on the lookout

It’s late at night, and so quiet you could be persuaded that the place was empty and not filled with hundreds of sleeping prisoners. The officer leads us through a series of metal gates into the medical wing, up a steep flight of stairs with a stair lift to one side, and onto a long, narrow corridor with cells off to the right and a duty desk and offices just to the left. A group of officers are chatting in a muted kind of way around the desk. It seems to me that they’re haggling over who should go with the prisoner, but they seem pretty relaxed and good humored about it.

The prisoner is lying on his bunk with his arms up over his head. He acknowledges us with a groan, but he certainly looks hungry enough to outrun any of us here, with or without a head start.

We back out of the cell whilst the officers move in to dress him in the special costume they have for high-risk prisoners – an extraordinary outfit, something like a Jester onesie, a garishly-patterned, yellow and green squared oversuit that only lacks a pointy hat with bells and a bladder on a stick.

‘It’s so he stands out in a crowd,’ says the prison nurse. ‘You’ll want to keep your eye on him. So just – you know. Be careful. Anyway – how are you?’

Whilst the other prison staff are pretty much who’d you’d cast for the role – thickset, powerful men, as no-nonsense as a knuckle of pork, the nurse seems able to flip from role to role, from homey aunt to gang matriarch. So although she looks at home in this brutal environment, the heavy locks and steel-barred doors, the peep holes and key chains, the cold and echoing corridors, I can also imagine her outside, nibbling sandwiches and laughing too loud at some garden party. She reminds me of one of those delicate birds you see on wildlife shows, riding between the ears of a rhinoceros.

‘My allotment’s doing well,’ she says, folding her arms and leaning back against the wall. ‘Tons out already. But I tell you something interesting that happened the other day. We had the archaeological society come over. They were asking us if we’d keep an eye out for anything unusual, any bones or whatnot. And funnily enough just the other day I’d pulled out a big old vertebrae and I wondered what it was, because it was bigger than any cow bone I’d ever seen, and they said Yep! That’s the kind of thing! A giant deer! Well. I must admit I was a bit disappointed because I thought it might be a woolly mammoth, but they said Oh well! Keep digging! You never know!’

Meanwhile, the prisoner is ready to go. He shuffles out in his extraordinary uniform, shackled with chains and padlocks, and we all make our way down to the ambulance.

‘See you later!’ says the nurse from the top of the stairs.

*

There’s not enough room for everyone to ride in the back, so one of the officers sits up front with me.

We approach a point in the journey where we can either cut across country or go through town. At this time of night it’s quicker to go across country, but it suddenly strikes me that if anyone were to set-up an ambush, the cross-country route would be the place. There are fewer people around, and the single carriageway would be easier to block.

I put this to the officer.

He snorts.

‘Nah. Take the country road. You’ve been watching too many films, mate,’ he says.

speeded up

One of the police officers nods for a quick word off to the side.

‘Richard’s got a record for drug offences. Nothing violent, just a regular pain in the arse. Just so’s you know.’

‘Thanks.’

The patrol car had come across Richard lying on the pavement having a seizure. But the strange thing was, he’d gone from full-on shakes and foaming at the mouth to jumping up and chatting. Now, he stands approximately upright, his body undergoing such a rapid series of contortions you can only think it’s drug-related. It’s as if a film had been taken of Richard in an awkward social situation – a study of all those casual changes of posture, the hip slouches, shifting from leg to leg, raising of eyebrows, frowns, smiles, head-shakes and stretches of the back – but then speeded the whole thing up by a factor of six. Now and again he plunges his right hand down the front of his tracksuit bottoms and fiddles around, clenching and unclenching his jaw, flicking his attention between us like a mouse surrounded by cats.

‘Hello Richard. My name’s Spence, this is Rae. How are you feeling?’

How am I feeling? I’m feeling good, thank you. How are you feeling?

‘Good thanks. Yeah – not bad. Now, Richard, the police have called us because they said you’d had a fit.’

A fit? Me? No. A fit? No. Who? I’m fine. Thank you.

‘Now – I’ve never met you before, Richard, so I don’t know what you’re normally like. But I have to say you’re behaving in a very bizarre manner.’

Bizarre? What do you mean? I think you’re bizarre. Who?

‘Have you taken any recreational drugs this evening?’

At this point one of the officers steps forward.

‘Richard? We don’t care if you have or not, mate. We just need to know so we can get you the treatment you need? Do you understand?’

Yes. Officer. Uh-hum. Yep. Treatment? What treatment? I’m fine. Seriously. I just had an argument with my boyfriend and I’m on my way home, if that’s okay with you.

‘How are you going to get home? I happen to know you live about fifty miles away.’

Do you? Do I? How interesting. Well – I’ll manage, thank you. Now, if there’s nothing else, I’d like to go. I don’t have to have treatment. I can refuse.

‘That’s true. But it’s our job to look after your well-being. If we don’t think you’re safe, we’re obliged to take care of you, otherwise we’ll get into trouble with the Coroner later on. So why don’t you let these good ambulance people check you over, and if they’re happy you can be on your way.’

No, thank you.

Another of the officers steps up.

‘One thing we have to do is search your bag and pat you down, Richard. Okay?’

Sure. No problem.

He takes his shoulder bag off and goes to tip the contents out on the pavement.

‘Whoa! Slow down, mate. Just put it down here and I’ll do it in my own time.’

He goes through the bag, holding up anything suspicious.

Poppers. That’s legal, that is. You can buy it in the shops. It makes it easier to take it up the arse, officer.

‘I see. What about these?’

Retrovirals. My prescription.

The search goes on, but apart from toothpaste, a diary and some other things, it all looks fine.

‘Listen,’ says the officer, zipping the bag up again and handing it to Richard. ‘The easiest thing would be for you to jump up on the ambulance and get checked over.

No. I refuse and you can’t make me. Just give me the papers to sign and I’ll go. I’m fine. Thank you.

‘Would it shock you to know that you don’t look fine. You’re behaving very strangely.’

Am I? I don’t feel strange. You look strange. Maybe you should go to hospital.

‘Yeah? Well. Maybe I should. At least I’d get a break from this shit.’

Suddenly Richard pulls his hand out from his trackie bottoms and holds it out to me.

Goodbye. And thank you for coming.

‘Richard? Mate? I really don’t think he’s going to want to shake that.’

fetch

Eleanor has a field of anxiety around her as palpable as mains hum. Her features are slack, a wattle of loose flesh under her chin emphasizing each tremor and tremble, each nervous flick of attention and concern.

‘I have to get it sorted,’ she says. ‘I can’t go on like this.’

Her brother, Ralph, is anxious, too, but as a thinner, more active man, the quality of his worry has a defined and cartoonish quality. His home-cut hair sticks up like he’s just stuck a fork in a toaster; his teeth protrude from his mouth in an alarming dental flare which his tongue passes over from time to time.

‘Save your breath,’ he says, patting her hand. ‘Don’t exert yourself. You know what happened last time.’

Last time turns out to have been yesterday. And the day before that. And the day before that. A quickening pattern of acopia spreading through the preceding months.

 Eleanor has asthma. She’s on a conservative regime of medication, and it would appear to be adequately controlled. Eleanor felt short of breath this morning. She has a nebulizer in the front room, but the line doesn’t reach to the bedroom and she didn’t feel able to walk through. So she used her Ventolin and called 999. When we arrived all her obs were okay, she had no wheeze or worrying chest sounds of any kind, and she could certainly talk quite freely. Normally we would refer back to GP, but when I suggest it the response is prolonged and emphatic.

‘Useless. Absolutely useless.’

‘He never comes out.’

‘You never see him.’

‘How am I supposed to get down there?’

‘And when you do he always says the same thing.’

‘Don’t work yourself up, Eleanor.’

‘I can’t help it.’

‘Save your breath.’

And so on.

I make one last effort to persuade her.

‘You see, A&E is really for people who are acutely unwell, Eleanor. Your condition is more of a chronic thing. I don’t blame you for calling the ambulance when you were feeling short of breath – that’s perfectly understandable. You did the right thing. But now it’s all settled down, you’d be better off seeing your GP and talking through all the options there might be to help you cope better at home. The respiratory team, community health, that kind of thing. What do you think?’

‘I want it sorted. I can’t go on like this.’

‘But hospital isn’t really the place.’

‘Are you saying my sister should not go to the hospital if she wants to?’ says Ralph, moistening his teeth and then turning his mouth into a tight and approximate smile.

He looks tired.

They both do.

‘You’re perfectly within your rights to go to hospital if you want to, Eleanor. I’m just saying I don’t think it’s the right thing to do in this case. Your doctor is the person to co-ordinate a higher level of home care if it’s needed.’

‘He says I shouldn’t go,’ says Eleanor to Ralph, as if she’s having to translate. ‘What do you think?’

‘I think you need sorting out,’ says Ralph. ‘This can’t go on.’

I shift in the chair, and try a different angle.

‘What did they say up at the hospital when you were there last time?’

‘Nothing. They said I didn’t have a chest infection, that it was just my asthma, and I should carry on as normal. But are you telling me this is normal? Is it?’

‘Save your breath,’ says Ralph, patting her on the hand again. She moves it away onto her lap.

‘What do you think I should do?’ she says to me.

‘I’ve told you what I think. I think we should phone your doctor and arrange an appointment for him to come and see you.’

‘But he won’t get here till the afternoon.’

‘You’ll be okay till then.’

‘I wasn’t earlier.’

‘No, but you’ve got your meds, which seem to work. And Ralph’s here to keep an eye on you.’

‘I’m always here,’ says Ralph. ‘You know that.’

‘I don’t know what to do,’ she says, resting her head back and closing her eyes. ‘I just want to get it sorted.’

‘If you need the hospital you should go to hospital,’ says Ralph. ‘They’ve got a chair. They can carry you out.’

‘I don’t want to be a nuisance,’ she says, looking at me again.

‘You’re not a nuisance, Eleanor. We’re absolutely here to help. But sometimes that means taking a moment to figure out the best thing to do.’

‘Oh Ralph!’ she says.

He stands up.

‘It’s absolutely no use going down the doctor route. We have to get this sorted. Today. So I’ll get your things together,’ he says, then turns to me, closing his eyes and raising his eyebrows, like a fraught and only marginally restrained teacher confronting a child: ‘If you would be so kind as to fetch in a chair.’

carried

A late job, but central. If we crank it out without too much fuss we should be fine.

We’re backing up a car in town, to a big pub with a late licence and a female, unco.

The car’s already blocking the street, so I park up behind it.

One of the bouncers holds the door open for us, jerks a thumb inside.

A band playing, so loud you have to lean in and watch a person’s lips to have any hope of understanding.

Callum, the paramedic on scene, shows us the patient, a girl in her twenties slumped over in a corner. Her boyfriend is with her, a guy as heavy and square as the table. He’s pawing around at her ineffectually, getting in the way. We move him aside as tactfully as we can, but he’s pretty drunk and immediately angry. Two bouncers close in and stop him from doing anything whilst we clear as much space as we can and move the girl onto the chair. She’s not unconscious, but whether her floppiness is due to alcohol, drugs, a medical condition or anything else is impossible to ascertain in these conditions. I have the head of the carry chair; I wrap her in a blanket, snap the safety belt together and draw it tight. This seems to enrage the boyfriend, who must think we’re arresting her or something. He manages to break through the cordon of bouncers and grabs me by the shirt. ‘Hey!’ he says. ‘Don’t you fucking do that…’

The bouncers haul him back.

We carry the girl out into the street. Whistles and cat-calls from the crowds out there. A taxi-driver caught in the traffic jam, hugging the steering wheel and staring mournfully on the scene; I nod some kind of apology to him as we wheel the patient onto the tail lift. On board, with the lift stowed and the door closed for privacy, we top-and-tail her onto the trolley.

I put the chair away as Rae starts to assess her.

It’s at that point that the girl suddenly sits up.

‘I’m fine,’ she says. ‘I’d like to go back inside now, please.’

The change is remarkable, incredible, from unresponsive to perfectly normal in the space of a few seconds. Rae starts to question her closely and severely whilst I run through some obs, all of which are perfectly normal.

‘So what just happened?’ says Rae.

The girl shrugs.

‘I’ve been silly,’ she says. ‘Please can I just go back? I want to see my boyfriend.’

‘There’s no way your boyfriend is coming on this ambulance,’ I tell her. ‘He’s aggressive and obstructive. He’s lucky I didn’t call the police.’

‘He’s Irish,’ she says. ‘Can’t you just let me go?’

‘So how do you account for the fact that just a moment ago we had to carry you out of the pub on a chair?’ says Rae, folding her arms, looking even more furious for the contained way she holds herself, like a dam about to fail. ‘We carried you! Out of a pub!’

‘Don’t call the police,’ she says.

‘Because you know what? If you can’t account for it, I’ll have to assume you’ve suffered some serious neurological problem, and we’ll take you up the hospital for a check-up.’

‘I don’t want to go to hospital. I just want to go back inside. I’m sorry I wasted your time.’

The girl starts to cry, a corner of the eye affair as fake as her nails.

Rae softens a little.

‘Is it your boyfriend?’ she says. ‘Did you fake all this to get away from him or something?’

‘Get away from him?’ says the girl, laughing. ‘Why would I want to get away from him? We’re on holiday!’

It’s hopeless trying to make anything more of this, and anyway, we’re conscious of our finishing time. We get the girl to sign the non-conveyance form, she puts her shoes back on, straightens her skirt, and steps back outside. 

When we’ve tidied up the cabin and climbed back in the cab to drive, we can see the girl laughing on a street corner with her boyfriend, his arms around her, her right leg crooked back, the shoe almost falling off as he lifts her into the air.

hair scare

The hostel has a brisk, administrative feel to it, corridors and fire doors, numbered rooms, informative posters on pin-boards and a reception desk in the foyer. Natalie, the young key worker, meets us there and takes us up in the lift.

‘Bernadette’s lived here ten years or more. She lost her husband and went a bit crazy, ended up on the street, then here. She’s never been any trouble, no drinking or carrying on. She just keeps herself to herself, smoking away in her room, popping out every now and again. The mental health team have been keen to get involved for a while now but unfortunately Bernie’s a bit – how shall I put it? – independent minded?’

‘So what’s happened today?’

‘She pulled her alarm cord. Apparently she had a fall of some kind, don’t know why. She’d got herself up by the time we got there, and she doesn’t seem to have hurt herself. I wouldn’t have called you only she was behaving a little strangely so I thought we should. I hope we’re not wasting your time.’

‘It’s fine. Don’t worry. You should always call if you’re worried about anything.’

‘She’s just down here. Oh – and, one more thing. Don’t worry about her hair. She always looks like that.’

Natalie smiles reassuringly, then knocks on a door and opens it with her key.

It leads into a tiny hallway with a kitchenette and shower room straight ahead and two rooms, right and left. Natalie knocks on the door to our left, and lets us in to that, too.

‘Hello, Bernie. I’ve come back with the ambulance,’ she says.

Bernie is sitting on the edge of her bed. I’m glad Natalie warned us about her hair, because it’s the first thing anyone would notice. Whilst the rest of her long grey hair falls down around Bernie’s shoulders a little tangled a but otherwise quite normal, the top of her head is extraordinary. If I had to recreate it, I’d have to put a nest of baby yellow spiders on the crown of my head, spray them with a mist of sugared water and then get someone to pass a flamethrower over the whole affair.

‘Hello, Bernie,’ I say. ‘My name’s Spence, this is Rae. How are you feeling?’

‘Not good,’ she says. ‘Dreadful.’

‘I’m sorry to hear it. Natalie here tells us you had a bit of a fall earlier.’

‘Yes.’

‘Tell us about that. Did you hurt yourself?’

She rubs the small of her back.

‘Not much. Just where I landed on my bottom.’

‘Did you bang your head? Were you knocked unconscious or anything dramatic like that?’

‘No.’

‘Okay. So why did you fall? Was it a trip or something? Did you have a funny turn?’

Bernie looks at Natalie for a moment, then down at her hands.

‘I felt it coming through the day but I didn’t think much of it.’

‘Felt what coming?’

‘A darkness in the room. Coming over me. But I just ignored it. I went out shopping. Got some things. Had lunch. Chicken and chips. Came back. Felt tired, so I got into bed and fell asleep. I had some bad dreams, like the darkness had followed me there. Then when I woke up, it was right there, hanging over me. I couldn’t say nothing. Then it grabbed me out of bed and threw me on the floor. That’s when I rang for help.’

‘What do you think it was?’

‘A whatsisname. A poltergeist.’

‘A poltergeist?’

‘Yes.’

‘Okay. Wow! Have you seen it before?’

‘No. I don’t believe in ghosts.’

‘Well I have to say, neither do I. But something’s happened today, Bernie. Shall we run a few checks and see if anything’s amiss?’

‘If you like.’

There’s a curiously inert quality to her, the way she raises her arms and lowers them again, following instructions as neutrally as a mannequin. But everything seems normal, her blood pressure, blood sugar, temperature and so on. Up close like this it’s difficult not to look at her hair. There are two bold, brown streaks of matters from the temple back, like she dipped a finger in mud and swiped herself above each ear.

‘What have you done with your hair today?’ I ask her.

‘What do you mean?’

‘It’s just I haven’t seen that done before. What did you use?’

‘Lacquer.’

‘Is that what it is?’

‘I put it on every morning. For control.’

‘I see.’

I wrap up my cuff and steth.

‘Have you had any alcohol today, Bernie?’

‘I don’t drink.’

‘Anything else out of the ordinary?’

She shakes her head.

‘Well I must admit I’m a bit stumped. I’m glad you didn’t hurt yourself when you fell, but I’m a bit concerned about the reason for it all. The poltergeist, and so on.’

‘It picked me up and threw me down.’

‘Hmm. You see – I don’t think it was a poltergeist. I think it was something else, a hallucination of some kind. And it would be good to get a blood test done to see if there was a reason for it. Are you okay about coming with us to hospital for a check-up?’

‘I want to get dressed first.’

‘Of course. Shall we step outside and give you some privacy?’

Natalie helps Bernie get some clothes together whilst we wait in the little hallway. The place is having a refurbishment, because even though the walls in Bernie’s room are stained with ten years of tarry cigarettes, the kitchen and shower room are bright and white. In fact the kitchen has a notice taped to the sink: Wet Paint, and every surface is bare.

‘I suppose you’re just as likely to see a ghost here as anywhere else,’ says Rae, folding her arms and looking around. ‘They’re not obliged to hang around old houses and graveyards, are they?’

‘I suppose not.’

‘But I hardly think it can be a ghost.’

‘Why’s that?’

‘Her hair would scare it off.’

a good night out

A guy in his early twenties is lying on the pavement, shivering, his knees drawn up, his hands bunched in fists beneath his chin. A streetlamp taints the sweat on his face a ghastly orange. Three men stand over him. They aren’t with him; they came across him when they left the pub. One of them laughs and gives the guy a gentle punt with his trainers. The wee lad’s taken something, right enough he says. Something he shouldn’t ay’

We thank them for their help and they move off noisily, slapping each other on the back, goofing around.

I squat down next to him and squeeze his shoulder.

‘How are you? What have you taken tonight?’

He can’t speak. All he can do is roll his pupils onto me, pupils so massively round and black, if I let go of this pen torch I could watch its pin-point of light trailing down about a mile inside him.

I can only just feel his radial pulse. The kind of hectic, protozoidal rhythm you should only see under a microscope, sculling through a drop of water.

We give him oxygen, scoop him up, call ahead.

I go through his pockets: phone, keys, driver’s licence, bank card.

Luke. I wonder who’ll make the call, and who’ll answer?

We get to hospital as quickly as possible. We pat-slide Luke onto the hospital trolley in A&E resus, shouting out the facts and figures, the little we know.

The team close round.

I book him in at reception.

By the time I’ve come back with the paperwork, he’s tubed and ready for ITU.

‘Well,’ says one of the doctors, wearily pulling off his gloves as the porters move in, ‘so that's what counts for a good night out these days.’

son of the moon

There’s a low, blood-red moon tonight. It’s impossible to resist the feeling it’s having an effect.

On John, for example.

John is standing in the middle of a recreational ground just out of town. The hectic, drunken fuss of the centre is half a mile east, but you can feel the pull of it in your chest, like the presence of so much adrenaline has skewed the emotional isobars of the place. Only the sea is immune, running out flat and mirror-black the other side of the promenade. Standing like he is, perfectly still and upright, his white t-shirt ghosting in the strange half-light, John looks like some kind of sacrificial victim summoned to this place by forces he cannot resist, forces the alcohol have only helped liberate.

‘Is there someone we can call?’ I say, carefully hooking the phone from his pocket whilst Rae drapes a blanket over his shoulder.

‘Mum,’ he says.

‘Okay,’ I say, scrolling through his contacts. ‘What’s her name?’

He looks at me like I’m speaking from somewhere deep inside his head.

‘Mum,’ he says.

like marilyn

The smell permeating the house gets stronger the nearer you get to Philip’s bedroom. There’s a shakily written note taped to the door:

No carers admitted. I will not be taking pills or speaking to ANYONE if this door is shut. It means I am sleeping and must not on any account be disturbed.

Several crossings out, different pens, one over the other.

We knock, get no answer, go in.

Philip has a poster of Marilyn Monroe on the wall facing him. She’s in bed, too, lying on her side, smiling at the camera, partially draped in a white cotton sheet, her head propped on one arm, her short blonde hair mussing down over her face, whilst behind her golden sunshine spills around her through the window, holding her in a warm and sensuous wash of light.

But even though fifty years, a camera lens, Life and Death, separate the two, it’s still surprising Marilyn doesn’t jump up and run.

The atmosphere is fetid and thick. One small window is roped open, the rest are sealed with mastic. There’s a liberal scattering of desiccated flies along the sill; a half-finished plate of food on a dirty chair; a jug of urine maturing underneath.

Philip is as sick as the room. A tall, powerfully-built man in his sixties, he’s been clothed and in bed so long that getting him out will be more exhumation than extrication. Rotten with neglect, even his wild, white goatee looks like the flaring of some exotic fungus.

‘Please don’t touch my legs,’ he whispers. ‘You’ll just have to use your equipment to lift me as I am. I know you have your equipment, and you like to use it. But please – I beg you – just go carefully.’

We pull down the sheet to see how he’s lying and how we might get him out. His shirt is unbuttoned to the navel, revealing a shockingly distended hernia, full and round and veined, just like the crowning of a baby’s head. And with his septic demeanor, and in the feverish atmosphere of his room, it’s easy to think he’s somehow fallen victim to some obscure, vegetative process. He’s been staring at the poster on the opposite wall so intently, and for so long, through so many days and nights, that the image has taken root in him, and grown, and come to fruition, pushing out from the ripening pod of his body, turning slowly towards the light, its features resolving, like a woman’s face, those eyes, that smile. Like Marilyn.

‘I’ll get a chair,’ says Rae. 

guess what

‘You’ll need a back board,’ says Paul. Then he lets go of the door, turns round and heads back inside, where he resumes his position, spooning with Cariad on the bed in the sitting room. It’s a double-sized frame with two single mattresses, a high one for Cariad, and a lower one with a spread of all her necessaries – two laptops, a pile of inco pads, a box of tissues, an assortment of treats, a landline, mobile phone and walkie talkie, all charging in a nest of cables.

‘I’m not going to hospital,’ she says, pushing her wig back to get a better look.

‘The bloody doctor needs to get off her fat arse and get down here now,’ says Paul.

He’s as bulky as Cariad is fragile. The bed dips alarmingly in his direction, and she has to bunch up her knees and cheat her weight forward to avoid being drawn back and the two of them roll off onto the floor. But even if they did they wouldn’t hurt themselves. The bed is surrounded by a clutter of soft toys, coats, cushions and assorted bric-a-brac.

‘So what’s the problem?’ I say, adding a little pathetically ‘We haven’t been told much.’

‘What’s happening,’ says Paul, shifting his bulk into a sitting position, ‘What’s happening is that Cariad has been choking to death, turning blue and everything and the doctor won’t do a thing about it. She just told us to call you lot.’

The way he says lot. A candy-coating on something bitter.

‘Well if you were turning blue it’s no wonder he said dial 999.’ I put my bag down. ‘So how are you feeling now?’

‘Like I’m going to die, that’s how I’m feeling now,’ says Cariad. ‘I can’t breathe properly. My inhalers don’t work. I’m going to choke to death and no-one cares.’

Her voice is sharp and short as a paring knife.

‘The good news is that you’re able to talk to me now,’ I say. ‘So your breathing is okay for the moment.’

‘Oh? It’s okay, is it? Well I’m sorry if you think I’m wasting your time.’

‘No, no. That’s not what I meant. I can tell even without listening to your chest that you’ve probably got a bit of a chest infection.’

‘A bit of a chest infection? Is that what he said? A bit of a chest infection?’

Paul stands up and stomps out of the room, muttering.

I have a sudden, empty feeling, like a mountaineer who’s stepped confidently out onto a slope only to find it’s really a bridge of snow over a crevasse, doomed whether he goes back or carries on.

‘Anyway, it doesn’t matter,’ she says. ‘I’m not going to hospital. How will I get home?’

‘Why don’t we check your SATS, blood pressure and the rest and then take it from there?’ I say, opening my bag. ‘One step at a time.’

Paul comes back into the room, red in the face, like he’d only nipped out to shoot steroids in his neck.

‘What’re you doing now?’ he says. ‘I’m her carer. You should ask me first.’

‘Cariad’s the one who has to decide about her treatment,’ Rae says. ‘But obviously we won’t do anything that everyone’s not happy about.’

‘I’m not happy about it, ‘ he says. ‘Not happy at all. First the doctor, now this.’

Rae takes some observations, I write them down, asking questions that Cariad answers reluctantly.

‘Everything’s looking pretty good,’ I say at last. ‘It sounds as if you do have a chest infection, Cariad. Lying down like this makes it difficult to clear your lungs. Are you able to sit up? Only I saw your wheelchair in the hall and I thought maybe...’

‘No! I have to lie flat.‘

‘Okay. Well. Given that you went blue a little while ago, and it’s obviously been distressing for you...’

Paul snorts.

‘...the safest thing would be to take you to hospital. Even though it might be difficult to get you there.’

‘Like I said,’ snaps Paul, ‘You’re going to need a back board. Why does no-one ever listen?’

‘I can’t go to hospital. Not after last time.’

‘What happened last time?’

‘No-one would take me home, so I had to lie on the floor of a taxi, screaming in agony the whole way. I won’t do it, Paul! I can’t!’

‘If she goes to hospital, are you going to bring her back?’ he says.

‘It won’t be us, and I can’t even say it’ll be a frontline crew. But this should be the last of your worries given the problems you’ve had with your breathing. You’ll just have to cross that bridge when you come to it.’

‘I’m not coming home like that again,’ wails Cariad. ‘I’d rather die here.’

‘I’ll protect you,’ says Paul, plucking up a teddy bear by the face and looking at me.

‘If we do decide to go in,’ I say, trying to keep my voice as low and steady as I can, ‘it’ll be a little difficult getting out. We’ll have to clear all this stuff off the bed to get to you.’

‘No! Not my stuff!’

‘We’ll put it aside somewhere safe.’

‘Then what?’

‘Then we’ll have a think what’s the best way to get you out.’

‘A backboard. Christ, how many more times have I got to tell you.’

‘Try to keep your temper, Paul’ I say to him. ‘We’re doing our best.’

‘The last crew dropped her.’

‘I’m sorry to hear it.’

‘Yeah. Well. You’re sorry.’

He throws the bear off to the side, snatches up a box of tissues, tosses them after it.

‘We’re definitely going in then, are we?’ he says to Cariad.

‘I don’t know!’ she shouts. ‘Why can’t the doctor come out?’

‘We could certainly call the doctor and see what they say,’ I suggest.

‘Do it,’ says Paul.

‘I’m not speaking to her,’ says Cariad. ‘Useless piece of shit.’

Rae calls the doctor. After a while she hands to phone to Paul.

‘She wants a word.’

Paul grips the phone, holding it a little way off from his ear, like he’s wary of infection. After a short series of grunts and sighs he hands it back, then leaves the room again.

Rae finishes the call, and hangs up.

‘She wants you to go in for a chest X-ray, Cariad. Just to rule out the possibility of pneumonia or other complications.’

‘But how am I going to get back?’ says Cariad.

‘They can’t do an X-ray at home.’

Cariad buries her face in a pillow.

We call for another crew to help. Even though Cariad isn’t heavy, the fact that she has to be kept flat makes things tricky. The front room is cramped, we can’t get the trolley in the front door, and the only way out is through the kitchen and down a short flight of concrete steps into the garden. It’s no wonder the other crew struggled.

Ordinarily – perversely – I quite like these difficult extrications. Three-dimensional puzzles that demand a creative use of kit, teamwork and a flair for cheating angles. But Paul changes the dynamic. He masses darkly behind us all  like a thunderhead storm cloud, flashes of disapproval, spots of anger.

Just before the second crew arrives I offer to help clear the second mattress.

‘You’ve fucking asked me that already,’ he shouts. ‘I’m doing it, aren’t I?’

‘Please don’t swear at us, Paul. Okay?’

He keeps his back to me as he unplugs the laptops. I’m increasingly mindful of striking distances. 

The second crew gets here. Between us we discuss how best to get her out, at the same time struggling to contain Cariad’s rising levels of anxiety. She won’t even let us look at her meds. She clutches them to her chest like she’s terrified we’re going to steal them.

Despite everything we manage to get ourselves into position, ready to slide Cariad from the furthest mattress onto the backboard.

Ready, set – slide!

She screams, even though I’m certain we haven’t done anything to cause her any pain.

‘That’s it! Stop! That’s it!’ shouts Paul, storming forwards. ‘You can fuck off, the lot of you! I’m not having this. Put her back. You put her back how she was! Now!’

‘Please don’t swear at us,’ I tell him, wishing I could think of something else. ‘We’re doing our best.’

‘Well it’s not good enough. Put her back, now.’

‘Is that what you want, Cariad?’ asks Rae, in a steady voice. ‘We can carry on and take you to hospital if that’s what you’d like us to do.’

But Cariad is just crying and shaking her head, so we slide her back, pack up our things and leave.

We rendezvous back at base to put in an untoward incident form, and to alert any other crews who might have to attend in future. Whilst we’re there, Control ring. They want me to tell them what happened. ‘Because we’ve got Paul on the phone,’ says the dispatcher. ‘Guess what? He says you refused to take her to hospital.’

visitors

Dan meets us outside his mum’s house. He looks like a depilated bear gone punk, hair in spikes, a Damned t-shirt stretched over his belly, paws stuffed into a pair of rotten Converse All Stars, studs in his ears and nose and lip. Every bare patch of his skin carries a tattoo – ghostly figures, flaming pumpkins, a headless horseman, glaring skulls, all amongst a general tangle of black roses, Celtic knotwork and ivy.

‘Thanks for coming,’ he says, carefully lighting the cigarette he’s been rolling. ‘I thought I’d better give you the heads up.’

His mum is an alcoholic, he says. She’s been in and out of rehab, not doing too badly but gone off the rails this past week.

‘She’s started seeing things again,’ he says, flicking the match away across the drive. ‘Hearing voices. I phoned the unit and they said to call you.’

He takes us inside.

The bungalow has been built villa-style, with arches leading off from the main room, terracotta tiles on the floor, rugs here and there, and in the centre, an alcove with a statue of a saint raising his hand in blessing. The whole place should be flooded with sunshine – it’s a particularly bright afternoon – but all the blinds are drawn, and whatever bands of light make it through the slats only serve to accentuate the soupy darkness.

‘Through here,’ says Dan. ‘It’s a bit of a maze.’

He leads us through a sequence of rooms, each as gloomy as the last. He knocks on a bedroom door and we follow him in.

Mary is still in bed. She gathers the duvet tightly around her as we say hello.

‘It’s okay, mum. It’s okay. It’s just the ambulance. You remember I said I was going to call them, like the people at the centre told me? They’ve just come to see how you are.’

She scuttles back in the bed, rising up on the pillows into a semi-sitting position, and stares at us.

‘Be a love and open the window,’ she says. ‘He’s hiding over there in the curtains.’

‘Who is, mum?’

‘The man. The one I was telling you about. The one who’s been going on and on at me to drown myself. If you open the window he might go out in the garden and we can talk.’

Dan looks at us, then goes over to open the window.

‘There’s no-one here, mum,’ he says as he lifts the latch and pushes it open.

‘Can’t you see him?’ she says. ‘Really?’

She looks at me.

‘What about you?’

I sit down on a stool just off to the side and try to look as non-threatening as possible.

‘I can’t see anyone there, Mary. I think it’s probably one of those hallucinations you’ve had in the past. Do you think that’s possible?’

She roughly presses the heels of her hands into her eyes to clear them, then peers at me more closely. After a moment she reaches out to her bedside table and produces an alcometer.

‘I’ve been good,’ she says. ‘I’ve only been drinking enough to keep me on the level. Look.’

She shows me the screen, but the device is switched off.

‘That’s great,’ I say. ‘But these hallucinations are a bit worrying. Dan called the team at the unit about it, and they said to take you to hospital. Would that be okay?’

‘I’m fine,’ she says. ‘I can’t see the point.’

‘You need to go in again, mum,’ says Dan. ‘You’re not well.’

‘Aren’t I?  I don’t know. I’d be fine if it weren’t for him.’

She looks over at the window, as we all do. And just at that moment a sudden breeze fills the curtains, gently rolling them in, and then back, and then in again.

joints

The ewe must have died in childbirth. Pete found her on his morning round, lying in the field with a bloody newborn nuzzled up. His son Craig helped him load the ewe into the back of the Landrover, and they all rode back to the barn with Pete cradling the lamb on his lap and Craig driving. They cleaned off the lamb and put it in a pen, then laid the dead ewe on her back. Pete took  up an empty bottle, then bent down to salvage as much colostrum as he could.

That’s when his hip dislocated.

He fell backwards onto a pile of straw, and lay there screaming whilst Craig called for an ambulance.

*

Once the morphine and Entonox have dulled the pain, we splint one leg against the other and then with Craig and some other farmhands, we slide Pete onto the vacuum mattress.

It’s a wonderful place to work. All around us in the muffled, straw-light and sun-warm peace of the shed, lambs suckle or chew intently with their snouts poking through the bars of their pens. Sparrows twitter and screech round the old oak beams, whilst out in the yard the chickens that were scared away by our arrival have returned to reclaim their territory, scratching around in the dirt. The lambs are all excited, trembling, watchful. Sometimes they spin around on the spot, or spring straight up and then bound away into the straw. They all have numbers sprayed in blue on their sides, the same colour as the vacuum mattress. Meanwhile, the corpse of the dead ewe lies off to the side just beyond the tail ramp of the ambulance, like an abandoned, upturned table, all four legs sticking straight in the air.

*

The ambulance bumps about on the road, but we’ve immobilised Peter pretty well and he seems content. We chat about this and that, farming, mostly, with Peter explaining about vaccination, vet’s bills, flooding, seeding problems and so on. He patiently hears me out each time I ask a question, holding the Entonox mouthpiece between his teeth and taking contemplative puffs, like he’s enjoying a pipe at The Bull.

‘Do you ever use any of the sheep’s milk for cheese?’ I ask him.

He takes another puff.

‘No’ he says. ‘There’s never any spare. It all goes down the lambs’ gullets, to fatten them up. You know – for chops.’

‘Lovely!’ I say. ‘I could do with a couple of chops.’ But for a moment and in spite of myself I feel a little dizzy. I think it’s the contrast between the beautiful lambs playing in the straw; the dead ewe lying on her back; the farmer harvesting milk to give the newborn a fighting chance; the warmth, the hour, the elaborate care of it all – and the fact that in a few short months, every one of those lambs will be killed, jointed, wrapped, labelled, table ready.

‘How’s the hip?’

‘Bloody thing,’ he says. ‘You may as well shoot me.’

pictorial

Yelena, a carer with a manner as brisk as her woven yellow hair, opens the door.

‘Hello!’ she says. ‘James through here in this way. Am sorry to call you, but James he have much blood in catheter bag and I think he might need to go hospital about this.’

She leans forward and examines my face for a response. It’s disconcerting. Her spiky mascara eyelashes give her wide grey eyes an extra-vivid splash of attention, and her red lips pout, pre-empting a fight.

‘He ex-navy man,’ she says at last, as if that might explain the blood. ‘Is favourite. You take good care.’

James is sitting in a riser chair, his ancient hands contentedly laced over his belly. Yelena is right about the blood. It’s obvious he needs to go in.

‘Can we get James’ medication together?’ I ask Yelena.

‘Of course. I do this already,’ she says, producing a well-stuffed bag. ‘His favourite pyjamas and all the bits and the piece.’

She puts the bag down next to the carry chair, and then reaches over to the table and picks up a set of laminated cards joined at one corner with a treasury tag.

‘James cannot speak because of stroke. But look at this’ she says to me. ‘This is new, very good thing. It has all picture of things James want to say. Look.’

She begins flicking through the cards. The front one has a series of clip-art pictures of health professionals: a doctor, nurse, district nurse, pharmacist, carer. The next card has pictures of ailments: joint pains, tummy and chest, and for headache, the picture of a head with lightning bolts jumping out in an arc from ear to ear.

‘Where’s the picture for paramedic?’ I ask Yelena. ‘How come we’re not on there?’

‘You here,’ she says, leaning over my shoulder and pointing to headache. ‘Is you.’

euphemism

Marcia doesn’t want to leave her little dog. She hugs him to her breast so tightly his legs splay sideways and his eyes bug out. Still, he manages to cheat just enough room to turn his head and liberally lick her mouth. Marcia tips her head back in delight.

‘You be a good boy till I get back,’ she says as he squirms in her embrace. ‘You be a good boy. Don’t worry, Pippin. Mummy be back soon. Yes she will.’

The dog – a Papillon, apparently, some expensive cross between a spaniel and something else, a chinchilla, maybe – a tremblingly alert creature with dark lines under his eyes like he’s wearing Kohl, or not sleeping nights.

‘I wish I could take you with me,’ says Marcia, giving him one last squeeze, then plumping him down on the duvet and waving him off in the direction of her mum and dad. ‘Use the rest of that chicken,’ she shouts after them. They hurry out after the dog to get Marcia’s things ready.

‘So the doctor said for you to go into hospital on the phone?’ I ask her.

‘He didn’t like the sound of my head.’

‘Have you had it before?’

‘Yes. But not like this.’

She dabs a handkerchief under her right eye, and takes a steadying breath.

‘Sorry,’ she says.

‘That’s okay.’

‘A couple of other things I think you should know.’

‘Go on.’

‘Well, just lately my saliva has seemed thicker.’

‘Thicker?’

‘Yes. I don’t know if it’s significant or not.’

‘Okay. Anything else.’

She looks down and starts twisting her handkerchief, like she’s wringing out the tears. Then she takes a long breath in through her nose, lets it out through her pursed lips, looks straight at me and gives me a brave smile.

‘It’s my lady time.’

his business

Early morning, and the day has just started to move up, clear and bright.

A young woman is standing over a figure lying prone on the pavement. She waves when she sees us, and puts her phone away.

‘Thanks for coming so quickly,’ she says. ‘This is how I found him.’

It’s a guy of about thirty. His thin and wasted face looks familiar, and I’m guessing he’s a street sleeper, because although his trousers are round his ankles, he’s wearing a pair of tracksuit bottoms under them.

I lean down next to him and shout in his ear.

‘Hello, mate! It’s the ambulance!’

He doesn’t respond, so I squeeze his shoulder.

‘Hello? Are you all right?’

He flinches, and bats my hand away.

‘Fuck off,’ he says, in a spasm of irritation – then instantly goes back to sleep. 

‘So he wasn’t unconscious,’ says the woman, looking embarrassed. ‘I just didn’t feel safe to touch him myself.’

‘No. Don’t worry. It’s very kind of you to help. We’ll be all right now if you want to get on.’

She adjusts the rucksack on her shoulder, and with one last perplexed look down at the man, strides away down the street.

I lean in to pinch the guy’s shoulder again.

‘You can’t just lie down on the pavement, mate. People are worried about you. They think you’ve died.’

‘Fuck off n’leave me alone.’

‘Open your eyes for me, would you?’

He’s instantly asleep again, so I open his eyelids. His pupils are as small and hard as poppy seeds.

‘Have you had some heroin this morning?’

This seems to rouse him more effectively than the pinches on the shoulder. He struggles up onto his feet, and stands there a moment, swaying from side to side, his eyes closed, his trousers still round his ankles.

‘Come on, mate. Why don’t you come on the ambulance and we’ll check you over?’

He turns his head, raising his scrubby chin and sniffing the air in a general way, like a snake sensing heat off in the undergrowth.

‘Fuck off and mind your own business,’ he says eventually, then turns to walk away. But the trousers round his ankles immediately trip him up, and he veers alarmingly into the road, flailing his arms around and paddling with his feet to keep up with the top half of him. It can only be the heroin keeping him upright; anyone else would’ve fallen flat on their face.

‘Whoa! At least pull your trousers up!’

Incredibly, he makes it over to the other side of the road. A van waits to let him go. When it eventually moves on, the driver smiles at me and shakes his head.

Meanwhile, the patient has draped himself over a metal barrier and fallen asleep again.

I walk over.

‘Seriously. You can’t go on like this. You’ll end up hurting yourself, and anyway, we’ll just get another call back.’

No response.

‘Mate? Hello?’

I reach out and squeeze his shoulder again.

He flinches, and pushes himself upright.

‘Get your nose out of my business,’ he shouts, then tries to walk off again.

‘At least let us help you get your trousers up.’

‘Fuck off.’

He penguin-steps further onto the pavement, and then as if drawn by some invisible, irresistible current, waddles off sideways into an alley.

‘I’m not following him around all morning,’ I tell Rae. ‘Get your nose out of my business. There’s gratitude!’

Rae pulls off her gloves and hauls herself back in the cab.

‘His business in your nose, more like,’ she says.

what she do

‘Rachel’s dying. You come, please.’

Jake hurries ahead of us into the block and has disappeared by the time we’ve struggled into the lobby with all our bags. He’s a striking figure. With his long black hair, oiled beard and dark eyes, he wouldn’t look out of place on the set of The Three Musketeers. I half expect to hear his sword clattering on the concrete steps above us as he leaps them, three at a time.

A door stands open on the fourth floor.

‘Here! She here!’ Jake says, standing over a thirty-year-old woman collapsed on the sofa, her head pitched back and her breaths coming slow and noisy.

I lay her lengthways and tilt her head to open the airway. There’s a blue tinge to her lips and nose, and when I open her eyelids, her pupils are pinpoint.

‘Tell us what happened, Jake,’ I say to him, as I insert an airway and Rae gets some oxygen running.

‘Rachel was okay, okay? She smoke one cigarette, then have more ‘nother cigarette, then cough and cough like this – argh! – like she could not get air, you know? – then she roll back like this – urgh! I did the chest pushings and the mouth to mouth. Was this right thing to do?’

‘She’s got a pulse at the moment, so that’s good. The thing is, Jake, it all looks very much as if Rachel’s been taking heroin today. Obviously we don’t care. We’re not the police. We just need to know so we can treat her effectively. Has she smoked or injected any heroin, do you think?’

Rae has already drawn up some Narcan and hands it to me to inject into Rachel’s shoulder.

Suddenly Jake looks much less co-operative. He straightens up and glances behind him, like he’s gauging time, or listening for the lobby door.

‘I don’t know what this mean’ he says, his eyes super-wide in an effort of concentration.

‘Is Rachel a relation of yours?’

‘No. She jes’ friend.’

‘Does she have any medical conditions?’

‘I don’t know these things. I don’t know anything ‘bout her.’

‘How long have you known Rachel?’

‘Three, four year. That’s all.’

‘So you’ve known her three or four years and you don’t know anything about her?’

He shrugs.

‘Not name, not where she live, not what she do. Nothing.’

‘But her name is Rachel?’

‘Is Rachel, sure, I tell you. But I don’t know last name. Okay?’

‘Okay.’

Rae has cannulated her by this time. She draws up another dose of Narcan ready to give IV.

‘Did she have any belongings when she came to see you?’

‘Sure. Is bag there.’

He points to a tatty carrier bag. Inside is a purse, empty except for a debit card, and a bundle of lingerie. At leas the debit card gives us a name.

Rachel is pinking up nicely. She gags on the airway so we take it out. She starts to open her eyes, and cough repeatedly.

I set the chair up and we make ready to go.

‘Will you be coming with us, Jake?’

He shakes his head.

‘Me? No. Why fore I go? I don’t know this person. I don’t know Rachel and what she do. I told you everything.’

He watches as we load her onto the chair and wrap her in blankets.

‘She not die then?’

‘No. I think she’ll be okay.’

‘And I did good thing?’

‘Yes. You did fine, Jake. You called us at just the right time.’

He steps aside as we make to leave.

‘Drugs, eh?’ he says, softening a little. Then, hastily: ‘If that what she do.’

the tenant

There’s a slumped and disappointed hang about Constance that her shapeless grey t-shirt and jogging bottoms only emphasise.

‘Come in, won’t you. Please excuse the mess.’

The place is scrupulously tidy. In fact, the messiest thing about it is the old cat that comes out to investigate, a scraggily ancient animal whose arthritic joints make him walk with a robotic, side-to-side waddle. He yowls once, then marches back to his cushion.

There’s a bulb of garlic on top of the thermostat, but I don’t ask.

‘What’s the problem this morning, Constance?’ says Rae.

‘Look at my face, dear. What do you think? Do you think I’ve had a stroke?’

We check her over.

‘Everything seems fine, Constance, but if you feel there’s been a change, then we’ll go on that,’ says Rae. ‘Let’s just get a few details, then we’ll take you to the hospital for more tests.’

 ‘If you say so. But they hate me up there. Last time this foreign doctor came up to me and started shouting Do you have carf?  I said what on earth do you mean? Carf he said. Do you have carf? So I told him I couldn’t understand a word he was saying and would he please learn to speak English. At which point he started to swivel his eyes – like this – yelling at me that I was a racist and he refused to treat me. It was only later that I understood he meant cough, but honestly, if they will not speak English, how is one to make any progress?

‘I don’t have any luck with doctors. I’ve been banned from my local surgery, simply because I had one of them suspended. And I did feel a little sorry for the poor thing, but you see, it wasn’t my fault. And if I hadn’t taken action, who knows what else she might have done? I’d gone in to ask about my bites, you see, and whilst I was in the chair I began to feel a little swimmy. I told the doctor, who started banging on the desk and shouting at me to pull myself together and what did I think I was playing at and this sort of thing. So of course I didn’t want to hang around, and I went to get up. Only, the swimminess got worse and I collapsed to the floor. When I came to I found they’d dragged me out and put me in the waiting room – insurance you see, clever  – and later that day, when I took myself up to casualty, they found I’d broken three ribs and was suffering from concussion.

‘I know what the problem is, of course. These young girls, they go into medicine, then have a number of babies in quick succession to make the most of maternity leave, then when they’re forced to go back to work because of school fees they take it out on the patients. It didn’t give me any joy to have her suspended, but really – what else could I do? What do you think about these bites?’

She holds out her arms, both of them scarred with eczema and a few other spots.

‘I’m waiting to move,’ she says, relaxing her arms back down. ‘The whole block is infested, all manner of biting insects. It’s your cat people say, but I treat her with spray every month, so it can’t be that. And anyway, when the man from the council came to re-do the bathroom, he lifted up the lino and thousands of creatures came running out. I suppose they like the moistness. So the pest control people are coming sometime soon, and hopefully they’ll put a stop to it.

‘I really have to move, though. The insects aren’t the only thing. I don’t sleep a wink at night because of these strange green lights continually whizzing round my room. Plus the man upstairs. Every night I can hear him, peeing into the middle of the bowl. Put your damned penis away I shout up at him. But of course, he doesn’t listen.’