a quiet one

Dragging our sorry tails back to base, exhausted, a long and loveless day of heavy lifts, emotional traumas, disturbed meal breaks, disturbing rumours. But with ten minutes and two miles to go, it’s not looking good. All-calls are spraying out of the radio like spores from a rotten fruit. We’re praying for the night crews to sign on in time to pick them up and get us off the hook, but there are so many calls now we know we can’t possibly make it back on time. I lean back in the attendant’s seat and put my knees up on the dashboard, affecting an ease I do not feel. But the Fates aren’t so easily fooled; the screen lights up at the same time as Control calls us. A choice of two – neither good, but one a mile or so closer.
‘Let’s go.’
Frank dives down a wormhole of flashing blue. We make it in minutes.

A wide, tree-lined street, shining in the wet winter darkness. A woman waiting with her arms folded at the top of the stoop.
She doesn’t smile as we stride up the stairs with our bags.
‘Top flat,’ she says, and leads us up.

Anna’s husband Pavel is naked except for Calvin Klein boxers, face down beneath a coffee table. As we walk in through the door he snorts and thrashes, knocking the table over and scattering little finger bowls of pretzels and nuts across the room. The rug is smeared with dark, brown stains and fresher blood from his abraded knees.
‘This I find from vork,’ she says, lighting a cigarette. ‘With note who say I kill myself. With tablet and whiskey.’
Anna gives me the note, but it’s in Russian, so I hand it back.
‘What’s he taken?’ I ask, squatting down beside him.
She shrugs, and nods at a pile of empty blister packets – anti-depressants, pain killers and blood pressure pills. Pavel is pretty much unconscious, snoring as he struggles to keep his airway open. I tilt his chin up to clear it and open his eyelids to assess his pupils as Frank backtracks to get a chair.
‘Can you write your husband’s name on my form with his date of birth, his doctor and so on? That’d be really helpful.’
She does it, quickly, neutrally, as if she were signing for receipt of a package.
‘Has he done this before?’ I ask, putting in an airway. Pavel gags a little but takes it without vomiting. His SATS are good, but we need to get him in quickly.
Anna shrugs. ‘Once before. But he drink all the time. Is he bad?’
‘Bad enough.’
She blows smoke.
Frank crashes back in with the carry chair and a couple of blankets.
Pavel must be at least six feet tall, heavily built. Strictly speaking it should be a four man lift, but we know that asking for a second crew at this time of night, with so many calls stacking, it would be a while before our back-up came. So we top and tail him into the chair, bundle him up in blankets, and head for the door.
‘Could you put all those pills into a bag?’ I say to Anna, ‘And carry the clipboard down for me? Thanks.’
She follows us as we grunt down two flights and out into the street. When we make the ambulance she puts the bag and clipboard down behind me and watches as we roll him onto the trolley, sort out his positioning, rig him up to the oxygen, the ECG, the BP machine and everything else. A set of obs done we make ready to go.
‘Are you coming?’ I ask her.
She doesn’t say anything, but gives me a look as coldly swept as the street.
Frank slams the door.
We go.

***

Despite the ASHICE there is no team to meet us. Instead, Carol, one of the nurses, is frantically rearranging trolleys and stuffing used equipment into red bags. She pauses and looks at me, and it could be two doomed sailors on the deck of a sinking ship taking a second to smile at each other, at the hopelessness of it all.
‘It’s been mad,’ she says as I help her move a trolley up. ‘I can’t...’
‘Don’t worry.’
‘Who’s this?’
‘Pavel, thirty eight. OD pills and alcohol. GCS about nine. SATS good on air, fine on O2. Other obs okay. A bit tachy. Past medical history unknown.’
‘Christ – look at him. I’ll get a doctor.’
We slide him over onto the trolley whilst Carol hurries away.
She comes back a moment later and starts connecting him up.
‘The doctor’ll be here in a second,’ she says. ‘Jesus Christ. What a day. We even had to use the quiet room as a temporary morgue.’
Frank is backing out of resus with our trolley.
‘Well,’ he says. ‘ I don’t suppose they’d be noisy.’