clarity

I’ve been working COHORT most of the day, looking after all those ambulance patients that the hospital has no space for. It’s a tough, Roman-sounding word, and certainly it wouldn’t take much – a scattering of straw and a few goats – to turn this triage area into the kind of holding pen you might have found under the Coliseum. Maybe instead of this green ambulance uniform I should have a breastplate, leather skirt and scabbard (with a woven pouch for my obs kit). But for all the heat and stress and awfulness, there’s a certain epic buzz to it all. If someone blew on a great brass trumpet and the crowd rose up to take control of the hospital, I’d be happy just to sit down and enjoy the spectacle.

But anyway, the day passes quickly enough.

‘Brutalising’ says a nurse.

Everyone at full stretch, doing what they can, making the best of the appalling conditions. Patients and their relatives protecting whatever space they can make, scavenging chairs. Learning where to find water.

One of my COHORT responsibilities is to keep up a round of obs on my section, along with welfare checks and a general chivvying along.

Gordon has a trolley, at least. He lies on his back, staring up at the ceiling through the smudged lenses of his glasses. A cadaverous man in his early sixties, he looks in poor condition, smudges of faecal material here and there, dirt-caked fingernails, a yellow rind on his teeth and a liberal dusting of scurf over his skin like dried coconut on the crust of a madeleine.

‘Hello, Gordon,’ I say, picking up the cluster of notes from the foot of his trolley. ‘How are you bearing up? Sorry there’s such a delay.’

‘Oh, I’m not worried about that,’ he says, unlacing his fingers and making an empty handed gesture straight up, as if God will still bear witness through these ceiling tiles. ‘But what I am concerned about is a diagnosis. I mean – what can possibly be wrong? I’m intrigued to speak to one of your consultants to see what they have to say on the matter.’

‘Hm. Yes. Well – let’s just have a look at what’s been written down here. I’m afraid I haven’t been told all that much…’

I flick through to the ambulance report form: GP referral for alcohol dependency & acopia. Pt emaciated and in poor condition. Flat worst we’ve ever seen – excrement, flies, extremely unkempt and filthy.

‘Gordon. I just need to run through another set of observations, your blood pressure and so on. Is that okay?’

‘Be my guest.’

He lifts his arm to make room for the cuff, and the foetid smell from his armpits has such a nauseatingly sweet and sickly bloom to it I find myself assuming an even brighter tone to compensate.

‘So how are you feeling, Gordon?’ I ask him. ‘Are you reasonably comfortable like this? Can I get you any water?’

‘No, I’m fine, really, thank you. I’m just keen to know what the medical team are considering. Would you mind if I read my notes?’

‘No, of course not. Let me just finish this and I’ll pass them to you.’

I raise the back of the bed a little and then hand him the bundle of notes. I glance at him as he reads the ambulance report, to see how he’ll react to their description of his flat. But to look at him – head tipped forwards so he can read over the brim of his glasses, tangled eyebrows raised, the palsy of his fingers trembling out through the sheets of paper – you’d think he was some kindly old professor running an indulgent eye over a student’s efforts.

‘Hmm,’ he says, handing me the forms back. ‘Well. Once I’ve had a chat with the consultant maybe it’ll all come clear,’ he says.