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.


Anonymous said...

I like this one, Spence. Really strong writing, good prose. A very enjoyable story, all the more enthralling for knowing that it really happened.

But that asystolic episode, and shocking her out of it by dropping the trolley. Now *that* is frontline prehospital care. Put that in an episode of Casualty, nobody would believe it.

Keep up the good work, and good luck to Fiona +1.

Grace said...

That was very touching ... the imagery of the "resonant mark of doom" for Ethel and the new life growing in Fiona. It is the circle of life. Once again, thank you for moving me.

loveinvienna said...

Excellent post Spence! What was the eventual diagnosis or are you not sure? What is it about hairnets and quilted dressing gowns which instantly mean flapping and being flighty? Get it all the time at the Care Home :)

Liv xxx

Spence Kennedy said...

Thanks TA7!
BTW - that's the first time I've seen someone go straight into asystole rather than via the usual route (course then fine VF). And I've used a precordial thump before, but that's the first time I've seen the trolley drop trick work like that.

Thanks Grace!
You're right about the circle of life. Sometimes in the ambulance you're conscious of it - this was def one of those times!

Thanks Liv!
I don't know what the diagnosis was. She was our last job of the day, and my last shift for a week (in house training - pah!) So I'll prob never find out. She had no cardiac PMH, though, so it was all quite strange. It could've been some kind of electrolytic imbalance knocking her heart into deadly rhythms. Something to do with her potassium levels? No idea!
They were a great laugh at the flats. In retrospect.

Thanks for all your comments! :)

Kathleen said...

I don't think I have commented here before but I just wanted to say that I love your writing. This story made me cry - not the story so much but the way you wrote it. Thanks for bringing this to us and thanks for the job you do - and yes, my very best wishes to Fiona.

Spence Kennedy said...

Thanks v much Kathleen.

I think one of the reasons I like this job is the contrasts you're always coming across. Even at the end of a long day - the shifts are 12 hours - and in the context of a job that seems on the face of it to be quite straightforward, there's always the chance that something'll happen to give you a little shake!

I know Fiona's not looking forward to a long stretch of light duties (extending into maternity leave after the birth, of course). She needs to take it easy, but I think it's going to get pretty frustrating for her.

Thanks for your comment, Kathleen.

Wren said...

Beautiful writing on another wonderful story, Spence. Incredibly evocative; I could feel your boredom, see those ladies tee-hee-ing, and the building itself -- oh, my, what a fine description that was.

The end was surprise -- a good one. I hope Ethel survived and was able to rejoin her giggly friends.

Congrats and all my best to Fiona.

Anonymous said...

I had that problem, and nobody in A&E/cardiology could find anything wrong until I had an implanted monitor, which showed episodes of up to 30 seconds of asystole. Now I've got a pacemaker and I'm good as new. Only difference is I'm 21, and judging by the name 'Ethel' she's probably 60 years older... :)

Spence Kennedy said...

Thanks Wren!
I got the feeling that Ethel would do well. She seemed incredibly resilient, keeping her chin up despite feeling awful and despite all the fuss.

BTW - is your avatar 3D? It has the same quality as a hologram! (Or are my eyes even dodgier than I thought?) x

Thanks for your comment, Anon!
So is your condition an AV block of some description? The thing that was striking about Ethel was that her ECG was mostly normal, then bradycardic - then fell into that spell of asystole.

Anyway - really glad to hear the pacemaker is working. And yes, Ethel was a little older than you. 93! ;) x

Anonymous said...

Yeah, they eventually diagnosed it as 3rd degree AV block - I'm an expert on it now! Ethel was so lucky you managed to catch it on the ECG, sometimes it can take months to diagnose.

I've been reading the blog for ages now, and I love it. :)

cogidubnus said...

I don't need to say it do I Spence? Nut I will nonetheless...beautiful writing as ever...Oh god when you write the book(s) I'll buy it(them)...

Thanks for posting...

Spence Kennedy said...

Cheers for that, Cogi! :)