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.