Friday, April 23, 2010

out on the edge

When the sun set it dragged all its heat down with it, and the night rushed in deep and cold. The main streets leading down to the seafront, the promenade and the beach front walkway are suddenly massing with people, gangs of men shouting out, jumping up, running across, climbing up, smoking and walking tough; girls with arms folded against the chill high-heeling it across the road in threes and fours like raw, bare-legged birds wading out to feed.

We park up and take a torch down with us onto the beach.

The blaze of the seafront lights eases off the further out we walk. The creamy white lace of the breakers as they move in to shore are picked out in the moonlight, and the generalised roar of the traffic and crowds away up behind us on the promenade merge down into the sussurant rush and pull of the waves. Right up on the tideline Frank’s torch picks out the fluorescent stripe of a jacket, so we turn that way. We meet a group of clubbers standing back in a group.
‘She’s over there,’ a guy says, so quietly it’s hard to catch what he says. ‘We stopped her going in.’
‘Do you need us for anything else?’
‘Not unless the police do?’
‘We’ll be off then.’
‘Thanks for helping out.’
‘No problem.’

Two female police officers are crouching next to a seated figure. The waves are almost at the feet of one of the officers; every time another one comes in, she stands up and shifts her feet fractionally, but still she keeps between the woman and the sea.
Three torch beams light the scene erratically, swinging about as people change their positions, but they’re enough to show us a well-dressed woman in her forties, her long blond hair expensively mussed, diamond flashes on her fingers, fitted skirt and black patent slingbacks. If it wasn’t for the fact that it’s just past midnight, and both her arms are held by the officers, she could be a business woman taking a post-conference break on the beach before her train leaves for the shires.

‘Madeleine was seen acting rather distressed, and then those guys stopped her running into the sea.’
She shivers and shakes her head.
‘I was not running into the sea. I’m fine. Will you let me go?’
‘You’re obviously not fine, Madeleine. We’re all a bit concerned, to be perfectly honest.’
‘But why? There’s nothing wrong. I just want to go on my way, thank you. What have you done with my purse?’
‘It’s just here look.’
The officer momentarily lets go of her arm to reach for the purse. Madeleine immediately launches herself up, hurling herself forward in the direction of the water.
‘Hey! Hey!’
The other officer has a strong enough grip to stop her making the distance. They both retake their hold, just as another wave rushes up and slops over the first officer’s boots.
‘Let’s all move further up the beach or we’re all going in the drink.’
We half lead, half drag Madeleine up the beach. Up on the beach walk there is a raucous cheer, but it may not be for us.
‘Come on, Madeleine. Let’s get you up to the ambulance and have a chat.’
‘I’m fine, honestly. This is all a misunderstanding. I just want to go home.’
‘Where’s home, Madeleine?’
‘Please. Let me go.’
‘I’m afraid we can’t.’
‘No, Madeleine. Come on up with us to the ambulance and we’ll all have a chat.’
She sobs – and then makes one last desperate heave back in the direction of the sea. But the officers have a firm hold, and she quickly exhausts herself.
‘Just walk nicely now,’ one of them says. ‘We can’t let you go. You know that. We wouldn’t be doing our job if we did. So let’s just walk quietly and calmly to the ambulance, Madeleine. The alternative is we carry you there, and that won’t look great in front of all these people now, will it?’

She looks up and around at us all, her face porcelain white in the moonlight.

‘You don’t know what you’re taking me back to,’ she whispers.

Sunday, April 18, 2010

his name

A fifty year old man has died after a fire at a sheltered housing block.

The man sustained serious burns when the fire broke out in his fourth floor flat in the early hours of yesterday morning. He was pulled from the flat by fire crews, treated at the scene by paramedics and taken to the local hospital, but died from his injuries a few hours later.

Police and fire investigation teams are working at the scene to determine the cause of the blaze.


The long and narrow car park of the block is crowded with fire trucks and police cars, the blue flashes of all the lighting racks skimming around the steep sides of the scene, making the building windows seem to flicker and move.

We park as near as possible on the street.
‘I think I’ll put the old yellow jacket on,’ says Frank.
I grab the resus and obs bags out of the back, but for some reason I don’t go all the way inside and get my jacket.

We’re half way to the heart of the scene when we see a firefighter high up on a cherry picker put in a window with an axe and then lean back as a great coil of black smoke rushes past him out through the jagged hole and away up the face of the building. Despite being perched high up on the white metal platform, every detail of his breathing apparatus, the heavy jacket and boots, the grip of his gloves on the shaft of the axe – the smallest detail is caught in sharp relief by the emergency scene lighting.

I have a change of heart.
‘This looks bad,’ I say to Frank. ‘I gonna nip back for my jacket and some more stuff. Won’t be a minute.’

Back at the truck I hurriedly put my jacket on and then grab the burns kit, carry chair and a couple of blankets.

I pick my way across a maze of swollen hoses that run out across the tarmac. A torrent of water gushes from underneath one fire truck. Fire crews are tightening up breathing gear and passing ahead of me into the lobby and on into the upper reaches of the building. Police officers talk urgently into radios, or lead residents hunched over and coughing through the melee and out onto the patio on the other side of the building.

A fire officer in a chequered tabard waves to me.

‘In the lobby, mate.’
‘How many patients so far?’
‘One coming down. Nothing else so far.’
‘We’ve got more ambulances en route.’

I hurry into the lobby.

The last time I was here I was picking up a resident who’d fallen down drunk in front of the inner set of doors. Apart from the drunk and the warden kneeling alongside him, the lobby had been deserted. Rows of brand new, pressed-wood chairs quietly arranged along the walls, magazines of local interest lined up on the table tops, even the clay bead dressing of the potted plants seemed counted out and perfect. The warden had been so clipped he could have been shaken from the pages of a brochure.

But now the lobby is utterly transformed. Water slops around the laminate flooring. The air smells cool but tainted, drawn down low in a mist of grey and black, like something caught on the stove in a flooded kitchen. Back outside, the roar of the diesel engines rises and falls as the demand constantly changes for water pressure. Then I see Frank. He is standing over the blackened figure of a man on the floor supported from behind in a seating position by a fireman who holds an oxygen mask to his face. Another fireman stands in front of them, dousing the man with a fine spray.
‘Hey guys,’ I say, unzipping the burns kit. My hands shake as I pull some shears out of my pocket and rip open a large burns blanket. Frank has already cut away what he can of the man’s clothes; what’s left are pendant strips of scorched cloth and flesh. His burns are so extensive it’s hard to know where to begin. His abdomen seems to have split vertically above and below the navel, a mottled layer of fat extruding along the line. The man is conscious, but his only response is to follow us with his eyes. Around his nose and mouth the skin is blackened by the smoke he has breathed in, but other than that his face seems untouched by the fire.
I tuck the burns blanket the length of his body and up round his neck, then immediately fish around for any other burns dressings I can find. I use a couple of face dressings on each thigh. Frank has the chair open and ready to go.
‘On three … ‘
We lift him onto the chair with the firemen.
Another crew arrive in the lobby.
‘Any others?’
‘Just this one so far. Can you take the equipment?’
They carry the bags as we hurry outside. It’s an obstacle course of hoses and trucks. In our haste to get back to the vehicle we roughly manhandle the chair, but the patient stays strapped in position, utterly passive. He doesn’t appear to be in any pain, though. He breathes regularly through the oxygen mask and his eyes follow his own progress with ominous detachment.

At the vehicle Frank puts the lift down and we load up. We transfer him onto the trolley. He seems fixed in a seated position, his legs crooked at ninety degrees and his arms held stiffly along by his side. We don’t even bother to fold the chair away; we kick it to one side into the stairwell.
‘Good to go?’
As Frank climbs out to take us off, and I give the man a nebuliser. When he’s breathing that, I tip a bottle of saline over the areas of his lower legs that I couldn’t cover with burns sheets. I look for some cling film but can’t find any. The ambulance is filled with a cloying mixture of tea tree oil and burned flesh. As it rocks violently from side to side I put my face near to the man’s ear.
‘What’s your name?’ I shout.
He tries to speak.
I pull the mask a little away from his mouth.
He looks up into my eyes and his voice when it comes is rasping and faint.
I replace the mask.
‘Peter – my name’s Spence. We’ll be at the hospital before you know it, okay? Just hang in there, mate.’
I touch him gently on the shoulder as we scream away along the road. I try to estimate the burn area. It has to be in the nineties. His eyes stare out over the mouthpiece of the mask, grey and glistening.
The hospital is just two minutes from here.
‘Almost there,’ I say into his ear. ‘Almost there.’

At the resus room a team of medics is there to meet us. The shock on their faces as we bring him alongside their bed is unmistakeable. As we slide him across on the sheet I shout out what I know, his name, what we’ve done. It isn’t much.
‘I used as many burns sheets as we had,’ I tell the consultant.
‘Good boy,’ he says. ‘Well done.’

The team closes around him as we withdraw with our filthy trolley.

He lives another two hours.

Wednesday, April 14, 2010

the green fuse

We step outside to give the family time alone with Bill.

The house is part of a long and steeply-banked estate cut into the side of a valley. Way off in the distance, the last of the farms that used to dominate the landscape stand hard against the sky on the valley rim, horses roaming the high-sided fields, scatterings of sheep, smoke from a brush clearance. The day has risen with dizzying clarity. You can almost hear the fizz of sap rising in the hedges and trees and shrubs, filaments of green springing from the dark networks of branches; intense bursts of colour from the daffodils, anemones, forsythia, camellia. The edge of everything, every nick and stretch, from the flick of a pigeon’s eye to the splinters on the rough cut timbers being delivered next door, everything hangs with a clarity of focus as bright as the ringing sky above us.

‘Everything all right?’ says the delivery guy, wiping the back of a gloved hand across his forehead.
‘Not all that great, to be honest.’
‘Oh. Is the van all right up there or d’you want it moved?’
‘You’re fine. Thanks anyway.’
‘Give us a shout if you need a hand.’
He walks back up the steep steps to grab another timber.

The police arrive. We meet them at the top of the path.

‘Thanks for coming. Nothing suspicious. What it is – we’ve got a seventy seven year old – Bill. Got up at six as usual to make the breakfast. His wife Ellen didn’t hear anything more from him, went down about seven thirty or so and found him lying on his side in the kitchen, not breathing. She says he opened his eyes when she shook him, but didn’t say anything. Couldn’t move him or do any CPR. We got here and did what we could, another crew backed us up, but it wasn’t any good. Asystole throughout. The rest of the family – son and daughter in law – came by about five minutes after we got here. They’re all in the sitting room, pretty upset. Come on in. I’ll introduce you.’

One of the officers stays with the family whilst I take the other into the kitchen to inspect the body. We’ve tidied our clutter away, put back the oven gloves I used to kneel on when I did the compressions, mopped up the bile-stained vomit, wiped Bill’s face clean and closed his eyes. He lies on his back with a blanket under his head and another stretched over his length. Only his face is visible, waxy and slack, and the tips of his slippers poking out from the bottom of the blanket, angled left and right.

‘He was in hospital a few months ago about some breathlessness and fluid retention, discharged with query heart failure and an upcoming heart appointment, but other than that his health was pretty good. Apparently Bill had complained of some chest pain last night but he’s always been a stubborn so-and-so and just wanted to go to bed with a hot water bottle. Was out all day yesterday on his bike, up town buying flowers.’

I hand the officer copies of the paperwork, and leave him to it. We say goodbye to the family as we pass by the sitting room on the way out.

As we step onto the patio, I’m struck full on again by the force of colour and light outside. It feels as if I’ve been given a pair of x-ray specs, so dreadful in their scope that every hidden network, from the water pipes running under the path to the tiniest capillary bed in my nail; from the sapwood in that laurel tree to the spidery crystalline threads in the granite; from the red blood cells drifting down and pooling in Bill’s veins to the molecules of chlorophyll hustling light in the cells of the grass - an infinite, unremitting network of being and becoming, reaching out, growing and connecting, breaking up and then blindly making good again.

We pick up our bags, walk back up to the ambulance, and I radio control to tell them how things stand.

Thursday, April 08, 2010

the afternoon of the third day

Danny’s boyfriend Ahmed meets us at the door and leads us through.

She sits crouched on the edge of the sofa, her arms folded over her stomach, jiggling her legs up and down, looking pale and distracted. The room itself is sparsely furnished, as sharp as the sunlight that cuts through the foliage of the plants on the window ledge.

‘What’s up, Danny?’
‘I’ve been bad.’
‘In what way, bad?’
‘Stomach cramps, throwing up.’
‘Any pain?’
‘Not really. Just cramps.’
‘Any diarrhoea?’
‘Since how long?’
‘Three days.’

I look over at Ahmed, a silhouette leaning up against the window, the light dissolving his outline. I give him a nod and a smile, but however he looks is lost in the glare. I turn back to Danny.

‘Any other symptoms?’
‘Any health problems?’
‘What do you mean?’
‘Heart, breathing problems, that kind of thing.’
‘Are you on any medication?’
‘For depression?’
‘Well. Let’s do a quick health screen, your blood pressure etcetera. Then we’ll have a think what’s best to do.’

But I already know what’s best to do. Danny has D&V. Danny has a bug. We can’t take Danny to hospital. She’ll pass the bug on, more wards will close. Why can’t people see this? Why aren’t they more - aware?

‘Everything’s fine so far, Danny. Just a few more questions. Any chance you might be pregnant?’
She looks up.
‘And these cramps come and go? And they’re not too bad?’
‘Okay. And is this your address?’
‘No. It’s Ahmed’s house.’
‘Where do you live?’
‘Nowhere. Mum threw me out yesterday. I’m getting back in touch with Dad, but it’s difficult. I haven’t seen him in a while.’
I finish writing the report form, then put the clipboard on my lap and fold my hands on top of it.

‘I think you have a stomach bug, Danny. It’s horrible, it’s a nuisance but it is what it is, and the only thing to be done is ride it out at home. If we take you to hospital you’ll end up passing it on to people there, and some of them are so ill already it’ll finish them off. Plus they’ll have to close the ward down to prevent it spreading through the rest of the hospital. So all in all they’re really reluctant for us to take a case of D&V into hospital unless there’s some other serious medical problem, or it’s been going on for ages and you’re dehydrated. So the only thing to be done is tough it out here. Drink plenty of fluids, then when it all dies down – which I think it will pretty soon for you – start eating again, plain and simple food in small amounts.’

Danny nods, and folds her arms more tightly around her stomach.

‘Still getting cramps?’
She nods.
‘Taken any pain killers?’
She nods again. ‘Some paracetamol.’
‘Good. When did you take them?’
‘Three days ago.’
‘And how many?’

The room seems to brake, and everything lurch forwards.
‘Maybe more.’
‘Why did you take forty paracetamol, Danny?’
She shrugs.
‘Do you know how dangerous that is?’
She nods.
‘Did you take them deliberately?’
She nods again.
‘Okay. Phone, keys, jacket – we’re off to hospital.’
She stands up and brushes her forehead lightly with the fingers of her right hand, as if she’d forgotten something important and was trying hard to remember what it was.

Ahmed steps over and takes her arm.

We leave the house. As we step beyond the porch the afternoon crashes down upon us, hard and bright and blue.

Wednesday, April 07, 2010


Frank throws himself down in the chair.
‘How are you mate?’
‘Good. I’m good, thanks.’
But he’s not. He hinges his glasses up onto his forehead, then massages his face with the vigour of someone washing something away.
‘Did you go to that one off the cliff?’
He finishes, takes his glasses off his head and starts cleaning them on his shirt. ‘It’s weird, you know. Apparently she sat in the car half an hour before she drove over. Not much for us to do when we got there.’ He mimes someone peering through a hole: ‘Yep. She’s dead.’

The TV in the rec room is constantly on. Now it’s showing a nature programme, life in the rain forest. Some kind of monkey, hurling itself from branch to branch, falling, gliding, hundreds of feet in the air. David Attenborough explains in sonorous tones exactly what the monkey hopes to achieve.

‘Easy money,’ says Frank, holding his glasses up to the light, then putting them back on his nose.

Rae gets up to make tea.

I think about all the suicides I’ve either been to myself or heard discussed back on base. In just three years, enough to make up a small army, a legion of the damned. I imagine them rising up and coming together from their scattered scenes of death, linking arms, marching forwards out of the chaos. Such a lot of people – and every one of them so desperate they would hang themselves in a cupboard, in a hospital toilet with the light pull, set themselves alight in an orchard, tie a bag around their head, or lie down on a railway track. A lost and bloody host, arm in arm in solidarity, new additions straggling after, a scattering of notes carried off behind them on the wind.

The red phone rings.
‘Frank, mate. You’re on break.’
‘Ah. Yep. Thanks.’

With one practised motion he flicks out the padded footrest of his easy chair, crosses his legs, puts his hands behind his head, and closes his eyes.


Monday, April 05, 2010

the spirit of acopia

‘Cecily. Cecily. Look. You need to pinch your nose - here. Just here.’
‘I can’t! I can’t! You do it!’
‘Come on, Cecily. There’s no reason why you can’t. Just pinch your nose here, go on.’
‘Make it stop!’
‘Pinch, pinch. That’s it.’
‘Make it stop!’
‘How long’s your nose been bleeding?’
‘An hour.’
‘And this is the third time today?’
‘Make it stop!’
‘Cecily. If we can’t get it to stop by pinching, we’ll have to take you to hospital.’
‘I’m not going up the hospital.’
‘No-one likes to go to hospital, but sometimes there’s nothing else for it. If we can’t stop the bleeding by pinching, we have to take you to hospital.’
‘I’m not going up the hospital.’
‘I don’t understand, Cecily. Why did you call the ambulance if you didn’t want to go to hospital?’
‘Make it stop!’
‘You have to come, Cecily. We can’t leave you here like this.’
‘I’m not going up the hospital.’
‘There are nurses and doctors at the hospital – special doctors, with special … nose equipment. They’re good with noses. It’s what they do. They know exactly how to make it stop. All we can do here is pinch it and see if it stops of its own accord. If not – well, you just have to go to hospital.’
‘I’m not going up the hospital.’
‘There’s nothing else for it, Cecily.’
‘I’m not going up the hospital.’
‘Don’t drink that, Cecily. That’s a cup of bloody water.’
‘I’m not going up the hospital.’
‘Come on.’

Five am.

A thin blue light lays against the French windows, flowing up around the dark elements of the garden, bringing it into focus. Cecily sits by the window, her image doubled up in the glass. On her high backed chair, in her blood splotched terry towelling bathrobe, clutching the handle of her dirty aluminium walking stick and surrounded by a scattering of bloodied tissue blooms, she sits on her throne, firm and immoveable, a hologram of the Spirit of Acopia caught in the glass, Divine Angel of Anxiety, Blessed Mother of the Hopeless, the Confused, the Blindly Afraid.

‘Cecily. Come on. What are you going to do if we leave you here?’

She looks at me for a moment, running the tip of her tongue backwards and forwards across the blood stains on her lips.

‘Call an ambulance?’ she says.