Monday, December 24, 2007

Ralf's room

The elderly mother appears before us in the hallway, as flattened and fixed by her pain as the cardboard figure of a wraith in a Victorian toy theatre.

‘They’re upstairs’, she whispers. ‘Please hurry. Please help them.’ Her husband wraps her to him and manages a smile as I excuse myself past them and struggle up the narrow staircase.

My bags catch on the crudely wrought statues, dusty fossils and stacks of books that are piled on every step. Annuals and encyclopaedias on each level, a precariously balanced collection with no book published later than the 1960s, and the drawings and paintings on the wall looking like the work of a precocious ten year old.

The message on our terrafix had read: ?Cardiac arrest. Male, aged 53.

On the landing I can hear a woman calling ‘Hello? Over here. In this room.’ I follow the voice into a close and cluttered place. It feels like I’m entering a big red nest spun from raw information, every smallest inch covered with collages, maps and portraits, every standable space occupied by a crudely designed piece of furniture, a statue or a little pile of rocks.

The voice comes from the other side of the unmade bed. A middle-aged woman is kneeling beside the body of a bearded man, his arms raised up in front of him like the pastiche of a sleepwalker.

‘They’re here now’, she says into the phone she is holding, and immediately throws it onto the bed, of no more use to her. She stands up and looks at me.

‘I don’t think you’ll be able to do anything.’

I touch her on the shoulder as I move to take her place. She hooks a loose strand of hair back behind her ear and steps aside for me to have a closer look.

Her brother has been dead for some hours. Even though his torso is still slightly warm, peripherally he is mortally cold; where his pyjamas have ridden up you can see that his skin is adopting the blotchy patches of post mortem staining as his blood pools. Rigor mortis has fixed his arms and legs in position, and his neck holds his head straight back on the pillow. His face has the colour of ruined sausage - a dreadful, mottled puce, and his tongue pokes out between his lips.

‘When was the last time you saw your brother?’ I can’t quite bring myself to say ‘alive’. Not yet.

‘Last night. About eleven. Then when he didn’t come down for breakfast…’ She looks at me and presses her lips together. ‘He’s dead, isn’t he?’

‘I’m afraid he is.’

‘I thought he might be.’

She turns round and brushes her skirt. Then she adds, quite matter of factly, ‘Mother is going to take this hard. She buried her sister last week.’

At that point the mother comes into the room, and the father peers round the door behind her. A delicate, desiccated couple, they stare over at me kneeling beside the bed as if I were the strangest thing, a polite but terrible angel come to visit from the future to pray beside their child.

‘Can you - help him?’ she asks me.

‘I’m very sorry – but there’s nothing we can do. Your son is dead.’

She shapes her mouth around a fathomless howl and shrinks a little into herself. I look away, and stroke the hair from her son’s face. ‘I’m very, very sorry for your loss.’

My colleague tells her that we will put her son back to bed and make him comfortable. The mother has to be supported out of the room by her husband and daughter. We lift her son back onto the mattress, arrange the sheets around him, close his eyes and reposition his arms as best we can. I find a chair and place it beside the bed. I go out onto the landing and ask if the mother wants to come and sit with her son. She lets me lead her to the chair. The father stands beside her, and steadies her as she leans forward to stroke her son’s face. I go downstairs to get some more details from the daughter.

Thursday, November 08, 2007

coming up for air

I slow down as I turn from the main drag into the street, shut the blue lights off, creep along on the lookout for a man on the pavement. Then up ahead, the familiar one hand waving, one hand holding a mobile phone to the ear; I sprint up to him, grab the torch, and we both climb out to see what’s happened.

The man who is patting his mobile phone away has the sharp chin and tailored suit of a model. This could be a photo shoot, if it was not past three in the morning, in the freezing dark, by a figure groaning up against a wall. The man’s demeanour is equally clean.

‘Thank you so much for coming. This is how I found him. It looks as if he has a nasty head injury. He keeps saying he’s been assaulted.’ And then he adds, as a favour: ‘I’m sorry, but would you mind if I carried on my way? I’m already disastrously overdue.’

I wonder where he could possibly be headed – but smile and thank him for his help. He clips smartly away, and we turn our attention to the patient.

He is curled on his side in a semi-foetal position, making a mewling noise, and screwing his features up into a childish expression of the hurt done to him. Rae tries to get him to talk, whilst I use the torch to look him over and establish the nature and extent of his injuries. He has a small gash on the crown of his head and some minor abrasions on his torso, but nothing serious. He reeks of alcohol and unwashed clothes; on the face of it, here is a drunk who has fallen and caught his head on the wall, but we need to find out more.

‘They beat me up! They beat me up! Why would they do that?’ he cries. But, strangely, his tone then turns completely around in an instant and he says, quite conversationally, ‘You seem nice. Do you like what you do for a living?’

We help him to his feet, and he stands competently enough.

At this point the police arrive in two cars, and the scene takes on a much brisker, more official demeanour, with blue and white police tape around where the man had been lying, and someone with a notebook writing things down.

‘What are the nature of the patient’s injuries?’, a policewoman asks me. ‘Was he attacked? Is he going to hospital?’

I tell her that we’ve found out his name – Darren – but apart from a rough outline of his injuries, we haven’t found out exactly what happened to him yet. I tell her that we’ll give him a thorough examination on the vehicle and let her know. We half prop, half pull him up the stairs of the ambulance and sit him in a side seat.

He is effusively grateful. I keep having to tell him to keep still whilst I take some obs and begin cleaning his head wound. His behaviour is bizarre – obviously influenced heavily by alcohol, but something else, too. Drugs? Head Injury? He certainly struggles to answer any of our questions, but instead repeats himself constantly, telling Rae she’s nice and asking her if she likes her job. He also drops into a clownish version of despair every now and again.

‘Why would anyone want to beat me up?’ he wails. ‘Why? Why?’

And then, smiling, as an afterthought, brushing some bloody hair from his face: ‘It’s so important to like what you do.’

Just then another policeman knocks on the door, and asks me to step outside for a moment. Rae is happy to carry on with the examination, but as I get up the policeman gestures for the policewoman to take my place. He obviously has some concerns, so I swap places and jump down to talk to him.

‘I know this guy. He’s a piece of work. He lives in a lovely house just round the corner. Absolutely loaded. Used to be a diver, working rigs in the Far East, Africa – you name it. I’ve been out to him a couple of times, always domestic violence. He’s got several convictions for assaults and generally drunk and disorderly.’

When I re-open the back of the vehicle, Rae gives me a look to let me know that although she hasn’t got the whole picture, she understands that a police escort in the back is necessary. I shut the door again and we set off for the hospital. I can hear Darren telling the policewoman how beautiful she is, and then in a moan that he hasn’t done anything wrong.

At the hospital it transpires that Darren is known to the staff. Another regular to add to the list. One of the nurses tells me that I should see the CT Scan of his head one day. Apparently his ventricles are so dilated by the effects of alcohol abuse it’s like someone’s been at his brains with an ice-cream scoop.

‘It’s a wonder he can function at all,’ she smiles.

As we wheel him into a cubicle, Darren raises himself up on his forearms. He looks up at the policewoman and squeezes one eye shut in the gross approximation of a wink.

‘We had a job once. In Japan. No-one knew a thing about it. We had to locate four hundred tonnes of gold bullion. We stayed in that chamber a month.’

He settles himself back down onto the trolley.

‘You’ve got some stories,’ the policewoman tells him. But he looks back up at her, without the slightest recognition at all.

Friday, November 02, 2007

moving on

Red car. Man slumped at wheel sounds interesting. It’s a minute from the ambulance station, too – a rough strip of road that cuts through a spread of allotments just above the cemetery, a rat-run between main routes. It’s the city’s shabby little version of Mulholland Drive, with sheds instead of penthouses; at night it’s like flying out above the city towards the sea.

Just as Rae turns the engine over and I write down the incident number and location, Control tells us that the police will be attending. At the same moment a patrol car rushes past the station exit up the hill.

‘Damn’, says Rae. ‘I wanted to get there first.’ She slams out of the car park and away after them.

Turning into the Drive I can see the splashing blues of the police car a little way off in the distance. As we careen along the poorly lit road, our blue lights tag after theirs, and we become mad paparazzi in the dark, wasting our film on some chain fencing, a group of kids, that tree.

They pull over behind a sports car without lights on the right hand side of the road. Rae hauls up immediately alongside. If the man has had a heart attack, time is everything, and we can worry about parking niceties afterwards. We both jump out. There’s a policewoman standing at the driver’s door. Rae goes to that one, and I pull open the passenger door and look inside.

As always on an incident – especially with high adrenalin calls, and especially at night – the details come to you in bursts. The challenge is to make sense of the scene as calmly and quickly as you can. Simple questions: Is there danger here? What’s happened? But although simple questions work best with simple answers, it’s an effort of concentration to ignore the peripheral and make straight to the essential.

In this case, the essential seem to be: a middle-aged man with facial injuries, conscious and breathing; car cold and not smelling of fumes; no sign of weapons.

Rae is the other side of him, now. We have him in a cramped little cross-fire of inquiry, both verbal and non-verbal. A torch to have a good look.

He smells of drink. I’m about to kneel in a pizza box. The back seat is rammed with clothes, other stuff. He can tell us his name, but is disorientated and slurred. Drunk? Or head injury? Is he sleeping rough in this car and has been beaten up? By those kids we passed?

A second patrol car has arrived. They are standing outside the car, one on the radio trying to get information on the licence plate, the others chatting about other things. There is a palpable sense of stepping back two or three levels from screaming emergency to Thursday night mystery. Who is he?

We help him out of the car. He is a heavily built man with a coarse goatee beard and an Eastern European accent. He is dressed like a shabby professor in a T-shirt that says: Don’t ask me to do anything. I’m retired, beneath a brown corduroy jacket.

‘I’m okay,’ he slurs, almost falling backwards as we manoeuvre him up the back step into the ambulance. We sit him down, shut the door, and take a breath.

‘Now then, let’s have a good look at you.’

His facial injuries are old, probably a few days, but it does look as if he had a beating. His nose is certainly broken. And he is definitely drunk. He has that slow, deep-and-off-to-the-side detachment from everything. He looks at his hands to move them. When I ask him for his surname he spells it out one fat letter at a time as if this is the first time he has ever really considered what his surname was or could mean.


‘Burows?’ I say, just as he continues with a K and an I.


He nods. We have arrived somewhere awful and he squeezes his eyes. Another policewoman looks into the back and tells us that they have to go off on another call and are we okay? I tell her we are. She shuts the back door again, and we are left to piece his story together.

He is from Poland. He has been living in the city for ten years. His girlfriend has left him. His friends – he shrugs. His life – he makes a sad little gesture with both hands down towards the floor, like a man in handcuffs being dragged down a well. He had an accident three days ago and was in hospital until this morning. He is sleeping in the car. He thinks he’ll call his brother in Poland in the morning. Maybe he should move back there.

He looks steadily at me as I undo the blood pressure cuff.

‘You came at the wrong time,’ he says.

I tell him that we think he should come with us to hospital for observation, because he’s had a recent head injury and we can’t be sure that his current condition is solely due to alcohol. But he does not want to go to hospital. He wants to get back into his car and go to sleep. So reluctantly we end up helping him back off the vehicle, and when we say goodbye he is standing with his driver’s door open, nodding a farewell – which would, in any other circumstance, be a normal scene, except here when we leave it will be very dark, and the night is coming down cold, and all four tyres on his little red sports car are flat.

Thursday, November 01, 2007


‘Don’t you dare look at me – aren’t you nice? – you’ve seen worse - I haven’t got my teeth in – toy boy like you – what’s your name? – I had a man who wanted to see me again – he was only forty four – I said I’m seventy three – he said I don’t care - just don’t look at me – oh, I do feel dizzy...’

We are sitting like disciples around her, Rae, me and the psychiatric nurse who called us out this morning. We nod and smile sympathetically, but we are mutely aware that our collective life force is being leached away by this woman. If people can really be classified as either radiators or drains, this woman is an oceanic trench. Her monologue is a hypnotically plosive drone, her wrinkled mouth wobbling around the words, her light blue eyes flicking open only occasionally to see if there are still people alive in the room.

The psychiatric nurse smiles at us, and taps her diary encouragingly, directing us back to the idea that time still exists outside this room.

‘Dotty did seem a little breathless and out of sorts when I got here. Sorry if I’ve called you out unnecessarily.’

She opens her diary and writes something in it. I hand Rae the blister pack that contains all Dotty’s medication so she can write it down on the patient report form. There is a crudely written note by the pack – a list of things to do. At the top of the list is 'put teeth in mouth'.

I stand up and approach Dotty to make the serial observations; I feel like an astronaut, bravely alone, moving towards the thrumming source.

‘…That’s the first time I’ve been touched by a man in a long while – oh, I’m getting a funny feeling in my arm – should I take my top off? - my first husband didn’t want to know – left me alone – not this house, another one - when I had my first he was nowhere – it was supposed to be the last baby on Christmas Day – they said ‘when’s it coming then, Dotty?’ – I said, 'there’s something not right,' – I could feel the elbows digging in – then it was the next day – and the next – no-one listened to me – no-one believed me – and then when it came out it took most of me with it – I was in for weeks – stitched me up with an infection and everything turning black…’

Occasionally Dotty pats her head, which is tightly wrapped in a transparent plastic bonnet. It’s as if you can see her brains – yellowing, tightly curled. Her hands are a puffy red, because she spends most of her day at the sink continually washing them.

I finish the health check and everything is fine. Rae patiently begins the build-up to our leaving, weaving in little encouragements and pieces of advice between Dotty’s constant output.

‘….what if I go unconscious? – what happens if I fall over? – at least you didn’t leave the door open – I used to have a dog, but he ran away – the last ambulance who came out left the door open – they pulled faces at me and didn’t give a damn – you’re all nice, though – especially you – oh, listen to me – did I say that? - everything’s swimming – I suppose you’re going, too, now….?’

I pack our equipment away and back away, nodding and smiling, through the door. The psychiatric nurse, clutching her diary like a bible, throws us a brave smile as we go.

Wednesday, October 10, 2007

start to finish

‘Help me!’
As we push our way into the cluttered bedroom the elderly woman slumped on the edge by the head end throws us a look pressed with fear. She is such a ghastly white colour, and the sheen of sweat on her face and body is so immediately apparent, that without saying anything to each other Rae and I cut the usual preambles and set to work more quickly. The woman has cans of oxygen – trendy looking things advertising pastel peach and jasmine flavours – scattered around her across the rumpled duvet. I ask the intensely worried man who gestures for us to go ahead of him into the room what his wife’s name is.
‘And how long has Elsie been like this?’
‘Fifteen years.’ Then he realises what he has said. ‘But not as bad as this, of course.’
‘Help me, please!’, she gasps.
Simply getting round to her is difficult; getting her into the chair will be a struggle. And from the way her abdomen balloons out underneath her soaked nightie, the two flights of stairs and the dark jaunt across the lawn will be a serious challenge.
I pull out our oxygen cylinder from the resus bag and fit a mask together as quickly as I can. Rae establishes that Elsie does not have chest pain at the moment, does suffer with angina, has been breathless all day but acutely short of breath for about half an hour. I step over the piles of clothes, books and boxes to put the mask on her, but she wrests it away, saying that she can’t have her face covered.
‘I’m scared,’ she whispers. ‘Please!’
Rae holds the mask back up and insists she wear it. Meanwhile I put the carry chair together and get in as close to her as I can; Elsie looks at the chair, gathers up a clutch of bedclothes around her and refuses to move. Rae talks to her severely, parent to child.
‘Listen to me, Elsie. Listen, now. You must do as we tell you. If you want help, you have to get into the chair and let us take you down to the vehicle. The sooner you move, the sooner we can get you the help you need.’
Despite her whimpering, and with anxious entreaties from her husband the other side of the bed, we haul her up and into the chair. She has pulled the mask off again. The oxygen hisses vainly into the air. Rae wrestles it back onto her face as I blanket her as best I can from behind. We know that Elsie is combative because her brain is being starved of oxygen. It’s a struggle to move this situation along, and we are aware of the clock ticking.
‘Can you take the bags down for us?’ I ask the husband. His big, crescent moustache, yellow with nicotine, emphasises the mournful expression in his eyes.
‘No. They look heavy. I’m not well myself, you know.’
‘Okay. Don’t worry,’ I tell him, measuring out this effort of control word by word.
Rae grabs the bags, takes them to the head of the stairs, throws them down to the first landing, then comes back to help move the chair. Elsie is at the limit of our lifting ability, but the adrenalin of the situation gives us the extra power we need. Down onto the first landing, I steady the chair whilst Rae throws the bags down into the lobby. A neighbour has come out to see what all the noise is about.
‘Can you collect our bags and carry them out to the vehicle for us?’ I shout down to him.
‘Sure. I’ll just get my shoes on.’
Every little detail is in sharp focus. How each factor may help or hinder us.
We have Elsie outside now. When her breath allows she gives fearful moans. I drag the chair backwards across the lawn. It’s good to be outside; my shirt is already sticking to me. At the back of the vehicle I move the chair into position, climb into the back, and we dead lift Elsie inside. Alongside the trolley, Elsie refuses to move out of the chair.
‘Look at me, Elsie. We can’t go anywhere until you get onto the trolley. You have to do this. We’ll help.’
We count one, two, three, I tilt the chair forwards, and we manhandle Elsie’s bulk onto the trolley. I pull the chair off to the side and then with shaking hands find a nebulising mask and a couple of vials of salbutamol and atrovent to help ease her breathing.
Rae says: ‘She’s gonna go on us.’
I fumble, trying to work even more quickly, but then:
‘She’s gone.’
At the same time Rae has dropped the trolley into a flat position and thumped Elsie in the middle of the chest. The back of the vehicle opens and the husband peers inside.
‘Can you shut the door please?’ Rae shouts over her shoulder. He retreats.
I throw the mask and drugs to the side and pull an airway out of a side drawer whilst Rae rips Elsie’s nightie apart and slaps some defib pads on her. I try to get the airway into Elsie’s mouth, but her jaw is locked tight – probably a hypoxic fit. I toss that aside in favour of an airway that goes down through the nose, as Rae looks at the ECG – some waveforms, but there is no pulse, a condition called PEA, or pulseless electrical activity, which is, in effect, no activity at all. I pull the BVM out of the resus bag and start trying to force air into Elsie, but her airway is blocked. Rae interrupts the chest compressions she has been doing to flick the aspirator on so that we can suck out the vomit that’s clogging up her airway. As we do all this we discuss our options – Rae needs to cannulate so she can start up with the necessary drug therapy; she also needs to intubate, which we know will be difficult as Elsie has such a short, fat neck. We also need to call for back up. I take over compressions and ventilations whilst Rae gets her equipment out. She cannulates quickly, blood spilling onto the floor. These are hurried, pressurised moves. We are aware of Elsie’s husband waiting outside the vehicle, but awareness is all that we have at the moment. There is no time for sympathy. I interrupt CPR just briefly to help Rae try to visualise the vocal chords, but two attempts both fail – the tube goes down into Elsie’s stomach, and trial ventilations only serve to drive up more vomit – more to suck out. Rae takes on the CPR whilst I jump out of the side door and climb into the cab to radio for assistance. I punch the priority button, and when Control answers I simply say:
Resus in progress on the back of the vehicle. Back up to this address, please.
I hear them say that support is on its way from quite a distance. It will be a judgement call whether to run as we are or stay and wait for help.

Fifteen minutes later and the second crew is with us around the patient. The back of the vehicle looks just as if it the ambulance had rolled down an embankment and landed back on its wheels. There are empty syringes, dressings, tubes and blankets scattered around us. Elsie is spread massively across the trolley, arms and legs over the sides. In any other context you would think that this was simply a restless sleeper, but here, in this cramped and clinical chaos, the posture is the undignified sprawl of death.
The second paramedic agrees that the cardiac rhythms we are seeing on the ECG are the random firings of a heart artificially goaded by the chemicals we have shot into her. There is nothing viable here, but we all decide to run to hospital anyway. The other technician says she will take the husband in her ambulance. I jump out into the cab for the second time, pass a brief summary of the situation through to Control, and then drive on blue lights to hospital.

‘My God! This couldn’t be any more difficult!’
The medical registrar at the hospital has climbed on board to assess Elsie. He picks his way through the detritus of the incident with the fastidiousness of someone simply used to more room.
‘I can’t imagine having to intubate in these circumstances. And I have to agree with you – this patient is a definite Category Four.’ This means that even in an operating theatre, using fibre-optics, they would intubate with difficulty. Elsie is declared dead, and the form signed.

When the second ambulance arrives a few minutes behind us, the charge nurse takes the husband to the relatives’ room, gives him a cup of tea, and prepares him for the worst. The nurse tells us afterwards that he had said: ‘I know. I saw them jumping up and down on her chest. I knew it wasn’t good.’
Rae and I realise that the husband will want to see Elsie before we take her off to the Mortuary, so we tidy her up as best we can, and make the vehicle presentable. When we are ready, we send word to the nurse, and he leads him out. We help him onto the vehicle, and he collapses in tears across her. We leave them alone for ten minutes or so, then we help him into a chair to talk about what happened and what we tried to do. We tell him what to expect now, and leave him in the care of the charge nurse.

It’s just after midnight. I ring the on-call Mortuary Attendant. He tells me that we are to admit the patient ourselves. We drive back to base and collect the keys, then head out to the Mortuary, which is located at the end of a discrete driveway inside a large municipal graveyard.

Inside the Mortuary there is bank of fridge cabinets four high and five deep, with a separate section for longer term residents. Each occupied compartment has a label in the door; we identify an empty compartment, then I fetch over the mortuary forklift – something like a pallet truck, with a large white tray suspended in front of it. I raise it up level with our trolley, and with some effort we roll Elsie on to it. Rae goes over to a Victorian-looking ledger, and I shout out the items of jewellery that Elsie is wearing for her to write down. Gold watch, gold chain, wedding ring, ear rings. Her bag of medication, slippers and other things we put in a bag and place this on the tray between her legs. I tie a label to Elsie’s left big toe: her name, date of birth etc. Another label goes in the door. Then I manipulate the forklift into position, and open the door. There is a hard, metallic smell to the fridge, something like a cold, well-cleaned butcher’s stock room. We count to three and then slide her in, feet first. Her arm lolls out to her right, so I reach in to replace it by her side. It lolls back out again. It won’t catch in anything, and I can’t think how to secure it, so I leave it there. The other people in the fridge are all wrapped in white plastic, with only their heads showing, but we haven’t the time or the expertise to do this with Elsie. She will have to wait the few hours till morning. I move the forklift back, and we shut the door. It swings to with a clunk.

Thursday, October 04, 2007

manhattan by night

We’ve just cleared up from our first job of the evening, way out in Oldport. A man had been dancing along the pavement outside his house, playing his tin whistle, when he fell down an uncovered manhole and scraped his shin. I was surprised that he escaped with such minor injuries. He lay contentedly sprawled on some tie-dye cushions like some down-at-heel sultan whilst his girlfriend talked – with worrying intensity – about infection, fractures, compartment syndrome. I had cleaned the graze and offered some reassurance whilst the man stroked his wispy black beard and stared down at me lovingly.

Back in the cab, finishing off the paperwork, I put the cab light on. The grey evening sky is plump with rain; thick spots begin to rattle down on the cab. And then a red call comes through on the terrafix: along with the address, the description of the problem reads Man with bag on head. We laugh, just as Control calls up on the radio asking us to advise and assess as this patient is possibly deceased. I ask for the police to attend as well; Control tells me that they are already en route.

‘Are they all like this in Oldport?’ I ask Richard as he puts the blue lights on and we bully our way out into the traffic.
‘Absolutely every last one,’ he laughs. ‘But the houses are affordable.’

We pull up outside the address, one of a long row of light coloured semi-detached houses, each one only differentiated from the other by the colour of the door and the condition of the little white wooden balcony over the living room window. Through the downpour I can see two men standing hunched over mugs in the doorway. I jump out, haul out the resus bag, and then walk over to them.
‘Hello,’ I say briskly, ‘What’s the problem?’
Whilst one of the men stares at me, glassily white as his mug, the other takes a bracing sip and then turns to lead me up the stairs.
‘We’ve been away for the weekend’, he says. ‘We came back and found him like this.’
‘Is he a relative of yours?’
‘A friend.’ And opening the little bedroom door, he stands aside to let me through.

There is a naked man lying on his back on the bed over by the window. He is obviously dead. Even through this sixty watt gloom I can see the post mortem staining – the blotchy tide mark on the underside of his body where the blood has pooled. But then, without this marker, there would still stretch out a profound distance between us, the living ones at the door, and the dead one posed and frozen over there on that bed. The difference resonates on the chill air as the rain rails down outside.
As I walk into the room I check the details: a clutter of little plastic popper bottles and something that looks like a small thermos flask around his feet; his penis lolling darkly up onto his abdomen from its tightened scrotal sack; his arms fixed upright, crooked ninety degrees at the elbow, his hands and fingers delicately curled. I am reminded of Millais’ portrait of Ophelia, drifting off to her doom on a dark river. But whilst that Ophelia wore an expression of sensuous detachment, this one is racked by a monstrous Elvis sneer, and for a second I wonder why - until I understand that he has something stretched tightly over his head, nose and mouth.

Richard stands beside me. ‘Whoa!’ he says.

‘Isn’t that – a condom?’ I say.
The nipple shaped crest, designed to catch his ejaculate but filled here instead with a quantity of stale air and some nitrous oxide, pokes up like the button on a joke policeman’s helmet. Through the translucent rubber bubble the man’s eyes stare out at us, his eyelids half-closed.

Richard nudges me, and gives an infinitesimal shake of the head to let me know that he doesn’t think I should mention the condom again.

‘Could you go to the vehicle and ask for an ETA, please?’ he says, pleasantly. And then leads the friend back out of the room to ask him further questions.

I pick up the resus bag and turn to follow them out. My last impression of the scene is of the picture that hangs above the man’s bed, a cheap, gold-framed print: Manhattan by night.

Friday, September 21, 2007


The woman is doing well, with the phone squashed to her ear with her left shoulder to free up her arms as they push up and down on her friend’s chest.
‘They’re here’, she sobs into the phone, then throws it into the corner of the room where it lands without a sound amongst the piles of clothes, shopping bags and accumulated junk.
‘Help me.’
There is only just room enough to step over the body on the floor to get to her. I touch the woman on the shoulder; she stands up with difficulty and staggers over to the window, to join a man who is standing there wiping his face vigorously as if he were trying to wake up, pacing to the left and the right.
Malcolm asks them if there are any needles around. The woman says only one, and points to the sofa. The man begins pulling at his hair and groaning.
‘So what can you tell me about him?’ I ask them. ‘What’s happened here?’
The woman says that she spoke to John on the phone about an hour ago. He was fine then. When she got back to the flat with the shopping, she found him slumped back on the sofa, as blue as he is now. The other man was on the mattress in the other room. They had shared a needle of heroin, but she said that John had been off the stuff for a month, and was maybe not as used to it as he once was. He is thirty four. A touch of asthma sometimes, but otherwise fine.

I stop compressions briefly, to help Malcolm visualise John’s vocal chords and introduce the ET tube. He attaches the BVM and oxygen, and we plough on with the resus protocol. Malcolm tries to cannulate him, but has problems finding a useable vein. He swears quite a bit. We have no room to work, the flat is stifling and rank, and the other man is looking increasingly volatile. Although the woman is hugging him by the window, he keeps repeating: ‘Is he breathing yet?, then moaning, and slapping his face.
‘They’ll tell us when he is,’ she says to him, then to us, with much less certainty: ‘You can’t let him die. Please.’

John is completely inert. His face has the shadow of death upon it – a ghastly blue-grey hue, his lips purple. I cut his T-shirt off, straight up the middle, and then as I continue with chest compressions, Malcolm puts the defibrillator pads on. We watch as it prepares itself to monitor, then I come off the chest to watch the pattern it displays.
‘Asystole,’ he says; the flat line that trails ineluctably across the screen, the bleakest horizon imaginable. The prognosis is unlikely to be good.
‘Is he breathing yet?’ The voice grinds metallically with aggression.
We ask them to go into the next room to give us space to do what we need to do. When they are safely out of the way, Malcolm looks at me and asks the time. We work out that we have been struggling with John now for twenty minutes.
‘Let’s give him a couple more rounds, but this isn’t going anywhere.’
The call had come through to us as a cardiac arrest for a young man, but the call taker had no idea that this was drug related and potentially dangerous. For any death at home we have to notify the police, but in this situation we know that his friend could well take the news of his friend’s death badly. To make things worse, we both realise that in the rush to get up here we have left the radio in the truck. Malcolm asks me to go down there – to tell the flatmates that I’m off for an essential bit of kit – but in reality to call for police back-up urgently.

When I come back into the flat carrying my little red bag, the woman throws me a weak smile, as if I’m coming in with something that might finally save her friend. She follows me back into the room, whilst the other man shadows close behind her like he’s waiting for a word or signal. He has a bottle of white wine in his hand and he drinks about a third straight off.

I join Malcolm back on the floor. We make a play of checking the monitor one last time, but nothing has changed. We both stand up. The police will get here as quickly as they can, but we know that we are exposed. The woman has her hand to her mouth.

‘I’m sorry. There’s nothing more we can do.’

She releases one awful, belly-deep cry. The man takes a step to come round her, and for a second I wonder if he is about to attack us. But maybe hearing the definitive news that his friend is dead is some kind of release for him; the volatility we were so wary of seems to ebb. He stares for a moment at his friend on the floor, as if he was amazed that he could sleep with so much going on around him. Then he turns and walks back into the bedroom, slumps down onto the edge of the mattress, and takes another long pull from the bottle. The woman goes to stand beside him. We tell them what to expect next. She begins crying quietly into a filthy handkerchief. We hear heavy footsteps running up the stairs.


Down in the street, the afternoon is bright and busy. There are a few people watching the scene, wondering what the ambulance and police cars might mean. I throw the bags of equipment in the back, slam the doors and walk back round to the cab. I notice that the flat is opposite a church, which has a board outside that says: Come, join your prayers with ours.

We return to base, re-stock, then get sent straight back out to deal with an elderly fall at home. He is fine – just needs a hand back into the chair.

Wednesday, September 12, 2007


We can tell from a distance there is an argument going on as both the fluorescent jacketed policeman and the man in the pinstripe suit are leaning in towards each other and gesturing a great deal - the policeman with a notebook and the man with a carrier bag stuffed full of clothes. He also seems to have a large painting in a heavy gilt frame tucked under his other arm. A policewoman is standing off to the side as if she is embarrassed by the whole scene; she chews the aerial of her radio and smiles at me as I climb out of the cab with my clipboard. The policeman makes an exasperated, pacifying wave of his notebook, a gesture I also try to use when I want our dog to sit and be still, then tucks it away and strides over to me. He nods for me to come close so he can tell me something important.
'This gentleman is an arse,' he says. 'We pulled him over because he failed to appear at the station with the correct documents following a traffic misdemeanour earlier in the week, and now he's accusing us of harrassment...'
The man has stepped over to us.
'Don't you try to drag him into your pathetic little conspiracy,' he spits.
'Now, now. Take it easy,' both the policeman and I say together.
The policeman asks me if I would check the man over because at some point during their conversation he appeared to complain of chest pain.
'I'm going to make a very serious and formal complaint about this and you're going to be sacked,' he says, almost dropping the painting. 'This is victimisation, harrassment... this is a police state. It's unbelievable.'
I touch the man on the shoulder to lead him into the ambulance. 'Let's just take things a step at a time,' I say, 'Let's just give you the once over to see you're okay, and then we can think about the rest of it after. What's your name?'
'Okay, Alexander. Have you got any chest pain at the moment?'
'No. I'm fine. Well - I say fine.'
He stamps up the steps and throws himself down on the trolley. I take his belongings from him and put them on the floor. The painting is a study of some boats at low tide, in oils. The man pushes his heavy blond hair back from his face and looks up at me. 'They're all absolute bastards.'
He seems as moneyed and unconvincing as his painting. He has a pin striped suit, a tan and a rugged, Captain Hurricaine-style cleft chin, but there is something a little off-balance about the whole ensemble.
'I own an antiques shop in the Quarter,' he says. 'They know that. They know exactly who I am, and they don't like it.'
As he readjusts his fringe, a heavy gold bracelet slides down his thick forearm.
'They cannot accept it.'
And then, incredibly, a tear spills onto his cheek. Rae hesitates as she turns on the blood pressure monitor and looks at me. 'My father died, I've got endless money worries. And now this.' He fumbles with his shirt buttons with his other hand to reveal a broad expanse of chest hair. 'How's my heart? If they've killed me, they're going to pay.'
'Well, no-one's dying at the moment,' Rae says, widening her eyes at him like someone flashing their headlights. 'Your blood pressure is up, but then you're obviously stressed.' She fetches out a razor to shave off some hair for the ECG dots. 'This won't hurt.'
'My blood pressure's up? Right. I want that written down. I want that in writing. They've made me ill.'
There is a knock on the ambulance door and the policeman looks in.
'How are we getting on?'
'You bastards have made me sick. Tell him what you just told me.'
'Alexendar's blood pressure's raised, but nothing you wouldn't expect from someone under stress. Otherwise, everything's looks okay. He doesn't have any chest pain, but we're just doing a quick ECG to make sure it's all fine.'
The policeman nods at us and then makes a gesture at the man.
'After they've finished, we'll talk about what you need to do, and then you can be on your way.'
'What's going to happen to my car?'
'Well, without the correct documentation you won't be able to drive this car any further, sir. It will be impounded, and you can collect it following the usual procedures. I'll explain it all when my colleagues have finished with you.'
The policeman retreats again and shuts the door.
The ECG is completely normal, and we tell Alexander that as far as we're concerned everything has checked out and he's fit enough to go. As he buttons his shirt back up I collect his belongings together and hand them to him. He tucks the painting back under his arm and stands up quickly like a soldier with his orders. Rae opens the door for him and helps him down the steps. I can see the policeman and woman straighten up by their squad car, unfolding their arms as he looks across at them. Then, just before he rejoins this battle, he hesitates and looks back at us.
'Ssh,' he says. The carrier bag swings from his wrist as he puts a finger up to his lips and says in a pantomime whisper: 'I'm taking delivery of a BMW M5 tomorrow.'

Tuesday, September 04, 2007


It is a lovely long blast out along the coast road. The sea is out, flat, crab-boated and crystalline, and the mysterious foreshore of pools and boulders lie baking in the bright sunshine. K. is driving; I’m lounging back in the attendant’s seat as our sirens peg out our progress above these scuttling patterns of traffic and our blue lights sparkle in a hundred rear view mirrors. It’s a beautiful morning, and this is a great job.
We pull up outside the flats. The call is to a fall at home, so I jump out and grab my magic red bag out of the back.
At the main door I ring the flat number, as there is reportedly a carer on scene. She crackles onto the intercom and buzzes the entrance, but for some reason the door will not open. Just as I’m about to push the button again, a woman in a white uniform trudges up the steps behind me toting a face of disapproval.
‘You pushed it too soon,’ she says.
‘Oh. Okay. Have you got a key?’
‘No. Why would I have a key?’
‘If you push it before they buzz, it ruins the mechanism.’
‘Shall I buzz again, then?’
‘You can try,’ she says, then looks behind at her and shrugs to some imaginary, incredulous audience.
I push the button again, the door clicks and I open it.
‘You were lucky,’ she sighs, and pushes ahead of us.
‘It’s flat 19 we want,’ I say to her back.
‘Third floor. And the lift’s out.’
‘Thankyou’, I say, and then exchange a look with K. We make our way up to the third floor and find number 19. The door is open. The carer is standing waiting for us, a spherical woman clutching a sheaf of papers and swinging a big bunch of keys.
‘Had trouble getting in?’ she says brightly.
‘It wasn’t too bad. Now – where’s the patient.’
The woman nods around the corner, then retreats into the kitchen for some reason. I walk around the corner and see a white-haired old lady in a nightdress lying on her back on the floor beside her bed. There are ornaments and cosmetics jars all around her, looking as if she cleared the dressing table when she tried to stop herself falling. At first I think she has covered herself in some kind of mud pack, and then realise that this is actually faeces. She has been on the floor for some time, and in her confused state has smeared it over her face, in her hair – everywhere you might touch with your hands over the course of a few incoherent hours. The smell is overpowering, and I realise that I have been standing doing nothing for a minute whilst I took in the scene and wondered how we were going to proceed.
‘Hello, it’s the ambulance,’ I begin, bravely. ‘My name’s Spence, and this is Rae. What’s your name?’
‘Hello, Spence,' she says. ‘I’m Helen. I wonder if you could help me. I seemed to have got a bit stuck.’
I clear a space around her, and check her over to make sure she hasn’t hurt herself in the fall. Then with Rae we help her up and sit her down on the bed, grabbing pillows and her duvet to prop her up and make her comfortable. Rae goes into the kitchen to fetch a basin of warm, soapy water, a flannel and a dishwashing brush, and then we set to a brisk cleaning of her hands and face, at least. The carer hovers uncertainly in the background.
It seems that Helen has been perfectly mobile and self-contained until today. At ninety-three, she still looks after herself in this flat, and only has a carer in a couple of times a week to help with hoovering and the occasional shopping trip.
As I rub away the unspeakable mess from her face, she tells me that she has a flannel wash every morning. In fact, she repeats this several times, further evidence of a confusion that seems with her high temperature to point to a urinary tract infection.
When I tell Helen that I think a trip to the hospital is needed, she is indignant.
‘I have never been to hospital in my life. Not once. Not for either of my children, nor anything else. And I certainly do not intend to start now.’
She looks up at a portrait of a formidable woman in a big straw hat.
‘What would mummy say?’
I finish wiping her face and sit back on my heels like an artist.
‘I think mummy would want you to get help when you needed it.’
It’s a measure of the depth of her confusion that she cannot recognise the extremity of her situation, and twenty minutes of patient repetition to persuade her that a hospital trip would be a good idea fail utterly. Even a phone call with her son does nothing to change her mind. Eventually, Rae says:
‘If you can stand up and take a few steps we’ll leave you in peace. But if you can’t stand up, how on earth are you going to cope?’
Incredibly, Helen seems to recognise the logic in this, and tries to stand up from the bed. Each time she slumps giddily backwards, but each time she says: ‘No! No! I can do this! I will do this! I am not going to hospital!'
She gives up after the sixth attempt, and sits looking utterely dejected.
‘Come on, Helen,’ I say, handing the bowl of filthy water to the carer. ‘Let’s get you to hospital. You’re son can meet you up there. It’s not so bad.’
She looks up at the portrait on the wall, smooths her filthy nightdress across her knees and straightens slightly.
‘I suppose we’d better go, then,’ she says with a sniff.
We put her into our chair and carry her out to the lift which turns out to be working after all.

The day seems fresher than ever.

fixed expressions

After a few repeated knocks and a call through the letterbox, Miranda comes to the door. Her usual pose – one hand on the doorframe, one hand on the door, slung pitifully between these two points of connection like a domestic Jesus on the cross. With reading glasses.
‘What do you want?’
‘You called for an ambulance, Miranda. Something about an overdose. Can you tell me what’s happened?’
She bobs her head in a non-committal way, still holding on to the door.
‘Can you tell me what you’ve taken and when?’
Miranda pushes her glasses back up her nose to consider the question. She calls an ambulance many times each night; Control allow her one visit. We’ve all been here a number of times, but so far no-one has made it over the threshold.
She gives a curious facial spasm, then dismisses us with a slap of the air in front of her nose.
‘You can fuck off.’
Then she slams the door. We can hear her crash back into the dark recesses of her bungalow.
We turn back to the vehicle.

My torch picks out the glazed smile on one of her gnomes.

Sunday, July 22, 2007

partially blind

The rain is finally coming down after a night of menacing flashes out over the sea. Thursday night clubbers are clustering under awnings and in doorways trying to escape the downpour as it scours the pavements. They watch us, giving us whistles and claps, as we jump out of the ambulance and patter squealing over to the old apartment block.
Above the entrance is the name 'Adastra House' picked out in modish black letters; an intricate pattern of bars criss-cross the upper half of each double door. Many of the stained glass panels are missing, replaced by pieces of crudely fixed wood and cardboard. Most of the black and white floor tiles are still in place, with a bouquet of bleach and a finish of urine and dirt.
'Art Deco', says Rae.
'Uh-huh,' but the architects of this doorway to the modern age must surely have had higher aspirations than us.
I ring the bell for Flat 54, wait, and then a young voice tells me to push. Inside, the lobby is deeply shadowed, its curved mahogany desk untended.
We ride the battered brass elevator to the fifth floor. Out along the corridor, each flat door has the stump or more of a cute little electric lamp, many of which are still working. And at the end of this dingy landing-strip, by the furthest door, a woman is standing watching us with her arms crossed.
My first impression is that she has something bulky strapped onto the left side of her head. But when I get closer, I see that where her right eye should be is a ghastly swollen mass. Her left eye is fine and proportionate, but her right is like the cartoon of a sad and sleepy eye thinly scribbled onto the side of an ostrich egg.
'I'm Spence and this is Rae', I say. 'Can we go inside for a minute?' Although as soon as I've said this I wonder whether the assailant is still around. As we follow her in I put my response bag fully onto my back to free up my hands.
'Is the person who did this to you still here?'
'No. He called the ambulance and then went.'
Rae says: 'That was nice of him.'
'Have you called the police?'
'He said I'd better not.'
She stands hugging herself. The stale air stirs in the flat like an alcoholic gruel around the jumble of her furniture and belongings. It would be impossible to tell if a fight had just occurred here; no doubt it always looks like this.
'I can't find my work keys,' she says. 'I absolutely have to go to work in the morning.'
She studies me with her good eye. 'Do you think I'll be able to go to work in the morning?'
'Let's just take this one step at a time,' I say, reverting to cliché reassurance. 'What's your name?'
'Tell me what's happened to you tonight, Claudia.'
Claudia starts to cry, clear tears from her left eye and blood stained tears from her right. She tells me she is twenty four, but has the physique and demeanour of a sixteen year old girl.
'Do you know the person who did this to you?'
'My boyfriend.'
'Has he done this before?'
'Not really. He's punched me once or twice, but not hard. Pulled me around by my hair. But he isn't really like this.'
'So tell me what happened.'
'We'd been drinking. Not much. We had an argument, it got out of hand, and he punched me.'
'Were you knocked out?'
'Well, I woke up in the bath. The shock of it - I didn't know what happened. This terrible bang. Then I found myself in the bath looking up at him. And he was saying "My God, your eye", and then he called for an ambulance, and went.'
Rae gives me a look, nods towards the door.
'Claudia - you need to come with us to hospital to get your eye sorted out right now. And that's not the only reason we should go, because to be honest I'm uncomfortable with the idea that the person who did this to you could walk in that door at any time.'
Claudia flinches. 'Oh - you'll be fine. He's really not - that way.'
'Well, excuse me for being blunt, but this is a man who has just punched you in the face as hard as he can. I think it's fair to say he absolutely IS that way.'
Claudia starts to cry again.
'Help me look for my keys,' she says.

Out on the ambulance we try to gently open her right eye to gauge the injury, but it's closed too tightly now. Claudia tells us that he doesn't wear rings, so maybe there isn't a cut. But there is obvious damage here, and the swelling will have to be relieved as soon as possible.
Claudia lies quietly on the trolley as we take her blood pressure and other observations. There is a knock on the door. Rae opens it cautiously, and a policeman looks inside.
'Hello' he says, taking his hat off and tucking it under his arm.
Claudia sits up.
'Who called them?'
'It's okay,' I say, easing her back down. 'Our Control always sends the police along in these situations. But you know, Claudia - I'm glad they're here, for lots of reasons. Despite what your boyfriend says, I think the police should definitely get involved.'
She seems to accept this, and relaxes back.
The policeman pulls out a notebook.
'This is Claudia,' says Rae. 'Claudia's been assaulted by her boyfriend tonight.'
'You can say that again,' he says, but Claudia is thinking about other things and doesn't seem to register this.
'I absolutely have to go to work tomorrow,' she tells me.
'Where do you work?'
'I run the desk part-time for a hotel. I've got the keys. I'm a student at the moment - business and finance. But I need this job, and I had a lot of time off at the end of last year.'
'What happened to you last year?'
'I fell out of a window.'
I look at her. The policeman momentarily stops writing. I hardly dare ask, but do, anyway.
'Did you fall, or was your boyfriend involved somehow.'
She smiles up at me. 'Well - you know.'

Monday, July 09, 2007

the game

Fred has been lying on his back on the kitchen floor since he tottered in from the sitting room at ten o'clock this morning, tripped and went down. It is now just after five; his wife came back from an epic expedition into town, found him stretched and helpless, and called the ambulance.
Fred's right leg is lying a good inch shorter than his left and turned slightly outwards - a good indication that he has a fractured neck of femur. The morphine is helping him cope with the pain. It needs to. We will be moving him outside to the ambulance shortly, and it will inevitably aggravate his injury.
'But once we've got you on the vehicle the worst will be over and we'll be on our way to getting your leg sorted out.'
'Will you be needing these?' his wife says, standing with his cardigan in one hand and his slippers in the other. 'I'll be following up later with Rene.'
Fred is ninety four years old, a powerful man blasted by long years and late-stage Parkinson's. In his crumpled white shirt, black braces and trousers he looks like a preacher laid out by the hand of God.
'Thanks for coming,' he says.

On the trolley, easing tentatively away from the horrible pain of the move, Fred comes to himself sufficiently to be able to chat to me. He struggles to make his words clear above the noise of the ambulance and the depradations of accident, illness and age; he rests between phrases, and stares up through the skylight to the sky rushing above us. I piece together this war story:

Fred was the youngest child of a family of six. His parents owned a big garage, and Fred, along with his five sisters, picked up light engineering skills. When the war began, Fred's sisters found work in the new aircraft factory whilst Fred joined the RAF. He became a flight engineer, mostly on Lancaster bombers, stationed up in Lincolnshire. He was twenty-five.

He lasted the entire war, flying seventy missions across Europe. In all that time he crashed just twice, once mid-way when they limped back to the strip in tatters, the young tail gunner dead, and once on the very last mission when the plane was skewered by a German fighter, thirteen millimetre shells ripping through everything but him. The whole crew was wounded, and Fred had to land the plane on his own - the one and only time he took the controls. He managed to ditch safely in the sea, and they were all picked up by a naval frigate.

'I bet the others liked flying with you,' I say to him, adjusting the blood pressure cuff on his arm and taking a final reading before we turn into the hospital. 'I bet they thought you were lucky.'

'Nah,' he says, clearing his throat. 'It's a game. It plays itself out, and there's nothing you can do. One time I was supposed to crew up with a pilot to test a new Mosquito they'd delivered, but I was late coming back from a meeting and he took some other poor fucker up. That one crashed.'
He shrugs, and whinces.
'Will my wife know where to find me?'
I tell him I think she will.

Wednesday, July 04, 2007

on time

At six in the morning the alerter wakes us. Daylight has slid across the world again, low and grey as an aluminium lid, and found us simmering by the TV.
We finish at seven, so we offer to take the job in place of the six thirty crew. They wave us off.
N. smacks his palms, says: 'This should sort us out nicely.'
I climb into the driver's seat and read out the details of the job: Seven Acres Taxi cabs. Woman fallen. Greater than sixteen feet. Status unknown. I wonder whether she's fallen off a ladder or something, and then I wonder what she may have been doing up a ladder at this time of the morning. But you never know till you know, and anyway I am so tired it makes no real difference to me.
As we turn out of the station and head up the road, another message comes through: Patient fallen from cliffs. Lying on walkway beneath. Police on scene.

This is a suicide.

I know the cliffs here very well. Before we moved it used to be one of my favourite fossil hunting places. I would spend hours with the dog stalking and chipping out sea urchins, bivalves and brachiopods amongst the chalk falls and pools. Eighty five million years ago these cliffs were the chalky ooze at the bottom of the sea, lain down at a knuckle's depth every thousand years or so, a slow calcareous rain of microscopic planktonic shells. And then the waters receded, the land rose, was carved by glaciers, picked at by tides and frosts. About sixty feet at this point.

It's still early in the morning, and the scramble to get to work has only just begun, so in no time at all we've passed the taxi offices and are heading up to the car park at the cliff edge. We can see a police car there. The officer there tells us that a man walking his dog found the woman this morning and made the call from the taxi office. The policeman thinks she may still be alive. There is vehicle access to the undercliff walkway, but there's a barrier across the driveway at the moment and a council official coming with a key.
We debate whether to walk down with our gear but the policeman tells us that the woman is about half a mile along from this spot, so it will take us a while. I go back to the ambulance to fetch out a pair of bolt croppers, but just as I'm figuring out how to cut through the padlock the man arrives with a key. We drive down the steep path to the walkway, and then along to where we can see two figures leaning over something on the floor.

The woman is lying on her left side, one leg and one arm drawn up underneath her, as if she were slowly trying to get up. Her tangled hair obscures her face. One shoe has come off and is lying off to the right. There is a discrete halo of blood beneath her head. I kneel beside her, give her a gentle shake, but I quickly see that she is not breathing.
We need to roll her over. N. supports her head whilst the rest of us take a section of arm, leg, hip. We turn her. Immediately it's apparent that the woman's head is lopsided and wrong, pressed in along a line from the crown to the ear. There is little blood; what there was seems to have been caused by the pieces of gravel that have been pushed into her skin. Her eyes are half open, the pupils wide and fixed. Her nose is squashed and her mouth puckered up into a grotesque expression of disdain. I feel for a pulse at her neck but I know she will not have one. She is vaguely warm, though. As N. pulls the defibrillator from the bag I reach for my scissors to cut away her clothes. The first layer is a heavy coat with easy buttons, so I decide to undo those first. Beneath this coat, pinned to her cardigan, is a note: Please do not try to revive me. Sorry. I cut around the note and we attach the pads. But we do not really need the machine to confirm what we can readily see for ourselves here on this concrete walkway with the sea shouldering in on another high tide and the seagulls scrawling through the morning air.
We turn the defibrillator off. I fetch a blanket from the vehicle to cover her. She stares up and beyond us all to the top of the cliffs, as if she's seeing where she came from for the first time.

N. completes the paperwork.

The policewoman tells us about a car she went to that had driven at the cliff edge so fast it ended up on its roof in the sea.

The coroner's van arrives.

We finish on time.

Monday, April 30, 2007


The first thing Margaret does after opening the door is to lead us into the kitchen.
'There', she says, proudly pointing down to a splash of crimson on the lino. 'That's me, that is.'
She is holding a flannel to the back of her head. Although she is about forty, she stands with a childlike hunch to her shoulders, as if she is expecting instructions, or perhaps some shouting. She is wearing a saggy old, shiny arsed tracksuit; her straight black hair is flecked with flakes and curls in at the neck like a costume wig.
'Margaret - let's sit down for a minute and see what's what,' I say. She slumps off into the sitting room and plops herself down on the sofa amongst dozens of sheets of drawings. She fishes one up for us. A line of men sitting cross-legged and looking off to the left, each with a flame coming out of the top of his head. They are identical, drawn with a poor grasp of perspective that makes their limbs seem broken rather than folded. Their faces - the repeated face - is just familiar enough to give me a stab of recognition.
'Who's this?' I ask.
'Oh. OK.'
She offers up another. That face again, but close up and smiling, wearing a Robin Hood cap.
I recognise him. Errol Flynn.
'I copied the video cover,' she says.
'Excellent, Margaret. Right. Let's have a look at your head.'
There's no wound to speak of, just a minor abrasion. Margaret answers all our questions, so she won't need a trip up to A&E. She tells us she fell over when she had another fit, and banged her head on the kitchen wall. Although her medication has been working well lately, she still averages a fit or two a month. I fill out the form and make the usual run of observations. Whilst I take these, Rae asks her about her drawings, and the two big black and white photographs on the wall, side by side, seemingly taken minutes apart. One is of a woman in bat winged specs holding up Margaret as a smiling toddler, her hair flying out like pine shavings. In the foreground, the muzzle of an enormous dog emerges darkly.
'That's Bobby,' says Margaret, as I dab at her head. 'He was a cross between an Airedale and a Great Dane.'
The other picture is of Margaret again, with the same frilly dress and curls, laughing and hurling herself forwards on the swing.
'I was raped by my brother for seven years,' she says suddenly. 'From the age of seven, in fact.'
'Oh. My goodness. Have you spoken to anyone about this?'
Margaret ignores the question and holds up another drawing instead. With the same, neutrally informative tone she says: 'Look. This is one I did as if I was flying over the house.'
There is a moment's silence, then a muted roar sounds from outside and reverberates through the room.
'Hark at that rain,' says Rae. 'We'll be getting wet later.'
The pattern of the rain on the patio windows smears watery shadows over everything.
'I fell down the stairs once,' says Margaret.
'Was that a fit as well?'
'No. It was the cat. It wound itself round my legs. The plumber was at the bottom. He'd just taken the old toilet out. I fell all the way down and landed on top of him. He ended up with his head wedged in the toilet. They had to walk him out to the ambulance holding either side.'
I take a step backwards with the beauty of this image.
'That's fantastic!'
Margaret looks up at me. 'Maybe, but the plumber was furious.'

Friday, April 20, 2007

polaroids of pets and their owners

#1 A woman is lying on the pavement in front of a rusty promenade bench. Her knees are drawn up to her belly, trying to make her waterproof jacket into a kind of cut off sleeping bag. Her arms are curled to pillow her face, but you can't see it because of a tangled spread of black and grey curls . On the bench behind her, wedged between a khaki green shoulder bag and a stack of free magazines, a teddy bear. It is over-stuffed, made of caramel cloth worn down to the ticking at the hot spots. The arms and legs stick out gingerbread man style. It has a pink ribbon around its neck, with two little plastic bells. It has a flat face, no ears. Its nose is higher than its eyes.

#2 A woman is lying on a sofa, groaning. Her left hand is flat against the left side of her chest; her right hand lies over her left. She is breathing quickly, from the stomach. On the floor over by the open french windows is a large porcelain collie. It is sitting obediently, looking up, its head cocked slightly to the right. The glaze on the dog is so thick it blurs the colours beneath, like the photo of something taken in low light. There is a layer of dust over the thing, especially along the nose, but at the right ear there is a new, white chip.

#1 An elderly woman is lying on her back on a single bed. Her neck is arched back over the pillow, the crown of her head pressed against the padded headboard. Her eyes are wide, fixed at a point on the ceiling. Her mouth is gaping open, at an angle which acts to partially lever the bottom set of her false teeth up and out. Her right arm is hidden beneath the rucked blue pattern counterpane that the left hand has grasped and drawn up around her chest. On the second single bed that lies alongside this one is a large elderly Beagle. Its wide white forepaws are expertly draped over the edge, upon which the Beagle has patiently rested its head. Its ears hang down either side. It watches the woman.

Sunday, April 15, 2007


We have trouble locating flat number 32, the scene of female 40 assault/lacerations/ dangerous body area. It's dark, it's late, we're transparent with fatigue. Eventually we figure out that all the even numbers must be located round the side of the flats that face the street. The flat we want is a few buildings back, so I reverse into a convenient parking bay. I press the KRS button - which allows the engine to keep running even though you take the key with you - and follow Rae up the path to the hidden door.
She knocks, waits, knocks again.
Eventually a bolt is drawn back and the door opens a crack. A woman peers out from the harshly lit interior, holding a blood-spotted kitchen towel to her forehead.
'Oh. You.' She sounds disappointed.
'Come in.' She shuffles back to the sofa, sits down, and picks her cigarette back up from the ashtray. She makes no dabbing motions at the wound on her head; it's as if her left hand is frozen there. But there is so little blood, either on the kitchen towel or on her T-shirt - one penny-sized spot on the right shoulder - that I think the wound cannot be serious.
'Could you put that out, please?', Rae says.
'What? Really? Oh.' Her face crumples along with the cigarette. 'What's next?'
This is peculiar. I feel like a policeman. I self-consciously uncross my arms.
'I don't know,' says Rae, 'You tell us. I mean - you called us, didn't you?'
The woman nods. I exchange a look with Rae.
'First things first,' Rae goes on. 'What's your name?'
'OK, Lynette. Now, can you tell us what's happened tonight?'
I glance around the room. From the sofa Lynette faces a TV/video combination crammed precariously onto a maple-veneer stand along with a cluster of videos whose titles have been writtten and crossed out a number of times; a bad painting of a ship on one wall; an oval mirror on another, and then a beaded curtain separating the living room from the kitchen area. Another door leads off, presumably into a bedroom and bathroom. The whole is no bigger than a generous hotel room, and is just as anonymously furnished.
Lynette purses her lips. In her baggy brown T-shirt and her saggy cream trousers she sits on the sofa like a badly drawn bear. We wait for the story.
'A man came round. He wanted me to pay him the money I owe, but when I told him I didn't have it he punched me in the head. He said if I didn't have it when he came by again tomorrow he'd put all my windows in.' A pause, then she adds: 'And then break my legs with a brick.'
'When did this happen?'
'I don't know. An hour ago, I suppose.'
'Did you call the police?'
'No. I couldn't. He took the SIM card out of my phone.'
'Couldn't you have gone next door and asked them for help?'
'I didn't want to bother them.' Lynette reaches for another cigarette, and then draws her hand back slowly. I want to ask her how she called for the ambulance, but for some reason I don't. 'Anyway,' she continues, 'I know this is all to do with that stupid package I found when I moved in here. Letters and such. Drugs. I threw them all away but they won't believe me.'
'Well - let's have a look at your head, Lynette.' She peels away the kitchen towel.
There, in the middle of her forehead, is an extraordinary L-shaped incision. Full thickness, its puckered edges can be moved apart to reveal the skull beneath. There is very little blood from the wound, now, though it must have bled considerably when it was made. And it would seem by its condition to have been made longer than an hour ago.
'Lynette - this is quite a wound you have here. I'm afraid you're going to need a trip to hospital to have it sewn up. Tell us how you came by it again? Did the guy have a knife on him or something?'
'No. Just his fist. I was getting up from the sofa and he punched me back down. He had a big gold ring on, I think.'
'Janet - I have to ask you a few things. Have you been drinking tonight?'
'Okay. And are you on any medication?'
'Not really. I have some mental health issues, I'll admit. I don't see any sense in lying about these things. So I do take a few things for that. I've got a list somewhere.'
'And have you taken any recreational drugs tonight?'
'Oh. I suppose you saw the pipe, then.'
'No. I didn't see any pipe. I just have to ask these things as we need to know all the facts so we can treat you appropriately.'
'Well, I'll admit that I am a user. I have had a bit of a drug problem in the past, I may as well admit, but nothing serious. When they stitch this up - will I have a scar?'
'I think you probably will,' says Rae, 'Like Harry Potter - a little lightning stroke there.'
Lynette is impassive. She does not seem to know Harry Potter. She sighs, and begins hauling herself up from the sofa. She stuffs her pockets with her tobacco and lighter and purse.
'Let's get going,' she says.
'Will you be reporting this to the police?', says Rae, taking her arm as she stumbles towards the door.
'The police?,' she snorts. 'They wouldn't believe it.'

Thursday, March 01, 2007

the boss one day

Number 17 is the most lit-up of the cluster of neat little houses on the country road. The night is cold and black, pinned by the moon to a cloudless sky.
A thin teenage boy opens the door with a phone at his ear. He is wearing a baggy green T-shirt which says: One day I will be your boss.
'Just a moment' he says into the phone, and then smiles at us. 'Come in. She's just up the stairs, off to the right, in the bedroom. I won't be a moment.'
I am momentarily confused. How old is he? Physically he seems to be a boy of twelve or thirteen, but his bearing is that of a confident young man. I follow P, hauling the yellow resus bag up the narrow stairs.
'What's your name?' I ask the boy, following me up the stairs with his two phones.
'And how old are you, Logan, if you don't mind me asking?'
'Thirteen. Just a moment.' He begins another phone conversation.
The house is precisely tidy, like a corporate hotel. In the bathroom facing the top of the stairs a woman is holding on to the rim of the basin and being sick. She waves us away, runs the taps, wipes her mouth with a crisp, white flannel, and then stumbles back into the bedroom where she sits and then lies down heavily on the bed.
'Can I ask your name?' P. says.
'And what do we call you?', thinking this is her surname.
She pushes some strands of hair away from her face and then turns her face to stare up at us. Her pupils are so wide it is like looking down through twin portholes into an abyss. The skin of her face is waxy and slack. After a numb pause, she talks again, with difficulty, using the numbed, aphasic drawl of a bottle of gin. 'And who are you?' she manages.
'We're the ambulance,' says P., kneeling down in front of her. 'Your son called us. He was worried about you.' She smiles, and closes her eyes, like a saint pleased with her followers. '
'We're worried about you.'
No response.
Eyes hauled open again.
'What's happened tonight? What's wrong?'
'Nothing. I'm fine. I've just been a little sick.'
'Have you had any alcohol tonight, Tepponen?'
Logan catches my attention from the doorway and gestures for me to come out on the landing. I leave P. to take some basic obs and go to talk to him.
'So what's going on, Logan?'
'She drinks. A lot,' smiles, man-to-man. 'But I've hid her tablets, so at least she hasn't had any of them. I don't think so, anyway. Unless she hid some.'
'How much has she had to drink tonight?'
Logan shows me a litre bottle of gin that is now two thirds empty.
'Her diazepam's in my room.'
'Is there anything else wrong with your mum apart from the drinking?'
'Well, she's got a stomach ulcer, which the drinking doesn't help. She's supposed to be on a withdrawal programme. She takes thiamine and some other stuff. But it hasn't been going too well. This is the second time this week I've had to call the ambulance.'
Logan tells me has an elder brother, Tyler, who is fifteen and on a skiing trip to Canada. Neither his natural father or his step-father live with them anymore. Logan hasn't seen his father in ages; his step-father is in the pub tonight - Logan was on the phone to him trying to sort out a place to stay tonight. He couldn't come and collect him himself because he'd had too much to drink.
'He said maybe I could stay with Mr and Mrs Heinz. They live four doors down.'
'How well do you know the Heinz family?'
'Not that well. Not any more.'
'When was the last time you stayed with them?'
'Four years ago?'
Logan smiles at me. 'Don't worry,' he says. 'I've been through all this loads of times before. It's a problem. We'll sort something out.'
'Has the ambulance been out here before?'
'Actually, it was the police last time. She got drunk and assaulted me. She was in prison for two weeks.'
'Does she always get violent when she's been drinking?'
'Oh no. Mostly she just sleeps. And then the day after she cleans everything.'
'So - is your mum the sole carer?'
'Yep. But we have loads of social workers and stuff. We have one each for all this, Mum has another one for her addiction, I have a special one for school, and we all share a family liaison officer at the police station.'
I leave Logan to one last phone call whilst I take P. to one side. This seems to be less a call about the mother - who seems physically okay apart from being drunk, and safe to leave at home to sleep it off - and more about Logan's welfare. I contact Control, using the code word for child protection issue. After a few more calls we arrange for a police sergeant who is aware of the case to attend. It will be up to them to either escort Logan to the Heinz address, or take him into temporary foster accomodation. When the police finally arrive, Logan has packed an overnight bag and is letting the dogs out into the garden for one last stretch before sleep.
'Thanks for your help,' he says to us as he picks his bag up to leave with the officers. 'I hope I get you next time.'
Back upstairs, Teponnen is crying.
'All I want is a hug,' she says.
We make her comfortable, and let ourselves out.

Wednesday, February 14, 2007

dookey et decorum est

Rae tells me all about Stanley, the chest pain we're hurrying to on blue lights across town. Stanley is a frequent caller. When Stanley is fully active he phones 999 at least three times a day, and although his address is tagged, he still manages to present at A&E a couple of times a day. I've been on the road for six months now but he's one of the last frequent fliers I haven't run into yet. I'm looking forward to crossing another regular off my list.
'Whatever happens, don't get drawn into his flat. I'm serious. It's a trap. He'll keep you talking and we'll never get away. Just make sure he comes out to the ambulance, so we can play the game and do the tests - and then he'll say he can't possibly leave his dog, and go back inside.'
Stanley has a springer spaniel called Dookey, the one lovely thing in his life.
'Another thing he likes to do is come to the door in just his pants. So make sure you ask him to put some trousers on. He gets a big kick out of parading around in the buff, so watch out.'
The address is in an expensive part of town. I tell Rae that I came to another place here a few months back, and what an amazing house it was. Rae says that Stanley is renting a flat that's got potential but is pretty down-at-heel. In fact, Stanley is pretty down-at-heel.
'He's got some great paintings on the walls, and some nice sticks of furniture. I don't know what his story is. Some ruined old queen soaking up the inheritance. Dookey's lovely, though.'
We pull up outside the flat.
'Look. He's got the door open and ready for you.' She gives me a big grin. 'He's all yours.'

From the outside the Georgian building fits right in with the grand sweep of the terrace. It's a pleasure just to step up onto its wide pavements and push open the heavy iron gate. What a prospect of the city, too. But stepping through the door into the hallway I feel a percentage slide in the health of the building. There is a familiar, sweetly damp smack to the air, sporing up off the ruined carpet.
'That's his door, there.' She is standing beneath the sickly yellowed shade of the hall light and its pretentiously pendant glass diamonds. She reaches up expertly, plucks one off and hangs it from her ear.
'What do you think? Nice?'
I knock on the flat door and say 'Ambulance'.
'Come in. Come in. Don't stand on ceremony.'
I push the door open and peer inside. Another little hallway. Heavy gilt frames on the wall; a spread of disapproving Edwardians. Fronds of cigarette smoke reach around me, followed by a voice from the living room.
'I really am very sick this time. Honestly, this is the worst it's ever been.'
He shuffles out of the gloom towards me, wearing a soiled white dress shirt and an athletic support. 'Hello. You're new.' And then 'Dookey! Decorum!' as a beautiful springer spaniel dodges around him and leaps up to put her paws on my chest. 'Do come in. Don't mind the idiotic hound. 'Dookey! A la cuisine! Maintenant!'
Dookey runs out into the hallway. Rae scrunches up a pair of gloves into a ball and starts playing with her.
'I'm teaching Dookey another language,' Stanley says with a sniff. And then: 'Well, aren't you coming in?'
'Stanley, I need you to put some trousers on, some shoes and a jacket, and then walk out to the ambulance with us so we can run some tests. Okay?'
Stanley narrows a look at me, and it feels as if I am being scrutinised by an enormous cigarette. I want to pick him up by the legs and tap the ash out of his hair.
'If you insist - Dookey! Decorum! - I will follow your instructions to the letter. But you must understand, I could never leave my dog. She's all I have left.'
He turns and shuffles off to find some trousers.

When he eventually appears again, Rae and I have been playing catch with Dookey in the hall. She is a fantastic dog, with sleek, well-conditioned fur and a pair of bright brown eyes. Frankly, I am amazed that she is in such good shape. A professional breeder would be proud of this animal. She doesn't even smell of cigarettes.
Stanley appears at his flat door again.
'Dookey! Retournes à ton panier!'
Dookey looks up at us both, seeming so smart and self-possessed it would not surprise me if she held out a paw to shake, then trots inside. Stanley pulls the door to.
'Well I think you should put some shoes on, Stanley. It's pouring with rain outside.'
'I don't believe in shoes. I learned to live without them in Malta.'
Rae leads the way as I help Stanley out of the building, across the pavement and down to the ambulance. He does seem frail, although he's only about sixty, and it is hard to tell how much of this vulnerability is an act. By reputation, all of it.
On the vehicle we lay Stanley on the trolley and begin the usual run of tests.
Stanley directs his attention to Rae.
'You have beautiful dark eyes,' he says. 'Proud and lovely. Moorish bloodline?'
'Don't you remember me, Stanley?', she sighs, 'I've been out to you enough times.'
'No. I'm afraid I don't.'
Rae had told me earlier that once she had been called out to see him and he had been in a terrible mood. Despite all their efforts he had rung headquarters to make a complaint. Later that day they had been called out to him again. Not only did he fail to recognise them, but he told them all about the awful crew that had attended him that morning, the dreadful things they had done, not nearly as nice as you two etcetera.
Stanley is watching her intently. 'I can tell you don't like me,' he says.
Rae puts a blanket over his legs and then says: 'Spence, I'm going to sit in the front. Are you okay just to canter through these things? I just don't think I can bear to do all this again.'
I tell her it's fine. It's already apparent that the chest pain Stanley rang us about is put on. All his observations are coming through okay, and his overall demeanour - although not exactly healthy - is not that of someone having a heart attack or any other acute illness.
When Rae is sitting in the cab, Stanley leans up from the pillow and looks up at me, with an expression I last saw on his dog.
'Could you convey my deepest apologies to your colleague? I really did not mean to upset her.'
I tell him that I will certainly do it.
He relaxes back. Then: 'I do think she's awfully cruel, though.'
'Stanley, she's doing her very best to help you. She certainly does care about you. But I have to say, you're not doing anything to help yourself.'
He stares at me.
'Have you heard the story about the little boy who cried Wolf!'
He stares at me.
'There's a little shepherd boy who....'
'Yes! Yes! I know the story!' he snaps. 'And I must say I don't much care for being called a liar.'
'Stanley. I haven't met you before but I am well aware of the number of times you have called 999. You must realise that this is not the way to carry on. It's not fair - for lots of reasons.'
'Well I'm not going to hospital,' he says, swinging his legs over the side of the trolley and sitting up. He disdainfully hooks the blanket from his lap. 'I could never leave my dog.'
It seems pointless trying to talk to him further. I show him where to sign the paperwork to say he will not be travelling to hospital tonight. He makes a childishly extravagant flourish with the pen, obliterating half the form.
'That,' he says, giving me back my pen, 'can never be repeated.'

I walk him back to the front door. He fumbles with the keys, mumbling something about the lock being difficult, but I push it open to show that he left it on the latch.
'Many thanks,' he says. And as I turn to go, 'Please convey once again my sincerest apologies to your friend.'
I turn back to the ambulance, and the door clicks shut behind me.

Friday, January 19, 2007

animal welfare

Freighter's Lane may once have served the river that gently meanders a hundred yards at the end of it, when barges toted their agro-industrial cargoes to and from the English Channel, but now its metalled surface is pitted with deep holes; the few, expensive self-build houses off to the right all have four-wheel drive cars, and the dog walkers from the nearby village pick their way carefully.
S. drives the ambulance at a dead slow pace. The chassis rocks from side to side, and the equipment in the back shifts precariously. We are looking for a caravan where an elderly woman has fallen to the floor, query cause. So far all we have seen is an abandoned car chassis lying in a ditch, but S. has a feeling that there is a caravan site at the end of the lane.
Halfway along a driveway opens off to the right, leading to a substantial bungalow in a landscaped garden. Next to the driveway, set back amongst the trees, is a pristine antique caravan, picked out in Lincoln green, with large wooden wheels, a curved roof and a stable door carved with rustic patterns.
'Wow', I say, pulling on my gloves and jumping out of the cab, 'Now that's a caravan.' I climb up the three steep wooden steps and knock on the door. No reply. I try the door, but it's locked. I peer through the little porthole window. Empty. But it strikes me as odd anyway that an elderly woman would be able to live in this. Surely it would be difficult for her to get in and out.
'I didn't think this would be it,' says S. 'I'm almost sure there's a caravan site at the bottom of the lane. I'll head that way, if you get on to Control and ask for more information.'
By the time Control answer, we've made the end of Freighter's Lane, which terminates at a post and rail fence and a stile to the flood plain. We can see a caravan site off to our right, but access to that must be via another roadway. The sky is a vivid blue wash above us, and the air has a salty tang. It's great to be out in the country.
Control tells us that we are definitely in the right lane. They say that they will try to get back to the person that called us, a person out walking, but in the meantime, could we take one more close look back along the lane.
As S. reverses, the ambulance swaying precipitously each time we hit another crater, we notice in the mirrors a man waving to us. It looks to be someone from the bungalow we had passed earlier on, the one with the caravan in the grounds. As we draw alongside him we wind the windows down.
'Hello chaps. I bet you're looking for Mrs Meadows.'
I tell him about our search for an anonymous woman on the floor of a caravan that we can't locate. I tell him that I had a look in the caravan by his driveway as I thought that might be it. The man laughs, and the laugh seems to resonate caustically beneath the rest of what he has to say.
'I can absolutely guarantee that you won't believe me when I tell you where Mrs Meadows lives,' he says. 'We've all been trying for years to get her to move, to get something done. But she's very stubborn - well, crazy, actually. But you see the problem is, no-one seems ready to say that she is actually crazy, and of course that wreck is her registered address, so the whole sorry business drags on. I went as far as buying her a mobile home to live in. I cleared a site here, set it all up. But she wouldn't move and she wouldn't move, so eventually I had to have it taken away. Everyone's worried about her. The neighbours have been very good. We all take her food now and again. But at the end of the day - what can you really do?'
'So - where is she?'
He tells us that Mrs Meadows lives in the abandoned car that we passed at the top end of the lane, the one in the ditch. She has lived there for twenty five years, firstly with a husband, who had mental health problems and who disappeared a little while ago, and latterly with a number of cats. She used to be able to walk to the local shops until a few months ago, but now she is dependent on bags of food dropped off by passers by.
We use the man's driveway to turn around, and drive up the lane to Mrs Meadow's residence.

It is a desperate place. In the nineteen fifties it may have been identifiable as a caravanette, but now it is a blackened hulk. There are jagged, head-sized holes in the sides where rust has flaked away the metal, but the interior is dark and unreadable. What would have been the cab is lodged under a thick bush of blackberry thorns and filled with a sludge of detritus; the upper curve of the steering wheel is just visible, rising like the helm of a ship from the slime at the bottom of the sea. The whole thing is tilted into the waterlogged ditch at an angle. Around the back of the wreck where the door would have been there is now a filthy orange bathtowel strung across. I knock on the metal to the side and call out 'Ambulance. Mrs Meadows?'
I hear a voice inside.
'Can I come in?', and I pull the rag aside.
It takes a moment for my eyes to adjust not only to the gloom, but to the sodden chaos, a full minute before I can disentangle the animate from the inanimate, the human from the animal, the humanity from the neglect. Mrs Meadows is lying on her right side, her shape moulded around on all sides by a foetid morass of damp and unthinkable matter - a black tide of waste that fills this tiny space on a falling diagonal, from the back to where I now crouch, wondering what to say. Mrs Meadows seems able only to lift her head to see who I am, and to wave a small red plastic torch with her left hand. I count five cats at various points on the slope, one filthy white cat fastidiously licking a paw to the left of her head. There is a mulch of sodden cat biscuit boxes around Mrs Meadows' feet, and a shopping bag with some items for her, some buns, and a bottle of squash.
'Are you okay, Mrs Meadows? What's happened?'
She replies in a gently modulated whisper. If I shut my eyes I could imagine I was being invited to take tea with her in a cottage garden.
'Thank you so much for coming. I'm actually fine. It's not me at all, it's my cats. I'm desperately worried about them. You see I can't get about as much as I used to and it's really not fair on them.'
'Okay. Would you mind if I came a bit closer and gave you a check up?'
S. came to the opening just behind me. I heard him whince.
'No. No thank you. I'd rather you didn't touch me or come near me, thank you. I'm perfectly well. I simply want you to do something about my cats. Now - I have the number of a rather good animal shelter here somewhere.' She feels blindly with her left hand in the pocket of her coat, which is shinily filthy. She pulls out a scrap of paper and waves it out to me. The nails on her hand are curved and yellowed claws. I take the paper. It has the number of a cat rescue project written on it.
'Could you ring that for me and have them take my cats away? It would be such a weight off my mind.'
'Mrs Meadows,' I begin, 'There are lots of people very worried about you. We're very worried about you. These - conditions. They don't seem - all that good for you. And winter's just around the corner. What will you do? How will you cope?'
'Yes, yes. I know all that. But look. What I really want to know is - are you going to do something about my cats?'
'Let me just consult with my partner,' I say, withdrawing outside.
S. shakes his head. 'We can't just leave her here like this,' he says. 'No way. I've never seen anything like it.'
Back in the cab I call Control on my mobile phone. I tell them how shocked we both are. I tell them that I think Mrs Meadows should be taken into care - by force, if necessary. I cannot believe that this situation has been allowed to continue for a week, let alone a number of years. As I talk I have a dreadful image in my mind of her hand on the little red torch in the darkness.
But it seems that this is a formally registered address, so any forcible removal would have to be conducted via GP, mental health and social services. Control finds out that a recent assessment of Mrs Meadows' mental health had been made and she was found to be competent. Although I try to argue that the extremity of her living conditions must surely be interpreted as evidence of mental incapacity, Control are bound to say that these are questions for the mental health team in that area.
There is nothing more we can do.
I complete the paperwork. Mrs Meadows has refused treatment. All we can do is write a report highlighting our concerns.
And to notify the cat warden.
I have no doubt the cats will be re-homed immediately. This is no place for a cat.

Thursday, January 18, 2007

birthing partners

The first
The early hours, thin and grey. We lie sprawled on leather recliners beneath the sick and flickering light from the TV.
And then the alerter goes off and I find myself standing up, walking out of the door, incredibly. A fox looks up from amongst the bins.
In the vehicle the message on the terrafix gives us an incident number, address and then description: Abdo pain. Just as I turn the engine over, Control calls us on the radio. It's likely we'll be stood down before we make this one, he says, but in the meantime can we run routine until they've found out if we're definitely needed or not? I turn out of the drive. The fox lopes off.
A couple of minutes into the journey, it's Control again: proceed as planned, but nothing serious.
Another couple of minutes and I'm turning into the road we need, a decrepit square of two storey Georgian houses. It is dark and the numbers are difficult to make out, but after I cruise slowly round a light comes on in a porch the other side and I see a young woman step forward from the shadows to start waving over to us.

I drive round and pull up outside. The woman patiently waits for us as we get our bags and lock the vehicle. She stands hugging her arms to her chest for warmth, stepping from one foot to the other, a ghostly teenage girl with a scooped face and a mouth of decaying teeth. 'Follow me' she says, and leads us back up the steps with her arms still folded tightly to her chest. Sick as she looks, it turns out that it's actually her sister, Julie, who is the patient. D. asks her what the problem is.
'She's six days late.'
'Six days late for what?'
'For the baby.'
We exchange a look. 'Abdo pains?' Well, giving birth would fit.
'So - er - she's pregnant then?', he says.
The girl stops briefly on the stairs to drop a look back on us. 'Yes,' she says, without expression, then turns back round to carry on with the climb, but somehow slower than before.
This looks like some kind of temporary hostel. There is a fire alarm console in the hallway, and a noticeboard has been put up to display regulations and useful numbers. The lights on the stairs don't work, and it seems that every door we pass has been kicked in at least once in its life. The darkness smells sweetly spotted with damp. Eventually, at the top of the last flight of stairs, the girl shows us into one room and then disappears into another.
It is a fuggy, intensely lit space, with clothes, plastic bags, cigarette packets, hair brushes and newspapers strewn across every surface. And lying the wrong way round on the bed, looking as discarded as everything else, a pregnant girl, her swollen belly emphasised by a tight white top and the vivid tracings of blue veins standing out beneath the skin around the sides. Her cheeks are flushed, and strands of her hair stick to her forehead.
The bed sinks down to where another, more substantial teenage girl sits on the bed; standing over by the window is an angular, skinny guy in a baseball cap who gives us a nod and a raise of the hand as if we're waiters and he's ordering a beer. The girl on the bed dabs a face-cloth across Julie's forehead, the chunky silver links of her bracelet sway gently as she moves her hand back and forth. 'All right?' she says.
D. kneels down and tries to rouse her.
'Julie? Julie?' She gives a groan but does not open her eyes.
The sister comes back into the room and stands over by the window with the tall guy, who tells us he is Julie's boyfriend. He says he isn't the father of the baby, but wants to do what's right. He lights two cigarettes, one for him and one for the sister.
D. feels for a pulse and asks how long she has been like this. The sister tells us that they had all gone for a long walk along the front earlier in the day - Julie's idea - and she'd seemed fine then, fitter than any of them. When they got back they'd all had a bit of wine - Julie didn't have much - after that, Julie had complained she felt funny.
As D. asks the questions I take Julie's blood pressure and other essential observations, all of which seem fine.
The girl on the bed says that Julie's contractions are very spaced out, and that despite passing a 'show' yesterday, nothing much else has happened. 'I know all about it', she says, 'I went through it last year. I've got one of my own. A girl. A right pain.'
She tells us that no, Julie didn't faint or have a fit, she hadn't been complaining of any unusual pains or swellings anywhere. No, she doesn't have any health problems. She says that Julie is due for an appointment at the hospital in four days, when they say they will probably induce her. 'They'd better.'
It doesn't appear that Julie is either giving birth at the moment or in danger of pre-eclampsia, so we decide to sit her up, to see if we can lift her responsiveness, and get some information directly from her. We help her slowly into a comfortable sitting position - and the change is immediate. 'Where's my coke?' she says, and then smiles at us.
'Feeling a bit better, then?'
She nods as she sips. Her boyfriend comes across to us, holding out a clear plastic envelope with her notes in. I start filling in our worksheet. He says: 'Can we all come in the ambulance or ....?' but the silence that greets this makes it obvious that he's the only one in the room still thinking along those lines. The sister goes back into the next room, and he retreats back to the window.
D. says that the best thing to do is for us to call the maternity unit where Julie is registered so he can have a chat to one of the midwives there, relay all the observations we've made, and let them decide whether they want us to bring Julie in.
'We can do lots of things but one thing we can't do is check the cervix to see how dilated it is. That's the best way to tell established labour, I'm afraid. And it doesn't sound as if it really is that far along, to be honest. The contractions would be coming along much closer together, and the pain - well, I'm only a bloke, so what do I know - but I'm sure you'll notice a change in the quality of the pain.'
The friend has been turning the face cloth over and over in her hands as D. says all this, but she suddenly throws it across the room. 'I could tell you about that', she says. She brushes her lap. 'I had to have a caesarian. Twelve hours pushing, and then the baby got stuck.'
The boyfriend yawns and looks down into the street below.

The delivery suite confirms what D. already suspects. They're happy for Julie to stay where she is until the labour has progressed. We get a signature on our worksheet to release us, and leave. Julie waves to us from the bed, and we find our own way back down the stairs.

The second
The blue lights are leaping around us on the dark buildings as I drive quickly along to the incident given as: birth imminent. Control has told us on the radio that it's a busy night for maternity and the midwife is having to come from quite a way away. It means we will be on our own for at least half an hour. No problem.
The early morning streets are quiet, and we pull up outside the address in no time. I jump in the back to get the maternity pack and the resus bag, then lock the vehicle and join D. at the front door. He rings again. No reply.
A cosy Victorian semi in a quiet street. The hazard lights on the ambulance seem a terrible intrusion. He rings again, and knocks loudly.
Then, just as he bends down to have a look through the letterbox, we see a muted light through the door's delicately patterned glass panels. Someone's coming out. Slowly.
The door opens.
A large woman stands with one hand on the door and one on the frame, blocking the hallway. She has vividly spiked blond hair, thick framed black glasses and an expression that seems to me - at this hour, and in this situation - to be a curiously controlled hybrid of discretion and hostility.
An introduction seems redundant - here we are, paramedic and technician, for the pregnant woman, with all the gear - but after a pause, when it becomes apparent that one is necessary - D. says: 'Ambulance?' And then: 'So - where's the patient?'
The woman steps closer up to us.
She speaks quietly, and what I think she says is: 'I'm Adula' - which I take to be a variation on Adela. So I nod and smile and say 'Hello Adula - I'm Spence and this is D.' I can feel D.'s patience dissipating like drops of water on a griddle.
She looks at me, demonstrating even tighter control. 'Well. I'm Diane,' she smiles, 'Could you follow me into the front room, please?' Which turns out to be dark, and noticeably without patient. I am confused about the introduction, until it strikes me that she probably said she was a doula - a term which I hadn't come across before, but which must be some kind of birthing partner. Meanwhile D. insists on being shown to the patient right away.
'There is no patient,' Diane says. 'There is nothing wrong here. All that's happening is that a woman is having a baby.'
'Excuse me,' D. says, 'But - who exactly are you?'
'I'm Jane's Doula. I'm here to make sure her wishes are respected, that everything she planned for the birth goes ahead exactly as she wants it, wherever possible.'
'Do you have medical training? Are you a midwife?'
'No,' she says, 'I don't catch babies.'
D. straightens at this. 'Look. Someone called for an ambulance because a woman is in labour. That's why we're here. And we have been trained. We're wasting time talking to you whilst this patient is unattended, possibly in danger. How am I to know if I can't examine her?'
Diane is prepared for this. I wonder if she's faced this situation before.
'I'm not being obstructive. I'm not getting in the way, or stopping you from doing your job. Jane is in the birthing pool, with her partner, just in the next room. Everything's fine, and they don't want you in there. But if you feel that you need to go in, then of course I won't stop you.'
'Well there's absolutely no point in us standing here in the dark like this. I need to be sure that the patient is happy for us not to attend, and if that's the case, we'll wait outside for the midwife to turn up. If we're not wanted, it's all the same to us.'
'I'll go and talk to her now and see if that's what she wants.'
Diane leaves the room, and I switch the light on.
D. shakes his head. We put our bags down and stand looking around us. There is a large, painted canvas on one wall, a baby angel descending between two melting figures. Simply framed black and white family portraits. A book shelf crammed with books on travel, novels, books on film and jazz. Wall charts for identifying creatures of the shoreline, birds, woodland animals. Diane comes back in.
'Jane has asked me to thank you for coming. She says that she doesn't need anything at the moment, and asks that you wait - either here or outside in your vehicle - until the midwife arrives. Is that okay?'
D. shrugs, and she leaves again.
We wait for about twenty minutes in the front room. The woman's contractions are obviously coming intensely, now; with hardly any gaps, her cries resound throughout the house. Every so often she seems to sing as she shrieks. I look at D. He raises his eyebrows and shakes his head.
'If something goes wrong...'
And then we hear a car pull up. We go outside to brief the midwife. D. tells her about the Doula, and the midwife tuts. 'That's all we need.' She asks us if we'd mind hanging around until the baby is delivered, and then hurries inside. We wait in the hallway.
The labour progresses, with the midwife giving Jane encouragement and instructions.
At one point we hear her say: 'The head is out.'
And then: 'You must get out of the water if this next push does not deliver the rest.'
Soon after it is apparent that the baby has been delivered, but there are no crying sounds. The midwife speaks very sternly to the mother: 'Jane. You must give the baby to me so I can put him on the towel and get him breathing. Jane.' And then shouting out to us: 'Can I have some help here, please? Some oxygen?'
I pull out a cylinder and D. takes it through. Some long seconds later, then the baby's first cries echo through the house.
'Thanks' she says. D. comes back out, and we both go back into the living room.
Eventually the midwife comes into us. She tells us that Jane will not be having syntometrine to deliver the placenta, so it may take some time. We're near the end of our shift, so the midwife says she's happy to let us go. If she needs any further help she can always call for another ambulance.
We say goodbye to her, and leave.
I pull up round the corner, turn the radio down, lean back in the seat.
D. gets out and rolls a cigarette.
The sky is lightening now, but I don't feel tired.