Wednesday, April 29, 2009

contents of a fridge

After the death of Mrs Dorothy Cheeseman’s husband Harold following a brisk but inelegant struggle with prostate cancer; and after an efficient funeral on an averagely sunny day in a square-cut crematorium with adequate attendance and foliage, undercut somewhat by a vicar who could not pronounce his R’s and A Nightingale sang in Berkley Square (Harold hated London); and after six months had fallen from the calendar like so many dead leaves; and after the health insurance that Harold had arranged with his usual prescience had fattened up the joint account overnight, Mrs Dorothy Cheeseman – acting on the instructions of their only daughter, Claire, a woman who had obviously hooked all her genetic ducks from Harold’s ancestral pond, especially a talent for organisation and a thin-lipped approach to problem-solving, (but Claire’s edginess in company could only have come from Dorothy, whose own particular terrors had grown exponentially since she was eight years old at her father’s Christmas work’s do, 1948, when she was pushed up first on stage to collect her present from Father Christmas and threw up three bottles of apple pop and a crab-paste sandwich into his sack) – Mrs Dorothy Cheeseman, widow, sold the family home and moved into the manageable, one bedroom flat Claire and her silent partner Ben had arranged for her just a simple bus ride away from their front door on the other side of town.

And now her sciatica was playing up.

She had been sitting on the sofa looking out at the newly planted communal lawn for a few hours. The washing line had one plain white tea towel fluttering there, but no-one seemed bothered to add any more or take this one down. She watched it for hours. The sun moved across the grass and changed the angles of its shadows at the edges, until the ache in her leg – a cramp that spread from the root of her hip to the heel bone – forced her to get up, move about, find an aspirin. She swallowed the pill with a glass of warmish tap water, then suddenly picked up the phone and dialled 999.

She let the ambulance people in via a short struggle with the entry phone, then sat back down on the sofa.

When they came in they seemed to fill the room completely with their bags and their bulky jackets and their overloud characters. Mrs Dorothy Cheeseman wished she had not bothered.
One of them, the older of the two, a man who reminded her of Harold’s German business associate Klaus, with the same squashy features and crooked teeth, except Klaus was always on the verge of clasping her round the shoulders to draw her to him, and smelled of yeast and pipe smoke. But this man only touched her lightly round the wrist, and smelled of disinfectant. The other ambulance man, a squared-off chap who looked as if he should be outside sawing logs, drew up a stool and sat quietly.
‘I bet they think I’m a fool,’ she thought.
She told them about her leg. And, no, she hadn’t been to a doctor because she had only just moved here and these things were not easy to sort out.
She looked about the room and realised with a low-down stumbling feeling that she had not made the bed. In fact, all her clothes were strewn about the floor. She had been meaning to have a tidy up. What would they think?
‘I’m so hungry,’ she said to them. ‘I haven’t had a thing to eat in days. And I can’t go shopping because of my leg.’
She had been expecting to be scooped up and rushed to the hospital, but the men in green did not appear to be in any kind of rush. Were they always this slow? The old one carefully wrote down the facts and figures whilst the short one fussed about with blood pressure cuffs and thermometers and blood sugar kits – though what all this had to do with a leg she could not possibly say. Suddenly the short one seemed to be finished with all that. He packed his kit away, stood up and asked if she would like a cup of tea, then wandered off into the kitchen to get it. Dorothy tried to listen to the old one talking on in a quiet voice about options and such, but her attention was really focused on the kitchen.
‘I haven’t any food at all,’ she suddenly shouted out to him. ‘Not a thing.’
But when he looked in the fridge for the milk, Dorothy knew exactly what he would see: two spotted rashers of bacon, a tub of marge, and a dried-out slab of Leicester cheese.

Sunday, April 26, 2009

daniels then and now

Daniel then

I was born into this world on the thirteenth day of March, 1770, may it please you, received into the sure and respectable arms of the Lambert family senior, in the county seat of Leicester. My father, John, in stature and in public life a substantial and hospitable man, keeper of the Bridewell jail, redoubtable servant of the county of Leicestershire, breeder of dogs and fighting cocks, held me to his heart a boy of grace and opportunity, heir designate to the modest fortunes he had so assiduously acquired. I grew strong like him, swimming in the Stour, hunting and fishing, taking all of life that I could with an appetite born of a naturally expansive mind and a temperament which demanded of all experience the simple necessity of sampling as much of it that I could. By virtue of this temperament, in the most part the result of an indulgent heritage, by which I mean a father who wished me all the things he was denied in his youth, and a mother for whom bread and game, pies, puddings and pitchers of ale marched on through the household as like the very blood of the body Lambert – by virtue of this temperament, as I say, the weighty proclivities I was born with, and the idiosyncrasies I can only claim for myself, I grew in circumference as much as in height. The love people bore for me, my family and friends, indeed the very prisoners who were given into my charge when I succeeded my father as president of the gaol, all the love that orbited me in my heavenly path through life, seemed to act on me in much the same way as food.

By the time I was pensioned from my job in 1804, I was of considerable girth, my clothes specially made, and the furniture in my house reinforced by craftsmen without whose skill and ingenuity my comfort would have been in jeopardy. I grew to be such the celebrity in my home town that I would be followed about by crowds of rowdy boys, riding in my wake like so many bottles bobbing about behind the progress of a ship. Without work to maintain me, and with a pension grown exhausted by the demands placed upon it, I thought about the ways in which I might earn an extra sixpence or two, and struck upon the idea of charging admission to look upon me, five shillings per person, with a reduction for large parties. Though it pained me to exhibit myself in this way, it allowed for the fitting of a special carriage, and sundry other life essentials.

On the twenty first of July, 1809, I had repaired to the races at Stamford, and taken up lodging at an Inn in that fair town. It was there that my heart and my life finally acceded to the strains placed upon them. I fell asleep, and did not open my eyes on this world again.

The inn keeper and his men looked at the situation all of the morning and some of the afternoon, scratching their heads and pacing the circumference of my bed, taking measurements, gauging material strengths, angles and probabilities. Finally it was decided that the only way to remove my mortal remains was to take out the window adjacent to the cot, partially demolish the attendant wall, apply planks of wood as a bridge to a waggoner’s cart judiciously parked in the courtyard, and slide me out by means of ropes.

At my funeral, twenty pall bearers bore my coffin into the ground, and there it was, dear reader, my life’s adventure found its end.

Daniel now

We hear an obstructed rattle from the front room as the son leads us in to his father.
'He was like this yesterday, maybe not quite so bad,’ he says, pushing open the door.
A glutinous landslip of a figure, Daniel is not so much sitting in the huge electric chair as spilling out of it, his massive legs planted either side of a belly so enormous it would take a team of tailors with ladders to clothe it; as it is, he seems to be wearing a shower curtain as a nightshirt. The cupid features of his face float on an indeterminate mass of mottled flesh, the lips tinged with blue. I take up the controls to the chair and adjust his position, tipping him back enough to open his airway and stop him snoring. The cyanotic mottling gradually fades, his level of consciousness rises, but there is a crackle from his lungs.
‘How long’s his chest been like this?’
‘A few weeks. He normally has problems with his breathing, but it’s getting worse.’
We put an oxygen mask on him, check him over. His sats come up to an acceptable level, but he seems to be running a temperature, and his breathing is obviously compromised by infection. There is no blood pressure cuff available outside of London Zoo that would fit around his arm, but at least he has a good radial pulse.
The son stands watching us, his hands hooked in the back pockets of his jeans. He seems nervous, scooped out by things. I wonder when he ate last.
‘Normally with a chest infection like this we’d simply take your dad to hospital,’ I tell him, putting the clipboard to one side.
‘I don’t want to go to no bleedin’ hospital. I hate them places,’ wheezes Daniel, pulling off our mask and putting on his own nasal cannula instead. ‘They’re full of sick people.’
‘He won’t go if he doesn’t want to. He’s a stubborn old git.’
‘The thing is, even if he did want to go, it wouldn’t be an easy thing, given his weight. What – about thirty two stone, would you say?’
‘Charming,’ Daniel says, adjusting the cannula.
There is a knock on the side of the open door and a bright young woman hellos her way into the room.
‘Hi Keith. Everything all right? I saw the ambulance.’
‘Yeah. Thanks Jean. Dad took a bit of a turn’s all. We’re just figuring out what to do with him.’
‘Send me to the knackers,’ says Daniel. ‘Make a bit of money.’
‘Oh you,’ says Jean. ‘Well – just thought I’d check in. If there’s anything you need…’ And she goes.
‘It’s just a logistical problem, that’s all,’ I say to Daniel. ‘We’d need at least a second crew here to help with the lift, but then you won’t fit on our trolley anyway. So we’d have to arrange for a special truck to come out, and I’m not sure how soon that could be. I think the best thing is for the doctor to come out and have a look at you here – which is what you probably want anyway. See if this chest infection can be handled at home. And if the doctor thinks a trip up the hospital is definitely needed, then at least we’ve got a bit more of a run up to organise things. I’ll call Control and give them a heads up. What do you think?’
Keith sits on a stool, fishes a pack of cigarettes and a lighter out of his top pocket, then hands me across the phone.

‘They know us there,’ he says. ‘It’s on speed dial 3. Tell him I’ll be here all day to let him in.’

Friday, April 24, 2009

the piano tuner

I can imagine this crowd foraging through bargains in a Church hall. They have the same good-humoured competitiveness, the same restless sense of purpose. It is a disparate mix: mothers, office workers, middle-managers and students, all dressed militia-style in a haphazard kit of army surplus jackets, scarves, disposable charity shop t-shirts and good boots.
The two policemen shut the holding bay door behind us with a clunk and survey the scene.
‘Her name’s Marge. She’s been arrested under suspicion of trespassing and criminal damage. She’s sitting over there, in that corner,’ one says.
We follow him through to a middle-aged woman sitting on the bench that runs the length of the bay. She has her right hand wrapped up in a dirty white t-towel and held up in the air. She smiles pleasantly at us. I expect her to say: ‘How much for this?’ but instead she says: ‘I’m so sorry to bother you. It’s all a bit embarrassing.’
‘What’s happened?’
‘Well, there’s a fair bit I have to be careful telling you, apparently. But the gist of it is that I was climbing over a fence and hurt my finger. A friend of mine who’s a nurse did a makeshift dressing because we didn’t have time for much else. And the police called you when I – erm – got here because they were very sweet and they thought I’d better have it looked at. I’m sure it’s nothing.’
We help her up and lead her back through the crowd to the ambulance parked outside. A few people pat her on the back, wish her well. A young guy in a jacket sprouting all over with badges punches the air and cries out ‘Go Margie! Go Margie!’ but no-one joins in. The unexpected silence closes over him, and the door slams shut behind us.

With the patient sat comfortably on the ambulance, the two policemen waiting just outside, I set to work unwrapping her hand.
‘I’m a bit squeamish,’ she says, tugging off her woolly hat and shaking out a hedge of steely grey hair. ‘It doesn’t hurt though.’
In fact she has no sensation in her hand at all.
As I work my way through the extemporary bandaging, Marge tells us a little more.
‘We were at a laboratory that experiments on animals. Breaking in, actually. I mean, here we are, chatting like this, and there are dogs just the other side of town with disinfectant being dropped into their eyes. Did you know that? Disinfectant. You have to do something.’
She loosens the scarf around her neck.
‘Anyway. I was climbing over this horribly pointy fence and I got caught up. It was tricky and of course I’m not the world’s most athletic commando. I think I must have slipped back and got my hand caught. So I hung there for a moment until lovely Jake hoiked me up from below and someone else worked my hand free. We didn’t have time to hang around – no pun intended. We had to get in there and – well – complete the mission. Which we did. Hurrah.’ She smiles at me. ‘Down to it, yet?’
The inner layers of the dressing are crusty with dried blood.
‘How long ago did this happen would you say?’
‘I don’t know. Three, four hours?’
‘We’ll have to soak this lot off.’
‘Sorry to be a nuisance.’
I fill a bowl with saline and she dips her hand in it. A cloud of red slowly spreads outwards into the water. After a moment or two we ask Marge to hold her hand back up, and then with a large syringe filled with more saline I unwrap the inner layers, gently hosing underneath to loosen the dried blood and release the skin caught up underneath.
Rae is poised next to me with a large, damp gauze.
Marge looks off to the side.
The dressing comes away.
In the brief instant before squirts of blood arc delicately into the air and Rae leans in with a dressing, I catch a view of the injury: Marge’s ring and middle fingers have been partially de-gloved, the flesh and skin of both ripped at the root and slid upwards.
‘How is it?’ she says.
‘It’s quite a serious injury,’ I tell her. ‘And the delay hasn’t helped. We need to get you to hospital as soon as we can to get it repaired.’
‘It hurts a bit now.’
I clean the area as best I can, re-bandage the wound and put her arm in a sling. I tell the policemen waiting outside that Marge needs to go to hospital right away, and we’ll be driving on lights and sirens. Whilst they make arrangements, Rae jumps out and goes to the cab to call the job in .
‘It’s really quite a deal then,’ Marge says quietly. She rubs her nose with the back of her good hand and looks clear into me.
‘I’m a piano tuner,’ she says.

Sunday, April 19, 2009

beneath the cherry tree

A man has collapsed and died from a suspected heart attack in a local park. Two paramedic crews attended the scene but were unable to revive him. A popular family man in his mid-forties, he was a well-known character in the area, active in local charities and a familiar figure at the local pub. Friends and acquaintances described him as a friendly, witty man with an encyclopaedic general knowledge, always willing to put himself out for others and ready to help wherever possible. An Inquest is scheduled for later in the week.

I flatten the paper, push it across the table to my wife and tap the paragraph.
‘That’s the guy we went to.’


The cherry tree is out in blossom, its branches freighted with thick masses of light pink flowers.

A man is spread out on his back beneath it, his legs and feet stretched across the little tarmac pathway and the rest of him on a grass verge, the clothes cut away from his chest, a paramedic kneeling beside him with her arms locked, rocking up and down on his chest, and another paramedic with a mask clamped to the man’s face, rhythmically pressing oxygen into him. We duck beneath the blue and white police tape stretched across the path.

‘Hi guys. Thanks for getting here so quick,’ says the paramedic on the mask.

We take over their positions whilst they give us the story.

‘Okay guys. This man had been seen sitting under the tree by various people around lunchtime, nothing obviously wrong. A guy who works in that hardware store over there had passed him on his way back from the sandwich shop, slumped forwards and snoring, thought he was just the worse for drink. That was about one twenty. The guy came back outside the shop for a smoke at about one forty, noticed the guy flat on his back halfway across the path. He called the police to report him as drunk. The police responded on low priority to a D&D, getting here just on two. Found him apparently dead. We got here about five or eight past. So unfortunately no CPR attempted at any point until then, which must be at least half an hour, probably more. The guy’s asystole but warm, pupils fixed – but he’s young, so we went for it. What’s the time now?’
We carry on for another twenty minutes, bustling through a resus protocol that lacks for nothing but the one thing that would have made a difference: timeliness. Nothing changes, and nothing we can do can stop the man from riding out beneath us on a relentless line of asystole. We stand up, stretch the cramp out of our legs. Clear away the empty tubes, the oxygen line, airway adjuncts, pads and empty cartons, stuffing it all into clinical waste bags.

Two policemen come over to take details and discuss the next phase. They have his wallet and phone. They have numbers to call.

A scattering of cherry blossom drifts down across all of us, catching in our hair like confetti.

Saturday, April 18, 2009

Fiona in greens

Bear Court. Sounds more like a headline than an address. Fiona looks it up in the map book whilst I machete my way through the early evening traffic. This is perfect timing for a call; surely our last of the day, and the last that Fiona will do for the next six months until her baby is born.
She points the address out on the map. Perfect. And there’s a car on scene already, so the paperwork should mostly be done. We wave at the traffic like crazy royals as it falls away before us.

Bear Court. A great, sandstone cube landed amongst some trees. I drive into the car park past a wide, white sign and its logo: a bear, rearing up, with a sash. There’s a path and a run of stubby black path lights leading up to a door. You could swivel the building through ninety degrees and find no difference. The only thing that suggests that this is indeed the front is the fact that the RRU is parked here. I grab the chair out of the truck and we walk up to the building.

Bear Court. No wonder the bear in the logo is angry. A rage born of confusion, no doubt. This is the rear of the building. We walk back to the truck and drive round to the front (looks like the back, has poorer access). I park. We walk up to an identical door.

Inside, the building is run through with a blue carpeted corridor that seems to extend as we walk along it. About five miles further on we see that one of the thousand doors here is open. We can hear voices, and as we get even nearer, a formidable figure steps out and waves to us.
A woman as square as the building, she is contained by a quilted floral dressing gown and a hair net, utterly in keeping with her environment, somehow, like she’s not so much a resident as an architectural extension.
‘Over here!’ she calls, and we gradually make the distance.
Inside, the flat is as bustling as the rest of the building is dormant. Frank is on the car today. He’s kneeling down beside a rumpled bed where an elderly woman is sitting propped against a dressing table. Two more elderly women are fussing around in the room, laughing and giving each other playful little slaps on the shoulder.
‘Ooh, here comes the cavalry,’ one of them says. Then: ‘We’ll get out of your way.’
‘Watch from the cheap seats.’
‘You’ll be alright, Eth. You’ve got the A Team.’
‘Mine’s the one in green.’
‘They’re all in green. Even the lady.’
‘Well I’m not fussy.’
‘Oh you.’
Frank looks at me. If I ever came across a cow lost in a shopping centre I would expect to see the same expression: a lugubrious and silent plea to be led back to the fields.
‘Sorry I didn’t move the car, guys,’ he says. ‘I couldn’t face hauling all those bags back to the car, so I came up some steps at the side. Anyway. This is Ethel. Ethel has been feeling nauseous on and off today. Took herself to bed. Found herself on the floor. Looks like she passed out for a minute or two. Was sick. No pain, obs okay – blood sugar slightly high but nothing major. Had a similar episode a month ago, nothing found.’ He pats her on the hand. ‘How are you feeling now, Ethel?’
‘Okay,’ she says, with a washed-out smile. ‘Don’t fancy a trip up to hospital. Don’t like hospitals.’
‘Who does. I’m allergic to them,’ Frank says, taking off his stethoscope. ‘All yours, chaps.’
We help her into our chair and wrap her in blankets. I am at the business end of the chair and reverse out of the flat. Frank and Fiona walk off down the corridor to call the lift, leaving me surrounded by a flap of nightgowns as heavily made-up and frenetic as clowns at the circus, pushing each other around in some elaborate and incomprehensible piece of shtick involving keys, slippers, cats, scrawled phone numbers on scraps of paper. They seem never to have come across the concept of ‘a door on the latch’ and struggle to close it.

I look ahead into the distance to where the tiny figures of Fiona and Frank talk nonchalantly by an opened lift.

I will never make it there. I will live out the rest of my life here by this door.


Ethel lies back on the ambulance trolley looking as white - and flat - as the sheet. But her blood pressure is fine, everything seems okay. The ECG is ticking along nicely.
‘Ready to go,’ I say to Fiona.
‘Yep. Let’s head on out.’
I jump down, shut the door. Climb in the front.
The sun is low in the sky but it’s still warm. It’ll be a lovely summer. I put the radio on. Call our leaving time through the hatch, and set off.

Just as I’m pulling out of the car park, I hear Fiona call out: ‘She’s gone.’ Followed by a crashing noise. I stop the ambulance and hurry back round.
‘She went bradycardic, then asystole,’ she says as I climb back inside. ‘I dropped the back of the trolley and it shocked her out of it.’ She squeezes her shoulder. ‘Ethel?’ She opens her eyes and moves her head feebly from side to side, muttering. ‘Are you with us, Ethel?’
I look at the printed strip. Flat line for a few seconds. Incredible.
Ethel begins to retch, so we turn her on her side. She vomits a little into the bowl I hold for her.

After a while she settles down. She says she still has no pain. Nothing untoward shows on the ECG. Everything seems fine – but that period of asystole sits heavily on the paper in front of us, a resonant mark of doom. I go back round to the cab, call the job in, and head off through the traffic on lights and sirens.

I look in the rear view mirror. Fiona leaning forward, attending to Ethel.

Fiona with the baby growing inside her. Fiona in Greens, Provider and Protector.

Cars pull over to let us through.

Sunday, April 12, 2009

anatomy of a slap

Viren has only been at the EMI unit for a couple of hours, not that he could tell you. He lies back on the bed, heavy glasses on a wide and leathery smile, nodding and muttering and seemingly oblivious to the small crowd of people invading his room.
‘We find blood in pads,’ the nurse says, flicking through his notes with a sniff. ‘The first time we come to change we find blood in pads. From penis. I haven’t more, unfortunately. His name is Viren. V-I-R-E-N. Viren. There.’
She hands me the notes. ‘Wife will meet at hospital.’
I introduce myself and Rae. Viren produces a hand as padded and massive as a baseball mitt, wraps it round mine, then rattles on through a low and loose knit of words. I shake his hand and tell him what to expect. The nurse and her assistant stand to one side and dispatch an orderly for the hoist.
‘The notes say here that he can be violent. Have you found that?’
‘Like I say, he came two maybe three hours. I could not say. He’s fine.’
I look at Viren and smile, then go back to the paragraph describing his history. Vascular dementia. Wife sole carer. Some kind of incident on a bus when he refused to leave and became aggressive. Banging on the window. Police etc. Wife at risk. Having him put into respite care whilst longer term provision found.
‘How are you feeling, Viren?’
His reply could be anything.
‘We think UTI, maybe kidney. He has swollen abdomen. He has temperature.’
I run through the basic obs whilst Rae goes to fetch the trolley. I make notes on my form, interspersing each procedure with reassuring smiles, squeezes and words. Viren seems happy and calm, even when I examine his abdomen.
‘He prefer men,’ says the nurse. ‘Girl – not so much.’
When the trolley comes through we position it so that the hoist will have room to operate. The sling seems to be a sheep’s fleece with straps.
‘I’ve never seen such luxury, Viren,’ I say. He smiles and tries to pull my shirt.
The lift over onto the trolley is uneventful. At one point Viren is swinging in mid-air, his legs spread and his hands fluttering in the void like gross, featherless birds.
‘Here. Hold on to this,’ we say, directing his hands. But he flaps awkwardly until we land him.
We tuck him up, raise the trolley, make our farewells, and leave.


A&E on a Monday. Crammed with doctors’ urgents. People have had the weekend to fall ill, present themselves at their surgery and be referred on to the hospital. Accident and Emergency is transformed into some ghastly portal. Trolleys line the corridors; the status board is as scrawled and hectic as a race meeting tote. Walking in through the automatic doors I expect to see a gothic sign inscribed in slate: Abandon Hope All Ye Who Enter Here. But I give Viren’s hand another squeeze and excuse my way through to the charge nurse to handover my patient.
After twenty minutes I come back. Rae is a fossilised yawn.
‘We’re going into space nineteen,’ I say to them. And then specifically to Rae ‘I’ll get some half boards.’ I figure that Viren won’t tolerate being laid flat.
When I return with the boards I look around for someone to give us a hand with the transfer. Viren is a tall man and I don’t want his legs getting snagged on the foot bar as we go across.
Luckily, Erik the Viking is standing with a patient just behind us, and if there is one person in the wide ambulance world who is good for a smooth transfer, it is Erik the Viking. A tree-sized, red-faced man, in earlier times he would have looked at home standing at the prow of a longboat, squinting through a helmet with an axe across his chest, but these days he simply looks mighty in greens.
‘Help with a transfer, Erik?’
He clumps across.
‘This is Viren. Viren has dementia, but apart from being a bit grabby, hasn’t been too much of a problem. Viren has some bleeding from his penis, so it’s query UTI or other infection. Otherwise okay.’
‘I’ll take the legs if you’re happy with the middle.’
He smiles at Viren.
‘Just put your hands across your chest and let us do all the work,’ he says pleasantly. Viren smiles and looks around. I place his hands for him. ‘Keep them on your chest,’ I say.
We lean him to his right and slide the boards into position. He accepts this indignity without any trouble.
‘Ready to slide – and – slide.’
His right arm shoots out and grabs the edge of the board, stopping him moving.
What are you doing?’ he screams.
‘Viren. It’s okay. Just relax and let us get you over.’
‘Help! Help!’
I unclasp his hand. ‘Let’s get him over,’ I say. We slide him all the way.
‘What are you doing to me?’
‘All done now. All done,’ says Erik. He goes to roll him up a little to give me room to slide the boards out.

Viren draws his hand back and slaps him round the face.

When he pulls back to hit him again, Erik catches his hand.
‘You do that again and you’ll be in hospital for a lot longer,’ he says.
I know that the shock of the slap has jolted Erik into war mode, but it’s a truly dreadful picture, framed by the sudden thrill of attentive quiet that has flashed through everyone in the vicinity.
Whilst Erik controls Viren – who stares up at him with a look of whitened terror – Rae and I pull up the safety bars and arrange his blankets. Erik releases Viren’s hands.
‘I’m so sorry about that, Erik,’ I say to him. ‘That came out of nowhere. He was a bit grabby when we picked him up, but that was it.’
‘No worries,’ says Erik, but he looks about to blow. ‘I’m used to it.’
We put Viren into position. I tell the charge nurse what happened.
‘Oh great,’ she says, ‘that’s all we need. Thanks a lot.’

I go to the kitchen, make a round of tea and carry it outside on a plate. Erik is there, smoking. I hand him a cup.
‘I feel so embarrassed,’ I tell him. ‘The notes said he was aggressive, but he was so good it just went clean out of my head.’
‘Don’t worry about it.’ He adjusts his position against the railing. ‘It’s happened to me before. It’ll probably happen again. I can take it.’

Rae joins us. We drink our tea. Erik smokes.

I can feel the stress tonight. I can see its stealthy mycelia threading out beneath the A&E doors, along the tarmac and up to my boots, up my legs, over my chest, my arms and my hands, into the tea, into me.

I gave up smoking seven years ago but I could do with a cigarette tonight.

Thursday, April 09, 2009

a bag of nuts

The satnav has failed but I recognise the street from a siege last year. A burglar with a knife had been disturbed, chased by police and gone to ground in one of the terraced houses there. After a time, a police dog handler had arrived. The crowds taped off at the end of the street had been parted to let this new and terrifying apparatus through. The dog handler had parked in front of the house, stepped to the back of the van, and opened the door with the gravitas of an executioner. At a snap from his fingers out leaped a dog that, from where we stood, looked one part Alsatian, three parts grizzly bear. It sat in front of him, he gave it some instructions – which the dog seemed to understand and enjoy – then they padded off through the front door, and as far as I understand it, the burglar ran out the back into a big net. Anyway, it was a sunny, do-nothing standby, with people leaning out of car windows, looking on with folded arms, comparing mobile phones, cleaning their sun glasses on their shirts, or passing time with the easy, expansive chat that breaks out when anything cuts across the norm; a mixed crowd of sudden sociability, from the stab-vested police and evacuated neighbours to the local press, TV crews and any one of the hundreds of commuters drifting past on homeward currents, stopping to have a look.

The street is different now. The lamps have all failed, and the only illumination is the yellowy overspill from the railway station and a full moon hangs above us like a hub cap. The house numbers are difficult to read. But just as I go to pull a torch out of the rack to have a closer look, the truck headlights pick out a policewoman emerging from the gloom at the top of the street. Rae drives up and I climb out.
‘We weren’t told you’d be here,’ I say. ‘The job came through as a sick elderly woman.’
The policewoman smiles and comes up close.
‘Her name is June – we think. She was found wandering in someone’s garden, very confused. They took her in and called us. She says she lives in one of the cottages backing onto the alley, but doesn’t have a key, the people looking after her have never seen her around before, and well – it’s difficult to figure out quite what the story is. Come and see what you think.’
She leads us back up to the top left corner of the road and turns confidently into what would seem to be a high wall. But the thicker darkness there is actually the entrance to an alleyway I would never have guessed existed, a twitten tucked away as neatly as a secret compartment in a Georgian writing desk. A few yards along it we come across another policewoman standing by an arched trellis. She shows us through into a pocket-sized courtyard and the front door of a narrow cottage in front of which stands a figure who appears in the shadows to be a speaking facet of the rough flint wall.
‘Oh no. What now? Who’s this?’ she says.
I resist the urge to switch my torch on. The beam would blind us all, and the woman is so insubstantial it feels as if she would simply disappear.
‘Hello, June. My name’s Spence and this is Rae. We’re with the ambulance service.’
‘The ambulance service? Well for goodness sake! No-one’s sick, are they?’
‘That’s what we’re here to find out. How are you feeling?’
‘How am I feeling? Why do you want to know that?’
‘Because people are a little concerned about you, June.’
‘Are they? Who? Why are they concerned about me?’
‘June – it’s pretty cold and dark out here. Would you like to come and sit on the ambulance and chat to us there? It’s so much warmer and more private. We can sit down in comfort, have a chat and get to the bottom of this mystery.’
‘What mystery?’
‘Exactly. Will you do that, June? Come on, just for a minute or two. We won’t drive off anywhere, or do anything you don’t want to do.’
‘All right, if you think it’s absolutely necessary. One must always trust those in public positions of responsibility. But I have to say it all seems rather a nonsense. Who are you, do you say?’
‘The ambulance service.’
‘And why are you here?’
I take her by the hand. Even that small movement is enough to disturb an unsettling odour from her. It spreads out around us, a seamy musk of neglect.
‘Follow me.’
I lead her back along the alleyway to the ambulance. We sit her in a forward seat, close the door and settle in as pleasantly as we can.
‘And this is an ambulance, you say?’
June looks around like some visiting dignitary making conversation. Her silver hair is scraped neatly back into a black scrunchy, and her jacket and trousers have a smart line to them. But it looks as if she has been wearing the same clothes for some time now. They have a hazy, forgotten look about them.
June has a wide face, with an asymmetric twist to her mouth that would have been terrifying in middle age. Now it seems somewhat disconnected from her eyes, which flicker dully around her surroundings.
‘Would you mind if we did a few very basic tests, June, just to make sure everything’s okay?’
‘Of course everything’s okay. Why the fucking hell would they not be okay?’
‘Try not to get upset, June. Let me explain what the problem is.’
‘I wish you would. And don’t bamboozle me with jargon. Speak plainly and simply. I am not a fool and I will not be treated as a fool.’
‘Absolutely. Okay. Here’s the thing. Some people who live near here found you wandering in a confused state in their garden. They were worried about you, so they called the police. The police called us because they thought there might be something wrong with you.’
‘Something wrong with me? Like what?’
‘A urinary tract infection, for example. That can make you confused.’
‘Who’s confused?’
‘You seem confused.’
‘About what?’
Rae joins in. Whilst we give her a quick health screen, we try different approaches to find out the facts of her situation – where she lives, who she lives with, where she has been today and what she thinks of this whole situation. Her vital signs are fine, but although she is articulate and forceful, she seems to lack any reasonable insight into her predicament. And by the simple expedient of repeating isolated phrases back to us, she starts to make it seem as if we are the ones in need of focus.
‘Please. This is not amusing in the slightest – although I don’t doubt this fellow thinks it’s a hoot. I worked fifty years for the foreign office in Africa, and believe you me I know my way around the garden. I’ve put up with worse antics than you. I know what you’re about.’
‘June, let me try to explain again what the problem is.’
‘Please do. All ears.’
‘We’ve never met you before. We have no way of knowing what is normal behaviour for you and what is not. We can only go by what we see, the facts of the case.’
‘And they are?’
‘An elderly woman found wandering in the cold and dark, unable to give an account of where she has been or what she intends to do next. No key to get in, and no plan of action.’
‘What key? What are you talking about?’
‘June – do you live in the house you were standing in front of?’
She screws up the handle of her black bag.
‘Oh this is fucking ridiculous. Here you are talking about keys and confusion. You and your fancy equipment. Your mumbo jumbo.’
‘Okay. June. Do you have a key to that house? Would you mind looking in your bag?’
‘For what?’
‘For a key.’
She opens up the bag and rummages around. It flops about emptily, until suddenly she pulls out an unopened bag of salted peanuts.
‘Would you like a peanut? They’re very good for you, apparently.’
‘No thanks, June.’
‘How about your lovely colleague? Can I pass you a nut, dear?’
‘No thanks, June.’
There’s nothing else in the bag other than a two pence piece and a dirty handkerchief.
‘I don’t suppose you have the key on a string round your neck?’
June stares at me.
‘And why on earth would I have a key round my neck? Do you take me for an imbecile?’
‘June. Our duty first and foremost is to make sure that you’re okay.’
‘Good. Yes. You must do your job.’
‘Yes. It’s our job to make sure that no harm comes to you.’
‘I see.’
‘As things stand, we have no way of knowing if you actually live there, and no way of knowing what you will do next. What would you do if we dropped you off in the street now?’
‘I’d go home.’
‘And where is home?’
‘You know where my home is. I’m tired of these stupid questions.’
‘It’s cold and dark, and we couldn’t possibly just let you wander off. So here’s my plan. Come to hospital with us. It’s warm and safe there. You can see a doctor, just to make absolutely sure there’s nothing physically wrong with you. And there are people there who can help figure out what to do next. How does that sound?’
‘You must do what you must do. But I think the whole thing is a colossal waste of time.’
Rae climbs out to tell the policewomen what is happening. Then she calls back the leaving scene time through the hatch, and we set off for the hospital.
‘This is a rickety old charabanc,’ June says, sniffing and twisting her lips, hugging her bag to her on her lap. And then: ‘What an absolutely fucking ridiculous end to the day.’

Sunday, April 05, 2009

keep the change

Frank steps up to the bank of flat buzzers and presses number ten. We wait a while, and then just as Frank steps up to press again, a voice crackles something unintelligible, the lock thrums, and we push the door open.
From outside there is nothing to give away the fact that this is a care in the community hostel, but inside the institutional roots of the place are apparent. Along with the pin board covered in departmental posters and leaflets, illuminated exit signs fixed above every doorway, fire extinguishers hanging on brackets and a large grey alarm console winking over the stairway, there is a functional air about the hallway, a brisk, sanitary aura that smacks of observation and control.
A cadaverous man in a jacket suit and trousers – but not from the same suit – steps out of his flat and confronts us in the hallway.
‘Who’re you here for?’ he says.
‘Number ten.’
‘Number ten? Ah. Upstairs. Is he going to die?’
‘Let’s hope not. Thanks for your help.’
He studies us as we climb the stairs, but when we look back down to wave he hurries inside his flat.
The door to number ten stands open. I knock and push it open further.
‘Hello. Ambulance.’
The room is filled with cigarette smoke. Our patient, Michael, sitting bare-chested on a low stool in the middle of it all like a sumo wrestler in a steam room, nods for us to come in.
‘It’s a bit smoky, Michael,’ I say to him. ‘Are you able to come out here and talk to us? Only it’s the beginning of our shift and we’ll absolutely stink of fags if we spend much time in here.’
‘The window’s open,’ he says. But the yellowing net curtains hang straight down, the nicotine equivalent of stalactites.
‘Still – if you wouldn’t mind.’
He sighs, stands and walks out onto the landing. I sit him down on the stairs.
‘So what’s the problem, Michael?’
‘I’m depressed.’
‘We were given the call as an abdo pain. Do you have any pains around there?’
‘This morning. But it’s gone now.’
‘Any other pain anywhere?’
‘Any unusual feelings? Sickness? Dizziness? Shortness of breath?’
A fog bank of fag smoke is sliding out of the flat towards us.
‘No. I feel okay.’
‘So what’s the main reason you wanted an ambulance tonight?’
‘Like I said. I’m depressed.’
‘And is this a new thing?’
‘No. I’m always depressed.’
‘Are you on medication for it?’
‘Yep. These.’ He pulls out a scrip, a comprehensive list of anti-psychotics.
‘You see, Michael, the best person to talk to about these feelings of depression are your doctor. They know you. They’ve got all your notes. If you saw an out of hours GP tonight, they’d be hard pushed to give you anything you’re not currently taking – and they’d be loathe to do that, anyway. My advice would be to get some rest tonight and see your GP in the morning. How does that sound?’
A young woman is coming up the stairs. Dressed in a tracksuit top with the hood pulled over her head, she has a stealthy, predatory hunch to her. In this harsh hallway light I expect to see a Nosferatu shadow thrown against the wall. But half way up towards us she stops and calls:
‘Mickey? Are you all right, Mickey?’
‘Yeah. I’m fine. Listen – Leila. Come up here a minute, can you?’
She pads cautiously towards us. When she puts down her hood, her face is a disconcerting mix of ages; she has the eyes of a young teenager, but the skin and hair of a woman in her thirties.
‘Leila? If I give you this money, will you go to the shops and get me some Chinese chips and a bottle of lemonade?’
‘Yeah. Course.’
‘But I want the change. You can’t keep the change.’
‘I won’t keep the change.’
‘You promise you won’t keep the change?’
‘I promise I won’t keep the change.’
Frank looks at me. His face is impassive, but I can feel the power of his impatience trembling in my pen.
‘I’ll just finish this paperwork and we’ll be off.’
‘Yeah. Okay,’ says Mickey, scratching the sparse black hair between his breasts.
Leila leans in to study the two of us.
‘I dated Frank Sinatra. Do you know Frank Sinatra?’
‘Frankie. Oh yes,’ says Frank.
‘What’s your name?’ She squints at his name badge. I can see that he wants to cover it up with his arms, but he reluctantly pulls aside his jacket so she can read it.
‘Frank!’ she says. ‘Frank Sinatra!’
I’m writing as fast as I can.
‘Do you know anything about the shooting in the pub at the end of the road, Frank?’ Leila says to him, moving even closer.
‘No. What shooting?’
‘There was a man shot there.’ She leers horribly and puts two fingers to her temple. ‘Right through the brains. Dead.’
‘Oh. When was that?’
‘I don’t know,’ she says, suddenly dropping her fingers and her tone. ‘Ten years ago? Can I see you again?’
‘Just sign here,’ I say to Mickey, and he takes my pen
‘I’m sure our paths will cross,’ says Frank, picking up the bag and turning to go.
‘But who do I call?’
‘The usual numbers,’ says Frank, helpfully, and starts off down the stairs. I tear Mickey off a copy of the patient form and follow on. At the bottom of the stairs cadaverous man steps out again.
‘What’s happening now?’ he says.
‘Nothing,’ says Frank. ‘Everything’s fine.’
‘So how much does an ambulance man get paid?’ says the man, as Frank hauls open the door.
‘Not enough, mate’ - and he is in the truck with the keys in the ignition before I’ve shut the door behind me.