ET

We’ve handed over our patient in fast AF to the resus team. It’s frantic in there so I don’t hang around, but take the trolley out to clean and prep for the next one. The triage area immediately outside resus is so crowded it’s difficult to find space to move. I struggle to put the pat slide back in its place, and have to move the trolley backwards and forwards to make room for a bed to go through to CT, to let someone else out of resus, to let another crew come in the main doors. When it’s clear again I grab some wipes from the dispenser by the door and wipe the trolley down, bantering with staff and colleagues, getting my breath and checking out the general lie of the place.

There are about ten hospital trolleys crowding out the place like a terrible flood has picked them up from somewhere else and swept them all together: elderly patients in various states of distress; a drunk completely covered in a blanket, snoring; a young woman with her legs drawn up, sucking on a cylinder of gas and air; a middle-aged guy with a bloody nose and black eyes, all of them with relatives established where they can, slumped in poses of boredom or despair – and then a young guy sitting straight-backed on the fixed seats that run between CT and the door to the radiographers’ office. He’s extraordinarily tall and thin, drawn-up like a giant stick of asparagus, with his hair in tight curls making his head look twice the size. He’s preoccupied, like me, taking in the scene, the pallor of his face intensifying the power of his gaze. There are some human touches about him – the bloody bandages round his forearms, the bangles round his neck, the Pierce the Veil t-shirt – but it all looks premeditated, unconvincing, like an alien that’s come down in secret to check out our emergency health care and been made up to look like a self-harming teenager.

And then he turns his gaze on me.

It’s quite a shock to take such a direct look. I cover myself by nodding and mouthing something like Are you all right? but he doesn’t react. He just stares at me, his mouth slack, exactly as he had been looking at the people around him. I blush, and to cover my embarrassment I make a showily professional job of preparing the trolley.

Just before I leave I sneak a look back at him but he’s left his chair now. He’s standing on the edge of the triage area, his arms down by his sides, staring out at the rest of the department, taking it all in.

I have an overpowering urge to go and stand next to him and ask what he thinks of it all, but there’s no time and anyway, if there’s one thing the department can do without, it’s another bloody alien.

back from where

When Mike, the hostel support worker tells me who we’ve come to see, I can’t help reacting. Martina’s a frequent flyer of legend, a tough transsexual with a taste for the dramatic. She’d pick the most public places to fall to the ground and apparently have a seizure, often throwing herself out of her wheelchair into the path of a bus (so long as she was sure it was coming to a stop). She’s been convicted of everything you can think of, from drunk and disorderly to assault with a weapon (crutches), racial abuse and wounding with intent (a needle). When she’s not ‘unconscious’ she’s rolling out an endless monologue of misfortune that would have the Virgin Mary check her watch.

‘She’s only just come back to town,’ says the support worker, screwing up his eyes to judge how I’ll take the news.

‘From where?’

He shrugs.

‘Great’ I say. ‘Can’t wait to see her again.’

Martina is waiting for us on the landing just outside her room. She seems older and heavier. Her face is puffy and pale, she’s put on weight, dyed her hair black. She’s wearing giant, Elvis sunglasses that catch the strip-light as she turns her head this way and that, scanning our approach. Both her forearms are wrapped in bloody bandages.

‘What’s happened tonight, Martina?’ I ask her.

‘Nobody knows how hard it is, no-one,’ she says. ‘I’ve had enough and I just want to end it.’

‘Have you hurt yourself? I can see you’ve got those bandages round your arms.’

‘I cut myself with a razor, and I took an overdose as well. I wanted to do a proper job, ‘cos nobody here’s bothered whether I live or die.’

‘Have you still got the razor on you?’

The glasses study me.

‘No,’ she says, in a low voice. ‘I left it in my room.’

‘I’m sorry you’ve been feeling like this, Martina,’ says the support worker. ‘You know you’ve always got us to talk to. And your case worker. And your CPN. We’re always there for you.’

‘When you’ve got as much going as I have, what’s the point? You don’t know what it’s like. Everyone thinks I’m a freak and a waste of space so why don’t I do something about it?’

‘Martina? Can I take those bandages off and have a look? See what the damage is?’

‘Do what you like. I’ve got epilepsy as well and I haven’t got my meds. My room’s damp, I haven’t had nothing to eat all day and if I don’t get some help soon I’m going to go crazy and do something. I swear.’

I unwrap the bandages and find that she’s given herself a few very superficial swipes, nothing that needs anything more than a clean.

‘What about the overdose?’ I ask her. ‘What did you take?’

‘My inhalers,’ she says. ‘I started getting this wheeze, ‘cos I’ve got asthma and a chest infection and the doctor’s not bothered. So I was using the puffer and I thought why stop? Why not take the lot.’

‘So you’ve overdosed on Ventolin.’

‘Yeah. I’d have thrown myself out of the window but I couldn’t open it.’

‘Do you often get these suicidal feelings?’

‘When don’t I get them? I’m like it all the time. Aren’t I, Mick?’

‘Yes. You do suffer with it,’ he says.

‘Do you want to go down the hospital to talk to someone there about how you feel?’ I ask her, re-dressing her arms. ‘The cuts and the overdose, none of them need hospital attention. But the way you feel might.’

‘What are they going to do for me down there?’ she says. ‘What can they do? I need a job, a place to live that’s not just a crap hole like this place. What can they possibly do for me?’

‘I don’t know, Martina. It’s true, you do have people you can talk to here, and on the phone. Have you tried them yet?’

She looks at me, her eyes unreadable behind the shades. For a moment I think she’s going to take a swing – she’s done it in the past. But something’s definitely changed. Wherever she’s been this past year, it’s made her slower, blunter, less volatile.

‘No,’ she says.

‘We are here for you, Martina,’ says Mike.

‘Well then,’ she says, repositioning the glasses. ‘I suppose I’ll have to stay here.’

the right car

The traffic is so backed up you can tell there’s been an accident. It’s difficult for the drivers to make room for us as we pass, but they do their best, and we make it through the chaos with the cars parting right and left like the teeth of a zip. Eventually we see blue lights up ahead. Closer still, and the elements of the drama become clear – a lorry and trailer stopped at an unnatural angle; a four-by-four perched on its side up on the motorway barrier, as neatly balanced as a toy.

The driver, CJ, a smart woman in pastel knitwear and white slacks, is standing in the middle of the road shaking a mobile phone at a plump, middle-aged guy who watches her warily whilst he makes his own call. The police have only just got here. It’s apparent from the way they busy themselves setting up Accident signs and sorting out the traffic flow that this isn’t an entrapment, or a serious injury RTC. I put on my yellow jacket and jump out of the ambulance.

‘Do you see what you’ve done?’ CJ screams at the lorry driver. ‘You could have killed me and my child. She’s three years old. Three!’

The lorry driver winces, turns to the side and puts a finger in his ear.

I go over to an AA van where I can see a child in a yellow plastic mac sitting in the front seat, happily drawing. She looks up when I go over to say hello.

‘She was strapped up in her seat so she hasn’t been hurt,’ says CJ, hurrying over to stand with me. ‘It’s a Cybex,’ she says. ‘She’s probably better protected than any of us. Although BMWs are practically indestructible. If you’re going to have a smash, it pretty much has to be a BMW.’

I pick up the little girl and carry her over to the ambulance with mum following behind, making a call.

Darling? Call me when you get this. I’ve written off the Bee Em.’

‘I’ve only had it ten days,’ she says, stopping at the bottom of the ambulance steps, but then suddenly thinks of something else and hurries off to shout at the lorry driver again.

The little girl is perfectly happy.

‘I drew a engine’ she says, waggling her red-booted legs on the trolley and waving the pad at me.

CJ comes back, striding onto the ambulance and dumping herself down on the opposite chair, checking her phone one more time before dropping it into her bag.

‘Are you all right, sweetie?’ she says to the little girl. ‘Are you being a brave girl?’

‘A tooth came out,’ says the little girl to me. ‘The tooth fairy will give me a pound if she can find where mummy put it.’

‘I know where it is, darling,’ says CJ. ‘Don’t worry about that now.’

She checks her phone again and then looks at me as if it’s my fault she hasn’t had an answer.

‘I wait two years for delivery, then lose it in just over a week,’ she says. ‘Jack’s going to kill me.’

We check them over. Apart from a little muscular pain everything seems fine. I write the whole thing up whilst Rae keeps the little girl entertained. Mum is quite shaken up by the crash, veering from an anguished kind of dry-cry to a matter-of-fact tone that wouldn’t be out of place on the sidelines of a play session.

‘Do you want my email as well?’ she says, handing me her card. ‘I chose the name of a flower because, well, basically my philosophy is why be boring?’

She checks her phone again.

A police officer comes on board, taking off her hat and smiling warmly at everyone, especially the little girl.

‘He tried to kill us!’ says CJ, suddenly hysterical again. ‘Have you seen what he did? My child was on board!’

‘It looks pretty dramatic, I’ll give you that,’ says the police officer. She puts her hat down at the toddler’s feet, takes out a notebook and pencil, and gets ready for details.

‘Oh that’s a pretty ring,’ says CJ, suddenly changing again. She reaches out her hand and pushes the officer’s notebook down so she can get a better look.

‘Thank you! It’s my grandmother’s’ says the police officer. ‘I’m glad you like it.’

‘Like it? I love it!’ says CJ. ‘So nice that you can keep these family traditions going.’

‘Yes. That’s a part of it.’

She gives CJ the same smile she gave the little girl, then gets her pencil ready again.

‘Tell me what happened,’ she says.

‘I was coming up the slip road following directions, not speeding or anything, doing everything absolutely by the book – because this is a new car, you know. Forty-five thousand pounds. I’ve had it ten days. And then this clown, this psychopath in a tee shirt, he comes up on the inside, obviously speeding, and ploughs into me. God knows how he didn’t kill us. Picked us up and dumped us onto the central reservation.’

‘But you’re all okay, are you?’

‘Are we? I don’t know. I think so.’

‘They’re fine,’ I say. ‘Minor. Muscular.’

‘Marvellous.’

The police officer breathalyses CJ, then says she’s going outside to have a quick word with the other driver.

‘A quick word? I want him arrested and thrown in prison. He tried to kill us!’

The police officer makes placatory noises, then grabs her hat and withdraws.

‘Look, mummy! Look what I did!’

The little girl holds out her picture and CJ glances at it.

‘That’s super darling,’ she says, then cries again in a sudden squall of distress.

‘Ten days!’ she says. ‘Ten days! What a joke!’

‘Try not to worry,’ I say. ‘The main thing is you’re both okay. Your insurance will get you a replacement car, and then when the money’s settled you’ll be able to get another.’

‘A replacement car!’ she says, blowing her nose and almost twisting it off with the handkerchief. ‘No doubt that’ll be a Range Rover. I wouldn’t be seen dead in a Range Rover.’

dogman 2

The flat draws out ahead of us in a thin and low-lit vista of neglect. Time moved on years ago, leaving Richard to his fate, stuck as surely as a holed boat in the mud of a silted tributary. We find him waiting for us on the sofa, bare-chested, his left arm cradled in his right. A tall, heavily-built man in his forties, he looks so grey and unwell it makes his hair and beard look fake, somehow.  He’s not quite with it, but the story seems to be that he collapsed some hours ago in another room, broke his arm, and took this long to get to the phone. It’s an obvious fracture. When he shifts in the chair, the mid-point of his upper arm sags, and he clamps his teeth together with the pain.

We fix him up as best we can, get him in the chair and struggle back outside. The lift hasn’t moved since we came up with Dogman, so at least it’s quick enough getting him down to the lobby. Unfortunately, the tower block is much lower than the road. There is no ramp access; instead, we have to haul Richard backwards step by step up to the ambulance. He’s just on the limit of our ability to lift without help, so it’s an exhausting climb. Even though it’s a cold night, I’m sweating by the time we reach the ramp at the back of the vehicle.

Once we have him on board, we work quickly to get his obs, give Oxygen, get access, better pain relief. It’s difficult to figure out just how much or how little contact Richard has had with the world, what his medical history is, or anything that might better inform his treatment, so we have to go with what we have in front of us. Apart from a persistently low blood pressure and a broken arm, his other obs are okay. But he looks so unwell I call ahead, especially if the department’s as busy as it has been lately.

We set off.

* * *

When we come through the doors of the ED we’re directed into the normal patting area rather than resus. I guess the hospital staff must have taken the ASHICE and decided it wasn’t too serious. I can picture them taking down the basics – collapse query cause, broken arm, low BP.  Nothing to warrant the fuss. Sometimes it’s like that. You have to see the patient to know that something’s going on, even if you can’t figure out what it is. The triage nurse is experienced, though. She sees straight away that Richard isn’t right. His ECG’s clear, but if you didn’t have it in your hand you’d put money on him having an MI. She calls a consultant over. After a quick run-through of events he leads us through to resus.

We slide him over onto the hospital trolley, and after reviewing the case with the staff, I take the paperwork through to reception to book him in.

* * *

Reception looks more like an A&E stockade than ever – except one that’s been ravaged by a Christmas tornado. Amongst the cards and flashing, dancing Santas and thick vines of tinsel and glittering stars hanging down from the ceiling, the staff are as over-worked as ever, booking in patients, answering phones, dealing with people in various states of distress at the counter, photocopying documents, everything in the exhausted atmosphere of people doing their best to service something that will never be satisfied, never be straightened, never be level.

‘This one’s in resus,’ I tell Rose, handing her my sheet.

‘Yeah? Me too, in a minute.’

She’s wearing a pair of reindeer antlers. From the expression on her face, I’m glad they’re made of felt.

But she takes the paperwork and immediately calls up details on the screen as fluidly as if she only need think a thing for it to happen.

On the top of the mini-fridge behind her there’s a tray of mince pies, a scattering of tangerines, a carton of Twiglets.

‘Help yourself,’ she says. ‘Oh my God. If I have one more mince pie I’ll explode and I tell you what – if I go, I’m taking you with me.’

dogman

We’ve pressed the buttons for flat thirty-two but there’s no reply.

Whilst we’re waiting, wondering what to do next, a shambling figure with a can in one hand and the lead of a dog in the other appears behind us.

‘S’up?’ he says, pushing his hood clear with the can-hand, slopping lager onto his straggly head. ‘N’emergency?’

‘Yeah. I suppose it is,’ I say.

‘Wha’s the matter with ‘em?’

‘I don’t know. We haven’t got that far.’

‘Oh.’

The man looks down at the dog as if it just said something, but the dog, a large and well-padded Staffie, square and bow-legged as an antique footstool, stands as quietly perplexed as we are. The man jerks the lead, then looks back at us.

‘Why don’cha ring?’

‘We have, but there’s no reply.’

‘Maybe he’s out.’

‘Maybe. But maybe he’s in and can’t get to the door.’

The man takes a swig from his can, smacks his lips, jerks the dog lead again. His face is grimy, booze-blasted, his cheeks hollow on empty gums. In the flickering light from this porch he’d make a zombie blanch. I’d guess he was about twenty.

‘Wha’ you gonna do?’ he says. ‘Kick the door in?’

‘Haven’t you got a key?’

‘Me? No. I’m visiting.’

He struggles on the word visiting, like he’s giving a little sneeze.

‘I tell you what,’ I say to him. ‘Why don’t you call your number, and we’ll tag along after.’

He winks, touches the can to his head, points at me with it, then stumbles up to the intercom. He leans right in – so far in, it looks like he’s supporting his weight on his nose. The dog turns its head and looks up at me.

Eventually the man presses some buttons and staggers back. A voice comes on the intercom, thick and incomprehensible.

Ay-rgh?

Ugh?

Ay-rgh-ave-oos

S’Anee

Blargh

Whatever it was they said to each other, it has the desired effect. The door buzzes open and we all go in, walking in a group across the echoing lobby to the lift.

If Hell exists you’d probably get there in a lift like this, Dogman as attendant. (Although maybe sans dog. Hopefully the dog would catch a ride in the other lift, the one with heating, lighting, a clean floor and soft music, heading up.)

The man stares at us.

‘All right?’ I ask him.

He shakes his head.

‘How d’ah know y’ar who y’say y’ar?’ he says.

‘You don’t,’ I tell him. ‘I suppose we could’ve faked all this gear, our jackets and the rest of it. Did you not see the ambulance parked on the street?’

‘An amb’lance, ya say?’

‘Yep.’

‘Nah. I didn’t see no amb’lance.’

‘A big yellow thing.’

‘Is it?’

‘Yep.’

‘Well fair play to ya, man.’

He takes another swig from his can, timing the tilt to coincide with the rattling stop of the lift at the sixth floor. The doors grind open and the man staggers out like he’s been sucked there by a sudden change in pressure. Incredibly, he stays upright, and with the dog trotting along behind him, lurches round the other side of the corridor where there’s a terrible volley of swearing and shouting and the resounding slam of a door.

We knock on number thirty-two.

I try the handle.

It’s open.

‘Ambulance!’ I call ahead into the gloomy hallway.

We pass inside.

looking forward

‘Have you been here before?’

He holds on to the door  like it’s the door holding on to him.

‘I’m not sure. I’ve been to so many places I lose track.’

‘Lose track?’ he says, letting go of the door and tottering back into the house. ‘Bit young for that, aren’t you?’

‘You’d think.’

I follow him in.

John’s still an imposing figure, even though his eighty-five years are weighing heavily on him now, putting him forward at the waist, his vest hanging loose, the braces of his trousers holding a gap between the belt and his withered frame. In his prime he would’ve stood six foot four, broad and strong, with the kind of jaw and chisel-cut mouth that made decisions and stuck to them. Now, it’s all he can do to let us in the front door without going over like his wife.

‘She’s in the bedroom. I can’t get her up.’

He points to the bedroom and that’s where we find Olive, sprawled on the floor by the dressing table, surrounded by pillows and covered with a duvet, a panicked, extemporary nest pulled over her from the bed.

There’s not much room to move. John and Olive sleep in two beds, separated by a table with a lamp. The opposite sides reflect their individual needs – Olive’s with a commode and a rail; John a space for his Zimmer frame and a hook on the outside of the wardrobe with a hanger for his day clothes.

‘Last time it was me,’ he says, sucking his teeth, watching as we pull the duvet aside to examine Olive. ‘Give it me,’ he says, holding out his hand. ‘It’s wet. I’ll put it in the wash.’

Getting Olive up isn’t easy. Her arms and legs are grossly misshapen with lymphedema, lacking even the smallest amount of strength or suppleness to move herself into a better position or help us get the inflatable cushion beneath her. After a great deal of awkward manoeuvring we get her on the cushion, though, and gradually raise her up so she can find her balance, take the weight on her legs and make it to a chair.

Once she’s up, we find there’s some blood on the sliding sheet. We need to find out where it came from, so it means we have to lift her nightie to inspect her for wounds or anything else. We decide it’s nothing to worry about – a minor scrape from the original fall. We treat it quickly and then help her into the chair. With Olive safely landed, I put the bedroom back to normal, then rejoin them all in the front room.

Rae finishes her obs and I write them down. Olive has quite a history, but in the end it’s just about okay to leave her at home. It’s apparent the situation can’t continue much longer. They already have a high-level of care, the house is about as adapted as it could be without demolishing the place and starting from scratch. The outlook is bleak and surely measured in months or weeks, not years. None of this we say, of course. We take care of the immediate aftermath, and leave the rest to play out as it will.

They’re both quite chipper, though. I make them a cup of tea. Olive’s gets cold whilst she finishes talking things over with Rae; John sips his quietly, dividing his attention between his wife and the extensive spread of family photos around him.

‘Does Simon live close?’ I ask, pointing to a particular photo, the usual graduation photo, a man in a gown holding a scroll like a magic club he’s going to use to beat fortune to his will.

‘New Zealand,’ he says.

He gives me a long and appraising look.

‘Like rugby?’ he says at last.

‘Rugby? Me? No, not really.’

‘Oh,’ he says. ‘Pity.’

‘Are you a big fan, then?’

He puts his cup down, almost tipping it over on the floor.

‘You know what’s happening next year, of course?’

‘A big rugby thing?’

‘Big? It’s the World Cup, man! In England! It’s huge!’

‘Wow.’

He shakes his head, then picks his cup up again, carefully wiping the bottom of it so the drips don’t fall on his lap.

‘I’m going to Twickenham with Simon,’ he says. ‘He’s got tickets.’

He rests his gaze on me again, uncertainly, like a pale blue lamp with a faltering connection.

‘I’m looking forward to it,’ he says.

that poor dog

...and in case you missed it on the sidebar, here's a link to my daughter Martha's ukulele cover & animation of  John Denver's Christmas for Cowboys... ;) x

happy christmas

It’s a cliché, but A&E’s in meltdown.

Except meltdown doesn’t quite do it. Meltdown suggests movement, fluidity, a change from one form to another. Obstruction is more like it. Log Jam. The volume of patients coming through the automatic doors overwhelming the channels established to deal with them. With no beds further up the chain, nowhere for the current cubicle occupants to move up to, nowhere for the new ones coming in the door to go, it’s a logistical puzzle with no solution. A simple question of numbers – although as is often the case, the simplest questions are the most difficult to answer. No one round here has any time to debate. Coping has shrunk to a few centimetres of space, a cup of coffee, a clear view of the wipe clean board and the A&E clock.

The staff in A&E – the nurses, consultants, HCAs, cleaners, porters – everyone is doing whatever they can to alleviate the situation. No-one has the psychic or emotional room to do anything else, to see or believe in any kind of long-term plan. Home has retreated to the realm of fairytale. The best anyone can hope for is a chair and a cup of coffee, something to eat and a place to rest their eyes that isn’t occupied and doesn’t demand action.

I’m waiting with our patient, a young guy with a deep abscess on his left buttock that the consultant has just packed out with super-absorbent gauze in the humane but brisk manner of a field-surgeon under fire. The patient is on his back at least, on a trolley, the pressure of his body helping to staunch the blood loss. His wife is with him, wiping his forehead and kissing him now and again. The whole scene only needs straw on the floor to qualify for a Crimean certificate of tragedy, but everyone’s doing their best, the shift is nearly at an end (theoretically), and the pharmacy has antibiotics, for a few more seasons at least.

I’m chatting to the patient about this and that, keeping him distracted from the general scene of woe, when I feel a tug on my elbow. An elderly woman, peering up at me.

‘You look like the person to ask,’ she says.

‘Oh, really? Okay. How can I help?’

‘I’ve been told my taxi is out where the ambulances are parked, but I don’t know where that is. Could you tell me?’

‘Of course. Head for those doors in the far right corner. See them? Just where that guy in the yellow jacket is waving his arms about? Once you make it past him, you’ll see a couple of automatic doors, and about a thousand ambulances nose to tail in the car park just outside. That’s where your taxi will be. Okay? Do you want me to help you through, or are you all right?’

‘I’ll be fine, thank you. I can see you’re busy. I just got a little lost, that’s all.’

‘It’s all very confusing, that’s for sure.’

‘Well – thank you for your help.’

‘You’re welcome.’

She starts excusing her way through the melee; I turn my attention back to my patient.

About a minute later, I feel another tap on my shoulder.

It’s the old woman again.

‘Happy Christmas!’ she says.

‘Oh! Happy Christmas!’ I tell her.

She holds out her hand for me to shake.

‘And a very Happy New Year!’ she says.

Then with a neat little shake of her shoulders, a gracious nod to the patient, the patient’s wife, she releases my hand, turns, and with her head up and beak out, she addresses herself to the task of swimming upstream, and the heavenly prospect of a taxi, waiting with its lights on, somewhere out in the dark.

smoked carp

It couldn’t be more public. Two street drinkers fighting outside the pizza restaurant overlooking one of the busiest intersections in town. We have a big audience – people eating pizzas just the other side of the glass, Christmas shoppers and lunchtime workers hurrying past on the pavement, people in cars queuing at the lights, and a woman filming us on her phone.

‘Please don’t,’ I say to her. She zooms in.

It’s impossible to know what the fight was about. It seems to have something to do with a tatty, empty Adidas bag, but really that could just be the focus of all the tugging and pushing and ineffectual roaring. The call came through to us as a male, fitting. We wondered if it might have been a mis-type, but one of the cops who’ve stopped by to help says that Paulie, the guy who seems to be the centre of all the fuss, was seen at the start of it all to fall to the ground and start shaking.

‘Apparently he smoked something. A legal high of some description,’ says one of the cops. ‘He looks a bit out of it, but I wouldn’t say he was dangerously intoxicated. What do you think?’

‘Shall we get him on the ambulance and check him out there?’

It’s easier said than done. The scrappiest drinker – a guy with a face that would make an ogre wince – harries us around the second cop as we herd Paulie up the steps into the back. He’s submissive to begin with, enough to get a satisfactory blood sugar reading. Unfortunately the scratch on his finger awakens the beast again. He starts swinging his fists and kicking out, so we let him get off.

‘I won’t fight you, Paulie,’ says one of the cops. ‘Are you listening to me? I won’t fight you. I’ll just tazer you. Do you understand?’

If he does, he hides it well. He crashes out of the door and staggers around outside; we form a moving barrier round him again whilst we review our options.

The cops don’t want to arrest him. They’re supposed to be undercover, chasing sharks not sprats. If they arrest him, they’ll have to take him down the custody suite. The nurse there will be duty-bound to refer on to the hospital, just in case there’s something else going on. The hospital is completely overrun; an aggressive, intoxicated Paulie is the last thing they want. All in all, it would be better for all concerned if Paulie simply refused aid and went on his way, preferably with a sober friend.

Miraculously, the sober friend appears on a bike.

‘Hey!’ says Lance, jumping off and doing a little run to a stop. ‘Paulie? Whassap?’

Lance is as weathered as Paulie, but he’s so perfectly polite and helpful, we couldn’t be happier if St Francis had walked out of the pizza restaurant dabbing the sauce from his chin and politely inquiring if we needed a hand.

‘Mate!’ he says, turning to Paulie and laying a hand on his shoulder. ‘You’re a little bit fucked, aren’t you? Whad’av you been smoking? Not that bad shit again?’

Lance hugs Paulie round the shoulders and smiles at me.

‘It’s called Spice, but I tell you what, it’s not coriander. It’s pure evil. They put it in the water to make Koi carp swim straight.’

It takes a while, but Lance persuades Paulie to go back to the squat with him.

‘He just needs to sleep it off,’ he says. ‘He’ll be fine. I’ve got college this afternoon, but I’ll be with him most of the day.’

‘What are you studying at college?’ I ask him.

‘Me? Catering.’

hair

The security guard waves us into a parking space, then waits for us by the supermarket door as we fetch out some bags from the ambulance.

‘It is okay,’ he says, leading us in through the automatic doors, along the fruit and veg aisle to the back of the store. ‘This young person he had a fit of the shakings, like this...’ The guard hauls up suddenly and gives us a surprisingly vivid mime, rolling up his eyes and jerking his arms down by his sides, like someone unexpectedly wired to the mains – much to the astonishment of an elderly woman picking over some tangerines – ‘... then he fell down upon the floor.’ The security guard carries on taking us through, talking happily the whole while, waving to colleagues across the store as if to say It’s okay, Don’t worry. I’ve got this.

‘This young person he get better very quickly. We tell him don’t move, the amb’lance is on its way, but he said no no, I am not hurt at all, and he got himself up. We put him out back where it was a bit more private for him, then we gave you a call on the nine nine nines.’

He jabs out a code on the keypad by the back door, then pushes it open and takes us through.

Past shelves of shrink-wrapped trays of tins and packets and jars, the stockroom smelling of plastic and dust and old cardboard, out to an office, where Cameron is sitting on a chair, the hood of his sweatshirt fully up, his legs crossed, arms folded.

‘I’m fine’ he says. Hello. Sorry. I didn’t ask them to call you.’

‘Okay now?’ says the security guard, smiling broadly. ‘I’ll leave you to do it.’ He pushes his cap a little further back on his head, and saunters out.

‘So. Cameron. Tell us what happened.’

‘It’s all perfectly predictable,’ he says. ‘I’ve come down on a visit. I suffer with epilepsy, but it’s all well controlled with drugs. I tried to get a repeat scrip before I came, ‘cos I found I only had one left, and I need three a day, breakfast, lunch and supper, but the doctor was on holiday or some such bullshit and it was all going to take a bit longer to put through. So mum said I should go anyway because otherwise my supersaver ticket wouldn’t work, and I could go to the walk-in centre when I got here, because they’d be happy to give me a scrip, and everything’d be fine. I just popped in here to get a few things when I got off the train, and the next thing I knew I was on the floor. It wasn’t a bad fit or anything. I know my own body – as far as that goes! So I’m fine, really. It’s just I need to get some more Epilim, otherwise it’ll probably happen again.’

‘Did you bash your head at all when you went down? It’s difficult to see with that hood on.’

‘I did a bit, but honestly, it’s fine.’

‘Let’s have your hood down so we can have a good look. Is that all right?’

‘Sure,’ he says.

He flips the hood back.

It’s difficult not to take a step back. Cameron has a full, honey-brown Afro, except the centre has been cut away, front to back. It looks like someone went for a joyride on a lawnmower, crashed through the middle of a topiary hedge, and carried on.

‘What do you think?’ he says.

‘About what?’

‘About getting a scrip from the walk-in centre?’

‘Yep. Worth a try.’

‘Good. Let’s go.’

He stuffs his hair back into the hood, and we lead him out to the ambulance.

The security guard is back on the door. He smiles as we pass, lifting off his cap to reveal a veined, shiningly bald head. He wipes his free hand over it a couple of times, a stage magician proving there’s nothing there, then replaces the cap.

‘Have a wonderful day!’ he says, twitching the peak.

Then nods, turns and goes back inside.

jiminy cricket

It’s a novelty to get a call from a telephone kiosk, certainly one with a door. Most of those have either been torn up, turned into email hubs or works of art. Carl has found what must be the last functioning box in town. He’s still on the phone when we pull up. When I knock on the glass, he frowns and turns his back. I walk round the other side, knock again, and point at the badge on my jacket. Ambulance I mouth. He shakes his head and turns again, only this time the cord on the receiver stops him and he has to reverse, ending up facing back in the original direction.

For a moment I wonder if we’ve got the right person. Maybe the patient left and this guy took his place in the box. That would be embarrassing. I get back to Control. Nope. That’s the right location she says.  I’ll get the call taker to speak to the patient.

I wait outside the box. After a while, Carl turns again, squints at me through the glass, shakes his head irritably, and smacks the receiver back on its hook.

I hold the door open for him. He walks out and then stands on the pavement, his arms folded, shivering in the frosty night air.

A sharply pale, ferociously intense young guy in his thirties, Carl looks like the conductor of an orchestra who stepped off the podium, went on a three-week bender, wandered into the zoo and woke up in the lion enclosure. The jacket of his black suit has gone, his white shirt is grimy and untucked, and his black trousers are only held up at the front – at the back, the seat has been ripped away right and left, hanging open, revealing a pair of hideously soggy pants.

 ‘Shall we get you on the ambulance and have a chat there?’ I ask him. ‘It’s warmer and a bit more private.’

‘I need to go on a detox,’ he says, miserably, lurching up the ambulance steps and onto a seat.

Rae wraps him in a blanket and he sits there, shivering, staring at the floor.

‘I’ve drunk an improbable amount of alcohol,’ he says. ‘I’ve got liver failure. I’ve been having hallucinations. I’m really very, very unwell and I absolutely must go on a detox.’

‘We’ll certainly run you up the hospital – to warm you up, and see about these hallucinations. As far as any kind of referral onto a detox programme, that’s the kind of thing that needs to come from your GP.’

He snorts.

‘Who’s your GP?’ I ask him.

‘My GP is immaterial,’ he says. ‘My GP is a spectacularly ineffective individual who doesn’t care whether I live or die.’

‘I’m sorry to hear you don’t get on with your GP,’ I tell him. ‘Who is it, just for the record?’

‘Just for the record? Dr Death. And just for the record? I will never, ever go back.’

* * *

Carl makes quite an impression as he walks between us into the A&E triage area, holding the blanket open like he froze in the process of wrapping it tighter; the effect is of some ragged little bird with a plume of coal-black feathers on his head, walking with its wings outstretched in some tragic mating ritual. He hops up onto a trolley and perches there, staring down at his over-sized feet. His wings slowly lower around him.

‘Oh dear!’ says a nurse in passing.

Carl tuts, and shakes his head bitterly.

* * *

Once I’ve handed over and checked in Carl’s paperwork, I head outside to the ambulance.

It said on the news that tonight was the best night for seeing meteors from the Geminid shower. The sky is perfectly clear, the stars standing out in great number and depth. I lean back against the bonnet of the ambulance and stare up at the sky for a few minutes. It’s so cold I put on my beanie hat, fold my arms, and wait.

And then – there! Just east of Orion’s Belt. A thin swipe of white against the black. I read somewhere these things are only as big as a grain of sand, travelling so fast they burn up in the atmosphere. You wouldn’t think something so small could make such an impression, but really – it’s so exciting to see it. I can’t help thinking of Jiminy Cricket and the whole wish upon a star thing – although with him it might actually have been a star and not a meteor, I can’t remember. Anyway, when he sees it and makes a wish, the Blue Fairy comes down and turns Pinocchio into a real boy, eventually, after the puppet master and Pleasure Island – Da Rough House! Da Rough House! and a whole lot of other stuff. But there’s so much to be done tonight, so much tidying up and putting right, Rough House or otherwise, it’s just too tall an order, even for a fairy. So I don’t pursue my claim. I settle for having seen a meteor, and climb back into the cab.

Rae brings coffee out.

We sip it, listening to the radio.

It’s all good.

alice

The unmade road up to the standby-point has a frontier roughness. You wouldn’t be surprised to see a clapperboard saloon and an undertaker with coffins propped up on the rail; instead, the little magnolia-painted prefab is set between a social club for serial killers and a mean-looking garage with a dozen cut-and-shuts dump-parked out front.

At five o’clock in the morning, it couldn’t be more wonderful.

It’s been another busy night (another night, in other words.). We’re both too tired to say or do or think much of anything. On the drive out of town to the standby-point it starts to rain, a thin, dispiriting drift against the windscreen, irradiated by the street lamps, soft and unrelenting. Rae is so low down, her knees braced on the dash, it’s like she’s being subsumed by her chair. It’s happening to me, too. I can feel the plastic of the steering wheel creeping up my arms, whilst the rain falls and clears against the windscreen. Speckle. Wipe. Speckle. Wipe. Speckle. Wipe.

I slap my face and turn the radio up.

‘Huh?’ says Rae.

‘I’m falling asleep.’

‘Oh.’

But then suddenly, incredibly, I seem to be outside the standby-point watching Rae punch in the door combination.

 I turn to watch a car pass below us along the main drag, and I feel a great bond of sadness with the driver.

What brought us to this? Where did we go wrong?

But Rae is in and I’m following, and suddenly I’m warm and perfect in a beautiful recliner. The TV is as automatic as the lights in this place. A Countdown repeat. It’s all so safe and regular and predictable I could sob. I settle back, and free-fall Alice-style down a very deep hole, peopled with consonants and smiles and self-eating clocks.

* * *

‘Who are you?’

‘The ambulance. You buzzed us through. Who do you think?’

I don’t actually say the last two things but I think them so hard she must have heard.

‘Come on then,’ she says.

Bea tuts and grumps her way ahead of us down the corridor. A thin, middle-aged woman with a demeanour as bracing as a can-opener; if it wasn’t for the zip on her anorak, she’d fly into pieces.

‘They’re here!’ says Bea, tossing the announcement ahead of her into Maggie’s room like a stun grenade.

We follow her in.

Maggie has woken up with a racing heart. She has AF; sometimes it cuts loose and fills her chest with stampeding horses.

‘Calm down!’ says Bea. ‘You mustn’t get like this.’

Maggie is wet with sweat, trembling, clutching onto my left hand as I take her pulse with my right.

‘What have you done with your medication?’ says Bea, rootling around behind us amongst a pile of old newspapers and letters. ‘And where’s your jacket? Are you taking your jacket? You have to take your jacket. Just calm down and think.’

Rae yawns and heads back out to the truck to fetch a chair.

‘Let’s just take a moment,’ I say. ‘Keys, medication, reading glasses. It’s cold outside but we’ve got plenty of blankets. We’ll wrap you up snugly.’

‘Maggie’s got schizophrenia, arthritis and a new hip. And don’t forget to tell him about the gabapentin, Maggie. Maggie! Tell him about the gabapentin.’

‘Just – one step at a time,’ I say to Bea, palming my hand up and down in the space between us. It’s like playing whack-a-mole with a banshee. Every time I pat her down, she pops up somewhere else.

‘Were you … thinking of coming with her?’ I say, adjusting the oxygen mask around Maggie’s face.

‘Me? No. I’ve got things to do. I can’t just come to the hospital. I’ll ring later and find out how she’s doing. Maggie? I say I’ll ring later and find out how you’re doing. Just calm down, will you? You’re getting all worked up.’

I glance at my watch. I count Maggie’s resps, whilst at the same time visualising the distance to hospital, the handover, the transfer, the ride back to base.

‘Everything’s going to be okay,’ I say, releasing her hand.

Rae comes in with the chair and sets it up with an expert flick of her hands.

‘It’s all going to be fine,’ I say to Maggie, helping her to sit up. ‘We’ll be there before you know it.’

rain fall

It couldn’t possibly rain any harder, but then suddenly does, much harder, a startling intensification of the storm that obliterates every detail of the street in one furiously grey and undifferentiated pall of water. Luckily, there’s room in the street to park right outside the house. Jane’s partner Paul is waiting for us at the open door, hanging back like a man sheltering in a cave behind a waterfall.

Paul and Jane were late for work. They were hurrying out of their first floor flat together when Jane stumbled at the awkward tuck at the top of the stairs. She was holding a bag and umbrella in her hands, which meant she didn’t have time to grab on to the banister and stop herself falling. She toppled headlong, scrabbling on her front down the entire staircase until she came to a stop face down in the hallway.

Paul turned her on her back to make sure she was still breathing.  

She lay there stunned, staring up at the ceiling.

Paul phoned for an ambulance.

‘My wife’s just fallen down the stairs and she’s thirty-eight weeks pregnant’ he said.

*

Paulo, a Critical Care Paramedic, is also sent to the scene. I tell him that despite it being a long fall, Jane seems to have come off pretty well. There are no distracting injuries, she’s not complaining of any pain, nothing in the neck or back, doesn’t have any neurological deficit, she wasn’t knocked unconscious, has good recall, GCS 15 throughout, hasn’t felt sick or been sick – in fact, doesn’t have any of the signs or symptoms that might worry you. There’s no getting away from the height of the stairs, though, and the fact that she’s thirty-eight weeks’ pregnant. No problems with the pregnancy to date. She’s forty. This is IVF.

And no, she hasn’t felt the baby kick since the fall.

Paulo works quickly, reviewing everything before we think about moving the patient. He clears her neck and back, and together we sit her up. I help Rae take out all the immobilisation equipment we’d brought in, and prep the truck ready to go. A minute or so later Paulo walks out with Jane and Paul. We settle them in the back, and then set off for hospital.

Paul is sitting next to Jane, holding her right hand tightly; her left hand is across her lap, following the curve of her bump. She strokes her hand backwards and forwards beneath the bump as she talks.

‘I can’t believe I did it,’ she says. ‘I’m so sorry. It’s all so stupid.’

‘Don’t worry,’ says Paul. ‘It could’ve happened to anyone.’

‘But me. Why’d it happen to me?’

‘Those stairs are lethal.’

‘We should’ve moved when we had the chance.’

‘Yeah – but that far out of town? C’mon.’

The ambulance is buffeted from side to side and the rain rattles against the side.

‘Hark at that,’ says Paul. ‘It’s like the end of the world.’

They’re quiet for a while.

‘Shall I phone your mum?’ he says, eventually, pulling out his phone..

‘No. Let’s find out how things are first,’ she says.

‘Okay.’

‘I don’t want to worry her.’

‘No.’

He holds the phone without doing anything, then puts it away again, still holding on to her hand.

I don’t ask her if she’s felt the baby kick yet. I know if she had, she’d say immediately, and I don’t want to make too much of it. There’s not much to be done either way.

‘Were you off to work?’ I ask instead.

‘Yep. Not much longer to go and then, you know.’ She looks down at the bump.

‘What do you do?’

‘I’m a primary school teacher. The kids are going to want to know what happened.’

‘That sounds like a nice thing to do, primary teacher.’

‘Yeah. I love it. The kids are great. Well – they can be dreadful. But even when they’re dreadful, they’re kinda brilliant. If you know what I mean.’

‘Sounds like you really love your job.’

‘I do. I love kids.’

She strokes her bump gently.

The lights flicker off and then on again.

‘Dodgy electrics’ I say.

‘Oh,’ says Paul.

And we hurry on through the early morning commuter traffic, the storm, the next five minutes, to the hospital.

acronyms

Anyone could tell walking into that room that Adnan is mortally sick. His massive figure is sprawled helplessly on the bed, pale and sweating, a CPAP mask over his face. But if you missed the signs, the long list of acronyms on the discharge summary would make it plain in an instant: CKD4, CBBG, IDDM, CCF, AF, OSA and so on – a long, coded parade of woe with an eloquent line-space before the final four letters: DNAR. He was only discharged three weeks ago, but he’ll need to go back. He’s struggling with chest pain and breathing problems, and the family simply don’t have the resources or expertise to cope at home any longer.

Adnan’s son Bashir tells us what we need to know, translating into his father’s ear, and gripping him by the hand. Adnan’s wife, Rema, meanwhile, comes in and out of the room with a succession of things: a clean pair of inco pants, a fresh linen robe, some velvet slippers, solemnly handing each item to us with such a fixed and sad expression it feels like we’re officiating in some religious ceremony – which, by default, I suppose we are.

Together with Bashir we dress Adnan, and prepare him for the ride in our chair out to the ambulance.

*

Once he’s on the trolley we run through another set of obs. We need to do an ECG, so I undo his robe to the navel. Lying on top of the great, bunched scar that runs down the centre of his chest is a plain wooden cross on a chain. I hesitate to move it aside. It strikes me it’ll probably do him as much good as anything else Still, we go through the motions, sticking on dots, putting in a canula, giving morphine, working around each other in the cramped cabin space.

Adnan groans.

Bashir sits forward on his seat, squeezing his father by the hand and talking low and quickly.

Okay. Good to go?’ says Rae finally, surveying the scene and pulling off her gloves.

‘Yep. Thanks Rae. I’ll pass the ASHICE from the back.’

She jumps out and slams the door.

I press the Priority button and wait.

Bashir leans over, repositions the cross on his father’s chest, strokes his face, then sits back down again as the ambulance moves off.

sheep in boats

Jeffrey opens the door to us. A stooped and shuffling man in his early seventies, it’s immediately apparent he can’t talk. He makes grunting noises as best he can, peering up at us to see if we understand. He turns, and leads us inside to a set of steep stairs. We follow him up to where his mum lies in bed, staring at the ceiling. A wide, rose-pink bloodstain spreads like a spilled bloom of ink on the pillow either side of her head. The brightness of Agnes’ blue eyes contrasts with her ancient body, like seeing an unexpectedly bright light in the window of a dilapidated house.

‘Oh – I don’t need anybody!’ she says. ‘I’ll be fine.’

Agnes had a fall coming out of the bathroom. She went over backwards and caught her head on the radiator. She wasn’t knocked out, but she couldn’t get back on her feet. She bum-shuffled along the corridor, and then Jeffrey helped her into bed. He pressed the red button, the ambulance was alerted.

‘I’m sure I’ll be fine,’ she says. ‘I just need to rest.’

It’ll take more than that, though. Agnes has a nasty laceration on the back of her head, and it looks like she may have fractured her shoulder. Despite her pain, she’s still more concerned about Jeffrey.

‘You’ll be okay, won’t you darling?’ she says to him. ‘There’s plenty of food in the fridge. Margaret will come over at tea time. I’ll give Graham a call, just so he knows, and he can do a ring around. Okay? Give me your hand, darling. It’ll be fine. They’ll stitch me up and kick me out before you can say jiminy cricket. Won’t they? Hey?’

We help Agnes into our chair and carry her down the stairs. Jeffrey waits for us at the bottom. He follows us outside, but doesn’t come any further than the grass verge.

‘Don’t get cold’ says Agnes, blowing him a kiss. ‘Get back inside and have a nice cup of tea. I won’t be gone long.’

As soon as she’s on the ambulance trolley with the door shut, the effort of maintaining a front for Jeffrey falls away. She sinks back into the trolley and suddenly seems much older.

*

When I look up from my paperwork, Agnes is looking at me.

‘Enjoy your work?’ she says.

‘Yes, I do. It’s got its difficulties, like anything else. Annoying management, you know. Politics. You get that in any job. The good thing is in the ambulance you can pretty much ignore all that stuff. It’s still just you and your mate, driving around, helping people. I think that’s why I’ve stuck it so long. What about you? What did you do before you retired?’

‘Oh – I never really worked. I had a job as a secretary for a while, but then I had kids and that was that. They were my full time job.’

‘How many kids did you have?’

‘Eight.’

‘Eight? Wow!’

‘One by my first husband and seven by my second.’

‘I’m from a family of seven.’

‘What number are you?’

‘Five. I feel like I should have it spray-painted on my back, like a sheep.’

‘That’d make things easier.’

‘Come in number five, your time’s up.’

‘I think that’s boats, not sheep.’

‘Sheep in boats.’

‘I’m the one who cracked their noggin, not you.’

‘No. I blame my mother.’

‘The poor thing.’

We ride on in silence for a while.

‘I do worry about Jeffrey though,’ she says.

‘Oh?’

‘He’s the child I had with my first husband. He’s lived with me ever since. I worry what’ll happen to him when I go.’

‘It must be a worry.’

‘He couldn’t go into a home.’

‘No.’

‘But what else is there?’

‘I don’t know.’

‘The rest of my children wouldn’t have him. They’re sweet and everything, but it’s just not something they’d do.’

‘No. I suppose it’s quite a big ask.’

She gently prods her head and winces.

‘Do you suppose I’ll be in long?’ she says.

‘I shouldn’t think so. It’s hard to say.’

‘This is such rotten luck,’ she says.

She looks a bit teary so I hand her some tissue. ‘We were doing so well,’ she says, dabbing her eyes and then blowing her nose with a business-like twist. ‘Stupid! Stupid! Stupid!’

‘Try not to worry,’ I tell her. ‘These things happen. We’ve just got to get you better and get you home as soon as possible.’

‘I know – but honestly!’

‘It’ll be fine.’

She frowns.

‘Are you sure?’

‘Absolutely.’

‘I have the solemn word of number five?’

‘You do.’

‘Give me your hand.’

I give it.

She shakes it.

‘Then I’m happy with that,’ she says. And closes her eyes, and rests back on the trolley.