Thursday, March 27, 2008

the files on John Lennon

Mick’s beard has the coarse look of terrier fur, and his hair hedges over his head in a thickly tangled muddle. Along with his army boots, his shiny fatigues, his jacket and carrier bag of stuff, he looks as if he wrote the book on the etiquette of neglect. And in the context of a voluntary admission to Southview and case notes that begin with the assessment malodorous, it’s difficult to resist the obvious assumptions. But when I introduce myself I’m struck by the clarity of his eyes; beneath all that scrub he carries himself with quiet economy. On the journey into hospital he tells me his story, speaking in a soft Scottish accent.

‘I haven’t been well. I know that. I’m very extreme. One minute it’s party, and the next it’s “where’s the nearest bridge I can throw myself off.” That’s why I’m going in to Southview. I’m hoping they’ll have some ideas.

‘I’ve had a few things happen. My best friend died on me a few years back. He had meningococcal septicaemia, but the paramedic thought he’d taken heroin and gave him adrenalin, which pretty much killed him. I suppose he wasn’t to know. I did tell him, though. I said “Darren smoked some heroin a couple of years ago but that’s it. He’s terrified of needles, for starters.” But there you go. The house was usually filled with people. There was always something going on, it was a really busy place, a hive. But for some reason that particular day there was no-one about. Even the phone had been cut off. So he spent the whole day on his own, going downhill. It all added up to one big mistake. But he probably would’ve died anyway.

‘I was in a band for about ten years. Couldn’t play guitar all that well but Sye took care of that and I wrote the lyrics. We were like Paul McCartney and John Lennon. We balanced each other out. We did alright. But you can’t do it for ever, so I gave it up, pretty much. Concentrated on my novel. Short stories. It’s difficult getting the space to write, though. I need a bit of quiet, and it’s so noisy at home. You know – kids and that. Plus I had a lot else on my plate.

‘You know the FBI are going to release their files on John Lennon? They must be about so high. They were absolutely terrified of him. He had such a power over people. I always thought his peace thing came out of a deep personal anger. He was a tough working class scouse kid. Bit of a bully. I think his mum died, then his aunt looked after him, then she was run over. But he turned it all around, didn’t he? He channelled it. I bet those files’ll make interesting reading.

‘I’ve just been diagnosed with Huntington’s. It’s what killed my grandma and my mum. We all knew how the disease went on because we nursed grandma as long as we could and we saw how it took her. When mum was diagnosed she asked us to promise to kill her before she got to the later stages. Me and my sister talked about it, and we decided that when it came to it we’d give her a big shot of heroin. But then when she went into a home and we talked about it again, we realised that we couldn’t actually go through with it. It wasn’t because we were scared of going to prison. We just couldn’t do it. Funnily enough – although not really that funny – a little while later there was an accident at the home and mum died. That’s the thing about Huntington’s – or one of the things – you end up having trouble swallowing, keeping your airway open. So I think she choked. Not a nice way to go. But I suppose she was spared the worst of it. I mean – she was in a place with all these people with Alzheimer’s. They weren’t giving her the right drugs. It wasn’t nice.

When it comes down to it, I think I’m like Nick Cave. I don’t believe in an interventionist God. But when they told me about it, I must admit I was relieved. It was just like God had intervened. Spared her the worst of it.’

The ambulance parks outside Southview, and Rae opens the door. Mick looks at me and smiles.

‘So, that’s my life story,’ he says. ‘What’s yours?’

Wednesday, March 26, 2008

the onset of spring

Agnetha has two shelves of bowling trophies, a mini militia of silvered women bending over with arms extended over a series of dates. Beside the shelves are a couple of wedding photos, both with a faded seventies look – shapeless flowery dress, huge sunglasses, thirty five years of sunlight on crumbling photographic paper – both, as far as I can make out, identical. Agnetha herself is sitting on the floor, so drunk that she cannot co-ordinate the lighting of her cigarette, or the closing of her eyes. She pauses momentarily to swear at her carer.
‘You cow. I’m going to shmack you in the mouse.’
‘Netty,’ I say, ‘Please don’t say things like that. It really isn’t nice. We’re all here to help.’
It seems inconceivable that Milly, her home help, could come to this flat every day in the face of such abuse and yet still be as bright and smiling as she is.
‘Such a lovely day today,’ she says, glancing out of the window as she clears up the kitchen and unpacks Netty’s lunch. ‘So Spring-like.’
‘You louse!’ from the floor. ‘Did you call them? Warum?’
Milly raises her eyebrows to us, then gives her pony-tail a little shake, like a horse batting away a fly.
‘I don’t know how you put up with this,’ I tell her. ‘Whatever they’re paying you, it’s not enough.’
She laughs, then hands me the yellow folder with Netty’s care details.
I can see from the records that Netty often ends up on the floor after she’s been drinking. As the level in the bottle of gin sinks, so does she, until she slides forward off the armchair onto the floor. She doesn’t ever hurt herself –is uninjured today – but often refuses help in getting her back into the chair or into the big, white plastic poolside lounger that dominates the centre of the room. Her mobility is okay when she’s sober, but she isn’t looking after herself. A brackish smell of urine lays heavily across the room, cut only by the smell of old smoke.
‘Why won’t you let us help you, Netty?’
‘Shut up.’
‘Netty – are you from Germany originally?’
She stares at me across a deep void of drunkenness, then holds out her right hand to me. When I take it, she tries to hurt it by squeezing as hard as she can. But her little yellowed claws are like her words, full of intent, but powerless.
‘What are you trying to do, Netty?’
She drops her hand back onto her lap, inadvertently crushing the unlit cigarette in her left. She gives a couple of nods - then suddenly seems to wake up.
‘Prussia. I come - from Prussia.’
‘My mother in law originally came from Prussia.’
But she nods forwards again, this time for longer, and it seems she may now actually be asleep.
‘Stolp,’ I say. ‘Poland now, but Prussia before the war.’
Those heavy lids lever themselves open a crack.

We lift her into the lounger, and notify her GP that we have some concerns about her welfare, the fact that she doesn’t seem to be taking care of herself effectively, pointing out the fire risk she poses to the rest of the block. There’s nothing else to be done. We say goodbye to Milly, who needs to be heading off to her next client as soon as possible.
‘Have a great day,’ she says.

Sunday, March 23, 2008

kinder surprise

Hardly any of the flats in this block seem to have numbers on their doors, and the landing light clicks off too soon again. Who lives here? Sprinters? But we can hear a big-footed voice behind the door, and when Rae calls out ‘ambulance’ it stops, there is a pause, and then the door opens.
‘Blimey! Hello, Steve’, she says to the bulky policeman, and then: ‘I didn’t recognise you with your clothes on.’ I stand behind her, nodding and eyebrow raising like a hapless comedy stooge. But what can she mean?
‘Hello, Rae! How are you? Haven’t seen you in a long time!’ He steps back for us to come in, looking in his black leather gloves and body armour, and with the harsh bed-sit light haloing his bony head, like an estate agent from hell.

We go in.

As well as the usual squalid leitmotif of cans and bottles, over-spilling ashtrays and thrown clothes, there is a folk guitar smashed on a rug in the centre of the room, an electric guitar and a practice amp junked in a corner, the poster of a naked woman draped in a python curling off the wall above a portable TV, and sellotaped to the door of a kitchen cupboard, a faded, oddly colourized photo of a smiling old man demonstrating a folk guitar in a sunny garden. On the sofa in front of the smashed guitar sits the patient, a bare chested young man, fixed in a pose of readiness. His right hand, still clutching a little tuft of rolling tobacco, is placed on his right knee; on his left, a slashed and bloody forearm. A younger man stands on the other side of the room, next to the second policeman. Whilst the patient is half-naked, lean and furious, his friend is bundled up in a parka and woolly hat. His glittering eyes flick about as he tries not to cry.
The second policeman – a tall, pale figure who looks as if he was issued with a moustache at the same time as his uniform, speaks.
‘Guys, this is Mal. Mal has cut himself tonight - as you can see - and we wondered if you could tell us whether he needs to go to hospital or not?’
‘I do not want to go to hospital. I want to go to Southview.’
‘You know we can’t take you there just like that, Mal,’ says Steve. ‘You know how it works.’
‘I’m going to do something terrible if I don’t get some help.’
‘One step at a time, Mal,’ says the second policeman. ‘Guys – over to you.’
As the two policemen move closer to each other to chat about stuff, Rae goes to kneel down next to Mal. I fetch out some saline and some swabs from the dressings bag. She asks him the usual health questions as she cleans his arm. He is as immobile as ever. The patient’s friend moves over to the door.
‘Is he going to be alright?’ he asks.
‘Yep. But this middle cut will need stitching.’ She dumps the bloody swab into the bowl of red water and asks Mal if he meant to kill himself when he did this. He snorts. ‘If I meant to kill myself I would be dead now,’ he says. ‘But I was interested to see what would happen if I made the cuts downwards rather than across-wards.’
He looks over to the two policemen.
‘Take me to Southview.’
‘Mal. As I’ve explained – lots of times – that’s not the way it works, mate.’
Take me to Southview.
‘Calm down, Mal. First things first,’ says Rae. ‘You need to have a stitch or two at the hospital.’
Mal looks at her as she stands up. ‘My eldest sister is marrying her boyfriend next week,’ he says. ‘The same boyfriend that abused me for years.’ The statement is curiously flat, as if even he doesn’t believe it.
As we pack away our things ready to go and the policemen discuss logistics, Mal says: ‘You haven’t asked me what I cut myself with.’
Steve looks up: ‘Okay, Mal. Tell us. What did you cut yourself with?’ and turning to the second policeman adds: ‘I just assumed it was the glass over by the sink.’
‘Nope,’ and then ‘I cut myself with a razor.’
‘Okay, mate.’
Mal does not move. ‘You haven’t asked me what I did with the razor.’
‘Mal – what did you do with the razor?’
‘I’ll give you three guesses.’
‘Threw it in the sink?’
‘That’s one.’
The second policeman takes a step forward and looks around on the floor. ‘Dropped it on the floor?’
‘That’s two.’
I notice a kinder chocolate egg on the cushion next to him on the sofa, so I say: ‘You hid it in the kinder egg.’
‘That’s three.’
Mal smiles at us, but his eyes remain unchanged.
‘I’m still holding it.’

In the time it takes for me to look down at the tobacco in his hand, Steve has crossed the room, grabbed his arm and is shouting at him to drop the blade, drop the blade. Mal drops it. Steve plants his big black boot on top of it, then orders Mal to move to the other end of the sofa. When Mal does this, Steve picks up the blade and throws it across the room.
‘You idiot,’ he shouts. ‘Right. Enough fucking around. Let me tell you what’s going to happen now, my friend. And I want you to listen very carefully, because if you do not do exactly what I say, you are going to find yourself in a world of pain. Do I make myself clear?’
Mal re-collects himself on the sofa with much the same expression as before.
‘Take me to Southview. I’m telling you…’ he says.
‘No. I’m telling you. So shut up and listen. No more tricks. No more cute shit. We’re here to help you and you take the piss. You put my colleagues in danger and I am not having that. So not another word.’

From his dirty brown sofa at the centre of the universe, Mal looks around him.

‘You,’ he says, nodding at the second policeman, ‘you’re new to the job, and he’s showing you the ropes. You,’ looking at Rae, ‘you cleaned my arm; you want to help me. You,’ he says to me, and then pauses. I unfold my arms. ‘You’re some kind of nurse,’ he says. ‘But you,’ to Steve, ‘I know exactly what you are and what you stand for.’
‘Do you? Do you really? How fascinating,’ Steve says. ‘Now I want an end to this bullshit. I want you to get your shoes on and something on your top. And then I want you to walk down those stairs like a lamb, my friend. I am not in the mood.’
The only move Mal makes is to touch his cut arm absently. A small trickle of blood starts to run along his forearm again as he disturbs the edges of the wound.
‘I could lose it now and take you out,’ he says, staring at Steve. ‘I can’t take you all on, but I can certainly take you. I could be on you before anyone could do anything about it. I could rip your throat out.’
‘Come on, Mal,’ says Rae. ‘This is silly.’
Steve puts his gloved hand out to her. ‘No, no, Rae. It’s fine.’ And then back to Mal: ‘I’m not scared of a little prick like you. You child. But I’m warning you. Don’t be saying any of this.’
‘I’ve got a hammer and I’m going to smash your fucking skull.’
The second policeman steps forward.
‘Where is the hammer, Mal?’ – but before he has finished the question, Mal has launched himself out of the sofa, scrabbled on all fours across the room, pulled a hammer from a pile of clothes – but then the second policeman lands on top of him, and then Steve, too, and they all desperately wrestle for control in a heap up against a filthy divan. The second policeman twists Mal’s arm behind him, forcing him to drop the hammer; he throws it away from them, and it lands on the floor with a sickening clunk. Now Steve has Mal’s other arm and manages to twist it out behind him; eventually they handcuff his hands behind his back, then strap his legs together. With Mal trussed and subdued, they release their hold, stand up and get their breath. Steve puts a call out for a wagon to transport. Rae leads the friend outside, who is crying now.
‘Sorry you had to see that,’ Steve says to me, attempting a smile.
‘Uncuff me so I can have a cigarette,’ shouts Mal. ‘If I don’t have a cigarette I’ll really lose it.’
‘No you won’t. I’m going to be telling you what you can and can’t do from now on.’ says Steve. ‘And at the moment, no cigarettes.’
Mal’s tone changes. ‘Please don’t take me to the cells,’ he says. ‘I can’t stand to be on my own in there again. I won’t make it out alive.’
‘You should have thought about that before you tried to brain us with a hammer, mate.’
The second policeman straightens his uniform. ‘Maybe if you co-operate we can think about favours,’ he says. ‘But we have to see that you’re genuine. We can’t afford to take any more risks.’


Ten minutes later we are standing in the room waiting for the wagon and reviewing our options. Mal lies face down on the floorboards, sporadically tensing and testing the cuffs and straps, breathing noisily like a captured animal. The rest of the room is quiet around us; it has easily absorbed the violence of the last five minutes.

Mal’s wound still needs stitching, and that’s something that can only be done at the hospital. He seems to calm down markedly over the next ten minutes, answering questions rationally enough, and making assurances with what seems like a genuine desire to keep to them. With those dark flights of stairs in everyone’s thoughts – carrying him down would not be easy - the policemen agree to reposition his cuffs so he can smoke a cigarette before he goes.

Ten minutes later, Mal hobbles down to the ambulance. There is a police wagon parked with its hazards on behind us, and a group of policemen stamping their feet to keep warm, chatting on the pavement. The second policeman goes over to them to let them know what’s happening. Mal is shivering, but it seems more with fear of what’s to come than the bitter cold.
‘Please – I beg you – don’t take me to the cells.’
‘One step at a time, mate,’ says Steve, strapping him into the ambulance seat and sitting down next to him. He takes his gloves off and stuffs them inside his stab vest. ‘One step at a time.’

Thursday, March 20, 2008

do you fight?

There are several reasons why we decide to go down the crumbling basement steps and not wait for the police. The first is that we’ve been out to Robert, the guy who lives here, several times before, and although each time there has been a different derelict amongst the cans and ashtrays, the atmosphere has never felt dangerous. The second reason is that even though this particular call is given as an assault, the follow-up message assures us that the assailant has left the scene; there is an implicit understanding that although the police are aware of the situation, it won’t be high on their list of responses, so we’d be waiting a long time for them to show. The third and deciding reason is that we are due to finish our shift in thirty odd minutes, and if he needs to go into hospital it’s going to have to be now.

Robert answers the door. I’m only ever used to seeing him in bed – he never travels to hospital - and I’m surprised by how tall he is. He looms above me, stinking on a cigarette, the lower half of his head hinging backwards in a welcoming smile like a garbage crusher.
‘Someone’s attacked Ralph,’ he says, and leading us along the crudely painted red hallway and into his bedroom.
Ralph is slumped in a ruined wicker chair by the window. He looks like a rock star waiting in a hotel to be interviewed, except the interview is delayed, and he’s sat there five years whilst the room, his clothes, his face decayed.
‘What’s happened, Ralph?’
Robert goes to light another cigarette and I ask him not to.
‘Oh. Sorry,’ he gapes, then adds ‘We’ve known each other since we were babies.’

Rae is hugging the clipboard to her and smiling professionally. ‘Ralph. Sorry. Go on.’
‘I’ve been attacked,’ he says, and rubs the side of his face by illustration. There is a small splash of blood just above his left eyebrow, but when we look at it we decide it doesn’t need gluing.
‘Were you knocked out at all?’ she asks him.
‘Yep. Clean out,’ he says. Then with more animation: ‘He grabbed me and pushed me back against the wall, man. I don’t deserve that. No-one deserves that.’ He looks across at Robert, who is lying back on the bed, propped up on his elbows, staring at me. He carries on. ‘He grabbed me by the hair. He tore loads out. I put it on the table.’
There is a great clump of hair beside a two litre bottle of cider.
‘That’s awful,’ Rae says, then ‘Ralph – you really need to come with us to hospital. If you were knocked out it means you’ve had a significant head injury and need to be seen.’ Ralph says nothing, so she makes things clearer. ‘Ralph? Do you want to go to hospital?’
He blows his cheeks out like a bored child. ‘Do I have to?’
‘No. You don’t have to. But we think you should come with us. That’s what we’re advising you to do.’
‘I don’t want to come, though,’ he says.
Robert snaps out of his reverie and chips in: ‘I called the ambulance. I was very worried.’
‘So who was the guy who attacked you?’, I ask Ralph.
‘Some idiot who’s been coming round here sponging off Bobby.’ Robert smiles at this and raises his eyebrows at me. Ralph rubs the side of his face. ‘He’s been round here a lot lately “Can I have something to drink, Rob? Can I have something to smoke, Rob?” Then today, when I answer the door, he pushes his way in and starts having a go. He calls Bobby a doo-dah. Then he calls me a doo-dah. Then when I say to him “You can’t call me a doo-dah” he says “Do you fight?” and I say “What do you mean, do I fight? No! I do not fight.” Then he grabs me by the hair, holds me against the wall, whacks me, then runs out.’
‘Ralph – this is really a police matter. You should come into hospital, but if you refuse to come in that’s your decision. Other than that, speak to the police.’
‘Yeah. I think I will,’ he says, but we all know he won’t.
‘Is that it?’ says Robert, flailing up from the bed.

We follow him out. We pass two pictures on the darkly stained wall –a family of geese feeding by a beautiful river, and Christopher Robin dragging Pooh bear backwards down the stairs.

Tuesday, March 18, 2008

lost languages

The drunk who has fallen down a flight of stairs at the hostel is propped up against the railings outside. He folds and unfolds his arms, wipes his face with rough hand-strokes, shakes his head and mutters; he seems to be scolding himself with the asocial carelessness of drunks the world over. As Eric, the paramedic in the response car who we are backing up, walks across to us, I notice three scaffolders in the front of their lorry cramming sandwiches into their mouths and laughing, this whole scene an unexpected mid-morning cabaret.
‘Jim has had a drink or two this morning,’ Eric tells us. ‘He’s fallen down about six stairs and banged his head. He wasn’t KOed, C-spine seems fine, no back pain, so I don’t think he needs boarding, but he does have a little skin-flap on the top of his head that needs seeing to. No other injuries, no medical conditions other than a touch of asthma. He’s a bit down on his luck by the sound of things. He’s living in the hostel, estranged from his wife, doesn’t see his children, has a stormy relationship with his mother, blabbedy-blah-blah…’ Eric looks over to the patient and waves. ‘Apart from that – all kosher, all yours.’
When I go up to Jim and introduce myself he snaps off a volley of swear words.
‘Easy, mate,’ I say to him. ‘We’re here to help you.’
‘I know. I’m sorry,’ he says, with surprising clarity. ‘I’m just cross with myself. It’s so stupid. Stupid.’
We help him into the ambulance, dress his wounds and set off for the hospital.

Walking through the automatic doors at A&E, Jim’s mobile phone rings. He pulls it out and looks at it.
‘It’s my mother,’ he says, ‘I’d better answer it.’
So we back-track a few steps to allow him to use the phone just outside.
‘Hello?’ he shouts. ‘Yes, mother. Yes, yes.’ Then he looks at me and nods. ‘I’m just at the library researching the Picts. Bye.’
He snaps it off and then struggles to put it back in his pocket.
‘She’d only worry,’ he says.

Inside, I wait with Jim whilst Rae goes to handover to the Charge Nurse. There is no chair to sit him on, so we both lean against a cupboard.
‘How are you feeling?’ I ask him.
‘Me? Oh, well..’ he trails, folds his arms and looks down at his shoes. Nearly topples forwards.
‘The Picts?’, I say, when I’ve re-centred him. ‘Isn’t that why the Romans built Hadrian’s Wall?’
Jim smacks his lips together as if he’s just tasted something unusual, and frowns.
‘Well, yes, you see, it’s so interesting,’ he booms. The other ambulance cases just ahead of us - a red and rather inflated looking woman; a young girl slouched over a vomit bowl – and the technicians with them, all look up.
‘They’re quite a mysterious bunch, the Picts. There are so many theories about where they came from originally –Scandinavian? Did they come over in the early Bronze age? But they certainly dominated northern Scotland from very early on. That’s where I’m from – around Fife,’ he says, taking off his glasses. ‘Look how filthy these are.’ He tugs out his vest and begins cleaning them. ‘Oh yes, I had a lovely childhood. Bliss. My father was one of the first people ever to have a camper van. It was so unusual, if you passed another on the roads you’d pull over and chat. Sometimes we’d just throw some food and clothes into the back, jump in, and drive and drive until the road simply ran out. Then we’d stop there for a few days.’
He puts his smeary glasses back on.
‘Did you know the last person to speak Cornish – Dolly Pentreath – died in 1768. Mousehole, I think.’ He looks around him. ‘Lost languages. So interesting.’

Rae waves to us, so I lead him to his cubicle.

Monday, March 17, 2008

saturday night square dance

A-One, two, three, four…. (drums, bass, guitar and fiddle) …. Well, good evening Ladies and Gentlemen, boys and girls. Please don’t be shy now - let’s fill the floor right up, now, so we can see how you’re made, how you parade, if you’re two-tone, free-fone certifiably dismayed. Because Ladies and Gentlemen, boys and girls, tonight, live all night, you’ve got the quick blue straight to you Old Time Amb’lance Aiders. The cruel wind may be a blowin’ and the storm clouds may be a growin’, but we’ve got the attitude if you’ve got the gratitude, we’ve got the bus if you’ve got the fuss, we’ve got the croppers if you’re down on your uppers, we’re the team can take you places you only ever dreamed of on your little ol’ TV screen – yes, folks, it’s a big wah-wah welcome to another sensational Saturday spelt S-A-T, A and E and I don’t know about you but we’re itchin’ for another hot n’ handy all-nighter …..

Ready? Well, come on and Dosado!

The call is given as Cat A unconscious female overdose, downgraded to a Cat B conscious and breathing two minutes into the run. We’re told she’s outside a seafront hotel with some friends; we’ll be flagged down. We cut through the stuffed up streets and make it there as fast as we safely can. I see the group waving to us. We sweep round and jump out to see what’s happening.

A teenage girl in a white denim cut-off jacket and skirt is leaning against a van. She bats her friend away as she tries to make her stand up straight, catches us with a feral look as we approach. There are two teenage boys to make up the pairs. The one closest steps in front of me and starts telling me what he wants me to do. I ask him to stand aside whilst I talk to the patient. He keeps close to my shoulder, rolling a toothpick round in his mouth, a baby gangster in a bad movie. The other boy and girl waylay Rae and lobby her to take action. Meanwhile, the patient tells me that no, she does not have any medical conditions, no,she’s not sick in any way, yes, she has had a drink, no, she doesn’t want or need to go to hospital, she’s just tired and wants her bed. BabyGangster steps in front of me again.
‘Are you going to take her home or what?’ he says. The matchstick swirls in his mouth. He does not meet my eyes, but looks past my shoulder. This is a very poor script.
‘Okay. You tell me what’s happened tonight.’
‘What you mean – what happened? It’s obvious, mate. The taxi won’t take us with her like that, so how we supposed to get home?’
‘You do know what an ambulance is for, don’t you? Heart attacks? Broken legs? That kind of thing? Your friend is drunk. It is not a medical emergency.’
‘You’re not listening to me. I told you. The taxi won’t take us. If she falls down and cracks her head on the pavement it’ll be your fault.’
I look across to Rae to catch her eye, but she’s getting much the same treatment from the others and is struggling to make them understand. BabyGangster is getting angrier. He makes big gestures close to my face and his voice gets louder. I try reason once more, without any hope of success.
‘If the taxis won’t take you, you’ll have to go home on the bus.’
‘No. No, mate. It’s too far.’
‘We are an emergency vehicle. We’re not a taxi. What arrangements did you make for getting home before you came out tonight?’ I ask him, realising how ludicrous this sounds in the light of what he’s said so far. He shakes his head and his chin drops, as if he’s reaching the end of his tether with me. It seems as if this could get physical soon.
‘Just a minute,’ I say to him, then call over to Rae. ‘Can you come to the vehicle, please?’ She follows me.
BabyGangster thinks I am going to get some kit, but then it dawns on him that we may be leaving.
‘Where are you going?’, he shouts, throwing his matchstick on the ground. But we’re already in the cab and securing the vehicle with the central locking button. He strides over and begins banging on the door and pulling on the handle. ‘You can’t fucking drive off. I’m calling the police.’
‘It’ll save me the trouble,’ I say through the glass, and Rae puts the ambulance in gear. ‘Stand away from the vehicle, please.’
The other guy has come round the back and is trying to force the doors. The other girl is shrieking at us: ‘I want your names! I want your names!’, kicking the door. We drive off, pull over in a quiet spot, report what happened to Control, and clear up.

Half sashay family!

The call is given as a Cat A unconscious 1 year old boy, but a couple of minutes from the scene and it’s downgraded to a Cat B - sick, unspecified illness. The block of flats looms above us in the drizzling rain. We can’t make out how the numbers are running, but a guy coming along with a carrier bag filled with cans points out the way.

We are met at the flat door by the father, a middle-aged Bengali man in a smart arran knit jumper and leather jacket. He shows us into the living room where his wife is sitting on the sofa with a little boy on her lap. The boy is dressed in a perfect, scaled-down version of his father’s outfit. He gives us a wide smile as we settle down in front of him with our bags. The father is the only one who has any English. He tells me that his son vomited, once, about two hours ago. And this seems to be it – no breathing problems, no fits or floppy episodes, no diarrhoea, rashes or anything that might be taken as a sign of anything. No calls to the doctor for advice, no NHS Direct. No popping down to A&E – about a five minute walk away. It seems the only thing they have done is to dress the child formally, and brush his hair, which lies neatly and thickly across his perfect little head.

He child smiles at me, alert and enjoying everything.

We lead them out to the ambulance and make them comfortable in the back. Just before we set off, the child vomits once more – a tiny amount, almost apologetic – and then resumes his contented enjoyment of events. His mother wails.

Split the outside couple!

‘We were stood on the pavement having a lover’s tiff, when this black geezer comes past and says to me: white scum. So I says to him ‘You what?’ and he says to me ‘Sorry mate, I didn’t mean anything’. So we carried on. Then a little bit later he turns up again, pushes Janine over, and she whacks her head on the pavement. So I absolutely lost it. I pummelled the shit out of him – look at my knuckles. He was down in one hit. I beat him to shit and back. Then the police came and arrested him. He was lucky they did, ‘cos I was set to kill him. I mean – why do some people feel like they have to get involved?’
We are standing in the lobby of a smart hotel, which uncharacteristically has allowed this couple in to wait for the ambulance. There are no police, which is strange. Only a massive doorman standing discretely just a little way off. He waved us to the entrance and conducted us through the revolving doors to the patient, a young woman in a smart black suit who sits stiff and straight in one of the lobby chairs.
‘I mean, we all have tiffs, right? But why do some people feel the need to get involved?’
His girlfriend had not been knocked unconscious, but she does have a significant bump on the back of her head, and we agree with her partner that she should go into hospital for observation. She groans her assent, but it seems that the groan is more to do with the general run of events than her condition.
‘I’ll bring her shoes and bag,’ he says, gathering her things to him in a tidy fashion.

…and then Box the Gnat!

‘Josh went a bit vacant and then lay down on his bed and didn’t say anything – didn’t respond to us – and then he started twitching, his left leg was jerking a bit – and he went really white – and then he threw up.’
Josh sits on the edge of his bed, his face in his hands. His younger sister peers round the door, and his stepdad crashes around in the kitchen.
‘How do you feel now, Josh?’, I ask him, sitting beside him and feeling his pulse.
He looks at me, and his pupils are like little black saucers.
‘I feel fine.’
His pulse clatters away as if he’s just run in from outside after being chased round the garden by a lion.
‘So have you any idea what could be the matter, Josh?’
‘No. Not a thing. I had a few drinks with friends last night and I felt a bit hungover this morning. I haven’t had much to eat today. But other than that – no idea.’
‘Well – let’s go out to the vehicle, run a few more tests, and then take it from there. Okay?’
I’m hoping that his mum won’t follow us immediately, but she comes straight out with us.
On the vehicle, after wiring Josh up to the ECG and noting other obs – including an elevated BP – I ask Josh if he’s had any recreational drugs today.
‘No! God, no!’ he says, with his dark side of the moon eyes absorbing all the light in the vehicle. ‘Some of my friends were smoking dope, but I’d never do anything like that.’
‘Josh is a good boy,’ his mum tells us, hugging his jacket to her. ‘What do you think it could be?’

Wednesday, March 12, 2008

the voluntary visitor

The door opens a crack and a wizened old face peers round.
‘Ye-es? Who is it?’
‘It’s the ambulance.’
‘Oh. I suppose you’d better come in. She’s in the front room.’
There are three of us; Eric pulled up on scene in the car at exactly the same time, so we are two paramedics and a technician – the ideal team for a resus. We busy in with all our bags like champion shoppers home from the sales.
‘I’m afraid I’m no use to you,’ the old man says. ‘I’m blind, you see.’
I ask him to take a seat in the kitchen whilst the other two dump their bags around a female figure prone on the carpet.
I help the man sit on a wooden yellow chair. I ask him what happened.
‘Absolutely no idea. One minute she’s talking about roses or something – could have been box – no, definitely roses, because I remember…’
‘Sorry to interrupt, but I just need to know what happened to your friend.’
‘She is not my friend. She’s a voluntary visitor. I had nothing to do with it.’
‘Okay. Whoever she is. Did she complain of feeling unwell? Did she cry out? What happened?’
‘As I was just explaining to you – we were talking – she stopped – I asked her what she was doing – she fell out of the chair. I couldn’t do anything as I’m blind, you see. So I called you. And there you are.’
He places his left hand on the melamine tabletop and touches a wristwatch with his right.
‘You won’t be long, will you? She was only supposed to be here for half an hour and it’s already a quarter to.’
‘We’ll certainly be as quick as we can.’
‘Do I just sit here then?’
I tell him I’ll be back with an update in a few minutes. He sighs as I hurry out.

Back in the sitting room, Eric and Rae have turned the woman over, cut her top off, stuck defib pads on; Eric is cannulating whilst Rae compresses her chest. I join in, prepping drugs, helping Eric intubate, taking over the compressions. The woman is only about sixty, fit and trim. She has no health bracelets or anything on her that suggests any kind of illness.
After ten minutes of The Works – fantastically – we have plumped her up into a shockable heart rhythm. Two zaps later and her heart is beating again, and she is making some respiratory effort. Whilst Eric and Rae continue treating the woman, I set to making ready our escape.
The front room is tiny and cluttered with years of accumulated junk. There is barely room for us to work around the patient, but getting her out horizontally – to maintain what feeble blood pressure she has at the moment – is going to be a challenge. I clear as much of a space as I can, dumping an antique rocking-chair onto a settee, nests of tables and footstools onto the sofa, pushing the magazine racks, piles of books and the television as far as I can into a corner. Eric and Rae are already zipping up the resus and drugs bags; I pick them up and haul them out to the ambulance, which I prepare for take-off. I unload the trolley and make it ready just in the street by the front gate, then come back into the house with the orthopedic stretcher. The plan is to scoop her up on that, manoeuvre her through the sitting room door and tiny hallway out to the trolley.
It all goes to plan, although it is a struggle in such a confined space. We have her out on the vehicle pretty quickly. She still has an output, and I hurry back inside to gather the last of the bags and to tell the man what’s happening.
He’s still sitting at the kitchen table.
‘I’m afraid we’re going to have to hurry away now. Your – er – the woman – is very unwell and needs to go to hospital right away.’
He turns his face up to me, rucked up and livery with discontent.
‘First you must put my room back exactly how it was.’
‘Sorry,’ I say, ‘We really have to go.’
I can feel his outrage boring holes in my back as I shut the front door.

Tuesday, March 11, 2008

storm calls

All day I have been aware of the coming storm. The clear blue skies seem unusually clear, suspiciously blue. Are the birds quieter than normal? Where is the cat? I am morbidly drawn to each on-the-hour news bulletin, sipping tea by the radio and mentally flipping each hard phrase into My Little Well of Doom: damaging gusts, stay away from the coast, no journey unless absolutely necessary. Not a great career decision, to find yourself working a night shift at an ambulance station by the sea with a hurricane approaching. I lather up some morbid fantasies involving scaffolding, buses, planes, a tanker or two, rolling out catastrophes like a scriptwriter on Casualty, with me as a lovable but expendable technician, my last seconds captured on a camera phone from the pier, a blurred figure on the shore, his flapping fluorescent jacket the last little bit of colour beneath the wave.

I put together a packed lunch, though, just in case I live long enough for a break.

Our first call is to a frequent flier. Not one I’ve been to before, so I am pleased to tick her off the list. Control tells us that they have tried to avoid sending anyone out to Joy, but she has told them that she has had a fit, so we are duty bound to attend. Consequently, we find ourselves huddled amongst some bins as Joy fiddles around with the locks on her back door. Eventually she tells us that she can’t remember how to open it.
‘Can you remember how to lock it?’ Frank shouts to her above the wind.
‘Well do the opposite to that and you’ll be fine.’ He looks at me. He’s impassive, but his moustache looks like it might spark.
She fiddles with the locks some more. Nothing happens.
‘You’ll have to break in,’ she says.
‘Joy. We are not going to break in, darling. Come round to the front room and pass us the keys through the window.’
‘Okay then.’
We make our way to the little front garden and wait. At least it’s not raining. Frank warns me: Don’t agree to look at her chinchillas. A light goes on. We see her shuffle into the room, and then begin sorting through some papers on a sofa, obviously forgetting what the mission was. Frank reminds her with a sharp rap on the window. She jumps, then shuffles over to us and moves the curtains aside. Her face is bleach white and blank. A frail woman of about fifty, in teddy bear PJs. She smiles out at us.
‘The keys, Joy?’
‘Oh. Yes.’
She drops the net curtains and shuffles back out of the room to the back door. We wait. Eventually she comes back into the room with the keys. Frank has to perform a brutal little mime to make her see that the window is on a latch and needs undoing. Finally she manages to spring the window and pass us the keys. We march round the back again and open the door – mortice, then yale – and go inside.
It looks as if the place has been methodically randomised, with papers and medicine bottles on the floor, cushions on the table and cutlery on the stairs. Joy is standing waiting for us in the doorway between the kitchen and the sitting room.
‘I used to be a ballet dancer,’ she says, helpfully. I can see several empty bottles of strong cider in the sink, but Joy’s breath makes the check redundant.
‘Joy – Just take a seat for me, please.’
I clear a chair for her and she sits down.
‘Why have you called an ambulance tonight? What’s happened?’
She pulls up her right pyjama leg. ‘My foot’s swollen.’
It is slightly fuller and redder than the left, but nothing awful. She can obviously weight bear, and doesn’t seem in pain.
‘Is there anything else the matter?’
‘No. Just my foot.’
Frank shows me a referral letter he’s found - a foot appointment the next day.
‘You’re already seeing someone about your foot, Joy.’
‘Yes. Yes. You’d never believe I used to be a ballet dancer, would you?’
‘Joy – when are you due to see your CPN next?’
‘The day after tomorrow.’ She stretches out her bad foot and taps a calendar lying on the floor by the chair. It carries a glossy photo of a ballet dancer with her leg up on a barre.
‘Joy – you know you shouldn’t be calling out the ambulance when there’s nothing really wrong, don’t you? Whilst we’re here with you, someone else might have fallen down and hurt themselves, or had a heart attack. Wouldn’t you feel bad if you’d stopped them getting the help they needed because we were tied up here?’
She nods and bites her lower lip, looking about twelve. Then she brightens.
‘Would you like to see my chinchillas?’

Our second call is to transport a Section 131 voluntary admission to a psychiatric ward in a hospital about twenty miles from our home base. I’m the attendant in the back with Geoff, a scooped-out man in his thirties who took an overdose the previous night, one of several in recent months. Geoff sits crouched over in the seat, guarding himself like an abused pet, taking up as little room as possible. I try to put him at his ease, but he’s crouching at the edge of any normal interaction. The journey seems to take years, the noisy wind outside the ambulance emphasising the tense silence inside. When we pull up outside the ward and help Geoff out of the back, there is a black coated figure standing flat against the wall, trying to smoke a cigarette. We can barely keep our feet. Inside the ward, a member of staff leads Geoff away.

The night roars on.

A couple of genuine falls, an assault, nothing taxing. A chest pain that turns out not to be cardiac, but centred on the liver. Then a final call at half past five. A woman waves us round to a side entrance as the wind clatters on around us scattering bins across the road. She says: ‘Thanks for coming. Awful weather!’ and then in to a well-lit room and a man sitting on the edge of his bed with his legs apart and his blown-out belly hanging pregnantly between them. It is what it appears to be on first glance: gross fluid retention associated with ascites. The man is massively distended – so much so that his diaphragm cannot work properly, making breathing difficult. Despite his condition the man is quite sanguine about it.
‘Excuse my directness,’ he wheezes, ‘but I can’t move without messing myself. Have you got any pads?’
We help him out to the vehicle. As we make our way past some rose bushes in his front garden – and in my early morning torpor - I imagine him snagging on a thorn, bursting and whooshing up into the storm, his dressing-gown cord snapping and coiling behind him like the tail on an enormous kite.