The message is as direct as it usually is: Serious haemorrhage / lacerations – injury to hand – Cat B. We machete our way through the heavy traffic with our sirens; town is packed, with crowds massing around the shops for the post Christmas sales.
The follow-up message lowers our expectations somewhat: fire brigade on scene. Patient cut hand whilst striking fire alarm. We wonder how you can seriously injure your hand punching out the little glass panel from a fire alarm, but the category remains at B, so we hustle onwards.
Turning into the street we are confronted by two fire engines with their blue lights on and a bunch of fire-fighters milling around on the pavement. No sense of urgency and, crucially, no smoke. We pull up behind the last tender and jump out to meet the Incident Officer.
‘Nothing much here, lads. A candle got a bit smoky, and one of the residents punched the alarm. She says her hand is injured, but I’ll leave it up to you.’ We follow him to the high wooden fence at the side of the house. ‘She’s in the flat round the back.’
‘What is this place?’ I ask him.
‘Some kind of psych residential. Just through there, mate. You can’t miss her.’
We pick our way through piles of junk towards an open door. There is a large woman in a black coat smoking a cigarette in the garden. For a moment I wonder if she’s the patient, but she doesn’t acknowledge us at all. I hear voices from the room beyond the door, so we head for those.
We step into a small, square room, as congested with stuff as the alleyway that led here. Another fire-fighter is standing over by the only window. To his left, a vast woman is sitting quietly in an armchair facing us, so shapelessly huge it looks as if the chair is a mould and the woman has been poured into it. She is wearing a silky chemise, her bare arms and legs trunking out of the delicate lacy frills at the four corners. She has painted a thick war stripe of blue eye shadow that runs across the top of her face. Her lips are grey, and as Adam negotiates a path to her to take a closer look, she pre-empts our concern by saying:
‘I’ve painted my lips with ash.’
Adam looks at the fire-fighter, who shrugs, and looks at his watch.
‘Why have you painted your lips with ash?’
‘Because I’m a god.’
‘Oh. Okay. Well, first things first. What’s your name?’
‘Ellie. Ellie Sparrow.’
‘What’s happened here, Ellie? Was there a fire?’
The fireman reports the facts: ‘A Christmas candle with a leather base was put on the radiator and gave off some fumes. Ellie punched the fire alarm, and she says she’s hurt her hand.
Ellie holds up her hand. The fingers are swollen, the nails bitten right back and painted different colours, the knuckles covered with scabs of different ages. In other words, entirely like the uninjured hand, and normal for the patient. Adam examines the hand for movement, sensitivity, cap refill, and everything seems fine.
‘Do you have any medical conditions?’ he asks her, reaching for the paperwork.
‘I’m bi-polar. Where’s my bag? I have to show you something.’
Adam hands her a huge canvas bag. Ellie begins rummaging through it. She pulls out a ceramic pyramid-shaped incense holder. ‘I take that with me everywhere I go.’ She pulls out letters and CDs and a book jacket with a photo of Sting on it. ‘Do you like Sting?’ she says.
‘Ellie – we need to ask you a few questions and do a few tests just to make sure you’re okay. Can we do that?’
She looks up at him. ‘I just want to show you my fake saliva.’ And then – incredibly – she pulls out some medication that clearly says on the box synthetic saliva.
‘I need to have some chocolate.’ Before we can stop her, she produces a big glass bowl from the side of the chair, filled with bars of chocolate, pulls one out, opens it and has it in her mouth with practised economy.
We quickly make the observations that we are duty bound to make. Adam says to her:
‘Ellie. From all that we can see there’s no medical need for you to go to the hospital today.’
‘But I want to go,’ she slurps, wiping her chocolaty mouth with the back of her hand. ‘I’m on my own here. There are voices in the garden. I’m bored.’
‘I’m sorry to hear that,’ he goes on. ‘But none of these are reasons to go to A&E today. The best thing to do would be to make an appointment to see your GP in a day or so.’
He pauses, then tries another tack. ‘Casualty is full up today, absolutely crammed with drunks because of the New Year. You’ll be waiting for hours if you do go. I really don’t advise it. Plus, you’ll be depriving someone of an ambulance who might really need it.’ She stares up at him, and stops chewing briefly.
‘You know – heart attacks. That kind of thing.’
‘Haven’t you got a lovely speaking voice,’ she says, and gives him a dreadful smile.
‘Okay, Ellie. Do you want to sign the form to say you’re not going in?’
Incredibly, she takes the pen and form, and then makes a signature that’s more like a furious crossing out. She chucks it back at him.
‘Happy Christmas,’ she says, and looks at the fire-fighter, but he is following us out with the same sense of urgency.
We make our way back outside to the truck. The fire crews wave and move off. We sit in the cab, listening to music whilst Adam finishes the paperwork.
After about five minutes Control calls us on the radio. They tell us that Ellie is back on the phone. She says that she needs an ambulance for her hand. Reluctantly we agree to go back in to see her, but before we can get out of the cab she is there on the pavement, staring across at us. We climb out to let her in to the back. The whole ambulance rocks from side to side as she makes her way to the seat. The seat belt will not go round her. I slam the door shut and we set off.
At the hospital we show Ellie to a seat in the minors waiting area. We apologise to the staff nurse for bringing her in, and she accepts our reasons with commendable sangfroid. But A&E is already bursting, and we all know that Ms. Sparrow may well be the (gigantic) straw that breaks the camel’s back.