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?’
‘Sure.’
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.’
‘Fine’
‘I’ll take the legs if you’re happy with the middle.’
‘Yep.’
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.