The flat draws out ahead of us in a thin and low-lit vista of neglect. Time moved on years ago, leaving Richard to his fate, stuck as surely as a holed boat in the mud of a silted tributary. We find him waiting for us on the sofa, bare-chested, his left arm cradled in his right. A tall, heavily-built man in his forties, he looks so grey and unwell it makes his hair and beard look fake, somehow. He’s not quite with it, but the story seems to be that he collapsed some hours ago in another room, broke his arm, and took this long to get to the phone. It’s an obvious fracture. When he shifts in the chair, the mid-point of his upper arm sags, and he clamps his teeth together with the pain.
We fix him up as best we can, get him in the chair and struggle back outside. The lift hasn’t moved since we came up with Dogman, so at least it’s quick enough getting him down to the lobby. Unfortunately, the tower block is much lower than the road. There is no ramp access; instead, we have to haul Richard backwards step by step up to the ambulance. He’s just on the limit of our ability to lift without help, so it’s an exhausting climb. Even though it’s a cold night, I’m sweating by the time we reach the ramp at the back of the vehicle.
Once we have him on board, we work quickly to get his obs, give Oxygen, get access, better pain relief. It’s difficult to figure out just how much or how little contact Richard has had with the world, what his medical history is, or anything that might better inform his treatment, so we have to go with what we have in front of us. Apart from a persistently low blood pressure and a broken arm, his other obs are okay. But he looks so unwell I call ahead, especially if the department’s as busy as it has been lately.
We set off.
* * *
When we come through the doors of the ED we’re directed into the normal patting area rather than resus. I guess the hospital staff must have taken the ASHICE and decided it wasn’t too serious. I can picture them taking down the basics – collapse query cause, broken arm, low BP. Nothing to warrant the fuss. Sometimes it’s like that. You have to see the patient to know that something’s going on, even if you can’t figure out what it is. The triage nurse is experienced, though. She sees straight away that Richard isn’t right. His ECG’s clear, but if you didn’t have it in your hand you’d put money on him having an MI. She calls a consultant over. After a quick run-through of events he leads us through to resus.
We slide him over onto the hospital trolley, and after reviewing the case with the staff, I take the paperwork through to reception to book him in.
* * *
Reception looks more like an A&E stockade than ever – except one that’s been ravaged by a Christmas tornado. Amongst the cards and flashing, dancing Santas and thick vines of tinsel and glittering stars hanging down from the ceiling, the staff are as over-worked as ever, booking in patients, answering phones, dealing with people in various states of distress at the counter, photocopying documents, everything in the exhausted atmosphere of people doing their best to service something that will never be satisfied, never be straightened, never be level.
‘This one’s in resus,’ I tell Rose, handing her my sheet.
‘Yeah? Me too, in a minute.’
She’s wearing a pair of reindeer antlers. From the expression on her face, I’m glad they’re made of felt.
But she takes the paperwork and immediately calls up details on the screen as fluidly as if she only need think a thing for it to happen.
On the top of the mini-fridge behind her there’s a tray of mince pies, a scattering of tangerines, a carton of Twiglets.
‘Help yourself,’ she says. ‘Oh my God. If I have one more mince pie I’ll explode and I tell you what – if I go, I’m taking you with me.’