Monday, September 30, 2013


Jade and Emmy have both taken the same legal high, but it has affected them differently.
Jade doesn’t react to anything around her. She stands on the edge of it all like a bored body-double for herself, doing all the things Jade would be expected to do in that situation, like holding Emmy’s gothic stack shoes, answering her mobile phone (Benny Hill theme tune), talking on the phone – the facts, the reassurances, all with the same monosyllabic intonation – observing as we load Emmy onto the trolley and haul her up the slope from the club forecourt to the ambulance.

I imagine them both choosing a tab with an android logo on it. But if the drug has in fact turned them into robots, Emmy’s circuits have blown. She thrashes around on the trolley in a horizontal dance, saying the same thing over and over again: Come on now, now, now. Come on now, now, now. Come on now, now, now. Let’s have a bit of a tickle. Every so often she goes quiet, and scans the world around her.
Really? she says.

Then flips back to the start.

Saturday, September 28, 2013

a misunderstanding

Henry is sitting on the path leaning back against the wall, his face pale, his eyes closed, his breath coming fast.
‘Jesus fackin’ Christ I’ve never felt like this before,’ he gasps. ‘Fack me.’
His work colleagues are gathered round. They describe how he came staggering downstairs, one hand on the balustrade, the other bunched in the middle of his chest.
I take what history and obs I can whilst Rae fetches the trolley down.
‘One, two, three… h’up!’
‘I just can’t do it,’ he says.
‘Do what you can.’
‘I can’t.’
We haul Henry to his feet and settle him on to the trolley.
‘Just try to slow your breathing down, Henry. I know it’s upsetting, but your oxygen levels are better than normal, so that’s good.’
‘I’m dying of a fackin’ heart attack. Never mind slow your fackin’ breathing.’
Once he’s on board we work around him, putting on the BP cuff, the SATS probe, the ECG dots. He keeps his eyes closed throughout, resting his left elbow on the side shelf, the fingers of that hand trembling and trailing over his face, then his neck, then back to his face again.
‘What’s your past medical history?’ I ask him, fixing on the last of the dots.
‘I’ve been investigated for chest pains before – but it’s never gone on so long or as bad as this – they said it was costochondritis or samink – they don’t fackin’ know – I’ve had all kinds of tests – when I was nineteen I was in a car accident – had to be cut from the wreckage – I went through a bad patch – anxiety attacks – but that was twenty years ago – I know things have got a bit stressful lately …’
‘Just hold still for a second whilst we take the ECG,’ I tell him.
‘Well you asked me what my medical history was…’
‘I know. And I want to hear. But we need you to be still so we can take the snapshot. Just for a second or two.’
His fluttering hand covers his face.
We get the readout.
Rae tears it off then hands it to me with a wry smile.
‘See what I mean?’ she says.
I know exactly what she means. When we’d both come striding down the alley and seen Henry sitting there, seen how pale and sweaty he was, how he clutched at the centre of his chest, we’d glanced at each other and acknowledged what we both immediately thought: MI. Some old-timers still talk about the ONF, the overall nick factor, that first impression of the serious job that increases the pace and urgency of everything you do. Just that morning Rae had been talking about how she’d been getting things wrong lately, thinking things were serious when they weren’t, and vice versa.
Now that we had Henry on the ambulance and had spent a little more time with him, seen his observations in context, and had the ECG in our hands as further evidence, it was looking increasingly as if Henry was suffering from anxiety and hyperventilation – unpleasant, but not life-threatening.
‘See what I mean?’
But if I do, Henry doesn’t.
‘You fackin’ people, you make me sick!’ he says, tugging the leads off his chest and making as if to swing his legs off the trolley. ‘You fackin’ think you know it all. Yeah – yeah! So you think it’s just anxiety, mate. Well fack you. Fack the lot of you. I don’t have to sit here and take this shit. You can kiss my arse you fackin’ kant. Fack’s sake. Un-fackin’-believable. I’ll be putting in a complaint, you can fackin’ count on it.’
‘No, no! Henry! Seriously – it’s a misunderstanding!’
He shuts his eyes and rests his head back.
‘No. I don’t want to fackin’ hear your excuses. Just shut it. If you’re taking me to hospital then just do it  and don’t say another fackin’ word. I’m sick of you and all your snap judgements. Fack sake.’

Rae quietly withdraws.

After a brief pause I try to start winning Henry back again, but every attempt is slapped down.
‘I’m not answering any of your questions,’ he says. ‘Just shut up and drive.’
‘I’ve listened to you, Henry, so I think it’s only fair you listen to me. There’s a simple explanation for what happened just now and it’s not what you think. Will you let me tell you?’
‘No. I don’t want to hear your lame attempts at a cover-up. I know what you think of me. You think I’m a waste of time who’s just having a panic attack. Well fack you, I don’t want to know.’
‘You’re wrong, Henry. But if you don’t want to talk any more, that’s fine. I’m glad you’re coming to hospital. I think there are aspects of your condition that need looking at there.’
‘There are, are there?’
‘Yes. Now. Can I ask you a few very basic questions, like your surname and date of birth?’
‘I was telling you all that earlier and you completely fackin’ ignored me so what’s the fackin point? You couldn’t be bothered to listen to what I was saying. You were too busy swapping snidey comments with your friend.’
‘Sometimes we have to multi-task, Henry. I was listening to what you were saying – about the car crash and everything – but I was trying to do some other stuff at the same time.’
‘Well…’ he says. ‘It looked to me like you didn’t give a shit.’
‘I’m sorry if you feel like that, Henry.’
‘I do fackin’ feel like that. And I will be putting in a fackin’ complaint.’
‘That’s absolutely your right.’
‘Too fackin’ right.’

We pass most of the rest of the journey in silence.

Nearing the hospital, I tell Henry the story of a friend of mine who had an anxiety attack on a petrol forecourt and was so convinced he was having a heart attack he got out of the car and lay down between the pumps.
Henry opens his eyes and squints at me.

‘Un-fackin-believable,’ he says.

Wednesday, September 25, 2013


Cynthia is just able to make it to the door, even though she says her legs have gone numb from the knees down.
‘They said they thought I might be getting some peripheral neuropathy, but it was never as bad as this.’
‘Have a seat, Cynthia and we’ll talk about it.’
‘I’m sorry to call you out but I was just so worried. It felt like it was creeping up my legs, and I didn’t want to get to the stage where I couldn’t get out of bed. It’s a damned nuisance. I’ve only just been discharged, you know.’
She struggles to turn round in the narrow hallway, the rubber ends of her zimmer frame getting tangled up in the curtains that stretch across the doorway and an elephant’s foot umbrella stand.
A large, white cat watches the whole performance from the bottom of the stairs.
‘Oh – don’t let Meowth out. And that’s difficult to say without your teeth in.’
‘Meowth? Isn’t that a Pokemon name?’
‘I don’t know, dear. I inherited the damned thing. Pull that curtain aside would you?’
Once she’s untangled, she leads us through into a small but beautifully furnished front room. There is a bed piled with embroidered cushions along one wall; a religious triptych above the fireplace; a pair of dark green velvet drapes across the windows, and a dressing table with a cheval glass and a few neatly placed porcelain pots against the other wall.
‘Please excuse the mess,’ says Cynthia, plopping down onto the bed. ‘My goodness! What will the neighbours say? They’ll have me hounded from the street, that’s what. And who could blame them? What time is it?’
‘Almost midnight.’
‘Oh. I thought it was later than that. Listen, dear – you’ll find all my information in a yellow folder in the kitchen. It’s on the table along with all my dreadful medications.’
She sighs and shakes her head.
‘Don’t get old,’ she says.

* * *

All her observations are okay, but the fact remains she has this new onset weakness.
‘I’m sure the doctors are right when they say peripheral neuropathy. But from our point of view we have to treat for the worst case scenario, which means a trip up the hospital, I’m afraid.’
‘I thought you were going to say that. Oh well. Needs must and all that. Would you do me an awful favour and hand me down that shawl? That’s the one! That’ll see me through most eventualities.’
It’s an amazing garment, heavy and rough like old tweed, but run through with gold thread and a hand-stitched leaf-motif.
‘What about the rest of me?’ she says, standing up with the zimmer again. ‘Do I pass muster? Or should I put on some pyjamas?’
‘I think you’re fine like that, Cynthia. You’ll only have to change into a hospital gown when you get there, so I wouldn’t worry too much.’
‘But I’ve hardly got anything on under this dressing gown. Look!’
She’s been unbuttoning the thing as she talks, and before I can stop her, she pulls the dressing gown aside with a little flourish to reveal a black bra and knickers combination that wouldn’t look out of place in a burlesque cabaret.
‘But if you’re sure...’ she says, and does it up again.
We help her into the carry chair.
‘I suppose so,’ she says. ‘Although of course I’ve only got one  thing to say about this whole sorry affair.’
‘What’s that?’
‘I shall spell it for you. F-U-C-K.’
I could swear the cat has its paws over its eyes as we reverse out.

Monday, September 23, 2013

tea & toast

Arnold felt strange as soon as he woke up this morning.
‘I thought that was it,’ he says. ‘I thought that was my lot – waaalll, you do when you’re ninety-four. You can pop orf any minute.’
But it turns out it wasn’t so much his time as his low blood sugar. So now he’s propped up in bed steadily working his way through a plate of toast and a mug of sweetened tea whilst we chat about this and that and fill out our paperwork.
‘We’ll do your blood sugar again in a minute. Keep going with the toast.’
‘Righto s’ah.’
Arnold’s military moustache is still neatly clipped, perched on his upper lip like a band of silver thread. Around the walls of the bedroom are dozens of family photos, army memorabilia, faded clippings about Burma, a small glass cabinet of three medals, a selection of drawings and watercolours of foreign scenes, some by Arnold, some by his friends.
‘That’s my wife there,’ he says, pointing at the largest of the photographs with the crust of his toast. It’s a charming, black and white portrait of a laughing young mother, kneeling on the carpet with her arms round two small children. ‘She went first, nine years ago. Funny - I didn’t think it’d be that way round. Still. You do what you can. They say you get over it but you never do. You just – find a routine to get you through the days.’

We ask him about any health visits.

‘Oh – I had a funny one the other day from the heart failure nurse. She said would I mind having an ECG? I said what’s that? So she said it was a tracing they make of your heart. So I said be my guest, if you can find a heart. So she said would I take my top off. It’s been a long time since a pretty young thing asked me to take my top off, so ‘course I said yes. Well there I was with all these wires stuck here, there and everywhere, and these gorgeous nurses fussing over me, when suddenly Alf from next door shouts up the stairs was it all right for him to come up? And I shouts down ye-es, mate. So he comes up. And when he puts his head round the door he says Cor blimey it’s like one of them porn films.

He takes a sip of tea, then cradles the mug in his lap.

‘Mind you, if it was a porn film I wouldn’t be able to do much. There’s sod all going on down below these days. Do you know, the last time I had sex was ten years ago? I still get a little thrill from seeing a nice tight bum or a well-filled sweater going past in the street, but there’s nothing to back it up, if you know what I mean? I can appreciate it, but that’s about all.’

We tell him that the tea and toast seem to have done the trick, and would he mind having his blood taken again?
‘Fire away, mate,’ he says, smacking his hands clean.
I ask him about his medication.
‘Have a shufty through that Tupperware,. It’s all in there, mate. All except the Viagra.’
He gives me a stage wink.

‘I keep that under me pillow.’

Sunday, September 22, 2013

scooter man / crisp man

Jeremy has run out of juice. It’s difficult to understand the story exactly, but it seems he left his home on his mobility scooter yesterday, travelled the thirty miles or so along the coast into town, eventually running aground on this traffic island sometime in the early hours. And here he’s sat, slumped on his seat, waiting for what, it’s hard to say – a lightning bolt from heaven to reenergise his vehicle, because any other offer of help he’s refused. Not politely, either.
‘You’re only a police woman because you’re fat and ugly,’ he says. ‘You can hardly fit into your uniform.’
‘How nice!’ says the police woman. ‘Well I think you’re extremely rude and unpleasant.’
Jeremy doesn’t react. He soaks it up along with everything else.
An elderly man in a drab grey overcoat and dirt-shiny trousers, he looks and talks like Droopy. So this is what happens to old cartoon characters. They drift around town in the early hours on mobility scooters, insulting people.
‘And you’re a lesbian,’ he says, moving his head just sufficiently to cast his sad eyes up to Rae. ‘No make-up and a man’s haircut.’
‘Jeremy? Stop being vile and listen. You can’t stay here in the middle of the road. We want to take you to hospital to get you warmed up, something to eat and a check-up.’
‘I’d really rather not, thank you.’
‘We’ve got the trolley here. We’ve put all your things in a bag. All you’ve got to do is pivot your seat round, and we’ll help you transfer over.
‘No, thank you.’
It’s gone on like this for half an hour.
‘I must insist.’
‘If you touch me I’ll sue you for assault.’
‘By all means. But we don’t think you have capacity, Jeremy, so we’ve got to act in your best interest. That means one way or another you have to come with us to hospital. Don’t worry about your scooter. We’ll make sure it’s safe.’
‘I’m not going to hospital.’
‘Why not?’
‘I can understand your worries about MRSA, Jeremy. It has been a problem in the past. But over the last few years they’ve made enormous strides with infection control. What else is bothering you?’
‘I’d rather not go, thank you.’
‘Come on, Jeremy. We’ll help you.’
He’s actually pretty easy to put on the trolley, soaking up the move with the same lumpish inertia.
‘There we go. That’s better.’
‘I shall be contacting my lawyers.’
‘Please do.’
The police wheel the scooter to the side of the road; we load Jeremy onto the ambulance.

* * *

There’s a small crowd outside the supermarket.
Bob is lying on the pavement at the centre of it, a woman crouched down and holding his head.
‘He fell over when he came through the doors,’ she says. ‘He’s been going in and out of consciousness.’
A rough-faced figure of about sixty, Bob’s coat seems strangely full, bulging at the pockets with bags of crisps.
‘I’m all right. I’m okay,’ he says, trying to get up.
And on first glance he does seem to be. He’s fairly drunk, though, so we help him onto the ambulance to check him over and decide what to do.
‘Let’s have this coat off,’ I say to him. ‘We need to get to your arms to do your blood pressure.’
‘I’m all right,’ he says.
‘Come on, Bob.’
Rae frowns when she tries to free his arm.
‘What’ve you got down here, Bob?’
‘What? Where?’
She pulls out a bottle of wine.
‘How did that get there?’
He shrugs, and then pulls out a bag of crisps and makes as if to open them.
‘Don’t start in on your crisps yet, Bob. We’ve got to check you over first.’
He drops the bag on the floor, and closes his eyes again.
At least that’s what I think he says. Because of his accent, and because he’s had so much to drink, it’s almost impossible to make anything out.
‘What’s your last name, Bob?’
‘Nub? Bob Nub?’
‘North? Is that right? North?’
‘Spell it for us...’
And so on, through everything else.

All his obs check out, but he does have a small cut on the back of his head. He’s too unsteady to let out again, so we have to run him down the hospital to be monitored.
I hand the bottle to someone from the supermarket when I step back out to drive.
‘He didn’t pay for this,’ I tell her. I don’t mention the crisps.


When I open the doors at the hospital and look inside, Rae is sitting on the trolley shaking her head, and Bob is sitting eating crisps on his chair, fragments sticking to his beard and his jumper, the rest scattered around him on the floor.
‘Prawn cocktail, before you ask,’ she says.

Thursday, September 19, 2013

a second opinion

1.      Michael is lying on his side on the floor of the hostel room, a fifty-year old bog man, mummified in soiled denim, his legs crooked up, enfeebled, fucked. Shit stains on his bed, discarded bottles and cigarette butts across the floor, a scattering of DVD cases, everything tacky with slopped cider.
Two support workers stand over him, radios on their belts crackling like vital connections to a world of competence and health.
‘You’ve got to go in Michael.’
I’m not going in.
‘You’ve got to. You can’t stay here.’
I’m not going in.
We join in, trying to persuade him to sit up and talk to us.
‘Come on Michael. You can’t very well stay here like this. You’re not well.’
 I’m not going in.
‘You can’t lie here all day.’
Why not? I just want to die.
‘Come on, Michael. Why don’t you sit up and talk to us?’
He opens an eye and squints at me.
Now that’s a good-looking man.

2.      Bert is lying strapped-up, furious but utterly immobile in a cervical collar and vacuum mattress.
I free his right arm and wrap a blood pressure cuff around it.
‘Any medical problems, Bert?’
‘Do you take any medication for anything at all?’
‘Is there anything you’re allergic to?
Yes. As it happens, there is.
‘What’s that, then?’
Your beard.

Wednesday, September 18, 2013

roofer wool martian dropped

George is happy lying on the trolley. He has his ancient, liver-spotted hands neatly resting in his lap, his slippers just poking out of the blanket the other end. His glasses catch the light as he looks this way and that.

‘Bessie downed it,’ he says.

George’s false teeth don’t fit. The top plate is completely adrift, so whenever he talks, it drops and rocks from side to side, following the movement of his lower jaw. He also has to make urgent little gabbling motions with his lips from time to time, to stop it shooting out. It’s disconcerting to watch, like seeing two mouths working where there should only be one. And the upshot is, George’s words get completely mangled. We’ve tried to persuade him to take the plate out, but he won’t have it.
‘A cargo rout in Aberdeen,’ he says.
‘Sorry, George? A what?’

The only way you can understand him is to loosen your mind to the same extent as the plate. It’s like reading bad handwriting. If you don’t panic and simply let go, the sense will come. Hopefully.

‘Howling at the zoo was under the influence?’ he says.
‘How long have I worked on the ambulance?’
He nods.
‘Seven years.’
He reaches out and touches my arm.
‘I used a stork under brushes’
‘Did you?’
He nods.
‘On the buses?’
He nods.
‘Acorn chucked her.’
‘A conductor?’
He nods.
Another trolley comes through the doors and we all shuffle down a touch.
‘Move right down inside the car, please,’ I say.
He laughs, shakes his head, leans up and touches me on the arm.

‘Roofer wool martian dropped.’

Monday, September 16, 2013


It’s only after we’ve started chest compressions on the naked man, got the defib pads on, shocked once, PEA, carried on, passing smoothly on into the more advanced reaches of our resus protocol, that we notice just exactly what sort of room this is.
The bed frame has several metal loops bolted along the side with lengths of chain threaded through; there are handcuffs attached to the metal rods of the headboard; something leaning up against one wall like a medieval ironing-board with spikes and shackles; a wardrobe hung with capes and straps and one-piece zippy leather things, and a treasure chest spilling with toys, including a mini-cricket bat with a dildo for a handle.
Kenneth, the friend who called us, peeks round the door.
‘Is he okay?’ he says.
‘I’m afraid Steven’s heart’s not working at the moment but we’re doing our best. Can you tell us what happened again?’
‘Steven said he wasn’t feeling all that well and he needed to take some medication. I went downstairs to .. erm ... go to the toilet and freshen up, you know. When he didn’t come down after about twenty minutes I went back up to check and found him unconscious on the bed. The lady on the phone said to put him on the floor. Is he going to be all right, do you think?’
‘Like I say, we’re doing our best. Kenneth, could you do us a favour? There’s another crew on their way. Could you keep an eye out for them and show them straight up?’
‘Will do. Can I get you a cup of tea or anything?’
‘That’s very kind but we’re fine for the moment. When the other crew get here I’ll need to get some details from you, his date of birth, address, that kind of thing.’
‘Well I don’t know much. But I’ll do my best.’
‘Thanks, Kenneth.’
He snatches a brief, appalled look at his friend, then goes back downstairs.

* * *

The supporting crew have a senior paramedic on board who takes over the resus. They fit a Lucas to Steven – a machine that delivers chest compressions automatically. It’s a brutally efficient thing, a big rubber plunger on a piston, pumping up and down at exactly the right speed and depth. A curved board goes underneath Steven’s chest, fixed right and left into the gantry of the mechanism. A harness passes over his shoulders and behind his neck to stop the machine slipping down, and his hands are strapped up either side of the machine, too. With the chest compressions taken care of, it frees me up to go downstairs and get some details from Kenneth.
His next door neighbour, Janet is sitting with him. She saw the ambulances outside and came round to give him support. A sturdy woman in a white towelling robe, she clatters around in the little galley kitchen making tea.

After ten minutes or so I go back upstairs to find that Steven now has an output. I relay what information I’ve gleaned from Kenneth, then go out to the prep the vehicle and bring a chair back in, roughly clearing what I can from the hallway and the stairs as I go.
It’s an awkward space. But between the four of us we manage to manoeuvre him out of the room, round the corner and down the stairs. I’m aware of how strange it must be to see Steven in our chair with what looks like a bright plastic printing press strapped to his chest, but the effort of negotiating the steep stairs takes my mind off it somewhat.
Kenneth and Janet watch from the sitting room as we pass. Kenneth puts a hand out briefly to touch Steven on the arm. ‘I’ll come up and see you later,’ he says, then pulls his hand back and rests it on his own chest.

‘Oh, Kenneth,’ says Janet, and takes a sip of tea.

Saturday, September 14, 2013

pest control

We finally spot them, a group of four, over on the cycle path that circuits the park. A man is lying on the ground, a girl kneeling beside him, two other men standing around.
Rae drives the ambulance through an access point onto the path and pulls up.
I take out my pocket torch as I walk over.
‘Hello!’ I say, affecting a breezy tone. ‘What’s happened?’
I play the beam of my torch over the figure on the ground, then squat down to take a closer look (breathing, conscious, easily roused with a gentle poke behind the ear).
‘Don’t do that,’ he says.
I look up at his friends.
- We’ve all had a bit to drink.
- None of the taxis would take us.
- Funnily enough.
- We were walking back home when Aaron started being sick and just lay down on the ground.

I turn my attention back to Aaron and ask him some questions, but he keeps his eyes shut and doesn’t respond. When I dig him behind the ear again, he opens his eyes wide, grabs my hand without hesitation: I told you not to do that.
‘Well then sit up and talk to us, Aaron. What’s wrong? You can’t very well lie here on the path all night. It’s going to start raining in a minute.’
He rolls away from me, moving his hands like he wants to pull the tarmac over him like a quilt.
I stand up, careful to avoid the puddle of vomit.
‘Are you all with Aaron?’ I ask them.
- I’m his brother.
- I work with him. We’ve got a six o’clock start tomorrow. Cheers, mate.
- I don’t know him that well.
‘Does Aaron have any medical problems? Is he diabetic?’
- No. He’s good as gold.
- Just can’t hold his drink. Can you, mate?
Aaron’s brother takes a step closer.
‘We only live a mile that way. Can’t you just give us a lift home?’
‘No, I’m afraid we can’t. We’re not a taxi. We’re an emergency ambulance.’
‘This is an emergency.’
‘No it’s not. He’s just had a bit too much to drink.’
‘What do you suggest we do then?’
‘What were your plans when you came out on the lash tonight? How did you think you were going to get home?’
‘It’s not my fault he had too much to drink.’
‘Why don’t you try getting him on his feet again and seeing if he can walk? Because if he can’t, the only thing we can offer is the hospital. Hours on a trolley, sobering up.’
They haul him upright, but he doesn’t make much of an effort to take his weight. They put him down again.
I turn to Rae.
‘Shall we have the trolley out, then?’
She starts putting the tail-lift down.
‘You shouldn’t go to hospital just because you’ve had a little bit too much to drink, but what can I say? He’ll need one of you to go with him, please.’
They start to argue amongst themselves. The brother says he’s got work in the morning. The girl says she has, too. The other guy hangs back.
‘I’ll go with him,’ says the girl, eventually.
The other two drag Aaron to his feet by the belt of his jeans and dump him on the trolley. He starts hawking and spitting indiscriminately.
‘Hey! No spitting.’ I say. ‘Do not spit on the ambulance.’
‘Don’t speak to him like that,’ says Aaron’s brother. ‘You must’ve been drunk before.’
‘I’ve been drunk, yes. But I haven’t ended up spitting everywhere.’
‘Yes you have.’
‘No. I haven’t.’
‘You should learn to speak more politely to your customers.’

I feel a sudden and overwhelming spike of temper. I turn and go over to Rae, ostensibly to help with the trolley, but really just to buy some distance.
The brother says something else. I cut him off.
‘I’m - just - not prepared to discuss this with you anymore,’ I say, choking a little on the words.
The Hulk, splitting his shirt, bunching his fists, turning to face the tanks and then coming out with some lame quote from a self-help book.

Rae gives me a worried look as I operate the tail lift; we load Aaron into the back.

‘Make sure you keep an eye on this one,’ the guy says, as the girl follows me up the ambulance steps. ‘I don’t want him mistreating my brother.’
I slam the door.
We set off.

* * *

‘Half-brother,’ she says.
‘He’s Aaron’s half-brother.’

We rattle on in silence for a bit.

‘I’m a trainee nurse,’ she says, sighing.
‘That’s good. How’s it all going?’
‘Fine. Well. You know.’
She flicks the hair out of her eyes, then leans forward to put one hand on Aaron’s shoulder.
‘I just took this other job to make ends meet.’
‘That must be tough.’
Aaron hawks and spits again. I ask him not to, but he ignores me. At least it’s mostly landed on him. I wipe his mouth with a tissue, not because I want to, but because I don’t want the girl to worry.
‘Sorry,’ she says.
‘It’s not your fault.’
Suddenly I notice a wasp crawling on the shelf beside the trolley. It must have flown in from the park whilst the doors were open.
‘Mind out. There’s a wasp,’ I tell her.
She immediately throws herself back in the seat and tucks her legs up.
‘A wasp? Where?’ and then: ‘Are you sure it isn’t a hover fly?’
‘No. That’s definitely a wasp. Why? Are you allergic? Don’t worry, though. It’s quite drowsy.’
Aaron opens his eyes and raises his head.
‘What wasp? Where?’
He flicks the back of his hand in the air, then closes his eyes again.
The wasp lurches up. The girl screams. I follow it round with my board, ready to swat. At one point it lands on Aaron’s head and I draw back the board as if to hit it. ‘Only kidding,’ I say to her, and she smiles. Eventually the wasp settles back on the side, and I smash it.
‘Sorry, wasp,’ I say. I use Aaron’s tissue to collect up the wasp pulp and drop it in the bin.
The girl relaxes in the chair again, then puts her hand back on Aaron’s shoulder.
After a while he makes to spit again.
‘Shouldn’t we...?’ she says – and I guess she wants me to put him on his side.
‘He’s not unconscious,’ I say. ‘As you can tell by his wasp reaction. I’m not worried about him aspirating.’
‘Sorry about all this,’ she says. ‘I know it’s wasting your time.’
‘You’re very good to come with him. His brother should be the one sitting there, not you. Still, at least the hospital’s only round the corner.’
We turn onto the ramp.
‘In fact – here we are.’

When Rae opens the back door I tell her I’m going to get Aaron to lie on his side. Even though he’s fully conscious it wouldn’t look good rolling into the department with a drunk lying on his back. She opens the door to show the girl out. I lean over Aaron.
‘Aaron? We’re at the hospital now. Can you just roll onto your side, please?’
He ignores me.
I dig him behind the ear to get him to respond. As soon as I do he raises up to look at me.
‘I told you not to do that,’ he says, and draws back his fist to punch me.
I grab the sleeve of his jacket and manage to guide his arm across his face. I say something like: What the fuck is wrong with you?
He stares at me, then feigns unconsciousness again.
I’m a little rough when I release the trolley, not caring how it bumps against the back-stop so the whole thing crashes and judders. Rae takes a step back. I feel weak with the injustice and stupidity of the whole thing. There’s a hot feeling in my chest like one of those glo-sticks you snap and turn red. I’d be happier if we were pitching him out into a skip, but instead we lower him gently on the tail lift and wheel him through the A&E doors.
* * *

The receiving nurse listens to the whole story, then stands over Aaron.
‘Why are you here?’ she says, turning red in the face. ‘Why have you come to my department, drunk like this? Do you know how busy we are? This is a hospital. For sick people. Not for stupid drunks. Open your eyes. Talk to me, Aaron. Aaron?
She pinches his shoulder.
He immediately sits up and bats her arm away.
‘Will you just fuck off,’ he says, lurching to his feet.
‘Aaron! Don’t!’ says the girl.
He staggers out of the doors into the car park.
‘Sorry,’ she says over her shoulder. Then follows him.
The nurse sighs, then signs my paperwork.
‘Book him in anyway,’ she says.
Rae strokes my shoulder.
‘Oh dear!’ she says. ‘I think someone needs a hug and a cup of tea.’

‘Yeah,’ I say, rubbing my face. ‘And some careers advice.’

Friday, September 13, 2013


The flat is part of a single-storey, Georgian building, probably once quarters for the servants of some long demolished house. When it was built, that elegant chimney stack would have been the highest point in the street, but since the sixties a series of developments have grown up around it – hotels, housing blocks, multi-storey car-parks and city centre offices – until now it looks like a toy house, utterly dwarfed and out of place, lost at the bottom of a canyon of concrete and glass.

The front door is open, so I knock and look inside.

Hello? Ambulance.

The flat is in chaos. Every cupboard is open and spilling, the contents of every drawer dragged free and strewn about the place, up-ended suitcases, a put-you-up piled high with stuff, everything thrown about, dumped in odd places. A poltergeist would take more care.

Suzanne is on two phones at once. The landline, I would guess, is ambulance control. I can vaguely hear them saying hello? hello? But Suzanne is talking into the mobile phone instead, a tumble of emphatic and despairing words, something about a hundred pounds and a train to London.

‘Hello? Hi? Ambulance?’ I say, leaning forward and giving a little introductory wave. But Suzanne is too engrossed in her phone call and doesn’t acknowledge me.
‘Let me explain this to you once again,’ she says, gripping the mobile, and putting the landline back in its holder without even looking at it. ‘All I want is one hundred pounds. One hundred pounds that belongs to me. One hundred pounds that’s rightfully mine, that I can buy a ticket with, that I can get on a train with, and go to London, back to my home, so I can sleep in safety and not die – yes? Do you understand? Do you understand what I’m saying to you? I’m a sick woman and I simply want to be reassured that I will not die when I close my eyes to go to sleep tonight. Is that too much to ask? Because if it is too much to ask then I’d like you to put me through to someone who will not find it such a ridiculous proposition. Do you understand me? Do you?

I lean even further forwards and wave again.
‘Hello? Ambulance? Are you the patient?’

Suzanne shoots me a glance, then holds out a finger for me to wait.
I put my bag down.
She turns slightly and carries on her conversation – although from this end it sounds more like an emotional discharge down the line to a call centre operative who has either already hung up or should have, a long time ago.

After a few minutes I decide I’ve waited long enough.

I move forwards and gently touch her on the arm.
‘Suzanne? It’s the ambulance. I really must insist that you finish your call now and talk to me.’
She lowers the mobile a little, frowns, then throws it down amongst the mess on the table.
‘So there. Now we have it. Here I am on the verge of getting the money I need to get back home and you cut me off. How is that supposed to help? What do I do now? Are you going to give it to me?’
‘Suzanne? Let’s start from the beginning. My name’s Spence, I work for the ambulance service. We had a call to this address to someone who was fitting. Is that you?’
‘I suffer with blisters of water on the spine. Read my notes. It’s all there. Speak to my GP. I shouldn’t have to tell you this. Blisters – of water – and yes, I have fits. I’m incontinent – you can look at my pads in the bathroom if you don’t believe me...’
‘Suzanne? First things first. Has anything happened this afternoon that led you to call the ambulance?’
‘Look around you. What do you think? I have a boyfriend coming home who knows when, if ever, and when he does I don’t know whether to let him in. Because he won’t let me sleep, and anyway, what does he know? What can he do? I just need a hundred pounds to get back to my specialists. I have a team of them. Neurologists. Professors. Not ordinary people, like you. Scientists. They know what’s going on. They know what I have to endure...’

Suzanne is the personification of the flat. It’s exhausting, simply breathing the same air.

‘Do you mind if I have a seat?’ I say to her, trying to act the part of the unflappable medic even if I don’t feel it. I reach down and open my bag. ‘Would you mind if I gave you a quick health check? Apart from your spinal problems, do you have any other conditions? Are you diabetic, for example?’
‘No. I’ve told you. I suffer with epileptic fits. I am incontinent. I have a mountain of pads in the bathroom if you’d care to look.’
‘No. That’s fine. Let me just run through the basic checks and make sure everything’s okay.’
She takes a seat facing me and holds out her arm.
It’s quiet in the room for the first time. Pulses of traffic noise from outside, stirring through the net curtains in the warm afternoon sunshine. In the middle of the window ledge, a strange new-age sculpture, something like a pyramid, but made of glass and a conglomeration of coloured crystals, surmounted at the top by a glass sphere. The light from outside hangs and bends in the sphere, blues and whites and greens.

 The mobile phone starts to ring.
‘Just let me just finish your blood pressure before you answer, please, Suzanne.’
She stares at me, but holds her arm still.
‘There! All good!’
I unwrap the cuff, but the phone stopped ringing before she had time to answer it.
‘Well thank you very much. No doubt that was the bank. Now I can’t get the money I need to go back to London.’
‘I’m sure that can be sorted out this afternoon, if that’s the only problem.’
‘So you’re going to sort it out are you? You’re going to give me a hundred pounds? Because if I don’t have the money I’ll have to go to hospital, even though they don’t know me there, even though they don’t know anything about my condition...’
‘Suzanne? Just – try to take a breath and be calm for a moment? Okay? I’m here to help.’
‘And forbidding me to answer my own phone so that I can get some money and get my life sorted is help is it?’
She changes tone, dropping a gear, to something darker. Even though it’s an unexpected turn, I don’t feel threatened. It’s like being growled at by a tabby.
So that’s your idea of helping, is it?’
I decide to take a different tack myself. I finish writing down her observations, rest the clipboard on my knees, then lean forwards on it like I’ve decided to come clean.
‘Suzanne? Can I ask you something?’
‘Do you suffer with any mental health problems?’
‘What do you mean, mental health problems?’
‘Well – and I’m being perfectly honest with you, Suzanne – you seem a little emotionally volatile this afternoon.’
‘Define what you mean by emotionally volatile?
‘Do you have a CPN, Suzanne?’
‘A what?
‘A CPN – a Community Psychiatric Nurse.’
She looks at me with the same refractive brilliance as the sculpture.
‘So let me see if I understand you. I want to use my own phone – to arrange for one hundred pounds – to get a train, to get back to London – to find the space to go to sleep without fear of dying. Just because I want some help with unbearable pain, pain that the experts – professors of neurology – have all agreed is serious and irretrievable – blisters of water in my spine and you accuse me of being mentally ill...?’

I finish writing the report form whilst she talks. It’s not so bad actually, sitting here in this great, tumbling nest of a flat, with the afternoon leaning in through the window, the patterns of coloured light thrown out by the crystal sculpture animated by the curtains. After a while I realise that Suzanne is slowing down; when she pauses sufficiently for me to say something, I mention a referral I can make if she’d like. She says she would like – and she also says she fully intends to put in a complaint about me. I tell her I think she should, and she can use the report form I’ve written to do just that. She asks me to explain what I’ve written. I clear a space on the table and lay it flat. She reads what I’ve written so far. I apologise for some of the acronyms; we have a laugh about that.
‘Do you mind if I smoke?’ she says.
‘No, of course not. But why don’t we step outside? You can have your cigarette, I can finish off.’
We pick our way through the mess to the front door.

* * *

Five minutes later, Suzanne is standing in the doorway, her left arm folded across her belly, her right arm resting on it whilst she smokes. I am leaning against the old black iron railings at the front of the building, adding a couple more things to the paperwork I think might help.
An elderly man walks past.
‘Afternoon,’ he says pleasantly. ‘Another nice one.’
‘Isn’t it?’
He nods at Suzanne in the doorway, and carries on.
She smiles back, flicks her ash off to the side, then looks the other way along the street.
‘There!’ I say, tearing the sheets apart and handing Suzanne her copy.
‘Thank you,’ she says, then drops the fag butt to the flags and grinds it out with her foot. ‘Now. Can I go in and check my phone, do you think?’

Thursday, September 12, 2013

an adventure

The bus has its hazards on at the stop. No doubt a replacement is on its way, but for now the passengers have elected to stay where they are. Stepping on board is like walking into a modern version of the castle in Sleeping Beauty, every figure frozen in an attitude of despair. The only people who register our arrival are the driver – with his wild hair and enormous body looking like an ogre who took a regular job with the bus company – and our patient.
Geoffrey is immaculately dressed in a tweed three piece, starched collar and gold cufflinks, a carved horn-handle umbrella hooked over the seat in front of him. An ascetic looking man in his early sixties, he could be the executive director of some global corporation, or a retired art critic. The only jarring note is the mass of blood on the back of his head, and the spatterings over his shoulders. He’s wearing a hospital wrist-band, which confirms the notes we were given, that he self-discharged from hospital earlier in the evening.
The driver stands over Geoffrey, partially shielding him from the passengers (or the other way round), clicking off the mobile phone in his vast paw.
‘Over to you, guys,’ he rumbles.
‘Ah! And who do we have here? A brace of handsome young men in green!’
‘Hello Geoffrey. Nice to meet you. Now then – have you fallen over again, or is this the wound from earlier on this evening?’
Is this the wound from earlier on this... What on earth are you on about? My dear boy, what utter nonsense. Now look here. I’m a very wealthy man. I’ve had a pleasant lunch. I have enjoyed a bottle of fine Italian wine, as every Englishman should, per diem. Now what on earth is the problem with that?’
‘Nothing, Geoffrey. Except you fell over and cracked your head. How are you feeling? Do you have any neck pain?’
How am I feeling do I have any... Now look here – whatever your name is. What is your name?’
Geoffrey suddenly veers off into stage Cockney.
‘Pound shilling an’ Spence! Ere mate. Cor’ blimey. Strike a light.’
‘Let’s help you off the bus so these people can get on, shall we, Geoffrey?’
‘What a capital idea!’ he says, suddenly standing up and grabbing his umbrella off the seat. He turns and throws his arms wide to address the back of the bus.
‘Dear people!’ he proclaims. ‘I am so terribly sorry for delaying your journey in such an undignified way. I thank you all for your patience, and your kindness, and with my most humble apologies, I bid you all adieu.’
He turns and taps me on the shoulder with the umbrella.
‘Lead on.’

* * *

On the ambulance the story gradually becomes clear. Geoffrey came into town to have lunch with a friend, a long and boozy event that lurched on into supper, dinner and then a fall in the street.
‘Now kindly desist from your importunate questioning,’ he says. ‘An Englishman never tells. Now look – I am the last man in the world to have a mobile phone. Wretched things. Frightful things. But it leaves me at rather an inconvenience. I need to call Richard to let him know that I’m all right. I wonder if I might use your phone to do the business, gov’nor, as you would say. I’m frightfully wealthy and I can pay you handsomely for your trouble.’
‘That’s kind of you, Geoffrey, but I think what we need to do is get you back to the hospital, check you in so you can have your head examined...’
‘My head examined? What on earth can you mean? What rubbish. I’ve never heard such nonsense. My head examined? What do you think is wrong with my head? An Englishman may have many things examined in his time, sir, but I can assure you, his head will not be one of them.’
‘You’ve fallen over and bashed your head, Geoffrey. It’s bleeding and it needs stitches. Also, you need someone to keep an eye on you for a while, because of the alcohol.’
Someone to keep an eye on me? Now be quiet for a minute and look here. I need to call Richard to let him know what’s been going on, and after that we’ll see. You’re most terribly kind, both of you, and I do appreciate everything you’ve done for me. This is my first – no, second time in an ambulance, and I must say I’m most frightfully impressed. Yes. The system works exceptionally well. I admire your dedication to duty, even if you speak the most unutterable nonsense at times.’
‘Shall we go to hospital, Geoffrey?’
‘Yes. Carry on, squire! ‘Ere, strike a loit.
He tries to put his spectacles on but struggles because they’ve been bent out of shape in the fall, and because the bandage I’ve put round his head has covered up the tops of his ears. After a moment he lets the glasses drop back down on their silver chain and he rests his umbrella across his knees instead.
‘Who’d have thought tonight would have been such an adventure?’ he says. ‘Home James! And don’t spare the horses!’

Monday, September 09, 2013

the importance of paperwork

There are two police cars outside the house. As we head in with our bags, we pass an officer talking to a man sitting on a wall. He has an ID card on a lanyard, and I recognise him as one of the CPNs based at the hospital, but he doesn’t notice me.
Inside the house, the only light is from the open front door, and from a couple of flashlights in the hands of two officers on the stairs. One of them comes back down to give us room to go up.
It gets darker as we climb, our own torches illuminating snatches of detail – the floral wallpaper, the family photos, one of them knocked on a slant. The other police officer stands at the top of the stairs on the landing like a grim usher at the cinema; he points left with his torch.
The patient has hanged himself from a beam in the attic. A coarse, thick rope leads straight down to his neck, supporting him now in a strange kind of seated position, both heels resting forward on the carpet, arms straight down by his sides. Even though I would guess that when he kicked the chair away he was clear of the ground, gravity and decomposition have changed the relative positions of everything.
I breathe shallowly through my mouth, but there’s really no need to spend longer than a few seconds. The patient is obviously dead. Our presence is a formality.
We turn and head back down.
Outside, everything is overwhelmingly fresh and bright. We stow our bags. Rae gets the paperwork started.
‘My brother used to live round here,’ she says, writing out the incident number. ‘Years ago. When he moved in with Gianara or Gianina or whatever. She was a handful. We thought she was probably undiagnosed ... erm ...’
‘Bi-polar. She’d be an angel one minute, throwing plates the next. I’m amazed he stuck it as long as he did. It’s funny how these things work out. What’s the date today?’
She starts ticking boxes.
‘I wonder why all the lights were out’
‘Maybe they cut him off. Maybe that was the last straw.’
‘Do they do that these days? Cut people off?’
I shrug.
Another police car pulls up and one of the officers strolls out of the house to meet it.
‘Do you think we’ll get our break now?’
Just as I say that, we hear an all-call on the radio for two outstanding emergency calls.
Rae sighs, and smoothes the ROLE form flat on her board.
‘You can’t rush the paperwork, can you?’

‘No,’ I say, leaning back against the truck, taking a deep breath, resting my eyes on the brilliantly coloured flowers in the opposite garden, the hydrangeas and geranium, roses and lavender. ‘No. You certainly can’t.’

Sunday, September 08, 2013

the old lady, the baggie & the bird

The house is so crapped up it would take a team of grim, boiler-suited operatives a month to clean it, blasting their way down through the layers of plastic bottles, beer cans, fast food cartons, freebie newspapers, court injunctions, needles and crack pipes, all compressed in datable strata if they had the time or the inclination to look. The safest and quickest option, though, would be to nuke the plot from outer space, but our mission this morning is simpler: we have to find a path through to the lounge, to Gail, a young woman of twenty-five who called to say she can’t breathe.

Gail has the long, straggly hair and abstracted look of Venus in that painting by Botticelli – except instead of pearlescent skin she has the scabbed and blotchy face of a crack addict; instead of the voluptuous bodies of attendant nymphs and winds she has a couple of addled friends blowing smoke, and she rises not from a giant sea shell but a shit-brown sofa.

‘I’ve had this bad tooth for a week,’ she says. ‘The dentist said I had to make an appointment for a root canal and he only gave me a temporary filling. That broke, so I took thirty ten milligram MST to help with the pain, and a few co-codamol and aspirin. Unfortunately I’ve got this sensitivity to opiates, yeah? And I’m lactose and wheat intolerant. So I took a load of anti-histamines and went to sleep, and then when I woke up this morning I couldn’t breathe. And even now I can hardly get my breath. I feel all weak and dizzy, and I’m covered in sweat.’
‘The good news is that you can talk in complete sentences…’
‘But I can’t get my breath, you know? And that’s pretty serious. Wouldn’t you say?’
‘Your SATS are perfect, Gail, so even if you think you can’t get your breath, there’s plenty going in. From here I can’t hear any kind of wheeze, so I’m not worried about that.’
‘You’re not worried I’m struggling to breathe?’
‘Like I say, your SATS are fine. What I am worried about is the thirty MST you took. That’s quite a big overdose, and that’s probably why your breathing went off earlier. Why did you take so many?’
‘I told you. I had toothache. And I feel really….’
Her head lolls forwards, then back up again.
‘What?’ she says.
‘Let’s go out to the ambulance and do all our checks there, Gail.’
‘My blood sugar’s low,’ she says, suddenly reaching a hand out to a plate of cold, plain pasta shapes splodged with tomato sauce. She fingers one free of the pile and pushes it into her mouth.
‘Are you diabetic?’ I ask.
‘No. But I suffer with low blood sugar sometimes.’
‘Well that’s something else we can check out on the truck. Come on. Get your stuff together. Keys, phone, money to get back.’
‘And I’m allergic to hospitals,’ she says. ‘Only kidding.’
‘Do you take any recreational drugs?’ asks Rae, glancing down at a crack pipe.
‘What do you mean? You think everyone’s a druggie just because they live different to you?’
‘We don’t care what you do or don’t take, Gail – we’re not the police. But we do need to know all the facts so we can treat you properly.’
Gail notices the crack pipe, too.
‘That’s not what you think it is,’ she says. ‘We had the plumber in and he left some gear lying about.’
‘Oh. OK. We’ll see you out in the ambulance then.’
‘Can I take my plate of pasta? I don’t want my blood sugar to crash.’
‘No. Leave it here. If your blood sugar’s low, we can deal with it some other way.’
Gail turns to one of her friends. ‘Stick some Pringles in a bag, can you?’
We pick our way back outside.

* * *

It’s a pleasure to stand out in the yard. Even though it’s as trashed as the house, at least we can look up at the sky. On the wild lawn an abandoned suitcase lies open, spilling more empty cans and bottles like seeds from a nightmarish fruit.

An old woman walks past the overgrown shrubs by the front gate, one arm out to the side, one arm pulled straight out in front by a bulldog that snuffles and sneezes as it goes. She manages to haul the dog back just long enough to nod down at something on the path.
‘Watch it. There’s a baggie there.’
‘A what?’
‘A baggie. And it looks like it’s got something in it. No doubt one of theirs,’ she says, grimly flicking a look at the house behind us. ‘You take care.’ And the dog drags her on.
‘What does she mean, baggie? Where?’
Rae bends down and picks up a small, Ziploc bag half filled with white powder. Strangely enough, the bag has a picture of a bulldog crudely stamped on the front. Rae drops it back on the path behind her, nearer the front door.
When Gail steps outside, she sees the bag, stops and looks round.
‘Oh. Look at this. How interesting.’ She bends down and picks the bag up. ‘The neighbours must’ve thrown it over the fence as a sick joke.’
She puts the bag in her pocket.

* * *

Later, after we’ve handed Gail over at the hospital and aired out the back, Rae peels off her blue gloves and tosses them in the bin.
‘Funny about that old lady and the baggie,’ she says.
‘Yeah. No wonder she goes around with a big dog.’
‘And a hawk.’
‘What d’you mean, a hawk?’
‘You must’ve seen it.’
‘What – a hawk?’
‘She had a big bird of prey perched on her other arm, like a kestrel.’