Sunday, September 27, 2009

hazel no

As soon as I reach over to draw the bolt back on the garden gate, an overstuffed cream labrador lumbers into the doorway facing us. It stops, sniffs the air.
‘Woof!’ it says, just the once, as clearly as if it were written in a speech bubble.
I hesitate.
The dog narrows its eyes in an effort to make out just who it is at the gate, then takes a couple of heavy steps towards us down the path, holding its head up like a politician reluctantly drawn out to face the press.
‘Hazel! Hazel!’
A man’s voice barks from inside the house.
The dog stops and waits.
‘Hazel! No!’
A middle-aged man with dusty hair and bottle-end glasses hurries out of the house, hands first. He makes a grab for Hazel’s collar.
‘It’s okay!’ he says, ‘She’s perfectly harmless,’ hauling back on the animal as if it were an escaped tiger. ‘All bark and no bite.’
The dog suffers itself to be dragged to one side as the man nods back towards the house.
‘It’s my mother. You’ll find her in the sitting room.’
Then he puts his face down nose to nose with the dog.
‘Hazel! No!’
The dog looks at him, then sideways to us.
We walk on.

Inside the house an elderly woman is sitting forwards on a high-backed chair, clutching a plastic mixing bowl and groaning. A woman, the man’s wife, has an arm around her shoulder.
‘So what’s been happening?’ I ask, putting my bag down.
‘What hasn’t been happening?’ the man says, dragging Hazel through the room and shutting her in the kitchen. I wait for him to say something else. Eventually he says:
‘She won’t get out of there in a hurry.’ And folds his arms to watch.
The woman – a version of her husband, but taller, more capable, and wearing a purple flower print skirt – gives the patient a tissue out of her pocket and smiles up at me.
‘Liz has been sick like this for a few days. We thought it’d pass but it hasn’t. She’s really dizzy and weak and we started to get a bit worried. The doctor saw her yesterday and gave her some tablets, but we’re worried that they’re not doing her any good.’
Just as I bend down to see to Liz, Hazel appears right beside me with a cushion in her mouth.
‘Hazel! No!’ gasps the man. The dog just has time to drop the cushion at the woman’s feet before the man grasps her by the collar and drags her back to the kitchen.
‘Don’t worry about Hazel,’ I tell him. ‘She’s fine. Honestly. We’re okay with dogs.’
‘I just don’t want her getting in the way like this. She has a knack for it.’
He slams the kitchen door shut, then tests it with his foot. ‘There. That’s better.’
I turn my attention back to Liz. She isn’t well enough to tell me what her medical history is, so I ask the woman. Before she has a chance to answer, her husband interrupts with a yellow care folder.
‘There,’ he says, waving it about. ‘You’ll find all my mum’s details in there.’ Rae takes it off him and starts thumbing through it, but to save time I say to him: ‘Could you give us a quick summary of the kind of things your mum suffers from?’
‘What doesn’t she suffer from?’
‘Has she been in hospital recently for anything?’
‘She’s hardly out of the place. She’s always going in for one thing or another.’
‘Such as?’
‘It’s all there in the folder.’
Suddenly, Hazel is there again, standing quietly by my side. Rae reaches down to ruffle her fur.
‘Hazel! For god’s sake!’ the man says. He makes a grab for the dog again.
‘It’s okay. She’s perfectly fine,’ I say.
‘I just don’t like her – taking over like this.’
‘Why don’t you go and find Liz’s drugs, darling?’ the woman asks him. He sighs, then grabs Hazel’s collar and drags her backwards into the kitchen again.
‘It’s okay. Really. We don’t mind the dog.’
‘Maybe you don’t,’ he says, slamming the kitchen door shut again, then clumping off up the stairs. We can hear drawers being flung open, things being thrown about.
The woman looks at me and smiles.
Rae goes off to get a carry chair.
Suddenly, Hazel is standing next to me again with another cushion in her mouth. The man is heading back down the stairs. I want to hide her behind me, but before I can act on the impulse he’s there in the doorway again.
‘Hazel! No!’ he shouts.
Liz throws up in the bowl.

Monday, September 21, 2009

the unexpected

The archaeologist has on black boots, combat trousers, a black fleece – an academic paratrooper, dropped in to explain to this ramshackle rookie band the theory of Neolithic causeway enclosures. He supports his speech clearly and professionally from the belly, reaching almost to the back of the crowd, periodically hesitating, leaning forwards, touching his nose, continually pulling himself back to the simplest terms. We are so high on this bare hill, the world seems to turn below us. The wind cuts through the group, rattling our ripstop. My two girls hug my legs for warmth. The land falls steeply to the left into a valley long since occupied by a domestic glacier of houses and roads and shops. And then standing off further still, the sea, a dark curve of grey leading away to the edge of everything. Even though much has changed – that mobile phone mast, the racecourse, the houses and the roads – it feels as though the people who dug these banks and ditches seven thousand years ago must also have stood here like us, bullied by the wind but holding their ground, narrowing their eyes to the horizon.

‘Although there are no traces of any settlements here, this was a busy, well-used site, with abundant evidence of meat preparation, a mixture of ritualistic celebration and the mundane – though of course those things were probably much more intermingled than they are today.’

‘Daddy I’m cold.’
‘Hold on a minute, Eva.’
‘Can I go on your shoulders?’
‘When we move on.’

‘If you look over this way, towards the edge of what would have been the outer and fifth encircling ditch. This is where a number of burials were excavated. One was of a high status woman, in good health, about twenty, fine teeth, about five foot six, buried with great care in a grave whose walls were supported with blocks of carved chalk. In with the woman were several grave goods, including what were almost certainly loom weights, some pottery containing food etc, and a collection of fossils – echinoids, or sea-urchins – which, up until the last century, were often picked up as good luck charms by shepherds. Known as shepherds’ purses, colloquially, I think. Now, the other interesting thing about this woman was the fact that she died late in childbirth. The remains of a full-term foetus were found inside her, its head engaged, ready to be delivered. There is no evidence that she was killed or sacrificed before giving birth, so the assumption must be that she died in childbirth.’


‘Interestingly, a few feet away, the grave of another woman, similar age, but rotten teeth, much poorer overall condition. This woman was buried without any ceremony at all. Flung into the grave, her right arm trapped beneath her like this, her legs any old how. A ruthlessly quick disposal.’

‘Probably the midwife,’ someone says behind me.

‘Now – if you’d all like to follow me to the next area…’

I put Eva up on my shoulders.
I make horse noises. She laughs, tugging my hair and back-heeling her wellingtons into my chest. Chloe skips on ahead.

I remember a woman Rae and I went to, a home birth. The baby had become stuck and both the woman and baby were in danger. As soon as we were in the room and set up, the midwife performed an emergency episiotomy, a bold cut of such dimension that the baby came tumbling out into Rae’s hands, blue, but soon rubbed and chivvied into life.
The midwife straightened, pushed her glasses back up her nose, surveyed the scene through the bloodied lenses of her glasses.
‘Well,’ she said, then blew out her cheeks.
I passed her a clean towel, and she wiped her face and hands.

‘That was unexpected,’ she said.

Thursday, September 17, 2009

nudging the mouse

In the car on the way to a cardiac arrest. I’ve never heard of this address before, a new block of flats, no doubt. I pass up and down the road, making u-turns in the street, a crazy vortex of blue in the high street. The satnav keeps changing its mind. It wouldn’t surprise me if it suggesting rolling the car onto its roof and burying underground. Instead I pull to the side and radio Control. I hear sirens, and in the rear view mirror I can see my back-up ambulance bullying its way towards me up the street. At the last moment it indicates right, into a narrow courtyard. I throw the radio back on the passenger seat and follow them in. Almost immediately I hear the attendant go open mode on the radio. This isn’t the right address. They need help with the location. Control answers: You should be able to see the car. Can you see the car? I pick up the radio again and tell them that I’m right behind the ambulance, but I’m not on scene.

Stand by, they say.

Meanwhile I reverse back out of the courtyard, blocking the road so the ambulance can come out, too. The attendant calls open mode again: I can see the block from here. Then I do, too. Right next door, set back from the road and hidden in the way that only huge and obvious things can remain hidden. I follow the ambulance into the car park.
The attendant – a new paramedic I haven’t seen before – jumps out and hauls on a couple of bags. I nod to the driver, a guy I have worked with before. I take one of the bags off her and we hurry up the concrete stairwell to the second floor.

There is a woman standing on the landing holding the door open for us, a quivering pocket-sized Terrier tucked under her other arm.

‘She’s in the bath. I don’t think there’s anything you can do,’ she says. The dog growls as we go by.

The door to the bathroom is partially closed. The wall to the right of it, the handle of the door and the door itself are all smeared with blood. The paramedic gently toes the door aside. Puddles of blood on the lino, splashes of blood over the side of the bath, and in the bath, lying on her back fully clothed, a young woman of about thirty. The sleeves of her lumberjack shirt have been rolled up, and her arms have been laid open with a knife. The paramedic checks for signs of life, but it’s a technicality.

‘This is a crime scene. Let’s not disturb anything,’ she says. We reverse out.

Whilst the paramedic and her partner sort out police attendance and clear the bags back out of the flat, I take the mother into the living room to start on the paperwork. She sits straight-backed on the edge of the sofa, and sets the dog on her lap. She begins stroking it with heavy handed passes from head to tail, and at the beginning of each of these passes, the dog seems to compress to half its size, then spring back into shape. It studies me with raisin black eyes.

‘She’s done it before, of course. Many times. But I never thought it would come to this.’

The paramedic comes into the room to take over the paperwork. She thanks me for my help as I stand and give her the clipboard. I tell the woman how sorry I am for her loss, then turn to leave.

As I reach the living room door I notice more blood over by the table in the corner, a splash on the carpet beneath the chair, a spattering around the laptop that stands on and open there.

The screen is dark.

I wonder who will nudge the mouse to see what the girl was reading before she died.

Tuesday, September 15, 2009

watching for meteors

We have been on standby in a car park by the cliffs for half an hour, smoking, talking, watching the night sky, watching for meteors. There is a chill autumnal cut to the air. The day burned away quickly, without any of the easy summer margins we’ve grown used to, when the light from one day seemed to fade gently into the dawn of the next. It had been a busy afternoon, but now everything has lifted clean away, deepening into a night of sharp sounds and silences. A fox trots past, more shadow than animal. In the darkness I could swear it smiles and nods. I look up again. I make out a satellite as it glides across the sky, the only other scrap of humanity between us and the resonant deeps of space.

The alerter sounds. We climb back into the cab.


Outside the residential home, we can see Steve, the warden, smoking and waiting for us at the top of the slope by the front door. He waves.

‘Beautiful evening,’ he says as we walk up. He takes one last pull on his cigarette, drops it, scrunches it underfoot, then picks up the butt and tosses it away into some bushes. ‘Thanks for coming.’
A muscularly compressed man in his fifties, Steve holds himself like a pantomime dame sharing scandal at the footlights. His great tattooed forearms are folded, partly against the cold, partly against the chill of his recent experience.
‘Mary didn’t show up for supper tonight at eight like she usually does, I hadn’t seen her the rest of the day, and I thought: “That’s so not like our Mary”. I went up to her room to see how she was, and of course, well … oh dear.’
I touch him on his elbow. ‘Where is she?’
He leads us through the lobby of the home – a building so new the plastic umbrella plant looks real. Next to it, a glass tank, and a bunch of massy, stupefied fish. They stare as we pass. Their bubble machine is so loud it must be servicing the entire building.
‘She is normally so active, so out-and-about. The life and soul. Or she was. Poor Mary. I hope she didn’t suffer.’
He leads us through a fire door and up to Mary’s door. He knocks twice – ‘Force of habit’ – then opens it up with his master key. ‘She’s in the kitchenette.’

Mary is sitting on the floor, slumped up against some cabinets. Her head is sunk down onto her chest, her right hand palm up in her lap, her left hand out to her side, her swollen legs drawn up. It looks as though she had slid gently down the cabinets to the floor; the kitchen is otherwise quite orderly, nothing up-ended or thrown about. She could hardly have made a sound.
‘She’s still got her little blue pinny on, bless,’ says Steve, looking over our shoulder. ‘She was such a tidy soul.’
I touch her on the arm. She is quite solid, and there is the characteristic dark marbling on the underside of all her limbs.
‘What happens next?’ Steve says. ‘I haven’t had much experience of – erm – of this kind of thing. I didn’t phone the relatives yet, because they only live round the corner, and I didn’t want them seeing her like this.’
‘No. Quite right. What we’ll do next is call the police on a special line so they can send someone over, just routine. They’ll handle the rest of it. The Coroner’s office may take the body, or the undertakers, depending –the police will know. I think it’s a good idea to wait until they’ve done all they need to do before the relatives are called. I think it would be quite distressing for them. Because she’s quite stiff, it’ll be difficult laying her out in bed or anything. But they’re the experts. They’ll know what’s what.’
‘Okay then. Do you mind if I just pop out for a quick ciggie?’
‘Go ahead. The police won’t be long in getting here.’
He gives me a smile and turns to go. He’s sweating, and it seems more than just the over-heated room.
‘We’ll let you know what’s happening,’ I tell him.

After I’ve called for police attendance I sit down on a low stool and start writing out the story of this visit. Opposite me, Mary’s riser chair is in the up position, and the side table pushed to one side, witness to her final movements. I wonder who’ll put the chair back down, and push the table to the side.
Frank locates the yellow folder for the full name, date of birth, list of medications, GP details – the fretwork of Mary’s life she slid away from so quietly today.

Five minutes later and there’s a knock on the door.
‘Hello? Police.’
It swings open and an officer walks in, a buttress-booted giant, so broad and bulked up with his stab vest and equipment the hallway, the flat, in fact the whole damn building seems in danger of being pushed apart. He stands there, pulling on a pair of gloves, his face glistening in the light from the kitchenette.
‘I just knew if I had that kebab I’d regret it,’ he says. ‘Okay. So. What have you got for me, chaps?’

Tuesday, September 08, 2009

bad dream

A blond haired boy lying screaming in the middle of a road, a jacket thrown over him, a bundled jumper for a pillow. And then, working outwards, like figures frozen in a brutal urban nativity: three women leaning over the boy, a man running across, a pushchair empty and a pushchair attended, one child straddling the frames of her bike, one child lying her bike down and hurrying over, a man waving his arms, a teenager holding his mobile phone out, people leaning from windows, nodding and pointing, an elderly woman clutching on to an open car door, its front wheels on the pavement. And then, at last, this glassy web of attention trembles and shifts and opens to admit an ambulance to its centre. A green shirt jumps out and kneels in the road. Close up on the boy’s lips, split and dry, his bloody chin, his front teeth pushed in all-angles. Someone says the car he ran onto has a dent in the bonnet. In one falling moment the paramedic sees the chalky whiteness of the boy’s skin, the dark rings around his eyes, but then with a lift equally as giddy realises that the boy is wearing face paint. He has been made up to look like a panda. A hand on the boy’s head, how important it is to keep still.
But the boy wrests free.
‘Is this a dream?’ he gasps. ‘Am I asleep?’

Monday, September 07, 2009

notes on a drowning

A kitchen brittle with light, its neat domestic scene laid open in the afternoon, bright aluminium and white ceramic. Raw wood.
‘I drained the water from the bath,’ the husband whispers as we hurry through. One of my bags hooks a stool over; it crashes to the tiled floor.
‘Don’t worry,’ he says. ‘I’ve got it.’
His wife is lying dead in the emptied bath, legs hooked up on her right side, feet and hands wrinkled and grey from the water, eyes half opened, like someone figuring distance. Her teeth are clamped shut, her lips grey blue, drawn back.
I lean over, grab her under the arms and lift her up into a sitting slump.
Rae gives me her wrists, then hooks her under the legs.
We top and tail her out onto the laminate flooring. The flopping, landed lump of her. Her head bops back on the floor. I start compressions. Her ribs crack for the first three or four. Bloodied water pumps out of her nose.
The Community Responders go into the kitchen to talk to the husband, replaced by an ECP and another paramedic. Some more of the family have gathered in the kitchen. We hear them as we work.
Tubes and pads and cannulas, blankets and inco pads, torn boxes, plastic lids flipped and thrown. Lines and leads everywhere.
Time passes. Someone takes over the compressions so I can pick my way over the chaos and out to organise the exit. I have to go through the kitchen. I want to touch the husband on the shoulder as I pass but he shrinks back from me. They all do. I am death passing through their kitchen. I feel them close back around my absence.

I figure that the best route is through the french windows in the living room and out through the garage. No other angle will work for the scoop. I make the ambulance ready, take the trolley down on the lift, put it into position and then go back inside along that route to make sure everything is clear and ready for the move.

I hear the defib metronome counting out compressions in the bathroom, tagging the seconds as they flow implacably through the house.

Beep, beep, beep goes The Little Red Beacon in the Void.

Beep, beep, beep.

We parcel her up and carry her out.
The second ambulance takes the husband.
I do compressions en route.

The ECP in the back with me manages the airway.
‘It’s been a lovely day today,’ he says, holding the suction catheter with the insouciance of a dentist. ‘Nice and hot.’
He smiles up at me. I shake my head to clear my face of sweat. The sunglasses I had pushed up onto my hair and forgotten about, clatter off into some corner.
The aspirator jug bubbles with bloody water.
‘Good compressions,’ he says. ‘You’re clearing her lungs nicely.’
The ambulance barrels on.


As I’m coming out of the resus room I see an elderly couple standing hesitantly by the main doors. The husband’s parents. I take them with me to the relatives’ room, where the husband is waiting. The elderly man lags behind, bewildered, stopping and looking around.
‘Don’t let’s lose Bob. He’s ninety-two, you know,’ she says.
She takes his hand, I take hers, a chain of us through the department to the relatives’ room.
The husband stands up as we come to the open doorway. The foam seats around him in the room are so brightly purple it looks more like a children’s soft play area. But there are leaflets in a rack, a print on the wall, flowers on the table.
‘Can you tell us? Is there any hope?’ the elderly woman says to me as I let go of her hand. The husband looks at me. The question he dared not ask.
I know the woman has been declared dead already, but I say: ‘The doctor in charge is on his way. Let me get him for you.’
Back in the resus room, the doctor is having an earnest discussion close in with a junior doctor.
‘Ah,’ he says to me. ‘Just two things: patient’s name, husband’s name.’
I tell him. He rehearses them, then slaps the junior doctor on the arm.
‘Come on,’ he says, ‘This way.’ And they walk out together, shoulder to shoulder.

Friday, September 04, 2009


Frank answers the phone. He listens to the dispatcher, and after a second turns to look at the seven o’clock crew, star-fished in their chairs watching Top Gear.
‘Mrs Focaccia, he says. ‘Yes – I have heard of her.’
The sevens straighten up. One of them guffaws and claps his hands. ‘Yes!’ he says, and punches the air.
‘Who’s Mrs Focaccia?’ I ask him.
‘She’s a big loaf,’ he says. The other one says: ‘Oh my God!’
Frank replaces the receiver.
‘We’ve got Focaccia.’
‘Who is Focaccia?’
Laughter round the room.

Half an hour later Frank is parking up outside the house we want, a building as ruthlessly square, grey and anonymous as all the others in the street, the only difference being the lack of a wrecked car on the front patch and a concrete ramp up to the door. The architect must have a castle fetish. Even the windows look more suited for shooting arrows than letting in sunlight.
Frank has given me the SP on Mrs Focaccia on the way here. Twenty stones of pure awkwardness and a partner who both in looks and demeanour would seem more at home in an illustration by Cruickshank.
‘Registered blind, but spends his life on the computer,’ says Frank, locking the door. ‘You’ll see.’
I walk up the ramp and knock on the door. A thousand dogs bark close by and far off into the night.
After a pause, bolts are thrown back and the door opened.
Mr Focaccia stands silhouetted in the fierce hall strip light. At first glance he seems to be a tall, middle-aged man surrendering to the effect of gravity. He curls forwards at the belt buckle, and his long, curly black hair hangs down in front of him like a fraying plumb line.
‘It’s the ambulance. Hello. We’ve erm – come for Mrs Focaccia.’
‘This way.’
He swings round and we pick our way through the cluttered hallway after him. He leads us through into the living room.
‘They’re here. Again.’
Mrs Focaccia is lying on her side on a double bed, scrunched up in the far corner. There is a low bookshelf along the nearside of the bed that acts as a partial screen; the foot of the bed has a hospital-style table, and the walls all around the bed are fixed with shelves. Every available surface is piled high with clutter, and any spare inch of wall not given over to storage is blu-tacked with computer printouts. There are some grey-looking sheets rucked up at the foot of the bed; that area of mattress not occupied by Mrs Focaccia is given over to a tideline of wipes, cotton buds, tissues, pill packets, marshmallow cup cakes, cream pots, an ashtray and a pile of newspapers high as Friday.
‘Hello Mrs Focaccia.’
She gives a yelp.
‘We understand you have a back problem.’
Lying as she is on her right side, her right arm tucked up under her head, she looks like the kind of massy abstract sculpture you might find in a park. The mattress craters dangerously around her.
‘So what’s happened?’
Mrs Focaccia tells us the story. History of spondylitis. Wheelchair bound. Coming down the ramp of a taxi a few days ago, wheels rode off the edge, flung forwards, slid down on to foot plates. Pain since. Ambulance at home next day – said to see if any improvement with Ibuprofen. No good at all. Ambulance earlier today – not helpful. Recommended a GP home visit. Said it would be better if the doctor could assess and then arrange for her to go straight to an assessment ward rather than through A&E. GP came. Said just that.
I picture a line of people all pulling off their gloves.
‘I’ll get the trolley out and up to the door,’ says Frank.
‘The first thing we need to do is clear the immediate area. Because of your back injury, we’re probably going to have to put you on a vacuum mattress to keep you nice and straight.’
‘No! No! You can’t clear the bed! I know where everything is. I’ll be helpless if you do that.’
‘But we won’t be able to get you out like this.’
‘No! Gary will do it. Gary’ll get me out.’
Mr Focaccia sighs, rattles through one last email, closes down the computer, sticks a pen behind his ear, stands up and starts foraging for the supplies they’ll need. It may be that my impressions have been tainted by what I’ve already been told, but he seems to gives me a sideways look before crashing awkwardly back into the bookcase as if he misjudged the distance.
‘Oops,’ he says.
‘You can’t do this to me,’ Mrs Focaccia says from her corner.
‘Try not to worry yourself,’ I say.

For the first time I see what makes up most of the clutter around the room. Victorian dolls, forty or fifty of varying size, each shelf like a crowded school photograph, layers of dusty crinoline and lace, row upon row of the same porcelain face, stupefied with paint, each with an abundant crown of curly hair. And then it strikes me that the pictures on the wall are all of the same thing: head shots of Gabrielle Drake, in UFO, her hair a severe purple wig. And then leading across from the pictures, another, deeper shelf facing the bed, also crowded with dolls. But these are bigger, and every one has its hair combed forwards, completely obscuring the face.
Frank suddenly reappears behind me.

‘How are we getting on?’ he says brightly.

I have no idea.

Thursday, September 03, 2009

difficult questions

‘Listen. I’ve lived here all my life. I was born here, about a thousand years ago, I should think. Hrmph! So if anyone’s heard of The Old Coach House, I’ve heard of it.’ He frowns. ‘And I’ve certainly never heard of it.’ He grips with both hands on to Ellen’s open window as if he’s tethering the basket of a runaway balloon. He blinks, heavily, and it seems to carry on into a little sleep. Ellen touches him on the arm and he opens his eyes again with a start.
‘Okay? So there you are. Good. I don’t believe it exists, sir. Madam - of course.’
He releases his grip and tries to stay upright.
‘So I suggest you get straight on to Mission Control and check your facts. Good luck.’
He takes a catastrophic step backwards that almost puts him in a hedge, recovers himself, and waves us on. I expect to see him saluting in the rear view mirror.

I drive out of the lane and pull over at the top whilst Ellen calls Control to get a better fix. It’s only then that we see the painted white sign: The Old Coach House, on an opened wooden gate between two high flint walls. Ellen hits at scene and we jump out.

A moment later we’re waiting at the door with all our bags.
A figure appears behind the frosted glass.
‘Just a moment,’ she says, struggling with a top bolt and then turning the lock. The door swings open and an elderly woman stands there, dressed in a heavy brown tweed skirt and jacket, looking so much a part of the house you would think she was struck from the quarry along with the weathered old stones of the walls.
‘Thank you for coming so quickly,’ she says. ‘My eldest daughter Karen’s upstairs. She’s fallen out of bed and I can’t get her up.’
She shows us through the house and up the stairs.
‘I’m afraid my poor darling has cancer very badly. She was discharged from hospital a couple of weeks ago to spend her last days at home, and she seems to have taken rather a turn for the worse.’
‘What’s your name?’
‘Edie. My other daughter is on her way over, but she’s had to come quite some distance.’
‘And how old is Karen?’
‘She’ll be fifty-eight in October.’
Edie stands aside at the entrance to a bedroom simply furnished with two single beds, and waves us in.
There is a woman on the floor, lying on her side between the beds, her knees drawn up, with some of the bedclothes dragged down over herself.
‘Karen – it’s the ambulance.’
She groans. Her legs poke out from under the bedclothes with the waxy white skin tones of a mannequin. There is a dreadful metallic smack beneath the otherwise soft herbal scents of the room. When we get closer we see that Karen has vomited copiously, a quantity of foul, black blood that sticks her hair to her face, stains her mouth, nose and chin, and pools out around her on the carpet. Her lips are drawn back from her teeth, and she stares up at us with eyes so round and deep and lightless it’s like looking through a window onto the abyss. She grabs my arm and tries to talk.
‘I’m dying,’ she gasps. ‘Let me die.’
‘Just hold still, Karen.’
Ellen chucks me a towel and I wipe her mouth and face clear. She clutches on to me, her breath coming in spasmodic gasps
‘Karen’s extremely ill,’ I tell Edie. ‘We need to get her to hospital right away.’
‘Oh no, please don’t take my darling away. If she’s dying I want her to die here with me. That’s what she wants. Please don’t take her.’
Ellen passes me an oxygen mask and I put it around Karen’s face.
‘I have to ask you some difficult questions,’ I say to Edie. She sits down on a low wicker stool.
‘Does Karen have a DNAR in place?’
‘What’s that?’
‘A DNAR – Do Not Attempt Resuscitation.’
‘I don’t know what that is. These are her notes.’
She hands Ellen a file.
‘District Nurse, Doctor, discharge home,’ says Ellen, rifling quickly through the file, trying to make sense of the information there. ‘Can’t find a DNAR – but there’s a section here: Karen understands the extent of her condition and wants to spend her remaining days at home with her mother.
Whilst Ellen is reading this out, Karen stops breathing. I feel for a pulse at her neck.
‘She’s arrested,’ I say, then give her a quick thump in the chest. Ellen hands the file back to Edie, comes over to pull the bedclothes away and to cut off Karen’s nightdress whilst I compress her chest.
‘Oh, please, don’t,’ says Edie.
At once Karen is groaning again. Even before Ellen manages to put the defib pads on, she has a pulse and is breathing. I push the hair back from her face. She claws feebly at the oxygen mask, trying to pull it away.
‘Please, don’t do anything more,’ Edie says.
Ellen and I both know that without a DNAR we should make all due effort. We should be making ready to get Karen out to the ambulance, stabilising her as best we can, putting in an ASHICE to the hospital, the scenario playing itself out before us with wretched inevitability.

We have to make a decision.

The progress of her cancer is plain to see. This is a warm and loving environment. Far better to die here with her mother by her side than on a brightly lit resus trolley.

‘What do you think, Ellen? Shall we make Karen comfortable?’ I say.

We arrange things so she can rest comfortably against the bed, surrounding her with cushions and rolled up duvets. We unplug the defib, and then cover her up with soft blankets from the other bed. Edie gives us a box of tissues and a wet flannel so we can clean her face. Ellen brings the wicker stool over so Edie can sit next to Karen and hold her hand. She strokes it and presses it to her cheek.
‘This is all wrong,’ she says. ‘It should be me. It should be me. My poor darling.’
Karen seems calmer. Her breath comes in short, periodic gasps. Her head relaxes backwards and Edie strokes her forehead.

We have no way of knowing how long it may take for Karen to die. I phone Control to ask for an out of hours doctor, an ECP or paramedic practitioner to attend, but there are none available. The Dispatcher tells me he’ll get a senior manager to ring back to talk over aspects of the job as soon as possible. By the time the phone rings a few minutes later, Karen has stopped breathing again.
‘Has she gone?’ says Edie. ‘She’s gone, hasn’t she?’
Ellen checks for a pulse. After a few moments she shakes her head.
‘I’m afraid so.’
‘My poor, poor darling.’
‘Are you there?’ the manager says on the phone.
‘Sorry. It’s academic now.’ I tell him.
He says he’s logged everything. He understands the predicament, is sympathetic, says he might well have done the same.
I ring off, then contact the police number for a death at home.

I tell Edie that we’ll put Karen back to bed.
‘Would you like some tea?’ Edie says.
‘That would be great.’
I help her down the stairs, then go out to the vehicle to fetch the scoop stretcher.
‘Don’t worry,’ I say to Edie in the hallway. ‘It’s just something to help us lift Karen off the floor.’

The other daughter arrives whilst we’re finishing the paperwork in a spare room. We hear her crying along the hallway.

Later, she comes into the room and shakes our hands. She says she would’ve punched me had I carried on down the other route. She smiles when she sees the cup of tea Edie made us, asks us if we’d like another.

When the police arrive Ellen and I have to give statements. Without a DNAR this is not a straightforward death at home. We’re asked to hang on for a senior officer to come over from the station. We tell him we’ll be waiting outside in the ambulance.

We say goodbye to Edie and her daughter, and take the last of our bags out with us.

The evening has deepened into night. We sit in the cab, and wait, with only the occasional passing car and the moon to light us by.