Wednesday, January 30, 2013

the good boy

There’s a shout from up upstairs so we hurry in that direction, struggling to avoid dragging all the pictures off the walls with our bags. Up onto the landing, to a bedroom at the far end. I’m amazed they’ve managed to squeeze a hospital bed in here; there’s so little room the door can’t open fully, and all the other furniture – the TV on its stand, the armchair, the bed table and the boxes of medical supplies – means that Mr Cooper’s nephew Steve has struggled to find space to put his uncle on the floor. He glances up, almost losing the phone he’s cradling between his ear and shoulder as he presses up and down on his uncle’s chest.
Rae starts moving what she can to make a little more room whilst I take Steve’s place. He stands up awkwardly and throws the phone on the bed, then sits down next to it. He tells us he’s been with his uncle for a couple of hours, fallen asleep and then woken by a terrible gasping kind of groan. His uncle had pitched over to the left, and when he checked he found he wasn’t breathing and didn’t have a pulse.
‘What does your uncle suffer with?’
‘He’s got cancer, really bad, all over. Some other stuff.’
The cancer isn’t a surprise. Poor Mr Cooper looks pretty terminal. His body is so emaciated, as soon as I start compressions I feel that sickening crack as his ribs give way. It’s like pressing on an old wicker basket.
‘Does your uncle have a care folder?’ asks Rae. She’s thinking the same as me.
He fetches it from the pile of papers and boxes of inco pads by the TV. Rae opens it – then holds it up, there, first page, the distinctively red bordered DNAR sheet.
‘Signed, looks current,’ she says.
I stop compressions.
‘That sheet means your uncle doesn’t want anyone to resuscitate him,’ I say, kneeling back on my heels and rubbing my nose with the back of my hand. ‘Sorry, Steve. We have to go by that. You did really well, though.’
‘DNAR. Do Not Attempt Resuscitation. Your uncle’s had a conversation with the doctors and the family and decided if his heart stopped he didn’t want anyone to get it going again. But you weren’t to know, so don’t worry.’
‘No-one said.’
‘That’s okay. Look – why don’t you go and get yourself a cup of tea or something whilst we make him comfortable? We’ll put your uncle back to bed and take care of everything here, then we’ll come downstairs, have a chat and do the paperwork. Okay?’
‘Do you want a cup of tea?’
‘That’d be great, Steve. Thanks. White, none.’
He stands up, hesitates for a moment, then steps over his uncle to leave the room.
‘White, none?’
Rae nods.
‘I’ll do a ring around,’ he says, more to himself than us. He goes downstairs.


Mr Cooper’s family all seem to live locally. In the time it takes us to settle him back in bed and put the room to rights, half a dozen sons, daughters-in-law, brothers and so on are gathered in the front room, hugging each other, crying, pacing around, taking it in turns to make the walk upstairs.
Despite all this, Steve has still remembered our tea.
‘You’re a good boy,’ says a tired looking woman, sitting at a pine table at the far end of the room, an old Border Terrier on her lap.
‘Can I sit down here with you?’
She smiles and pushes a chair out with her slippered foot. The dog fixes me with a stare.
‘I’m his wife, Jean,’ she says. She ruffles the dog’s ears. ‘And this is Jinx.’
‘I’m sorry for your loss.’
She sighs and then presses the side of her face to Jinx’ snout.
‘We knew he didn’t have long, didn’t we? I suppose we were ready for it. Well – I say ready. I don’t feel all that ready, now it’s happened. It’s a relief for Stan, though. These last few weeks haven’t been all that easy for him. We did what we could, but he knew his time was up. He wanted to be off.’
The dog licks its chops and stares at me. He looks so grizzled and wise, it’s like he’s waiting for me to say something so he can add something weighty of his own.
I take a sip of tea.
Rae comes back in from the truck and sits with us.
‘I’d only gone out to take Jinxie for his walk,’ says Jean, leaning back in the chair and squeezing Jinx like a wiry pillow. ‘Typical, in’t it? D’you think he minded I weren’t there?’
‘I don’t think so. From what Steve was saying it sounds like he died in his sleep. I think that’s a pretty good way to go. And I think you know when you’re surrounded by the people you love, even if they’re not actually there with you.’
She kisses Jinx on the head and looks out on the room, which is so crowded now they’ve had to open the patio doors. All the men in this family seem to be giants; one more and the floor is bound to give way.
‘I don’t know,’ says Jean. ‘I suppose the next thing is how to feed this lot.’

Tuesday, January 29, 2013

a quiet night in

The A&E entrance has been changed.The good news is that the foyer is much bigger than it used to be; the bad news is we’ve lost a side room, one of the most useful rooms in the building.
Side Room One was the Crazy Cubicle, the Isolation Suite, the room we’d discreetly hurry in to with the disruptive patients – the psychotics, the wild drug casualties, the hostile drunks, the acute onset dementias. It was accessible immediately you came in. You could go straight through, shut the doors and effectively insulate the rest of A&E from the shouting and swearing and the distress of witnessing the level of restraint that’s needed sometimes.

But now Side Room One has gone, and instead we have an open plan foyer.

‘Can everyone just move down as far as possible?’ says Ellis, the charge nurse. ‘A bit more. That’s good. It’s just we need to make as much room as we can for something coming in. Guys – if you could put the mattress down there for me, that’d be great.’
Two porters drag over a double mattress and lie it on the floor in the space we’ve made. They grin knowingly, then walk away.
‘Just make sure you give the crew plenty of room,’ says Ellis. ‘There’s police with them, too.’
‘So what’s this for, Ellis?’
‘Oh - some kid kicking off on something or other. Apparently he’s quite a handful. Are you guys all right there? Good.’
He looks across at Enid, our patient, an elderly woman comfortably blanketed on the ambulance trolley, clutching on her lap a paisley print carpet bag and a green plastic carrier full of drugs. She nods and smiles and gives him a queenly wave.
‘We’ll get you a space as soon as we can,’ he says, then hurries away.

The following minutes drag with expectation. We try to chat about this and that, but it’s noticeable that everyone’s attention is really on the automatic doors. We hear another ambulance backing into the parking lot, but when the crew come through they’re pushing a middle-aged guy hunched over a vomit bowl in a wheelchair,. The crew stop short when they see the mattress on the floor.
‘Times really are hard,’ says one.
‘There’s a mad druggie coming in,’ someone tells him.
They tuck themselves as far away from the mattress as they can, even braving the space by the pathology tube that everyone’s scared of, because it whisks specimens up a vacuum run and then spits empties out onto the floor like the shell casings from a howitzer.

Time passes.

‘Shouldn’t be too much longer,’ I tell Enid. I meant the handover, but no sooner as I’ve said it then there’s the sound of more vehicles outside, shouting, doors banging, a confusion of instructions, the scuffles and commands of a big team effort – then the automatic doors swish aside and four policemen stagger in carrying a person whose arms are handcuffed behind their back and their feet zippered up with flex.
‘Here we go!’
‘Easy now!’
‘Almost there, fella.’
But their package – a hefty kid in his late teens – writhes and thrashes between them like some monstrous landed cod. A hang of drool trails beneath him as he bellows.
‘Is that mattress for us?’ says one of the policemen.
‘Oh yes.’
‘Jolly good.’
They land the beast, and then kneel around him puffing and sweating, hands on their catch to keep him in place.
‘If you calm down, we can loosen these restraints, Eddie.’
Ellis comes over with Mark, an A&E Consultant whose simple and open expression would make him the casting director’s choice either for the spiritual head of a monastery or a hit man.
‘Hello, Eddie. How’s it going?’ he says softly, crouching in front of him. ‘I understand you’ve taken something tonight?’
Eddie howls.
‘What have you taken? Can you tell us? Hmm?’
Suddenly Eddie seems to relax completely. He mumbles something, but it’s hard to hear because his great mop of curly hair is sticking to his face.
‘Let’s try and sit you up and talk to you properly,’ says Mark. ‘Is that all right, guys? Can we sit him up?’
The police officers adjust their position, and cautiously set him into a sideways kind of sit. Mark clears the hair from Eddie’s face and smiles at him.
‘I love you,’ Eddie says.
‘That’s nice,’ says Mark. ‘That’s what I like to hear. Now then, Eddie. Tell us what’s happened to you tonight.’
But the sudden calm is broken by another bout of wrestling and shrieking. Mark’s expression doesn’t change, but he shuffles backwards a little as the police officers move in to take a stronger hold. This is the pattern Eddie falls into for the next half an hour: periods of calm, periods of mania.
During a lull Mark manages to check his pulse.
‘We need to give you something to calm everything down,’ he says, releasing Eddie’s wrist. ‘Here. Will you take this tablet for me and a little sip of water? Okay? Eddie?’
Eddie looks up.
‘I love you,’ he says.
‘I love you too, Eddie. Now, how about taking this pill? It’ll really help make you feel better.’
What follows is a nightmarish stream of unconnected thoughts.
‘Do we have any idea what he’s taken?’ says Mark after a while, lowering his hand.
‘There was definitely some mephedrone floating around. Meow Meow or Hello Kitty,  or whatever you want to call it. Plus some LSD – quite retro, but there you go. Who knows? I don’t suppose he’s the last casualty we’ll see from that particular party tonight. The seeds of it are blowing all over town as we speak.’
Eddie slowly lifts his head again and smiles at Mark.
‘You’re all so beautiful,’ he says.
‘So are you,’ says Mark. ‘Now – how about taking this pill for me?’
‘I’ll take it if he won’t,’ says one of the police officers.

I’ve been trying to shield Enid from all this, but actually she seems to be enjoying the spectacle.
‘Poor boy,’ she says with a delicious shrug of her shoulders. ‘Trussed up like a chicken. Is that what happens when you take drugs?’
‘Sometimes. Depends what drugs. And then you can’t always trust your dealer, so you never really know what you’re getting. I imagine.’
She clutches her medication bag more tightly to her.
‘I’ve got plenty of my own without taking any more,’ she says. Especially if that’s what happens.’
‘It’s not good.’
‘What did he say it was called?’
‘Meow Meow. But they’ve got lots of weird names. My favourite so far’s Gorilla Rage.
Gorilla rage?’
‘Yeah! I know! Gorilla Rage. I don’t suppose you take that if you want a quiet night in.’
‘I don’t think I’d like Gorilla Rage.’
She watches as Mark carries on trying to persuade Eddie to take the pill.
‘But Meow Meow sounds nice,’ she says.

Wednesday, January 23, 2013


‘I tried to get him up me’seln but it was no good, fella, I just don’t have the whatsisname – the leverage I used to have, you know what I’m saying? Maybe you do, maybe you don’t.’
Aidan is standing next to me looking down at his friend, who is lying on the bedroom floor stuck between the bed and the dresser. Both men are in their nineties.
‘I threw that quilt over him because he was making the place look untidy.’
‘You can’t go around lifting people up, Aidan, not at your age. You’ve got to watch your back.’
‘Yes, good advice. But I’ve always been one for watching my back, now. Isn’t that right, George? Are you still wit’ us? I say I’ve got to watch me back, specially round here.’
George tries to look up but he’s just too squashed up.
‘Don’t listen to him,’ he says. ‘He’ll bend your ear all day if you let him.’
‘Let’s have a look at you,’ I say.
I pull the quilt aside and check him over. Luckily it was an easy slide out of bed and he hasn’t hurt himself. I’m able to shove the bed over, get a hand to him and with a judicious balancing of my weight, get him up. Once he’s safely on the edge of the bed, I go to open the curtains and let in some light. Unfortunately the rail comes away in my hand.
‘Don’t look, George. He’s breaking the place up, now,’ says Aidan. ‘Jayzus, but these paramedics are a fiery bunch.’
‘Don’t worry,’ I say. ‘I’ll fix that in a minute. Now then, how’re you feeling, George?’
‘All right,’ he says. ‘I could use a cup of tea.’
‘I’ll see to’t,’ says Aidan. ‘I know just how he likes it.’ He pivots smartly on his walking stick and heads for the little galley kitchen, calling back over his shoulder. ‘Would you like one for yourself, fella?’
‘Okay. No sugar.’
Whilst Aidan sorts out the drinks, I help George through to the lounge and sit him in his favourite chair. He’s feeling cold, so I drape a blanket round his shoulders. When Aidan comes in with the first cup of tea, I say: ‘Here he is – King George.’
‘King Kong, more like’ says Aidan, putting the mug down. ‘I don’t know. What you won’t do for a bit of attention.’


‘Is that you in the photo, then, George?’
‘Yep. That’s me. Eighteen years old in the Royal Navy.’
Aidan leans in.
‘George was in the Navy, I was in the Merchant Marine. Guess who worked the hardest.’
George dunks his biscuit, only just managing to get it to his mouth before it falls apart. He chomps the biscuit down, then follows it with a sip of tea. Aidan watches him carefully, his silvery, chin-strap beard and small bright eyes giving him the look of some giant species of owl.
‘I sank two minesweepers,’ George says, putting down his mug.
‘Is that so?’ says Aidan. ‘And what did you sink ‘em with? Your ego?’
Aidan has a blurry tattoo on the back of his right hand.
‘Can I have a look?’ I ask him.
‘Be my guest.’
He holds it out.
It’s hard to see, but it appears to be the picture of a bare-chested woman in a WREN’s hat, surrounded by a garland of fruit.
‘Singapore,’ he says, then leans across with his other hand and taps George on the side of the leg with his stick.
‘Did ya hear what I said? I said Singapore, you old fool.’
George shakes his head sadly.
‘Here we go,’ he says.

the cowardly leopard

It snowed so heavily last night even the washing line has a covering; it sags across the garden in a delicately-bladed curve of ice. Every detail has been re-modelled by the blizzard, every feature fattened and made strange, from the stone bird bath in the middle of it all to the tangle of vegetation through the empty frames of the tumble-down greenhouse. Track lines of animals and birds criss-cross in the snow, this one clearly a cat; that one strangely melted and then re-frozen, so you’d think some kind of bear had been out foraging.

Mrs Leppard has slid out of her chair. The carer found her and called us to get her up. And even though she says she’s frightened of going back to hospital, really we have no choice, because none of the arrangements that should have been in place before her discharge – the commode, the rails, the bed with sides, the hoist – nothing has been done. Maybe the snow has slowed these things up. Even the heating is ineffective.
The carer hands me a folder.
‘They discharged her yesterday after an admission for decreased mobility. She was offered a stay at an intermediate care facility but Mrs Leppard turned it down because she was scared it meant she was being put in a home.’
‘I’m not going in no home!’ says Mrs Leppard. She grips the sides of her chair as if she’s getting ready to jump up and sprint away. But her sprinting days are long gone. The only real animation about her now is in an exaggerated facial expression of anxiety, her chin bobbing up and down as if her jaw muscles had been replaced with elastic bands.
‘I’m a coward,’ she moans. ‘I’ve always been a coward.’
‘You’re not a coward, Mrs Leppard. Anyone would be worried – it’s quite natural.’
‘They said they didn’t want to see me again.’
‘Who did?’
‘Them at the hospital.’
The carer kneels down and drapes a young hand over Mrs Leppard’s liver-spotted claw.
‘I think you’ve taken it the wrong way, Sheila. I think they meant they didn’t want to see you back in hospital because that would mean you were sick, and they want you to be well.’
‘They’ll be so cross if I go back.’
‘No they won’t. Honestly they won’t.’
We set up our carry-chair, lift her across and swaddle her in blankets. ‘It’s cold, Mrs Leppard,’ which is true, of course, but we’re also mindful of the treacherous route out to the ambulance. We don’t want Mrs Leppard tipping us over with a panicked grab.


We settle her onto the ambulance trolley and stow the chair.
‘They’ll be angry,’ she says.
‘No they won’t, Mrs Leppard. Everyone just wants you to be safe and well.’
‘I’m such a coward. Not like my husband. He was too good for this world. He died twenty years ago. Twenty years! He was sick though. He had problems. With his heart.’
‘Oh yes? What kind of problems?’
‘You know. Whasisname.’
Her jaw bobs up and down as she casts her rheumy eyes about the ambulance interior.
‘Ischemic heart disease,’ she says, suddenly. ‘Ischemic heart disease, and erm... something else...’
I wait a moment.
China?’ she says, appalled. ‘He never went to China.’
Rae slams the door shut. A shouted goodbye to the carer, then the slushy trudge of her boots as she goes round to the cab. She calls the leaving time through. I write it down. We start to move.
‘They’ll be angry with me. They said they didn’t want to see me back there again.’
‘Try not to worry yourself, Mrs Leppard. Everything’s absolutely fine. The doctors will check you over, and then if everything’s okay – as I’m sure it is – maybe you’ll still be able to stay in that intermediate care place for a little while – not long, but just so you can properly get back on your feet. And then whilst you’re in there, the team can make your house ready with all the equipment you need.’
Her mouth springs open again and she struggles to sit herself up on the trolley.
‘I don’t want no-one in my house!’ she shrieks. ‘They’re not to go in without my say-so. I’ve told my solicitor. He knows all about it. He’ll stop them. I won’t have it. I won’t have it. There’s all my things there. My private things. I won’t have them going in there.’
‘Try not to worry about it, Mrs Leppard.’
‘No-one’s allowed in without my say-so.’
‘Okay, Mrs Leppard. Okay. I’m sure you can talk to the doctors at the hospital about it. They’ll be able to put things right. No-one’s going to do anything you don’t want to do. Okay? Everyone’s just trying to help.’
She eases back into the trolley, and begins plucking at the blankets.
‘That’s all my things,’ she mutters. ‘My things. I don’t want no-one touching them.’
Her jaw bobs up and down, gradually slowing. She doesn’t say anything else.
The ambulance heater powers up.
Mrs Leppard closes her eyes and passes the rest of the journey in a fitful kind of sleep.
I read through my notes.
The radio plays quietly through the hatch.
We hiss and splash along smoothly, making good time. Even though the side-roads are almost impassable this morning, the main routes are pretty much clear. 

Wednesday, January 16, 2013


After a couple of minutes, Marla the live-in carer opens the door.
‘Come in, come in befah you freet to det,’ she says, then throws the door wide and shuffles back. Generously packed into slacks and slippers, one bra strap halfway down her arm, she waves a cloth in front of her like she’s cleansing the air of nuisance.
‘Ya nah, Papa Jones he fell in the bat room but I can nat git him up by myself,’ she says cheerfully, leading us through the close and creaking old cottage to the extension out back. ‘I do nat think he has hart himself.’
We can see the figure of Mr Jones sitting on the bathroom floor, his trousers around his ankles, his catheter bag off to one side. ‘Amb’lance come, Papa Jones,’ she calls ahead, and goes to sit on the toilet facing him whilst we check him over, her massive legs planted wide apart. ‘I will pull up your trousers when you upright again,’ she says.
Marla’s right; it doesn’t look as if he’s done any damage. Dementia is obviously one of his problems, but we need to know more. Michael, the new paramedic I’m working with tonight, asks her questions about Mr Jones’ past medical history.
‘Wait just a minute and I will get the foldah,’ she says. She stops to stroke Mr Jones’ face gently as she rolls past us all into the living room. ‘You be good for me, nah,’ she says.
I fetch a chair in so Mr Jones can rest for a moment before we move him through to the lounge. Michael takes some observations whilst I start in on the form.
The phone rings.
Marla picks it up.
Yes? Yes. He fell in the bathroom but he has not hart himself. The paramedics are with him now and they will tell you more, but Papa Jones is fine. Ye-es. Okay then. Bye then.
She hands the phone down to Michael.
‘Who is it?’ he asks.
‘It is the doctor,’ she says. ‘She wan talk wit you.’
‘Oh hi doctor,’ says Michael, taking the phone, making a gesture for me to pass him the clipboard. ‘Well it would appear Mr Jones has had a mechanical, non-injury fall. We’ve checked him over and there’s nothing remarkable about any of his observations ... (he lists them all). Weight bearing, no new pain, GCS fourteen but of course that’s quite normal for this patient. We’re just about to settle him in his chair, then all things being equal we’ll finish the paperwork and go. Okay?’
He looks at me as he listens to the reply, raising his eyebrows slightly.
‘Really? Well – fine!’ he says. ‘Great! I’ll let them know to expect you. Okay then. Bye. Bye. Bye.
He hands me the phone; I pass it on to Marla, who goes away again.
‘That’s a good service,’ says Michael taking one side of Mr Jones whilst I take the other. ‘The doctor says she’ll be round in half an hour. I’m not sure why, but there you go.’ He thinks about it. ‘I mean - why would you?’ he says.
 We shuffle through together. Marla has been busy making Mr Jones’ chair ready.
‘Can I get you all something to drink, boys?’ she says. ‘Tea, coffee. A nice cup of Bavril.’
‘Yes!’ says Michael. ‘Bovril would be great. I can’t remember when I last had Bovril.’ 
He thinks about it. 
‘Scouts,’ he says.
‘And Papa Jones? Tea for you, too? I know just how you like eet.’
He looks at her and then says Bovril, too.
‘Well – that Bavril sure is pap’lar tonight,’ says Marla, heading into the kitchen.
We settle Mr Jones into his chair, then sit either side of him, Michael finishing the paperwork, me glancing round the room. An ancient black and white photo of a little boy in a tin pedal-car; a wedding photo; fine pencil drawings of various houses; a collection of family pictures in a procession of fading colours and fashions from the sixties onwards. An upright piano. Death in Paradise playing mute on the TV.
Mr Jones has one leg draped over the other. He kicks it up and down gently, humming under his breath. Dum de dum dum de dum he sings. Then sighs and says Oh well.
Marla comes back into the room with a tray and passes us our drinks.
‘Thanks,’ says Michael. ‘You know, I still can’t get over the doctor. That’s what you might call the personal touch. Who called her, anyway?’
‘Doctor? What doctor?’ says Marla.
‘The doctor. On the phone. It must have been Lifeline. But then she says she’s coming round in half an hour. At this time of night.’ He sips his Bovril. ‘You’ve got to admit, that’s good service,’ he says.
‘That no doctor!’ shrieks Marla, pulling the cloth off her shoulder and wiping her hands. ‘Dor – tah. Dee Oh Ar Tee Ay. Raquel, Papa Jones dor-tah!’
‘Oh. Right,’ says Michael. ‘Well. That explains it.’
He smiles and raises his mug to Marla.
‘Papa Jones?’ she says. ‘How yah liking the Bavril?’
He looks up at her.
‘I wanted tea,’ he says.

Monday, January 14, 2013

cocktails by the pool

It’s only been a month since I was last here, and I’m surprised to see Avocet Court under wraps. In fact, everything – Plover, Curlew and Sandpiper, the four cutely named concrete blocks of this estate, along with the shuttered newsagent and community centre in the hard-bitten little precinct between them -  everything has disappeared behind a vast network of metal poles, wooden walkways, yellow bucket rubble chutes and ragged, blue nylon mesh.
Peter is waiting for us at the end of the ramp that leads to Avocet.
‘I’m afraid it’s not pretty,’ he says.
‘Who’ve we come to see?’
‘My mum. She fell sometime last night and she’s been on the floor ever since. There’s blood and shit everywhere. I’m embarrassed, to tell you the truth.’
‘Don’t be embarrassed. That’s what we get paid for, to deal with things like this.’
‘Yeah, but still. It’s pretty bad.’
‘Tell us what happened.’
He walks ahead of us to the lift. The door slides open, and we step into a chill metal box, a single, reinforced light in the ceiling and a burnished metal mirror at the back.
‘We only got back from holiday yesterday. I was straight on the phone to let mum know, but she didn’t answer. I didn’t think much of it to begin with ‘cos she often goes out shopping. But I knew something must be up when she still wasn’t answering by lunch, so we came round. The chain was on the door and I had to kick it in. Lucky I used to be in the SAS.’
He smiles at me. I can’t figure out if he means it or not. It could be true, looking at him.
‘She’s lying on the hall floor. We haven’t moved her. We called you as soon as we were in, so we haven’t had time to clean her up. Sorry.’
‘What’s your mum’s name?’
‘Does Annie have any medical problems?’
‘She had a stroke a few years back. Apart from that, nothing, really. Her hip. And depression. She’s been threatening to kill herself for years. Ever since I was a kid.’
He smiles at me again, just as the lift door slides back and we step out onto the eighth floor. Number forty stands open, the door frame splintered at the lock.

Inside, it’s difficult to know where to put the bags. There’s a noxiously sweet, faecal drag to the air that the energy-saving bulb in its inverted cone overhead only seems to accentuate. Beneath its dreary light, the carpet is a chaotic pattern of splashed browns and reds, dried pools of matter. There is a wide smear of blood along the nearest wall where Annie must have fallen and then dragged herself back along the hallway. She has come to rest half in and half out of what looks like the bedroom door. A middle-aged woman is kneeling beside her now, cradling her head. She looks up at us as we pick our way further into the hallway.
‘Mind where you tread,’ she says. She looks back down at Annie, and picks a few bloody strands of hair clear of her face. ‘It’s hard to believe,’ she says, to herself more than anyone else. ‘This time yesterday I was sipping a cocktail by the pool.’

Wednesday, January 09, 2013

treasure island

Meg lies sprawled on the floor against the chair where she fell, the trolley overturned in front of her, the contents of its plastic tray scattered around her across the carpet: pills, inhalers, a TV guide, remote control, an empty glass tumbler, coins, toffees and a couple of sparkling ear rings.
‘Help me up,’ she says, waggling her hand in the air. ‘I’ve been here half an hour.’
We give her the quick once over, then get her back on her feet. She grabs at us when we encourage her to find her balance, pinching the backs of our arms.
‘I’m falling!’
‘We’ve got you, Meg. You’re perfectly safe. Just take a moment to get your balance. Come on. Where do you want to sit?’
But I hardly need ask, judging by the well-worn cushions in the armchair by the fire, everything arranged to hand.
‘Just a minute..’
She moves her swollen legs stiffly, from the hip, strangely up on her toes, like an astronaut in a spacesuit.
‘Just a minute, now.’
She lets out a sigh as we lower her into the chair, and puts her hands out right and left to stroke the armrests.
‘Thank you, thank you, thank you,’ she says, tearfully. ‘I thought I was down for good. I thought I was going to die.’
‘Do you want a cup of tea or something?’
‘No thank you. But make one for yourself, if you like. Go on. I don’t mind. I’m sorry I had to call you out.’
‘Let’s do all your bits and pieces, Meg. Your blood pressure and the rest. Do you think you might want to go to hospital?’
‘Hospital? I’m allergic to hospitals.’
‘Me too. God knows why I’m in this job.’
Rae goes into the kitchen to find the care folder; I kneel down next to Meg’s chair and get the obs kit out.
Hello? Meg? Are you all right?
The door opens and a gigantic man clumps in. With his stump teeth, spade hands and big bass voice, he could play the ogre in a pantomime with very little need for make-up.
‘Hello!’ I say, weakly.
I saw the ambulance he booms. I thought to myself – now I bet that’s Meg. Are you okay, poppet?
He reaches down to pat her on the shoulder; it’s like watching the boom of some massive crane swing into action. Meg drapes a hand over his, and presses her cheek to it.
‘Donald,’ she says. ‘I just want to die.’
Nonsense. Don’t talk like that, Meg. You’ll go when the good Lord’s ready and not a moment sooner.
‘But I am ready, Donald. I’m ninety-four. I’ve had my time. I just want to go to sleep and never wake up.’
Come on, Meg. That’s not like you.
He swivels his bucket head to look at me.
Is she okay? Has she broken anything?
‘Nope. I think she got away with it this time.’
Rae comes in from the kitchen and almost drops the folder.
‘Oh. Hello,’ she says.
I think you guys – and girl, h’ur! – I think you do a wonderful job.
‘Thank you.’
Donald bends down and starts clearing up the mess.
‘He’s so good to me,’ says Meg, holding out her arm so I can unwrap the blood pressure cuff. ‘If it wasn’t for Donald and Flora I wouldn’t be here now.’
‘Who’s Flora?’
Flora’s great, says Donald, scooping the entire contents of the trolley into one massive palm and transferring it carefully to the table. Flora’s her niece. Comes round once a week, even though she’s quite a way away. Not like the others. You never see them from one day to the next. But no doubt they’ll come out of the woodwork in due course. Shout if you need anything.
He sits himself down on a low chair by the sitting room cabinet, and begins flicking through an old copy of Treasure Island.
The phone rings. I pass it to Meg. She starts crying when she tells the person on the other end what happened. Donald catches my eye. Flora he mouths, then raises his eyebrows and goes back to his book.
Meg is too upset to say much more; she hands me the phone.
‘Is that the paramedic?’ says Flora.
‘Yep. Don’t worry about Meg. She’s had a bit of a tumble but everything’s okay. It’s a bit of a shock to the system, that’s all.’
‘Is that damned caretaker with her?’
I glance across at Donald. He looks up and gives me a cavernous, stump-toothed smile. Flora is speaking quite loudly on the phone and I wonder if he can hear me. I press the phone more tightly to my ear.
‘I’m not surprised,’ she says. ‘He’s always round. Does she smell of drink?’
‘Because that’s what he does. He goes round there and encourages her to drink. That’s why she’s fallen over in the past. Look – I’m coming up the day after tomorrow. I’ve got a meeting with social services because I’m not happy with the way things are going. But you think she’ll be okay tonight?’
‘I think so, yes.’
‘Okay. Thank you.’
I hand the phone back to Meg, who presses it to her face like it’s a gadget for soaking up tears.
Donald stands up, ducking his head at the last minute so it doesn’t extend through the ceiling.
What did she say? Is she coming?
‘Yep. The day after tomorrow.’
That’s grand. I knew she would. Now there’s a woman who knows her mind.
He winks at me, closes the book, caresses it absent-mindedly, then places it back on the sideboard where he found it.

Monday, January 07, 2013

where people go

We’ve come out to the neat sprawl of houses and shops just east of the city. As a money-saving initiative, the council have switched off the residential street lamps – great for star-gazing, but not so great for finding your way about. Still, Rae has parked immediately outside Celia’s little bungalow and left her hazards on, so we know where to go. Making it to the front door is more problematic. We have to use our torches to pick our way along a crumbling concrete strip that the wilderness of the front garden is gradually claiming for itself.
Celia comes to the door. A wizened old lady of ninety-three, she has the rolling gait, wild hair and benign but slightly disappointed expression of an ancient orang-utan.
‘Oh! There’s more of you, is there?’ she says, and then slowly turns to go back inside. Rae is just behind her.
‘Hi guys. This is Celia. Celia called the ambulance tonight because her father had a stroke and wandered off down the road.’
‘Her father?’
Rae widens her eyes and nods.
‘Isn’t that right, Celia?’
‘I don’t know. If you say so.’
‘Where do you think your father may have gone?’
We follow her into the kitchen, where she slowly takes a seat back at the table and puts both hands flat on the surface.
‘Over there. You know. Where those girls live. My sisters. The – um – where he sleeps sometimes.’
Rae sits next to her, tells me she found a number for the care agency, who said that Celia does have some short term memory loss, but nothing on this scale. Frankly, they’re concerned. They also mentioned a neighbour who pops round, but Rae says there was no answer when she knocked.
‘I was just about to do a round of obs when you turned up. It is looking like some kind of acute episode, and there’s the safety issue here, so I’m thinking we might have to go in.’
‘What are you saying?’
‘I’m saying we’re all just a bit worried about you, Celia. You don’t seem yourself tonight.’
‘Don’t seem myself? Who do I seem like, then?’
‘A bit confused.’
Celia bats her hand, tuts and crosses her legs. She is wearing odd slippers.
‘Doesn’t everyone get a bit confused sometimes?’
‘Yes. But...’
Celia looks away, then reaches out and strokes the door of the kitchen cabinet nearest to her.
‘I went all over London looking for that. You can’t get it anywhere else. But that’s how I am – particular about things.’
Next to her on the counter is a pile of old cutlery, stacked precariously, forks on top of knives on top of spoons.
‘When you’re gone I think I’ll get up and give the ceiling a wipe,’ she says. ‘I like to keep busy.’
We check the house to make absolutely sure there’s no-one else there. Many of the rooms are closed up, an abandoned air to them, a bed made-up but untouched, a dusty scattering of photos on a windowsill.
‘He’s a funny chap, my father,’ she says. ‘Very small. Runs a pub in Bethnal Green. You know where the canal is?’ She makes a vague gesture with her hands. ‘Where it goes – straight up? That’s where it is. My grandma had it first, then he took it on.’
She pauses, picks some invisible lint from her trousers, then settles her ancient hands gently in her lap.
‘Don’t know where she is now,’ she says.

Sunday, January 06, 2013


The night has come down quick and glassy, hard-edged with the lights in the shop windows, a huddled, hectic quality to everything, the restless herds of SALE shoppers and finishing office workers migrating east, west, north and south along the main thoroughfares, buses stacked full of people, their windows steamed, taxis and cars beeping and jostling for position. The store we’ve been called to is so centrally located it’s difficult to find a clear space to park. Luckily, one of the buses is just moving off leaving just enough room for Rae to squeeze the ambulance in. One of the store managers is waiting outside to greet us, shivering a little in his starched white shirt. He waits as we grab what bags we need out of the truck, and then hurries inside with us behind him.
‘It’s a twenty-eight-year-old man,’ he says, holding the door. ‘He came to the pharmacy with a scrip for inhalers of one kind or another, but when he was waiting in the queue he started complaining of chest pain. He’s with my colleagues in our little consulting room. This way.’
He eases us through the crowded store. As always it’s a shock for the shoppers to see us there. They double take as we struggle past with all our bags. Sometimes we have to ask twice to get round; I can only suppose we’re so crashingly out of place it effectively makes us invisible.

Michael is sitting on a chair in the tiny consulting booth, bent in half with both hands crossed flat across his breast, rocking backwards and forwards making a noise that’s a cross between a grunt and a growl. He’s such a skinny guy, my first thought is that he might have had a spontaneous pneumothorax.  Checking his chest with my steth is difficult because he’s making so much noise, but it sounds as if there’s equal air entry. I hesitate for a moment, but his SATS are fine – and then, to reassure me even further, someone opens the door to pass a message to the manager, and Michael suddenly straightens up and looks directly at them.
‘Who’s that?’ he says, clearly and flatly. ‘What the fuck do they want?’
There’s an uncomplicated directness to the way he says this – and certainly not the way you’d expect someone to speak who was struggling to breathe.
The person delivers their message and with one last, appalled glance at Michael, withdraws in a hurry.
‘Thank fuck they’ve gone,’ says Michael, then bends forwards again and resumes his growling.
‘Come on, Michael. Sit up for us. It’ll help with your breathing. And you’ve got to slow it right down. Easy, easy. Like this, look. In through the nose, out through the mouth – blow it out nice and slow. In, two, three – hold and out, two, three...’
Eventually he sits back and stares at me with a skinned expression, like a feral creature trapped in a cage.
‘What’s the matter with me? They said I was having a heart attack. They did this. They wound me up.’
Michael’s partner Julie is in the room with us. A short, dark woman whose blunt expression is only emphasised by the metallic blue of her eyeshadow, she shifts restlessly and picks at her teeth with her scarlet nails.
‘He’s had a lot of stress lately,’ she says. ‘Before he ran over here he was getting himself proper worked up. He came out of the bedroom and just dismantled himself.’
Dismantled himself?’
‘Yeah, you know. Dismantled.’
‘Shut up!’ says Michael, shivering a little and jiggling his knees up and down. ‘I’m dying here and what are you talking about?’
‘Have you had any drugs tonight, Michael?’ I ask him.
‘I sniffed some stuff, yeah.’
He bobs his head down again and I can’t quite hear what he says.
‘Sorry? Was that heroin, did you say?’
He looks up again and sneers.
‘Fuck off! Heroin? Who sniffs heroin?’
‘I don’t know. I thought..’
Cocaine, mate. I did some cocaine. But so what? I do it all the time. That’s nothing new. I lived in Barbados for years. That’s some proper mad shit there, man. You should try it.’
He laughs, like he’s wasting his time with me.
‘Michael – we need to get you out to the ambulance to do some checks, an ECG and the rest of it. Heavy cocaine use can have an effect on your heart, especially if you mix it with alcohol. But I’m sure you know all this.’
‘No, man. I’m good. I just can’t breathe. Why’ve I got this pain in my chest? They said it was a heart attack. What’s the matter with me, bro?’
 ‘He just needs to get some sleep,’ says Julie. ‘Come on, babe.’
‘Yeah. Sleep. I gotta sleep. I can’t remember the last time I had a good sleep.’
‘Come on then. Let’s take a slow walk out. But I want you to concentrate on keeping your breathing nice and slow for us. Okay?’
We help him stand. The pharmacy manager and his assistant are so relieved to be getting Michael out of the store they do everything with super-brisk efficiency. The manager clicks his fingers and gives directions; his colleagues scatter right and left to make a passage for us through the crowds to the service lift. Michael is still clutching his chest, grunting and groaning and dragging his feet. I feel sorry for the shoppers who watch as we go. They stand appalled, clutching their selections from the Two for One promotions in skin care, suddenly face to face with Michael the crack head, sweating horribly, his prominent teeth glistening, rolling his head from side to side and casting silvery-eyed stares around him. He snarls at a woman.
She shrinks back.
We frog-march him into the lift.

Thursday, January 03, 2013

the little ghost

‘Did you sense the ghost?’
Elsie is quite matter of fact about it. She may as well be talking about a touch of damp.
‘There’s a ghost? What ghost?’
I look around.
If there’s one house that should be haunted it’s Elsie’s. An ancient flint-walled cottage squashed shoulder to shoulder with its neighbours these past three hundred years. The builder must have been cross-eyed and in a rush, though, because there’s only one square dimension in the place I can see, and that’s the TV Elsie has put in the corner of the lounge.
Even the name on the ceramic plaque outside has a shiver about it: Rose Cottage  - the euphemism hospitals often use for the mortuary.
‘Yes. A little girl died in a fire here in the eighteenth century. I met a local expert who knows about these things. He told me this is the most haunted cottage in the village.’
‘Doesn’t that worry you?’
‘At first I thought: hmm. But then I thought: Well why not? What can they do? They’re only ghosts!’
‘Yeah, but it’s not like having mice, is it?’
‘Oh no, I think it’s much better. So long as you don’t make a fuss and just get on with your life, you can rub along together quite satisfactorily. You keep out of each other’s way.’
Elsie has her bag packed and ready. She takes one last look around.
‘She was here just a moment ago.’
‘The little ghost?’
‘I was in the bathroom having my shower. It gets quite steamy in there, you know. That whirly thing is a dead loss – all noise and no action. Anyway, I’d got out of the shower and was towelling myself down, when I saw these two tiny little hand prints appear, in the top right hand corner of the bathroom mirror. A darling little child’s hands.’
‘That’s pretty spooky,’ I say. ‘That’s like something out of a film. You know – the steamy bathroom mirror thing.’
‘Oh, she was just messing about. Although I’ve no idea how she got up there. I’d have to stand on a stool to reach.’
Elsie locks the door and drops the key into her purse.
‘I can only suppose she flew. Now then, where are you parked?’

Tuesday, January 01, 2013

the wind across the fields

I race across town faster than I’ve ever driven before, the back of the car kicking out as I accelerate hard down a clear stretch. The address on the screen for this cardiac arrest – surely it’s Frank’s house? I want to call Control to check, but I figure it’s best if I concentrate on the road and get there as quickly as I can. Another ambulance car appears behind me from a junction and tucks in behind. We drive in mad convoy out of town to the outskirts where Frank lives, falling onto the cars ahead of us like ravening blue devils, scattering everything left and right. We make the street and pull up outside his house. I’m dragging bags out of the boot when Malcolm says:
‘It’s his neighbour.’
There’s a porch light on and the door stands open. I leave a couple of bags for Malcolm to carry and we both hurry down the path towards it.
There’s a woman standing in the lobby, hanging on to the bottom post of the stairs. She’s so upset she can’t talk. Instead she points with her free hand, then gives a guttering sob and collapses on to the bottom step. We squeeze past her and hurry up to the bedroom.
It’s a dreadful scene. Frank is there, standing with his bare arms covered in blood, astride a woman on the floor who has suffered a catastrophic haemorrhage. Her face is a mask of blood, clots where her eyes should be, bloody matter extruding from her nose, a stream of blood running out of the side of her mouth, the tip of her tongue clamped outside of her blue lips. The double bed is liberally splattered, a pool of blood gathered in the central depression, something like finely chopped liver scattered across the bottom sheet, and a sodden trail of blood to the edge where the poor woman was dragged and dumped on the floor.
‘Close the door,’ says Frank, holding his bloodied hands and arms out to the side, touching his nose with the one clear space available to him on the back of his right hand. ‘It’s non-viable,’ he says. ‘Jesus Christ – what a mess.’
The woman is his neighbour. She was diagnosed with lung cancer about a year ago, metastases in the brain and bones. Palliative care, a DNAR in place.
‘Helen came round and got me. Apparently Jean started coughing an hour or so after she’d gone to bed...’ He pauses and we all take in the scene, imagining the horror of that.
‘Arrested soon after. Helen got her on the floor – God knows how – then came to fetch me. I didn’t know about the DNAR to begin with, so I tried a few compressions, but it was never going to work. I may as well have been working a pump handle. Poor thing. I think Helen knew it was hopeless from the start.’
We find some clear space to put our bags down.
‘Let’s do what we can to tidy things up. Then we can put her back to bed and it won’t be so hard on the family.’
We spend the next half an hour making Jean look more presentable. I use some clinical wipes to clear as much of the blood from her face and hair as I can. I talk to her as I do it – as much for my own benefit as hers.
‘There we go...’ (gently easing her tongue back into her mouth)
‘Sorry, Jean....’ (using the corner of a wipe to hook away the congealed blood from her eyes).
‘Let’s just get this... there...’ (rubbing her hair clear of blood, drying it off with a towel).
But Jean’s lungs are so corrupted, the slightest tilt of her head is enough to tip a fresh stream of blood down the side of her face. There’s nothing to be done about that, though. Our only hope is that when she’s lying on her back on the bed, she won’t be moved for a while.
Whilst I finish cleaning Jean up, Malcolm strips the bed, folding up all the spoiled bed linen and putting it in a discrete pile over by the window. He finds a couple of inco pads and we use them to wipe the parquet floor clean. Anything that’s tainted with blood we roll up and put aside with the linen.
There’s a cowbell near the headboard.
‘That was what she used to ring when she needed anything,’ says Frank, turning over the pillows to hide the stains. ‘It was their little joke. It’s such a shame it ended like this.’
When I put it aside I’m careful to hold the clapper so it doesn’t accidentally ring again.
We lift Jean up and settle her back on the bed. I clean her face one last time to catch any new spillages. We arrange her arms by her sides, and then drape one of our own blankets over her.
Frank goes downstairs to comfort Helen whilst I finish the paperwork. Malcolm calls the family undertakers and arranges for collection. We take one last look around, and then carry our bags back down.
Frank is standing in the hallway with Helen.
‘Thanks for all you’ve done,’ she says.
I tell her I’m sorry for her loss – the usual awkwardness – then leave.

Outside, the night has deepened. It comes rushing towards us across miles of open field with a tail of pin bright stars. It’s exhilarating, standing here outside the house like this. Dizzying, like we’re feeling the way the world moves for the first time, the spin, the implacable momentum of it all.

I stow the bags back in the car. We chat a little, make a few cracks, talk about this and that, head back to base.