Imogen is lying across her boyfriend in the back seat of the car, thrashing her legs and arms around, reaching up to grasp the hand grip above the door, pulling herself up and then letting herself go again, kicking the back of the passenger chair, slapping the ceiling, kicking the door. But as we approach the car in the dark, the whole performance seems just that – a controlled, intermittently hysterical display; her boyfriend and her boyfriend’s father look out at us by the interior light of the car, pale-faced, in need of rescue.
‘Asthma. Imogen’s having an asthma attack.’
Frank leans in, long and slow as an old-hand detective sniffing a crime scene.
‘This isn’t asthma,’ he says after a second or two, then: ‘Sit yourself up, love, and let’s have you on the ambulance.’
She had paused for a moment, but suddenly launches in to another bout of thrashing.
‘I’m serious now, Imogen. It’s cold out here. We can’t be all night.’
The hard edge seems to drop from her distress. She lets her boyfriend sit her up, then after a few fluttery passes of her hand across her face, slips out of the car and stands in the sharp night air, swaying impressively but not falling down, breathing quickly into the top of her chest.
‘Just slow that breathing down for me, would you, Imogen? And then let’s have you on the truck.’
She scuffs her feet as she walks, but makes it to the ambulance without us having to carry her.
‘That’s it,’ says Frank, offering a hand to get her up on to the truck. ‘There we go. Let’s have a seat and a chat.’
Imogen grips the handrails of the chair and breathes deeply, strange gasping respirations. She is a frail seventeen, the fringe of her long straight hair overhanging her eyes.
I go to put the SATS probe on her finger but she pulls it away as if I was going to pinch her finger in a clothes peg.
‘Don’t worry. Look. It goes on quite easily.’
I show her by putting it on my finger.
‘I need to do your blood pressure as well.’
‘There’s nothing wrong with me. I’m perfectly fit,’ she says, then grips the arms of the chair and kicks her legs forwards. ‘For the love of God!’ she screams.
‘Where is the pain, Imogen?’
‘In my back. In my fucking goddamned back. Excuse me swearing.’
‘Is this new pain?’
‘No. Yes. I don’t know what you mean.’
‘It’s quite simple, Imogen. Have you had this pain before?’
‘I fell off a bench in drama class last month and they said I strained my back. Oh dear God!’
‘Did you go to hospital?’
‘Yes. D’ur. They took x-rays and everything.’
‘And what did they find?’
‘They just said it was a strain.’
‘Did they prescribe any medication?’
‘No. Look – stop talking. Do something.’
‘We can’t do anything until we know what’s the matter. Look – your SATS are perfect, your blood pressure is fine.’
‘Call yourself doctors?’
‘But we’re not doctors, Imogen. We’re the ambulance.’
‘Well do something ambulance-y, then.’
She takes traumatised gulps of air, her head craning up like a distressed baby bird, for all the world like a person in the very last extremity of pain. But nothing leads us to believe that she is in fact in pain. Her obs are fine, nothing we do or ask leads us to believe anything different, and her boyfriend, when he looks in at the door, is calmly playing his DS.
'Is she going in, then?’ he says, not looking up.
‘We’re just trying to establish that,’ says Frank. ‘Do you have pins and needles in your hands Imogen?’
‘What d’you mean?’
‘You know. Your hands go all tingly.’
She looks straight at Frank – as far as we can tell, the fringe so completely covers her eyes.
‘Who do you think I am? Fucking Tinkerbell?’
‘Less of the attitude, young lady,’ says Frank, leaning back against the bulkhead and fixing her with a stern look. ‘We’re here to help you.’
‘You remind me of my teacher.’
But then she seems to remember where she is and what she’s about.
‘For the love of God!’ she screams, arching back in the seat and slapping the arm rest.
She seems to have learned her expressions of distress from the pages of a Victorian novel.
‘What were you doing tonight?’ says Frank, ploughing on.
‘I was at drama club.’
‘So. You did your back in at drama club a month ago, and now you’re having breathing problems at drama club. It all sounds very – dramatic.’
‘Ha bloody ha. Oh – dear God!’
This flip-flop behaviour is extraordinary. One moment extravagant expressions of agony, the next the kind of sassy street shapes you’d expect from a twenty-first century teenager. If I had to make a differential diagnosis it would be either anxiety attack or intermittent possession by Nancy from Oliver Twist.
‘Let’s review the situation. You hurt your back a month ago but nothing was found, you’re not on any medication for it and you’ve been back to normal since. Your back started to hurt tonight in drama club, and then later on when you got in the car to be taken home it started to affect your breathing. Since you’ve been with us your breathing has calmed down a lot, and all of your observations are normal.’
Frank studies her for a moment.
‘Is your mum at home?’
‘No. She’s on her way back from holiday.’
‘Is there anyone else at home?’
‘My older sister.’
‘Do you two get on?’
‘No. I hate her guts. Oh my sweet God! Jesus!’
‘You see, Imogen. Normally I’d be happy to let you go back home, but every now and again you still seem ready to tip back into another panic, and that can’t go on, can it? So the only other option is to take you to hospital.’
Imogen says she doesn’t want to go to hospital. She doesn’t want to wait for hours to be seen by a doctor.
‘At least you’ll be safe there. I think I know what the problem is, but there’s always a chance it could be something else.’
‘I’m not going to no hospital.’
We confer with the boyfriend, who sighs when he has to prematurely finish his game and put the DS back in his pocket.
‘Don’t worry, Immie. I’ll come with you.’
The boyfriend’s father, a benign, slightly worn down character with a pair of thick glasses, a scraggy beard and a walking stick that could all be part of a kit, seems happy to let him.
We park Imogen and her boyfriend in the waiting room. In front of this more substantial audience – one without the same investment or interest in her condition – Imogen calms down, and sits perfectly happily in the wheelchair, looking over her boyfriend’s shoulder at the DS.
We’re asked to take a transfer to another hospital, but there’s a delay as the patient is stabilised. We’re still at the desk half an hour later when a harassed woman in a crumpled black suit hurries up to the nurse’s station.
‘My daughter Imogen was brought in by ambulance and I’ve come to take her home.’
‘Yes. I know the girl. But she hasn’t been assessed by the medical team yet.’
‘Yes. Yes. It’s okay. I know all about it. I’ll just take her straight home, thanks.’
The nurse pulls a wise but tough, Robert de Niro face – a sub-text something like: If you’re sure that’s what you wanna do, then by all means. Go right ahead.
‘Through there,’ is all she actually says. The woman hurries through.