Thursday, August 28, 2008


We’ve been told that an ambulance car will be making a first on this severe respiratory distress. The satnav blue-lines us into a wide avenue and there we see it double parked a way up ahead, blue lights flashing. I drive up, park behind it, we climb out of the cab and go up to the front door of a detached Georgian house, its front garden built for speed with an unkempt clump of ornamental grass and a dump of slate chippings. The rack of buzzers by the battered front door testifies to the minute sectioning of this place into flats. The building has an air of slow, expedient ruin about it, like some grand family falling through hard times and scandals to a pragmatic accommodation with the modern age.
We are buzzed in to a musty hallway, original black and white tiling jarring with the notice board, fire extinguisher, alarm console and the casual scattering of letters above the radiator. With all the health & safety notices, contact numbers and house rules pinned up everywhere, it looks as if this may be some kind of hostel, but it’s not one either of us has been to before. We go up the stairs and in through the door marked ‘3’.
We step into a rancid atmosphere of nicotine and old sweat, and then: ‘Hello chaps,’ says Ray, the paramedic. He is standing with his stethoscope draped around his shoulders, his legs spread like a compass, scribbling observations down on his clipboard. Slumped on the bed in front of him is a half-naked young man who would not be out of place chesting walruses on an ice flow. His swollen breasts hang across his belly, a great, veined appendage that pushes his arms and legs apart and makes him look in danger of exploding. He raises a padded hand to stroke his Fu-Manchu beard, and nods at us.
‘More troops’ he says.
‘This is Henry,’ says Ray. ‘Henry has had a bit of chest infection for the past few days. Hasn’t seen his doctor, felt worse today, called us in. As you can see, he’s talking in complete sentences, his sats are fine, no chest pain or anything like that, I’ve listened to his chest, it seems clear, but Henry says he’d like to get some expert advice on all this. Sorry I didn’t get a chance to stand you down.’
Ray is brisk, with a kind of deadly clarity that only Henry seems impervious to.
‘And I can reassure you that he’s walking out to the vehicle.’
‘I’m sorry to call you people out,’ says Henry, starting to gather the vast black acreage of his t-shirt to him. ‘I didn’t know what else to do.’

We take in the bedsit whilst Ray finishes off the paperwork.
‘Are these your paintings?’ Rae asks Henry, nodding at the canvases brutally nailed to the walls. Each one is roughly covered with a smear of yellow, red and brown acrylic paint.
‘Yep. They’re my dreams.’
At one side of the room, opposite the kitchen with its nightmarish dump of dirty pans and pizza boxes, propped up casually against an old Laney amp, is a Gibson Les Paul guitar. Its beautiful, bright cherry finish is even more striking for the awfulness of its surroundings.
‘You play guitar?’ says Rae.

Henry half closes his eyes. ‘A little.’ He begins hauling the t-shirt over his head.
Above the guitar, on a cleanly swept, little blue votive shelf, there is a clip frame: a photo of Carlos Santana.


Later that night – one sprained ankle, one hyperventilation, one threatened suicide, one imminent birth and one collapse query cause later - I’m wheeling the trolley back outside to the ambulance when I notice a little grey triangle of plastic on the tarmac.

I nudge it with my boot. Unmistakable. A plectrum.

Wednesday, August 27, 2008


I knock on the door. A dog barks, a door somewhere deep inside the house is opened and then slammed shut; the barking is muted.
An elderly woman with a face as white as her apron opens the front door.
‘He’s upstairs’ she gasps, then stands aside.
We haul up the narrow stairwell with all our bags, and meet a young guy on the landing at the top.
‘I did what I could’ he says. ‘Grandad’s in the bedroom’

It’s a small room. His grandfather is lying on his back in the space between the bed and the wall. Rae pushes the bed as far over to one side as she can. I kneel down next to the patient. No breathing, no pulse. His face is a congested blue, but his body is still warm. I start chest compressions whilst Rae gets out the defib pads. For a second I wonder what’s causing the sharp pain in the palm of my right hand, then I realise that the patient has a staple in the middle of his sternum. I ask Rae to chuck me a gauze pad. When I take my hands off his chest to put the pad there, my rubber glove hangs in tatters from my hand.

A second crew arrives to help out.


The resus lasts an hour and twelve minutes. We manage a few shocks right at the beginning, but despite everything we do, the patient drifts away from us along a path of non-shockable rhythms to asystole.
Kerry, one of the supporting crew, goes downstairs to tell the patient’s wife that he has died. After a brief pause we hear a dreadful shrieking moan, and then a flurry of low voices. The dog starts barking again but then just as suddenly falls silent.
The three of us remaining upstairs pick the patient up, put him back to bed and make him presentable. Then we start tidying the room.
I take the resus bag from where it was thrown into the dog basket lying at the foot of the bed and pack the defib away. I open a clinical waste bag and we toss into it all the empty adrenaline phials, pads, caps, swabs, BVM – all the great clutter of stuff that accompanies a resus.

I notice a small whiteboard by the side of the bed. Along the top half of the board is a daily exercise routine written out in blue; some of the words are written in capital letters, some of them have next to them little hand-drawn stars and asterisks. The bottom half of the whiteboard is dedicated to important dates for the rest of the year. December has ‘The Wizard of Oz’, underlined twice, and an exclamation mark.

On the way out of the house we pass by the grandson again who holds the door open for us and thanks us for coming. A large man with silvered hair and a mouth so thin it could have been drawn with a sharp pencil, stands to one side, staring at us. I say to both of them how sorry I am. The grandson closes his eyes and nods. The silver haired man clears his throat, and I hesitate, expecting him to say something. But he remains as impassive as before, so I shoulder my bag, say goodbye and leave.

Tuesday, August 26, 2008


Gail is lying on her back on a boat-sized, brown twill sofa. As soon as we come through the door we can see that her left hip is dislocated; her leg shows the classic signs of shortening and rotation. She raises a smile and puts her left hand up in the air. Her husband Frank has shown us in, only interrupting his meandering description of the night’s events to take a pull on his cigarette. Frank has a face as red and slack as his tracksuit. His rheumy eyes check us slantways, and his chin is scrubby with the kind of perma-stubble you see in e-fit pictures.

‘To be frank with you – like I have to – it’s my name – hurgh - don’t worry, I’m always like this, I’ve had a bit to drink, it’s the weekend, so sue me. But hey – if you can’t have a little something now and again, well, what’s the world come to? Hurgh. Anyway, to be absolutely and perfectly honest with you, because there’s no point in lying about this stuff, hey? I mean, mate, we’re all adults. You’ve got a job to do. You need to know all the facts. And fucking hell, I mean, who’s hurting who? Hey?’

His mobile phone rings – the twangy guitar from James Bond.

‘Shit. Sorry. Gary? Yeah, mate. Yeah. The paramedics are here. They’re going to work on her now. Mate – I’ll call you back. No, mate. No. I’ll call you back.’

I take advantage of the interruption to say hello to Gail properly and take in the place. For the first time I notice that the walls are hung with dozens of small clip-frames. Hypercoloured photos, confusing at first, but then with a lurch seeing that they are of women – a woman – Gail – naked, in suspenders, or extravagantly zippered outfits, posing with a shadowy host of others, a Polaroid exhibition of proffered breasts, mouths, throats. In the whole room there is only one non-sexual photo, still of Gail – a crinkled up school photo, a little girl smiling demurely against a background of eggshell blue. Unframed, it is propped up against the DVD player.

Gail looks up at us from the sofa, a frail looking woman in her mid forties, pale freckled face and ginger hair. She is wearing pyjama shorts and a flowery t-shirt.

Frank clips his mobile shut and follows us over.

‘Gary’s such a twat. I don’t know. I suppose he has his uses. Hurgh. Anyway – I’ve dressed her for you, mate. Couldn’t have you seeing her in all her gear. Not that we care. Give you all a thrill. Well – you, maybe. Maybe not you (looking at Rae). Or maybe - yeah?’ He gives her a pouchy smirk, then blows out another litre or two of smoke.

‘It half killed her, mind. But she’s a brave girl – hey? Has to be, living with me.’

‘Don’t listen to him,’ Gail says, her voice dry with the pain and the alcohol, ‘He’s an idiot.’

‘So anyway,’ he carries on, ‘Just to put you in the picture. She’s had both her hips replaced, three months ago, arthritis. The right one popped out a month ago, had that done, and I’ll tell you something now for free – those bastards at A&E aren’t coming within a mile of her. Last time they broke her leg, like that’s gonna help. I want the consultant there to re-do this. I want him waiting for us, by the front door, with his hands out of his pockets, as we’re pulling up outside.’

We help Gail manage the pain with entonox, immobilise her, scoop her off the sofa on the orthopaedic stretcher and outside onto the trolley with a minimum of distress. Frank is a constant distraction, talking incessantly. It’s like having a puppy worry your foot whilst you’re trying to tidy up.

‘I drove lorries all round Europe. Worked hard, partied hard, different woman every night. Fantastic. But AIDS put paid to all that malarkey. I bought a pub in Deptford, ran that for a while. Then this geezer decided to shoot me in the legs, so I sold up, came down here. It’s not turned out bad.’

He squints at me.

‘I hope you don’t think badly of us,’ he says, as we load Gail onto the lift. ‘It’s been a while since the operation. A long while. A lean stretch, if you get me. I mean – I’ve been good, but there is a limit. We really thought it would be okay. So there I was giving her a right good seeing to and then she felt it go. Boom. I knew something wasn’t right because ordinarily she takes very good care of me. No complaints there. Hurgh. I remember, when I met her the first time, she looked me up and down, said – okay, mate, yeah, okay - took me home and tried me out, so to speak.’

He stands there whilst the lift rises into the air. Gail groans and takes another drag on the entonox. He suddenly seems reduced by the action and sound of the lift, the light spilling out of the back, everything. He flicks his cigarette off into the darkness.

‘I must have been all right,’ he says, patting his pockets for another. ‘We’ll have been together sixteen years next month’ At that moment his phone rings, and he starts, as if the patting woke it up.


Thursday, August 21, 2008


We are an extemporary group of five, rattling upwards in a bleachy lift – me, my partner, the chaplain third-manning with us and two police officers. The chaplain is carrying our dressings bag. He hugs it to him, emanating goodwill. Ellie is carrying her clipboard, I’m pulling on my gloves.
Ellie asks the policeman: ‘So what do we know?’
‘Called in by a friend. This is a twenty two year old male, history of self-harm, apparently sticking pins into himself tonight. Why, I don’t know. Maybe it’s some kind of voodoo ritual. God knows..’ he sneaks a look at the chaplain ‘… God knows I can think of better things to do with my time, but there you are. You probably know more about this sort of thing than we do.’
The chaplain, lean and quiet and dark as a Mafioso hit man, smiles and nods. The female police officer leans in to her colleague and whispers something to him. The lift careens upwards. It really does stink, and I’m glad we are not going all the way to the twentieth.
The lift crashes to a halt and the heavy metal doors slide open. The police lead on; as a joke, we push the chaplain out next.
But the door to the flat is right by the lift and the police are already banging on it, so we quickly draw on a professional mask of concern. A voice from the other side asks who is it.
‘The police. Could you open up please so we can have a word?’
Bolts. Chains. It swings open to reveal a boyish man in a faded black rock and roll t-shirt, boxer shorts and bare feet - a washed out yawn of a man whose reactions seem as woolly as his tangled brown hair.
‘What’s all this about?’ he says, wanly, then takes another toke on his spitty cigarette. His forearms are as covered in horizontal scratches and scars as the bark of a wild cherry tree. ‘What do you want?’
‘Would you mind if we came in and had a chat? We’ve had a call from someone to say that they were worried about your safety tonight.’
‘Who was that, then?’
‘Can we come in and talk about it?’
He considers us all for a second or two, then seems to lose interest. He lets go of the door, turns and slouches back inside; we follow him through the sparsely furnished flat into the front room. He resumes his place on the battered leather sofa, fitting the deep indentation there perfectly. There is a laptop propped open on an upturned crate in front of him, playing David Gray’s version of Say Hello Wave Goodbye. The ash tray is so full it spills over onto the disks and detritus that surround it. There is a bamboo blind tilted downwards across the main window; from behind it on a ledge, a tiny black faced kitten peers out at us, her fierce yellow eyes electrified with interest.
The man does not so much stub his cigarette out as bury it.
‘Was it Abby?’
‘Abby’s your girlfriend?’
The kitten suddenly jumps down onto the floor between us all. For a moment it stops where it lands in an intensely spiky attitude, front legs splayed out, shoulders at forty five degrees, staring and twitching – then bowls out between us and off through the hall.
‘She was my girlfriend.’
‘So what’s been happening tonight?’
The man seems to notice the chaplain for the first time, and frowns.
‘Don’t worry. I’m just along with the ambulance crew as an observer’ he says, gripping the dressings bag as if he wished it were bigger. Despite our uniforms, belts, blue gloves and radios, the police officers’ panoply of cuffs, batons and sprays – never has a simple collar of starched white fabric marked someone out so profoundly before. He may as well be dressed as a giant rabbit.
‘Have you hurt yourself tonight?’ asks the female officer, bringing us back to business with a flip of her notebook and click of her pen.
‘No. No more than usual. It’s not a problem. I just like to let blood, that’s all.’
‘How do you do that, then?’
‘With one of these’
He produces a syringe.
‘I draw a load out. Most nights. It’s no big deal. It’s something I have to do’
It’s just a kitten’s leap between the man on the sofa and the five of us here on this side of the room, but it feels more like a chasm. He stares at us with the syringe extended before him like a sacrament, his eyes glittering dark against the pallor of his skin.
‘Don’t look so worried. It’s normal for me’ he says.

The police ask us to check the man over, something he submits to with a bemused, slightly martyred air. He tells us about his CPN, how they try to help, but can’t really, as he’s never agreed that he does need help. He’s been in to hospital before with various infections. He’s anaemic. Ellie asks him if he has anyone he can stay with tonight.
‘Just the cat. My girlfriend left me months ago. I don’t know why she’s calling you’ He watches the BP cuff expand around his arm. ‘I haven’t seen my little girl in ages.’
We ask him what he intends to do tonight.
‘Take things as they come. I don’t know – improvise. I have no plans’
His blood pressure is low to normal, but he’s otherwise okay. He refuses hospital. We leave him to finish his interview with the police and let ourselves out.
‘I hope that cat didn’t go out the front door,’ says the chaplain. But we agree that the man didn’t seem concerned about it, so we let it ride.

Instead of taking the lift I suddenly sprint off down the stairs, and the other two try to catch me. It’s fourteen floors up, and I’m breathing hard as their heavy steps gain on me. The chaplain is singing the theme from Starsky and Hutch. Ellie throws her gloves at his head. Our laughter echoes up and down the stairwell.

Tuesday, August 19, 2008

a wood pigeon

This is a room of white. The early morning light is filtering in through two long drop white net curtains. A warm current of air is nudging through the opened sash. There are two beds in the room, both with white counterpanes, and the clinical curtain divider between them is white.
The bed on the left of this divider is occupied by an ancient man, a thoroughly dessicated figure propped up on a banana-shaped pillow, taking cursory tugs at a plastic beaker of tea. He drops the spout from his lips to give us a little smile as we walk in.
Our patient is in the bed by the window. He is also propped up on pillows, but his head is being supported by Ken, the ECP who was also assigned to this job and got here first.
‘Could you come and take Geoffrey’s head for me, please?’ he says. ‘He’s rather slumped over and we need to get him into a better position.’ I walk over to help. Geoffrey’s breath is coming quickly, in fluttering gasps. In the last throws of emaciation, the skin of Geoffrey’s chest pulses against the outline of his ribs.
‘Geoffrey has been refusing food for the last couple of weeks,’ says the home matron, who has come to stand at the foot of the bed, and is thumbing through his case notes.
‘Is there a DNAR for Geoffrey?’
‘Not as such. But he has said a number of times recently that he wanted to die and didn’t want any help’
I wipe away the meagre strands of hair sticking to Geoffrey’s forehead. His eyes have receded deep within his sockets. They are half opened, but red and dry and without recognition.
‘What about the relatives? What do they have to say?’
‘Oh, they’re absolutely in agreement’
‘And the GP?’
‘Hasn’t been in a day or so’
‘Well – I’ll make a call to the GP, if you wouldn’t mind getting in touch with the relatives and letting them know the situation. As you’re probably aware, Geoffrey is going to die very soon. I don’t think he would want us to resuscitate him, and I don’t think it would be appropriate. But we’d better start getting things in order. And we need the doctor here to make Geoffrey as comfortable as possible in his last moments’

Ken goes outside to call the GP whilst Ellie and I make Geoffrey comfortable.

Apart from the rise and fall of his chest, the only movement Geoffrey makes is a delicate rolling of the oxygen tubing between the shrivelled pads of his right thumb and index finger, the kind of exploratory movement you might make if you were blindfolded and asked to identify something. But the movement seems removed from him, an automatism rooted in some profound dream of absence.
I feel for his radial pulse, but his heart beat is only detectable now as a faint brachial twitch in his upper arm – the tail end of a rhythm set running when he was just a tiny embryo no bigger than his fingernail, easing away now ninety years later, here in this whitened room, in blue-striped cotton pyjammas, a clutch of photos propped up on pots of emollient creams and packets of wipes, the white net curtains ballooning inwards on the breeze, and a wood pigeon high up somewhere near, who-hoo-hooing, announcing itself to the world.

Saturday, August 16, 2008

Harold's lift

I am glad the warden has come to meet me at the door. The instructions for retrieving the key – a code for the keysafe outside, which holds one key for the front door and one for the main keysafe located in the lobby on the left behind the picture of HMS Hood, master key inside that safe, please pull the rope before you go in, please contact homeline to confirm entry – well, they’re just too complicated, especially when I’m on my own, especially at this hour of the night.
‘All right?’ she says, with a smoker’s rasp. ‘It’s only Cecil falling over again. He’s okay. Haven’t I seen you before?’
The warden has bright pink lipstick and bleached yellow hair tumbling in tightly orchestrated curls about her head. I would guess she’s about sixty, but her tanned face is marked by a profusion of leathery creases, as if she’s lived most of her life outdoors. She is packed into a pair of crease-free navy slacks and a plain white cotton shirt; if it wasn’t for her makeup and hairdo, she could pass for a retired whaling captain.
‘I’m sure I’ve met you before’ she gasps.
I follow her into the lobby. She leads me through a succession of narrow corridors to the lift, where she presses the button and we wait. A gloomy aroma of parma violets and flea spray settles around us.
‘Lonely shift for you,’ I say. ‘On all night?’
‘Me? Kind of. But I’m only out and about if there’s something happening, like tonight. Only if rude boys like you come knocking me up.’ She gives me a dig in the ribs. ‘Mostly I’ve got my feet up with a mug of cocoa catching up on the soaps. You ought to get yourself that Sky Plus, mate. I tell you what – it’s a bleedin’ miracle.’
The lift arrives and the doors open with a worrying judder.
‘That doesn’t look too healthy,’ I say.
‘Oh don’t worry. It’s only broken down about five times this week. And if it goes again and we’re stuck for a while..’ she gives me a dentured leer, ‘.. well, it could be worse.’
We step inside, the lift doors close and after an extended pause we are shaken upwards suddenly.
‘Blimey’, I say. ‘Well, I suppose it beats walking. Just.’
‘And that’s not all. I tell you what. This lift is actually haunted.’
‘Haunted by who?’
‘The warden before the warden before me. If you follow. He hanged himself one night, down in the utility room. Poor fella. I never knew him. Until now.’
‘Have you actually seen him?’
‘Nope. But I feel him sometimes. Like a chilly presence, standing where you are now. So I talk to him. I say “All right, Harold? How are you mate?” But he never answers. He just kind of stands there. I don’t think he’s up to any mischief. I just think he wants a bit of company.’
The lift doors open and we step out. She leads me over to Cecil’s door.
‘Hold on, Cecil. Here comes the cavalry.’ And she lets me in.

Friday, August 15, 2008

use your head

This is a steep street of small shops and cafes, many of them still following the Edwardian layout of bay fronted windows and recessed doorways to flats above. It’s midnight, dark and threatening rain. We struggle to read the numbers on the shops, and those that we do find don’t seem to follow a logical pattern. I’m just about to call up Control to ask for some help in locating the address, when a man steps out from an alleyway a little in front of us. He gives us a discrete nod, and looks up and down the street. I hang up the radio and we pull level with him. Ellie, the trainee technician I’m working with tonight, lowers the window.
‘Are you the patient?’
He nods again, and unfolds his arms.
‘Chest pain?’
‘Let’s just get inside, shall we?’ he says.
Ellie taps the ‘at scene’ button, and we both get out. By the time I have come round the front of the vehicle, she has opened the side door, put on the interior lights, the patient has jumped inside ahead of her and taken up position on the forward seat. I’m unnerved by the sequence so far. It feels as if the patient has snatched a lead on the normal run of things, first onto the back of the ambulance, sitting above us as we climb up into the back. I feel exposed, wrong-footed. It has not started well.
And getting a clear look at Keith beneath the harsh strip lights, I don’t feel any easier.

He is a tall, spare middle-aged man in a dirty yellow t-shirt and jeans, already sitting with the air of someone consciously holding himself in check, his hands resting in his lap and his feet evenly placed on the floor. He has a roughly carved head, the kind of face you could imagine climbing without ropes. But despite the angular chin, broken nose and cheekbones, his mouth is a little cupid’s bow, and when he talks – quietly, with an effeminate sibilance – he reveals two rows of crooked yellow teeth, sharp like a predatory fish. The most worrying thing about Keith, though, is the disconnection between the grey eyes and the smile he uses to punctuate his monologue.

‘I don’t know how much you know about my case. Yes – I was up at the hospital earlier today and yes – I did self discharge. But this pain. I tell you, I’ve got an immense tolerance for pain. Far more than the average person, far more than you. I was captain on a merchant ship for ten years. I’ve worked harder than you could possibly imagine and never been sick. I’ve taken knocks that would’ve killed a lesser man. I know all about pain, my friend. But let me tell you – this is worse than anything I’ve experienced. You see, the police know where to punch you. They’re trained. This one – he punches me here (centre of chest) with his knuckle, so it digs in – but doesn’t show bruising. And here, right on the point of the shoulder. He’s damaged the nerve. I can’t remember the name of it. I know a great deal about anatomy. I worked as a mortician’s assistant for years. I have an incredible knowledge – the whole body, its systems, muscles. Much greater than yours. I’ve personally opened up four hundred and fifty corpses for autopsy. You see, the police have this idea that I’m a violent person. I’ve spent the last ten years fighting it. I’m currently in dispute with the PCT about the fact that I’ve been put on the violent patient’s register. I’m not supposed to visit the doctor or the dentist without a police escort. How crazy is that? All because a while ago I went to see my GP, told him about my problems, he tried to tell me what was wrong, didn’t like it when I put him right. I don’t see any sense in being pushed around, especially by someone who knows a lot less than me. So admittedly I may have been a bit too – positive, shall we say? - in my defence, and end up on the register. Without appeal. And everyone has access to it, police included, and anytime anything happens, they come down heavy on me, and treat me like this.

‘But I am not a violent man. I’m a tough man, yes. I have great physical courage. But I’m not a violent man. And there’s a difference. It’s called self control. Let me explain. I’ve faced up to all kinds of assaults and abuse, but I’ve stood there like this (smiles and nods). I’ve looked down on this or that person, recognised them for what they were, and done nothing, knowing in myself exactly what I could do. Choosing not to react, simply holding off. Of course, I know I could completely destroy anyone who tried it on with me, so what have I got to prove? Nothing, my friend, and there’s the real power. Let me explain. Once there was this guy in a pub, big guy – you know - and he kept needling me and needling me, saying “Go on then, see what you’ll get if you start something”. This went on for ages. I did nothing, and I did nothing, until finally I heard this voice inside me. Do you know what it said? It said, very simply: ‘Come on Keith. Use your head’ What I thought it meant was – ‘Think about this. Don’t react.’ But then I realised what it actually meant was ‘Use your head’ – So I head butted him. He needed twenty eight stitches. Was in hospital for a week. But I know what a bottle can do, and that’s worse. So it was the kinder option.

‘Let me take my top off so you can do your observations. I’ve already had an ECG today at the hospital and it was fine. They said I have the heart of a twenty year old. But I could’ve told them that.’

He pulls off his t-shirt. His torso is rangy and scarred, with a coarse black spread of chest hair. Some hospital dots are still in place.

I’m trying to think of some way to get across to Ellie that we need to get this person off the ambulance as soon as possible, but she seems pinned to her seat.

In a blanched whisper she asks him the name of his doctor. The volume of his voice increases, the tone drops ten degrees.

‘I’ve already told you. You’re not listening to me. Will you please listen? I do not have a doctor. I’ve been struck off the list.’

She puts the clip board aside. The back of the ambulance seems suddenly as pressured and confining as a diving bell.

We have to wrap this up.

‘Keith – you can put your top on. It’s obvious that there’s nothing wrong with your heart. We just need to ask you a couple of questions, you know – for our form. Just give us the basics, that’ll be fine. For doctor we’ll just put “not currently registered” As far as your shoulder goes, I’d recommend you take some pain killers tonight and get yourself up to the hospital in the morning. Okay?’

He gives me a brutally condescending smile.

‘You’ve got your job to do,’ he says. ‘Ask away. Do what you have to do. I don’t want to make things difficult for you. I know there are people out there who would give you a hard time. But I think you do a wonderful job. I met one of yours the other day. My son, Jake, he’s only four. He had a seizure. He went completely blue. Cyanotic. I know the terms. My girlfriend called the ambulance whilst I resuscitated him. Saved his life. The ambulance turns up – one like this, newer perhaps, and a paramedic on a car. And the police, of course. The police started getting involved, like they do. Pushing and shoving. The ambulance crew said I wasn’t to come on the back. Admittedly I was shouting by this point – but you tell me you wouldn’t shout if your son had just died in your arms? But the paramedic, a big black guy, he told the crew to fuck off – excuse my language. He told the police to fuck off. He took me and Jake into his car and he drove us up the hospital. He told me that he’d had to put up with that stuff all his life, too, because of his colour. He understood how I felt. And he respected what I’d done. He said he’d never seen such skill under pressure. But this is how things are for me. This is my life.’

He puts his t-shirt back on. I notice some recently healed cuts under his right arm.

‘I expect you’re wondering about those scars,’ he says. ‘Don’t worry. It’s nothing. I was walking down the street when this car tried to run me over. I couldn’t believe it. I was knocked into the air, and came down with my arm punching through the passenger window. The driver obviously thought I was reaching for them, so they took off – with me hanging out of the window. I managed to free myself, and rolled to a halt on the road. Of course, the police weren’t interested.’

He pats his knees.

‘But that was last week. Tonight - I’m not going to hospital. I know I don’t need it, you don’t need to tell me that. And I’m not about to waste anybody’s time.’

I open the door. He jumps out.

‘Thank you for coming by,’ he says, rubbing his face briskly, as if he has just woken up. ‘You don’t need to see me inside. I’m perfectly able to look after myself.’

I watch him stride off back down the alley.

I look back at Ellie. She’s standing up, pulling her gloves off. It feels as if the sweet night air is rushing in to fill the Keith-shaped hole between us.

Saturday, August 09, 2008

lightning glass

As I turn on to the estate, the late night sky – for so long pregnant with the coming storm – begins lighting up with diffuse flashes. The horizon is closing down on us, and a few fat drops of rain begin to fall.
Rae looks out at the block of flats, raps her pen on the clipboard.
‘I’m not sure if I’ve been here before or not,’ she says.
As I back the vehicle up there’s a deep rumble of thunder. As if working to some melodramatic script, a police van followed by a police car appear around the corner. They park either side of the road. We all get out and convene on the grass verge. Everyone is relaxed, chatty, excited by the prospect of the storm. Some confusion about who called who. They say our ambulance control requested police back up; we were told the other way round, also that the police had already attended once today. News to them. But after a minute or two of pleasantries we become aware of the face looking down at us all from an upstairs window.
‘Best go up, then,’ says a young policeman.
‘What can you tell us about this one?’ asks Rae.
‘There’s been police out to this address a few times in the past – none of us, though. Domestic disputes, suicide threats, blah. The woman, Shelley, she’s a notorious drunk, apparently. Arrested a couple of times for public order offences. An on going situation, as they say.’
We all stand outside the main entrance to the block, but before anyone can buzz, the door opens and Shelley is there, a tired looking woman in her late twenties, a heaviness about her face and eyes as if there’s some cruel spiritual gravity being exercised on her. Even her yellow hair seems burdened, her whole body exhausted by something she has no power to change.
‘Come in,’ she says flatly, turns, leads the clumping pack of fluorescent jackets and squawking radios up the stairs. An elderly man peers over a balcony at the top.
‘Everything all right, Shell?’
‘Yeah. Go to sleep, Ron’
‘I’m here if you need me.’ But he stays out on the landing to watch.
She stops outside her front door and pushes it to go inside, seems confused that it doesn’t give. Then she says: ‘It must have shut when I opened the main door. I don’t have any other keys.’
She kneels down in front of the door and tries to push her arm through the letterbox to reach the catch.
One of the policemen says: ‘Don’t get your arm stuck, love. We’ll have the fire brigade out, next thing you know.’
‘It’s not a strong lock,’ she says, standing up slowly by pushing up on her knees. ‘You only need flip the catch and it’ll open.’
‘Here. Let me try.’
A policewoman extends her baton, pokes it through the letterbox and rattles around.
‘Don’t drop your baton in there, for God’s sake. We’ll never hear the end of it’
The atmosphere is practical and helpful. Even Ron offers the use of his flat, and he’s thanked politely.
Another policeman steps up, levers the bottom of the door with his foot, then pulls out a laminated crib sheet and tries to work open the yale by inserting it along the doorline.
‘Suspect skill you’ve got there, mate’ says another.
‘Poacher turned gamekeeper’
The card bends but the lock holds.
Suddenly Shelley says: ‘Actually – I’ve just remembered there’s a spare under a stone outside’
She excuses herself past the little crowd, hurries back down the stairs, and returns a moment later holding a key.
She lets us all in. We follow her into a sparsely furnished front room, two simple leather sofas, a table and two chairs, an expanse of laminate flooring, a large photo of a grinning toddler with curly hair in a plain wooden frame on the wall. Shelley sits on the sofa beneath it; we sit on the sofa facing her, and the police all crowd in the doorway.
There is a pause. The dim light in the room is shockingly augmented by an occasional flash of light from outside. A sudden rattle of hail against the windows.
Rae rests her clipboard on her lap, and leans on it.
‘Shelley. My name’s Rae and this is Spence. Why are we here tonight?’
Shelley turns her tired grey eyes on her.
‘I’m having bad thoughts.’
‘What bad thoughts?’
‘I don’t know. Like I want to kill myself.’
‘Have you done anything or taken anything tonight that might cause you harm?’
The policewoman standing at the doorway unfolds her arms, pulls out a notebook.
‘Shelley. Can you tell us a little bit about your domestic situation?’
Shelley pushes her hair back from her face and looks at her.
‘My domestic situation? My domestic situation is I’m fucked and no-one’s interested. My domestic situation is that the fucking police don’t give a shit.’
‘Now – Shelley. We’re not from this locality and this is the first time we’ve met you. So you’ll have to bear with us and give us a little more information.’

There is a sudden and dangerous change in the emotional orientation of the room. With only these few words having been spoken, Shelley has locked on to something. She seems suddenly galvanised with a thrill of dark self-absorption, as if everything up to now – the storm, the 999 call, the meeting of the emergency services outside and getting locked out of the flat –that this was just a process of gathering or preparation for the main event. She speaks loudly, emphasising her words with a level rocking of her head from side to side like a street rapper, making hard angles in the air with her hands, tipping backwards and forwards on the sofa. It seems as if she is now fully possessed by her grievance.

‘Well - how about this for some information. He was here giving it all that. Shouting out down in the street how I was a fucking prostitute. He was down the pub telling his mates if they got a thousand pounds together they could come round here and spit roast me. But no one’s interested. I tried to get the police to stop him and they ended up sending him a letter. A fucking letter! I said to the police that the next time he comes round here I’m going to stick a knife in his eye. And then I’m going to hang myself from the banister. I told the last policewoman that - and the cunt laughed. She fucking laughed. I said I hope it’s you that finds me swinging there, darling. I hope it’s you that has to push past me to get to my kid…… I can’t bear these thoughts that I have. I swear I’m going to kill him and me. But no one takes me fucking seriously. No one’s interested.’

The hailstones against the window suddenly stop and the room is utterly quiet.

The policeman who tried breaking in with a laminated card pushes to the front. He takes his hat off and asks if he can join Shelley on the sofa. She looks away, but doesn’t refuse. So he sits down next to her.

‘Shelley. I don’t know you and you don’t know me. But one thing I can tell you is that I take people as I find them. I don’t know the first thing about your problems because I’ve never met you before. But all I can say is, you seem genuine enough, and I’m willing to help you as much as I can. But you have to help me, too. You have to tell me what’s going on, and I’ll tell you what I think should happen next. Okay? I can’t speak for those other police you saw. The police is like any where else. You get wankers in all walks of life – the police is no different. I know you get wankers in the police, Shelley, because I’ve worked with some of them. But if you’re willing to calm down and tell me exactly what’s been going on, I’m willing to do what I can to help. How does that sound?’

I glance at the policewoman by the door. She has put her notebook back in her jacket and shifts her weight onto her other leg. Her face is utterly impassive; I can’t make out if she approves of her colleague’s intervention or not.

Shelley looks at him.

‘You want to know how that sounds? I’ll fucking tell you how it sounds. You’ll do exactly what everyone else has done. “Poor Shelley. She’s a fucking nutter. Her life’s a joke and her ex was right to dump her. Shelley’s a drunk. Shelley’s a fucked up bitch. She deserves everything she gets. Yeah - I’ll listen to what she has to say, I’ll scribble something down in my pathetic little notebook, then I’ll go away and have a good chuckle and write him a letter. A fucking letter!”

‘No. Shelley. You’re not listening to me. You need to calm down and try to help us’

‘Help you? Help you? What help have you ever given me? The last policewoman to stand there turned round and laughed in my face. And then turns round and says they’ve sent my useless cunt of an ex – the low life who breaks into houses and sells drugs, who goes round telling people I’m sleeping with a black man, and taking heroin, telling everyone I’m a crazy slag, shouting up at my window from the street, with all the kids in the neighbourhood gathered round, laughing – my ex gets a letter. He hasn’t even got an address! How’s he supposed to get a letter?’

‘What do you want to happen tonight?’

‘I want you all to piss off.’

Rae makes to stand up.

‘Shelley. I’m very sorry that you’re having all these problems and I do hope you get them sorted out. But it seems to me that it’s more of a police matter. So we’ll go now, and give you a bit more room.’

Back out on the landing we start to explain our position to the policeman waiting there, but suddenly there is the sound of shouting and crashing furniture, and he rushes inside to help them.

Rae is writing the job up out in the ambulance when we see her carried out, cuffed and struggling between four of them. They put her into the van, and after a little while, drive her away.

Fierce cuts of brilliant white lightning, now, ripping across the sky, coming to earth somewhere. Rain booming on the roof. The air smells crystalline, electrically charged. I tell Rae that I vaguely remember reading about how a crooked piece of glass is formed every time lightning hits the ground. Now that’s something we’d both like to see.

Wednesday, August 06, 2008

who goes where

The private road veers up and off in an exclusive arc high above the main sea route, as illustrative of the residents’ earnings differential as a steep black line on a graph. The houses here – a grandly stucco’d selection of Caribbean villas, contemporary mansions and sternly cast homesteads with eagles on pillars and spiked electric gates – are set way back from the road. The caller must have used a telescope to report her concerns.
The car we want is easy to spot: a small, banana yellow affair parked crookedly by the raised grass bank at the verge. When we draw closer we can see a pair of legs sticking out of the opened passenger door, jeans down by the ankles, bare feet. I jump out of the vehicle.
There is a middle-aged woman lying across the two front seats, her head in an empty metal dog bowl. There is a bottle of vodka in one foot well, a can of deodorant in another, and around them both a scattering of empty pill packets. There are some clothes spilling out of a holdall on the back seat, but other than this the car seems quite well kempt.
‘Hello. It’s the ambulance. My name’s Spence and this is Rae. Can I ask your name?’
She raises her head to look at me like she’s being hauled up on a chain. She tries to speak, but her mouth is claggy with a white residue.
‘Say again,’ she manages.
‘It’s the ambulance. People are worried about you.’
She slumps back down again. ‘Hah. That’s rich.’
‘What’s happened to you today? Are you hurt in any way? Come on – sit up so we can talk to you.’
We help her. She starts making an ill-focused attempt to pull her trousers back up.
‘Sorry about this,’ she says.
‘Don’t worry about that for the moment. First things first. Can you tell me your name?’
‘What are all these pill packets here, Sandy? Have you taken them?’
She shakes her head.
‘Where are the pills then, Sandy?’
‘I was going to take them, but I didn’t’ she says, her cracked lips struggling up into something like a smile. ‘I wanted to kill myself, but I couldn’t’
‘Have you had much to drink?’
‘Half a bottle of vodka’
‘But no pills?’
She shakes her head.
‘Sandy – let us help you onto the ambulance so we can check you over properly and have a chat to decide what to do.’
She blinks asymmetrically, focuses on me, then hauls her mouth into a big statement.
‘I’m not going to hospital, so don’t even think about it.’
‘Sandy – to be quite blunt – we can’t force you to come to hospital, but we can’t possibly leave you here. If you refuse, we’ll call the police, they’ll arrest you, and you’ll end up in hospital anyway. At least if you come with us you won’t have all that extra fuss and embarrassment.’
She shakes her head and starts trying to pull her jeans up again. They are soaked through with urine.
‘Just give me a minute,’ she says.
I wonder if the caller is watching us from a balcony somewhere.

‘Where do you live, Sandy?’
She gives me an address, the other side of town.
‘What’s the dog bowl for?’
‘My dog’
‘Is your dog here?’
‘I dropped him at my mother-in-law’s’
‘What sort of dog have you got?’
‘A sharpy’
‘What – is that like a husky or something?’
‘No – squashy face’
She looks up at me, her eyes bloodshot and her face puffy with the trauma of everything.
‘Oh yes – I know’ I say, as if looking at her face has helped me place the dog. ‘A sharpy.’

We lift her into a carry chair and away into the ambulance. Rae locks Sandy’s car up and brings back her shoes and jacket. She has about five hundred pounds in cash in the pockets.

At the hospital, A&E is as busy as I’ve seen it in a while. There are crews queuing with their patients all along the corridor. When I go to handover to Elena, the charge nurse, she has a board marker in one hand, two clipboards in the other and one under her arm. She stands astride the centre of the department, dispensing order and place like a fierce blue postman sorting letters at Christmas.
‘Dehydrated old lady to resus one, pleuritic chest pain to cubicle three.’
(Takes a phone call, signs something, pushes a heap of forms across to a passing nurse).
‘And you,’ she smiles, hanging the phone up and then scrawling her signature onto my sheet, ‘You my friend, please could you take your OD to cubicle number five.’ She tosses the board back to me.
Sandy gets wheeled into position.

Saturday, August 02, 2008


‘Who’s there?’
‘It’s the ambulance.’
‘Just a minute, please.’


The entire building seems to be asleep; it’s so quiet you can almost hear the miles of hallway carpet stretching their luxurious tufts upwards to the pools of light outside each flat door.
‘Okay. You may come in now’
The door opens with a little tug of air. Mrs Jessom stands revealed to us, a sad eyed lady of seventy odd years, aura of glade freshener and alcohol, wearing a voluminous leaf patterned housecoat so heavy and triangular on her she seems like the worn out clapper in an Arts and Crafts bell. She pats her hair.
‘I look a fright’
‘Can we come in for a chat?’
‘Of course. Do.’
She lets us in, then closes the door firmly behind us.
‘The living room, I think’.
We follow her across a polished parquet floor. I feel that my work boots are growing in size and awfulness as she leads us into a richly furnished front room, darkly expensive oil paintings on the walls, glass cabinets sparkling with porcelain treasures, a leather ottoman and braided pouffe, a regency striped chaises longue and an occasional table of walnut and cherry – everything smelling of beeswax and fuss, everything placed meticulously with respect to everything else. In fact, the lines and relationships between each piece in this room are so strong, merely the act of sitting down reads like a serious assault. I feel hot and hemmed in, but we’re here to talk about Mrs Jessom’s suicidal feelings, so I try to clear my head.
‘My name’s Spence. This is Rae, my partner. Now – could you tell us what’s happened tonight, Mrs Jessom?’
She sits, poised in a gilt chair, her fingers fretting away in her lap. She stares at me.
‘My husband died,’ she says.
‘I’m very sorry to hear that.’
‘I just don’t know what to do with myself anymore. It’s all too difficult. I don’t see the point.’
‘Was it very sudden?’
‘Was what sudden?’
‘Your husband’s death’
‘Yes. I suppose it was. I can’t remember it all that well’
‘When did your husband die?’
‘Yes. How long ago did he die?’
‘Eighteen years or so. ’
‘It must be hard,’ I say, nodding empathetically, whilst at the same time making a radical adjustment to my reading of this scene. ‘And has anything happened tonight in particular? Has anything set you off, made you feel bad for some reason?’
‘No. I always feel like this.’
‘So what did happen tonight?’
‘Well. I had my friend Susan round for drinks and a game of cards as per usual for a Wednesday night.’
‘Sounds nice’
‘That sounds like a nice thing to do’
She grimaces.
‘One does one’s best. It’s more for Susan than for me, of course. She’s always – I don’t know – such a mope.’
‘Did you have much to drink?’
‘No. Just the usual. A glass or two of whisky. Nothing – hardcore.’
She uses the word hardcore with a little downward turn of the mouth and stiffening of the spine, as if she’s making every effort to communicate to us in words that we might understand.
‘And excuse me for asking this, but have you taken any tablets tonight or done anything that might cause you harm?’
‘Certainly not’ she says. ‘But these things, they’re always there, always available. And I often think – well, why not?’
‘But you haven’t tonight?’
‘But I haven’t tonight. I’ve been very good about it’

The interview continues, Rae joining in with questions and suggestions, making all the usual health checks and taking details, until we reach the point where Mrs Jessom needs to decide what she wants to happen tonight.

‘Of course we wouldn’t like to leave you here on your own if we thought you might hurt yourself in some way.’
‘I’m not going to do that. I suppose I just wanted someone to talk to. And now that’s done.’
‘You can always come with us up to the hospital and speak to someone there. I’m afraid we’re quite limited as far as time and practical things we can do.’
But as I’m saying this I know that if Mrs Jessom did come up to the hospital, she would spend hours on her own in a cubicle, with no access to anyone resembling a psychiatric nurse or counsellor. The hospital is poorly set up for emotional problems during the day; during the night, it’s actually the last place you’d want to take anyone who was feeling low.
‘I want to thank you for coming tonight,’ she says, standing up and concluding the interview. ‘I know you’re busy.’
‘Please – do call again if you’re feeling desperate. There’s always something to be done,’ I say, half expecting the porcelein fish on the table behind me to leap up and fracture at that particular falsehood.
Mrs Jessom leads us back towards the front door. I notice something for the first time, the life-sized figure of a little girl in a bright red raincoat, turned with her face to the wall and her arms crooked up as if she were crying. It’s a ghastly figure, and one that makes me shudder despite the flat’s stifling heat.
‘She’s – erm – she’s unusual’ I say.
‘Yes. I was given her some time ago. Don’t know why I keep hold of her. Silly really.’
She hauls open the door and we leave.
Back in the cab we look out over the sea, the moon bright and low in the sky, silvering the glassy black surface.
‘Waxing or waning’
‘Waning. I think.’
‘At least it’s not full, thank god. I’m really not in the mood for it tonight.’
We share some fruit flavoured chewing gum, and turn the music up.

Friday, August 01, 2008

cat wrestling

‘Excuse my state of undress,’ says Janice, coquettish sausage finger to chins. ‘It all happened as I was getting into bed, you see. I didn’t have a chance to put on my nightie.’
All exactly to script. Each crew will land a trip out to Janice at least once a month. Always late at night, and always the same reason – an injury to one of her legs whilst transferring from wheelchair to bed. Every time I pull up outside I expect to see a neighbourhood posse with flaming firebrands. I know they’ve made several complaints about noisy ambulances in the street in the early hours.
‘Is the front door shut? I don’t want the cats getting out.’
Janice is elephantine, a gross caricature fashioned from pillows and fat-filled balloons, stuffed into a pitted casing. She holds her World Wrestling Federation duvet across her naked chest as we stand there, repeating silently to ourselves the stern promise we made out in the cab to be chilly, clear and quick.
‘Show me where you’re hurt.’
Janice tosses the duvet aside.
‘Janice. You really must make an effort to have some clothes on.’
‘I know. I know. But you’ve seen it all before.’
I have. The glossy WWF calendar; the black and gold thread tiger embroidery above the bed; the racks of wrestling DVDs; the fluffy toys, and the cats, five black shadows, draped indifferently on shelves, chairs and a plush blue cat activity tower.
‘So where are you hurt?’
‘It’s my knee. My right knee.’
A young woman in her mid twenties, Janice lost sight and sense of normal joint function when she passed the 180kg marker a few years ago. Both her legs are terribly swollen. It’s a wonder she can move at all.
‘And what happened exactly?’
‘Well – I was just getting up from the wheelchair to get onto the bed when one of my cats head-butted me in the ankle and I fell forward.’
‘Onto the floor?’
‘Onto the bed.’
‘And was there much pain?’
‘Not really. I just caught my knee on the armrest and it hurt. Is it going to be all right?’
‘Can you move it?’
She flops back on the bed, and partially bends the knee.
‘Oof. That doesn’t half hurt.’
‘Well – the knee cap looks well placed. It’s difficult to tell if there’s any more or less swelling than usual. You have some movement, but that’s not always an indication. At the end of the day the only sure way to know whether you’ve damaged yourself is to come to hospital and see a doctor.’
‘At this time of night? I don’t think so.’
‘Of course the other thing would be to see your doctor in the morning.’
‘He’s no good.’
‘A third option would be to take anti-inflammatories, rest up and see how it feels in the morning.’
‘That sounds like a good idea. I think I’ll do that.’
‘Okay. I just need to complete the paperwork.’
‘Can you help me back up, please?’
We help her into a sitting position again.
‘Phew. Thank you so much for coming. I hate to call you out like this, but I didn’t know what else to do. I’m all on my own here. Apart from the cats. Shame on you, Diesel, for throwing mummy on the bed like that.’ She smiles at me, and wipes away some hair sticking to the side of her face. ‘But I suppose that’s his nature.’
I write out the ticket from memory. It only takes a minute. I collect Janice’s signature and we see ourselves out.

‘Make sure the door’s shut,’ Janice shouts after us.

I accidentally scrunch a snail on the path. A fox barks somewhere off in the distance. There is a mist hanging about the lawns and driveways; it feels like the enmity of Janice’s neighbours coalescing in the chilly night air.