Monday, October 13, 2014

gift ideas

In the normal run of things you only become aware of frequent fliers over time. They gather momentum slowly, until they’ve acquired enough critical mass for everyone to know the address, the details, every last thing about them.
Yvonne is different. She’s emerged fully formed, Godzilla rising up from the sea. Whatever it took to make her, the nuclear waste and the earthquakes, happened somewhere else, far away. And now suddenly here she is, reeeeooooarrrrghing in the harbour, an ambulance in her claws, shaking the paramedics out.
You can tell I’m tired.
Frequent fliers know when you’re most stretched, least able to cope. They feel it, in supernatural ways.
Yvonne has had an ambulance eight times in the ten days she’s been at the drink & drug dependency hostel. Her MO is always the same: drinks and smokes all day, wakes up in the early hours feeling tight in the chest, rings 999 saying she can’t breathe. The duty manager is never aware the call has been made. She will be sitting on her bed in the smoke-filled room, talking fluently without any wheeze or effort, complaining that she’s unable to breathe and needs a nebuliser.
The first time I went to her I was at the beginning of my run of nights. I gave her a full examination, (blasted in the ears when she carried on talking when my steth was on her chest); found nothing particular, tried hard to understand just why it is she won’t go to see her GP, won’t go to hospital, won’t follow direction about any medication that might have miraculously landed in her hands from somewhere, or any lifestyle change that might improve her situation. For every suggestion a reaction: she can’t get to the GP because her legs don’t work properly, she’s agoraphobic, the doctor isn’t any good anyway; she can’t go to the hospital because she doesn’t want to wait around with all those people, and can’t get back from the hospital because she had no money for a taxi and she had a bad experience on a bus; she has to smoke because she’s living in a hostel full of junkies and how would I feel?; she has sleep apnoea; she has panic attacks; she only wants a nebuliser. Where can she get one for herself?
And like many of the crews who’ve been out to her, I gave her a neb, to shut her up as much as anything else. But then taking it off her was a problem – ‘I want the whole bottle’ she said. I turned it off, unplugged her, to huge protest. We didn’t leave so much as retreat, bullets ricocheting off her hide.
Tonight, again, Yvonne.
Prepared this time.
No, we won’t give her a neb.
She needs to see her GP.
She can’t go on calling an ambulance like this.
We have Rick, the duty manager just outside the door; we call him in to review the situation and to witness the abuse.
‘I’m going to die and it’ll be your fault’ she says.
‘Yvonne, that’s enough’ says Rick. ‘They’ve come to help you. Listen to their advice.’
‘They just tell me what to do. They don’t want to help. Fuck off and leave me alone.’
‘We’ll be talking about this in the morning, Yvonne. We can’t go on like this.’
 ‘You’re not doing your job. I’m going to report you.’
‘These kind people have come to help and you’re refusing to take  their advice.’
‘They’re not nice. They’re wankers. Especially him.’
‘This is going in your file, Yvonne. We’ll talk later.’
‘Why won’t anyone help me? I can’t breathe.’
We retreat to the office.


The rain is really coming down now. The thick, dark leaves of the rhododendron outside the office window rattle and shatter beneath the force of it all. Rick, the duty manager takes his office chair and swings gently from side to side, looking out the window. He doesn’t have an office light on; there’s plenty of illumination from the security light outside, and the effect as it shines through the torrent of water is of the whole building melting and sinking into the ground.
The office couldn’t feel emptier, even though it’s muddled-up with administrative clutter, the trays of files and piles of correspondence, unwashed coffee cups, yesterday’s paper, over-pinned notice boards, dry-wipe boards of essential numbers. Only one computer on, a screen saver image skating round a blank screen.
I’m finishing off the paperwork. A couple of times Yvonne comes to the office counter, planting her arms wide left and right on the counter and fixing us with a stare.
‘I want a neb’
‘I’m not giving you a neb, Yvonne. You know what I think. You should come with us to the hospital or speak to your GP in the morning.’
‘I can’t. I’ve told you. I can’t use my legs.’
‘How did you get to the counter, then?’
She pushes herself back, says she’s going to kill herself, thumps off back down the corridor.
‘Are you going to check on her?’ I ask Rick.
‘Nah,’ he says. ‘She’s been threatening to kill herself the whole time. We’ll have a meeting about it tomorrow. We’re keeping a record in the log.’
I go back to my form.
Yvonne appears one last time. We have the same conversation. She makes the same threat, makes the same stomping noises retreating back to her room.
Rick shakes his head.
‘This can’t go on’ he says.
We talk about the whole 999 thing, how the policy is for an ambulance to be sent regardless of the pattern.
I tell him I’m surprised that Yvonne has surfaced like this here; we normally only associate the hostel with overdoses, respiratory arrests, serious jobs.
He laughs.
‘I know. We’re normally much better value.’
After a minute when we’re all quiet and the sound of the rain is filling the place, Rick shifts heavily in the chair and says: ‘I’ve taken loads of different drugs, you know, but I’ve always shied clear of heroin. I suppose because it’s always seemed such a one way street. But it does have plenty going for it.’
‘I know what you mean. Life’s difficult. It’d be great to take a little something to make it all better. Who wouldn’t want that?’
‘It’s just getting the quantities right.’
‘And not knowing what it’s cut with. I went to a user the other day who freaked when he had a reaction to his hit. He went all flushed and itchy and felt he was going to explode. And that was from his regular dealer.’
I make a few idle strokes on the patient record with my pen.
‘I mean, this was a nice, hard-working guy. He had three jobs, for god’s sake. He had a Burberry cap.’
‘No wonder he took heroin.’
‘He had to pay for it somehow.’
There’s the sound of a door slamming somewhere deep in the hostel, maybe Yvonne, looking to see if we’re coming down the corridor.
‘Yeah. Just enough to smooth things out. So long as you don’t get hooked,’ says Rick.
‘Or infected. I’ve seen some pretty horrendous needle sites. You run out of veins and start shooting up in your groin. Or your feet.’
‘Still. Just a little now and again.’
‘Yeah. It’d be great.’
I put the finishing sentence on the form, sign and date, hand him a copy.
‘Anyway, Rick. At least now I know what to get you for Christmas.’


tpals said...

What's in the nebulizer that she wants so badly?

Spence Kennedy said...

You give salbutamol in a neb to help open up the airway and ease someone's breathing. For Yvonne I don't think it was that she wanted so much as the fuss & attention, maybe the power to have someone turn up whenever she called, esp. when that power seems lacking elsewhere in her life. Who knows? :/

jacksofbuxton said...

How about giving her nitrous oxide instead Spence?

Spence Kennedy said...

I think the strongest thing she should have is a cup of tea - and a stern talking to... :/