names

Paul the social worker is waiting for us out on the pavement; he leans out on tip-toes and waves his folder in the air to attract our attention.
‘It’s a difficult situation,’ he says as we gather round the cab of the truck. ‘Mrs Macaulay doesn’t want to go to hospital, so I’m not sure how successful we’re going to be. We might have to get the police involved, but let’s see how far we get with a little gentle talking first.’
A small, gently rounded man, he stands in the sunshine radiating as much empathy and goodwill as a freshly laundered soft toy. He adjusts his glasses and smiles. ‘Such a beautiful day today. Anyway chaps. Mrs Macaulay is eighty-four, going downhill a bit these past few months. Recent diagnosis of paranoid schizophrenia with a query on dementia. Non-compliant with meds since the start of the year, self-neglect generally, abusive. Not sure about the actual threat of violence. Her grandson Jeremy is here. I’ll introduce you.’ He holds up the folder. ‘I’ve got all the paperwork, of course.’
He leads us up a set of steep concrete steps to the open door of a small, red-brick house. A weathered thirty-year-old man appears from inside, licking a roll-up cigarette and lighting it with the air of someone ready to stand back and await developments.
‘She’s locked herself up in the bedroom,’ he says, tossing the match into the garden and then squinting up and down the street. He picks a strand of tobacco from his bottom lip and looks us over. ‘She says she’s not going.’
Paul grimaces. ‘I know. I know. It’s tricky.’
‘Tricky!’ says Jeremy. ‘Good luck. She was spoon feeding a doll all last night.’ He stands aside to let us pass through a cloud of blue smoke. ‘But watch yourself. She’s already waved a Bowie knife in my face, and she keeps an iron bar by the bed.’
‘Mm. Maybe we’d better get the police along,’ says Paul, hugging the folder to his chest at the bottom of the stairs.
‘I don’t mind having a word through the door in the meantime,’ I say to him. ‘I’ll jump back down if she comes out swinging.’
As I walk up, I think about that scene in Psycho where the detective gets stabbed up on the landing; the camera watching from high up in the corner of the ceiling as Mrs Bates scuttles out and plants a carving knife in his chest. But this isn’t the Bates residence. There’s an old Hoover on the landing, and a bunch of appliqué violets in a frame on the wall.
‘Hello? Mrs Macaulay?’ I say, laying a hand lightly on the door – a cheap, three ply affair with a straight lever handle and a mortice lock.
‘Go away.’ The voice is high pitched and quivering, like a young girl pretending to be old. ‘Leave me alone.’
‘Mrs Macaulay? My name’s Spence. I’m with the ambulance. Can you open the door so I can say hello properly?’
‘I said go away! I’m not going to let you take me. I know you. You’ve want to drag me out and dump me. You want to cut me up. And I won’t let you. Go away.’
‘Mrs Macaulay? We’re just worried about your health. We’re worried you’re not yourself and we want to help.’
Silence.
‘Mrs Macaulay?’
There is a sudden thump against the door and I pull back.
‘I’ll kill you!’ she screams. ‘You’re not taking me.’
‘Come on, Mrs Macaulay. We’ve just come here because Jeremy and your family are worried you’re not well.’
‘I have no family. They’re all dead.’
Suddenly there is the sound of someone stumbling over furniture to get to the other side of the room, then screams through the window ‘Help me! Help!’.
‘The police are en route,’ says Paul up the stairs.
Silence from the room.
‘Mrs Macaulay?’ I say at the door again. ‘Are you okay?’
I hear her clumping slowly back towards the door.
‘Why are you still here?’ she says at last, breathing hard close up to the crack. ‘I’ve told you. I’m not going to be dragged off and cut about.’
‘All we want is to meet you face to face. Come on. Open the door and say hello.’
There is a pause, and then she whispers: ‘Why don’t you fuck off back home to your prostitute wife?’

***

Later that morning we’re driving through the backstreets.
‘Look at that,’ I say to Frank, nodding to a run down café on the corner. ‘That’s got to be the worst name in the history of catering. Burpers.’
‘I always thought Sam n’Ella’s could really work,’ he says.
‘And then, if you were a hairdressers, maybe you could call yourself Crawlers.’
‘Blunts.’
‘I’m thinking of opening a swimwear shop: Crabbies.’
Frank laughs.
‘Talking of names,’ he says. ‘You didn’t tell me Mrs Macaulay knew your wife.’

the continental

A&E is overrun, has been all week. Pushing Mrs Riseborough on the trolley through the swing doors, it’s as if we’ve just stepped into the blood and carnage of an epic painting by Delacroix, with a health care assistant waving an x-ray form in the air, rallying the charge.
‘I’ll just go and have a chat with the nurse,’ says Frank, sauntering off through the chaos.
‘How are you feeling?’ I ask Mrs Riseborough. Her breathing is dreadful, a chronic rattle-bag of wheezes and rubs. She didn’t want to bring the nasal canula she uses at home because the respiratory nurse had told her not to take any equipment out of the house. Instead, she’s using one of our low-flow oxygen masks, holding it off a little way from her nose and mouth, like a dowager sniffing an exotic plant.
‘I’m feeling hot and I don’t want anything to make me hotter,’ she says. ‘I hate to feel restricted.’
‘I can understand that.’
A drunk tries to throw himself off a trolley, and his equally drunk friend thinks sitting on him will help. Security run from place to place, restoring order with fat, black leather gloves.
‘I’m sorry it’s all a bit of a mess at the moment,’ I say to Mrs Riseborough. ‘Time of year or something. But hopefully we won’t be too long.’
‘Don’t worry about me, dear. I’m quite comfortable, thank you.’
A scream from behind some curtains. A kid wrapped in a blanket drifts past in bare feet.
‘So. What did you do before you retired?’ I ask Mrs R. to distract her from her surroundings.
‘You’d never guess to look at me now but I was a dancer. I auditioned for the Continental up in town – quite famous in its time. Have you heard of it?
‘Yes. Very famous. A kind of Moulin Rouge cafe revue place, wasn’t it? With comedians and singers between dances?’
‘That’s it. I went up town and auditioned and they said “Okay. You can dance all right, but we need to see how you go.” So they took me on for a week, and renewed the contract every week after that, and that’s how I went on for eight years. I had a wonderful time.’
‘When was that?’
‘Just after the war. About nineteen forty-nine, I should think. A really wonderful time. I worked with all the famous stars. Whatsisname – thought himself a real ladies man. He wasn’t all that, but he wouldn’t be told. And you-know who, off of the telly. We had these skimpy costumes – feathers and lace, all very arty, you know - nothing sordid. I met my Bill there.’
‘How did that happen?’
‘He’d just been demobbed and was up town working. He came by the theatre once and saw me on the stage and really took a fancy to me. So he used to come every night from then on, and in the end he plucked up the courage to have a word with Harry on the stage door – Harry was a lovely man, really knew what was what, really looked after us girls. So Harry said “Of course. Come through and say hello.” So he let him backstage one night. Well, I was coming off stage and there was Bill, looking all shy and shifty and holding out my dressing gown. He was such a dear. So he takes me out to dinner and that was that. And here we are, sixty years later – sixty two actually, if you count the last two, which I do, even though he’s gone now.’
‘Sorry to hear that.’
‘What can you do?’ she says, taking another gasp of air. ‘It’s life and you’ve just got to make the best of it. I said to the doctor “Be straight with me now. I want to know what’s wrong with me and how long I’ve got”. “Are you sure?” he said. And I told him. I said “Absolutely” I said. “I want to be like Bill. I want it laid out flat so I can have a good look at what I’ve got and know what it is I’ve got to do about it.” “Well,” he said, “There’s not an awful lot that can be done about it,” he said. “I should think you’ve got about four to five weeks.” “Good,” I said. “Thank you very much.” Because you know I’ve had a wonderful life and I’m not sorry about going. I’ve had my lot. I danced at The Continental, I married a lovely man, I had a lovely family, and what more can you say about it?”
She lays a frail hand on mine and smiles at me. Her face has been ravaged by illness, but the cheekbones are as high and fine as they must always have been, and her eyes as blue.
‘I was a fabulous dancer,’ she says. ‘And you know what my daughter Chloe said? She said “When you’re gone, Mum, don’t for Gawd’s sake let anyone else have them photos.”

a painted wall

The moment Frank puts his hand on the latch of the gate, a monstrous dog rears up behind it, slamming into the wooden slats, barking viciously.
‘Jesus Christ!’ says Frank, jumping back. ‘The size of it!’
The dog stops barking just as suddenly, and presses its piano-sized head up against the top, breathing hard and looking at us with a cold, shark-black eye.
There is a brief stand-off as the dog – surely the bastard offspring of a Shetland pony and a wolf – stares at us, gauging distances, thicknesses. Then it starts again, coming at the fence with every ounce of hatred in its body. The pine slats shudder.
‘Fuck me.’
Just then, a woman appears in the yard. She strides up to the beast, slaps it on the nose and takes its place at the fence, peering at us over the top with much the same expression.
‘It’s only Jessie,’ she says. ‘But come round the front if you don’t like dogs.’
‘Right.’
We pick our way along the alleyway, past car parts and carrier bags, and meet her at the front door.
‘Julie’s upstairs.’
The house would feel crowded if you wore a jacket; as it is, every surface and corner, shelf and recess, is comprehensively junked-up, an accumulation of stuff in settled, dateable layers. We pass a sitting room given over to a wall-sized TV screen and a white leather sofa whose three occupants seem to have absorbed the hue and form of the cushions they lie amongst. They barely look up as we pass.
From the top of the stairs we can hear the anguished groans of a young girl.
‘Baby’s coming,’ says the woman, following behind us.
‘Can I ask what relation you are?’ I say to her. If she had said Great Grandmother I’d have believed it; she has a coarse, desiccated look, a pulling in around the mouth and eyes, and a hint of ash when she shakes her pony tail out.
‘Her mum,’ she says. ‘Jake’s the father. He’s up there.’
We go on into the room of a young teenage girl, fluffy, white, heart-shaped photo frames on the wall, My Little Pony figures on the window-ledge, and a crowd of Care Bears and cuddly Disney characters set four deep along the top of the chest of drawers, jostling for position like some nightmarish audience ready for the show. A small girl is lying on her left side on the bed, her legs drawn up to her swollen belly, her arms clutching her knees. Her eyes are closed, and her damp yellow hair has fallen across her face. Jake, her partner, is sitting on the edge of the bed, one hand draped on her leg, a mobile phone open in the other. He looks up as we come in, and springs away to the side as if we’d caught him cheating.
‘How often are your contractions, Julie?’ asks Frank.
‘I don’t know. It just hurts. Mum!’
‘It’s okay Julie. Listen to the man.’
‘Has everything been normal up till now?’
She groans.
‘Yes?’
She still has on her tracksuit bottoms. They look dry.
‘How long has she been like this?’
‘I don’t know. Since about six?’
I know Frank is thinking the same as me. Delivering a baby in this cramped little room would be less than ideal. And taking into account all the variables - the partner, the dog, the people in the room downstairs - the chances of an uncomplicated delivery seem remote.
‘Let’s ride this one out and then we’ll get you down to the ambulance,’ he says. ‘The hospital’s only round the corner.’

***

‘I’m glad we didn’t have to deliver that one,’ I say to Frank in the cab, clearing the job off the screen.
‘It would’ve been all right,’ he says. ‘We could’ve used one of those Care Bears as a pad.’
Another job comes up immediately.
‘You have got to be kidding.’
Birth imminent, the other side of town.

***

The other side of town, and even though it’s only five minutes away, for all the differences there are between the two places it may as well be the other side of the world. Whilst the streets of the first estate were set close like the high-sided runs of some penal colony; the feel here is of light and air and space, the sun smiling in an arc across the neat grass verges and gardens of Spring blossom.
Mrs Jessop is on all fours in the bedroom, naked from the waist down and panting to avoid pushing and delivering too fast. Mr Jessop is by her side, rubbing her back and whispering encouragement. We break open the maternity pack. She declines Entonox. The baby’s head bulges out slowly, then after a moment or two the rest of the body follows. She turns and takes the bloody infant on her breast, sobbing and laughing; we help her clear the baby girl’s face; she swaddles her, and lays her on to suckle.

Half an hour later, the midwives arrived and in charge, we’re sitting in the kitchen as a family friend makes us tea. The Jessops have only just moved here. The place is stripped out, back to bare board and plaster. The basics of the kitchen units are in, but everywhere else there is a sense of a bright new home being worked up from a sound base. The main wall of the kitchen is covered in writing – a happy graffiti to be painted over soon and worked into the fabric of the house like domestic white magic – all by the friends and relatives who’ve stopped by to help over the last few weeks, making everything ready for the baby.
‘It’s going to be a lovely place,’ says Frank, looking out into the sweet little garden and sipping his tea. ‘Good choice.’
I look over the graffiti wall again, the signatures and messages, the cartoon flowers and smiling faces. I wonder how many babies will be born today, across the world. And I wonder what’s been written for each of them, and what’s been done, in the days and weeks and months before they came.

convoy

Mrs Eldridge is sitting in her wheelchair ready to go, an imitation snow fox blanket over her lap and a furry, zebra print poncho over her shoulders. Her hair is gathered up and gelled into an extraordinary beehive, a silvery sculpture so perfect it could be a comedy wig, with a sheen like the gloss on a giant sugared almond. Her expression is as sweet as the hair – a contented, confectionary glaze to her face, as if some current of sweetness was rising up through her, up from the luxurious pillows of the chair, focused by the cone of the poncho, lifting the corners of her mouth, pushing up her eyebrows and gathering in the beehive.

‘She’s been off her legs these past four years,’ says Mr Eldridge, bringing the last of the bags through. ‘But this last week she just hasn’t been able to do a thing.’
‘Has the doctor been out, then?’
‘Oh yes. He said for her to go in.’
‘Did he leave a letter?’
‘A letter? No.’

Mr and Mrs Eldridge are both ninety three, married at twenty one, the world gone to hell, but the two of them making a stand together outside the church, laughing happily into the camera, the bride leaning forwards as she struggled to hold down great layers of white lace and crinoline with one arm whilst keeping the other firmly threaded through the arm of the sailor groom by her side.
‘I see you were in the navy then?’
Mr Eldridge puts a bag down by the wheelchair and straightens up.
‘Escorted the Russian convoys through the war,’ he says, then adjusts the blanket across his wife’s lap.
‘Blimey,’ says Frank. ‘That must have been a tough time.’
‘Well it was fucking cold, I remember that much. But we made it through. Didn’t we Grace? We made it through.’
He lightly fetches on his jacket, and it seems to hang directly down from his shoulders without touching any other part of his body. I pick up all the bags and Frank takes up his position at the back of the chair. As he makes to go I ask Mrs Eldridge if she’s comfortable enough, but she says nothing, smiling exactly as she did before, without the least change of expression.

ambulance noir

This job is so far off patch we may as well be setting sail for Marrakesh. A low priority call, we figure a local crew will come up long before we get there. But the minutes roll on as smoothly as the road, and the country changes and becomes unfamiliar. It’s warm enough to open the window, the radio plays a stack of good songs, but it’s still tedious that we’re expected to run on this one, and I can’t help prodding Control for updates every few minutes. The dispatcher gets annoyed.

‘Give me your mobile number. Talk to the PSIAM desk yourself,’ he says.

I’ve always pictured the PSIAM desk as a dimly lit backroom in Control, richly furnished with rugs, palms, overhead fans, a mahogany desk and a hookah, a Bakelite phone and a bronze eagle, Sydney Greenstreet sipping sweet, cardamom-flavoured coffee, sweating in an off-white suit, something heavy in his pocket.
‘Sidney here,’ he wheezes. ‘Good morning, Spence.’
‘What’s the story, Sidney?’ cringing like Peter Lorre. ‘I don’t like it. I don’t like it, I tell you.’
‘I hate to send you boys out there,’ he sighs. I hear a noise, like the slapping of a fly-swatter and the scattering of papers. ‘A dreadful waste of everyone’s time, I’m sorry.’
‘So tell me again what it’s about?’
‘An eighteen year old chap suffers low potassium. Ongoing thing, hereditary. Starts feeling low a week ago, usual symptoms of tingling in the arms and legs, but doesn’t have his usual medication to correct it. He says he’s moved house and hasn’t registered with a GP in the new area yet. He does have a repeat scrip but says he wasn’t sure if the pharmacy would accept it. He’s living with three other people. None of them seem interested or able to take the scrip to the pharmacy. They say they have no car and no money.’
‘Did you Google the nearest pharmacy, Sidney? Did you find out if they could walk?’
‘I did, Spence. I did. Nought point five miles, Spence. A light afternoon stroll. Even I could manage it.’
‘And what did they say?’
‘Not a thing. The phone went quiet.’

As it does now.

‘I told them that this was not what the ambulance service is for,’ he carries on - the sound of a pistol barrel being broken open and spun? - ‘but they still demanded an attendance. So there you are. All our other vehicles are on other jobs, or getting diverted. I’m afraid it looks like you’ll be stuck with this one, Spence. I’m sorry. I’ve done my best.’
‘It’s not your fault, Sidney.’
‘It’s this damned system. Let me know how you get on.’
I hang up.
‘They want us to attend.’
‘Shit,’ says Frank.

***

There’s a middle aged woman and a younger girl smoking and chatting outside the house. They wait until we’ve parked, then turn and lead us up to the patient. Rich, the eighteen year old, is lying on his back under a stained and uncovered duvet. A pleasant faced kid, he nods as we walk into the room and introduce ourselves. His girlfriend, her mother and a family friend, file in after us. The family friend perches on the edge of the other bed in the room and continues to play a game on his phone, held up close to his face, using both thumbs and maybe the tip of his nose.
‘My arms and legs are pretty much completely numb now,’ Rich says. ‘Sorry.’
‘I understand you ran out of your meds. Why was that?’
He makes a face.
‘But you do have a scrip?’
‘Yep. I didn’t know if it would work, though.’
‘But you didn’t try?’
‘No one would go and get it for me.’
I turn to the mother, a pale faced forty year old, weighed down by years of mascara and a leopard print dressing gown.
‘Could you really not have taken his scrip down to the pharmacy? This has been a few days coming.’
‘I don’t have the money.’
Usually about this time I let things go and retreat into a more resilient kind of politeness. But there’s something about all this – the distance we’ve travelled, the terrible waste of resources, the shocking passivity in the room – that makes me want to ride it out for longer.
‘What about you?’ I say, turning to the girlfriend. ‘Couldn’t you have helped out?’
‘I haven’t got a car.’
‘You could’ve walked.’
She shrugs.
‘And you?’ to the boy on the phone. ‘What do you think?’
He frowns and leans harder into the phone.
Frank shifts in the doorway.
‘A few bananas and an energy drink usually puts things right,’ says Rich, helpfully. ‘But there weren’t any.’
‘Bananas,’ I say to the mum.
She shakes her head as if I’ve offered her one.
‘There’s a supermarket at the end of the road,’ I say. ‘I’ve never seen such a big one. Have you Frank?’
He smiles.
‘It’s the size of a small town. They’ll have bananas. Couldn’t you have got him a bunch?’
‘Like I say. I don’t have the money.’
‘For a couple of bananas?’
She shrugs.
‘Have you any idea how much it’s cost to run an ambulance out here?’
I look back at Rich. He’s lying with the same expression on his face, waiting for something to happen. ‘You’ll be hours up the hospital.’
‘I know.’
There’s a silence in the room. Everyone’s waiting for me to say something. I think of Sydney, standing by the phone, dabbing his forehead dry with a handkerchief.

‘I suppose we’d better go to the hospital, then. Who’s coming with him?’
The two women stare at the boy with the mobile phone. After a while he looks up and says: ‘What?’

well?

‘Do you ever get to drive?’
‘We swap over at the hospital. It’s pretty much fifty fifty.’
‘Oh yes?’
‘Yeah.’
‘On blue lights?’
‘Sometimes. It breaks the day up.’
‘All the knowledge you people have. You’re like doctors nowadays.’
‘Well – not really. Doctors have to study a lot longer. They’ve got five years of medical school, then two more working in different areas before they’re qualified to practise. So that’s seven. A paramedic degree takes three. My technician course was ten weeks.’
‘There’s nothing you can’t do.’
‘Well...’
Mr Halliburton is sitting on the ambulance chair, his corduroy trousers riding up, exposing his sock garters, his aged mother nervously turning a paper tissue over and over in her hands.
‘All right?’ he says, leaning over and tapping her on her papery arm.
She smiles sadly, then moves her arm from under his hand to dab ineffectually at her nose. Mr Halliburton sighs, adjusts his position, then peers restlessly out through the slats of the window.

I’ve often thought there must be a Handbook of Ambulance Misconceptions somewhere. Part of a secret, international series – one for every job in the world, with a preface roughing out the basic howlers, a stock of questions indexed at the back. I’d bet if I was a trapeze artist, Mr Halliburton would be waiting for me backstage, nodding and winking and drawing himself up to say: ‘I couldn’t do your job, mate. All that swinging about.’

We go over a bump and it seems to shake him from the window into conversation again.
‘I couldn’t do your job, mate’ he says. ‘All that blood and guts.’
‘There isn’t that much trauma.’
‘All that piss and vomit. I couldn’t do it.’
‘We get our fair share of drunks.’
He looks at me, and his eyebrows start to creep up ominously, like a release valve finally giving way to the pressure of the ultimate question.
‘I bet you’ve seen some things,’ he says. ‘ I bet you’ve got some stories to tell.’ He licks his lips, folds his arms and waits.

It makes me cringe, but I can’t say I blame him. I know that the reason I feel uneasy is because I recognise the same curiosity to hear this stuff myself. On the face of it – the cool, rational face - I joined the ambulance service for the hours, the wage, the driving, the out-and-about spirit, the patent usefulness of the job. And all those things stand, of course. But I know too that beneath this safe, CV language move darker, less admissible currents – the urge to satisfy my curiosity, to see what death looked like, how it moved, what it meant. Essentially I wanted to know what the traumatic and bloody events I read about in the papers and soak up endlessly on TV and in films – I wanted to know how those things behaved in real life, and what they might mean to me. I wanted to know if I could cope.

So now – if I was honest, if I tried my best to think about all the jobs I’d done, to tell him what I’d seen and felt and heard over the last four years, what really could I say? What did it come down to? A story about a dead man and his dog? A railway line? An overflowing bath?

‘Well?’ says Mr Halliburton.

bogof

Ralph normally works up country, but an overtime shift has landed his response car rudely and squarely in the centre of town. A paramedic for thirty years, Ralph carries his experience as lightly as his epaulettes. If it wasn’t for the uniform he could be a retired headmaster, his benign smile only slightly undermined by the ascetic pinch to his face, as if things just kept turning out the same despite all hopes to the contrary.

The first time we back him up he’s on a job at a solicitor’s office. We are shown in by a Kevlar stockinged secretary past a rack of leaflets and brochures on personal injury claims, through to a consulting room out back. The table and chairs have been pulled to one side, and lying stretched across the carpet tiles, crying and slapping at her forehead is a large woman in a white brocade dress. Ralph is kneeling next to her, trying to persuade the woman to open her eyes so he can shine a light in them. He smiles pleasantly as we come into the room.
‘Hello chaps,’ he says, standing up. ‘Well. I haven’t long been here myself, but what we seem to have is a woman in her thirties – Jamila - who complained of a sudden pain in her head and neck, looked as if she was going to faint, and was helped to the floor by this kind gentleman.’
‘She didn’t fall or hurt herself in any way,’ the man says in a clear voice. ‘I made sure she was still breathing, then I phoned for help.’
Ralph pauses for that to sink in, then continues.
‘And that’s as far as I’ve got really. Her pulse and SATS are fine. She’s shaking as you can see but it’s not any kind of seizure. I haven’t been able to get an awful lot more out of Jamila than her name, though.
I lean in past his shoulder to get a better look at her face.
‘I know Jamila. I went to her a few weeks ago.’
I straighten up and nod back towards the door, then step away from the patient. Ralph distributes his smile evenly around the room once more for good measure, retreats, then moves in close to me like a priest about to hear confession:
‘Frequent flyer. Always the same presentation – finds a floor to lie on, pains in head and neck, big shakes, big drama, they’ve never found anything at the hospital. Exactly the same as last time.’
‘I see.’
We both turn back into the room.
‘Well,’ says Ralph, clapping his hands. ‘Shall we help you to your feet, Jamila?’ She stops crying and runs me through with a look. ‘Let’s get you out to the ambulance where it’s a bit more private.’
‘Is she going to be all right?’ asks the man in the corner, hastily putting aside a folder and adjusting his tie. ‘I thought it looked pretty bad.’
‘She’ll be fine,’ says Ralph. ‘Don’t worry.’
We help her up, and lead her back through the office. The receptionist scrutinises us from behind the desk.
‘I have a list of contacts,’ she says.
Ralph takes the printout and thanks her warmly.
Out on the ambulance, Jamila makes herself comfortable on the trolley, then resumes her attitude of distress, her long white dress flowing over the sides of the trolley like she’s the corpse of a Victorian tragedienne lying in state. She begins slapping at the side of her head.
‘I just want to press this vein, here. Could you press it for me? Everything went black, then dancing light, bright light, then flash! Then out of focus. You, for instance – when I look at you – to begin with it’s like oh my god what is this creature with two faces and many eye and then now it’s like oh, okay, almost normal. I just wish you would reach in and press my head here.’
‘I see,’ says Ralph. ‘So, chaps? You don’t want me for anything do you, guys? It seems as if you can cope. All right if I shove off?’
‘No problem, Ralph. See you later.’

But it’s sooner than we think.

Barely two hours later, we are heading back to base for lunch when we’re diverted to back up a car on scene at a collapse in a restaurant. Frank drives with the murderous precision of a hungry man, and within five minutes we’re turning into the road. Ralph’s four by four is parked up outside the pizza place, with a bored waiter standing guard, a cigarette discretely cupped in his hand. When he catches our attention he nods for us to follow him inside, then turns and flicks the cigarette away.

Despite or maybe because of the dazzling afternoon sun, the interior of the restaurant is muted and dark. Ralph is standing in the centre of a small group of people; sitting in the centre of the group, a young man in a pin stripe suit, an ornate black walking stick in one hand, a bag of medication in the other.
‘Well, well,’ says Ralph as we walk over to them. ‘Nice to see you again.’
The group parts to let us in.
‘This is Jasper. Jasper is twenty two. He appears to have had some kind of seizure. He suffers from a whole raft of illnesses, don’t you? ...’
I catch Ralph’s eye and as discretely as I can mouth the word: Munchausens.
Ralph’s expression barely registers the exchange, but I can see he has understood. He continues his train of thought for a second longer: ‘... Parkinsons, Diabetes, Epilepsy, heart problems – you name it, Jasper’s probably – erm – just excuse us for a second, would you?’
We both step over to the restaurant lobby.
‘I don’t want you thinking that every patient we go to today is a phoney,’ I whisper.
‘But?’
‘But Jasper is very well known up at the hospital. The diabetes is real, but everything else is strictly Hans Christian Andersen. Even if we took him up there they wouldn’t see him. Last time I saw him at A and E he had a security guard sitting on him in the car park, waiting for the police.’
‘What for?’
‘Hitting a nurse with his stick.’
‘I see.’
We turn back to the group. Jasper has struggled to his feet and is making a fuss about what bags he should or shouldn’t have.
‘Look here,’ he says, straightening his arms to adjust his starched cuffs and almost falling backwards into a floral display. ‘I don’t want to cause a fuss. I’m sure there are people much more deserving of your attention at the moment than I am. I simply want to go home and carry on with some extremely important, extremely high value business transactions.’
‘Why don’t we have a chat on the ambulance, Jasper? It won’t take long. Just to make sure everything’s in order.’
He sighs. ‘I honestly don’t – oh - I suppose if you think that’s what’s medically required. But this is highly embarrassing for me. It’s just Parkinson’s you know. And there’s not an awful lot one can do about that, is there?’
‘Come on, Jasper.’

Outside on the ambulance Jasper employs all his usual methods of delay, his campaign of passive resistance taken to the maddening, improvisational levels of a clown. At one point, an alarm starts to sound. He hunts through the pockets of his jacket, and the bag of medication, scattering packets of pills across the trolley, chasing the bleep into a document folder of phoney contracts and pseudo-business correspondence. Eventually he retrieves the electronic device and switches it off.
‘To remind me to take my medication,’ he says. ‘Now – what have you done with my stick?’
Ralph smiles and goes to leave the vehicle. ‘Goodbye Jasper.’
By the back door I say to him: ‘That’s weird. Two patients – two frequent flyers. But I don’t want you to think every patient we go to is a psyche, Ralph.’
He rests a comforting hand on my shoulder.
‘Don’t worry, Spence. But have you ever thought – and it’s just a thought - maybe you attract them?’
He laughs, shakes his head, and saunters off to his car. I climb back into the truck.
‘Ah. Good. There you are,’ says Jasper. ‘I was just telling your colleague. Chest pain.’

a pattern of circles

‘Have you come for me now?’

Geoffrey levers himself up in his chair to look at us as Maggie shows us into the room. It is icily cold outside, but the sun is sharp and bright. It splashes in through the windows and casts every item of furniture, every picture, photograph and domestic item into brilliant relief.
‘Hello Geoffrey. I understand we’re taking you to the hospice.’
‘Yes. I’m all done now and I’m going there to die.’
‘Right.’
He settles back into his chair.
‘Do you suppose I might have time to finish my tea?’
‘Of course.’
Maggie shows us to the sofa next to Geoffrey’s chair.
‘Can I get you boys a cup?’ she says.
‘Why not? Always time for a cup of tea.’
‘How do you take it?’
She stands in front of us, hand in hand, a small, neat woman with a generous smile, her hair as perfectly ordered as the heavy tartan skirt pinned around her waist. ‘Milk and sugar?’
Geoffrey shifts in the chair again and almost spills his cup across his middle.
‘Oops!’
Frank helps him re-balance, then finds a cloth to dab his jersey dry.
‘Thank you so much,’ he says. ‘How clumsy and stupid I’ve become.’
‘It’s your illness darling,’ says Maggie, superintending the clean up. ‘All right? Okay? Shall I get you another?’
‘No, darling. This is absolutely lovely.’
She hobbles off to the kitchen.
‘I’ll give Tony a ring in a minute,’ she says over her shoulder.
Frank carefully hands Geoffrey his cup back, then sits down.

Geoffrey is ninety three. Age and illness have robbed him of substance; he sits in his chair like a meticulously realised soft toy of the man that was, the strands of hair across his head and the lines of his pencil moustache picked out in silver thread. The most vital thing about Geoffrey are his eyes – two dabs of aquamarine beneath the liver spots and the spilling, waxy flesh of his face.
‘I flew with Bomber Command,’ he says, turning just sufficiently to look at us, almost dropping his tea again in the process. It’s an odd feeling, as if he were scanning us for traces of the people we might have been. ‘Stirlings, Lancasters, Wellingtons. I’ve had my adventures. But now I’m just so damned tired. I’m no good for anything anymore and I just want to sleep
‘Most of my lot were in the army,’ I say. ‘But my Mum had a cousin, Arthur, who was a tail gunner in a Lancaster. She used to say she remembered standing on his shoes and dancing with him once when he came over on a visit.’
Geoffrey smiles gently.
‘Did he live?’
‘No. I’m afraid not. He was shot down somewhere over the North Atlantic.’
‘So many of us were.’
Maggie has come back in and settled herself in the opposite armchair.
‘Poor fellow,’ she says. ‘Such a waste. Do you know how many we lost? Fifty six thousand. Fifty six thousand! And it’s still going on today. All those boys in Afghanistan. There just never seems to be an end to it.’
Geoffrey takes another trembling sip of his tea.
‘Almost there,’ he says.

‘The hospice is lovely,’ says Frank. ‘Out in the country. Beautiful view of the hills.’
‘Yes.’
‘And the staff there are always so friendly.’
‘Splendid.’
Geoffrey regards his wife.
‘Sixty five years we’ve been married. Just when it all finished. After a long and difficult courtship.’
Maggie laughs and dips her head; for a moment she could be twenty years old, swinging her legs on a chair at the side of a dance hall, waiting to be asked.
‘Long and difficult, my eye,’ she says. ‘It took five minutes and you know it. But things were different then. You didn’t have the luxury of time.’
‘No. No, that’s true. I know it.’ After a pause he says: ‘Sixty five years. I think we’ve come to – an understanding.’
‘Yes. I think we have.’

I put my empty cup down on the coffee table. I notice the scene beneath the glass: an ancient alabaster carving, medieval knights clashing swords on a battlefield. The sunlight lowers as the afternoon moves on. It intensifies through the windows, falling across us all and everything around us, the black and white photographs, the tea cups, our carry chair waiting in the corner, and framed in dark wood on the opposite wall, an embroidered piece, a simple pattern of three circles, blue, white and red.

the god of the smoking mirror

I’m on the bathroom floor, my hands clasped around the toilet bowl, my eyes reflected back at me from its waters. I’m trying to rise above it all, these relentless bouts of nausea and vomiting, to find peace beyond the sickness; the white ceramic is a welcome chill against my cheek.

It started so well. I wasn’t working, the girls were off school, and my wife had a meeting up in town. So I took the girls to the British Museum and we all planned to meet up at the end of the day in a pizza place off the Strand.

We spent the morning gently grazing with the rest of the tourists, room through room with a copy of the museum map in one hand and a camera in the other. But the longest time we spent by any cabinet, longer than the mummified cats, the golden galleon table ornament, the Saxon helmet and the Iron Age burial, was in the Americas room, in front of the carefully lit display of Aztec ceremonial pieces. One in particular: a skull representing Tezcatlipoca, God of the Smoking Mirror. It was decorated with bands of blue turquoise and black lignite, the eyes polished spheres of iron pyrites on discs of white shell. From either side of the mask, two neatly coiled straps of deerskin, which the priest used to tie on the mask for the ceremony.
‘Imagine what that must have looked like grinning over you on the table.’
‘With that knife,’ pointing to the blade with the crouching warrior handle.
‘Urgh.’
The girls moved on, but I stayed a little longer, staring at the skull, until a sudden flash from a camera bounced off the glass and dazzled me back.

Outside the museum the clouds had lowered and a fine rain was dragging across the city. We hurried on, down Museum Street and on into Covent Garden. But in the plaza the traders were packing up already; there was a wintery chill to the place, and only the hardiest tourists were still sitting outside on the iron seats, hunched like survivalists over plastic trays of noodles.

The offices where my wife, Hannah, was having her meeting were as closed up as the market. The CEO was in town, and a man in a fluorescent jacket wanted to know exactly what our intentions were, intercepting us as we hurried across the forecourt towards the lobby. In our bedraggled state we managed to persuade him that we meant the CEO no harm; he waved us on, we pushed through the revolving doors and found sanctuary on some over-stuffed leather chairs beneath a potted palm. Chloe picked up the Financial Times and pretended to check her shares. After ten minutes or so of trying to pass ourselves off as a raggedly eccentric billionaire family, we were rescued by Hannah and we all left for the pizza restaurant. I tried to catch the receptionist’s eye to say thanks for letting us have a seat, but she remained professionally welded to the screen.

We’d been to this restaurant before, a backstreet Italian-Schmitalian place where the pizza just about makes up for the décor and music. It was lovely to be warm and out together though, and I settled in. But half an hour into the meal I began to feel an ominous churning in my stomach; an hour or so later out in the street as we made our way back to the train station, I was rinsing as white and green as the advertising for the soya dessert they were promoting on the station forecourt. A salesman put an open tub under my nose and asked me what I thought; it was all I could do not to vomit into it. I shook my head in horror and hurried on.

The train ride took a hundred years. Rush hour, and every station stop it seemed they were actually herding cattle onto the train. My skin prickled; the windows ran with my sweat. I tried positive visualisation, that every clatter of the rails was bringing me quickly over ground to home, but then I’d look at my watch and see barely a minute had passed and we had half an hour to go. I groaned and yawned again, struggling to hold back a tsunami of vomit that would surely sweep everything ahead of me down the track to the next stop, bobbing with screaming passengers, laptops, rucksacks, hats, magazines, book club specials. I buried my fingers into my face in an effort not to embarrass myself any more than I already had. When I looked up again I imagined I saw the Aztec priest, holding onto the straps with the others, innocently reading the paper over his neighbour’s shoulder, with the skull of the God of the Smoking Mirror gawping at me from around his neck.

It would be impossible for me to overstate the bliss I felt on making it home. The comfort, the peace, the warmth. It is a treat lovingly made in heaven to be up here now on the bathroom floor, throwing up into this deliciously cool and clean toilet. Despite the hideous mechanical emptying, the Alien-like slavering extensions of the jaw, the washing-machine noises – my body seems to know what to do - I am profoundly happy to be here. An atheist, I thank God with every fibre of my being that I am home, miraculously brought back here, away from the train of despair, to this blessed place where I can be myself and do whatever I need to recover. And as the dreadful mechanics of the sickness subside, I prop myself up against the bath, and think – not for the first time – how enormously comforting it is in times of extremity to appeal to some bigger, all-powerful spirit. I picture those Aztec craftsmen, decorating the skull with their fine mosaic pieces, carefully setting the eyes, attaching the straps. I think about the priest, tying it on for the ceremony.

Anything to appease the spirit of the time, to find favour, to make it home.

bad vase

The flat is up a steep track of badly carpeted stairs. The overhead bulb is on a timer and clicks out before we reach the landing, so I pull out my torch and light the rest of the way until I find the upstairs switch and put it back on again.
‘Nice,’ said Frank, wiping his shoes on the carpet outside the door. ‘Lovely.’
The door stands open.
I push it wider.
‘Hello? Ambulance?’
It’s dark inside. There is no sound, and I pause a moment. Frank taps me on the shoulder and leans in.
‘You know,’ he says, in a low voice, his breath smelling of coffee. ‘If I didn’t know better I’d say you were actually enjoying all this. You love these psych jobs.’
‘Well. Maybe that’s because I’m a bit of a psycho myself.’
I turn the torch up under my chin, widen my eyes and smile at him.
‘Careful,’ he says. ‘It might stick.’
‘Too late. It’s been years in the making.’
There is a noise from inside the flat, something like a muffled sob.
‘Hello? Ambulance?’
We go inside.

***

I went through a difficult time when I was in my twenties. I wouldn’t call it a breakdown, but I wouldn’t waste too much time trying to say what I would call it. My teens were pretty flammable, of course, but my twenties had a tougher, leaner feel to them. At least when I was a teenager I was still a kid and there really did seem no end to the things I could do to step up and change the course of my life; by my mid-twenties, life didn’t seem quite so generous, the margins were closing in, and there was a tougher cast to my plans.

I ended up sharing a flat in London with John, a friend of a friend. We moved in to a boxy flat in a boxy block overlooking the park. It was a narrow and meanly appointed building, which through the trees looked like a Thirties liner ran aground and left to rot. There was an old sink on the balcony with a pigeon’s nest in the corner, but it had chicks in it so we couldn’t clear it out straight away. Every time we went into the kitchen we could hear the creatures moving around, peeping feebly. I tried to ignore them, but now and then I’d be tempted to have a look – a clutch of skinned, sickly looking beasts stumping around in a mess of twigs. I wasn’t the only thing to find life a struggle.

A few people came to stay now and then. One Spring, Kevin, an old college friend of John’s, came back to the country after a teaching post in Mexico. He’d married out there, and his new wife came back with him. Maria was a solid and powerfully silent woman whose red lipstick was so thick it seemed to seal her mouth. When Kevin spoke Spanish to her it was with a strong Liverpudlian accent. Maria seemed to absorb his cheerful conversation in the same way she absorbed what light there was in these reduced circumstances, hungrily, without comment, soaking it all away with black brown eyes.

Kevin was between teaching jobs. He had another coming up in Guatemala in a couple of months, and in that time he wanted to visit family and friends in this country, to introduce Maria to them and make things well here before he started his new post. They made themselves at home. We set up a camp bed in the living room. They kept most of their things in the suitcases, but we cleared a couple of shelves for clocks, books and the little things they’d need now and again. Maria took the higher of the two shelves for her ceramic collection – a family of rabbits; a miniature wheelbarrow; a toadstool with a fairy reading a book cross legged on the cap; a mini being driven by a family of holidaying pigs – everything miniaturised, cartoon expressions, whimsical gestures. I picked the mini up to have a closer look.
‘Careful,’ she said, from over on the sofa. ‘Especial.’
I put it back.

John was a printer and out all day; Kevin had work at the university. But I was unemployed then and Maria had nothing to do. Even when I’d run all the errands I had to run, signing on or scanning the boards at the Jobcentre, I found myself with time heavy on my hands. I tried to stay out of the flat, but it was a wet Spring and I was forced back indoors more than I wanted. Maria had no English, I had no Spanish, and even though we both tried at the beginning to make the best of it and establish some kind of rapport, neither of us seemed able to bridge the differences. She kept to the living room. The blinds were down all day, and Maria spent all her time watching TV, the colour turned up until she was staring at the screen through a super-saturated haze. The heating in the flat was up in the red zone, too, a roiling shimmer of heat that made the warm Spring air outside seem frigid. Kevin was happy coming home each day. John was as savoir faire as ever. We ate our meals perched in a line together on the camp bed, me at one end, Maria at the other, laughing and drinking and everything fine. She enrolled in a short pottery course. I had an interview. Things were looking up.

But over the coming weeks I began to feel more and more uneasy about the relationship between me and Maria. That she didn’t like me was undeniable, and trying to shrug off the bad feeling I got from her was like trying to ignore the heat from the radiators – it only made me more conscious of it, and edgier. It seemed that whenever she was with John and Kevin, Maria would be relaxed and lively. She would take loving slugs of wine and tip back her head, laughing at John’s attempts to speak Spanish, revealing a brilliant rack of hard white teeth stained at the front with lipstick. The more I tried to join in, the more awkward I felt, until I started to think that maybe it was my problem, that I was paranoid and unreasonably down about the situation, a function of my general state of mind, and lack of direction. But as hard as I tried to rationalise my unease, the stronger it grew, until I was faced with the unshakeable conviction that Maria hated me, resented me even, and wanted me out. When I confided in John, he told me not to worry.
‘They’ll be gone in a few days,’ he said. ‘Cut her some slack, mate. She’s acclimatising.’

The plan now was for them to head up to Liverpool to see Kevin’s relatives, then head on to Guatemala from there. Friday was their last day in the flat.

I thought Maria would be looser and more friendly as the big day approached, but if anything she seemed to retreat into herself even more when the others weren’t around. She kept herself to herself in the living room, stewing in the hectic light of the TV, throwing me a look whenever I ventured past the doorway into the kitchen to make a drink.

Friday afternoon I was alone in the flat when she back in from pottery class. She was carefully carrying something in a green plastic bag, and put it gently down on the hall table whilst she hung her handbag up on the pegs by the front door.
‘What have you made?’ I asked, standing in the kitchen doorway.
She stared at me and nodded, once.
‘Can I see it?’
She hesitated, as if she was tempted to deliberately misunderstand the question and carry on into the living room with her haul. But when it became clear I wouldn’t let her go so easily, repeating my question, she sighed heavily and then carefully took her pot out of the bag.
Seeing it was like a physical blow. It was the kind of pot a camel could’ve made, a rudely hooved rectangular vase with a thickly gouged pattern around the outside and a rim of looped clay.
‘Bonito,’ I said after a pause, and then, the only other Spanish word I know: ‘Poquito.’ It wasn’t. She knew it. She gave me a brief screw of the mouth and headed into the living room. I turned away as discretely as I could, but she must have been aware of me sneaking a look as she cleared a space amongst her collection of ceramic figurines and placed her vase amongst them.

That night we had a bon voyage meal. Maria was in charge, busily rolling tamales and fajitas, filling the flat with delicious corn fried flavours and spicy aromas. We all drank too much. I felt hysterically happy, buoyed by alcohol, the weekend and the prospect of the flat to ourselves again. I made even more of an effort to connect with Maria, and she seemed to respond a little. I thought she was as relieved as I was that our enforced partnership was drawing to a close.
After the meal we drank and chatted and listened to music. My mood settled as heavily as the meal and the alcohol. I caught Maria staring at me a few times, hurriedly turning away into her glass or some other phoney distraction. And in that superheated, alcohol-saturated, early morning haze, the dreadful thought came to me that she actually meant me harm.
I’d tried to be friendly. I’d done everything I could to make her feel at home. But from the very beginning she’d taken against me, and now, after two long months in this hot-house proximity, it looked to me as if the enmity she felt had distilled into something more potent, more deadly, more actively hostile. She would be leaving the flat tomorrow, and the country in a couple of days. I understood now what she meant by that look, that contemplative swirling of her glass.

Maria meant to kill me.

It was a preposterous idea. I think when I thought it I actually laughed out loud. But in the manner of a suddenly revealed truth, the inevitability of the whole thing presented itself to me in the same lurid colours of the TV. Maria was crazy and she meant to kill me. I had a vision of her in the pottery class, violently thumbing that vase whilst in her mind she was gouging out my eyes. I had come to represent all the frustrations of her life. I reminded her of someone who had once done her harm. Whatever the reason, I was her enemy, and she wanted to kill me.

The evening hit the rocks somewhere around two. Kevin and Maria were the first to turn in. They had a long drive in the morning. We hugged each other – I thought Maria looked hungrily at my ear – and the two of them retired.
‘What a great night,’ John said, slapping me on the shoulder and giving me a hug. ‘Thanks for letting them stay.’
‘No worries,’ I said. ‘It’s been lovely.’
‘What do you think of Maria?’
‘She’s amazing.’
John looked at me for a moment and then smiled. ‘I think it must be a huge thing, to come to a new country like this, to start a new life.’
‘God. Yes.’
‘I think I’d struggle.’
‘Me too.’
‘Do you mind if I use the bathroom first?’
‘No. Go ahead.’

I began tidying up the kitchen. Whilst I was making a neat pile on the draining board, I noticed that one of the knives – the big jointing knife – was missing from the block. With a jolt I pictured Maria sitting quietly on the camp bed whilst Kevin was asleep, holding it in her lap and following the noises I was making in the kitchen. Horrified, I stood completely still.
‘Don’t worry about all that,’ said John, almost stopping my heart with the suddenness of his appearance. ‘We’ll see to it in the morning. Get yourself off to bed.’
‘Oh. Right. Sure.’
He padded off down the corridor, and I heard him close his door quietly behind him.

After a moment the flat was silent, except for the toilet cistern refilling after John had flushed it. I waited for that to stop, then waited. Nothing. No sounds, even from down in the street.
I walked to the bathroom and got myself ready for bed. I stared at my reflection in the bathroom mirror as I brushed my teeth.
‘You stupid,’ I said to myself, foaming at the mouth, pointing at my reflection with the brush. ‘Stupid, selfish. That poor girl, starting life over in a new country, and all you can do is make up ridiculous stories about her. You’re the crazy. You’re the one with the paranoid delusions.’
But the darker part of me that had fed these morbid fantasies was speaking at the same time. ‘She’s going to get you,’ it said. ‘She’s going to plunge that jointing knife into your heart. Then she’s going to cut it out and put it in the vase. Watch out. I’m telling you. It’ll be all over the papers tomorrow.’
I spat into the sink disgustedly, then dropped my toothbrush back in the mug. I should see a psychiatrist. I’ve been so down lately. I turned to look at myself in the mirror again, and pointed a finger.
‘You make an appointment tomorrow,’ I said, ‘Tomorrow!’ then turned out the light and opened the door.

The toilet was housed in a separate room just a step across the corridor from the bathroom. I went into it, turned on the light and lifted the lid.
As I did this, I had the sudden, certain and overwhelming conviction that there was someone hiding amongst the coats the other side of the toilet wall. I held onto my water and listened. There! Wasn’t that the noise of someone breathing?
I opened my mouth to breathe more quietly myself.
There again!
And in that instant I knew who it was. I could see her as clearly as if the wall had been suddenly turned to glass. It was Maria, standing with the jointing knife raised to her chest, her face turned in to the coats to listen.
Suddenly my heart was beating in great wooden thumps. What could I do? She really did want to kill me. How could I escape?
And there!
Definitely someone outside the toilet.

Thinking with painful clarity, I decided to turn off the toilet light, open the door slowly and creep out on my hands and knees. At least that way her first thrust would miss, and give me a chance to catch her wrist, and wrestle the blade out of her hand. It was better than nothing.

I turned off the light, hesitated a moment, then slid quietly down onto the floor. I built myself up for the exit, then opened the door and crept out on all fours.
No sooner had I come out then a figure stepped forward and brought a hand swinging down onto my head. Despite my fighting plans, the horror of the situation completely overwhelmed me. I cried out – a huge, unmodulated bellow that seemed to burst out of my throat like an animal howling through a metal tube. Both my hands went up and I rolled onto my back, closing my eyes, waiting for the cut.
‘Spence! Mate! It’s me!’
I opened my eyes and saw John leaning over. He was holding the chopping board with the handle, and he raised it up to show me.
‘When I put my head on the pillow I found this inside. I thought you’d done it, so I came out to get you back.’
I stared up at him with my heart still thumping.
Kevin came out into the corridor, followed by Maria.
‘What’s happening guys?’ he said.
John showed him the chopping board.
‘I gave Spence a bit of a fright.’
‘Well it’s April the first,’ he said. As I got to my feet they both laughed, but Maria, she just tied her red poppy robe around herself more closely, smiling gently, then moving up behind Kevin, putting her arms around his waist, and resting her head on his shoulder.

aftermath

This housing estate is as real as a theme park, verges efficiently lain in squares, saplings with their labels showing, sleek, low mileage cars parked according to contract in sleek, low mileage bays. The map book is way out of date, but even the Sat Nav does not recognise the place; according to the screen I’m floating in a grey zone. I slowly drive the ambulance four by four towards the chequered flag around an intricate network of roads, cul-de-sacs and roundabouts so confusingly run together that you can probably only get the picture and sense of it all from the air - a giant chameleon, with its tongue extended. All the houses are dark and sleeping except for a few solar garden lights at jaunty angles in the grass carpeting out front, and the occasional stab of yellow behind an upstairs window. But here is a house with its uPVC door ajar and an elderly man raising a hand. I park up, grab a bag out of the back and head over.

Mr Muir is as carefully put together as the estate. His scarlet woollen jersey is shop-sharp, two neatly pressed shirt cuffs at his wrist, the crease of his linen slacks aligned with the centre of the crosses of his laces, his silver moustache clipped to the lip and his hair as buffed as the silver top on an antique box.
‘I took her pulse, which felt rather light and fast to me. But see what you think,’ he says, quietly closing the door behind me. ‘This way.’

He seems to move without making contact with anything, leading me up a pale carpeted staircase to a landing plumped out in creams and whites, past a Japanese bamboo print and a tall white biscuit vase filled with cracked willow spray painted silver, to a small and superheated bedroom.

Valerie, his middle-aged daughter, is lying on her side on the bed. She raises her head and smiles thinly as I put my bag and board down and introduce myself. Over in the corner, Lisa, her twenty year old daughter, shifts palely on a black velvet dressing stool. Mr Muir follows me in, then rests against a white veneer chest of drawers and examines his cuticles as I ask the woman what the matter is.
‘I’ve been getting this pain,’ she says, ‘all over. My neck, shoulders, into my arms and hands. My legs.’
Mr Muir clears his throat.
‘What would it take to get a scan done?’ he says. ‘We’ve had an x-ray but the doctors said it didn’t show anything.’
‘Tell him about the faint,’ says Lisa, chewing her lip. ‘Tell him what happened.’
‘Did you faint then?’ I ask, kneeling down and feeling her pulse.
‘I went dizzy, yes. There were these white spots, moving around.’
‘But did you actually pass out?’
‘No. I didn’t pass out as such.’
‘And this pain. How long have you had it?’
‘About three years. I wish I knew what it was. The doctors don’t seem to have an idea. I think they think I’m just some hypochondriac and they wish I’d leave them alone.’
‘So have you had any new pain tonight?’
‘Well it’s been getting worse and worse. I can’t do anything.’
‘Over what period?’
‘Three weeks or so.’
‘And does your doctor know about that?’
‘I don’t think he cares.’
‘You can’t go on like this, mum,’ says Lisa, sitting on her hands and chewing her lip. ‘You just can’t.’
Mr Muir stands more upright.
‘How is her blood pressure? Would you be able to find that out for us?’
‘Of course. I’ll run through the usual checks and see where we are.’
‘Because I wouldn’t mind betting it’s low. What do you think about her pulse? I thought it was dangerously thready.’
‘No. It feels pretty good to me. Regular, not too fast. Pretty good.’
‘Really? I am surprised. You’re sure about that? It definitely felt off to me. But I suppose you know best.’
‘Let’s do the checks and see what’s what.’
Mr Muir and his grand-daughter watch me carefully. I ask question after question, as much to lighten the atmosphere as anything else, but my efforts sound thin and unconvincing even to me, the soft furnishings absorbing my bonhomie as ruthlessly as the acoustics.
‘It all looks fine,’ I say, curling up and stowing the stethoscope, wishing I could follow it into the bag. ‘So now we need to think about what to do next.’
‘This can’t go on,’ says Lisa. ‘You’re not well.’
Valerie props herself up on one arm and flashes her daughter a look. ‘What can I do? No one seems to believe that I’m ill.’
‘Are you sure you wouldn’t be able to get her a scan? Wouldn’t that show if a nerve was being impinged in the neck? Or anything else? I mean – what can be causing all this?’
‘As far as the faint goes, it’s not uncommon for someone to be sitting down in a hot room then feel light headed when they get up. You didn’t pass out, you haven’t had any new pain – and you’ve recently started some strong pain killers, which might be making you drowsier and more susceptible to this kind of thing. I think it would be as well if you went back to see your doctor about how you’re feeling, but I don’t think you need to go rushing off to hospital tonight. I don’t think they’re in the best position to help.’
She lies back down and drapes a hand across her forehead.
‘It just goes on and on.’
‘If you’re not happy with your doctor, you could always change.’
She glances at me from beneath her hand.
‘Really? Do you think? How?’
‘I’m not sure. But you’re perfectly entitled to see someone else.’
‘And have him ring up the new chap and say: “Watch out for this one. She’s a waste of time.”’
‘I’m sure that wouldn’t happen.’
‘Are you?’
‘It shouldn’t happen.’
‘Well, there.’
Lisa sighs. ‘Go to hospital and get a scan.’
‘They won’t be doing any scans tonight,’ I say to her, as pleasantly as I can. ‘Your doctor will refer you if he thinks it’s called for.’
‘But it takes ages. Months and months.’
‘Not so long as that. And if they think it’s urgent, they’ll work one up right away.’
Mr Muir clears his throat.
‘My wife went to the doctor with shooting pains in her leg. He said it was muscle strain and sent her off with pain killers. Three months later she was dead. Riddled with cancer. If they’d taken action sooner, she might have lived.’
‘I’m sorry to hear that.’
‘”Just muscle strain”, he said. “Take these”. Three months later she was gone.’
‘How awful.’
‘You must get this sorted, mum,’ says Lisa. ‘Please.’
The room is silent for a moment. Valerie almost seems to fall asleep. But then suddenly she opens her eyes again, and as the brightly enamelled radiators quietly click and the night presses up against the window, she studies me from where she lies, glittering darkly against the pillow.

high

I can imagine the Georgian architect lowering his papers and making a sign in the air – a simple twist of his hand – and the staircase rising up in front of him, the DNA of his vision for the building: a towering iron and stone helix, with an elegant cherry wood handrail and black curlicue spindles, spiralling up from the black and white squares of the hallway, six storeys up to the angled white glass of the skylight above.

Two hundred years later, Dave – dead drunk, one month into a breakdown - climbs onto the handrail on the very top floor and says he wants to slide down. Dixie, his fiancée, and Rich, his best friend, both lunge forwards. Rich gets a hand to him just as Dave starts to fall off at the first turn, manages to grab him by the collar of his shirt and swing him away from a fatally simple plummet; but he’s at the fullest extent of his reach and as Dave pitches head first into the void he only manages to turn him into a more survivable fall before the hand rail breaks his grip. Dave flies in slow motion, somehow missing the next curve of the balcony below to land with a jarring crash flat on his back on the carpeted landing.

Dave is stretched out in front of me, completely still, breathing slow and shallow from the belly as I kneel down by his head. A wet patch of urine spreads darkly in the crotch of his jeans.
‘Can you talk to me, Dave? What can you tell me about the fall?’
His eyes are half open but he makes no sound or sign of recognition.
Rich squats down beside me. He moves quietly for such a powerfully built man; his great, tattooed forearms resting lightly on his knees, he slowly rubs his knuckles together as he talks.
‘How bad is he? I didn’t move him, that’s what they said on the phone. I’d know that anyway, from the army. But it’s a fuck of a way to fall, mate.’
Dixie sobs loudly when he says this, hugging herself on the deep windowsill of the landing window behind us. Her mascara has melted across her face, and she shivers despite the heat of the building.
‘Let’s have a look. What’s his health like normally?’
‘Fine. He’s a tough little nut. I tried to stop him, but when he gets an idea in his head...’
I reach gently under Dave’s neck and feel for any deformities.
‘Does that hurt?’
He stares up inertly.
Whilst I’m trying to gauge the extent of his injuries, the back-up ambulance arrives. I hear a crash of doors and a cluster of voices down below.
Rich stares me for a moment.
‘I know you,’ he says. ‘You took me in a few months ago when I had too much coke.’
‘I thought you looked familiar.’
‘I haven’t touched it since, mind. It proper freaked me out.’
‘I bet.’
‘Yeah. Funny you turning up.’
‘Small world.’
‘And high.’
Whilst the crew is talking to someone way down in the hallway, Dave suddenly starts to moan and move about.
‘Keep still, mate. You’ve had a bad fall. You mustn’t move your head.’
‘What’s happened to me?’ he says. His eyes flick alight, two sharp and glassy beads; I feel suddenly compromised, like a chicken inadvertently waking a leopard. ‘Who the fuck are you? Where’s Dixie?’
Rich leans over him.
‘You fell off the banisters mate. About twenty feet, you cunt. You’re lucky to be alive.’
‘Get off me! Fuck off! Where’s Dixie?’
He shakes his head from side to side and struggles to get up.
‘Well his legs move all right.’
I let go of his head.
‘I’m not going to restrain him, Rich. It’ll only make things worse.’
Dave staggers to his feet, then groans and clutches his side.
‘You’ve had a significant fall,’ I say to him, as calmly and clearly as I can. ‘You have to keep still in case you’ve hurt yourself.’
He stares at me and frowns. ‘Who the fuck are you? You’re fucking dead.’ He bunches his fists and almost seems to waggle his hips, like a cat about to pounce.
‘Let me sort this,’ says Rich, stepping between us. He puts a massive hand in the centre of Dave’s chest. ‘Mate. Look at me. Look at me. It’s Rich. You’ve had an accident, mate. You slid down the banisters and fell off.’
‘Fuck off.’
‘I saved your life, mate. But listen. You’ve got to let the paramedics sort you out. You don’t know what you’ve done.’
‘Where’s Dixie?’
Dixie sobs again from over by the window.
He thrashes his head from side to side, sensing rather than seeing her.
‘Dixie! Dixie!’
She comes running over to him, takes his head in her hands. They put their foreheads together, Dixie crying ‘Babe! Babe!’ and Dave roaring ‘My side hurts, babe! I’ve hurt my side.’
The back-up crew have made it to the top of the stairs now. They lean on the handrail, getting their breath and taking in the scene.
‘My side, babe! My neck! What’s happened to me?’
‘My baby! My babe!’
Rich pulls his phone out of his pocket and idly checks a text. Then he flips it off again and turns to me.
‘I suppose you get this a lot,’ he says.
‘Some.’
I move back to talk to the crew.

making it home

Something must surely have happened today, something big. Or at least, a public announcement in the shopping centre, or maybe a plane dragging a banner across the sky: Come to hospital! Now! Everyone!

The department is overflowing, overwhelmed, bursting at the doors with patients and relatives - an expectant press of people, stewing dangerously like commuters at rush hour, all looking in the same direction, the desk at the centre, that plucky little veneered emplacement of computers, filing trays, dry wipe boards and coffee cups, the Rorke’s Drift of the A&E, where everyone, from ward clerk to registrar, are fielding requests and making decisions faster and more decisively than they ever thought they could, but saving the last canula for themselves.

I queue up to handover.

Ron, the Kiwi Charge Nurse, outwardly as smooth and unflappable as ever, is working so quickly his Maori tattoos seem to ripple up and down his arm like waves on the ocean.
‘Hey! Surfer Nurse!’ I shout.
He looks up and smiles. ‘I’m out there soon, mate’ he says. ‘I can taste it.’ He smiles with the shine of a wet board for a second, then he’s back in to it, crooking a phone to his ear, writing a name on the board, passing out an X-ray request to a porter and nodding to a patient’s relative who has begun shuffling dangerously behind us, foot to foot. I check the time. We need to finish promptly tonight, and I mentally pattern out the likely run of events: how long to handover, how many crews on tonight, the likelihood of copping a late job. I look back across that wretched stretch of humanity and catch Frank’s eye from where he waits with our patient. He is so focused, even at this distance he makes his opinion clear with nothing more than a gentle tilt of his head.

***

‘Okay. We can do this one and still finish on time. Buckle up.’
I put the truck in gear and edge forwards, but the A&E car park is impassably jammed with ambulances, taxis and cars. Frank surveys the scene for a second, then unclips his seat belt again and leaps out. He strides up to three cars in turn, giving firm directions to each. They follow the pattern he lays down – back up a foot; turn into that space; reverse into there; you, forward an inch, stop. Then he jumps back in the cab. ‘Go,’ he says, and calmly crosses his legs; we cautiously shimmy out through the channel like a ship through pack ice.

***

Mr Montague’s son, Jerry opens the door to us. A man in his thirties, he smiles with the wide, peg-toothed simplicity of a child. ‘Hello!’ he says. ‘My dad is on the floor. I did what the lady said. I did what the lady said to do on the phone.’
‘Okay Jerry. Through here, is it?’
‘Yes. Through that door, there. He’s on the floor, but I left him there, like she said.’
You would think the flat had been abandoned years ago. The bulbs are unshaded, the filthy curtains hang limply across the window frames, the carpet is tacky with ingrained dirt. The air has a rancorously sweet cut to it; it swirls around us as we move through, like the inside of a chocolate swiss roll.
Mr Montague is lying on the floor beside a ruined sofa, feebly clawing up at a plain wooden kitchen chair. His pyjama bottoms have ridden down, and the hollow scoops of his pelvis stand out like a dreadful signifier of his decrepitude.
‘How long has he been on the floor like this?’
‘I left him there like she said to leave him.’
‘Jerry? When did you see him up and about last?’
‘I did my jobs today. He hasn’t been very well.’
‘No? What’s been the matter?’
‘I don’t know. Not very well.’
‘Does anyone come in to help?’
‘Does who?’
‘Do you get any help?’
‘I help.’
‘Right.’

I go back down to the truck to fetch a chair. A neighbour from one of the ground floor flats comes out to see me, smoking nervously and clutching the pink towelling bathrobe around her.
‘Sorry to butt in, but – can I have a word?’
‘Sure.’
‘Is he all right?’
‘I don’t think he’s great. He might have been on the floor a while. We’re taking him in to hospital.’
‘Good, ‘cos it can’t go on like this. We’ve been on the phone to just about everyone, and no-one seems to take us seriously. They’re not coping. His son’s got learning difficulties and they’ve always lived together, but have you seen the state of the place these days? Well of course you have, you’ve just been up there. Just last week Mr Montague was walking about in the gardens in a right old state, didn’t seem to know where he was. He’s refused help time and time again and you can’t force someone, can you? And the doctors and whatnot just seem to take the attitude that unless he asks for help they can’t do much. But it can’t go on like this, can it? You’ve seen what it’s like.’
‘We’ll do our best to get things going. I think you’re right. Something needs to happen.’
‘I mean – it’s a shame. But enough’s enough.’
‘Thanks for your help.’
‘You’re welcome. Just make sure they get the picture.’

But the picture I get is of us wheeling the decrepit husk of Mr Montague in through the A&E doors, Jerry shuffling along beside the trolley holding his hand, as we excuse our way in through that melee of competing claims, to bid for a bed, to bid for attention, and a quiet place in which to give it, for everyone to have a clear chance, Mr Montague, Jerry, the other patients, their anxious friends and relatives, the overworked hospital staff, and us, the ambulance crew, cleaning up as quickly as we can and hauling our exhausted frames back to base, to finish another long, long day at a reasonable hour, and make it back home.

before dawn

Low down and dozing in the seat, my knees wedged up on the dash. The interior lights are off but the engine is still running, the radio tripping quietly in the background. Dark figures move around the hospital forecourt, smoking, chatting, making calls, occasionally hurrying out from the lobby into taxis. The night is warmer than it was and a fog is coming in from the sea, rising up over the wall in hectic, luminescent rags. I watch the perimeter streetlamp; it darkens and dims, darkens, dims, as the fog rolls around it; and after a moment it’s easy to imagine that it’s not the fog moving but us, and that this is the deck of a ship, and we are its crew, standing or sitting, alone or in groups, all lit by that fitful orange lamp, sliding inexorably together into dissolution.

I am fading. Lain down and done. I see rather than feel my mouth slackening, my breathing becoming heavier. I am the ghost of an ancient photographer asleep behind the drapes of his tripod, dreaming images onto the plate:

a man shouting and crying, raising his arms; a police officer swiping them aside and speaking sternly;

a Community Responder kneeling in the hallway, bobbing up and down like a beam pump;

the livid red marks around the young girl’s neck from the dressing gown cord she hanged herself with;

the lightless pits of her eyes;

the co-ordinated mess of the effort to save her; the tubes, chemicals, syringes, pads; the paramedic coolly speaking to himself, watching himself – sharps away - the right thing done, the right order;

outside for more equipment; faces on the verge, watching and shivering;

the inconsequential weight of her as we snap the scoop stretcher into place, top, bottom; can we use the dressing gown to lift her hips a little? thanks.

the slick, blue fury of the drive to hospital; a car, pulling over to the side of a deserted street, putting on its hazards and watching as we pass;

the faces gathered round the trolley in resus all looking in our direction as we push through the doors; taking over compressions, thank you;

the facts; the flock of gloves efficiently following their appointed movements;

the police officer outside resus, opening a notebook;

liaising with the second crew; swapping back equipment that got mixed up on scene; tidying the back of the truck;

retrieving the scoop from resus; the doctors and nurses have dispersed now, the few that are left in the room are detaching lines, moving apparatus aside, finishing off, insulating themselves with banality;

the immature line of her hips as we ease the scoop stretcher apart; and on settling again, the gentle tipping inwards of her toes;

a cup of coffee, a sheet of paper, picking white fluff from my trousers;

climbing into the cab, turning the lights off, sliding down into the seat, the fog flowing up over the perimeter wall, the lamp beginning to move, and letting myself be dragged along behind it, irresistibly out to the very furthest line of that black horizon, the limit of the world, where the sun must surely rise again soon, as it always has, and people wake to see it.

a vase of flowers

A broad and pleasant tree-lined avenue. Most of the Regency houses have long since been sectioned up into flats, but still, from the street at least, they maintain a facade of wholeness. The black wrought iron railings, Grecian porticos, black and white tiled thresholds and intricately leaded porch windows make me feel we should really be pitching up in a carriage and four rather than an ambulance. But the rack of chrome buttons by the front door are a reminder that time has moved on.

Mrs Mackenzie comes to the door.

‘Oh. You’re here. Come in.’
She turns and leads us past the letter boxes, bicycles, notices, hand-written reminders and alarm consoles, diagonally across the hallway to her front door. She shuffles like a careworn, domestic bear in a purple roll-neck top and brown slacks, a little absent, as if a long hibernation had been interrupted. We follow her into a bright and comfortably furnished studio flat, with silver family photos and porcelain nick-nacks on the mantelpiece, and a radio playing softly in the background. Mrs Mackenzie silently manoeuvres herself in front of a black leather sofa, then sits down in two distinct stages – the first, a slow and cautious bending of the knees; the second, a sudden release past the tipping point, dropping down with a gentle sigh. The silver haired cushion at the other end of the sofa turns out to be a cat. Bounced awake by the shock wave, it gives her a murderous look, then hurries away into the bedroom.
‘What seems to be the problem?’ says Frank, drawing up a chair. ‘Why have you called us?’
‘I don’t know. I’m not sure.’
‘So talk us through it. What happened this afternoon?’
‘I was at the hairdressers and I didn’t feel right.’
‘In what way?’
‘I’m not sure.’
‘Were you in pain? Did you feel sick or dizzy or short of breath?’
‘No.’
‘Any pins and needles anywhere? Numbness, loss of control? The shakes?’
‘No.’
‘Okay. So what did you do at the hairdressers?’
‘I came home.’
‘Right. Then what happened?’
‘I’ve got these numbers you see.’
She leans forward and picks up a neatly typed list of names and numbers from the coffee table.
‘I wanted to ring Janice to cancel her for this evening.’
‘Who’s Janice?’
‘Janice. My helper.’
‘Okay.’
‘But when I tried to dial the number, I just couldn’t do it.’
‘Do you mean your fingers didn’t work properly?’
‘Not really. And then when I got someone on the phone, I couldn’t find my words.’
‘Do you have any of these funny feelings now?’
‘No. Everything feels fine.’
‘Nothing untoward at all?’
‘No. I just feel a little foolish.’
‘Let’s do a few tests and see what’s what.’

***

Mrs Mackenzie is reluctant to come to hospital.
‘How will I get home?’
‘There are ways and means. The important thing is to get you checked over by a doctor. Worry about getting home later.’
‘But am I all right?’
‘Everything looks fine now, but there’s a chance you might have had a mini-stroke.’
‘But I’m all right now?’
‘Now, yes. Don’t worry about it. These attacks are quite common. But you are more at risk of a bigger stroke, so you should definitely come with us up the hospital now. Your health is more important than anything else.’
‘Yes. I suppose. Will you call Janice?’
‘Yes, I’ll call Janice. Let’s get your meds together, your coat and keys and whatnot. Okay? No rush. Let’s make sure we get everything.’
We help her up off the sofa. She wanders around the flat, dropping things into a carrier bag, muttering to herself. I leave a message on Janice’s answer machine, then open the door ready to go. For the first time I notice the strange vase in the centre of the mantelpiece – an old, craquelure white ceramic head of a smiling young woman, her eyes closed, the top of her head cut off above the ears; and from the hollow space there, a bunch of young carnations rising up in delicately spreading whorls of pink and red.

a day out

Cal and Lenny have just returned from a long and complicated job and look about finished for the day. Cal grunts and shuffles off to the kitchen; Lenny throws himself down in a chair, his legs flying up to come crashing back down onto the expertly timed, flick-up foot extension. He looks like the marionette of a grizzled wild west lawman, chucked back in the box after a showdown.
‘Well that was fun,’ he says.
Cal and Lenny have about a million years of service between them. They joined the ambulance service sometime after the last ice age but before Kennedy was shot. Together they’ve stepped out of a hundred makes of ambulance onto a hundred thousand scenes – every conceivable variety of tragedy and triumph, every kind of weather, all hours of the day and night. Their long years of work weigh in their faces, but they carry their experience well, as if the best and the worst has blown itself out now, and all they really need is somewhere warm and comfortable to put their boots.
‘What happened then, Lenny? I heard you had to come back for the bariatric truck.’
‘The guy was big. I mean phenomenal. Seriously. It was incredible. Forty stone and he collapses on the toilet – a tiny little shitter he must have to grease himself to fit. So then the fire brigade arrives. They take the door off, then a wall and window so we can get him onto this special lifting canvas and out with a cherry picker. Six of them, two of us, and even then it’s touch and go. So we get him down to the truck. You know the specially wide trolley? Well that almost gives up. Creaking and groaning. The hoist practically burns itself out dragging him on board. And then driving to the hospital – well, we were so low I thought I was back home, ploughing. But we get him to hospital, and there’s a team of porters standing by, and we rope them all up like huskies, heaving and dragging to get the poor sod inside. Cal was cracking the whip. Get on there! Come on! So then we get him inside and the charge nurse has to discharge about a dozen patients to make room. And then the doctors all come and have a butchers. Mm, they say. He’s going to need a CT scan. But he won’t fit through the hole, and anyway we’d never get him on the table. I know, says one. We’ll send him over the zoo. They’ve got a really big scanner there for the elephants. It’s okay. I’ve seen it done before. And he’s on the phone arranging it when the guy arrests, and that was it – game over. So he never got his day out at the zoo after all.’
Cal comes back into the room with two cups of coffee. He hands one to Lenny, then walks slowly over to a chair and lowers himself gently down into it.
‘The zoo!’ says Lenny, his eyes sparkling through the wisps of steam from his coffee. Then he settles back in the chair, and the two of them drink in silence.

old wounds

The flat is in uproar. Joyce is having her hair done by Janice’s friend Mary; she is sitting in a plastic bib at the kitchen table, her excitement as tightly wound and brightly coloured as the curlers in her hair; Mary is holding up her hands in their yellow washing up gloves like some crazed surgeon, chasing Joyce’s husband Harry out of the kitchen and back into the sitting room. Janice is still on the phone, and waves pleasantly as we come into the room. When Mary turns Harry round with the points of her elbows, we see the knitting needle he sat on sticking out of his butt like an arrow.
‘Wait a minute,’ he says. ‘Just a minute.’
‘What have you been playing at, Harry?’ says Frank, dumping his bag on the floor and going over to him. ‘Cowboys and Indians?’
‘I – what? No – you see – Joyce had to have the table for her hair, so we swapped places. Only she’d left her number sixes on the cushion, and I got one up me jacksy.’
The needle has gone through his jeans, the tails of his shirt, his boxers and about an inch into the flesh at the top of his right buttock.
‘They told us not to pull it out,’ says Joyce.
‘I don’t think you could pull it out,’ says Harry, wandering over in her direction. ‘But have a go, by all means.’
‘No! I’m not pulling it out. Who d’you think I am? King Arthur?’
Harry looks at us. ‘You see what I have to put up with?’
Frank gets out his shears.
‘Good god! What are you going to do with them?’
‘Just a little minor surgery, mate. Don’t worry. I’ve read all the manuals.’
‘Oh, yes? That’s encouraging.’
‘We’re just going to cut your jeans around the needle so we can inspect the wound. Sorry. I hope you weren’t too attached to them.’
He shrugs.
‘What can you do? If they’ve got to go, they’ve got to go.’
‘Exactly.’
I help support the needle and stretch the material whilst Frank makes a few neat cuts. We get down to skin level, and Frank gently feels around the wound to get an impression of the depth and severity of the injury.
‘It’s gone in about half an inch, but it’s a fatty part of the body, so there are no other organs or blood vessels to worry about. We can pull it out for you if you want.’
‘Yes. Go on. I’m not bothered. It’s nothing to me.’
He points over to a glass display cabinet on the wall. Pinned to the red velvet of the case, a line of old battle medals.
‘See that?’ he says. ‘When you’ve had lumps shot out of you in North Africa, shrapnel in the leg at Suez and your eardrums blown out in Korea, you don’t worry much about – oh!’
He turns round and looks at Frank, kneeling on the carpet behind him, waving the knitting needle in the air.
‘There you go. That wasn’t too bad, was it? Now then. When did you last have a tetanus?’
Frank stands up and hands the needle over to Joyce, who makes a face as she takes it.
‘I’m not using that,’ she says. ‘I know where it’s been.’
‘You could always frame it like his medals’ says Frank.
Harry wanders over, rubbing the seat of his trousers. ‘Good idea. Maybe then I won’t end up sitting on it.'

case solved

‘A blue tag? Not heard of that before. Patient has history of exaggerating illness or injury for pain relief. Lovely.’
This street is so narrow and the terraced houses so tightly packed together it’s a good thing all the PVC doors open inwards. Frank has to drive half on and half off the pavement to make any progress.
‘This is it.’
He manages to leave just enough room to lower the tail lift, but at these angles it’s debatable whether we could ever really use it. I can see a young girl waiting for us by an opened door, hugging herself against the chill, watching us park up, smiling sweetly.
‘It’s my mum, Susan,’ she says, stepping aside to let us in. ‘Top of the stairs on the right.’
She quietly follows us up the narrow stairs, then stops outside the first bedroom on the landing, a teenager’s purple retreat: Twilight posters, CDs, school books.
‘I’ll be in here if you need me.’
‘Thanks.’
She tucks herself away with practised economy.

Susan is groaning beneath a voluminous caramel coloured duvet, the back of her left hand pressed melodramatically to her forehead.
‘Oh god, it hurts.’
She slaps the bed with the flat of her other hand, submitting to the pain, wrestler-style.
Frank makes his introduction; Susan squints, then says: ‘Help me’ as soon as he finishes. ‘Please. Do something.’
‘So. Tell us what’s been happening, Susan.’
‘I’ve got this excruciating pain in my groin. Here. It goes all the way down. And now it’s starting up the other side.’
‘How long have you had it?’
‘Two weeks, but it’s much worse tonight.’
‘Have you seen your doctor?’
‘A few days ago. He wanted me to have a blood test, but I just forgot. I’ve been so tied up I didn’t get round to it.’
‘Why did he want you to have a blood test?’
‘He thinks the pain is tissue damage related to my anaemia.’
‘Oh? I’ve not heard of that before. And when you say tied up, what do you mean?’
‘My brother’s dangerously ill in ITU. I just haven’t been able to think about anything else. And then today the pain got worse and worse. So I came to bed, and now I can’t move.’
She looks at us with a doughy expression of need. ‘Help me.’
We’re both mindful of the blue tag, but she seems quite plausible.
‘I’m going to be sick.’
Susan suddenly sits herself up in the bed and makes a flapping gesture of urgency in the air. Frank passes her a bucket from the side of the bed; she dips her face into it, her lank, yellow hair effectively curtaining the event, and makes a noise like an angry bear growling in a cave.
Eventually she pulls back, wipes her mouth with a tissue, drops it in the bucket, places the bucket back beside the bed, then flops back inertly onto the pillows. I move over discretely and glance down. There doesn’t seem to be anything in it.
‘Have you had any diarrhoea?’
‘No. That’s normal,’ she says, breathing rapidly. ‘Aren’t you going to do anything? I don’t know how I’m going to get down the stairs,’ she adds, squeezing her eyes shut and rolling her head from side to side. ‘This pain is unbearable. I can’t move my leg at all.’
‘We’ll help you,’ says Frank, moving round to her side and feeling her pulse. ‘There’s no rush.’
I step back onto the landing and knock on her daughter’s door. When she comes out she’s unhooking a pair of iPod earphones, smiling benignly.
‘Is she going to hospital?’ she asks.
‘Well, she’s in pain, so hospital’s really the only place,’ I say, studying her response, shambling and innocent as Lieutenant Columbo.
‘I’ll get her meds and slippers,’ she says, and moves quietly downstairs.

I glance back into Susan’s room. She is sitting up on the edge of the bed holding on to Frank’s hand. They hold their position and look out at me, framed through the doorway like a moral Victorian painting.

‘I don’t think I can take any weight on it,’ she says, waggling a plump foot in the air.
‘You can always shuffle down the stairs on your bottom,’ says Frank. ‘There’s no rush.’

***

At the hospital, Frank waits with Susan whilst I go round to the nurse’s station. Susan reclines on the trolley, an entonox mouthpiece clamped between her teeth, drawing on the regulator like a professional diver.
‘Shan’t be a moment,’ I say.
Frank folds his arms and gives me a level smile.

Rachel, the Charge Nurse, is complaining to a student doctor about her bra strap.
‘It’s been chafing like a bastard all night,’ she says, squirming on her office chair. ‘I’ve wrapped some gauze round it, but honestly, I’m fit to kill.’
‘Where did you buy it?’ I ask, laying my clipboard on the counter.
‘Primark. Though what it’s got to do with you I don’t know.’
‘Primark? Buy cheap buy twice.’
The young doctor nods sagely. ‘That’s true,’ she says. ‘He’s got a point. Primark’s carp for bras.’
‘Anyway. What’ve you brought us? Something nice?’ says Rachel. ‘Jesus. Honestly. I’m going to scream.’
‘Well. I have to say this is a strange one.’
‘You’re not selling it.’
‘There was a blue tag on this patient’s address.’
‘Whatever that means.’
‘I know. I’ve not heard of it, either. But it seems to be some kind of warning. It said the patient acts up for pain relief. I’ve not come across her name before, but I wonder if you have.’
‘What is it?’
She swivels the board round and reads the name.
‘Yes – do I know Susan!’ she says. ‘It’s one of her aliases, anyway. I’ve been treating Susan since I started my training here, and that’s a long time. Munchausen’s. She fakes it. There’s nothing wrong with her. Have you given her anything?’
‘Just Entonox.’
‘Take her off it.’
‘So tell me about Susan.’
‘She’s a phenomenon. I’m surprised you’ve not met her. Just under the name Susan she’s had four hundred attendances in the last couple of years alone. What’s she come in with today?’
‘Groin pain.’
‘Yep. Seen that. But you know her favourite thing is to wait in a field for some ramblers to walk past, then lie down and pretend to have been kicked in the head by a cow. Fits, unco, the works.’
I feel a sudden chill.
‘Or maybe a horse?’
‘Yep. Horses. She’s been kicked in the head by a horse a few times.’
‘Was she brought in by helicopter just before Christmas?’
‘Why? Were you on that one?’
‘Me and a dozen others.’
Rachel shakes her head.
‘It’s outrageous. I thought there was supposed to be a management plan in place.’
‘So what happened when she was choppered in that time?’
‘A full trauma call went out and the team was waiting in resus. When the trolley came in, the consultant took one look and said “Oh, for fuck’s sake – it’s Susan”. Then they all threw off their aprons and walked out. She was sat up and out of the department in under ten minutes.’
Rachel leans forward, arching her back and shoulders to get relief.
‘The weird thing is, her family are absolutely lovely. You’d think they’d give some sign this was all a bizarre charade – but I suppose they’ve just grown up with it, and it’s a part of their lives.’
‘I’ll bring her round.’
‘Do. I look forward to seeing her,’ says Rachel, grimacing. ‘But don’t go using pat slides – she can transfer perfectly well herself. And take her off the Entonox. And tell her to cut the amateur dramatics because Rachel’s on duty, she’s tired, she’s in a cheap bra and she’s in no mood to fuck around.’

one thing

The late night, mini-supermarket security guard is too big for his shirt. The collar squeezes his neck so hard it seems to distort his head, like someone has taken a partially deflated pink balloon, nipped it half way and drawn a face on the bulge.
‘He was all right when he came in. Well – drunk,’ he says, rubbing his nose on the back of his hand and staring down at the man who is lying half in and half out of the doorway. ‘You couldn’t just drag his feet inside a bit, could you? Then I can shut the doors.’
The moment after we do that a small crowd of zombied clubbers run up against the glass. ‘Let us in. Come on, man. We only want a few things. It’s not eleven yet.’
The guard glares at them and gestures with his hand.
‘Piss off. Can’t you see it’s an emergency?’
They move away, but one of them stays to press her face up against the window, making a shielding bridge with her hand to see inside. Then she takes a step back, and clatters off to catch up with the others.
Meanwhile I’m attending to the patient. He lies on the floor like a washing machine tipped on its side with the door open, a prodigious mess of blood, beer and noodles emptying out of him, fanning in noxious waves across the floor and on into the store. He snores horribly, ropes of blood and what looks like wallpaper paste spattering out of his nose.
‘Tell me what happened again?’ I ask the guard as I fiddle around trying to get an airway in. I could be James Herriott in a barn; any minute now I expect to land a bloody calf on the anti-static mat, but then he vomits copiously again and feebly tries to bat me away.
The guard takes a step back.
‘Jesus Christ. Okay. Yep. He wandered in, headed for the booze aisles, obviously drunk. I politely turned him round by the shoulders and led him back to the door. We even had a little laugh and a joke. Then he seemed to stumble at the entrance, slid down the wall, passed out, and started being sick.’
‘Did he have a fit at all?’
‘You mean did he shake? No. Not that I saw.’
‘Have you seen him before? Do you know his name?’
‘No idea.’

I’m on the car, so I strip off my gloves, stand up and radio for back-up.
‘There’ll be an ambulance along in a minute,’ I tell the guard as I clip the radio back on my belt. ‘Whilst we’re waiting, I’m just going to get a couple more bits of kit. Are you all right here for a second?’
‘Yes. Yes. You get what you need, son.’
He pulls a bunch of keys out of his pocket with a silver chain, then shakily activates the door again. I’m parked right outside, so I don’t have to go far.
When I come back, the guard is arguing with a young guy who wants to go in to the supermarket.
‘I only want one thing,’ says the guy.
‘How many times do I have to tell you? We’re closed.’
‘But it’s not eleven yet.’
‘It’s a medical emergency.’
‘What emergency?’
I come up next to him and for a second there’s the guard, me with a squawking radio, the body on the floor surrounded by a lake of bloody vomit, and the guy. He looks at all three of us, hesitates, then goes to step over the body. The guard grabs him by the shoulder, hauls him back, and shoves him outside again.
‘Out you go.’
‘But I only want one thing,’ he says, then stands back on the pavement, breathing heavily, flexing and bunching his fingers, like a stunt man screwing himself up to take a long, running jump.