the magician's hat

We take a call to a ‘generally unwell’ in-patient at a psychiatric hospital I haven’t been to before.

When we get there, Jake is lying flat on his bed with his legs crossed and both hands laced across his eyes. The psychiatric nurse standing next to him tells us the story: how Jake had been feeling unwell all day with a temperature and some dizziness; how he’d just started to complain of neck pain; how they’d tried to have him assessed in situ, but in the end had to arrange for an ambulance to take him to A&E.

‘So is this a query meningitis?’ I ask him.

He shrugs.

‘No!’ shouts Jake. ‘ I fell over. I was in the toilet and  I felt dizzy, yeah? Next thing I know I’m on the floor. So I crawl onto bed and I haven’t moved since.’

I feel his neck and he yelps when I apply a little pressure on the bone. When I pull my hand away there’s no trace of blood, no other sign of trauma. But still.

‘How was your neck before the fall?’ I ask him.

‘Fine.’

‘Do you have any funny feelings in your arms or legs? Any pins and needles?’

‘My left leg feels numb.’

I look at the nurse.

‘What’s your take on all this?’ I ask him.

He shrugs again. It’s difficult to tell whether he believes Jake’s story or not, but when I mention C-spine tenderness and immobilisation, he sighs a little. When I ask Jake to talk me through the course of events again his recollection is slightly different, all of which leads me to think he’s an unreliable witness, and this story of a fall lacks credibility. Nevertheless, he did flinch when I pressed in the middle of his neck.

‘It looks like we’ll have to treat you for traumatic neck pain’ I say, as much to the nurse as anyone else.

The nurse remains impassive.

‘So, Jake. That means full immobilisation. We’ll need to fit you with a cervical collar, get you onto our special vacuum mattress, and keep you nice and flat for the journey in. All precautionary. Okay?’

As I leave the room I ask the nurse if their lift will take a trolley.

He closes his eyes and nods, like an obliging maître d.

‘Of course’ he says.

I use the stairs to walk out to the truck, get the trolley, load it up with a scoop stretcher, vac mat, pump, blocks, tape and blankets, and head back in to the hospital.

The nurse on the front desk shows me to the lift and punches in the security code. We chat about this and that as we wait for it to come.

The moment the doors open I can see that the lift is only half the size of the trolley.

‘Is there another, or…?’

The nurse shakes her head sadly.

‘This is it. This is the one.’

‘But the nurse upstairs said it would take a trolley.’

‘It will.’

I look inside the lift again. I’m tired, after all. Maybe it’s like a magician’s hat. You can pull a ladder out of it.

‘I don’t think so,’ I tell her, after I’ve stepped inside and rapped the panels to make sure.

‘Yes, yes! Go on. You will see. They all do it.’

‘Who?’

‘The ambulance. They all get their trolleys in there. This is how we bring bodies out.’

‘Bodies?’

‘Yes.’

‘How?’

‘Go on. Try it.’

Despite the obvious problem, I go ahead and push the trolley inside.

A third of it sticks out.

‘No, no’ says the nurse. ‘Sitting up. You have to sit them up.’

I shrink it down top and bottom. Still, the doors will not shut.

‘More,’ says the nurse. ‘It will go.’

‘Maybe I’m going crazy’ I tell her, immediately conscious of the fact this is a psychiatric facility, ‘but seriously, this is never going to work. Anyway, we shouldn’t even be thinking of sitting our patient up. We’re querying a neck injury. He needs to stay flat.’

‘He can sit up for a bit.’

‘Not really.’

‘Yes. Just for a minute. One minute won’t matter.’

I smile at the nurse.

‘Well, it’s immaterial. The fact is the trolley won’t go in the lift.’

I wheel it back out again.

‘We’ll use a wheelchair,’ I say, putting the brakes on. ‘And the only reason I’m agreeing to that and not carrying him down the stairs is because I don’t seriously think he has hurt his neck.’

‘We don’t carry people,’ she says.

‘No. But we do, unfortunately. You need to get yourself a better lift, though. One that’ll take a trolley.’

‘We have one.’

‘You have one?’

‘Yes.’

‘Another lift?’

‘Yes. On the other side of the building. But you can’t get there from here.’