his night from hell

Malcolm is sitting on the crumpled bonnet of his car with his arms folded, like a man taking his ease in the moonlight.

‘Halloo!’ he says as we walk over. His teeth are wine-gray.

‘Hello. What’s happened?’

‘Life. Life has happened. I was just turning the car round when this other chap appeared out of nowhere and I went into the side of him. All terribly low speed, but there we are.’

In his long goatee beard, straggly hair, shapeless earth-pattern cardigan, shorts and flip-flops, he is the spit for the Big Lebowski. I ought to be handing him a White Russian, but feel his neck instead.

‘Nope. No pain. I’m completely fine, honestly. This is all very embarrassing. Is the other chap okay?’

Malcolm’s face is pretty banged up for someone who had a low speed crash, wearing a seat belt. It was a frontal impact but the air-bag didn’t go off, which means it was all probably slower than fifteen miles an hour.

‘You were wearing a seatbelt, Malcolm?’

‘Absolutely.’

‘And you weren’t knocked out?’

‘Nope.’

‘So how did you get these injuries? You’ve got a cut on the side of your head. Your nose is swollen and cranked over. You’ve got a black eye. Is anything coming back to you now?’

‘Nope.’

The police arrive. An officer knocks and comes on board the ambulance. When he takes his cap off he looks absolutely hairless in the bright cabin lights, like a plastic baby with a glowing core of enthusiasm.

I make the introductions, describe the situation.

‘Hmm,’ the officer says, peering at Malcolm.

Malcolm smiles back.

‘I’m required to ask you to complete a breath test. Have you consumed any alcohol tonight, sir?’

‘Oh – but that was hours ago!’

‘No worries. Just a moment,’ he says, unwrapping a mouthpiece and snapping it in to the top of the alcometer. Once it’s in, the officer gives his spiel, then holds it out for Malcolm to blow into.

‘Keep going… keep going… keep going … and stop. Good. Thank you.’

The machine beeps. The officer shows the read-out to Malcolm.

‘As you can see you’ve failed the breath test, which means I’m arresting you for drink driving.’ More spiel, whilst Malcolm says Well that’s just great and Unbelievable and I crash my car and now I’m being arrested. Arrested? I’m supposed to be starting a new job on Monday. I’m best man at a wedding tomorrow! Unbe-fucking-lievable. And so on.

It all slides over the officer’s shining head.

He makes himself comfortable in the seat opposite.

‘Tell me how you got those injuries,’ he says, when Malcolm calms down.

‘It’s nothing. Really. Let’s just – get on and get it over with.’

The officer looks at me and shrugs. Then back at Malcolm.

‘It wasn’t from the accident, was it?’ he says. ‘Have you been in a fight tonight, Malcolm?’

Malcolm sighs, shakes his head a little, as if the words are building up inside him but he’s still reluctant to let them out. He folds his arms. Taps his foot. Sighs again. Then looks straight at the officer.

‘Yes, yes. Okay? I was assaulted tonight. But I don’t want to press charges. It’s not going to come to anything. But yes – I had a stupid disagreement with a very good friend of mine. It got out of hand, we exchanged – blows – apparently. He went off, and now here I am, being arrested. Can I just say, officer, this is officially, unequivocally, without any doubt whatsoever, my night from hell. I’ve just got myself a job, starting Monday, but how I’m to supposed to get there once I’ve lost my licence I have no idea. I’ve had a fight with an old friend of mine. I’ve got a broken nose and a black eye and I’m the best man at a wedding tomorrow – no – today, actually. Tonight. So yes, I can quite honestly say that today is the worst day of my entire life. This is it. Here, now. With you two fine people. I’m sorry, but there you are. It’s fabulous. It’s absolutely marvellous. It’s happened, and there’s nothing to be done about it. So now, why don’t we just crack on? Because you know what? I’m genuinely interested to see what’ll happen next.’

The officer soaks it all up with radiant good humour.

Flips open his notebook.

‘I should be a detective,’ he says. ‘Straight in there.’

off by heart

Reece is lying on his side in the lobby of the homeless shelter.

‘I’m going to fit,’ he says. ‘I’ve been throwing up blood, man.’

There are two support workers standing over him.

‘Reece came down to us today from up-country. Do you want us to make contact with the rough sleepers initiative team there to get more information?’

I tell them not to worry for the moment, and squat down next to Reece.

He’s a slight, wizened figure of anywhere between thirty and fifty, so intensely worn through he must have spent the majority of his life on the road. ‘Don’t take me shoes off, mate, you’ll be sick.’

‘Well we’ll leave them on for the minute, then, Reece. Tell us why you’re lying on the floor?’

‘Mate – my vision’s all to cock. If I look at you, yeah, like straight on, yeah? it’s not too bad, but when I go like that…’ he slants his eyes up to the left, ‘…you go out of focus.’

‘Okay. So why have we been called today, Reece? What’s the problem, exactly?’

‘What’s the problem? How much time’ve you got? My knees are fucked, I’ve got cirrhosis of the liver, hepatitis C, my lungs are shot, yeah? I’ve got bi-polar, acute anxiety disorder, short term memory loss. I’ve got alcohol dependency, substance abuse and alcohol related seizures. And I got attacked yesterday.’

‘What happened when you were attacked yesterday?’

‘Yesterday?’

‘Yep.’

‘This geezer, right, he didn’t like my Spurs tattoo. So he says: “Tottenham’s are well batty, man” and grabs me round the neck. So we had a bit of a tussle, yeah? And I fell over and banged my head.’

‘Were you knocked out?’

He sneers.

‘It’d take more than that to put me out!’

‘So then what happened?’

‘This old lady called me an ambulance, yeah? And they rush me up the hospital. And I was waiting in the waiting room when suddenly I started vomiting blood. Tons of it, yeah? Like a volcano erupting. And they all come running. This doctor, right, he pulls me up and bundles me in the emergency room, and he sticks a big tube down me neck, and gets it all out. Yeah. I was there three days, and then I came down here.’

‘Three days?’

‘Three days, yeah.’

‘But you said this happened yesterday.’

Reece squints at me.

‘Why’re you being like this?’ he says. ‘Why’re you giving me the three degrees? I’m sick, man. I can’t remember this shit.’

The staff have never met Reece before so they can’t help, either. They certainly don’t want him in the shelter if he’s unwell, so I’m driven to make the offer.

‘Do you want to go to hospital?’

‘Yeah. Yeah, I think I need getting sorted out, man, ‘cos I can’t go on like this.’

He wants to be carried out, and makes a fuss when we encourage him to walk. He goes to grab on to our shoulders, and takes it badly when we guide his hands away.

‘I’m not getting fresh, man. I just need support.’

‘Fine. We’ve got your arms. You’re perfectly safe.’

‘Jeez.’

We make it out to the truck.

*

The lobby of A&E is as crowded as ever, but it’s a chance to catch up with our colleagues. We chat and joke whilst we keep our various patients happy.

Eventually the triage nurse makes it round to us. She stops at the foot of the bed and shakes her head. Reece looks up.

‘Hey! Are y’all right, sister?’

‘What’s he doing back here?’

‘You’ve met Reece before, then? He said he’d just come down to us today from up country.’

‘He said that yesterday. And the day before.’

‘Oh.’

‘He’s been in five times in five days. Are you going for some kind of record, Reece?’

‘Record? What’s she on about, record?’

The nurse sighs and starts filling out an admission sheet.

She smiles at me when I show her my form. ‘Don’t worry,’ she says, tapping herself on the chest with her pen. ‘I’ve got it all here, off by heart.’

fireworks

Mr Loesser lies propped up in bed, a plastic basin on the floor, a box of tissues and a child’s beaker of water on a side table. He barely stirs when we come into the room; his voice, when he talks, is so thin and indistinct it could be coming from his reflection in that dressing table mirror on the other side of the room.

‘So sorry to be a nuisance,’ he says. ‘But I feel so wretched.’

His son is sitting on the bed next to him.

‘Dad hasn’t been well the last few days,’ he says, stroking his hand. ‘Nausea and vomiting, possibly haemetemesis, some epigastric pain, constant, non-radiating, a bit of a temperature, general lassitude and general all-round fed-up-ness.’ He pulls a grumps face, then adds: ‘I’m a GP, by the way.’

‘And a good one, too,’ says Mr Loesser with a weak smile.

We read the notes the out of hours doc left, then help Mr Loesser into our chair.

‘Can you believe I used to be a rower?’ he says, then retches into the bowl.

Outside in the corridor, a group of elderly women are lined up. They’ve heard the ambulance arrive and have come to see him off.

Bye, bye, Eric.

All the best, love.

You’ll be back in no time.

Chin up.

Don’t forget we need you for the bridge match on Wednesday.

Toodle-oo.

He gives them all a royal wave as we process towards the lift.

*

I pull up at A&E just as a massive fireworks display kicks off nearby. A hundred brilliant points of light rush up into the sky above the hospital, booming and crackling, flowering, scattering, then drifting away on long tendrils of smoke before the next burst takes their place. The noise of it all reverberates through the air.

When I open the back door, Mr Loesser Jnr. pauses on the top step, looking up, then jumps down and moves to the side as I lower the tail lift.

‘Do you know what the fireworks are for?’ I ask him.

‘They’re for my father!’ he says. ‘They’re for my father, coming to hospital!’

dog shorts

1. Mr H passes Mrs H another piece of toast. She’s just finished buttering it when she drops her knife with a crash and slumps over to the right. Mr H calls the ambulance. When he opens the door to us, a small, light brown poodle scampers out and runs around our legs, barking. Whilst I attend to Mrs H, Rae says to Mr H: ‘Can you put your dog away please?’ He seems affronted. The dog has stuffed its nose in my response bag; he’s about to run off with my stethoscope like a string of sausages. ‘Can you put your dog away please?’ ‘Oh. Sorry.’ He turns round, shuffles off to the bedroom, goes in, quietly shuts the door. Even the dog seems temporarily confused. Rae sighs, goes up to the bedroom, knocks on the door. Mr H opens it. ‘Not you. The dog.’
   
   
2. Mr C lives with his elderly mother in a dark and cluttered basement flat – just the two of them, and six terriers. There’s no room for the humans, let alone the dogs, but they do their best (the dogs, not the humans), jumping up on the table, the sofa, fighting each other for top-dog spaces, only stopping to hurl themselves across the room and up on to the window ledge to bark as loudly as they can whenever a person or a car passes in the street. Which is all the time. ‘Sorry about the dogs,’ says Mr C, scratching his porcine belly. ‘They said put them away but I told them I didn’t have a room where the door shuts.’ Mrs C isn’t too bad; it appears she’s had a few crews out before. We go through the motions, get the information, make the referral. ‘Do you want to see my babies?’ says Mr C. Tired of throwing dogs off my lap, and in an effort to get away from the heater Mrs C has in front of her chair, I say yes, I would very much like to see his babies. He leads me through the undergrowth of their living space to a room out back. In contrast to the rest of the house, it’s pretty clear, with a workbench, modelling tools, lamp – and a dozen or so beautifully detailed submarines displayed on the walls or hanging from the ceiling. ‘That’s my favourite,’ he says, stroking the conning tower of something German.
   The dogs mass at the doorway, but they don’t come in. 

the spirit of damnation

Ten past six in the morning. A late job. Shit.

‘Load and go,’ says Rae. ‘Okay? Load and go.’

An attack helicopter wouldn’t be quicker.

‘There!’

Police cars in the street.

Up on the landing to the door with the fist-sized holes and a police battering ram resting on its end amongst the debris.

Shouts and wild screaming beyond.

I knock and push the door open.

Ambulance?

A police officer just inside.

‘Great,’ he says, moving towards us. ‘This is mad, mate. Absolutely crazy. It’s difficult to make out, but what we’ve got are three people, a guy, two girls, all naked. They came back to the hostel for a threesome or something, who knows? But this girl, Belle, she started to freak out and smash the place up. Neighbours called us, we called you ‘cos she’s obviously on something. She’s possessed, mate, completely out of her box, rolling round on the floor, cuts from all the glass, vomiting, just terrible, basically. Prepare yourself, ‘cos it’s not easy in there.’

We follow him into a sparsely-furnished room. Four other officers are struggling to restrain a young girl on her back on the floor. She breathes heavily, her black hair in a tangled sweat, her cheeks flushed, her eyes rolling like she’s crashed into the room from the core of a tornado. Her pale flesh is smeared with blood from the little cuts she’s sustained rolling around in all the broken glass. She’s quiet only for as long as it takes to build up enough energy, but then her screams are truly appalling –open-throated, her tongue straining out from the root, tinted copper green like the organ of a hellish parrot. Even the police are struggling for control; as it is, the quilt they’ve thrown over her gets wrested aside. In her nakedness, she is the embodiment of pure rage, a devil baby, primal, formidable, terrible. She would kill us all if she could.

‘Belle! Belle! Calm yourself! Be calm! We’re here to help, okay?’

The guy part of the trio appears at the door.

‘Leave her alone, you cunts,’ he says. ‘Leave her alone, yeah?  All you big guys for one girl. How’s that right? Just leave her alone.’

The officer who showed us in tries to move the guy back out of the room and along the corridor to the other woman who is screaming in the background. He only gets half-way when the guy attacks him. Belle has fallen quiet again, so the four officers pile out of the room and there’s a huge fight. We lift Belle into our carry chair, swaddle her in blankets, strap her legs onto the foot rest, buckle her up, and head for the door, making vague, soothing noises as we go, like we’re kidnapping the ogre’s baby and we’ll be killed if she wakes up and screams.

A neighbour, appalled, on the landing.

‘Hi!’ I say, trying to sound reassuring. ‘You couldn’t do me a huge favour, could you? You see that ambulance bag and clipboard just inside the door?’

The neighbour nods.

‘You couldn’t grab that for me and bring it out to the ambulance? That’d be great. Thanks a lot. Cheers.’

The neighbour goes inside, whilst a little further down the corridor the police fight with the other guy.

‘Thanks a lot. That’s kind of you. Great.’

He follows us down the stairs.

Belle comes to again and struggles madly to get out of the chair. By some miracle of balance – strengthened by our desperation to get out of there – we make it down the stairs and out into the street.

.

Belle writhes and screams and curses like the very spirit of damnation.

There are a group of elderly people waiting at a bus stop, nicely dressed, maybe on their way to church. They watch as we struggle on one wheel over to the ambulance. I wouldn’t be surprised if they crossed themselves. Who knows – maybe it would help? I’m open to anything at this point.

Belle has almost made it out of the chair now, her arms and legs thrashing around. I wrestle with her on the ramp as it goes up. I don’t know how I manage to keep upright but by luck and main effort we get her inside. Top and tail on to the trolley. More blanketing, straps. All the while Belle screaming, cursing, laying those frantic black eyes on us like she’s being abducted by a team of sulphurous goats.

I call ahead to the hospital.

We’re met by security, who help restrain her.

The consultant leads the handover in resus.

‘So. Who do we have here?’ he says.

I’m sweating, breathing as hard as Belle.

His urbane, early morning savoir faire is extraordinary, wonderful, and utterly stalls me.

For a moment I look at him much as Belle does.

Then she starts screaming again.

‘Oh-kay!’ he says. ‘A mattress on the floor, I think, people. And let’s not bother with needles and things just yet.’

no rush

‘Have you come for me?’ says Lionel. ‘Well. Bye, bye, dear.’

We help him out of his chair. As soon as he’s up and stable, his wife June gives him a kiss on the cheek, then stands back, anxiously smoothing her apron.

‘You don’t mind if I stay, do you?’ she says.

‘No. Of course not. You’ve only just come out yourself. You don’t want to be going back to that place. No, no – you stay here and get an early night. I’ll be okay. Maybe David will come up later? Anyway – bye, bye, dear. Bye, bye.’

I pass him his walking stick. The hallway of their flat is bare, just a couple of framed pictures on the wall, and a row of energy-saving light bulbs glowing without shades above our heads.

We start the long shuffle out to the ambulance.

*

Lionel has an extraordinary mouth. The upper jaw is tight, rounded out like a quarter of coconut, utterly immobile. The lower jaw hardly moves much, either – just enough to get the words out, past a row of pointed, grey and fish-like teeth. In fact, hunched over in that grimy raincoat, flicking a sideways look in my general direction every now and then, he might easily be an ancient species of land-dwelling fish, in old man-disguise for a trip to the vet. He speaks softly and rapidly without much pause for breath, none for questions. All he needs from me is the occasional grunt to show I haven’t wandered off.

‘When I came out of the army I had no idea what I was going to do next. My father didn’t help all that much. He wasn’t any good. He used to say “What nonsense have you been thinking now, Lionel?” In some ways he was right, I suppose. I didn’t apply myself, you see. I thought I could do all kinds of things, but they just didn’t seem to go my way. So when I got out of the army I found myself a job in the stores department of an engineering firm. That was a good job. I liked that job. But then after seven years I got made redundant. So I gave myself a jolly good talking to and I said: “Right! On with the new!” And I came to London. And I went in to the Labour Exchange there, and I said: “What have you got for me?” And in turns out, what they’d got for me was another job in stores. In a… in a fabrication place. You know. A place where they make things. Anyway, I was there for seven years, I think. And then I got made redundant. But by that time June had got her eye on me. I used to work with her brother, you see. That’s how we met. Well one day she came up to me and she said “I’ve got tickets for a show. At the Royal Albert Hall.” And I said “Oh?” And she sort of waved them in my general direction. Well – we went to that show, and it was very good. But we took things slow, d’you follow? I don’t like to rush things. We didn’t even hold hands until a week later. And stuck at that for a month. But anyway, things happened, and here we are now, forty years later.’

He pivots in the chair and tries to look at me.

‘Do you think David might be up later?’ he says.

film night

Stephen is being sent to a psych unit in another town because there are no beds here.

‘Sorry it’s such a long way,’ says Rae. ‘And so late.’

‘It’s not your fault,’ says Stephen, hauling an enormous black sports bag onto his shoulder.

‘Can we help with that?’

‘No. Thanks. I’m fine.’

A nurse comes over with a file of notes, but it turns out they’re the wrong ones –Steven, not Stephen. She tuts and goes away again.

The idea that we might take the wrong person hangs unspoken on the air between us. We make other, safer comments.

The nurse comes back, apologises – she has to go to the office to do some photocopying.

Stephen puts his bag down again.

The person in the opposite bed has been staring at us all this time; he doesn’t acknowledge me when I nod in his direction. I wonder if it’s Steven.

Stephen pushes his huge steel glasses up his nose, tips his head back slightly, and stares in the direction of the nurses’ station. Picks his bag up, puts it down again.

*

A long drive out, but easy enough. After midnight, and this busy commuter route has been cleansed of traffic. The moon is low and full, more like a ghostly sun. Its light has a strange effect on everything, on me.

I’m dreaming about driving.

I open the window and take deep breaths.

I’ve not been to this unit before. Even the sat nav seems vague. But after some last minute adjustments, I pull up outside.

The lobby is empty, hard-lit. When I buzz the ward there’s a long wait before anyone comes to let us in. Stephen waits anxiously between us.

‘It’s a long way for anyone to come and visit,’ he says.

‘Sorry.’

‘It’s not your fault,’ he says again. And then: ‘I’m a bit nervous. I don’t know what to expect.’

‘That’s natural,’ says Rae, looking around. ‘But it looks like a nice place.’

*

Two women come down to greet us, both in their early twenties, both dressed in jeans and t-shirts. They introduce themselves, shake Stephen’s hand, lead us back upstairs. In the ward itself one of them shows Stephen to his room whilst the other asks us if we want a coffee. She swipes us into a room, and goes off to make it.

The room has a stack of chairs in one corner, a bookshelf of DVDs, and a wide, beech veneer conference table in the centre. Rae sits one side of it, I sit the other. I put my feet up on a chair.

‘Thanks for coming,’ I say. ‘Shall we begin?’

The chair cuts into my back so I put my feet down again.

How are you feeling? she says.

The outside windows are more like panels in an aquarium – thick Perspex panels secured with rivets.

The nurse comes back with two plastic cups of coffee.

‘Take your time,’ she says with a smile, and goes out again.

We sip our coffee, yawn, chat.

Suddenly Rae nods at something she’s seen behind me.

I turn round and see someone pressed up against the security glass, a middle-aged man in a zipped-up top. Because he’s standing so close to the glass, and because his hood is pulled low over his forehead, I can only make out the smallest fragment of light reflected in his eyes. He doesn’t acknowledge that we’ve seen him. His breath mists up the glass.

After a moment, I turn back to Rae. Raise my eyebrows. Finish my coffee.

The man has gone when the nurse returns to let us out again.

Suddenly there are screams and ripping sounds from a room across the way.

‘Don’t worry,’ she says. ‘Film night.’

nappies

‘It’s dead boring, mate. The same fookin’ questions over and over and over. For what? For the paperwork, thassall. And you get treated like shit as soon as they find out you used to do a little gear. You can see it when they read them fookin’ letters: I V D U. Snigger. Point. Yeah? But that was years ago. I’m clean now, man. I’ve not touched the stuff in ten years. That’s what you get though. That’s what you get for being different.’

Alex is different. You can see it in the jaundiced glow of his face, like a solarised photo; you can see it in the way he walks, crabwise, jabbing at the ground with a stick, crooked over to one side with the drag of a leg that was damaged when gangrene set in from a filthy injection; you can feel it in the drum-tight swelling of his belly; you can hear it in his accent, a tight, Mancunian drawl, case-hardened in smoke and rage, and you can see it in his eyes, when he opens them wider than a slit. Pinned through Subutex.

‘Look at them porters,’ he says. ‘Loafing around. You can’t tell me that’s work. Skivers, plain and simple. And them nurses are no better. I’ve seen smarter monkeys. Fookin’ ell  – I can’t sit here much longer, pal. I’m off outside for a fag. Eh? In fact I think I’ll just fook off. There’s nowt for me here. Just hours and hours of hanging around – for wha? They can’t do nothing, mate. They do nothin’ for me. I’m fit for the knackers, that’s all there is to it. But I tell you one thing for free – when the time comes, I’m not going to be wearing no fookin’ nappy. That’s it. That’s the truth. No-one’s putting no fookin’ nappy on me.’

completing the circle

Mary isn’t being straight. Not with her doctor, not with her friend, certainly not with us. Even her cat Bob takes the long way round to the kitchen.

‘No. I haven’t had a drink tonight? What do you take me for?’

‘It’s just that your speech is a bit slurred, Mary. And there’s a carrier bag of empty vodka bottles just inside the door.’

‘Yes, well, I gave up drinking a long time ago, thank you very much. An’ the reason I might possibly-be-slurring....’ (she exhales down the three words with her eyes half closed) ‘... is because I’m very, very tired. Okay? Officer? I’ve had a busy day, what with one thing or another. Now then. What are you going to do about my back?’

Mary’s next door neighbour Janet came round as soon as she got in from work and picked up the message on her answer machine. She’s still got her coat on, and the spare set of keys in her hand. Caught between wanting to help Mary and wanting to go home, she sits perched on the edge of the armchair, periodically glancing at the door.

‘Mary’s had trouble with her back before,’ she says. ‘Haven’t you, Mary? She saw the doctor last week and he gave her some different pills, but they haven’t really agreed with her. And then of course she had that fall.’

‘When did you have the fall, Mary?’

She shrugs. ‘Last week.’

‘Did you see anyone about it?’

‘The doctor! Keep up.’

She tuts and closes her eyes.

‘And what did the doctor say?’

‘He gave me some more pills.’

Janet hands me a paper bag.

‘I think this is everything.’

It’s obvious from the blister packs that Mary hasn’t taken her full complement.

‘It’s no wonder you’ve got pain if you’re not taking your meds,’ I say to her.

‘You don’t like me, do you?’ she says.

‘Do you know, you’re the second person who’s said that to me recently.’

‘Oh? Coincidence, you think?’

‘Maybe. Maybe not. But that’s beside the point. Let’s see how we can help you tonight. Are these the only meds you take?’

‘She has diazepam, too,’ says Janet.

‘Really? So where are they?’

‘I told you, Janet. I don’t like taking them things. They make me go funny in the head.’

‘But were they prescribed for your back pain?’

She nods.

‘I don’t like them.’

She starts to cry.

Janet sighs.

Bob looks in from the kitchen, hesitates, then turns and goes out through the flap in the back door. I have a strong urge to follow him, but I take a steadying breath and carry on.

We’re there some time.

We refer her to the out of hours.

*

Much later, we get a call to an elderly fall. I’ve been to this address before – some time ago, but I know the ambulance makes frequent visits here. Agnes is ninety something, unsteady on her feet, but still living with her husband Norman, who has Parkinson’s.

We use the keysafe to gain entry and find Agnes sprawled half on and half off the bed. Agnes has activated her careline button – not so much because of her position on the bed, but because of Norman – and I can see why. He seems flushed and confused, wandering about the bungalow on some obscure mission. We can see from an ambulance sheet that a crew’s already been out tonight. All things considered we can’t leave them alone. We take them both in, as a job lot.

*

I park alongside another ambulance at the entrance to A&E. Dermot is round the back of his truck, putting the ramp up.

‘We just brought in someone you know,’ he says.

‘Oh? Who’s that?’

‘Mary.’

‘No!’

‘Yep. The out of hours went round, saw her slumped on the sofa, banged on the window but got no response, so he called the police who smashed down the door with their big red key.’

‘Is she all right?’

‘Pissed, is all. Complaining of back pain but we couldn’t get much sense out of her so we brought her in.’

I start to open the back of our truck.

‘Funnily enough, we’ve got one of yours.’

‘Oh? Who?’

‘Agnes.’

‘Agnes! So what about...?’

‘Yep. Norman, too.’

I swing the door open to reveal the bright interior, Agnes on the trolley, Norman on a side seat. They both look out, see Dermot, and wave.

He waves back.

‘And so the circle is complete,’ he says, in a mock heroic voice. ‘Our work here is done.’

a wash and brush-up

Mr & Mrs Taylor live in a house on a hill served by a system of concrete stairs so complex you’d think you’d blundered into a landscape by Escher. We go up to go down to go up again. None of it makes sense.

‘And I bet he’s upstairs,’ says Rae.

Early morning, last hour of the night shift. A heavy lift will probably kill us.

I ring the bell.

An elderly woman shuffles to the door with her zimmer.

‘Can you come in and help him, please?’ says Mrs Taylor. ‘Only I can’t get him up. I’m not good myself.’

Stan is sitting scrunched up on the floor of the little downstairs bathroom. He fell over when he went to spend a penny at eleven o’clock at night, and he’s been there ever since. But Stan is a heavy man; at least eighteen stone, his torso a great conical lump with a couple of stringy legs hanging from the base.

‘Get me back to my chair’ he says, puffing and blowing.

We have to slide him backwards to give ourselves some room. He yelps and swears.

‘Where’s that hurting?’ I ask him.

But he ignores the question and waves his hands speculatively in the air.

‘Why won’t you put me back in my chair?’

‘Oh, no, don’t put him back in his chair,’ says Mrs Taylor, watching from the sitting room doorway. ‘He’s stuck in that thing all day, all night. He won’t even use the bathroom. He just sits there and wets.’

‘Get me back to my chair,’ says Stan.

‘I can’t cope,’ she carries on. ‘I can’t. He won’t have the doctor in. He won’t take his pills. He won’t use his frame. He just sits and sits and sits. And wets. I think he’s going a bit...’ she taps her forehead with a bony finger. ‘You know.’

‘I’m not going to hospital,’ Stan puffs. ‘Just get me up, will you? What are you waiting for?’

‘You feel hot to me. Are you hot, Stan?’

‘Why are you leaving me on the floor? Why don’t you help me up?’

Rae comes back in with the Mangar inflatable cushion.

‘What’s that?’ says Stan.

‘It’s a device for getting you off the floor. You’re too big for us to just pick you up.’

‘Am I?’

‘Unfortunately, yes. But this is good. Look. It goes under here – if you could just shuffle backwards a bit...’

He yelps and screams again.

‘What’s up, Stan? Where’s that hurting?’

He grumbles, but doesn’t tell us.

We start to inflate the Mangar. Despite warning him what to expect and what he has to do as the cushions inflate, he reacts to the whole business with the same level of uncoordinated, hoofing panic you might see in a cow being hoisted out of a ditch. With a great deal of counterbalancing and bracing, we manage to inflate all four cushions without Stan falling off, and then help him to stand. He clutches on to the door of the bathroom, his spindly legs buckling.

I fetch a wooden chair in from the sitting room.

‘I took the cushion off,’ says his wife. ‘He’ll just wet it.’

‘I’m not going to hospital’ Stan says, collapsing back into the chair. ‘Why have you put me in this thing?’

‘Because you obviously can’t walk through to the sitting room and I don’t want you falling over again.’

‘Just help me up and I’ll be all right. I’m not going to the hospital.’

‘We can’t very well leave you here like this, Stan. Now – if you can prove to me that you can get yourself up and walk through to the sitting room, fine, I’ll leave you alone. If not, it’s the hospital and no question about it.’

He tries to stand up again, but his legs will not support him. He keeps a grip on to the doorframe, though, and looks at me to see that I’ve understood.

It’s looking increasingly as if we’re going to be stuck here for hours, and we’re off duty in a few minutes. Rae calls Control and asks for a second crew. We’re going to need help lifting Stan up and down those concrete stairs – and then they can take him to hospital whilst we clear up and hurry back to base.

‘They’re sending a reserve crew,’ she says, hanging up.

‘A what?’ says Stan. ‘I’m not going to hospital.’

‘You go with these nice people!’ says his wife, glaring at him from her zimmer frame, as homicidally furious as Davros of the Daleks. ‘You can’t go on like this, Stan. You can’t!’

There’s the sound of boots on the concrete steps outside.

The fight seems to go out of him.

I slap him reassuringly on the shoulder. ‘Don’t worry, Stan. It’s only for a check-up. I reckon you’ve got a little urinary tract infection and it’s making you weaker than normal. You need a thorough-going overhaul. Wash and brush-up ,tuppence. Maybe they can get someone in to look at the house, and see if there’s not stuff that can be done to make it easier for you generally. With any luck they’ll discharge you later today. But you absolutely have to go, Stan, because to be honest – you’re so weak, if I left you now you’d fall over again and then where would you be?’

‘On the floor,’ he says.

A knock on the door. A friendly face.

‘Hello! Who’ve we got here, then?’

Stan submits to the carry-chair, and we all struggle outside to the truck. 

the cuddly toy conspiracy

Sienna is sitting on the edge of her bed, crying into the phone, whilst two of the other hostel residents look in at the door.

‘I’ve made too many mistakes,’ she sobs. ‘I just can’t cope anymore. I can’t cope.’

Along with a packet of tobacco and an asthma inhaler, there’s a neat mound of empty blister packs beside her.

When we’ve chatted to her for a while, calmed her down, established that yes, she will come with us to the hospital, Rae asks if she has everything she needs. Phone, keys, money for the taxi home?

‘Humphrey,’ says Sienna, reaching for a tatty owl that’s reclining on her pillow. She stuffs it in her handbag along with the rest of her medication.

I carry the bag and her coat so she has her hands free to support herself as she goes down the stairs.

The owl stares up at me from the bag as we descend.

*

Waiting with Sienna in the triage area of the A&E department.

Another crew comes in, pushing a young man in a wheelchair. He’s slumped forward over something; at first I think it’s a vomit bowl, then I see a little more of it and think it must be a furry hat, but when they park themselves next to us I can see that it’s actually a little toy fox. He moans slightly, and strokes the head of it.

When the triage nurse comes over to them, the attendant smiles and waves a little bundle of empty blister packets in the air.

*

Giles buzzes us into the flat. A twenty year old man, he has the bland and fleshy complexion of celery forced in the dark.

‘I took all my meds at once and went to sleep. I’m a bit disappointed I woke up, to be honest.’

Have you got everything you need to go to hospital, Giles? Phone, keys, money...?

He hands me a canvas bag whilst he pulls on a Slipknot hoodie.

And yep, there in the bag, just visible beneath the headphones, the magazine, the drink bottle and cigarettes, a cuddly little toy hedgehog, staring up at me with an off-centre kind of smile, as if to say: Sssh! Don’t say anything. I’m hiding.

charles and emma

The door stands open. I knock and push it open even further. A dark hallway, with dull light spilling down from a first floor landing, over photos and pictures, a narrow shelf of souvenirs, a chair-lift track with the chair upstairs. I say Hello, but there’s no reply, no sound.

Ambulance?

Nothing.

We go in, head up towards the light.

Hello? Ambulance?

Charles Westinghouse is fussing over his wife in the main bedroom he’s adapted for her. Everything has been cleared out except the basics – a hospital bed, a hoist, a commode, an electric armchair by the window, and another, simpler chair nearer the door. Emma Westinghouse is lying in bed with the back fully in the upright position. Her wasted arms are along by her sides, the right one under the duvet, the left on top. She doesn’t wear teeth anymore; as a consequence her mouth is a puckered crater. A PEG tube winds out to the left, a catheter tube to the right. Her skin has the waxy pallor of the profoundly inert, someone whose main experience of movement over the past eight years has been the hoist or the body roll, and of the outside world, sunshine filtered through curtains, and traffic passing in the street. Apart from the rise and fall of her chest and a certain flickering of her eyes – which, for all the low light and late hour, seem sharp and blue – she is absolutely still. Surrounded like this by all the details of her care, utterly immobile, she could be the centre of a tough new display by Tussauds, something to bring the collection up to date, Domestic Trials and Tribulations, sponsored by the NHS.

‘Oh! There you are!’ says Charles, straightening up and pushing his thick grey hair back. ‘Sorry to drag you out like this.’

He called because Emma had started grunting in a new way, something that suggested pain. There’s no sign of it now, though. All her observations are within range.

‘We’ll be guided by you, Charles. We’re more than happy to take Emma to hospital. The other option is to see how you go tonight and get the GP involved tomorrow morning – on the understanding that if anything changes you give us a call back.’

‘Will do. Just give us a hand to make her more comfortable.’

Whilst we’re doing that, Emma stretches her face a little more, making strange little panting noises, her eyes flashing.

‘Is that what she was doing?’ I ask him.

‘No. She laughs at me sometimes. I think it’s when I bend over her and my stupid hair flops forwards. Is that it, Em? Is it my hair again?’

We lower the back of the bed.

And slowly, like a doll whose weighted eyes gently close when you lie them down, she drifts off to sleep.

definitely dumped

Five o’clock in the morning, and dawn’s a spill of ink. Clubbers clacking and scraping in the direction of taxis, or anything that looks like a taxi.

There’s a guy standing outside The Spur Hotel, his hands planted deep in the pockets of his parka. I nod to him as we pull up, but he doesn’t respond.

‘Did you call the ambulance?’ I ask him as I climb out.

‘Me mate? No mate?’ His face cracks into a dreadful, stumpy grin. ‘Why – someone dying?’

‘Well I couldn’t possibly say.’

He watches me as I pull out my bag; Rae locks the vehicle behind us as we go up to the revolving doors. I glance behind as we push through; he’s still watching.

Our boots don’t make a sound on the thick blue carpet. We cross the vestibule, walk up a shallow staircase and approach the reception desk, spot lit at the far end of the atrium. The hotel rises up around us like a renovated prison – layers of identical rooms forming the four sides of the atrium, with the dining room and bar in the middle. The silence is overwhelming, accentuated by the empty dining tables all dressed for breakfast, the jardinières, the fans, the fish tanks.

A red-eyed, puffy faced receptionist is waiting for us at the desk, his arms spread left and right along the desk as if he’d been flat on his face when the call came through.

‘Room two three two,’ he says. ‘Come. I show you.’

‘So what’s the story?’

‘Well – a man and his girl, they got back from club about an hour ago. He was propping her up, you know – like this?’ He smiles at me, does the mime. ‘I thought it was the vodka.’ He shrugs.  ‘It happen lot.’

The lift puts us out on the fourth floor, an identical floor to the one we’d just left. Without even looking up, the receptionist pads ahead of us along an endless corridor, turns at the end, then along another, turns at the next end, then two doors down stops and swipes the lock.

‘Hello ambulance peoples’ he says, rapping with his knuckles on the door before he opens it.

Lying on the tiles of the en suite bathroom is a young woman, her head underneath a melamine shelf containing twin sinks and a dressing mirror. Kneeling by her side is a heavily built guy in his twenties.

‘That’s fine now,’ I say to the receptionist, who is soaking up the scene from over my shoulder. ‘We’ll let you know if we need anything else.’

‘Okay, my friend,’ he says. He nods to the boyfriend, and quietly withdraws.

‘So what’s been going on?’

Craig tells us what happened. They’d come away for the weekend. Been to a club. Not drunk all that much. Not taken any drugs. Natalie had become anxious and wanted to leave. She’d collapsed on the bathroom floor when they got back.

Natalie starts to hyperventilate, but in a non-committal, stagey kind of way. I coach her resps back.

‘Have you ever had a panic attack before?’ I ask her. She nods. ‘Okay. So you’ll know how over-breathing can make you feel.’ She nods again.

In between encouraging the breath control, I ask Craig about Natalie’s medical history.

‘I wouldn’t know,’ he says. ‘I’ve only known her a month.’

Natalie lifts her head.

‘You’re going to dump me,’ she says.

‘I’m not going to dump you. Don’t be silly.’

But Natalie drops her head back to the floor and starts breathing quickly again – and too soon after for it to be at all credible, passes out.

‘She’s not unconscious,’ I say.

I show him how I can tell.

Over the next half an hour, and despite all our efforts, Natalie carries on as before, small bursts of hyperventilation followed by unconvincing faints. Rae and I play Good Cop, Bad Cop, but nothing works. We try to encourage Natalie to stand up and move to the bed where she’ll be more comfortable, but Craig intervenes, physically picks her up, carries her through.

‘Watch your back,’ I tell him.

He shakes his head and staggers with her into the bedroom. As soon as she lands on the bed she throws herself flat and pretends to pass out again.

‘Why’s she doing this?’ he says, red in the face.

‘I don’t know. Natalie? Come on. Let’s sit you up and have a chat about how you’re feeling. We’ve just got to reassure ourselves that everything’s okay, then we can leave you alone.’

She sits up and stares at me for a moment.

‘Natalie? How are you feeling? How can we help?’

She holds out her hand to Rae without taking her eyes off me.

‘You don’t like me, do you?’ she says.

‘It’s kind of immaterial whether I like you or not, Natalie. We’re here to help and that’s what we’re trying to do.’

Suddenly she jumps up and runs out of the room.

Craig follows her, shouting over his shoulder: ‘I’ll be okay from here in, guys. Thanks for your help.’

We stand outside the room and watch Natalie run down the corridor, followed by Craig. Right at the end, where the corridor turns to the right, she stops, and after hesitating a moment, neatly puts herself on the floor.

Wearily, we walk up to meet them.

Craig is kneeling beside her, stroking her hair; amazingly, he nods at us in a friendly way.

‘All right?’ he says.

I check Natalie over.

She’s feigning unconsciousness again, only coming out of it to look up at Rae and say: ‘I like you. You’re all right.’ Then lapsing back into a little fast breathing again.

‘Try to encourage her back to the room, Craig. I think you’re doing a great job. But obviously she can’t stay like this all night. The hotel security might get involved. I don’t think Natalie needs to go to the hospital, but if anything changes later or you become concerned, you can always call us again.’

‘Thanks,’ he says. ‘Sorry to have wasted your time.’

‘It’s no bother.’

We leave them to it.

Back down in the atrium, the receptionist has resumed his position on the desk.

‘What was matter?’ he says, looking up from an early edition of the newspaper. ‘Vodka?’

‘She’s not too bad,’ I tell him. ‘Lying in the corridor at the moment, but hopefully they’ll be back in their room soon.’

‘Okay chief. I keep eye on this business.’

Back outside on the pavement, the strange guy hasn’t moved.

‘No good?’ he says. ‘Nothing doing?’

‘Another life saved.’

He watches us stow the bags and get back in the cab.

‘One month in,’ says Rae. ‘Good god. If I was him I’d be running in the other direction.’

‘Dumped,’ I say. ‘Definitely dumped.’

We clear up, take another job.