Tuesday, September 25, 2012

the cabbie

‘I have to warn you. The flat’s in a terrible state.’
Jean, the scheme manager, hurries ahead of us down the corridor, stiffly propelling herself forwards from the hip, her shell tracksuit rustling and swishing.
‘Ken’s been on the slide for a few months, ever since his wife died. Drinking and such. He wouldn’t let anyone in. When you saw him – which wasn’t often – he looked thinner and thinner. Wasting away - like a scarecrow. I dropped some shopping off from time to time, but I had to leave it at the door, he wouldn’t let me in. I could tell something wasn’t right so I kept an eye on things. Well – as much as I could.  But then he stopped going out completely and I wouldn’t get the whisky like he said. I knew he wasn’t well, so I got the doctor in, but the doctor stuck his head round the door, took one look and refused to go anywhere near him. He said Ken had to detox, and made him an emergency appointment at the Massingham Centre.  So I went in to help him get ready – oh my God! I can’t even begin to describe.... I was going to put him in a taxi – although I’m not sure the taxi would’ve taken him, to be honest, the state he’s in. But then he fell over and I couldn’t get him up. The power’s gone from him. And so thin! That’s why I called you. I hope you don’t mind. I’m really sorry.’
The lift door opens. We all get in and Jean presses the button.
‘I hope you’ve got strong stomachs,’ she says.
She folds her hands in front of her, leans in to me, closes her eyes and whispers: ‘Faeces’.


The door to Ken’s flat is standing open.
‘Watch where you put your feet,’ she says.
The first thing that strikes me is the extent of Jean’s courage. No wonder the doctor refused to go in – amongst the scatterings of filthy newspapers, unopened letters, empty bottles, dirty plates and carrier bags of half-eaten, putrefying food, the carpet is liberally smeared with patches of dark matter. The noisomely sweet atmosphere makes you long to throw the windows open, to let in air and light and health, but to get there would mean climbing over an upturned sofa, piles of soiled clothing and Ken himself, stretched out amongst the wreckage.
He looks comfortable, though, in four or five layers of jumper, a West Ham scarf, and a beanie hat pulled down low to the crook of his nose. He has a wild, grey beard, wiry as an Airedale, with eyes just as black and small, but his cheeks are yellowing, sunken, and the fingers he has laced comfortably over his middle are long and skeletal.
‘Hello,’ he says. ‘Sorry about the mess.’


At the hospital, Rae goes to handover and I wait with Ken.
‘She died of anorexia. And there wasn’t a thing I could do about it,’ he says. ‘Wasted away. To nothing. I lost the will after that.’
‘It must’ve been tough.’
‘It was tough. Tougher than me. So – here we are.’
He moves his hands out from underneath the blankets, palms uppermost, right and left, holding them there for a moment like a martyrd saint, dragged out of the wilderness and wrapped in cellular blankets. Even that slight movement disturbs the air around him; it’s difficult not to gag.
‘I’m not sure you’d have made it into a taxi, Ken,’ I say.
He laughs, and his yellow teeth crackle.
‘Maybe not. And anyway, I don’t suppose the cabbie would’ve been too happy with me in the back.’
‘No, probably not.’
‘No, definitely not.’ He closes his eyes a moment, then opens one and squints at me. ‘Trust me. I should know,’ he says. ‘I used to be one.’

Monday, September 24, 2012

vera, first to last

If the first job of the night points the way to the rest of the shift, I may as well go home now.
I call Control.
‘I was just wondering how many ambulances Vera has had today.’
Control doesn’t have the information to hand. Which is surprising. Vera is so prolific, you’d think they’d have a big portrait on the wall, where the eyes flash when she calls and a big electronic counter flips round.
We don’t run red to the job, because in all conscience we do not want to put any other road users at risk unnecessarily. We probably miss the Category A time, which in auditing terms makes whatever happens next a failure, but then of course everything about this job is a failure. One frail old woman, the resource profile of a major incident, money wasted, nothing done.
Even if a multi-discipline meeting between health, social services and the housing trust cost a couple of thousand to organise – even if they held it in the plushest hotel with the finest coffee and biscuits, free gold pens and a table magician – if they finished the day with a handshake and a workable solution it would still represent a saving of hundreds of thousands.
But if there’s one thing Vera is good for it’s to demonstrate the fatal lack of continuity in the system, the lack of resolve between the various agencies. Despite being a prodigiously expensive irritant to everyone from the carer to the local GP, Vera still gets endlessly wheeled around and around, insulting and assaulting and goading and absorbing and causing havoc as she goes. Defiantly untouchable.

Vera is sitting in her chair watching TV: Fiona Bruce investigating the life and works of J M W Turner.
‘I’m in pain! I’m in pain!’ says Vera, over and over, but her eyes remain as hooded and watchful as they always do, her hands placed lightly on the arms of the chair. Vera has three distinct voices – the first and most used is a piping-falsetto for pain and distress; the second is a lower, huskier tone for threats, insults and instruction, the third is the least often heard - a wheedling kind of whisper, for saying how sorry she is. She seems to use each voice instinctively, blindly sensing the advantage in the air. She is like some malign porcelain doll, playing through her voices on a loop until she gets what she wants.
She looks sideways at me and says in Voice Two: ‘Don’t you mess my sofa up.’
The carer is trembling, red in the face, putting her coat on.
‘The other ambulance crew only left about half an hour ago. They’d talked to the out of hours doctor and she’d arranged for a visit later on. But then Vera picked the phone up again. What can you do?’
‘Unplug it?’
The carer smiles as best she can and then shrugs. ‘She threw a can of coke at me, you know.’ she says. ‘Anyway. It’s all logged. Do you need me for anything else? Only I’m behind on my calls.’
She leaves, with a grim, backwards nod to us from the hallway as she closes the door.
We turn our attention to Vera.
‘I’m in pain! Help me! You’re not doing anything!’
‘Where are you in pain, Vera?’
She flutters a hand over her middle.
‘My chest. Around my heart. My legs. Help me!’
Rae picks up the last ambulance sheet to read what actions they took.
Fiona Bruce is in Margate. Apparently Turner had a mistress there. She holds up an old photo, and points to a house marked with an X.

‘Turn that off,’ says Vera. ‘It’s my TV. Turn it off. This is my house. Get off my sofa.’
As she talks she reaches to the table at her side and another can of coke.
‘Don’t you be throwing that, now,’ says Rae, lowering the ambulance sheet. ‘I’m serious, Vera. If you throw your coke at us we’ll have the police here to arrest you for assault.’
Vera withdraws her hand.
Voice Three: ‘I wouldn’t do that. You’re such kind people. I wouldn’t hurt you.’
‘Didn’t stop you throwing it at that poor carer, though, did it?’
‘I’m in pain! I’m in pain!’
She carries on crying out whilst we decide what to do. The most common way of dealing with Vera is simply to load her up and take her in. It’s the most emotionally aerodynamic method. Everyone has attempted to go down other routes, but it gets more and more tortuous and anyway the outcome is always the same – another call from Vera, another attendance. The dull, default position is that if emails, phone calls and reports are ineffective, maybe constant appearances at A&E will inspire some other more definitive action. But it’s the beginning of the shift, we’re fresh and optimistic and still up for an attempt at the right thing to do.
Rae calls the out of hours service. The doctor tells us not to take Vera into hospital. Someone will be with her in an hour or so. I call Control to log the discussion and our visit, but the Dispatcher routes us through the Duty Despatch Manager, who refers us to the Duty Com for a discussion about the implications of the call. The worry is that Vera may actually collapse with an MI or something, and as the last clinician contact, we’d be liable. After all, Vera is complaining of chest pain. It might be real this time. Her ECG does show some anomalies, the kind of thing you might expect to see in an elderly woman, but still, not perfect.
‘Emphasise the concerns you have about her mental capacity,’ he says. ‘We’ll log everything and see if we can sort it out in the morning.’

Fiona Bruce is standing on the sea wall at Margate, holding up a laminated copy of one of Turner’s paintings, trying to identify the landmarks.

I glance across to Vera. She has the phone in her hand. Whilst I’ve been chatting on the mobile to Control and Rae has been writing up her sheet, Vera has dialled 999 again.
‘Yes, I know, we are still here,’ I say to the Duty Com. ‘I think she’s going for a record – how many crews she can fit into her sitting room at the same time.’
We take her in.


Behind the nurse station at A&E majors, the bed board is as busy as the Tote on Derby Day . Our arrival with Vera is greeted with a dismay bordering on hysteria. It transpires Vera currently has an ASBO served on her for racially abusing staff, the result being that only white Anglo-Saxon nurses can attend to her. As a political move more than anything, we’re bumped round to minors where there are fewer BME staff working tonight.
The nurse running the desk there is dabbing a tissue at her eyes and nose.
‘Shall I give you a moment, Stacy?’
She looks up and smiles sadly.
‘Nope. No. I’ll be okay. Phew. Now. How can I help?’
‘I can’t tell you how sorry I am to bring this patient to you.’
‘Who? What do you mean?’ she says, straightening a little.
‘Jesus Christ!’
For a second she flames as brightly as a roman candle. But the white heat of her anger almost seems to cauterize the sorrow that was overwhelming her a second ago. She takes a deep breath; her fire burns blue and cold. She reaches up and gently brushes a strand of hair away from her forehead.
She calls out to a young HCA called Steve, one of only a few staff in the department who are able to deal with Vera.
‘Guess who’s in again,’ she says. Steve slowly puts down the sheets he was carrying, and walks over.

In the A&E reception I get some stats: one hundred and seventy five A&E attendances this year alone, which necessarily means at least double that in ambulance call-outs, five of those tonight. We drive back to base to complete the paperwork – an untoward incident form, a vulnerable adult form, supporting emails and faxes – any angle we can think of to raise Vera’s profile and get something done. Three hours start to finish. We have a cup of tea, realign ourselves with the night, and carry on.


Half an hour before the end of the shift, we get our final job.
Exhausted, we make our way back into the cab. Read the MDT.

Rae drives.
There’s no conversation, none at all when we turn up at her flat. We are clinical operatives, delivery people. We put her in our chair, load her onto the ambulance. She toggles through all of her voices, desperately looking for an angle, a point of leverage, but we are cold to her.

The department has pretty much emptied when we go in through the automatic doors.
A black cleaner working his broom in tired loops.
A Filipino nurse.

Vera watches them both.

Saturday, September 22, 2012

the time

Mrs Blake is lying where her sister found her, face down on the carpet, one arm crooked through the legs of a nest of mahogany tables, a scattering of custard creams and an upended Tupperware container lying on its side just away from her other, outstretched hand. I struggle to disentangle her whilst Rae moves some furniture to make room enough to drag her out. Once Mrs Blake is on her back, I start chest compressions whilst Rae works around me, cutting through her clothes and sticking the defib pads on.
A second crew arrives to help.
We work through our protocols.
After every aspect has been played out – almost an hour in this case - we review the facts, and decide to stop.
‘What time have you got?’ says Rae.
‘Eleven o’clock.’
Suddenly there’s a frantic whirring and popping noise from behind us up on the wall – a cuckoo clock. A little door just below the roof of it swings aside, and a crazy-looking wooden bird crashes out. It hoo-hoos the hour, jerking its body up and down, flapping its wings in time to the striking of a bell inside. The moment eleven has been counted, the bird disappears back inside - and the little door slams shut.

Monday, September 17, 2012


Janice is sitting on the sofa, eight roll-up cigarettes neatly finished and lined up in a fish-shaped dish on the coffee table in front of her. She is utterly still. She doesn’t even turn her head as we come in the door.
‘We understand you’ve taken an overdose, Janice.’
She nods.
‘What have you taken?’
She glances down at the torn blister packs on the sofa beside her.
‘All my meds for the next two weeks.’
I pick up the packs and start writing down the names of the meds.
‘Any alcohol with that?’ I say, sounding like a waiter.
She shakes her head.
‘Alcohol doesn’t agree with me,’ she says.
‘I think we’ve met before,’ says Rae. ‘Didn’t I take you in with something similar? A couple of weeks ago?’
Janice looks up and squints.
‘Yes. You did. I recognise you now.’
‘So what’s happened between then and now?’ 
Janice closes her eyes. ‘It’s the anniversary of the twin towers. I lost a good friend,’ she says.
 ‘Okay. Shall we go down to the ambulance, Janice? Have you got everything you need?’
The words seem to cross over slowly, a satellite delay. But then she sighs, leans forward, carefully gathers up her cigarettes and drops them in her pocket.


After we’ve handed Janice over at the hospital, Rae passes me a cup of coffee and we settle back into our cab seats. The A&E car park is crammed with vehicles – ambulances, cabs, private cars. It’s like a monster version of one of those puzzles where the tiles are all in the wrong order and you have to find the right sequence of moves to reveal the picture. We sip our coffee and watch it play out.
‘I suppose you can divide suicides into those that want to be found and those that don’t,’ I say.
‘I went to this one suicide a little while ago,’ says Rae. ‘A hanging, up in a tree. And I mean – way up. He’d climbed up this enormous old oak tree as far as he could go. It must have been a good fifty or sixty feet. And he was wearing this big black leather trench coat, and heavy black boots, like he was out of some industrial metal goth band, you know? A dog walker found him – surprise, surprise – god knows how. You don’t often look up, do you? That must have been a shock. When we got there it was still quite early in the morning, and I remember there were all these crows in the wood making this colossal fuss – caw, caw, caw - flying around and carrying on like they thought the guy was a giant crow trying to muscle in on their territory.’
She takes another sip of her coffee, then balances it on the dashboard to blow her nose.
‘There wasn’t anything we could do,’ she says, stuffing the tissue back into her pocket. ‘I sure as hell wasn’t going up there. I’m terrified of heights. I get stressed changing a light bulb. Anyway, the police came and took over. I never did find out who retrieved the body.’
She picks up her coffee again.
Janice emerges from the A&E entrance. She carefully pulls one of her roll-ups out of her pocket, lights it, then stands there quietly smoking, watching the traffic. 

Tuesday, September 11, 2012

a world of signs

The sea is a glittering expanse of greens and blues, almost too bright to look at. Some early boats are out on the water, far off out on the cut of it, shavings of light moving in slow lines.
Rae takes us to the scene – a cafe down on the front. The staff have sprinkled water over the paving slabs to freshen the place up for the breakfast crowd, but the day is already so warm it’s burned off most of it. A couple of chairs and a table have been moved aside at one point, leaving room for our patient, her husband and a community responder.
Carol is sitting on the pavement leaning back against the railings, her hands resting in her lap, staring down at her union jack flip-flops. Carol is a heavy woman in her fifties, her body a sinus wave of flesh formed by the pinch-points of skirt, t-shirt, blouse, jewellery. There is a streak of red in her bobbed blonde hair, and her blue mascara has run. Her husband Barry is patiently waiting on the periphery of it all behind a pair of seventies-style, Reactolite sunglasses.
‘I can’t believe this,’ she says as we introduce ourselves. ‘I’m so embarrassed.’
‘What’s happened then?’
‘Well, look around. There’s nothing, is there? No sign, nothing. How stupid can you get? Spraying water everywhere and not telling anyone about it. They should have a sign up. Get a photo with your phone, Barry. I’m going to sue them for everything they’ve got.’
‘So you fell over?’
‘Yes, I fell over. And I cracked the side of my head on this concrete ledge as I went down. It don’t half hurt.’
I check her over. Apart from a small abrasion on the side of her head, there’s nothing to suggest Carol has suffered anything other than a minor head injury.
‘Let’s get you up and do the rest of our checks on the ambulance,’ I say. ‘Shall we help you up?’
‘No – thank you. I don’t mean to be rude, but I know how I need to do this.’
She struggles, but every time we step in to offer a hand she refuses.
When she’s finally upright she bats her skirt clean and says: ‘You can see where I fell, can’t you? Honestly, those Serbo-Croats. They’re absolutely useless. Have you made a note of all this, Barry? We’re definitely going to sue.’
I offer Carol my arm but she refuses that, too. We make our way slowly across the promenade and up the steps to the ambulance.


After a thorough examination the only thing I can find wrong is a minor abrasion.
‘I don’t think you need to go to hospital, Carol,’ I tell her. ‘What I suggest is you go back to the hotel with Barry, take some paracetamol and rest up. You’ll be fine.’
She dabs at her eyes with some tissue, and sniffs.
‘What about Natasha Richardson?’ she says.
‘Oh. Well. Yep. That was a surprising case.’
‘Natasha Richardson went over and banged her head when she was skiing. On the nursery slopes. They all said she’d be fine. She didn’t go to hospital – and look what happened. Dead in a few hours.’
‘I know. That was pretty shocking.’
‘How do you know that won’t happen to me?’
‘I can’t guarantee it. I don’t know enough about Natasha Richardson, but in your case, you don’t have any of the predisposing signs of a serious head injury. You didn’t bang your head with a lot of force, you weren’t knocked out...’
‘She weren’t knocked out.’
‘Was she wearing a helmet, do you know?’
‘No – and neither was I.’
‘No. But you don’t have any of what they call neurological deficit – numbness, blurred vision, dizziness and whatnot.’
‘Neither did she.’
‘Didn’t she?’
She sniffs again and dabs at her nose with the tissue. Then she crumples it up and looks across at Barry.
‘What do you think I should do, pet?’
He shrugs, but says nothing.
‘Did you get the pictures?’
He waves his phone in the air.


Back in the cab outside the hospital, I throw the clipboard onto the dash and lean back in the chair.
‘Jesus! It makes you wonder how the human race ever made it out of the swamp. How do people survive when every little thing’s a hazard?’
‘It’s insurance, Spence. Where there’s a blame and all that...’
‘And because everyone’s terrified of being sued, they have to put signs up for everything. Pretty soon there’ll be signs all over the place. Every tree, pond, and hill. And then they’ll put up a massive fence along the coast, with signs to warn you about the sea, and signs to warn you about the fence, probably. It’ll be one vast world of signs, and even then it won’t be enough. In the end they’ll have to clear everything away. There’ll be nothing left, completely flat – like Cambridgeshire, only without the dykes - with maybe a scattering of cushions, big enough so you can’t choke on them, but not so big you can’t accidentally smother yourself.’
‘Yeah,’ says Rae, stretching. ‘Great. Then I can sue for emotional cruelty.’

Wednesday, September 05, 2012

the use of farce

Nigel’s front door has not so much been kicked in as utterly destroyed. There is a great punched hole where the handle used to be, the letterbox has leapt out of its seating and hangs by a single bent screw, and the door itself, splintered and torn, lies at a precarious angle half in and half out of the frame.
‘That’s one angry postman,’ says Kyle, picking his way through the debris.
We’ve been called to transport Nigel on a Section Three to The Glades, a secure unit about forty miles out of town. A crew yesterday had told me they’d been sent there, as there were no psychiatric beds to be had anywhere in the county. I wouldn’t be surprised if they started diverting us to the Orkneys,’ he said, climbing wearily into the cab. ‘See you later – hopefully.
A social worker meets us in the hallway, clutching a clear plastic wallet of section papers to his chest like cards he doesn’t want anyone peeking at.
‘Thanks for coming, guys,’ he says. ‘Nigel’s on a compulsory section, as you know. He needs to go out to The Glades for treatment. He’s not too happy about it, I’m afraid. Unfortunately he knew we were coming and barricaded himself in, so it’s all a bit of a mess. The police are in the bedroom with him now. He’s calm at the moment. He’s never been violent, but he does get worked up sometimes and shouts and carries on and so forth. Will you be okay with that? Or do you want the police to go with you?’
‘We’ll be fine,’ says Kyle.
‘Great. The other thing about Nigel is that he speaks in different accents or identities, so don’t let that throw you. Shall we go in and say hello?’
There’s not much room in the flat. One thing that strikes me is the number of fishing rods stacked up against the wall, along with a few fishing rod shaped parcels still to be unwrapped. On the facing wall there’s a framed photo of a grinning man holding a fish up to the camera. For a minute I think I’ve seen the photo before, in another house, but then I guess it’s just a generic thing. Next to the photo is a roughly blu-tacked A3 sized finger painting - an alien, jumping into the air, spiky hair and teeth, hundreds of arms waving about either side. Wow I think. He really is crazy. But then I see the dedication at the bottom, and realise it’s by his nephew.

Matthew, Mark, Luke and John, bless the bed that I lay on.
Except now instead of angels we have two enormous police officers, a social worker and Kyle, all trying to persuade Nigel to put his crocs on and follow us down the stairs to the ambulance.
‘You use evil farce on meh? I use evil farce on you. Let see who use the most farce.’
‘Come on, Nigel. Let’s get going.’
‘Get going? Where get going? I show you some farce...’
If I had to animate that voice I might start with a raucous, Rastafarian-styled parrot, but it’s startling to see the reality of the man himself. Nigel is white, middle-aged, paunchy, with a pair of huge steel-framed glasses slid half-way down his nose and a sparse combing of slick black hair across his head. He stares at us all through the smudged lenses of his glasses, and in the brief periods when he’s not chattering, his mouth is slack. He could pass for a clerk in an office with a social conscience, but here, lying half naked in a red-dragon-patterned, green silk kimono and surrounded by police, he seems like an actor leading a workshop on how to appear mad.
‘Let’s not talk about force anymore,’ says one of the police officers. His colleague checks his watch.
‘Farce you say? Farce? You use farce on meh door. What happen to door? Door broke ope and flew away. You use evil farce and I use evil farce and let see who win.’
The social worker says some bland, calming things to Nigel, then turns to the police officers.
‘They say they’re okay without an escort.’
Both police officers smile at us, very warmly indeed.


Luckily, I’m driving. The day is warm and bright. I have the window down and there is a beautiful rush of later summer sunshine into the cab. Behind me it’s reassuringly quiet. When we managed to coax Nigel out of his flat, Kyle had settled in to the chair against the bulkhead, and Nigel in a seat opposite. For all his hyper-energised protest, Nigel had come out meekly enough, his kimono fluttering open and displaying a pair of greying pants despite our efforts to keep him covered up. He took his seat and seemed to fall asleep almost immediately.
The police officers slapped the side of the ambulance appreciatively as I pulled away.

Once I find the hospital I follow the signs through to The Glades – like psychiatric units the world over, sited discreetly round the back. There’s a barrier across the road leading to the unit, and I get out of the cab to look for an intercom or buzzer but there’s only a card swipe. Nigel seems to have woken up. I can hear him laughing and chattering wildly with the reassuring bass notes of Kyle’s voice beneath it all. I don’t want to leave Kyle on his own with Nigel, so I call Control to ask them to phone the staff to let them know we’ve arrived and need access.
Whilst I’m waiting for a reply, someone drives out of the car park, and there’s just enough time to duck through before the barrier closes again.
I park the ambulance as close to the main entrance as I can, then climb out. There’s a woman sitting on a bench to the left of the building, a staff pass on a ribbon round her neck, eating a sandwich and studying me with bovine grace. I’m tempted to ask her whether she could go in and fetch a nurse or two out, but she makes no sign that she has any interest or duty to anything other than her food, so I leave it.
I open the side door and join Kyle and Nigel in the back. I leave the door open, but drape myself innocently across it, one foot up on an empty shelf to complete the man-blockade.
Kyle yawns and stretches.
‘So – ‘ I say to Nigel. ‘You like fishing?’
‘Fish? Wha’ fish? Hah ha ha. Put rod in water, fish in water,  flick ‘em out, mate. Flick ‘em out. Hah ha ha. What fish? Hah ha ha. They come in water, fish in water….’
Kyle massages his face. The sunshine falls warmly on the ambulance and the cars and the trees and the absolute inactivity of the place.
Where are the staff?
A woman walks past, glances in, hurries on.
Kyle sighs and stands up.
‘Come on. Shall we walk you inside?’ he says.
‘Walk? Wha’ walk? Walk you say…’
I pick up the bags and section papers and back out first. Nigel ducks out after me, hesitating at the top of the steps to blink and glance around, pushing his specs back up his nose, his kimono blowing open like a cut-price porn star expecting photographers at the airport.
And then, the moment his brown crocs touch down, he runs off.
I make a grab for him but the bag gets in my way.
‘No farce. No farce,’ he calls back over his shoulder as he runs. ‘Hah ha ha.’
Kyle sprints after him.
I throw the bag and papers back into the ambulance, slam the door and jump in the cab. I glance at the sandwich woman on her bench.
‘You should’ve waited for staff to come out,’ she says, pointing at me with a crust.
I do a quick three-point turn and drive after my crew mate. I just catch a flash of green shirt doubling back right out of the top of the car park. I head that way, but I’ve lost them. After a minute or two my phone rings.
‘Got him,’ Kyle says, out of breath. I can hear Nigel squawking in the background. ‘Just follow the road you’re on down to the bottom and turn left. You’ll see us on the grass.’

Back outside The Glades, with Nigel firmly back on the ambulance and Kyle standing over him, I go into the building to fetch help. There is an airlock style door system that takes an age to get through, as if visitors have to decompress first. Across a bare and echoing foyer to a receptionist, slowly taking notes on a pad with a phone to her ear.
‘Can I just…?’ I start to say, but without looking up the receptionist simply holds her hand up flat between us.
‘Go on, Bill,’ she says into the phone. ‘No – just someone at the desk. Ye-es…?’
There’s no-one else to speak to. Figures pass back and forth in the distance behind reinforced glass. I wave to one of them and he stares back; I have no idea if he’s staff or patient.
Finally, after a protracted goodbye, the receptionist gently replaces the phone.
‘We’ve got a…’
She holds her hand up flat again, and slowly puts the finishing touches to the notes she’s made.
A dot.
A flourish on a T.
She lays the pen down.
‘There. Now. How can I help?
‘We’ve brought Nigel on a section three. We need staff to collect him off the ambulance. He ran off when we got here, but we managed to get him back.’
‘I see. I’ll send someone out to you.’
‘Thanks. Just outside there.’
‘Ye-es. They’ll be with you presently.’
She buzzes me back out through the air-lock.

Back on the ambulance, Nigel is talking wildly. Kyle looks at me as I open the door.
‘On their way,’ I say. ‘On their way.’

Ten minutes later, I’m just about to go back inside when the air-lock whooshes and a male nurse saunters out. He drifts over to stand at the bottom of the ambulance steps and listens to our report with his hands lightly clasped in front of him and his thumbs slowly twirling round each other.
‘Hmm, I see,’ he says, pleasantly. ‘Well – thanks for that. Hmm. Hello, Nigel, is it? Okay? Well. Good. Let me just go back inside and – ahm - fetch the relevant documentation, then we can – ahm - begin to initiate the whole process of transferral.’
‘But we just want to drop him off,’ says Kyle hopelessly.
‘Ah-hmm,’ says the nurse. ‘Just a moment.’ And he turns and walks back in.
Nigel pushes his glasses up his nose.
‘Use farce,’ he cackles. ‘Lethal farce.’

Sunday, September 02, 2012

the other side of the glass

Liang is lying on his back in the CDU, hugging a pillow over his face. The charge nurse doesn’t seem concerned, though. She looks exhausted, all her thoughts turned irresistibly in the direction of home like boats in the harbour when the tide runs out.
‘He’s ready,’ she says, not looking up, scribbling something on a sheet of paper and then stuffing it in an envelope. ‘His bag and notes. He’s no bother, so you don’t need an escort. And yes he can take the pillow. Anything else?’
‘No. That’s great, thanks.’
We go over.
Slowly he pulls the pillow aside and blinks up at us. Liang is neatly dressed in a dark denim shirt buttoned to the neck and seam-sharp chinos. His Caterpillar boots are impeccably aligned on the floor at the foot of the bed, their laces in parallel lines on the floor, right and left. A heavy-set man in his early twenties, Liang’s cheeks are plumped out like he’s storing all his anxiety there.
‘Sorry to disturb you at this late hour, Liang. But we’re your transport to Claremont,’ I say. ‘Are you ready to go?’
He sits up, gently puts the pillow to one side, and then plants his feet in his boots. When his laces are tied, he hugs the pillow to his middle and then stands and awaits further instruction.
‘Great! So – if you’ve got everything, we can set off. Do you want to take the rest of your sandwiches?’
There’s a half-eaten pack on the table behind him, but he shakes his head, squeezes his eyes shut, and whispers into the pillow that no, he does not want to take the sandwiches.
We say goodbye to the nurse, and leave.


From the cab it doesn’t sound as if much is happening back in the ambulance. Neither Rae or Liang are saying anything; I figure that Liang has probably gone back to sleep, and with nothing to do – no observations to make or treatments to attend to – Rae has probably drifted off herself, or is braced on her seat, Tweeting. The roads are quiet at this time of night. Claremont is out in the country, and pretty soon the traffic thins to nothing. The road feels as weighted with sleep as the houses we pass. Even the streetlamps seem exhausted; they trail their thin yellow lights across the way like strangely drawn fishermen dragging their nets across a river.

I put the radio on and lower the window to let in some air.


It feels like a major achievement to make the hospital without falling asleep and ploughing into a ditch.
I turn into the hospital driveway. The road turns smoothly to the left, past the medical blocks and round through stands of fir trees to the psychiatric wing. I park just outside the foyer, lit up like a deserted hotel. I climb out of the cab and ring the buzzer by the ward name we want; after a long pause, a cheerful voice says Hi and the door buzzes open. Rae leads Liang out of the ambulance and we all walk in together.
Another set of doors, a brightly lit corridor in primary colours, anodyne flower prints framed in beech along the walls.
Half way down the corridor I notice that there’s actually someone standing in the dark courtyard beyond the window, watching as we pass. When he sees that I’ve noticed him, he rises up on his tip-toes and waves as hard as he can. I wave back.
‘Who’s that?’ asks Rae. ‘Friend of yours?’
And then for one dislocated moment, I have the feeling that it’s actually my own reflection, cut off behind the glass, free at last to warn me about something.
Liang glances to his right, hugs his pillow a little tighter.
The door to the ward stands open.

Saturday, September 01, 2012


‘This is a wind-up, right?’
I lean forwards to read the screen as well.
Self-harm / suicide. Swallowing chicken bones. Pt name Fox.
Rae presses the call button, a weariness to her movements like she’s an astronaut struggling to operate on an increasingly bizarre planet.
But it’s true. Control is quite straight-faced about it. There’s a car on scene requesting routine back-up to an intoxicated patient by the name of Fox, a fifty year old female who attempted suicide by swallowing chicken bones, then punched the floor. Police also on scene.
Rae settles back into her seat and folds her arms in a self-hug. She’s asleep and twitching before I’ve even made the turn at the end of the street.


A full moon rides low over the estate, washing everything out, making it all strangely one-dimensional, hard and unrelenting. Flickering TV lights behind some of the windows, like the moon has set multiple moon-fires there. Feral shouts and cries from further off. And then an actual fox, limping across the road.
‘There she goes!’
Two police officers, one male, one female, wait by their car at the bottom of a ragged rise of concrete steps. The female walks towards us, bright, blond and smiling; the male waits behind on her dark side, leaning back against the patrol car with his arms folded, chin tucked in.
‘Sorry about this,’ she says, cheerfully. ‘I don’t think Rose is really a threat to anyone, or herself. I’ve been out to her before and it’s always the same – high drama, low impact. Did you get the note about the bones?’
‘Don’t worry. She hasn’t done any damage. She sicked it all up again, threw her weight about but then lost interest. I think your colleague’s just coming out now. She’ll tell you the rest. Anything else you want us for?’
‘No – that’ll be fine.’
‘Okay then. See you later - no doubt.’
She climbs into the patrol car. I wonder for a moment if she’ll drive away and leave her colleague to fall backwards into the road. But he sighs, stands up straight, and finds the minimum energy required to climb in next to her.
Niamh, a new paramedic, comes down the steps to see us.
‘I can’t apologise enough for turning you guys out to this,’ she says. ‘I thought we had it all sorted. There’s no real need for her to go to hospital. She’s way too drunk for a psych assessment, and anyway I don’t think they’ll find anything new. She hasn’t hurt herself tonight. The bones thing was a bit weird, but she didn’t choke or do any damage.’
I imagine Mrs Fox snatching up a chicken carcase and trying to cram it all into her mouth. It makes me feel queasy, so I take a deep breath; the night air feels chill and good.
‘I don’t actually think there’s much danger of her doing anything else,’ says Niamh. ‘We had managed to settle her down and get her into bed, with a view to referring her on in the morning. But then her brother came out of nowhere and it all started up again. And now she’s complaining of chest pain and what not – again, nothing going on there, I don’t think, but she’s adamant she wants to go to hospital, and I couldn’t talk her out of it.’
‘No worries.’
‘Here they come.’ Niamh shivers and hugs her clipboard. ‘Been busy?’
‘The usual.’
There’s a scuffling and swearing from the top of the steps. Mrs Fox emerges from the communal doorway, her brother with one arm around her waist, the other holding a bag and smoking a fag. Mrs Fox has her hands out in front of her and a wretched expression on her face, like a ham actress playing Lady Macbeth.
‘Come on, Rose,’ he says. ‘Look. The ambulance is here and everything.’
‘Leave me alone,’ she says. ‘Just fuck off and let me get on with it.’
‘No! You know what we said. You have to go in and get seen. You can’t waste any more of these good people’s time. We agreed, remember?’
She nods, then waves her crabbed hands higher in the air.
‘Look what I done!’ she says. ‘Look what I done to my hands.’
Niamh grimaces, and turning slightly side-on, whispers: ‘Absolutely nothing, as far as I could tell.’ Then smiling, back up to Mrs Fox. ‘Come on, Rose. Least said soonest mended.’
But as we all stand there watching them curse their way down the steps towards us, our collective breath misting in the first really cold night of the year, it’s abundantly clear to anyone who might be watching that none of us has the least idea what really needs to be said, or the smallest clue what needs mending.