I hope not, anyway.’
He stops chewing his thumb and stares directly at me. I hold his gaze for a second, but the intensity is such that I am forced to look away.
‘Have you ever done anything like this before?’ I ask him, using the clipboard as a diversion.
‘Two weeks ago. I took sixteen times five hundred milligrammes Paracetamol.’
I write that down.