Saturday, March 29, 2014


I’ve been to this estate many times over the years. I could lay the jobs out in front of me like cards from an urban pack of Tarot: King of Cups; The Needle; Queen of Acopia; Misfortune. But today the sun is out, and the daisies in the grassed areas are shining and white. Even the fly-tipped mattress and fridge have an artful look about them. There's a tangle of scaffolding outside the main entrance on this side. Half of the flats have already been fitted with new windows, and the fresh PVC is as strikingly white as the daisies.

We were called to an MS patient who’d fallen on the floor whilst moving between his wheelchair and the bed. He’d been smoking a fine, fat doobie at the time, and his room was royally hung with smoke.
Thanks guys!’ he shouted. ‘I love what you do! It’s amazing!
He was so high, we could’ve tied a ribbon round his ankle and floated him up. Once we had him safely on the bed, he rolled around with the sheer pleasure of it, then told us his story whilst we checked him over. How he’d been perfectly healthy up until about six years ago. How the MS had put him in a wheelchair. ‘But what the hell! I’ve still got me health – well, the MS aside, of course. But seriously, though. I’m grand, fellas. Just  grand.’ He planned to do a parachute jump in the summer. ‘That’s about the only thing left on my list! I used to climb mountains, you know. But sure I’m still good enough to boot out of a plane.’

As I step from the lobby back outside the sunshine is so intense I have to screw my eyes up. The shredded plastic sheeting hanging from the scaffolding flaps gently above us in the breeze, and for a moment it feels as if the whole place – the blocks and ramps, the concrete gulleys and the bald swatches of grass between them –it feels as if everything is gently stirring and moving and shaking itself in happy anticipation of the summer.

A gang of kids appears over the brow, coming down the slope in ones and twos, the smallest of them a straggling, knot-haired girl of about seven leading a brindle-coloured whippet on a length of rope. As soon as they catch sight of the ambulance they all speed up and run down the slope to investigate, the little girl and the dog tripping along behind.
‘What happened, mister?’
‘Did someone die?
‘Shut up!’ says the girl at the front. ‘He’s not allowed to say!’
Another girl gets a dig in the ribs, and the digger gets a kick.
The whippet sniffs the back wheel, and the little girl reaches out to touch the ambulance decals, shining in the sun.
‘Don’t worry,’ I tell them, throwing my bag in the back of the truck. ‘Everything’s fine.’
It’s meant to be reassuring, but in truth they look disappointed. After a minute or two they move away, and stare as we get into the cab. Once it seems as if nothing much else is going to happen, no sirens or dangerous driving, they lose interest, and carry on over to a utilitarian brick building I hadn’t noticed before. More bunker than recreation hall, it’s windows are covered with a protective grille. All around the grille is a bright mural – animals, flowers, people, all made out of scavenged materials, scraps of wood, bent metal and old patterned plates broken up into mosaic tiles and stuck on with grout. The gang of kids drape themselves over the railings that run in front of the building, waiting. Eventually, slightly out of breath and walking with a limp, a middle-aged woman comes down the slope and meets up with them in front of the building. She hunts in her pocket for a key, and grumps her way past them all to get to the door. The only one of the gang to pay her any attention is the whippet, who sniffs her tracksuit pockets.

Once the door is open, all the kids try to run inside at once, fighting each other in the crush, ignoring the woman, who shouts and waves her arms ineffectually as she gets swept away in the tidal wave. Only the little girl with the dog hangs back. She gives the ambulance once last look, then, with the doorway finally clear, she shrugs, and with a little tug on the dog’s rope, skips inside. 

Thursday, March 27, 2014

the manager

Mr Grayling is stuck on the toilet. Although, given his gargantuan size, it might be more accurate to say the toilet is stuck on him.
‘I found him like this on my morning round,’ says the scheme manager, a thin man in a trim black suit and goatee. ‘I don’t think he’s all that well.’
‘Mr Grayling? Mr Grayling?’
He nods his head up and opens his eyes.
‘Get me up!’ he says.
‘We will, just as soon as we can. We’ll get our trolley right up alongside you, but you’re going to have to help us, because obviously we can’t lift you.’
‘Get me up!’
Rae goes to fetch the trolley.

With the manager’s help I move as much stuff out of the bathroom as I can. The gate to the walk-in shower opens both sides to accommodate Mr Grayling’s size, a fact which works to our advantage, as it gives us more headroom for the trolley. Environmentally it seems as if we have just enough space to do the transfer, but given Mr Grayling’s bulk, it’s going to be a close-run thing.
‘We’ll try it once ourselves, but failing that we’ll have to call in the cavalry.’
‘Of course,’ says the manager, narrowing his eyes to emphasise the delicacy of the situation. ‘Meanwhile, should I gather his medications and things together?’
He gives his a little nod of his head, then moves quietly away in the direction of the kitchen.

After Rae has returned and we’ve positioned the trolley as best we can, the first stage is to take off Mr Grayling’s trousers, a trip hazard, looped around his ankles along with his pants. Luckily the trousers have enough flare to slip over his swollen feet, and I pass them over to the manager who delicately puts them in a bag.
‘Stage One, complete,’ I say to Mr Grayling, wiping my forehead with the back of my gloved hand. ‘We’ll pull your pants up when you’re on your feet. We’ll come either side and give you a little boost, but your job is to take your weight, and then make as much a turn to the right as you can and sit on the trolley.’
I look at Rae.
‘When we’ve got him sat down I’ll help him lie back and hopefully the momentum of that will carry his legs up enough to roll onto the trolley.’
‘I’m not convinced,’ she says.
‘Me neither, but it’s worth a shot. If not, we’ll get on the radio.’
‘Get me up!’ says Mr Grayling.
‘Okay, then. Here we go.’
He does manage to take his weight, and after we’ve pulled his drawers up, a couple of tottering steps. I guide him onto the trolley. When he sits, the whole thing creaks and sags alarmingly.
‘And turn...’
He flaps his arms about in alarm, but the movement does allow us to get his legs up. Once he’s lying on the trolley we haul him out into the corridor. With a little more room to move, we untuck the trolley sheet, slide him into a better position, then together raise the back.
‘Mission accomplished!’
‘Well done,’ purrs the manager.
‘Thanks for your help,’ I say.
‘You’re very welcome.’
And if he dropped down on all fours and started rubbing himself around my legs – well, actually, I wouldn’t be all that surprised.

Sunday, March 23, 2014

stag down

The pink tutu Carl is wearing only accentuates his powerful, tattooed physique. He’s sitting on a chair in the lobby of the hotel, holding a tea towel to the side of his bloodied face whilst his friends fuss around him, arguing with the manager, making calls on their phones. There’s a general change of focus as we come through the revolving doors.
‘They’re here. Talk to you later.’
We get the story. How they were all up town for Carl’s stag-do. How they’d had a bit to drink. How Carl had pitched face first into the tarmac when he stepped off the kerb. No, he wasn’t knocked out. No, he wasn’t run over. His neck’s fine. He’s just chipped a few teeth and cut his eye.
Carl groans and takes the tea-towel away so I can examine the wound.
‘It’s quite deep, Carl. That’ll need some attention up at the hospital.’
‘It’s my teeth I’m worried about.’
‘They’ll give you some advice about them, too. Come on.’
He stands up, even taller than you’d think, at least six foot four, arms as thick as my legs.
‘Mind your head,’ I tell him as we open the door to the ambulance. The truck leans towards us as he climbs aboard.


‘Ellie’ll kill me,’ says Carl, holding the sterile dressing in place. ‘She’ll rip me to shreds.’
‘Nah, mate,’ says Rich, his Best Man, coming with him to the hospital. ‘Don’t forget, she’s got the hen party next week. God knows what that’ll be like.’
Carl shakes his head and stares at his feet.
‘I can’t believe it,’ he says. ‘This shit doesn’t happen to me. I’ve been so tired lately. What with the kids and everything. Really all I wanted was a good night out and a bit of a lie-in.’ He looks up at me. ‘Sad, in’it?’
‘I don’t think so. Whatever makes you happiest. There’s nothing wrong in that.’
He sighs and looks back at the floor.
Rich laughs.
‘I’ve just thought,’ he says. ‘We’ve got that photo-shoot tomorrow. Fuck knows what you’ll look like for that.’
Suddenly it’s apparent that Carl is crying a little. He uses the bloodied dressing to wipe his eyes, then sits back in the chair and takes a breath.
‘Sorry, mate. Sorry. It’s the shock of it all, I guess.’
‘Don’t worry about a thing, Carl. We’ll get you fixed up and back on your feet in no time.’
‘I’m just tired,’ he says. ‘All I wanted was a night out with the lads and then bed. And now this.’ He holds out the dressing as evidence. ‘Wasting your time. You’ve got more important things to do than dealing with fuck-ups like me.’
‘You had an accident, Carl. That’s what we’re here for. It’s good. It keeps us in a job.’
‘What, driving drunks around?’
He shakes his head.
‘I can’t believe it. Ellie’ll fucking kill me.’
‘Don’t worry about a thing. Leave Ellie to me,’ says Rich, hugging him round the shoulders. ‘It’ll be like nothing happened.’
Carl looks at him, then smiles a bloodied, crooked smile.
‘You think?’
‘I know.’
Rich’s phone starts to buzz.
He glances down at it, then back up at Carl. And even though I admit it might be more to do with a change of light in the cabin than anything else, his smile seems to lose about ten per cent conviction.
‘Oh Christ!’ says Carl.

Saturday, March 22, 2014

the time

There is a power-saving regime in this neighbourhood at night. All the street lamps are out, everyone’s in bed, and the sky is so utterly black, the stars standing out so clearly, in such limitless number, the earth feels like some dark and cluttered plate, falling and turning beneath them.

Even though it’s impossible to read the house numbers it’s easy to find the address we want; the light from its front room splashes across the garden.

Emily’s daughter Maggie is waiting for us in the porch, hugging herself in a chenille dressing gown.
‘Sorry to call you out,’ she says, leading us inside. ‘I didn’t mean to add to your workload.’
‘Don’t mention it,’ says Rae. ‘What can we do for you?’
‘It’s my mother. She’s fallen out of bed and we can’t get her up. She hasn’t hurt herself or anything but she’s just too heavy for me and my husband. She’s through here.’
Emily is sitting on the floor alongside her hospital bed. Maggie has surrounded her with pillows and a duvet to keep her comfortable, untangled the nasal specs and catheter tubes. Emily is completely deaf, so we reassure her as best we can and then set to work. It takes a bit of arrangement, moving side tables, lamps, a radio and a waste basket – and a heavy chair the family have put against the side of the bed as an extemporary means of keeping Emily from rolling out.
‘We’re not allowed cot sides,’ says Maggie, helping us shuffle things about.
‘They say it’s deprivation of liberty,’ says Rae.
‘I know. It’s so frustrating. The thing is, she doesn’t need to get out of bed. She can’t walk anymore. She has everything done for her where she is. But sometimes she wakes up and gets confused.’
‘I know. A cot side would help.’
Maggie goes to sit down on the sofa with her husband, Phil. Even though Maggie is in her dressing gown, Phil is fully dressed in heavy shoes, jeans and a sensible coat zipped up to the neck. He is sitting there so neutrally, with his hands resting in his lap, he could be secretly asleep, a pair of open eyes painted on to the inside of his glasses.
‘She’s ninety-eight,’ says Maggie. ‘She’s been going downhill these past couple of years. We only live round the corner but we may as well have moved in. Nights are the worst. We can’t afford a sitter, so we just have to hope she stays put.’

Once we have Emily in bed, the three of us set everything back as it was and make her comfortable.
‘It’s no kind of life,’ says Maggie. ‘She’d never have wanted this.’
‘Have you thought about residential care?’ says Rae. ‘Only it’s looking like you’re reaching the end of what you can cope with at home.’
Maggie shakes her head.
‘She won’t do it. She wants to die at home. We thought she was fading last month, but she rallied.’
I bring over a substantial bag of medications. Rae writes them down.
‘You’ve got to think about your health, too,’ says Rae. ‘It won’t help if you get sick with stress. I think a spell of respite care at the very least. Maybe it’s time for a family conference with your GP.’
‘I’ll do it,’ says Maggie. ‘I will. In the morning. First thing.’
She smiles bravely – then notices something on the floor. A little clock, lying on the floor half under the sofa where it had been knocked off the side table. I help her retrieve it, and the little black plastic cover. Neither of us can find the battery.
‘Phil? Can you put another battery in there?’ she says, passing him the clock and the plastic back cover.
‘Righto,’ he says, then stands as if invisible hands had grabbed him by the shoulders and lifted him from the chair.
It’s quiet in the front room. Emily has fallen asleep almost immediately. The only sounds are the gentle hiss of the oxygen, a hypnotic, expiratory sigh as Emily breathes out each time, and Phil, opening and closing cupboards in the kitchen..
Eventually he walks back in, a battery in one hand and the clock in the other.
‘How does this work, Maggs?’ he says. ‘I can’t figure it out.’
Maggie takes it off him and spends the next minute or two turning the battery first one way then another, trying to snap the cover into position. Eventually she manages it, and holds the clock up.
‘There!’ she says. Then lowers it again to re-set the hands. ‘What time is it?’ she says.

Friday, March 21, 2014

the woman with the keys

Hugh fell in the hallway on the way back from the bathroom. He managed to get himself into a sitting position, but now he’s stuck; a fatal combination of three factors – his illness, his Falstaffian physique, and the narrowness of the hallway – have left him stuck there, feet wedged against one wall, back pressed against the other, like Father Christmas stuck down the chimney.
‘Get me up, would you?’ he says. ‘I feel such a prat.’

He’s too big to hoik up by the shoulders, so I go back down to get the Mangar, our inflatable cushion.
When I get back, Marion, Hugh’s ‘woman that does’, has arrived on scene.
‘So now you’ve got two good-looking young men, Hugh. I don’t know – you just snap your fingers and they come running.’
‘You lascivious bastard,’ he says in thunderous Welsh tones. ‘You’re jealous. Just because for once it’s not you getting all the attention.’
‘That’s the last time I soap your balls.’
‘I don’t know  whether you’re doing a good job down there or not. I said goodbye to my balls about five year ago.’
‘Well I’m here to tell you, Hugh, they’re not all that.’
‘Thanking you.’
‘Maybe I should get you a mirror on a stick.’
‘Maybe I should get you fired.’
Marion laughs, a rich, smoker’s bubble.
‘No-one else would put up with you’ she says, then dabs at the corner of her eye with a knuckle like it’s the funniest notion ever. ‘Hugh, Hugh, Hugh. Huge Hugh. What’ll we do with you?’

Whilst all this is going on we’ve been setting up the Mangar, giving instructions, getting into position. Hugh is naked, and I have to keep adjusting the modesty towel.
‘Make sure you keep that puppy covered,’ says Marion. And then just before we start, ‘Where d’you want me?’
‘On the sofa stuffing your face with chocolates, where you normally are,’ says Hugh, grasping on to my hand and struggling to haul his legs back as the pump moans and the first cushion begins to inflate.


Hugh is enthroned back in his favourite chair, swaddled in blankets, with a round of toast and jam and a mug of tea on the side table.
‘That’s wonderful,’ he says. ‘Ahh! King of all he surveys.’
Marion clears up in the little kitchenette.
‘I’ll get started once the boys are gone,’ she calls out.
‘Started on what exactly?’ says Hugh, wiping a gob of jam from his beard.
‘You, you great lummox,’
It’s a lovely flat. Bright and warm, with a fascinating collection of theatre posters, photos and paintings. Next to a portrait of Hugh exuberantly daubed out in vibrant colours, is an equally striking portrait of a young woman in a safari suit, leaning forwards, smiling mysteriously, against a background of Acacia trees and an orange, African sunset.
‘Who was that?’ I ask as Rae finishes the paperwork.
Hugh leans sideways in his chair to look up at the painting.
That,’ he says. ‘That was the only woman I ever knew who had the keys to the Kremlin and the Vatican.’
Marion is leaning in the doorway of the kitchen, watching us. Her eyes shine as she looks at Hugh.
‘He could tell you some stories,’ she says, wiping her hands on a tea towel.

‘Oh yes,’ says Hugh, relaxing back in his chair. ‘It’s not just a lot of soapy old balls, you know.’

Thursday, March 20, 2014

a disney finish

‘Have you met Stephen before?’
‘Maybe I’ll recognise him when I see him.’
‘He’s a piece of work.’
Certainly the notes would point that way. His address is tagged for threatening and abusive behaviour. Shouts and swears when questioned about his medical history. Multiple attendances.
‘Sounds delightful.’
‘Glad you’re in the back.’
In many ways it’s a good one to finish. The right side of town, the right degree of difficulty. In this never-ending game of Trying to Get Off On Time, this is a move I can see working to our advantage, abuse or otherwise. I can soak most things up when I have a higher purpose.

I’ve certainly been to this block before, an austere slab of architecture that would’ve made Stalin twitch. The corridors on each floor are so long there is a lift either end. As you walk along the corridor, the lights flicker on for that section, gradually illuminating what’s ahead – which begins to feel like a reflection of what’s been. The only thing to differentiate each door is the offensiveness of the welcome mat outside and the degree of distress to the woodwork. Stephen’s stands out in that respect. A crazed pattern of dents and crudely mended holes – an eloquent history of forced entry – underlined by a letterbox sealed with gaffer tape.

The door stands open.

‘Hello? Ambulance?’

Stephen is in the little bathroom immediately to the right as we go in, scowling dangerously. As soon as I see him I remember that I have been here before. I’ve certainly seen him around A&E. A history of COPD, non-compliant both in meds and lifestyle, mental health issues. The notes had said thirty attendances in the past month, which sounds excessive even for Stephen, but none of this influences our game plan. Mindful of his temper and how any mishandling could de-rail the smooth end to our shift, we have armoured ourselves against any outrage just as effectively as the shiny metal panels in the lift behind us proof it against graffiti. Expedience makes us invulnerable.

‘’ he says.

‘Hello Stephen. We’ve brought our chair for you. Do you have your keys, phone, a coat to wear? There we go! Let me get that for you. Would you like the lights on or off? Okay – you may keep your arms over the straps as a special favour, but only if you promise not to grab. Can you do that for me? Great! Here we go then!’


Stephen sits on the edge of the ambulance seat, hands planted on his knees, the nebuliser hissing and vapour gently rising from the vents in the mask. He looks like a character from a Disney film, a dark and magical tale about an angry man who gets turned into a boiler. And if he’s the boiler, I must be the princess, fa-la-laaing on the opposite seat, meeting his scowls with a laugh and a series of cute little ticks on my form: abusive, uncooperative, aggressive. There now! Gracefully adjusting levels, finding wonder and enchantment and love in just about everything.
‘Have you seen your doctor lately?’ I ask him, frowning at first, and then sighing with disappointment when he tells me to shut the fuck up.
At least that’s what I think he says. The neb is so noisy it hides much of it.
‘Oh that’s a shame!’ I say, feeling another song. Well – Fiddle-de-Dee!

The road is magically clear of traffic. We get to the hospital a little more quickly than I’d anticipated, and when we finally roll up the ramp to A&E, there are half a dozen trucks already parked there.
‘Bit of a queue,’ says Rae, ominously, after calling out the arrival time.
A little shiver, but then – no matter!
‘Let’s get a blanket for your shoulders,’ I say to Stephen. I snap my fingers, and a flock of bluebirds fly in through the back door with a lemon coloured cell blanket. They drape it around him, bickering in a comical fashion at first, losing a feather or two, but getting it right in the end, and hugging each other in a mid-air heart-shape.
‘Cunts,’ says Stephen. 

Saturday, March 15, 2014

trouble in store

It’s so perfectly arranged – Mrs Rogers on the chair with a phone to her ear; the supermarket manager standing by her right shoulder, holding her bag; the First Aider, kneeling at her feet, taking details; the vegetable section guy standing guard over the three of them, stopping people cutting through to get to the cucumbers – you’d think there was an easel set up opposite, in soft fruits, and an artist capturing the whole scene in oils.
‘Is she on the phone to control?’ whispers Rae to the manager, after we’ve stood waiting for a couple of minutes. I’ve already pointed out the bananas to one person. Any longer and I’ll be going to the stockroom for more.
‘I think so,’ says the manager.
‘Well – can you tell her she can hang up now? The ambulance is here.’
Mrs Rogers holds a finger up.
‘Just a minute,’ she says, then back into the phone: ‘Now look. Can you reassure me that this has all been logged? Because it’s not satisfactory you know. Okay? Good.’
She hangs up without another word and tosses the phone to the manager, who only just manages to catch it.
Rae steps forward to speak to her, but she holds her finger up again.
‘Did you get all my details?’ she says to the First Aider.
‘All except the postcode and phone number.’
Mrs Rogers tells him, emphatically, using the International Phonetic Alphabet, then asks the First Aider to read it back, just to be sure.
He’s half-way through the phone number when Rae interrupts.
‘Mrs Rogers?’ she says. ‘Sorry. We just need to reassure ourselves that you’re okay, then we can be on our way. Tell me what happened.’
‘I tripped over a plastic crate that someone had left on the floor,’ she says, her face and eyes hard. ‘On the floor! What it was doing there I don’t know. But down I went.’
‘Did you hurt yourself?’
Mrs Rogers rubs her knees through her polyester slacks, so roughly I half expect to see sparks.
‘Of course. I’m very sore.’ She glances over at the manager. ‘I shall want all my shopping put through the tills.’
He shifts uncomfortably.
‘Did you stand up after the accident?’ says Rae.
‘Yes. Then eventually someone had the sense to find a chair.’
She pulls up the trouser legs to expose her knees, neither of which show any sign of trauma.
‘They look good,’ says Rae.
A woman privately appreciating the weight of a large butternut squash glances across at me, then carefully puts it back and hurries away.
‘Come on. Shall we go for a stand?’ says Rae. We offer our hands; Mrs Rogers rises out of the chair.
The manager holds his breath.
The First Aider’s pen hovers above the form.
‘There! How does that feel?’ says Rae.
‘Well. Hmm. Of course, last time I broke something down there I didn’t know about it for a month,’ she sniffs. ‘Then I was hobbling about in a cast till Christmas.’
‘I think you’ve probably escaped without serious injury this time, though,’ says Rae. ‘Do you think you’ll be needing a trip to the hospital?’ She shakes her head as she says it.
‘Probably not.’
‘So you don’t really need us here?’
‘Okay. That’s fine. Well. Goodbye Mrs Rogers. I’m glad you’re all right.’
She nods to the manager.
‘We’ll be off,’ she says, patting him on the shoulder.
‘I hope this has all been officially recorded,’ says Mrs Rogers, sitting back down again and folding her arms.
The Manager smiles anxiously.
The First Aider checks his watch, then finishes writing the form.

Friday, March 14, 2014


The whole time we’re in the bedroom treating Rita’s hypo, Spangles the morbidly obese Chihuahua wheezes around our ankles, checking us out. He’s an unprepossessing creature, Peter Lorre’s head grafted onto the body of a pig and then shrink-rayed to the size of a cat.
‘Don’t pay him no attention,’ says Rita, thickly.
‘Good! You’re a bit more with us now,’ says Rae, checking her pulse. ‘Keep eating the sandwiches.’
Rita shudders down a bolus of bread, takes a sip of lemonade, pulls a lemon face, then asks me if I’ve got dogs.
‘Two. A lurcher and a terrier.’
‘He can smell ‘em on you,’ says Rita, pointing a crust at me and nodding sagely. ‘He’s got a good nose on ‘im.’
‘A real cutie,’ I say, glancing down at Spangles, who immediately bares his teeth and then click-clacks away across the parquet floor to stare at me from the dresser.
‘I expect he’s after scraps,’ I say.
‘Well he’s not allowed,’ says Rita. ‘The Vet keeps telling us off about it. When we took him off our neighbour he didn’t weigh no more’n a rat. It’s difficult not to feed ‘em up when they look like that. Especially when they’re so quick if you drop anything.’

Spangles has ventured back out again. I can feel him sniffing around my boots.
‘Guess what his favourite snack is’ says Rita.
‘I don’t know. Salami?’
‘He crawls around under the furniture eating dust.’
Dust? How can you like eating dust?’
Rita picks up another sandwich and studies the top and bottom of it without enthusiasm.
‘I don’t know. I think he just likes all the crumbs you get in it.’

real life

There are three other ambulance crews waiting to handover in the triage area, so we take our place in the queue, tucking ourselves in as best we can, somewhere between CT and the exit. It’s only when we’ve settled in that I notice Richard, the lead consultant, standing by a patient on a stripped-down ambulance trolley. The patient is wearing a collar, lying in a strange position on a vac-mat, but although it strikes me as odd that he’s not fully immobilised, I assume he’s been semi-cleared, waiting to go off for x-ray or something.
‘Now don’t move,’ says Richard. ‘You’ve got a fractured femur, remember?’
‘I can’t believe this is my second go.’
‘And you’ve got a lot of alcohol on board. Okay? Happy?’
Richard goes over to the other crews but I can’t quite hear what he asks them. It all seems very odd, but still, I take it at face value. I make sure our patient is as comfortable as possible, then look over my paperwork to see if there’s anything else I want to add.

Suddenly, Richard is standing in front of me.
‘Could you come in and hand my patient over for me, Spence?’ he says. Before I can say anything, he takes me by the shoulder and leads me over.

‘This is Luke. Twenty-four years old. Luke’s been drinking alcohol today. He jumped over a wall and fell twenty feet onto concrete. Landed on his left side. A period of unconsciousness. Reduced air entry on the left, query left femur. Okay? They’ll be ready for you in a minute. I’ve just got to go in and set up.’
And he hurries off through the resus doors.

Intensely odd.

‘Hi Luke,’ I say, looking down at the patient. And then: ‘Oh! Luke!
Luke is a nurse who works at A&E.
He wriggles around on the vac-mat.
‘Just hold still,’ I tell him. ‘It’s important you don’t move your head.’
There are no straps on him, no tape securing the blocks. Why isn’t he fully immobilised? Reduced air entry? Fracture femur? Where’s the oxygen? The Kendrick? And why aren’t there any poles on this trolley? Why is it in the down position?  And any moment now I’m supposed  to handover to the resus team.


I’m utterly confused.

Luke sits up.
‘I can’t bear this fucking collar,’ he says, turning his head from side to side. ‘Is it on straight?’
‘Luke! Luke! You must keep still and lie flat. You’ve had a long fall and you might have hurt your neck.’
He lies down again.
‘Yes, but is it on straight? I can’t believe I put it on myself. This is fucking ridiculous.’
‘I hardly think you put this collar on yourself,’ I tell him, holding his head still between the blocks. The head injury is making him combative, I think.
But there’s no blood. He doesn’t smell of alcohol. His tracksuit and t-shirt are immaculate.
‘Where did you fall?’ I ask him.
‘I don’t know,’ he says, staring up at me. ‘The beach? You decide.’
‘You don’t remember?’
He stares at me.

Richard pushes the resus doors open.
‘Come on. Ready for you now. Bring the patient through.’

Not only is the trolley in the down position and without any poles to steer, but there’s something wrong with the wheels. They’re locked into the in-line position, and the red button that normally releases them won’t respond to my kicks. It’s difficult to do that, anyway, as two nurses are hurriedly dragging us forward and not stopping to do anything about it, even though they’re forced to lift the trolley a couple of times to make the turns.

The team is standing around a resus bed ahead of us.

‘Let’s get the patient across and take the story once he’s over,’ says Richard, running the show from a white metal trolley off to the side. ‘Ben? Airway and primary survey please.’
‘Is he on a scoop?’ says another consultant.
‘Er – no. Apparently not.’
‘Why’s the trolley so low?’
‘I don’t know. Battery’s flat.’
‘How are we supposed to get him over?’
‘Someone could get a replacement battery from another trolley.’
‘Just lift him up on the mattress for now.’
‘It’ll sag in the middle.’
‘We’ll pretend it doesn’t.’
‘No, no. Let’s do this properly. Nurse, fetch the scoop.’

There’s a lot of unconvincing fussing around.
Ben starts his assessment, leaning over me in the cramped conditions beside the trolley.

None of it makes sense.  

And then suddenly I understand. And all the facts and scraps of information that should’ve tipped me off, crowd in:

The sheepish crews.
The strange trolley.
Richard, loitering outside resus with a seriously injured patient.
‘I can’t believe I put this collar on myself’
‘Where did you fall?’
‘You decide.’

This isn’t real life.
Nor is it a waking dream.

This is a scenario.

‘Let me tell you the story now,’ I say, speaking across the team. ‘ We’ve got Luke. Twenty-four years old. Alcohol. Fell twenty feet onto concrete. Unco for a time. Query reduced air entry on left; query left femur. Richard? Would you mind if someone else took the head? Only I ought to be attending to my patient outside.’

‘Of course. Thanks for your help.’

I’m blushing so much as I exit the doors, when I peel my blue gloves off and throw them in the bin I want to jump head-first after them.

Saturday, March 08, 2014

after mr walsh

There is a girl standing in the garden. Her fear is a visible thing, shimmering around her, like a heat haze.
‘Are you a relative?’
She shakes her head.
‘This guy came running out and told me to ring you.’
‘Can I go now?’
‘Just wait for the police, if you wouldn’t mind.’
The front door is open.
We go in.

A man calls down to us from up on the landing.
There is a hand poking out through the railings at the top. We duck to avoid it.


Half an hour later, with the rest of the team finishing off upstairs, I come back down to speak to Aleksy. I had sent him downstairs when we arrived.
‘Any information you can find would be really helpful. Date of birth, medications, that kind of thing.’
Cutting through the t-shirt, sticking the pads on, pressing up and down on the chest.
‘Sure. Sure.’
It’s awkward for him to get round the body. He holds on to the banisters with both hands.

There are two police officers with him, one looking through a desk for identification, medical papers, anything useful; the other is in the kitchen, checking for a note. Aleksy is sitting on a chair in the living room, his powerful shoulders rounded forwards, his weight carried on his forearms as he picks flakes of paint from the calloused skin of his fingers.

A mug of tea on the table next to him, untouched.

He looks up.
‘Is dead?’
‘We’re doing all we can, Aleksy, but it doesn’t look good.’
‘I know for sure is dead,’ he says, going back to his hands. ‘I know when I see hang on rope like doll. Ay!’
He takes a deep breath and leans back in the chair. ‘Ja pierdolÄ™’
‘Are you okay?’
‘Me? Of course. Is no problem.’
‘Tell me what happened.’
‘Is like I tell policja. I come back from work. Hello? Mr Walsh? No nothing, not sound. Okay. Very well. I go up for clean little bit. I find Mr Walsh on rope. I go in kitchen for .. erm .. ‘ he shakes his head, mimes a cutting action.
‘A knife? A bread knife?’
‘Yes. Exactly this. Bread knife. So I take bread knife and I go back upstairs and I make cut in rope at top. He fall on floor. Boom. Then I make to cut here also, because rope no good very tight to breathe, you understand? Okay? Then I run outside for to get help. My phone no good, phone of house, no good.’ He shrugs. ‘Every damn something else. No good.’
‘You did well, Aleksy. It’s a tough thing to happen.’
He shakes his head and stares out of the window.
‘Is there someone you can call?’
‘My brother. He come soon.’
‘That’s good. Would you like some more tea?’
‘No. Thank you very much.’
I start writing out the sheet, the few details I’ve been able to discover from the police, what we found and did, the ordered futility of the resus.
‘What I do now?’ says Aleksy. ‘Where I go? I pay all monies yesterday for deposit and rent. But I can’t stay here in house after Mr Walsh. What I do?’
‘Couldn’t you stay with your brother?’
‘I did this too long time, too long time. This is why I took house share. Ja pierdolÄ™.’

More police arrive. A sergeant or something.
‘How are you getting on?’ he asks, pleasantly, taking off his hat and putting it under his arm.

‘Nie ma sprawy’ says Aleksy with a bitter laugh. Then shifts his bulk forwards in the chair again, and goes back to examining his hands. 

Thursday, March 06, 2014

guess the year

Margaret trips and falls in the street. A couple help her into a sitting position, and whilst the woman cleans up her face with some tissues, the man calls for an ambulance.

Margaret isn’t too bad. She has a small laceration above her right eye, some general nicks and scrapes, but all in all seems to have weathered the accident pretty well. She stands and walks with confidence, and whilst it’s true she has a distracting injury, she has no significant pain, no neurological deficit, so we’re happy not to immobilise.
‘We still need to take you to A&E for a proper clean-up and to keep an eye on you the rest of the afternoon,’ I tell her.
She’s happy with that. She’d finished her shopping. I mean dash it all, at ninety-four she’s old enough to recognise what’s important and what’s not.

At the hospital Niall, the rockabilly Charge Nurse, writes down another set of obs. Margaret’s blood pressure has gone up, and there’s even a suggestion her right pupil’s bigger than her left.
‘Have they always been different sizes?’ he asks her.
She shrugs.
‘No one’s mentioned it,’ she says.
‘Do you have a headache at all?’
‘Blurred vision? Nausea?’
‘Not a thing. It’s all just a bit of a nuisance, really.’
Niall writes down her temperature, frowns, clicks his pen.
‘And she’s been GCS fifteen the whole time?’ he asks me.
‘Absolutely. We’ve had a good ol’ chat.’
‘Hmm,’ he says, then squats down and rests his hand on Margaret’s.
‘Can you tell me what year it is?’ he says.
‘What year?
‘Yes. What year are we in now?’
She stares at him, opens her mouth a little, closes it again, gives her head a little shake.
‘What year? Well now – let’s think.’
After a little pause she looks at him again.
‘Nineteen fifty-eight,’ she says.
‘Okay. It’s actually two thousand and fourteen,’ he says, patting her hand, then standing up again.
Rae unwraps the cuff from Margaret’s arm.
‘Your haircut’s confusing her,’ she says.

a bad feeling

We’re desperate to be off on time. We’ve all had several shifts, long overruns. Rae’s got a dinner date, Caz the student paramedic is meeting friends up town, and I feel like I’ve only seen the family long enough to kiss them goodbye or hello. Timing is everything, then, which is why Rae is driving like an urban fox, any trick or shimmy, whatever it takes to get us through the evening rush hour to the female, overdose in the centre of town.

‘Scoop and run,’ she says, flipping the ambulance arse-up, nose down and diving down a manhole. ‘Breathe in’

There are two guys of indeterminate age, raddled with rough living and rougher vodka, sitting out on the stoop of the block, watching the sun go down.
‘Is it Emma?’ says one.
‘Door’s open,’ says the other. They both lift their bottles in a hearty salute.

Deeper inside the building and we find another security door between us and the corridor we want. For a moment we wonder how we’re going to get through, because Emma isn’t answering her buzzer. I’m just about to go back and ask one of the stoop guys when Caz calmly reaches through the space where a pane of glass should be, and flips the latch.
‘I just thought it was very clean,’ I say.
We hurry on.

Emma’s front door is unlocked.
Hello. Ambulance.

The hallway to the flat is lit by a shadeless bulb, a feeble spread of yellow light over walls daubed with words in turquoise paint: DIE TOM. I WANT TO HURT YOU BAD. TOM IS SCUM.
There’s a loud noise from the bedroom, something like a klaxon on a sinking submarine: BARRP BARRP BARRP BARRP.
Hello? Ambulance.

Emma is naked on the bed, reading the text message that the hideous alarm has alerted her to.
With her pendulous breasts and generous folds of flesh rolling out over wide hips, all in the dip of the mattress, she reminds me of one of those Palaeolithic figurines carved in bone or stone, an abstract, totemic figure. But if the ice age women were carved to represent fertility, Emma has come to represent something else, something less productive and more despairing. She sobs, then chucks the mobile across the room, rolls over on to her side, and pulls an Arsenal quilt over her.
‘My head,’ she says, her voice muffled by the quilt. ‘I’ve got a bad feeling in my head.’
‘What bad feeling?’ says Caz.
Rae glances at her watch.
‘Shall we get you some slippers and a dressing gown, Emma?’ she says.
I hurry off to find them.

Monday, March 03, 2014

a puppy too far

Mitzi meets us at the door. She’s been crying; two messy splodges of mascara where her eyes used to be.
‘He’s through there,’ she sniffs. ‘I told him not to come out.’
Gary is moaning in bed, his left arm crooked over his head, the other one bunching up the sheets to his side.
‘Just – one second,’ he says, before rolling over and throwing up in a bucket.
‘He discharged himself from hospital this morning,’ says Mitzi, tearing off some toilet roll and passing it to him. ‘He’s got a kidney infection. They said he wasn’t over the worst of it and now look.’
‘Why did you discharge yourself, Gary?’
He flops back on the pillow, exhausted.
‘It’s my birthday,’ he says.
‘Oh! Happy birthday, Gary!’
‘Yeah. Right. Thanks,’ he says, the words pattered out by the rigors of his fever.
‘The doctor said to come straight back in if his symptoms got out of control again, which they have,’ says Mitzi, squeezing his feet through the duvet.
‘It’s back to the hospital, then, Gary.’
‘I know,’ he says. ‘Fuck it.’

Whilst Rae takes a few obs, I follow Mitzi out of the room to help her get things ready. The kitchen is sectioned off with a baby gate; just beyond, a beautiful black and tan puppy yips and yaps and skitters across the laid out sheets of newspaper, crazy with the unalloyed joy of it all.
‘Sorry about the mascara eyes,’ says Mitzi, pausing at the gate to blow her nose. ‘It just all got too much. First Gary getting ill, the birthday and everything, and then the puppy.’
‘What’s wrong with the puppy?’
‘Nothing. I don’t know. I just forgot how much work they were.’
We both pause a moment and watch as the little dog throws itself around some more, leaping up, wagging its tail, trying to force its head between the bars, yip-yapping.

‘Just one night. That’s all I need,’ says Mitzi. She takes a breath, then slowly, wearily, reaches over and unlatches the gate.

Sunday, March 02, 2014

where ever there was danger

 Seb is asleep on the trolley, his mouth sagging open, his fingers laced across his belly. With that tangled mass of grey hair, and those tattoos of whales and other sea creatures curving round his powerful arms, it could be King Neptune lying there, if Neptune had drunk a litre of cider for breakfast and found himself washed up on the pavement of a suburban British street.
Seb twitches, and his eyes are suddenly open.
‘All right?’ I ask him.
He stares up at the light just above the trolley, then struggles to sit up. I pull the back of the trolley into a sitting position.
Seb rubs his face.
‘I was dreaming,’ he says.
‘What were you dreaming about?’
‘Same thing I always do.’
‘What’s that?’
‘Being underwater.’
He takes a deep breath, just exactly like he was breaking surface, then looks at me.
‘Why do you think you always dream of being underwater?’ I ask him.
‘I was a diver,’ he says. ‘All my life. Since I was twenty-one.’
‘Wow. That’s impressive.’
He shrugs, then folds his arms.
‘I went everywhere. Started off in the North sea. Shetlands. Then Syria, Saudi, Yemen. Somalia. Where ever there was danger, I was there.’
‘Sounds like a tough job.’
‘It’s all I knew. And now look.’
He raises his hands up and apart like he was letting something go.
‘An al-co-holic,’ he says. ‘Plain and simple.’
 ‘Are you getting help with that?’
‘An al-co-holic,’ he says again, like I hadn’t really heard him.
The cider has dried his mouth, and it’s an effort for him to talk. I pass him a little carton of water and he takes a few shaky sips. His face is reddened with the alcohol and the time he spent lying in the street.
I turn the heating up a notch.
‘It must be difficult, keeping your cool underwater,’ I say. ‘Not getting panicked.’
‘S’all right,’ he says. ‘I used to feel more at home down there. I understood it better, d’you know what I mean?’
‘I think so.’
He grunts, then smacks his lips drily and hands me back the empty carton.
‘I never had a moment sick – well, apart from a touch of the skin bends once. But at least I didn’t get it in the spine, which is what happened to Boysie. He never walked again.’
‘That’s pretty tough.’
‘Good money though.’
The ambulance rocks from side to side and suddenly the lights go out.
‘Sorry,’ I tell him, standing up and putting them back on again. ‘Dodgy electrics.’
‘Don’t worry about it ’ he says, swatting the air in front of him, then folding his hands on his belly again and closing his eyes. ‘I’ve seen worse.’

Saturday, March 01, 2014

bra bra bra

You can almost see Jean’s loneliness. It’s palpably there in the room with her, a witch’s familiar, sadly pacing the carpet between the window and the chair.

‘Hello me duck,’ she says, her head nodding slightly, her eyes shining. ‘Sorry to call you out but I was having another one of my do’s you know and I got me’self in a bit of a lather.’

I’ve met Jean before. She’s been checked out a number of times for chest tightness and palpitations, but nothing’s ever being found. She gets plenty of help at home, and her son comes over regularly through the week. Despite it all, for whatever reason, sitting quietly in this pristine room, with the sunlight shining in on the rich green leaves of the umbrella plant, and glinting off the framed pictures on the wall, and the gold coloured casing of the carriage clock gently ticking on the mantelpiece, with the sound of children shouting and laughing and screaming in the playground just across the way, for some reason Jean gets overcome with a feeling of doom, and her heart skips up, and she presses the red button on the cord round her neck.
‘Sorry love’ she says.
I chat to her whilst I go through all the obs and wire her up to the ECG.
‘You used to work in a shop, didn’t you, Jean?’
‘I did. I was in women’s underwear. Lacy knickers, camisoles, combinations. You name it. All very high-end. I loved it. All the girls under me. We had a right laugh.’
‘Sounds like a nice thing to do.’
‘It were. I used to do the windows, n’all. Dress ‘em up nice. Different times of year, you know. Valentine’s Day. Christmas, with all the fur. We had a right laugh. But the shop got bought out by one of them big chains. And not long after that I was walking by and I tell you what it almost broke my heart. Just a load of bras, piled up in the window. I mean, what’s the good in that? Who’d want that?’
‘You’d think they’d take a bit more care.’
‘I used to take a lot o’care. All interesting poses, dressed up nice. Enticing, you know. But this! This was just bra, bra, bra.’
She holds still whilst I take a print out of her heart.
‘No wonder they went bust,’ she sniffs, as the paper spools out. ‘How’s me heart looking, mate? I’ve still got one I tek it?’