astrological twins

A tall guy vigorously kitted out in active leisure wear waves over to us from the kerbside up ahead. We pull level with him. He smiles as I climb out of the cab.
‘So this is what happened,’ he says. ‘Gerry and me found this guy lying face down in the middle of the pavement. He smells quite a bit of drink, and I guess you’d say he may well be intoxicated. I don’t think he’s hurt himself, but you’re the experts. Anyway, he wanted to go back in his flat. This one, here. So we helped him up and inside, and – well – that’s it. I hope we did the right thing in calling you. I hope it isn’t a waste of time.’
He touches me on the shoulder, generating such a voltage of goodwill I’m sure I feel a tingle there.
He leads us up some stone steps and into a warm and neatly prepossessing hallway. The door to the ground floor flat stands open, and we follow him in.
‘The ambulance are here, Gerry,’ he says to a similarly tall and waterproofed man, with a smile as invigorating as his friend.
‘Thank you so much for coming,’ he beams, then stands aside, and with a magician’s sweep of his arm says: ‘And this is Jim.’
Jim sits slumped forwards on the edge of a sofa. With his beany hat pulled low over his brow, his chin buried in the folds of his jacket, his hands hanging between his knees and his shoulders rolling down after them, he seems like the illustration for a grimly modern tarot card: The Beaten Man. He has a bottle of white wine by his leg; when I introduce myself and Rae, he picks it up and takes a long pull.
‘Please don’t drink any more just now, Jim.’
‘You can’t stop me.’
He puts the wine back down, wipes his mouth with the back of his hand, and resumes his position.
The first helpful guy looks across at me brightly.
‘Well. I guess you won’t be needing us any more,’ he says. ‘Good bye Jim. Nice to have met you.’
Gerry taps Jim on the shoulder. ‘We’re going now, but we’re leaving you in the capable hands of these lovely people.’ Jim looks up, bewildered. ‘Good bye, Jim.’ He holds out his hand. Jim shakes it. They leave, shutting the door behind them with a barely audible click.
‘Jim? Do you mind if I take a seat?’
He gestures vaguely to some collapsible chairs over by the sash window. I put one up for me and one for Rae.
‘Great. Now then. Tell me what’s happened today?’
Between periods of silence and the occasional, choking sob, the fragments of Jim’s story are laid out before us.

He has a drinking problem. He had an appointment today at the Alcohol Abuse Centre, but missed it. He has been drinking since this morning, went out to the corner shop first thing, came back, drank some more, then fell over in the street on the way back to the corner shop for another bottle.

Like an incriminating exhibit in a courtroom, there is an unopened pot of coleslaw (with bacon pieces) on top of today’s paper on the cluttered table in front of the sofa. I imagine Jim shuffling round the shop, coming to just sufficiently to pay for the wine, the newspaper and the coleslaw at the till, and then staggering out.

Jim says he has an American girlfriend who had to leave the country a few months ago when her visa ran out. He says she tried to kill herself last week. Jim can’t cope with any of this anymore. He knows the drinking isn’t helping, but he can’t stop.

He gestures to some bar bells over by the far wall.
‘I’m fit,’ he says. ‘I’m really fit for my age. I go to the gym. I work out. But now. Well – now I’m just whacked out and done for. I’ve let everyone down. And I’m embarrassed, with you lot being here.’

He takes another swig from the bottle.
‘Jim. I really must insist that you don’t drink whilst we’re here. To be honest it makes me feel stupid – the fact that we’ve been called out to you because you’ve had too much to drink, fallen over in the street, can’t get yourself up, and yet here you are carrying on. I’d be failing in my job if I let you do more of the thing that’s caused the problem.’
No response.
‘It’s the same as when we’re called out to people with breathing difficulties who want to spark up a fag. It makes a mockery of us being here. So please don’t do it. If you carry on drinking, we’ll just have to go.’
‘You can’t stop me drinking,’ he says. But at least he doesn’t make a grab for the bottle.
‘Okay. I just need to take some information,’ I say. ‘How old are you?’
‘Forty five.’
The same age as me.
‘And what’s your date of birth?’

It’s so unusual to come across someone with the same birthday as me that for a second I almost say it out loud. But I hesitate, and the hesitation seems to jump from me like the flash from a camera, lighting up the studio flat, the bar bells, the pot of coleslaw (with bacon pieces), the beany hat, the bottle of wine, the sprawl of letters from the Alcohol Abuse Centre, the unopened utility bills.
I want to shake his hand and say fancy that, born on the same day, the same year. I want to ask him what time he was born and where. I want to swap notes on the journey so far. But I worry that if I do tell him, me sitting here with a clipboard in my lap and a biro in my hand, Jim with his head down, irresistibly reaching out again now for that bottle of wine – well, I'm worried that it just won’t help at all.

meat / hat

#1: meat
‘We’re all standing on the front talking about where to go next. Out of nowhere this funny looking guy comes up to us and asks if we know where he can get something to eat. Joe just stands there, all Joe-like, in that way he has, and he says “We passed a meat place back that way.” And the guy says “Meat?” And Joe says “Yeah, you know. Meat.” The guy looks at him kind of weird – like “Why would you be saying meat to me?” Then he turns round and walks off. So then we carry on talking about where to go next. Suddenly the guy’s back with a gang of his mates. Real rough types. One of them gives him a kind of leg-up, he literally flies up into the air behind Joe, and brings his fist down – wham – as hard as he can, right on the back of his head. Joe falls to the ground, and the gang runs off.”

She’s standing with the focus of her weight on her left leg, swinging her hips gently from side to side and hugging herself with both arms. It’s like she’s trying to rock an invisible baby to sleep.

‘Why would you do that?’ she says. ‘What’s wrong with people?’

#2: hat
‘Where’s my hat? Oh bloody hell I can’t have lost my hat. I’ve got to go back. I haven’t had it long.’
Mick is standing up in the back of the ambulance rooting through the pockets of his combat jacket. He dumps the contents onto the seat that he should be sitting on: an unopened can of cider, a bag of rolling tobacco, a scrunched up copy of the Big Issue, some Werthers Originals. The congealed blood on the top of his spikily shaven head glistens in the interior light.
“Mick. Sit down mate. We’ll think about your hat in a moment. The most important thing now is to take a look at your head.”
“No. You don’t understand. I can’t lose my hat. I just can’t.”
‘What sort of hat is it?’
‘Brown. Furry. Ear flaps. I haven’t had it long.’
‘I’m sure we’ll find it just as soon as we’ve finished treating you.’
There’s a policewoman standing in the road looking in at the back door of the ambulance. ‘Don’t worry about your hat,’ she says. ‘The whole place is a crime scene. No one’s going in or out. Your hat’s quite safe.’
‘No. No it’s not. It’ll be gone. With the rest of my stuff. I’ve got to go.’
‘Will you let us at least clean your head before you leave?’
‘Oh – quickly then. But be quick. My hat’ll go before you know it, and I can’t lose my hat.’
Rae shines a light on the top of his head and I start to clean the wound with some sterile water. Mick has been bottled in the park, knocked clean out. I can see and feel toothy shards of green glass in the gashes.
‘This is a serious wound, Mick. You’re going to have to come to the hospital for treatment.’
‘No. I can’t go to the hospital. I won’t.’
‘Is it your hat you’re worried about?’
‘Yes. Yes – my hat. But what’s the point going to the hospital? They won’t give me methadone there.’
‘Methadone? Well – I don’t know about that. But you can certainly talk to someone there about it. The most important thing …’
‘Yes. Yes. The most important thing. The most important thing is that I get back to the park and find my hat. I can’t lose my hat. Not my hat. Enough’s gone wrong today without losing my hat. Jesus Christ. And don’t worry about the methadone. I’ll just have to score some heroin tonight and think about the rest tomorrow.’
The policewoman takes one step into the ambulance.
‘So will you be pursuing this assault, Michael? It’s a serious thing that’s happened to you. You should take the advice of these good ambulance people here and go on up to the hospital.’
‘No. Forget it. I didn’t call anyone. Leave me alone.’
He re-stuffs his pockets, and suffers to stay still just long enough to have a bandage taped around his head.
‘So what happened exactly?’
‘I was asleep on a bench. Suddenly this guy was shaking me awake. I said “What do you want?” and he said something like: “Do you want to feel pain?” and I was confused and I said “What do you mean? Say what again?” He bent down to put his bag on the floor, I sat up, he produced a bottle, smashed it over my head, knocked me out. Next thing I knew I was walking out of the park and some kids were asking if I was all right.”
‘You’ve got to get this wound treated, Mike,’ I say to him. ‘It needs cleaning out and gluing.’
‘No it doesn’t. It’ll be fine. I can’t be doing with all this.’
He makes to walk off the vehicle.
‘I’m serious, mate. It’ll get infected. It’s got glass in it, for goodness sake.’
‘Infected', he says, bending down to retrieve a toffee that’s fallen on the floor. ‘Thanks for all you’ve done. I appreciate it, I really do. But this is ridiculous. I’m going.’

And he’s gone.

stop the world I want to get off

From the outside, the shelter for homeless people still carries itself with the architectural politesse of the few remaining Georgian houses in this part of town. The elegant windows in the front, the fan-shaped stained glass panels above the door, the simple white columns either side, and the three stone steps – worn in the middle by two hundred years of boots - lead us up into a tougher environment than the architects could possibly have imagined.

The great hall is now partitioned by security-glassed fire doors controlled by buzzers from a grilled and gated office. The walls are white, without decoration. There is strip lighting, fire exit signs, extinguishers. Easy-clean lino with non-slip grips at the danger points. The grand old staircase, still wide enough for a brocaded Georgian day dress, proves just wide enough for a key worker, two ambulance men, a chair and a bag.

‘So what’s the story with this guy?’

‘His name’s Brad but we don’t know too much more about him. IV user, drinker. Came to us late yesterday. Got into a fight outside – in fact, he got a right kicking by all accounts. Had the ambulance out but didn’t go in. Found him this morning incoherent, difficult to rouse. Acting like he’s taken something, but then his pulse is banging away. We were due to evict him for his aggressive attitude.’
‘Is he likely to be aggressive now?’
‘Not in the state he’s in.’
The key worker leads us up the stairs, up past landings that diverge into corridors so numerous it’s like she’s taking us into the heart of a grim metropolitan hive. Brad’s room is right at the very top of the building. I swap a pained look with my partner, Clive.
‘I think we’re going to need the oxygen, at this rate,’ he says.
But we’ve reached the door, guarded by another key worker.
‘Hi,’ she says, pushing it open. ‘Thanks for coming.’
She lets us in to a plain, boxy room with the morning sun blazing in through the sash window opposite.
‘This is Brad.’
Brad is sprawled on a low bed. He has an arm crooked over his face to shield it from the sun, his legs drawn up to his stomach. A blockish, crudely tattooed man in his late twenties, he breaths heavily, and only vaguely bats my hand away when I go to wake him.
‘Brad? Brad? Sit up and talk to us, Brad.’
He grunts and snorts like a tranquilised horse. I lift up an eyelid. His pupil is small, but not pinpoint. His pulse thumps away beneath my fingers.
‘What’s he taken this morning?’
‘We don’t know. Maybe some drugs. We wondered if he’d taken more than he should of his quetiapine. We found some empty packets.’
‘And he was in a fight, you say? Do you know if he was knocked out?’
‘No. Don’t know.’
I study his face. He has some scuff marks on his head and a graze to the side of his mouth, just visible beneath the stubble. He opens his eyes to look at me, but it is the abstracted focus of a sleepwalker.
‘We need to take him to hospital, all things considered,’ I tell them. They seem relieved. The key worker by the bed mimes a little cheer. The one that led us up here says: ‘How are you going to do that, then?’
‘Main strength,’ I say, but without much conviction. ‘Come on, Brad.’
Clive helps me sit him up. I use my body to keep him on the edge of the bed whilst they all make ready for the chair.

Brad has a crude tattoo on his left bicep: Stop the world I want to get off. Both of his forearms are striped with great waxy scars. I can’t decide what would be better: having him conscious enough to walk down but at risk of being violent, or sedated but needing a carry chair. I think the first option would have been better. At least then we could have withdrawn for safety reasons. But Clive has the chair up and ready, so we load him on to it, wrap him in the blanket, strap him securely, and set off on the long haul back down the stairs. The key workers follow, carrying our bag and clipboard.

A couple of times they say they owe us big time as we struggle downwards one step after another; by about the second landing we could tell them the exact weight of that obligation. But we battle on, and make it down to the foyer. They open the doors wide, keep a few early risers away, and then cheerfully walk along with us to the ambulance as we wheel Brad out into the bright and busy morning.

mandy

We swing open the heavy iron gate, walk down half a dozen worn stone steps, down to the binned and weed-strangled little flagstone forecourt of this basement flat. Rae rings the buzzer; almost immediately the door is opened by a policewoman.
‘Hi Guys. Keith’s in the bedroom. He’s had a row with his mum on the phone and told her he’s taken another overdose, prescribed medication. Mind your step as you come in.’
The flat is oppressively low and squashed in, dim and very dirty, a feverish thick red paint behind all the film posters, old bikes, clip frames, mosaic mirrors, collapsing bookcases and precarious towers of clutter. There are sentences in scratchy black ink on the walls. I can only make out the odd phrase in passing: Tell them everything, tell them it helps / Ring, ring, ring if you feel this / I wouldn’t if I were you because you never know.
I bark my shin against a bike pedal.
‘Careful,’ says the policewoman, who seems quite at home.
‘Can we get some more lights on?’
‘This is it, I’m afraid.’
We follow her along the passageway, the clogged artery that serves all the rooms off to the right. We come to the bedroom and see Keith, a man in his thirties, as thin and drawn-out as a spindly underground root. He lies on his front hugging a filthy pillow. Next to him is an ancient brindle and white English bull terrier, who raises up her long head to sniff the air as we stand in the doorway.
‘The ambulance are here, Keith.’
‘Why?’
He opens his eyes, but only one is clear of the pillow. Both dog and man seem to sense rather than see us in the gloom.
‘This is what he’s taken.’ The policewoman hands me some empty packets of carbamazepine.
‘Are you epileptic, Keith? Or do you take these as an anti-psychotic?’
He shakes his head.
‘Anti-psychotic?’
He shakes his head again. ‘I don’t want to go into hospital. I just want to get some sleep.’
‘Well, if you’ve taken all these – and had a bit to drink, by the looks of it – you will have to come to hospital.’
‘No.’
‘Sorry.’
‘Come on Keith.’
Rae grabs some trousers off a chair, and puts a pair of trainers next to the bed.
‘Let’s get you ready for the off.’
‘I’m not going.’
‘We can sort out something for your dog.’
Keith suddenly sits up.
‘There’s a number on a piece of paper just outside the door. Call Chris. He’ll take Mandy for me.’
‘Okay.’
I turn round and the policewoman is holding out a scrappy piece of paper to me.
‘There,’ she says. ‘Some kind of support worker.’
I look back at Keith, who is sitting cross-legged in his pants, scratching Mandy between the ears. The room is as forlorn as the rest of the house, great hammocks of dusty black cobwebs in all the corners, a pair of heavy red curtains sagging across the French windows, some acrylic paintings nailed up – abstracts, self-portraits, smeared straight out of the tube - and on every available wall space, more handwritten paragraphs, urgent scrawls, reading like the other half of an ongoing conversation.
‘He did the same thing a couple of weeks ago,’ says the policewoman, silencing her radio. ‘Do you need me for anything else or can I stand down?’
‘No. I think we’re good.’
I look back to Keith. ‘Ready?’
He throws himself backwards on the bed, his arms straight out to the sides.
Mandy waits for the bed to stop bouncing, then settles back down to sleep.

PPE

A full moon sharp as a security guard’s torch shines on us as we sip coffee and swap war stories round the back of the parked ambulances.

Kaz, the new SHO – a short, powerfully built Asian doctor who takes hungry bites of his cigarette every time he puts it to his mouth – crosses and uncrosses his legs, and points to us enthusiastically.
‘You guys. I don’t get why you guys don’t wear stab vests. All the crazies, all the druggies – you get it as bad as the police. I don’t know why you don’t get issued with something like that.’
Watching him endlessly shifting position, munching his way through cigarettes, it strikes me he’s probably bald because he doesn’t sit still long enough for any hair to grow on him. He speaks loudly, briskly to purpose, even his leisure time set at the same pitch as his life in the A&E department.

Suddenly Mel, who has been standing quietly to the edge of this group of ambulance and hospital staff, speaks up.

‘I wish I’d had a stab vest the other day. The whole thing really shook me.’

There is a pause as we try to imagine Mel shaken up. Although she has the physical demeanour of a sporty nun, there is something about the way she carries herself – a quietly hard-edged economy – that makes you think of professional killers, assassins, samurai for hire. She wears her long brown hair scraped back in a swordsman’s ponytail, and her silver rimmed glasses glimmer in the unearthly light.

‘It shook me so much I could hardly use the radio.’

She gives her pony tail a little flick, rearing slightly at the memory, then tells us the story:

“We got a call to a man, short of breath, Category A, the full monty. And then on the way we got a follow-up saying they couldn’t get anything out of the guy, he was struggling so much he couldn’t talk. And then the line had gone quiet, so this was now a query collapse.

“We hauled up outside this house, dead of night, everything dark, front door open but looking like no-one home. On a social housing street, nothing too awful. So I took a torch with me just in case, Bill took the resus bag. I knocked on the door. ‘Hello? Ambulance?’ No reply. Flicked the hall light but the power’s off. I really didn’t want to go in – I was getting a bad feeling about the whole affair, but this was a guy who was maybe breathing his last so I thought I’d go in a bit further. Nothing. No-one. Flashed the torch around. No-one in the kitchen, no-one in the sitting room. No-one in the little back room. So then I thought I’d take a look upstairs. Bill was right behind me, thank God. He asked me if I wanted to call the police and I said something like: ‘Let’s just see what we’ve got”. Like an idiot. So I crept up the stairs shouting: ‘Ambulance. Hello.’ All the doors on the landing standing open. None of the lights working. I thought: I really don’t like this. But then I thought: maybe there’s someone very sick who needs me. So I had a quick look into the bathroom, the toilet and the two bedrooms. Nothing. Everything quiet. We both went back downstairs, stood outside in the garden looking up at the house and wondering what we were going to do next. Bill got back to Control. They said the line was still live, and they heard us shouting in the background. They reckoned that the guy was on the floor somewhere. But then they also said they couldn’t be sure, but just before the phone went quiet it sounded as if there were some inappropriate words said, nothing distinct, they couldn’t be sure. But maybe this is a hoax. They said the police would be round as soon as possible, stay put in the meantime.

“But like an idiot I thought I’d better go back into the house one more time to make absolutely sure. I suppose I just didn’t want to look stupid when the police arrived and we all went in and found a poor guy lying dead on the bedroom floor. Maybe the lights blew and he had a heart attack trying to change the fuse. So we went back inside.

“This time I was a bit more thorough. I even opened some cupboard doors downstairs, looked behind the kitchen counter. Then we went upstairs. I went straight up to the first bedroom and stepped inside. I flashed around by the bed, on the floor. And then I had this horrible sick feeling, and I turned around.

“There was a naked guy standing behind the bedroom door, staring at me with his cock in his hand.

“So I screamed – which I don’t think I’ve ever done before – shouted for Bill to get out, and we both ran down the stairs three at a time and back out into the garden again. The police turned up right then and all piled inside. They found him masturbating up in the bedroom.

“It took me ages to calm down after that one. I think that’s the most danger I’ve been in since doing this job. It was horrible. I was shaking so much, when I eventually got on the radio to control I could only talk like this: Hello…. Control…. this is …. Mel. I just couldn’t get the words out. They were sticking way down. In here.”

“And to think I could have turned out to that one alone, on the car. Stab vest? These days I feel like I need a suit of fucking armour.”

oedema

This modern quadrangle of glass and red brick could easily be a Halls of Residence in the grounds of a university. The shock would come, though – a lurch forward in time – when instead of a surge of teenagers running out into the yard you saw a derelict shuffle of elderly people, not text books but prescriptions in their hands, not jumping onto bikes with baskets on the front, but tentatively raising specialist footwear onto the running boards of mobility scooters (with baskets on the front).
With my colleague Frank next to me, zipping up his jacket against the cold, I press the flat number we need to visit the patient who is sick, unspecified. After a long pause towards the end of which I’m reaching for my mobile, the intercom crackles on. It’s almost impossible to understand what the voice is saying, distorted by dodgy electrics, accent and – is that whisky I can smell through the little aluminium grille? As far as I can make out the voice is saying, at top volume: It’s me you want. It’s me you’ve come for.
‘Could you buzz us in please?’
‘It’s me. It’s me you want.’
‘Yes - could you let us in please?’
Nothing. Then, just before I buzz again we hear a door slamming and the sound of two maybe three voices from an interior stairwell.
Eventually, a grizzled man – intense, wild, like a backwoodsman who’s been trapped in his cabin all winter – hauls himself up the stairs and reaches for the door. He’s being pursued by a large middle-aged woman in a seedy black raincoat with markedly less drive than the man, and a young woman who looks like a scaled down version of her. He flings back the door and they all start talking at once.
‘That’s it. Go. Take me.’
‘I’m a nurse. He’s not well.’
‘Fucking hell it stinks. I’ve got better things to do than this.’
And a verbal dump of other stuff, none of which makes sense. I talk over them, as calmly and clearly as I can.
‘Could we just go back inside please and sit down? I need to find out what’s going on, then we can take it from there. It won’t take long. Bear with me. Inside, please. Inside. Thank you.’
They all turn around and clump back down the stairs, the elderly man flinging his arms out from time to time at furious spots in his continuing monologue. The young woman reaches the flat door first. She stands aside and holds her nose.
‘I ain’t going back in there. It stinks,’ she says.
We leave her by the door and follow the other two in. Wild man throws himself down in a knackered armchair, the woman in the raincoat sits on the edge of a nearby sofa. He blows furiously through his nostrils and glares at me, for all the world like James Finlayson in a Laurel & Hardy short.
‘So. Now. Let’s start this properly. My name’s Spence and …’
‘If you’re not going to do anything then fuck you, fuck you all for wasting my time. Look at this.’
He suddenly raises his left leg up and crashes the foot down on the table.
‘What are you going to do about that?’
I look over at Frank and he raises his eyebrows. I look back at Ian and lower mine.
‘Please don’t swear at me. We’ve come here to help, but if you start, we’ll simply walk away. Do you understand?’
He squints up at me.
‘I mean it.’
The woman starts undoing his filthy trainer shoe.
‘I’m a nurse,’ she says. ‘Ian’s foot has oedema.’
‘Are you here professionally?’
‘No. I’m – erm – a friend. I used to be a nurse. I know about all this stuff.’ She gives his foot a poke. ‘Look at that. Look at all that oedema.’
A dodgy relish to the word, like a bent lawyer using Latin.
‘And I’m guessing this is not normal for you, Ian?’
He sits up as if someone’s jabbed him in the back through the chair.
‘What did he say? What do you mean, I’m not normal? What the fuck do you mean?’
He stands up and hops around dangerously as he tries to snatch the trainer back from the friendly ex-nurse.
The young woman has decided to come into the lounge now. She stands next to Frank, smirking and rubbing her nose.
‘What’s your connection to all of this?’ I ask her.
‘Me? I’m his niece. For my sins. God it smells in here. How do you bear it?’
I’m about to tell her that – as these things go – this one isn’t too bad, when Ian stamps his trainer back into place and then comes at me.
‘Are you going to take me to the fucking hospital or not?’
He’s working up a head of steam, as if the next word I see will be the one he has tattooed on the knuckles of his right hand.
‘Ian, don’t!’ says the nurse. Then to me, in a curiously happy tone, as if she’s telling me something cute about a pet of hers: ‘I don’t think he’s had his diazepam today.’
‘That’s it’, I say. ‘Make your own way to hospital. There’s no way I’m having you on the ambulance with an attitude like that, foot or no foot. And even if we did take you, the nurses at A&E would throw you out in a second.’
‘Fuck you! Fuck you! You don’t care!’
‘We do care, Ian – but we’re not here to be abused. Make your own way.’
We walk back out of the flat, the niece lapping the scene up, the former nurse sitting helplessly on the sofa and Ian flexing and unflexing his hands as if he wants to grab hold of something or someone but can’t for the moment think what.

finn the driver

Finn is stretched out on the bathroom floor, his head just beneath the red emergency chord. He lies neat as a soldier, his arms straight along by his sides, palms, thumbs, fingers all parallel to his withered old legs.
‘Sorry to trouble you boys but I can’t get me self up. I toppled over on the way back to bed and I just can’t seem to do a thing about it.’
‘Have you hurt yourself, Finn?’
‘Well – I should say only my pride, boys. I had a touch of whisky with an old mate from Ireland. We haven’t seen each other in a good long while and one thing led to another thing and – well, I’m in the sorry state you find me now.’
‘Let’s get you up, then.’
Pete gets under one arm, I take the other. We help him bend at the knees, place his bare feet flat on the floor, then – on three – he’s up.
‘Thank you boys. God bless you. So now that’s the way up we’re all supposed to be and doesn’t it feel great?’
He ends the sentence with a little rising intake of breath, like he’s snatching a sample of the air we’re about to make our reply with.
‘Where would you like to go now?’
‘Back to bed, boys. Back to bed would be grand.’
Finn is eighty seven, his strong figure drained and made slack by the long passage of years. He shuffles between us to the bedroom, a chill, cell-like box with a low wooden bed and cheap wooden side stand. The bed linen is rucked up, grey and unwelcoming: pillow, sheet and mangy pink chenille bedspread. On the side stand he has a mug of water and a pair of dentures in a plastic container. There is a small enamelled portrait of the Virgin Mary above the headboard; behind the glass, she seems to clutch her baby against the silvery whisper of mould in the air.
‘Do you have any help here, Finn?’
‘Help? No, not really. I suppose I ought to. Do you think I ought to?’
‘Yeah, why not?’
‘Well okay then. If you think I ought to.’
Pete starts on the paperwork. I check Finn over and he’s fine, but we tell him we’re going to refer him to the Falls team and anybody else we can think of.
‘Ah you’re good boys,’ he says, pulling the awful sheets up around his neck. ‘Thanks for coming. I’m sorry to be a bother.’
‘Where are you from?’
‘Ireland.’
‘Where in Ireland?’
‘Kilkenny. Do you know it, Kilkenny?’
‘No, sorry. I don’t know Ireland at all, really. I’ve got friends who come from Cavan.’
‘Cavan! Well! I know Cavan. Up there on the border. Oh I know Cavan. I’ve driven all over there, of course. All over the place. All over the world. You name the place, I’ll tell you. I used to be a driver, you know. That’s what I did. Mercedes, Rolls Royce. You name the car, I drove it. Buses. Trucks. That was my job. I was good at it. Then when I retired, I used to drive coaches, on the voluntary.’
‘Good for you.’
Finn lies holding the sheet up to his neck. He runs his tongue over his chapped lips, and I ask him if he’s thirsty. He nods, so I help him to sit up, and hand him the mug of water from the side stand. It has a lurid green picture of a leprechaun holding a mug of beer and winking. I wonder who bought it for him.
‘My grandad used to be a chauffeur for a family in County Mayo,’ I say, easing him back down on to the pillow. I remember the photo: a skinny young man in an unbuttoned starch collar and straw hat, standing in front of a charabanc with a dipstick in one hand and a fag in the other. ‘He died before I was born, though. I never met him.’
‘County Mayo? I know County Mayo very well. Beautiful place. Fancy that. So your dad was a driver.’
‘My grandad.’
‘And he was a driver, you say? Who would’ve thought it? What a coincidence. Do you know the Heneghans? From Crossmolina? I think it was Crossmolina.’
And he tips off into a rambling commentary on people and places. It unwinds before us like a great foxed tapestry.
‘No finer people,’ he says, eventually. ‘No finer people in the world.’ He closes his eyes as if to see them all more clearly, smacks his lips once or twice, and suddenly falls asleep.

The paperwork done, we leave a copy on the side stand, turn the bedroom light out (but leave the hall light on) and creep away.

tell me something beautiful

‘Basically, Tara came back to the hostel tonight and blew a fifty four, which isn’t drastically over the limit – but still it’s over the limit, maybe one and a half times. So she’s scared that she’s broken the terms of her parole by drinking alcohol tonight – which she has, of course, technically – and she’s scared she may get sent back to prison. Which we don’t know, but still.’
‘What was her offence?’
‘GBH – landlady, child. ABH police.’
‘And what’s she done tonight? We’ve only been told she’s cut herself.’
‘She broke up a safety razor and used it on her arms and face. Nothing too serious, I think – but a couple of quite deep wounds that might need attention. She’s calm at the moment. A couple of members of staff are sitting with her. I don’t think she’s a threat any more.’
‘Have you called the police?’
‘Well, we didn’t really want to. We thought it might inflame things. We thought we’d take advice first from you first.’
‘And will you be able to spare a member of staff to come down to the hospital with Tara? If she’s this volatile she’ll need supervision at A&E.’
‘Oh. Um. Maybe.’
Sheila, the female hostel worker, folds her arms and exchanges a look with a colleague standing over by the office fire door. Of the two he is the calmest, sipping from a mug of tea and studying the CCTV. Sheila seems brittle, as if the padding of a generous disposition had been chiselled, thinned out by experiences such as this.
‘Let’s go up and see how she’s getting on, then.’

She leads us up a steep and narrow staircase that branches off through a network of small landings and fire doors. This tall Edwardian town house has been converted into a probation hostel, with anti-slip marmoleum treads and strips, fire extinguishers and exit signs, notices and rules. But to counteract the expedient institutional feel, the staff have put up motivational posters: we pass one that shows the silhouettes of two climbers at the peak of a mountain at sunset, the highest one reaching a hand down to help his mate. The tagline is: You can succeed best and quickest by helping others to succeed.

Sheila knocks on room number nine, and we go inside.

Tara is sitting on an unmade bed, intensely smoking a hand rolled cigarette. A male hostel worker sits opposite her with his arms crossed and resting on the back of a reversed plastic chair. Tara’s left arm is wrapped around with a bloodied white towel, she has a stripe of blood on her right cheek, and her right arm is bloodied, too. It looks as if she is struggling to keep the cigarette going; her fingers are too damp with blood.
‘Hello Tara. My name’s Spence and this is Rae. What’s happened tonight?’
She stares at us for a second or two, then looks away, tries to drop the cigarette in a yoghurt pot but it’s stuck to her fingers.
‘I’m not going to prison again.’
‘Can we have a look at your arms and see if any of these wounds need hospital treatment?’
‘Do what you like.’
We’ve been told that Tara is twenty years old, and she certainly looks it in her physical self, being a tall and thickset woman with powerful arms and hands. But her face seems curiously juvenile, utterly without mark or experience. In fact, the only visible sign of distress in or on her face is the cut she put there with the razor – and in her eyes, which continue to stare disconnectedly at the mess she seems to have found herself in.

Her arm is unwrapped now. She has carved the word HOME along the soft underside of her forearm. After the letter E she has swiped her arm across – a vicious underscore – laying it open to the muscle. The other arm has a series of swipes, nothing so deep. Maybe she practised on that arm first.

‘These are quite serious wounds, Tara. You’ll need to come up to hospital to have them stitched, I’m afraid.’ I go to my bag to fetch out a couple of bandages and a sachet of sterile water.
‘I’m not going back to prison,’ she says. There is no change to her voice or her facial expression, but the male hostel worker watching from the plastic chair – acutely, like a fisherman on a riverbank watching his float – straightens and unfolds his arms. Tara stands up.
‘Calm down, Tara,’ he says, ‘Take it easy.’
Suddenly she reaches over to a cluttered bedside table and grabs an orange safety razor hidden amongst the scrunched and bloody tissues there. She puts it in her mouth, bites the plastic guards away at the top, and then plucks out a shard of blade. She drops the plastic handle and holds the blade fragment to the side of her neck.

This could only have taken a fraction of a second, and the pause that follows only a breath or two more, but the silence seems to fill the room without end.

‘Come on, Tara. We’re only here to help,’ I manage to say. I’m holding the half-opened bandage and sachet of water, and it feels like some utterly lame demonstration of intent.
‘Put the blade down, Tara. This is not helping.’
The cool hostel worker from the office downstairs is standing by the door. He is as neutral as Tara. ‘This is not what you want.’
Tara looks at him, at us.
‘Tell me something beautiful or I kill myself,’ she says.

The silence that follows is deeper and more deafening than the first.

Later, in the ambulance, and then in my car on the way home, I try to think of all the things that are beautiful to me. And though I don’t know Tara, all the things that I think of first – images of family, homey things, feelings of love and connection – these are all things that Tara seemed violently removed from. And though it hurts me to replay that scene, to consider the fact that when I was called upon to make some meaningful statement, I hesitated, and joined my mute silence to everyone else’s, when I put myself back in that room the only reassurance I can manage for myself is the thought that if I’d mentioned any of these beautiful things I might well have only intensified her despair.

At last Sheila says: ‘We all care about you, Tara. We want you to be well.’

For the first time Tara flames with purpose.

‘Get out of this room or I cut my throat,’ she shouts. ‘Get out!’

We leave.

The police are called; half a dozen turn up within minutes. One of them accidentally knocks the mountaineering picture off its hook with his riot shield as he goes up the stairs. After half an hour of patient negotiation, a policewoman persuades Tara to open the door and submit peacefully to an examination. When we are invited back in, Tara is sitting back down on the bed, her elbows strapped behind her back. She doesn’t look up.

an urban willow pattern

Bill, the manager of the housing association flats, is using some gaffer tape to fix the black rubber cover back on to one of the key safe boxes outside the main door.
‘Thanks for coming,’ he says, straightening up with an audible click. ‘I don’t know what we’re going to do about Jack. It’s the second call today.’
He shows us inside to the lift. It’s already on its way down, disgorging with a shudder an ancient couple who smile at the three of us with amiable confusion.
‘It’s his breathing, in case you didn’t know,’ says Bill, leaning in to me confidentially. ‘Asthma, but he won’t leave his dog. It’s a terrible mess up there, so watch where you put your feet. If you need me, I’ll be down in the office. Don’t expect he’ll go, but see what you can do. All the best to you.’
We ride up to the tenth floor and find our way along booming corridors smelling of chlorine to a battered blue door standing half open. Just below the knocker there is a scrap of paper taped along all four sides. It’s written out in a blocky, green scrawl: ‘no callers papers sales no jahovers witness.’
As I’m reading this, a barrel-shaped terrier waddles out through the gap to meet us. Its body is so inflated it can only move by leaning from side to side, an arthritic kind of sculling action it performs with a grim set to its face. The dog’s eyes are cloudy like worn-out plastic buttons, and its muzzle sprouts a mess of fine white wire.
I push the door open a little more.
‘Ambulance! Hello!’
The dog – without any change of expression - leans aside to let us pass; its claws clack behind us as we go in.

The air in the flat seems to be made up of two distinct odours - dog piss and filter cigarettes. They fill the atmosphere in visible layers, geological strata of neglect folded one into the other, lain down over many years. Our boots crackle as we walk across the parquet floor.

There is a wheeze coming from the front room. I push the door open.
‘Hello?’
Jack is sitting in an armchair, leaning forwards, propped up on his arms, his elbows turned out and his hands in.
‘I’m not going,’ he says.

Jack looks dusty, a shop dummy dressed in a fright wig, chequered shirt and braces, then forgotten about in the storeroom.

The dog catches up with us and plops down on his right foot.

We fix up a nebuliser; Jack pulls it over his head in one practised movement.

‘You can’t go on like this, Jack,’ Rae says. ‘You must want help, or you wouldn’t have called for an ambulance.’
‘I don’t want help, I want oxygen.’
‘But we can’t stay here the rest of our lives, can we? You need to come with us, see a doctor, get your meds up to date. You need attention, Jack. I’m afraid you really absolutely cannot stay here.’
‘Well what about Millie?’
‘Millie’ll be fine,’ she says, scratching her behind the ears. ‘Bill says he’ll look in on her.’ Rae flicks me a look –mental note: speak to Bill before we leave. ‘The important thing is to sort your breathing out. One step at a time, Jack. You’ll be no good to Millie if you – er – pass out.’
Jack looks up at both of us.
‘She’s had her walk this morning. I took her out on the mobility scooter.’
‘So she’ll be ok for a little while whilst you come up the hospital. There are ways and means, Jack. We’ll sort it. Important thing is to get your asthma under control.’

He studies us. The silence is underwritten by the spluttering hiss of the nebuliser.

‘Well – okay,’ he says, finally. ‘But I’m not staying in.’
‘Let’s cross that bridge when we come to it.’

And I suddenly have an image of Jack as a painted blue figure on a willow pattern plate, escaping over a rickety wooden bridge in his mobility scooter, Millie in the basket in front, their hair and ears flapping behind them as the housing association pagoda gradually shrinks away below the tree-line.

demolition

A young man with a fussy beard and chunky media specs waves us over to the entrance. We park just down from it; I follow him into the foyer. He seems upset, which I translate into degrees of seriousness.

The elderly patient is sitting slumped against the wall, his left arm up on a plain wooden chair. He has the lumpish torso and receding forehead of a great silverback gorilla, white-haired and washed out, incongruously dressed in a Hawaiian shirt and nut brown slacks. He opens his eyes and looks up at me when I crouch down to him. I can smell alcohol, but the guy who flagged us down is standing watching over by the facing wall and he still seems very upset, which is puzzling, and makes me question whether this is just alcohol. But then – maybe he’s an unreliable witness and has issues of his own.

‘This is how I found him,’ he says, biting the quick of his finger, his eyes flicking from side to side. ‘Is he going to be all right?’

Another man comes into the lobby, a solid-seeming guy with more to tell us. Our patient’s name is David, and – yes - this is unusual for him. He tells us that David has heart problems.
‘David? Are you in pain? Do you hurt anywhere?’
The massive head pivots slowly on his neck, and his rheumy eyes seem to slide down the inclination. He is definitely very drunk.

‘Why are you people bothering?’ he says. And suddenly a tear runs down his pock-marked nose. ‘Why now? I don’t get it.’

We help David into the ambulance. At one point – alarmingly - he produces a GTN spray and squirts himself under the tongue. But the ECG doesn’t show cardiac distress other than some ongoing problems. He has a bulge under the skin of his left breast, just above the head of a big-breasted tattoo, but he isn’t able to tell us if it is a pacemaker or ICD. He wants to tell us instead about his long life in the construction industry.

‘I ended up in demolition,’ he says, almost falling off the trolley as tries to pull a vast chequered handkerchief from his pocket. ‘I could knock a building down with these arms.’

David seems to brighten up a little with all the attention, but keeps refusing to go to hospital.

‘The last time I went in one of these here fucking ambliences, with one of you lot, I went over boom and didn’t come up for a week,’ he says, almost rubbing his nose off with the handkerchief. ‘I should be dead now. Dead and gone and no bother to anyone.’ Then he stops absolutely still and studies us, frowning hard, as if we were ghosts he’d just shaken out of his handkerchief. ‘What the hell do you want with me?’

We tell him we’re worried about him and want him to be well. We tell him we want him to come to the hospital for a check-up.

He thinks about this, then seems utterly to lose interest. He settles back into the trolley, which creaks horribly.

‘Go on then,’ he says. ‘I’m past caring now. I just want to go to sleep and never wake up.’

the first time

Rae drives with supernatural incisiveness, powering through the heavy morning traffic, anticipating with cool clairvoyancy the smallest deviation or hesitancy, flashing through gaps with a paint sweat of clearance, braking down before that driver even thought to indicate left and pull over to the right. We are heading out to a fifty year old female in cardiac arrest, and we want to get there quickly.

Swinging round into the close we can see the house we want: the one with the door open and a naked man pacing about on the grass verge outside. He holds a phone to his ear with one hand, the other the ends of a bath towel he has bunched around his waist. He flips the phone shut as we pull up.

‘Please, please be quick. She’s upstairs on the bed and she’s not breathing or nothing. Please, please, please, oh god. oh god.’

As I stride across the grass with the resus bag I ask him questions. He says his wife has a history of angina. She complained of chest pain when she went to get up this morning, but keeled over before she’d had time to grab her spray.

Inside the house and it’s horribly cluttered with junk. I wonder how we’ll fit the chair down these stairs, but immediately focus on the scene in front of me as I pick my way across the landing into the bedroom - an elderly man, pushing up and down on the chest of a naked woman sprawled on a double bed. Her body bounces lifelessly as he tries to compress her chest. He stops as soon as he sees me.

‘Help’ he says.

It feels like I’m climbing through some kind of waste facility. There are heaps of old clothes, boxes of video tapes and newspapers, chairs with dusty television sets and VCRs, lino squares and carpet off-cuts.

‘We need to get her on the floor,’ I tell the man. ‘Help me clear a space.’

In a few seconds we pick up and throw across onto the other side of the bed an occasional table with an overflowing ashtray and spilled packets of sweets and just enough boxes to make room for the patient. Rae is in the room now and she cheats the bed over to one side by another critical inch, just enough to get the patient down on the floor. I start chest compressions whilst Rae gets out the defib. The elderly man – the woman’s father – scrambles out of the way over the bed, and goes to stand with the husband on the landing. A technician working on the response car turns up to help. He fetches some extra pieces of kit we need, then takes the two of them to one side to get the paperwork going.

The readout is good for a shock. Rae hits the button. The patient gives a convulsive jerk and her head whumps back on the dirty carpet. I compress her chest for a further minute then we check the readout again. She has a pulse on the screen. And, crucially, at the neck. Her abdomen positively quivers with it. It’s fantastic to see. She starts to gasp beneath the mask with crude, primal intakes. I support these with the BVM.

After twenty minutes we have her wrapped in a blanket and on the chair ready to go. In those twenty minutes the father and the husband have cleared a path for us down the stairs. Fear lends them strength. Adnan, the technician, bussing our kit from the scene and making the ambulance ready, tells us that the father picked up an entire bookcase by himself.

We run the patient out to the vehicle and transfer her on to our trolley. Although she’s still unconscious, her vital signs are encouraging, with a respectable blood pressure and saturations. Rae passes the ashice and we set off for hospital. Adnan follows on with the husband and father.

***

I can see them now, standing side by side in the dirty frame of the bedroom door, the husband holding on to his towel, the father intensely still, watching us as we work. It seems to me that they were standing together at the edge of some new and extreme margin, the outermost point of their lives together so far, where the solid earth they had built their home upon had inexplicably given way to a great gulf of black water. They had watched us struggle to drag their wife and daughter back from this terrible place.

And this time – the first time, for me – we managed it.

a job holding on to things

The betting shop reaches back fifty feet from the glass doorway we push open on the highstreet. We step onto blond laminate wooden flooring, walk past a bank of screens, a neatly curving counter and a Wailing Wall of information – blu-tacked racing pages, dry-wiper odds and runners, magnetic titles, fluorescent notices – excuse our way through half a dozen men fixed like badly dressed mannequins beneath The Commentary, the great thundering drone that fills the place, over to a little protective semi-circle of chrome chairs on an area of dirty blue carpet at the back. An elderly man is lying on his side on this carpet with his head resting on a rolled up jumper. Two members of staff in blue t-shirts are kneeling next to him. One of them is holding an aluminium walking stick, a carrier bag and a brown tartan cap. He waves us over.
‘This is Bill. One of our regulars. Aren’t you Bill?’
‘Where’s my cap?’
‘I’ve got it here, mate. Bill had a funny turn and slid off his chair. I don’t think he’s hurt himself, but we left him where he was, just in case.’
‘I don’t want to lose my cap.’ He smiles up at me. ‘It’s a job holding on to things. It’s not so easy, finding yourself a good cap.’

We check him over, help him to his feet and walk him out to the vehicle. He settles back on the trolley and surrenders to our regime of tests with the air of an old man indulging grandchildren around his deckchair. The skin of his face seems waxy, stressed by age and circumstance, but his eyes are still sharp; his smile, balanced beneath the philtrum of his large nose, is a generous crescent-shape.

All his observations are normal, but he says he wants to go to hospital for a more thorough check-up as he’s never fainted before and can’t remember the last time he saw his doctor.
We set off.
‘I grew up in London,’ he says, folding his arms and offering me another smile. ‘Holland Park. Know it?’
I tell him my sister lives in Ladbroke Grove.
‘Does she? Well, isn’t that funny? I know Ladbroke Grove, of course. Years ago, mind.’
He seems to fade slightly, then comes back.
‘I had two brothers and a sister. All gone now. Do you know, I’m the last survivor of my kind? Lost my eldest brother in the war. He was in Burma. I was with my Mum when she got the telegram. I’ll never forget it. It just said “Frank missing on Burmese-Thailand border.” Nothing else. Never heard another thing about it. I was in the RAF. Ground crew. Went to Africa. Came back. Got a job doing this and that. Decorating, you know. Getting by.’

He looks out of the window, but can’t make out where we are through the blinds.

‘I lost my daughter last year. She had one of those brain tumours. They whipped out as much as they could, but left some in, and of course it grew back. My wife’s in a home.’
He smiles at me.
‘How long do you think they’ll keep me in, then? I’ve got things to do.’
I tell him it depends.
‘I know,’ he says. ‘Listen, I bet you thought I’d won a fair bit. Fainting in the bookies like that.’
We both laugh.
‘Anyway. Have I got everything? Where’s my cap?’

He pulls it firmly onto his head as we roll into A&E.

the little black duffel bag

The doctor’s surgery looks closed from here. All I can see as we turn into the car park is a pair of yellow rubber gloves bobbing about behind the dull glass panes of the foyer. Eventually I make out the cleaner wearing them, finishing her rounds, gathering bags. But as we park up, a middle aged man appears in the doorway to watch. When we come to a stop he sets out towards us, walking across the deserted car park with a convicted, deadbeat shuffle, rounded inwards at the shoulders, head down, his demeanour as washed-out as his raincoat. All he has in his hands is a small black duffel bag, but it may as well be a medicine ball. He stops and stands still, swaying slightly as we climb out of the cab to say hello.
‘I’m guessing you’re Eddie’.
He nods.
‘And I’m guessing the doctor’s gone home.’
He nods again.
Rae opens up the back of the ambulance.
‘Here. Let me carry that for you.’
He gives the bag to me, and I help him up the back steps, suddenly finding myself up to the nose in a wake of alcohol fumes and stale sweat.
He lands himself on the trolley and draws his knees up to his chest.
‘So what’s the problem, Eddie? Why does the doctor want you up to the hospital today?’
‘I’ve got pains in my front, here.’ He makes a general sweep with his right hand. ‘I can’t bear it. I can’t bear it any more. Something’s got to change.’
‘Did the doctor give you a letter?’
He pulls one out of his raincoat. The doctor has sketched Eddie’s abdomen as a hexagon and shaded in the top margins with little crosses. Here be dragons. Eddie is having another bout of pancreatitis.
‘Have you had a drink today, Eddie?’
‘Just a quarter bottle of vodka. Honestly, my friend, this is true agony. I’m dying.’
We plug him into the monitors and take down the information, then Rae jumps out and goes back to the driver’s seat. We set off.

Eddie settles back on the trolley. His face is a boiled cherry-red, cooked through years of alcohol abuse. The silver-rimmed glasses that he wears give his face a strangely plastic complexion, like the model of a man made by an alien with no sense of human colouration. He opens his eyes again and studies me.
‘I buried my dad two weeks ago. Yeah. Two weeks ago.’
‘I’m very sorry to hear that.’
‘Two weeks ago. Yeah. I went to the funeral. I carried the coffin with my brother and sisters.’ I try to imagine him under one end of a coffin, but all I can see is Eddie struggling with his little black duffel bag.
‘I carried the coffin. Even though I’m a sick man. Even though I broke both my ankles a couple of years ago. But these things – you have to do them, don’t you? He was only eighty four. Cancer. I hardly ever saw him though. He didn’t want to know. I couldn’t stick around for long. I was only there for the service. When they all went back to the house for drinks I made my excuses. I think I was only there ten minutes. At least I went, though.’
He relaxes back on the trolley, and after a while seems to fall asleep. But there’s a sudden jolt and he opens his eyes again.
‘Two broken ankles,’ he says, turning his head to look at me. ‘Two of them. Make sure you get that down on your form.’

pinch

The retirement block is frankly laid out in new red brick, but a stand of young ash trees planted in front are already softening the geometric lines of windows and walkways, and there are vigorous bushes of jasmine hauling themselves up from the small patches of garden at the front. The sounds of children playing in a nearby park drift across to us, and to the group of elderly women standing by the open front door. It’s a cardigan-wrapped, whisperingly tight little huddle, although as I open the gate and walk up the path towards them, they chip in brightly enough:
‘Stanley?’
‘Flat Eight.’
‘Ground floor.’
‘Turn right as you go in, dear.’

We make our way along a narrow corridor to number eight. The runner is rucked up outside the open door. ‘Ambulance’ I call out, and make my way inside. Another confined space, but this one strewn with a pair of broken glasses, the contents of a toppled plant stand, a discarded jacket. We pick our way through towards the voices we can hear in the sitting room.

‘In here, guys.’

Stanley is sitting on the edge of a flower-patterned arm chair. He looks up at us, and dabs at a small cut above his right eye with a blood spotted handkerchief. A policeman stands next to him; over in the kitchen a policewoman looks round the door and waves at us. They’re both wearing rubber gloves.

‘What’s happened here, then?’

Stanley – an eighty year old with a full eighty years of gravity expressed in his face – lowers the handkerchief.

‘I’ve been beaten up, threatened, locked in a cupboard and had all my savings taken. That’s what’s bleedin’ happened.’

The policeman puts a hand on his shoulder and tells us the story: two guys knocked on the door, when Stanley opened it they pushed him backwards into the flat and onto the floor. They punched him in the face but he wasn’t knocked out. They threatened him with further violence if he didn’t tell him where his safe was, then they locked him in the broom cupboard and stole his money. He managed to escape from the cupboard by undoing the hinges with a screwdriver.

‘I don’t understand how they knew I had a safe’, he says, dabbing his eye again. ‘How would they know that?’

We clean his wounds and check him over. He seems to have come through the ordeal reasonably intact. We offer to take him to hospital but he refuses.

‘They can’t do nothing. They can’t get me my money back,’ he says. ‘What I really need is a glass of brandy and a cigarette. Can I have those, do you think?’

I tell him he’s in his own home and he’s perfectly at liberty to have what he likes.

‘My own home,’ he echoes, closing his eyes and waggling his jaw slightly, as if he were rolling those words around in his mouth for the first time.

‘No good will come of these people,’ I say to him, packing my stethoscope away. But no-one in the room, not the neighbours looking in from the hallway to pay their respects, the Scene of Crime officer arriving with a detective, not Rae, and not the police completing their paperwork – no-one can say that this will be so.

I shake Stanley’s hand, give a copy of the PRF to the police, and we leave.

Outside, the day has moved on. The children in the park have gone and the sky has deepened. The air seems colder. For the first time I really notice that the trees have started to lose their leaves; I scuffle through a patch or two back to the ambulance. There is definitely, definitely an autumnal pinch about the place.

the jacket with the bible in it

We don’t need satnav on this one. I used to live in this part of town and I know the street well, an early Victorian terrace with brightly coloured houses packed together like fancy cakes on a shelf. The street has managed to hang on to some cute period details, stretches of raised pavements, cobbles, and intricate patterns of bricks dividing up the road, the nineteenth century equivalent of speed humps. And still determinedly flying its pub sign, a tiny drinking den squeezed into the middle of the row, last serving survivor of a dozen or so in this stretch alone.

The job is given as a forty nine year old male with haemorrhage/lacerations. The follow-up notes tell us that the guy has started bleeding from a burst blood vessel in his groin. The lighting in this street is poor, but we still make out a man flagging us down a little way ahead. He stands waiting by the kerb, and as we draw level with him he pulls out his iPod earphone with a sigh as audible as the electric window Rae puts down.

‘He’s over on that wall’, he whispers, but looks the other way down the street. ‘I guess he’s been doing something he shouldn’t.’
‘Sorry? I didn’t … what did you say?’
‘Who knows? Drugs, maybe? Anyway – he’s on the wall and he’s bleeding a fair bit. That’s it.’
‘Okay. Thanks for your help.’
He nods without commitment, reattaches himself to the iPod. It seems to steer him away into the gloom.

I grab a dressings bag and we walk over to a man who is sitting on a low brick wall with his trousers down by his ankles, one hand pressing a towel into his groin and the other keeping him propped upright. There is a substantial course of blood running from underneath his boxer shorts, across the pavement to the gutter.

‘I injected into a femoral vein yesterday and it’s just gone on me,’ he gasps. ‘Don’t forget my jacket. It’s got my bible in it.’

In a few minutes we have him on the truck, his legs raised, three dressings binding his leg, oxygen flowing, connected to various monitors. I hand Rae a cannula.

‘You’ll not find a vein,’ he tells her with a ghastly smile beneath the oxygen mask, but says ‘Fair play’ when she does. We set a bag of Hartmann’s running.

He watches everything with a grim, glistening detachment.

‘Don’t think bad of me. I’ve got titanium plates in my back. Five, six, seven and eight. I can’t bend my knee. I could tell you a few things about pain, mate. I quit the smack but, fuck it – things, you know? Beyond my control. I was clean for years. But then – don’t ask – it’s big, big, unreal. Another time, mate.’

He pulls off the finger probe and produces a packet of tobacco.

‘I need a smoke, mate.’

We stop him from smoking.

He absorbs that.

Rae takes the clipboard, jumps out and slams the door behind her. I hear her give the ASHICE in the cab.

‘Have you got my jacket?’, he says, raising his head up, pulling the mask aside and looking around the bloodied compartment like a man suddenly conscious in the middle of a dream set in a butcher’s shop.

‘I can’t lose that, mate. It’s got my bible.’

I hold up his jacket, a dirty brown corduroy sack, heavy with stuff. He sighs and replaces the mask. Rae passes the board back through to me. We set off in a rattle of blue.

getting out

The patient’s house is easily identified by the ambulance standing outside. I park where I can – this is a crowded little red-bricked estate with cars up on any horizontal surface that will have them. But the first ambulance is already blocking the street for anyone at the end, so I don’t worry too much about leaving the way clear.

The front door stands open. We can see a trolley set up in the hallway. Going inside I hear the crew that has called for help chatting pleasantly in a bedroom off to the left. Walking round into the doorway I see an enormously heavy man standing supporting himself on a reproduction Georgian bedside table, something I expect to explode into splinters any moment. He is leaning forwards on his swollen arms, legs planted at shoulder width. His legs seem to have morphed into great, bandaged elephant trunks, patches of rotten brown skin flaking off on the inner aspects of his thighs. His body - a thirty stone reservoir of pendulous fat – sways in the gap between man and table. He smiles across at us, his pouty mouth underlined by a stack of chins.

‘Hi guys,’ says Frank. ‘This is Peter. Peter’s been seen by his GP this morning with an on-going cellulitis problem. The GP wants him into the hospital today to have a thorough-going look at that, and a few other bits and pieces. Obviously we needed a little help – erm – with the trolley.’

Frank smiles at me and taps the clipboard on his chest.

‘Go on, you can say it,’ Peter says, hauling one of his legs forward half an inch. ‘I don’t mind if you call a spade a spade. I’m a big fat bastard. There. It’s out. And I’m sorry to trouble you all.’

Someone leans on their horn in the street.

flimsy things

‘He had a bit of a fall earlier in the week. He didn’t seem too bad at first. A cut finger, a scrape over his eye, but other than that, fine. He’s normally so fit and well – better than any of us, actually. It’s just that yesterday and today he’s started to seem a bit, well, confused. Keeps talking about seeing things. I’ve never seen him like this before. I have to say I’m worried.’

The neighbour, Ken, a brisk and self-possessed old man in his eighties, has met us at the wrought iron gateway to the block of flats. It’s an imposing thirties construction that forms one corner of an old street leading directly off the front. The wind is strong here, barrelling in off the sea, squeezing between this canyon of buildings and up into town. Our little group leans slightly to compensate.
‘Let’s go up and have a look then.’
Ken hauls the gate open a fraction more. He leads us up a flight of stairs, along a narrow and shadowy corridor to William’s flat. The door stands open; Ken walks inside and says: ‘The ambulance are here, William,’ and we all walk in.

William is in his bedroom, pulling on a starchy white shirt and patting his trouser pockets for keys. If you looked at him quickly out of the corner of your eye you would think he were a slight young man in a rush to get ready for work. It would be a shock, then, to look straight at him, as we do now, and see that he is, in fact, a desiccated old man of about ninety, his face worked out in deep lines and liver spots, his neck as pendulous and ropey as a Galapagos tortoise.
‘Just a minute,’ he says, and almost topples over in his rush to pull his braces up.
I go across to him, introduce myself, then help him with his socks.
‘My shoes are in the other room,’ he says.
‘Okay. Let’s get those on, then we’ll have a sit down and a chat.’
We follow him next door into a crowded sitting room, a scattering of knickknacks on every surface, framed photos on the wall, a painting in vigorous lines of fishermen hauling in nets on a wild beach, and to the side of the fireplace a ceramic humpty dumpty with a placard round its neck saying ‘Don’t blame me – I didn’t vote Tory’. Laid out in front of this fire are a dozen pairs of shoes, laces spread apart, in three shades of brown.
‘It’s like a shoe shop,’ I say. ‘Which pair do you want, William?’
‘The brown pair.’
I help him on with the nearest. He relaxes back into the chair when the laces are tied.
‘So what’s this all about?’ William says, looking around.
‘You know what it’s about,’ says Ken from over by the door.
Ken has his arms folded across his chest. His chin is looking alarmingly soft, as if he might cry at any moment.
‘Ken has called us in because he’s worried. He says you had a fall a few days ago and haven’t been yourself since. Is that right?’
He looks at me with astonishment. His hair seems to stick straight up with the force of his bewilderment.
‘I suppose I have been a bit off,’ he says.
‘Ken says you’ve been suffering from hallucinations.’
‘I’ve been seeing things, yes.’
‘What kinds of things?’
‘Oh – people, tables, animals. Things that aren’t there. Paper objects on the ceiling. Flimsy things.’
‘And how does it make you feel when you see these things?’
‘It confuses me. It makes me feel a bit – unsteady. If I see a table in front of me I’ll make to go round it, but then when I see it’s not really there, I’ll go all wobbly.’
He wipes a finger under his nose and then hunts around in his pockets for a handkerchief. He has wrapped white sticking tape around one of his fingers, and there is a graze above the coarse white curls of his right eyebrow.
‘William – how about coming down to the ambulance with us? We can give you the once over, and then have a think about what to do next. Would that be okay?’
He stares at me above the handkerchief as he blows his nose, and blinks heavily a couple of times.
‘Will you be bringing me back? I don’t want to spend all day there. I’ve got things to do.’
The wind rages against the metal-framed windows. It feels as if we’re on the bridge of a doomed old liner, heading out to sea.
‘Make sure you hold on to my belt, though, won’t you, mate?’ he says, leaning over to one side and stuffing the handkerchief back into his pocket. ‘I’ll blow away, else.’

relatives

#1 I used to work in a lovely little factory making bears. I started out on the stuffing machine, progressed up to eyes and bows. I loved it there – such a cozy team. The man who ran the place was a bit haphazard, but we managed. He’d stamp his feet a bit when we’d take our lunch break in the pub next door, and then finish off the afternoon with the arms and legs a bit skew-whiff, but he was happy enough. Five shillings a week. Not much, when you think about it. But I was younger then. I just seemed to cope with things better. It was just a tiny little mews factory. Not there now, of course. But the pub is.

#2 I was born in Sunderland, knocked around there until my National Service, then when I came out I moved down to London and got a job as an ambulance man. That’s why I’ve got this scoliosis of the spine and my knees are worn out, but that’s the way of it. All that lifting. I worked over in the Wembley area. We used to volunteer to do the big matches. Once, I was at the Cup Final, 1973, Sunderland versus Leeds United. Well. As you probably know, Sunderland won. Amazing. Fantastic. We were in the tunnel, and I says to my mate ‘Why don’t you go to the dressing rooms and get us some signatures?’ and he says to me ‘Why the hell don’t you go yourself?’ And I says ‘Well I’m shy’ And he turns to me and says ‘You’re a Geordie, man. Away with you to the dressing rooms.’ Well, I certainly was scared about doing it. It was one hell of an occasion. But I did go down to the dressing rooms. Of course there was this enormous party going on, shouting, carrying on, everyone spilling about and everywhere. And this man – don’t know who he was – he claps me on the shoulders and gives me a hug and says to me: ‘Can I help you?’ and I says ‘I wonder if I could have a few autographs, like.’ And he says: ‘Where are you from, then?’ and I said: ‘Wearside’. So he shouts across the room: ‘Hey! Let’s have that cup over here. This here ambulance man’s a mackem.’ And do you know what – they passed over the FA Cup, and I held it in these hands, and I had me a big old drink of champagne.’

boxed character

Angela is standing over by the far window, two thin white leads dangling from her ears to the pink DS Lite she grips fervently with both hands. She has an intensity about her that is accentuated by her bloodless face and hands and the mess of grey blond hair piled on her head like a wig made of wire wool. She is so engrossed it’s like the console is playing her.
‘Hello, Angela. Do you mind if we come in and have a chat?’ I say to her. ‘It’s the ambulance. My name’s Spence and this is Rae.’
She flicks up her eyes only briefly, something like a snake tasting the air, then settles back into the game.
It seems as if Angela has been standing in this room – crammed full of pop posters and soft toys - since she was twelve. She’s now forty, and I can imagine the view out of the window changing as she stands there: a new housing development along by the port, increasing numbers of cars in the road, deep green hedges racing up in one garden and mature apple trees torn down in another. The sun rising and setting, the moon waxing and waning, whilst Angela stands by the window or sits on the bed, and her dressing table gradually fills with a collection of boxed characters from films and TV shows – Princess Leia, Charlie’s Angels, Wonder Woman – twist-tied in action poses behind their yellowing plastic bubbles.
‘Did you know we were coming?’
She looks up at me briefly, nods once.
‘Do you know why?’
She stops playing with the console.
‘I’ve been having trouble again. The voices were back really strong and they were telling me to kill – certain people.’ She looks at me again as she says this, as if to check that I understand who those people are.
‘That’s what your mum told us downstairs. She’s pretty worried about you, Angela. She’s worried that you might try to hurt yourself again.’
Angela begins tapping at the console again.
‘We’ve just got to think what’s the best thing to do for you tonight. Have you got any ideas? Is there anything you’d like to do. Or not do.’
She ignores me.
‘Do you think you might hurt yourself tonight, Angela?’
With a sigh she sits down heavily on the bed, pulls out the ear pieces and lays aside her console in a dead flat sulk, as if I’ve just told her off.
‘I tried to kill myself last year. I climbed onto this bridge. The police were there and they stopped me. I ended up in hospital then.’
‘And do you think you might do something similar now?’
She shrugs.
‘If the voices tell me to, then – maybe, yeah.’
I hear a car pull up outside and the thunk of doors being closed.
‘Angela – the police were called here tonight, too. I don’t want you to be worried. We had to have the police along because it said in the notes that you were potentially violent – had been violent, to some hospital people, when you were last in. Is that true?’
‘Maybe.’
‘What we’ll do – we’ll meet the police downstairs, talk to your parents, and then decide what we can do to help tonight. If you want to come downstairs, too, that would be great.’
She stares at me, her eyes half closed. The medication is obviously taking off a good deal of the pressure, but what little you can see of her eyes is a crystalline grey, hard and implacable. It’s like talking to a camera lens.
‘Shan’t be a moment.’
We make our way back down the narrow staircase to talk with the parents in the kitchen. The police are there – a man and a woman – and by the way the mother is up and making tea, it would seem they’ve been here before, many times.

excavation

The hallway is brisk and well kempt, its carpets swept and sprayed, white walls above the dado, aquamarine below. But there is a man lying on his side up the stairs from the bottom step to the sixth, inert and out of place, as if a giant child had been called away mid-game and left a figure there.
‘I said goodbye to Stanley when I left for work this morning. He was standing at his door, holding on to the frame, looking a bit confused, you know, but then he’s been like that for a few weeks now, so I didn’t think anything of it. Do you know what I think? I think he must have made it to the stairs and lain there till I got back just now.’
His neighbour, a generously proportioned black woman who lives in the flat above, leads us over to him.
‘Stanley?’ she says.
He twitches and looks up, then after a second or two of clownish focusing, repositions his glasses and gives us the old-school thumbs up.
‘What’s all this, then?’ he says.
Up close to him now and we can see the neglect. His windcheater jacket looks like it has been pulled from a skip, torn in a couple of places and fixed with safety pins, the lining poking through, and at every place of contact with the world - on the back of his jacket and trousers, round the pockets and sleeves, there is a grimy shine of dirt. His fly gapes open; he has a brown shoe on his left foot and a black one on his right, both unlaced.
‘What’s going on?’ he says.
‘Well, that’s what we want to know,’ says Rae. ‘Have you hurt yourself, Stan? Are you in pain or anything?’
He considers the question, then raises his eyebrows and shakes his head.
‘No. No – I’m absolutely fine. What’s this all about, Hope?’
‘It’s a funny kind of fine, though, Stan. Lying on the stairs like this. People are worried about you.’
‘Are they? How kind people are.’
‘So what are you doing on the stairs?’
‘I felt a bit off.’
‘In what way, off?’
‘Just – off.’
Hope is standing over us all, her arms folded, a guardian angel / security guard hybrid.
‘He’s been on the slide for months now, but I’ve not seen him as bad as this before. He doesn’t seem to have any oomph about him at all. He must be sick, but he won’t see the doctor. What can you do?’
Rae asks Stan if he’ll come out to the ambulance and let us give him the once over. He agrees, demurely, like a vicar accepting an invitation to tea.
‘But could I first get my keys and shut the windows?’

We help him to his feet and hold on to him either side as he sways slowly over to his front door. He smells bad, unwashed, a rank margin about him you could chip with a hammer. He pushes open the door, and we follow him into his bedsit room.

I remember reading a description of the moment Howard Carter and his team broke into Tutankhamen’s tomb – the rush of foul gas as the breach was made, the way they gradually made sense of the wonderful clutter of objects around them. The difference is that instead of ornamental caskets and golden effigies, here there are dozens of carrier bags stuffed and tied-off at the handle, boxes of junk, newspapers lined up in columns and stacked up on every horizontal surface. The walls of the bedsit are clear, with the exception of an alternative suit of clothes, even filthier than the ones Stanley is wearing, hanging from a picture rail, next to one small picture in a gilt frame – a pastel study of a series of lock gates on a canal lined with dark poplar trees. The gate in the foreground is open, inviting you to make your way up river.
If this really is a tomb – and it certainly doesn’t seem a place where you could expect the living to be found - then its occupant has woken up and been moving around. Between the seamy bed and the sink, the sink and the armchair, the armchair and the door, there is a narrow channel of access kept clear by the simple action of walking. Everywhere else is utterly silted up with junk.

‘I’ll just get my keys,’ he says, and puts his hand straight to them.

plectrum

We’ve been told that an ambulance car will be making a first on this severe respiratory distress. The satnav blue-lines us into a wide avenue and there we see it double parked a way up ahead, blue lights flashing. I drive up, park behind it, we climb out of the cab and go up to the front door of a detached Georgian house, its front garden built for speed with an unkempt clump of ornamental grass and a dump of slate chippings. The rack of buzzers by the battered front door testifies to the minute sectioning of this place into flats. The building has an air of slow, expedient ruin about it, like some grand family falling through hard times and scandals to a pragmatic accommodation with the modern age.
We are buzzed in to a musty hallway, original black and white tiling jarring with the notice board, fire extinguisher, alarm console and the casual scattering of letters above the radiator. With all the health & safety notices, contact numbers and house rules pinned up everywhere, it looks as if this may be some kind of hostel, but it’s not one either of us has been to before. We go up the stairs and in through the door marked ‘3’.
We step into a rancid atmosphere of nicotine and old sweat, and then: ‘Hello chaps,’ says Ray, the paramedic. He is standing with his stethoscope draped around his shoulders, his legs spread like a compass, scribbling observations down on his clipboard. Slumped on the bed in front of him is a half-naked young man who would not be out of place chesting walruses on an ice flow. His swollen breasts hang across his belly, a great, veined appendage that pushes his arms and legs apart and makes him look in danger of exploding. He raises a padded hand to stroke his Fu-Manchu beard, and nods at us.
‘More troops’ he says.
‘This is Henry,’ says Ray. ‘Henry has had a bit of chest infection for the past few days. Hasn’t seen his doctor, felt worse today, called us in. As you can see, he’s talking in complete sentences, his sats are fine, no chest pain or anything like that, I’ve listened to his chest, it seems clear, but Henry says he’d like to get some expert advice on all this. Sorry I didn’t get a chance to stand you down.’
Ray is brisk, with a kind of deadly clarity that only Henry seems impervious to.
‘And I can reassure you that he’s walking out to the vehicle.’
‘I’m sorry to call you people out,’ says Henry, starting to gather the vast black acreage of his t-shirt to him. ‘I didn’t know what else to do.’

We take in the bedsit whilst Ray finishes off the paperwork.
‘Are these your paintings?’ Rae asks Henry, nodding at the canvases brutally nailed to the walls. Each one is roughly covered with a smear of yellow, red and brown acrylic paint.
‘Yep. They’re my dreams.’
At one side of the room, opposite the kitchen with its nightmarish dump of dirty pans and pizza boxes, propped up casually against an old Laney amp, is a Gibson Les Paul guitar. Its beautiful, bright cherry finish is even more striking for the awfulness of its surroundings.
‘You play guitar?’ says Rae.

Henry half closes his eyes. ‘A little.’ He begins hauling the t-shirt over his head.
Above the guitar, on a cleanly swept, little blue votive shelf, there is a clip frame: a photo of Carlos Santana.

***

Later that night – one sprained ankle, one hyperventilation, one threatened suicide, one imminent birth and one collapse query cause later - I’m wheeling the trolley back outside to the ambulance when I notice a little grey triangle of plastic on the tarmac.

I nudge it with my boot. Unmistakable. A plectrum.

routines

I knock on the door. A dog barks, a door somewhere deep inside the house is opened and then slammed shut; the barking is muted.
An elderly woman with a face as white as her apron opens the front door.
‘He’s upstairs’ she gasps, then stands aside.
We haul up the narrow stairwell with all our bags, and meet a young guy on the landing at the top.
‘I did what I could’ he says. ‘Grandad’s in the bedroom’

It’s a small room. His grandfather is lying on his back in the space between the bed and the wall. Rae pushes the bed as far over to one side as she can. I kneel down next to the patient. No breathing, no pulse. His face is a congested blue, but his body is still warm. I start chest compressions whilst Rae gets out the defib pads. For a second I wonder what’s causing the sharp pain in the palm of my right hand, then I realise that the patient has a staple in the middle of his sternum. I ask Rae to chuck me a gauze pad. When I take my hands off his chest to put the pad there, my rubber glove hangs in tatters from my hand.

A second crew arrives to help out.

---

The resus lasts an hour and twelve minutes. We manage a few shocks right at the beginning, but despite everything we do, the patient drifts away from us along a path of non-shockable rhythms to asystole.
Kerry, one of the supporting crew, goes downstairs to tell the patient’s wife that he has died. After a brief pause we hear a dreadful shrieking moan, and then a flurry of low voices. The dog starts barking again but then just as suddenly falls silent.
The three of us remaining upstairs pick the patient up, put him back to bed and make him presentable. Then we start tidying the room.
I take the resus bag from where it was thrown into the dog basket lying at the foot of the bed and pack the defib away. I open a clinical waste bag and we toss into it all the empty adrenaline phials, pads, caps, swabs, BVM – all the great clutter of stuff that accompanies a resus.

I notice a small whiteboard by the side of the bed. Along the top half of the board is a daily exercise routine written out in blue; some of the words are written in capital letters, some of them have next to them little hand-drawn stars and asterisks. The bottom half of the whiteboard is dedicated to important dates for the rest of the year. December has ‘The Wizard of Oz’, underlined twice, and an exclamation mark.

On the way out of the house we pass by the grandson again who holds the door open for us and thanks us for coming. A large man with silvered hair and a mouth so thin it could have been drawn with a sharp pencil, stands to one side, staring at us. I say to both of them how sorry I am. The grandson closes his eyes and nods. The silver haired man clears his throat, and I hesitate, expecting him to say something. But he remains as impassive as before, so I shoulder my bag, say goodbye and leave.

Gary

Gail is lying on her back on a boat-sized, brown twill sofa. As soon as we come through the door we can see that her left hip is dislocated; her leg shows the classic signs of shortening and rotation. She raises a smile and puts her left hand up in the air. Her husband Frank has shown us in, only interrupting his meandering description of the night’s events to take a pull on his cigarette. Frank has a face as red and slack as his tracksuit. His rheumy eyes check us slantways, and his chin is scrubby with the kind of perma-stubble you see in e-fit pictures.

‘To be frank with you – like I have to – it’s my name – hurgh - don’t worry, I’m always like this, I’ve had a bit to drink, it’s the weekend, so sue me. But hey – if you can’t have a little something now and again, well, what’s the world come to? Hurgh. Anyway, to be absolutely and perfectly honest with you, because there’s no point in lying about this stuff, hey? I mean, mate, we’re all adults. You’ve got a job to do. You need to know all the facts. And fucking hell, I mean, who’s hurting who? Hey?’

His mobile phone rings – the twangy guitar from James Bond.

‘Shit. Sorry. Gary? Yeah, mate. Yeah. The paramedics are here. They’re going to work on her now. Mate – I’ll call you back. No, mate. No. I’ll call you back.’

I take advantage of the interruption to say hello to Gail properly and take in the place. For the first time I notice that the walls are hung with dozens of small clip-frames. Hypercoloured photos, confusing at first, but then with a lurch seeing that they are of women – a woman – Gail – naked, in suspenders, or extravagantly zippered outfits, posing with a shadowy host of others, a Polaroid exhibition of proffered breasts, mouths, throats. In the whole room there is only one non-sexual photo, still of Gail – a crinkled up school photo, a little girl smiling demurely against a background of eggshell blue. Unframed, it is propped up against the DVD player.

Gail looks up at us from the sofa, a frail looking woman in her mid forties, pale freckled face and ginger hair. She is wearing pyjama shorts and a flowery t-shirt.

Frank clips his mobile shut and follows us over.

‘Gary’s such a twat. I don’t know. I suppose he has his uses. Hurgh. Anyway – I’ve dressed her for you, mate. Couldn’t have you seeing her in all her gear. Not that we care. Give you all a thrill. Well – you, maybe. Maybe not you (looking at Rae). Or maybe - yeah?’ He gives her a pouchy smirk, then blows out another litre or two of smoke.

‘It half killed her, mind. But she’s a brave girl – hey? Has to be, living with me.’

‘Don’t listen to him,’ Gail says, her voice dry with the pain and the alcohol, ‘He’s an idiot.’

‘So anyway,’ he carries on, ‘Just to put you in the picture. She’s had both her hips replaced, three months ago, arthritis. The right one popped out a month ago, had that done, and I’ll tell you something now for free – those bastards at A&E aren’t coming within a mile of her. Last time they broke her leg, like that’s gonna help. I want the consultant there to re-do this. I want him waiting for us, by the front door, with his hands out of his pockets, as we’re pulling up outside.’

We help Gail manage the pain with entonox, immobilise her, scoop her off the sofa on the orthopaedic stretcher and outside onto the trolley with a minimum of distress. Frank is a constant distraction, talking incessantly. It’s like having a puppy worry your foot whilst you’re trying to tidy up.

‘I drove lorries all round Europe. Worked hard, partied hard, different woman every night. Fantastic. But AIDS put paid to all that malarkey. I bought a pub in Deptford, ran that for a while. Then this geezer decided to shoot me in the legs, so I sold up, came down here. It’s not turned out bad.’

He squints at me.

‘I hope you don’t think badly of us,’ he says, as we load Gail onto the lift. ‘It’s been a while since the operation. A long while. A lean stretch, if you get me. I mean – I’ve been good, but there is a limit. We really thought it would be okay. So there I was giving her a right good seeing to and then she felt it go. Boom. I knew something wasn’t right because ordinarily she takes very good care of me. No complaints there. Hurgh. I remember, when I met her the first time, she looked me up and down, said – okay, mate, yeah, okay - took me home and tried me out, so to speak.’

He stands there whilst the lift rises into the air. Gail groans and takes another drag on the entonox. He suddenly seems reduced by the action and sound of the lift, the light spilling out of the back, everything. He flicks his cigarette off into the darkness.

‘I must have been all right,’ he says, patting his pockets for another. ‘We’ll have been together sixteen years next month’ At that moment his phone rings, and he starts, as if the patting woke it up.

‘Gary?’

visitors

We are an extemporary group of five, rattling upwards in a bleachy lift – me, my partner, the chaplain third-manning with us and two police officers. The chaplain is carrying our dressings bag. He hugs it to him, emanating goodwill. Ellie is carrying her clipboard, I’m pulling on my gloves.
Ellie asks the policeman: ‘So what do we know?’
‘Called in by a friend. This is a twenty two year old male, history of self-harm, apparently sticking pins into himself tonight. Why, I don’t know. Maybe it’s some kind of voodoo ritual. God knows..’ he sneaks a look at the chaplain ‘… God knows I can think of better things to do with my time, but there you are. You probably know more about this sort of thing than we do.’
The chaplain, lean and quiet and dark as a Mafioso hit man, smiles and nods. The female police officer leans in to her colleague and whispers something to him. The lift careens upwards. It really does stink, and I’m glad we are not going all the way to the twentieth.
The lift crashes to a halt and the heavy metal doors slide open. The police lead on; as a joke, we push the chaplain out next.
But the door to the flat is right by the lift and the police are already banging on it, so we quickly draw on a professional mask of concern. A voice from the other side asks who is it.
‘The police. Could you open up please so we can have a word?’
‘Sure’
Bolts. Chains. It swings open to reveal a boyish man in a faded black rock and roll t-shirt, boxer shorts and bare feet - a washed out yawn of a man whose reactions seem as woolly as his tangled brown hair.
‘What’s all this about?’ he says, wanly, then takes another toke on his spitty cigarette. His forearms are as covered in horizontal scratches and scars as the bark of a wild cherry tree. ‘What do you want?’
‘Would you mind if we came in and had a chat? We’ve had a call from someone to say that they were worried about your safety tonight.’
‘Who was that, then?’
‘Can we come in and talk about it?’
He considers us all for a second or two, then seems to lose interest. He lets go of the door, turns and slouches back inside; we follow him through the sparsely furnished flat into the front room. He resumes his place on the battered leather sofa, fitting the deep indentation there perfectly. There is a laptop propped open on an upturned crate in front of him, playing David Gray’s version of Say Hello Wave Goodbye. The ash tray is so full it spills over onto the disks and detritus that surround it. There is a bamboo blind tilted downwards across the main window; from behind it on a ledge, a tiny black faced kitten peers out at us, her fierce yellow eyes electrified with interest.
The man does not so much stub his cigarette out as bury it.
‘Was it Abby?’
‘Abby’s your girlfriend?’
‘Well’
The kitten suddenly jumps down onto the floor between us all. For a moment it stops where it lands in an intensely spiky attitude, front legs splayed out, shoulders at forty five degrees, staring and twitching – then bowls out between us and off through the hall.
‘She was my girlfriend.’
‘So what’s been happening tonight?’
The man seems to notice the chaplain for the first time, and frowns.
‘Don’t worry. I’m just along with the ambulance crew as an observer’ he says, gripping the dressings bag as if he wished it were bigger. Despite our uniforms, belts, blue gloves and radios, the police officers’ panoply of cuffs, batons and sprays – never has a simple collar of starched white fabric marked someone out so profoundly before. He may as well be dressed as a giant rabbit.
‘Have you hurt yourself tonight?’ asks the female officer, bringing us back to business with a flip of her notebook and click of her pen.
‘No. No more than usual. It’s not a problem. I just like to let blood, that’s all.’
‘How do you do that, then?’
‘With one of these’
He produces a syringe.
‘I draw a load out. Most nights. It’s no big deal. It’s something I have to do’
It’s just a kitten’s leap between the man on the sofa and the five of us here on this side of the room, but it feels more like a chasm. He stares at us with the syringe extended before him like a sacrament, his eyes glittering dark against the pallor of his skin.
‘Don’t look so worried. It’s normal for me’ he says.

The police ask us to check the man over, something he submits to with a bemused, slightly martyred air. He tells us about his CPN, how they try to help, but can’t really, as he’s never agreed that he does need help. He’s been in to hospital before with various infections. He’s anaemic. Ellie asks him if he has anyone he can stay with tonight.
‘Just the cat. My girlfriend left me months ago. I don’t know why she’s calling you’ He watches the BP cuff expand around his arm. ‘I haven’t seen my little girl in ages.’
We ask him what he intends to do tonight.
‘Take things as they come. I don’t know – improvise. I have no plans’
His blood pressure is low to normal, but he’s otherwise okay. He refuses hospital. We leave him to finish his interview with the police and let ourselves out.
‘I hope that cat didn’t go out the front door,’ says the chaplain. But we agree that the man didn’t seem concerned about it, so we let it ride.

Instead of taking the lift I suddenly sprint off down the stairs, and the other two try to catch me. It’s fourteen floors up, and I’m breathing hard as their heavy steps gain on me. The chaplain is singing the theme from Starsky and Hutch. Ellie throws her gloves at his head. Our laughter echoes up and down the stairwell.

a wood pigeon

This is a room of white. The early morning light is filtering in through two long drop white net curtains. A warm current of air is nudging through the opened sash. There are two beds in the room, both with white counterpanes, and the clinical curtain divider between them is white.
The bed on the left of this divider is occupied by an ancient man, a thoroughly dessicated figure propped up on a banana-shaped pillow, taking cursory tugs at a plastic beaker of tea. He drops the spout from his lips to give us a little smile as we walk in.
Our patient is in the bed by the window. He is also propped up on pillows, but his head is being supported by Ken, the ECP who was also assigned to this job and got here first.
‘Could you come and take Geoffrey’s head for me, please?’ he says. ‘He’s rather slumped over and we need to get him into a better position.’ I walk over to help. Geoffrey’s breath is coming quickly, in fluttering gasps. In the last throws of emaciation, the skin of Geoffrey’s chest pulses against the outline of his ribs.
‘Geoffrey has been refusing food for the last couple of weeks,’ says the home matron, who has come to stand at the foot of the bed, and is thumbing through his case notes.
‘Is there a DNAR for Geoffrey?’
‘Not as such. But he has said a number of times recently that he wanted to die and didn’t want any help’
I wipe away the meagre strands of hair sticking to Geoffrey’s forehead. His eyes have receded deep within his sockets. They are half opened, but red and dry and without recognition.
‘What about the relatives? What do they have to say?’
‘Oh, they’re absolutely in agreement’
‘And the GP?’
‘Hasn’t been in a day or so’
‘Well – I’ll make a call to the GP, if you wouldn’t mind getting in touch with the relatives and letting them know the situation. As you’re probably aware, Geoffrey is going to die very soon. I don’t think he would want us to resuscitate him, and I don’t think it would be appropriate. But we’d better start getting things in order. And we need the doctor here to make Geoffrey as comfortable as possible in his last moments’

Ken goes outside to call the GP whilst Ellie and I make Geoffrey comfortable.

Apart from the rise and fall of his chest, the only movement Geoffrey makes is a delicate rolling of the oxygen tubing between the shrivelled pads of his right thumb and index finger, the kind of exploratory movement you might make if you were blindfolded and asked to identify something. But the movement seems removed from him, an automatism rooted in some profound dream of absence.
I feel for his radial pulse, but his heart beat is only detectable now as a faint brachial twitch in his upper arm – the tail end of a rhythm set running when he was just a tiny embryo no bigger than his fingernail, easing away now ninety years later, here in this whitened room, in blue-striped cotton pyjammas, a clutch of photos propped up on pots of emollient creams and packets of wipes, the white net curtains ballooning inwards on the breeze, and a wood pigeon high up somewhere near, who-hoo-hooing, announcing itself to the world.