Friday, February 28, 2014


The day is ending and the light coming down, with a blue clarity the cars and the shop windows only seem to intensify. We’ve been given one last job – male, suicidal – which, given the hour, the proximity to the hospital and everything else, should finish us off.

I’m absolutely and completely ready to finish. It’s the end of the fourth day and I’m as glassy and flat as any of the puddles we step across.

I haven’t been to this address before. A single, weathered pine door set back between two shop fronts on the high street, diminished by the neon vibrancy of the kebab restaurant on the right and the spot-lit sports shop on the left. The intercom is as battered as the door, the paper strips behind each plastic button written over so many times or so blurred with damp you can’t read the names. I take a guess that the top button is the top flat, and push.

After a moment, a voice crackles on. Instead of simply buzzing the door open when I say ambulance, the voice chats on in a voice as unreadable as the name plate.
‘Can you let us in, please?’ I say, leaning in to the grille. ‘Just for a chat. Only I can’t hear you very well.’
The voice carries on.
‘I’m sorry but I really can’t hear you,’ I say. ‘Can we come in and say hello? Just for a moment? It’s starting to rain.’

The door buzzes; we go through.

Into a surprisingly high-ceilinged hallway, lino-clad stairs leading up, a row of letter boxes on the left hand wall, every one twisted and bent apart with a crowbar.

There are only two flats per level, so we guess the flat we want is four floors up. I can’t figure spatially how the whole thing works. I guess the building must go back a-ways, then branch out over the shops left and right in a T-shape. But the atmosphere is so deep with shadow, you could tell me this building exists in a dimensional plane of its own and I’d believe you.

The stairs are about as steep as you can get without actually being ladders. The light switches work on the next two storeys, but cut out too soon, so we have to use our torches.

Eventually we make it to the top.
A hatch in the ceiling with a pull-down ladder.
Graffiti on the wall, names and numbers, Jeremy: Neighbour, July 11. Where ARE you? A list of light bulbs – when they went in, how long they lasted; the scrawled face of a smiling devil.

I knock.
Hello. Ambulance.

‘You can go away now. I don’t want you. I’m suicidally depressed and I’m going to kill myself. I don’t need anyone’s help.’
‘I’m sorry to hear that. Richard, is it? Richard – I’m Spence and this is my partner Rae. We’d just like you to open the door so we can talk to you. No-one’s going to force you to do anything you don’t want to do. No strong-arm tactics. We just want to see if there’s anything we can do to help. Is that all right?’

The door opens, and Richard looks round the edge of it, just half of his face and the fingers of one hand visible.
‘There. You’ve seen me. Now you can go,’ he says.
‘Hi, Richard. I’m sorry you’re not feeling well. Can we come in and have a chat?’
‘I’m fine. Honestly. Well – I’m just about to throw myself out of the window, so only fine in that sense, but I really don’t need any interventions or clever talk or powerful drugs because I’ve done all that and quite honestly it’s all bullshit. Okay? Does that compute? I’m a worthless piece of shit and I really think I should just be culled. Which I’m perfectly able to do myself. So thank you for your time but honestly there’s nothing to be done.’
‘Can we come in and chat, Richard? Just for a moment.’
‘Be my guest’ he says, but doesn’t move away from the door.
‘We can’t really come in until we can see you properly. I’m sorry to sound a bit suspicious, but you know what it’s like...’
I shrug and smile as if people concealing machetes was one of those regrettable social slips one just had to live with.
‘I know what you mean,’ he says, letting go of the door and moving further inside the flat.
He lifts his t-shirt up and does a turn on the spot.
‘Nothing to hide, officer,’ he says, then puts his hands on the top of his head and retreats into the bedroom.
‘Sorry to be such a pain,’ I tell him.
‘No, no. It’s fine. You don’t live with a bunch of psychopaths for neighbours like I do’ he says. ‘I’ve been broken into five times. They knock on your door at four in the morning and whisper through the keyhole. I know exactly what it’s like.’

The flat is as crapped up as any I’ve seen. Scatterings of dirty laundry, crates of crushed beer cans, curling stacks of paperbacks, lank yellow curtains, abstract pictures sellotaped to the wall – crude, fractal paintings, vividly coloured swirls of pastel.
The homeward bound traffic surges below us in the street like waves against the beach.

Richard sits on the edge of his unmade bed and starts puffing away on a hefty electronic cigarette that looks more like a cook’s blowtorch.

‘I just can’t decide how to do it,’ he says, blowing smoke off to the side. ‘I mean, I spent weeks trying to figure out how to tie a noose properly. It’s more difficult than you might think. Because that’s the best way to do it. Quick. Hypoxic. End of story.’
‘I don’t know about that,’ I say, sitting next to him.
‘Do you want a seat?’ he says to Rae.
‘No, I’m fine, thanks,’ she says, leaning in the doorway. ‘I’ve been sitting all day.’
‘Maybe you can swap over after a while,’ says Richard, and puffs pleasantly on his e-cigarette.

I ask him about his medical history. He says he’s not been taking his meds because they don’t work. No-one’s interested, he says. He doesn’t have a support worker. What’s the point?
‘What we’d like to do is take you down the hospital to chat to someone there.’
‘Why? What are they going to do? Make me wait around for hours then send me home again? Or call the police and have me thrown in a cell, naked, under a blanket?’
‘The thing is, there’ll be someone there at the hospital – one of the mental health team – someone much more expert in these things than me. They’ll be able to talk to you in depth about how you feel and your whole situation.’
‘Why? I know what my whole situation is. My whole situation is I’m a fucking waste of space. A Waste of Space. That’s it. That’s all there is. I’ve thought about it a lot. It’s no biggie. I’m high up here. It’d be quick.’
‘I think you should give yourself a chance to get better, Richard. Obviously we’re limited what we can do for you here. I’d love to have a magic wand and fix all your problems, but if they’ve got them they’re not handing them out. Why not come down the hospital and talk to someone there?’
‘What do you care? This is just another job for you. You don’t know me.’
‘We do care, though, Richard. If we didn’t we wouldn’t be in the job we’re in.’
‘We wouldn’t have climbed all those stairs,’ says Rae.
‘What do you need to take with you?’ I ask him, hoping the practical question might tempt him towards the door. But Richard just laughs and looks at me. He reaches behind him, finds an army surplus cap with a low brim, pulls it down on his head, then puts on a pair of rectangular sunglasses. He stares at me a moment.
‘Why don’t I just throw myself out of the window and save everyone a lot of trouble?’ he says.
‘You could do that. But you might land on someone and kill them. I know you don’t want to hurt anyone.’

‘You think hanging’s the thing, then?’ he says. Then he laughs, a strange and dry thing, as sparse as his beard. He reaches over and pats me on the knee.
‘Don’t worry, mate. I’m not expecting a leaflet.’

Saturday, February 22, 2014


‘It'd better not be Bobby.’

It is.

Bobby is sitting on a bench seat facing the fast food restaurant doors, slumped down in his parka, a waitress standing over him.
‘Hello!’ she says. ‘Thanks for coming! I’m afraid this gentleman has had a bit of a collapse. We couldn’t rouse him, so we called you.’
‘That’s okay. We’ve met Bobby before.’
‘Have you?’ she says. ‘Great! Well – if you’re okay here...’ and she hurries back to the counter.

‘What’s the story then, Bobby?’
He sways his massive head in my direction, his beard parting in a scowl to reveal his one rotten tooth.
‘Aargh!’ he says. ‘Yeearrghhh!’
‘Come on, Bobby. Let’s get you outside to the ambulance. We’ll talk there.’
‘Jes’ a minute,’ he says, rolling right and left as he struggles with his trousers. ‘Jes’ a minute.’
‘Don’t worry about that. Let’s get going.’
Next to him on the seat is an opened tin of luncheon meat he’s been pawing out with his fingers. Chunks of it lie scattered across the seat, and over the sides of an empty bottle of sherry.
‘You can’t go on like this, mate,’ I say. ‘This is a restaurant.’
‘Yaaarghh!’ he says.
He sways alarmingly as we help him to his feet, and his trousers fall down. He isn’t wearing any pants.
‘I need a wee wee,’ he says.’
‘No! Just hold it, okay? You’re not going here.’
‘Where’m’ah gonna go then? On th’ambl’ance?’
‘No. You can wait till we get to the hospital, mate. Now hold you trousers up and concentrate on putting one foot in front of the other.’
I ask a builder coming into the restaurant if he’ll hold the door open for us.
‘Yeah – no worries,’ he says, and sympathetically tuts and shakes his head when I thank him.


Getting Bobby up the back steps of the ambulance is like shoving an octopus into a milk bottle. His suckers are everywhere, and I’m continually having to redirect him, a task made more complicated by my efforts to keep his trousers up and the living nightmare of his arse out of my face.

‘Hy-arrrrgh!’ says Bobby.

Finally, with one last, desperate heave from me, one big tug from Rae, Bobby pitches head first into the ambulance. I tuck his feet up just enough to be able to slam the door; when I turn round I see a row of horrified faces on a bus that has pulled alongside. I realise it must look as if I’ve just thrown some poor patient into the back, so in an effort to make light of the whole thing  I smile and clap my hands together as if to say That’s that! – and wonder if it’ll make the papers.


The triage nurse at the hospital takes my handover with a surprising degree of sympathy. After all, Bobby comes up to hospital pretty much every day. Sometimes he gets thrown out by security for punchy behaviour, or shouting obscenities, or a hundred other anti-social activities. Sometimes when he’s been thrown out he’ll lie himself down in a nearby street and end up in the back of yet another ambulance, relentlessly rolling up the ramp to A&E. It’s an endless cycle of awfulness, but despite every attempt at help, despite the most philanthropically creative interventions, Bobby remains non-compliant, and seven or eight years have passed without respite. He’s a scourge, by any definition, a scourge no-one can treat. Death would seem to be the only resolution now, the only prospect of peace – for Bobby as much as anyone else.

‘Ah!’ says the triage nurse. ‘It’s such a shame. He’s had a hard life, what with his PTSD and all this and that. It’s no wonder he’s at war with the world.’

‘Wow!’ I say to her. ‘That’s very enlightened. I thought you’d tear my head off for bringing him in again.’

‘I know,’ she says, laughing, and touching my arm. ‘But don’t worry. I’m just back from a year’s sabbatical. I’ll be normal again come lunchtime.’

the other side of the window

Anna, the old woman who died half an hour ago, sits in the chair with her head resting back on a cushion, her hands placed neatly either side of her, as peacefully as if she’d just popped out for something but forgotten to take her body with her. Her eyes are half-open, and she stares through the window immediately opposite, at the dark green canopy of the evergreen oak that grows up from the nursing home car park, past her window to the storeys above.
The manager and a carer are in the room with Anna. The manager has Anna’s folder tucked under her right arm; in the left hand she holds a red DNAR form.
‘Aggie found her. They used to go down to lunch together,’ says the manager. ‘She’s terribly upset, as you can imagine.’
‘So who was the last person to see Anna alive?’
‘The hairdresser. Half an hour! If that! She is dead, isn’t she?’
‘I’m afraid so.’
‘Poor Anna. It’s all so – sudden.’
The manager suddenly looks pale and tearful. The carer passes her a tissue.
‘Sorry,’ she says. ‘Do you mind if I just step out for a few minutes? I could make you some tea if you’d like?’
‘That’d be great. We’ll do the paperwork and then liaise with Control about the next step.’
They leave the room and quietly shut the door behind them.

The light in the room suddenly increases threefold as the clouds break and the sun shines through. It throws everything into sharp relief, especially the little collection of things on the window-ledge: a silver framed photo of an elderly man in a yellow cardigan, two miniature porcelain cottages, all arranged around a bonsai tree in a shallow ceramic dish. Unlike the oak outside, the little tree is blackened and leafless.
There’s a knock on the door, and the manager comes back in with a tray of tea. She sets it down on a side table, then perches on the edge of the bed and helps with the paperwork, calling out drug names, the dates of operations, hospital admissions.
‘It’s the first time I’ve been in a situation like this,’ she says. ‘You know – not really doing anything.’
‘I know. It feels odd. But good, I think. It couldn’t be more peaceful. Usually it’s the complete opposite.’
The manager finishes her tea and then holds the empty cup tightly in her lap like she’s appreciating the warmth.
‘Is that Anna’s husband in the picture?’ asks Rae.
‘Richard – yes. I never met him. He died a while before Anna came here. Looks like a nice chap, though.’
She puts her cup back on the tray.
‘Maybe she’s meeting Richard right now,’ says the manager. ‘I don’t know what you think, but I believe in heaven. I don’t mean big white gates and all that, but some other place, where you all meet up again. I couldn’t believe when you died that was it, none of this meant anything. I know when I was ill it was God that kept me going. Sorry if I’m talking too much.’
‘No, no. I don’t mind.’
Rae tidies up the equipment and puts the bags aside, ready to go.
‘I think there’s an afterlife’ she says. ‘Probably nothing we’d recognise. Something purer, less human. It’s just a feeling.’
‘I know what you mean,’ says the manager. ‘Did you see that programme last night on bugs and parasites? It was amazing. Kind of disgusting, but amazing too. When you see how these things are put together. I mean, the big stuff you can understand, but when you get down to it, all the cells and atoms, floating around in space – well, there has to be a creative force behind all that, surely? I mean – what else could it be? It stands to reason.’
‘I read this interview with a palliative care nurse,’ says Rae. ‘She told this story about a patient with dementia who was absolutely raving right up till the end. The curtains had been pulled round, and the nurse stepped outside for a second to get something when she heard the woman suddenly talking in a voice she hadn’t heard before, all calm and low, you know?  – full of sense – like she was talking to a whole load of people who’d suddenly turned up. And when the nurse pulled the curtain aside she found the woman had died.’
I finish my tea and put the cup on the tray next to the manager’s.
‘Thanks. That was great.’
‘You’re very welcome.’
‘I’ll make the call.’

Rae and the manager sit quietly whilst I dial the number.

Anna remains exactly as she was, of course. Staring straight ahead, at the leaves of the great evergreen oak, restlessly stirring just the other side of the window.

Wednesday, February 19, 2014

what to do

I haven’t been to William before, but that’s the thing about frequent flyers – no matter how prolific they might be, it’ll be some time before you can cross them all off your list.

William’s front garden is a raw patch of grass and weeds. A stone heron lies beak down in a pile of rubble; a line of perished Christmas lights hangs down in front of the kitchen window from the last remaining clip.
‘Don’t be tempted inside,’ says Rae as we walk up the path. ‘We’ll be there for hours, and the outcome’ll be exactly the same. I’ll try to tempt him out.’
She knocks, and knocks, and eventually William comes to the door, a middle-aged man so plump and soft and white it’s like she’s coaxed him out of the furthest chamber of the deepest burrow.
‘I don’t feel right,’ he says, bunching his t-shirt up. ‘I’ve got chest pain.’
‘Let’s get you out to the ambulance then, William and we’ll do all our tests there.’
‘Couldn’t you do them here?’
‘We could, but the advice would be the same – to come to hospital for a check-up. You’ll need a blood test for one thing.’
‘But I don’t want to go to hospital.’
‘We always advise it for chest pains, William. You know that. You’ve done this before.’
‘I know, but how’ll I get back?’
‘Maybe you could walk. It’s five minutes away. If that.’
‘What about my medication?’
‘Take it with you.’
‘But it’s all set out in the kitchen.’
‘I can put it in a bag.’
‘I need to take the next tablet in half an hour.’
‘Take it at the hospital.’
‘I have to take it with tea.’
‘They serve tea. Or water.’
‘It has to be tea.’
‘I don’t know. I don’t want to go.’
‘What did you expect would happen when you dialled 999 and said you had chest pain?’
‘I don’t know.’
‘The only other thing is to see your GP.’
‘He won’t come out any more.’
‘Well he’s even closer than the hospital.’
‘I know but how will I get there?’
William shakes his head.
‘I haven’t been out in ages.’
‘How do you get your shopping?’
‘Dad takes me.’
‘Can’t your Dad take you to the surgery?’
William shakes his head.
‘He says he won’t do it anymore. What should I do?’
‘You know what we think you should do, William.’

He shifts his weight from side to side and plucks at the loose flesh beneath his chin.
After a while he says: ‘But can’t you do all the checks here?’
‘Our advice is that you come to the hospital for a review, William. If we did an ECG right here and it was clear, we’d still say you should come.’
‘So you could do it here.’
‘Yes. But say we did do an ECG and it showed you were having a heart attack. Would you come then?’
He shakes his head.
‘Why not?’
‘Because I can’t wait hours up the hospital. I know this is just anxiety. It’s how I am. And all this is making it worse.’
‘I think you’re right. I think it is anxiety. Have you had all your meds this morning?’
‘I haven’t had my Diazepam.’
‘When do you take that?’
‘In half an hour.’
‘Well I think you could safely bring that forward and have it now.’
‘But the kettle’s not boiled.’
Rae sighs.
‘We’ve been down this road before, William. Haven’t we? We’re just going round in circles.’
‘What’s the point in going up the hospital? They’ll do all their checks and find nothing wrong.’
‘You don’t have to come with us, William. You could always see your GP.’
‘But he won’t see me no more.’
‘He won’t come out to see you. But you could make your own way there.’
‘I can’t. My dad won’t take me.’

Rae sighs and steps away from the door.
I try my luck.

‘Do you have a support worker, William?’
‘Maybe you could call them and see what they say.’
‘I can’t keep calling them. I’m too stressed. What should I do?’
‘That’s when you should call them, when you’re stressed.’
‘They can’t do nothing more for me.’
‘What do you think they’d tell you to do if you told them you had chest pain?’
‘Go to hospital.’
‘And that’s what we think you should do. So that’s all of us saying you should go to hospital. Come on William. Sooner you go, sooner you can come back.’

He shifts his weight, foot to foot.

‘What should I do?’ he says. ‘I’m all confused.’
‘Come to the hospital and speak to someone there. Maybe they’ll have some ideas.’
‘But how will I get back?’
‘I haven’t go no money.’
‘He doesn’t drive.’
‘Not without Dad.’
‘Give him a call?’
‘He won’t go up the hospital.’
‘The GP, then.’
‘Or them.’
‘The main thing is, William, you don’t feel well. You were worried enough to call an ambulance. I think you should do whatever you have to do to get checked out and reassure yourself everything’s okay, and then worry about how you’re going to get home later.’
‘But my medications…’
‘We’ll put them in a bag.’
‘They’re in a box.’
‘We’ll put the box in a bag. It’s a big bag.’
He strokes his head, shuffles from side to side.
‘What should I do? I don’t know what to do.’
‘William? We really need to make a decision,’ says Rae, stepping back again. ‘We’re an emergency ambulance and we might be needed on another job. What’s it going to be? Hospital or GP?’
‘I don’t know. The GP won’t see me.’
‘I’m afraid we’ll have to go then, William.’

He stands at the door watching us walk back to the truck, anxiously stroking his head from the nape of the neck to the forehead and back again.

By the time I’m in the cab, he’s speaking on the phone.
I catch his eye.
He holds up an index finger for me to wait.
I wind the window down.

Sunday, February 16, 2014


The Custody Suite is as busy as ever. People standing where the footprint decals on the floor indicate they should stand; officers at each segment terminal on the raised dais entering details, issuing instructions, explanations, documents; faces at the windows of the interview rooms; officers wandering out, wandering in, fetching property bags, storing them away; phones ringing, keyboards rattling, steel doors slamming – all in an atmosphere of airless, plainly lit process, the administrative nexus of the day’s drama.
‘Here they are!’ says one of the custody officers. His colleagues look over at us and smile.
‘You’re going to love this!’ he says, logging out of his terminal. ‘Or maybe not. Have you been told much?’
Rae shakes her head.
‘Section patient to Southview. That’s it.’
‘You wish,’ he says, standing up. ‘Have you got gloves, or...?’

Just as he comes out to lead us round, someone calls out to me from a room at the back.
Hello mate!
It’s the custody nurse, a man I’ve never seen before. ‘Fancy seeing you here! How are things? Keeping well?’
‘Yeah, fine!’ I say. ‘You?’ I struggle to place him, but nothing fits. He leans back in his chair and laces his fingers behind his head.
‘No worries,’ he says. ‘I saw Jack just the other day. Nice to see the old faces now and again.’
If I’m going to admit I don’t know him it has to be now. But in that panicked instant before confession or pretence, I opt for the latter.
‘How long have you been working here?’ I ask him, as the custody officer punches in the security code and opens the door to the cells.
‘About a million years,’ the nurse says. ‘Feels like. Anyway – nice to see you again. I’ll let you get on. But hey – don’t blame me!’
I laugh and nod and hurry after Rae.


‘I don’t know how you want to handle this,’ the officer says, pulling on some white plastic gloves. ‘The story is she was found wandering in the street, very distressed, not making any sense. A car brought her here, but not without some difficulty. She’s – how shall I put it? – covered in shit, I think is the technical term. When we put her in the cells she defecated on the floor and started throwing it around, so we had to withdraw. She did calm down enough for your nurse friend to take some obs, though, blood sugar and whatnot, and he was happy with all of that. The psych team assessed her and she’s being packed off to Southview. I don’t reckon she needs an escort, but see what you think. You’ll have to watch your step inside, but I’ll leave the rest to you, to price the job, so to speak. All right?’

He has a quick look through the letterbox observation hole, then unlocks the door.

‘Paula?’ he says. ‘The ambulance are here to see you.’

A young woman is lying on her back on the low bed shelf at the other side of the cell. She is covered up to the neck in a blanket. All you can see is a pale face above the top of it, framed by a tangle of sweated black hair. She is talking quietly and quickly, a smooth commentary, staring up at the patterns the light through the tiny window throws across the ceiling.

Getting to her is a problem, like walking across a minefield. There are lumps of excrement liberally scattered around the floor and against the wall, smears where boots or feet have slipped up. The cell has been sprayed with air freshener, which only makes the stench more sweetly overbearing.

‘Hi Paula. I’m Rae and this is Spence.’

We pick our way over.

She doesn’t acknowledge our presence at all, but carries on her strange monologue.
‘... Jesus be kind to me. Jesus kiss me and save me. Come unto me here and say that you understand the nature of my blackened heart. In your sweet, sweet name, amen. You were always aware of my sins and the power of your demons to capture my heart. And after all that happened ... Yes? You remember? Sweet Jesus how you always remember. You see me now thrown into the pit of ... that despair which was foretold, that was cast into the likeness of liars and frauds and deceitful demons. That which you have taken unto yourself be forever blessed and understanding for evermore, amen....’

Paula is unreachable. She doesn’t respond, not even a glance. The fact that we are two strangers standing over her makes no impression at all. She carries on staring straight up, her voice softly pattering out what in any other circumstance would pass as speaking in tongues, or automatic writing, when you write without editing, whatever comes to mind, falling into the prophetic cadence of the priest or shaman.

‘...and you understood what befell me there. You could see what lay on the other side. And when you said you loved me, what did that mean, and how did that manifest itself? The demon understands. He is waiting for me, licking his lips with the deliciousness of it all. He is waiting to consume me in his blessed fire, and I know you would do something if you could, but he is as much a part of it all as I am. He understands my weaknesses and fears, he has consigned them to the flames along with me. But I am not afraid. I am lain low and dying, but I am not afraid....’

We step carefully back out of the cell.

‘We’ll get the trolley,’ I say to the officer. ‘And some blankets.’
He closes the door behind us. I can still hear Paula’s whispering monologue, right up until the very moment the lock engages, slotting into place, coming to with a resounding clunk that echoes ahead of us down the corridor.

Saturday, February 15, 2014


Mitch has a Borgnine smile, a stretch of small teeth like someone just unzippered the bottom half of his face. It’s a utilitarian thing, a first line of defence, the kind of smile you might use no matter what. I can imagine him in the garage, wiping his hands on an oily rag, smiling in that way as a customer describes the dink dink noise from the engine, or smiling in the cluttered office as the accountant bawls him out about the state of his books, or in the pub, lowering his pint to watch his apprentice play pool. It’s an unsettling smile, a volatile mix of affable and aggressive, like he’s holding you there whilst he makes up his mind.
‘I didn’t get no reply when I rang, so I thought I’d come by and see,’ he says, smiling. He looks down at the bed, at his wife sprawled there, surrounded by empty blister packs. ‘You can’t keep doing this, Shirl,’ he says. ‘You really can’t.’

Shirl says she doesn’t want to go to hospital, but the pills have made her so drowsy it’s easy enough to coax her up, into boots and down the stairs.

Outside the rain has stopped and the sky is a beaten blue. Shirl’s hair whips around her face. She plucks at it ineffectually.
‘Three steps up. There you go.’
She lies back on the ambulance trolley and seems to fall straight asleep. She’s rousable though, enough to take sips from a bottle of activated charcoal. Her lips get stained with a pouty little circle of black, like a geisha.

‘Urgh,’ she says. ‘I don’t want it.’

‘Well you shouldn’t have taken all them pills then,’ smiles Mitch from the opposite chair. Then he plants his elbows squarely on his knees, leans forwards, and and massages his face with his big, calloused hands.
‘I don’t know,’ he says, sighing, straightening up again and looking at me. ‘I’ve had enough, mate. The mental health lot are worse than useless. You get some geezer from the crisis team come round, and all they do is bosh out more Valium. And the psychiatrist ‘aint much better. She just sits there sucking her glasses and scribbling notes. Hm. I see. And what about this and that? And then writes a prescription for more pills. I’ve had it up to here, mate.’

He smiles at me, and the distance between that smile and the resonant black of his eyes could not be more profound. 

Friday, February 14, 2014

is that it?

An elderly man meets us at the entrance to the block.
‘I’ll show you up,’ he says. ‘Second floor.’
He has a greyhound with him. Even though the dog is immaculately dressed for the weather in a smart brown gabardine coat snugly fastened round the neck and tummy, it looks utterly woebegone, staring up at us with a disappointed sag to its face, like all this was just bloody typical. He turns in sync with the old man, and they both trudge ahead of us to the lift.
We’re carrying lots of heavy bags; this is a possible resus, after all.
When the lift fails to arrive, Rae says:
‘Maybe we should use the stairs.’
‘The stairs?’ says the man. ‘It’s three floors up! Anyway, it’ll be here in a minute.’
The dog stares up at me.
The numbers are lighting up as the lift descends, maddeningly slow.
‘I think we’d better take the stairs,’ says Rae, re-shouldering the bags.
‘Are you mad?’ says the man. ‘Her flat’s just opposite the lift. One step out and you’re there.’
But just as we’re about to head off up the staircase, the lift arrives.
‘Here we are,’ says the man. ‘Come on.’
We all pile in. It’s a struggle, what with all the bags and the dog, too, who makes room only reluctantly, and then stares up at me with a novel hybrid of clinical depression and chronic disappointment.
Just as the man reaches for button number three, an elderly woman sprints in from nowhere and hits button number one.
‘Gladys!’ he says. ‘This is an emergency!’
‘Oh! Sorry love. Is it?’
‘Yes, it is!’
As the lift door slowly closes she cranes forward and peers at me and Rae.
‘What kind of emergency?’
‘An emergency kind of emergency, Gladys. These are paramedics.’
‘Ooh. Who’ve you come to see?’
‘I’m afraid that’s confidential’ says Rae.
‘Winifred,’ says the man. ‘The carers found her collapsed on the floor. She could be dead.’
‘Poor Winnie,’ says Gladys. ‘Well I hope she’s all right. Give her my best.’
The man sighs.
We ride the rest of the way in silence, with the dog still staring at me, so intently that eventually I crack. I put a bag down to free up a hand and reach down to gently scruffle the dog between the ears.
‘Good boy! Who’s a good boy?’
He closes his eyes in a resigned kind of way, and then when I stop, carries on staring at me again, as if to say: Seriously. Is that it?

Thursday, February 13, 2014

old trees

One of the carers is waiting for us at the doorway to the house.
‘Front room,’ she says, pointing to her right.
Her colleague is pumping up and down on May’s chest, at the feet of May’s husband Geoffrey, who sits watching the whole thing from his armchair by the window. I take over compressions whilst Rae quickly unpacks the bag and sets to work.
‘This might be distressing for you to watch, Geoffrey,’ I say to him over my shoulder as I feel May’s ancient ribs crackle and snap beneath the heel of my hand. ‘Wouldn’t you rather go next door for a while?’
Both carers come over to help him up. We pause compressions just long enough to move May down sufficiently to give them room. They shuffle off into the kitchen, the two carers either side, Geoffrey in the middle with his frame.
‘I think she’s been down a while,’ says Rae when they’re out of ear shot. The defib shows a resoundingly flat line, and although May still feels warm, her pupils are fixed, and there’s a torpor to her eyelids and face.
The first carer comes back in.
‘Anything I can do?’ he says.
‘So what happened, exactly?’
He tells us they’d only just arrived themselves, found May unresponsive in the armchair beside Geoffrey.
‘Geoffrey thought she’d gone,’ says the carer. ‘But I wasn’t sure when. She was okay at breakfast, but that was a couple of hours ago.’
‘How’s May’s health?’
He waggles his hand from side to side. ‘Not eating and drinking all that well the last few weeks. Antibiotics for an infection, but nothing major. It’s all a bit of a shock.’
‘How old is she?’
Rae has the laryngoscope in May’s mouth now, pushing down the tongue to visualise the cords.
‘She’s definitely been down a little while,’ she says.
But we’ve started, and with no absolute certainty about times, we’re obliged to continue.


Twenty minutes later we stop CPR and record the time of death.
We start clearing up the room, making May comfortable and presentable. A cushion and a blanket.
The carer brushes her hair.
‘She was a character,’ he says. ‘A bit sharp sometimes. You were never in any doubt what she thought. But once you got used to her ways she was brilliant. A heart of gold.’
He straightens up and takes a last look at her.
‘Goodnight, May,’ he says. Then he quietly put the brush back on the side table, and goes back out to the kitchen.


Geoffrey has a tartan rug over his shoulders, a cup of tea in his hands.
‘She’s gone, hasn’t she?’ he says when I walk in.
‘I’m so sorry, Geoffrey. We did everything we could, but I’m afraid May has died.’
He closes his eyes, not crying so much as blindly absorbing the shock of the word, powerfully sharp and sudden, like I’d just shot an arrow into an old tree.
‘I held her hand,’ he says after a while. ‘I didn’t want her to go.’
The carers are sitting either side of him. One takes his tea so he doesn’t spill it, the other hands him a tissue.
‘Thank you for all you’ve done,’ he says. ‘You’ve been kind.’

Just beyond the three of them is a large patio window. It’s been raining all morning, but it’s got progressively worse and now a storm has come in. The black and twisted branches of an ancient apple tree just beyond the terrace whip violently back and forth, and fierce gusts of rain rattle across the glass.

‘Oh my good God’ says a carer.

Everyone but Geoffrey looks up.

Saturday, February 08, 2014

on the wheel

A policeman is waiting outside the flat on the balcony.

‘Thanks for coming,’ he says. ‘We’ve got two patients – husband and the wife. Steve is currently under arrest, but he’s got a cut to his head we’d like you to look at before we take him off. Anna’s in the living room. She doesn’t seem that bad – a bit of swelling round the mouth, but see what you think. They’ve got a seven-year-old in the bedroom. My colleague is looking after him. Mind how you go when you come in. There’s broken glass everywhere.’
There is a two-panelled door between the kitchen and the hallway, each panel with a pane of safety glass. But someone has crashed against or maybe through it; the central strut bows out, and only a few shards of glass remain in the frame, the rest liberally scattered across the lino. There is a splatter of blood up the side of one kitchen cabinet, and handprints here and there on other surfaces.

Steve seems calm. He is leaning against the fridge with a bloody tea towel pressed to the top of his head. Whilst my colleague Paul goes to examine him, I go on through to the living room to see Anna.  

She is kneeling on an exercise mat in the middle of the room, her hands palm down on her thighs, her eyes closed. Her long blond hair trails over her shoulders in sweated strands. Her mouth looks plump and bloodied on the left.

I introduce myself, and kneel down, too.

‘I’m okay,’ she says. ‘I’m fine. But I can’t do this anymore. I can’t...’
The tears she’s been trying so hard to control come rushing up. She’s overwhelmed by them, and drops her head.
I pass her some tissues.
‘Anna? It’s really important that I find out if you have any injuries. Can you tell me what happened?’
She half-opens her eyes and wipes her nose.
‘He’s just a college friend. But Steve gets so jealous and I can’t go on. He doesn’t let me do a thing. And I’ve been trying so hard. I’ve been taking classes, trying to improve myself. But he won’t.. he can’t...’
She squeezes her eyes shut again, and a fresh wave of tears spill down her cheeks.
‘So you had a fight, is that what happened?’
She nods.
I hand her some fresh tissues. She throws the old ones to the side.
‘Did he hurt you?’
She shrugs, then laughs.
‘I hurt him. And I’m glad.’
‘Tell me about the fight.’
She takes a deep breath, one that seems to catch inside.
‘I don’t know. He slapped me and I went crazy. I’ve had enough. I can’t do it anymore. I can’t live like this. I think I put him through the door.’
The police woman who has come into the room sits down with me.
‘From what I can gather he assaulted Anna and she fought back big time. I definitely think he’s come off worse.’
Paul comes in from the kitchen.
‘Steve needs a couple of stitches but it’s nothing serious. Another police car has just taken him to the hospital.’


After an examination, it seems that Anna just has a swollen lip where she was struck in the mouth. There are no other signs of injury.
‘I’m staying home,’ says Anna. ‘My boy’s next door. I’m staying with him.’
‘He’s just gone off to sleep,’ says the police woman. ‘But he was showing me his hamsters a minute ago. Lovely little things. Itchy and Scratchy. You should see them,  tumbling round in that wheel.’
Anna laughs.
Then she cries, and cries, and cries, fully and deeply, without end.

Friday, February 07, 2014


Martin has fallen in the kitchen. The carer lets us in.
‘Do you need me for anything? Only...’
I’ve barely finished saying ‘I don’t think so...’ when she’s grabbed her coat off the back of a chair, the lift door closes and she’s heading down.
‘Get me up!’
Martin hasn’t hurt himself, but he’s a fair size and we’ll have to use the inflatable cushion.
Rae goes back down to the truck to fetch it; I start taking his obs.
Martin is only in his early sixties, but his illness is in an advanced stage. He’s PEG fed and catheterised.
‘How did you get into the kitchen, Martin?’
‘With your zimmer?’
‘Without a stick or anything?’
Walked! Get me up!’
 He talks in a harsh monotone, his heavy-lidded eyes staring at a point six inches beyond the tip of his nose. The paperwork doesn’t refer to any learning difficulties, but I wouldn’t be surprised.
‘Get me up!’
‘Won’t be a moment, Martin. I’m sorry there’s a delay, only we need some special equipment.’
‘Get me up!’
‘Not long now.’
Despite the eight carers he has each day, the flat is still only marginally habitable. Excepting a few islands of order – a space at the end of a kitchen work surface where some medical apparatus has been laid out to dry; some information sheets in plastic folders tacked to the cabinets; the hospital bed in the lounge and the cabinet next to it – everything else is tacky and malodorous. At the foot of the bed is a high chair with a padded blue cushion facing the television, a pile of porn magazines to one side.
‘Get me up!’
He has a prominent underbite, exposing a line of greasy grey teeth that glisten under the kitchen striplight.
‘I can hear the lift, Martin. She’ll be back in a minute.’
‘Get me up!’


The cushion works well, but even so, Martin is difficult to handle. As each of the four interlinked cushions inflate, the patient needs to move their feet back to give them some kind of purchase and stop them slipping forwards. Martin doesn’t seem able to do this.
‘Falling!’ he says.
‘How did you get in the kitchen?’
‘I’m just a bit surprised, the way your legs are at the moment. Are they worse than normal, would you say?’
‘I think we’ll have to take you to hospital then, Martin.’
‘Don’t want hospital.’
‘Let’s get you in our chair and then have a chat about it.’
He doesn’t seem able to weight bear at all well, and it’s a struggle to stand him up, take the cushion away and put the chair behind him. Even when he’s in the chair, he starts to slip forwards again.
‘Maybe you’re a bit weaker today, Martin.’
‘No. Don’t want hospital.’
‘We can’t very well leave you here like this, though, can we? How would you get to the loo?’
‘I mean the other loo.’
‘I want my chair.’
But there’s no way we can leave him like this. Although it feels perilously like kidnap, we bundle him up and start heading out. It takes a while to leave, though, as we can’t find the key, and have to phone the care agency to clarify the situation.

Down in the ambulance Martin is as uncooperative as before. And in the cold light of the ambulance, it does seem more attitude than illness. All his observations are normal, so there’s not even much of a suggestion of a UTI or any other organic reason why he might fall and not be able to get up again.
‘So how are you feeling now to how you normally feel?’ I ask him, struggling to find a way to phrase it. ‘Do you feel your normal self is what I mean.’
‘Nothing out of the ordinary?’
‘So why did you fall?’
‘Don’t know.’
‘Have you fallen in the past?’
‘And gone into hospital?’
‘And what did they say, the last time it happened?’
‘Don’t know.’
I shuffle through the papers again.
‘But you didn’t seem able to take your own weight when we helped you up, Martin.’
‘And that’s normal for you?’
‘And you walked to the kitchen?’
I turn to Rae.
‘I still think he’ll have to go in. Off legs.’
‘Fine,’ she says, and gets into the driver’s seat.

But after five minutes or so of grinding clicks and clunks, she turns and looks back at me through the hatch.
‘Won’t start,’ she says.

Thursday, February 06, 2014

to the station

A tall, thin red-bricked building with a bay window almost obscured on the left by a vigorous growth of wisteria. A decorative fan-light above the front door, lion-head knocker, mosaic tiles, antique boot scraper – everything perfectly in keeping with the rest of the Edwardian terrace.

A mournful, moon-faced man in a dark suit and tie is staring at us through the window.
I wave as I climb out of the cab.
He pulls back.

Cynthia opens the door when we knock. Behind her, a care worker is standing half-way up the stairs.
‘I don’t know what to do,’ says Cynthia. ‘What can I do?’
‘Shall we come in?’
‘I don’t want to go to the railway station.’
‘You don’t have to if you don’t want to.’
‘What’s to stop me?’
The care worker joins us in the hallway.
‘Cynthia called you from her room,’ he says. ‘She’s had these feeling before – haven’t you Cynth? – and we’ve discussed the things she can do to help herself through them. But of course we can’t stop her calling the ambulance.’
‘Shall we have a chat, Cynthia?’
She leads us into her room, and sits down on the unmade bed.

Despite the high ceiling,the air is thick with stale smoke. What light there is comes filtering through a hang of heavy yellow drapes. A radio plays thinly by the side of the bed. The wardrobe at the foot of the bed stands open, a line of empty hangers on the rail. Just to the side of it is a pile of boxes and suitcases, some still open and their contents spilling out.
‘We’re just in the process of moving,’ says the care worker, closing the door. ‘We’ll be in the new place this time tomorrow, won’t we, Cynth? That’s exciting.’
‘What’s to stop me going to the railway station?’ she says, her eyes drilled deep either side of her nose.

Just beside the bed there’s a piece of paper tacked to the wall – an action list.
Don’t lie on the bed smoking and listening to music all day it says. You don’t want those dark thoughts taking over. Keep busy! Go for a walk up town and treat yourself – a coffee, maybe, and something nice from the shops. Come back and have a lovely soak in the bath. You deserve it! And so on. Upbeat advice, bullet points, capitals, smileys, exclamation marks. Tidy your room. It’s amazing how good a thorough-going spring clean can make you feel!

‘I don’t know what to do,’ she says. ‘Will you take me to the hospital?’
‘Do you remember what the psychiatrist said, Cynth? She said she doesn’t want you going up there anymore’ says the care worker. ‘She said you’d be better off taking your medication and staying here. With all your comforts, and people to talk to. We’ve got lots to do, Cynth. We’re moving out tomorrow. There’s plenty to keep you busy.’

She hasn’t moved on the bed, staring at me, gripping the frame of it either side of her legs like she’s ready to spring up at any moment.
‘Your care worker’s right,’ I say. ‘I’m not sure what more they can do for you up at A&E. It’s so crowded. Not nearly as comfortable as your room here.’
‘But they’d keep an eye on me, though. They’d stop me going to the railway station. Wouldn’t they?’
‘They’d do their best, Cynthia. But they can’t sit with you all day.’
‘Who’s going to stop me, then?’
‘You’ve managed so far today, haven’t you? And that’s really good. You’ve managed to stop yourself going to the railway station, haven’t you?’

She stares at me a while longer, then reaches inside her pocket, gets a cigarette out, lights it, and carries on staring at me through the smoke.

Wednesday, February 05, 2014


Sasha La Ruche should be dancing at the Folies Bergère, not swigging from a shoplifted bottle of wine in Starbucks. But if she ever was in sequins and feathers, she hocked them years ago, and the left arm of the tatty red overcoat she lives in these days has been cut up the seam from cuff to shoulder by the paramedics who attended her yesterday. The nurses put it back together with strips of Micropore.

She’s been up to A&E every day for the past week, always presenting in the same way – unconsciousness in some public place, on the pavement, bench, grass verge, supermarket, once outside a clothes shop where she was trying to walk out wearing a lifted pair of jeans (which the store did not take back, given that Sasha had promptly defecated in them). But although Sasha is always drunk, her unconsciousness is an adaptation, a ploy. In much the same way the puffer fish inflates itself to distract predators and make itself as difficult to handle as possible, Sasha closes her eyes and goes floppy.

It’s a bright, busy morning and Starbucks is crowded, the shoppers and workers on lunch politely fighting over every last seat and table top with trays of coffee, Danish pastries, baguettes. It’s a mark of how busy it is that the spaces on this padded bench either side of Sasha are still occupied. After all, a seat’s a seat. On one side of her, an old lady with such a wholesome gloss about her she could have been dipped in white chocolate.
‘It’s such a shame,’ she says. ‘Tsch.’
On the other side, a woman and her friend, shoulder to shoulder, both sipping coffee and texting with their phones just south of their noses, scrupulously avoid any kind of contact, with us, or each other.
‘Come on Sasha,’ I say, squeezing her shoulder. ‘Open your eyes.’
Two police officers stand just behind us. We’re all wearing gloves, which feels much the worst detail, given the environment, far more than our uniforms or radios.
‘Sasha. Open your eyes. We need to stand up and walk out of here. Okay? Come on, then.’
I apply some more unpleasant stimuli and she’s driven to bat my hand away.
‘Up we come. Ready? Two, three, four... and stand.’
She does, but in a showily unsteady way.
‘Mind your backs!’

And if nature abhors a vacuum, that’s doubly true of a busy coffee shop. Sasha’s spot is taken before we’ve made it past the cookies.