anatomy of a slap

Viren has only been at the EMI unit for a couple of hours, not that he could tell you. He lies back on the bed, heavy glasses on a wide and leathery smile, nodding and muttering and seemingly oblivious to the small crowd of people invading his room.
‘We find blood in pads,’ the nurse says, flicking through his notes with a sniff. ‘The first time we come to change we find blood in pads. From penis. I haven’t more, unfortunately. His name is Viren. V-I-R-E-N. Viren. There.’
She hands me the notes. ‘Wife will meet at hospital.’
I introduce myself and Rae. Viren produces a hand as padded and massive as a baseball mitt, wraps it round mine, then rattles on through a low and loose knit of words. I shake his hand and tell him what to expect. The nurse and her assistant stand to one side and dispatch an orderly for the hoist.
‘The notes say here that he can be violent. Have you found that?’
‘Like I say, he came two maybe three hours. I could not say. He’s fine.’
I look at Viren and smile, then go back to the paragraph describing his history. Vascular dementia. Wife sole carer. Some kind of incident on a bus when he refused to leave and became aggressive. Banging on the window. Police etc. Wife at risk. Having him put into respite care whilst longer term provision found.
‘How are you feeling, Viren?’
His reply could be anything.
‘We think UTI, maybe kidney. He has swollen abdomen. He has temperature.’
I run through the basic obs whilst Rae goes to fetch the trolley. I make notes on my form, interspersing each procedure with reassuring smiles, squeezes and words. Viren seems happy and calm, even when I examine his abdomen.
‘He prefer men,’ says the nurse. ‘Girl – not so much.’
When the trolley comes through we position it so that the hoist will have room to operate. The sling seems to be a sheep’s fleece with straps.
‘I’ve never seen such luxury, Viren,’ I say. He smiles and tries to pull my shirt.
The lift over onto the trolley is uneventful. At one point Viren is swinging in mid-air, his legs spread and his hands fluttering in the void like gross, featherless birds.
‘Here. Hold on to this,’ we say, directing his hands. But he flaps awkwardly until we land him.
We tuck him up, raise the trolley, make our farewells, and leave.

***

A&E on a Monday. Crammed with doctors’ urgents. People have had the weekend to fall ill, present themselves at their surgery and be referred on to the hospital. Accident and Emergency is transformed into some ghastly portal. Trolleys line the corridors; the status board is as scrawled and hectic as a race meeting tote. Walking in through the automatic doors I expect to see a gothic sign inscribed in slate: Abandon Hope All Ye Who Enter Here. But I give Viren’s hand another squeeze and excuse my way through to the charge nurse to handover my patient.
After twenty minutes I come back. Rae is a fossilised yawn.
‘We’re going into space nineteen,’ I say to them. And then specifically to Rae ‘I’ll get some half boards.’ I figure that Viren won’t tolerate being laid flat.
When I return with the boards I look around for someone to give us a hand with the transfer. Viren is a tall man and I don’t want his legs getting snagged on the foot bar as we go across.
Luckily, Erik the Viking is standing with a patient just behind us, and if there is one person in the wide ambulance world who is good for a smooth transfer, it is Erik the Viking. A tree-sized, red-faced man, in earlier times he would have looked at home standing at the prow of a longboat, squinting through a helmet with an axe across his chest, but these days he simply looks mighty in greens.
‘Help with a transfer, Erik?’
‘Sure.’
He clumps across.
‘This is Viren. Viren has dementia, but apart from being a bit grabby, hasn’t been too much of a problem. Viren has some bleeding from his penis, so it’s query UTI or other infection. Otherwise okay.’
‘Fine’
‘I’ll take the legs if you’re happy with the middle.’
‘Yep.’
He smiles at Viren.
‘Just put your hands across your chest and let us do all the work,’ he says pleasantly. Viren smiles and looks around. I place his hands for him. ‘Keep them on your chest,’ I say.
We lean him to his right and slide the boards into position. He accepts this indignity without any trouble.
‘Ready to slide – and – slide.’
His right arm shoots out and grabs the edge of the board, stopping him moving.
‘What are you doing?’ he screams.
‘Viren. It’s okay. Just relax and let us get you over.’
‘Help! Help!’
I unclasp his hand. ‘Let’s get him over,’ I say. We slide him all the way.
‘What are you doing to me?’
‘All done now. All done,’ says Erik. He goes to roll him up a little to give me room to slide the boards out.

Viren draws his hand back and slaps him round the face.

When he pulls back to hit him again, Erik catches his hand.
‘You do that again and you’ll be in hospital for a lot longer,’ he says.
I know that the shock of the slap has jolted Erik into war mode, but it’s a truly dreadful picture, framed by the sudden thrill of attentive quiet that has flashed through everyone in the vicinity.
Whilst Erik controls Viren – who stares up at him with a look of whitened terror – Rae and I pull up the safety bars and arrange his blankets. Erik releases Viren’s hands.
‘I’m so sorry about that, Erik,’ I say to him. ‘That came out of nowhere. He was a bit grabby when we picked him up, but that was it.’
‘No worries,’ says Erik, but he looks about to blow. ‘I’m used to it.’
We put Viren into position. I tell the charge nurse what happened.
‘Oh great,’ she says, ‘that’s all we need. Thanks a lot.’

I go to the kitchen, make a round of tea and carry it outside on a plate. Erik is there, smoking. I hand him a cup.
‘I feel so embarrassed,’ I tell him. ‘The notes said he was aggressive, but he was so good it just went clean out of my head.’
‘Don’t worry about it.’ He adjusts his position against the railing. ‘It’s happened to me before. It’ll probably happen again. I can take it.’

Rae joins us. We drink our tea. Erik smokes.

I can feel the stress tonight. I can see its stealthy mycelia threading out beneath the A&E doors, along the tarmac and up to my boots, up my legs, over my chest, my arms and my hands, into the tea, into me.

I gave up smoking seven years ago but I could do with a cigarette tonight.

a bag of nuts

The satnav has failed but I recognise the street from a siege last year. A burglar with a knife had been disturbed, chased by police and gone to ground in one of the terraced houses there. After a time, a police dog handler had arrived. The crowds taped off at the end of the street had been parted to let this new and terrifying apparatus through. The dog handler had parked in front of the house, stepped to the back of the van, and opened the door with the gravitas of an executioner. At a snap from his fingers out leaped a dog that, from where we stood, looked one part Alsatian, three parts grizzly bear. It sat in front of him, he gave it some instructions – which the dog seemed to understand and enjoy – then they padded off through the front door, and as far as I understand it, the burglar ran out the back into a big net. Anyway, it was a sunny, do-nothing standby, with people leaning out of car windows, looking on with folded arms, comparing mobile phones, cleaning their sun glasses on their shirts, or passing time with the easy, expansive chat that breaks out when anything cuts across the norm; a mixed crowd of sudden sociability, from the stab-vested police and evacuated neighbours to the local press, TV crews and any one of the hundreds of commuters drifting past on homeward currents, stopping to have a look.

The street is different now. The lamps have all failed, and the only illumination is the yellowy overspill from the railway station and a full moon hangs above us like a hub cap. The house numbers are difficult to read. But just as I go to pull a torch out of the rack to have a closer look, the truck headlights pick out a policewoman emerging from the gloom at the top of the street. Rae drives up and I climb out.
‘We weren’t told you’d be here,’ I say. ‘The job came through as a sick elderly woman.’
The policewoman smiles and comes up close.
‘Her name is June – we think. She was found wandering in someone’s garden, very confused. They took her in and called us. She says she lives in one of the cottages backing onto the alley, but doesn’t have a key, the people looking after her have never seen her around before, and well – it’s difficult to figure out quite what the story is. Come and see what you think.’
She leads us back up to the top left corner of the road and turns confidently into what would seem to be a high wall. But the thicker darkness there is actually the entrance to an alleyway I would never have guessed existed, a twitten tucked away as neatly as a secret compartment in a Georgian writing desk. A few yards along it we come across another policewoman standing by an arched trellis. She shows us through into a pocket-sized courtyard and the front door of a narrow cottage in front of which stands a figure who appears in the shadows to be a speaking facet of the rough flint wall.
‘Oh no. What now? Who’s this?’ she says.
I resist the urge to switch my torch on. The beam would blind us all, and the woman is so insubstantial it feels as if she would simply disappear.
‘Hello, June. My name’s Spence and this is Rae. We’re with the ambulance service.’
‘The ambulance service? Well for goodness sake! No-one’s sick, are they?’
‘That’s what we’re here to find out. How are you feeling?’
‘How am I feeling? Why do you want to know that?’
‘Because people are a little concerned about you, June.’
‘Are they? Who? Why are they concerned about me?’
‘June – it’s pretty cold and dark out here. Would you like to come and sit on the ambulance and chat to us there? It’s so much warmer and more private. We can sit down in comfort, have a chat and get to the bottom of this mystery.’
‘What mystery?’
‘Exactly. Will you do that, June? Come on, just for a minute or two. We won’t drive off anywhere, or do anything you don’t want to do.’
‘All right, if you think it’s absolutely necessary. One must always trust those in public positions of responsibility. But I have to say it all seems rather a nonsense. Who are you, do you say?’
‘The ambulance service.’
‘And why are you here?’
I take her by the hand. Even that small movement is enough to disturb an unsettling odour from her. It spreads out around us, a seamy musk of neglect.
‘Follow me.’
I lead her back along the alleyway to the ambulance. We sit her in a forward seat, close the door and settle in as pleasantly as we can.
‘And this is an ambulance, you say?’
June looks around like some visiting dignitary making conversation. Her silver hair is scraped neatly back into a black scrunchy, and her jacket and trousers have a smart line to them. But it looks as if she has been wearing the same clothes for some time now. They have a hazy, forgotten look about them.
June has a wide face, with an asymmetric twist to her mouth that would have been terrifying in middle age. Now it seems somewhat disconnected from her eyes, which flicker dully around her surroundings.
‘Would you mind if we did a few very basic tests, June, just to make sure everything’s okay?’
‘Of course everything’s okay. Why the fucking hell would they not be okay?’
‘Try not to get upset, June. Let me explain what the problem is.’
‘I wish you would. And don’t bamboozle me with jargon. Speak plainly and simply. I am not a fool and I will not be treated as a fool.’
‘Absolutely. Okay. Here’s the thing. Some people who live near here found you wandering in a confused state in their garden. They were worried about you, so they called the police. The police called us because they thought there might be something wrong with you.’
‘Something wrong with me? Like what?’
‘A urinary tract infection, for example. That can make you confused.’
‘Who’s confused?’
‘You seem confused.’
‘About what?’
Rae joins in. Whilst we give her a quick health screen, we try different approaches to find out the facts of her situation – where she lives, who she lives with, where she has been today and what she thinks of this whole situation. Her vital signs are fine, but although she is articulate and forceful, she seems to lack any reasonable insight into her predicament. And by the simple expedient of repeating isolated phrases back to us, she starts to make it seem as if we are the ones in need of focus.
‘Please. This is not amusing in the slightest – although I don’t doubt this fellow thinks it’s a hoot. I worked fifty years for the foreign office in Africa, and believe you me I know my way around the garden. I’ve put up with worse antics than you. I know what you’re about.’
‘June, let me try to explain again what the problem is.’
‘Please do. All ears.’
‘We’ve never met you before. We have no way of knowing what is normal behaviour for you and what is not. We can only go by what we see, the facts of the case.’
‘And they are?’
‘An elderly woman found wandering in the cold and dark, unable to give an account of where she has been or what she intends to do next. No key to get in, and no plan of action.’
‘What key? What are you talking about?’
‘June – do you live in the house you were standing in front of?’
She screws up the handle of her black bag.
‘Oh this is fucking ridiculous. Here you are talking about keys and confusion. You and your fancy equipment. Your mumbo jumbo.’
‘Okay. June. Do you have a key to that house? Would you mind looking in your bag?’
‘For what?’
‘For a key.’
She opens up the bag and rummages around. It flops about emptily, until suddenly she pulls out an unopened bag of salted peanuts.
‘Would you like a peanut? They’re very good for you, apparently.’
‘No thanks, June.’
‘How about your lovely colleague? Can I pass you a nut, dear?’
‘No thanks, June.’
There’s nothing else in the bag other than a two pence piece and a dirty handkerchief.
‘I don’t suppose you have the key on a string round your neck?’
June stares at me.
‘And why on earth would I have a key round my neck? Do you take me for an imbecile?’
‘June. Our duty first and foremost is to make sure that you’re okay.’
‘Good. Yes. You must do your job.’
‘Yes. It’s our job to make sure that no harm comes to you.’
‘I see.’
‘As things stand, we have no way of knowing if you actually live there, and no way of knowing what you will do next. What would you do if we dropped you off in the street now?’
‘I’d go home.’
‘And where is home?’
‘You know where my home is. I’m tired of these stupid questions.’
‘It’s cold and dark, and we couldn’t possibly just let you wander off. So here’s my plan. Come to hospital with us. It’s warm and safe there. You can see a doctor, just to make absolutely sure there’s nothing physically wrong with you. And there are people there who can help figure out what to do next. How does that sound?’
‘You must do what you must do. But I think the whole thing is a colossal waste of time.’
Rae climbs out to tell the policewomen what is happening. Then she calls back the leaving scene time through the hatch, and we set off for the hospital.
‘This is a rickety old charabanc,’ June says, sniffing and twisting her lips, hugging her bag to her on her lap. And then: ‘What an absolutely fucking ridiculous end to the day.’

keep the change

Frank steps up to the bank of flat buzzers and presses number ten. We wait a while, and then just as Frank steps up to press again, a voice crackles something unintelligible, the lock thrums, and we push the door open.
From outside there is nothing to give away the fact that this is a care in the community hostel, but inside the institutional roots of the place are apparent. Along with the pin board covered in departmental posters and leaflets, illuminated exit signs fixed above every doorway, fire extinguishers hanging on brackets and a large grey alarm console winking over the stairway, there is a functional air about the hallway, a brisk, sanitary aura that smacks of observation and control.
A cadaverous man in a jacket suit and trousers – but not from the same suit – steps out of his flat and confronts us in the hallway.
‘Who’re you here for?’ he says.
‘Number ten.’
‘Number ten? Ah. Upstairs. Is he going to die?’
‘Let’s hope not. Thanks for your help.’
He studies us as we climb the stairs, but when we look back down to wave he hurries inside his flat.
The door to number ten stands open. I knock and push it open further.
‘Hello. Ambulance.’
The room is filled with cigarette smoke. Our patient, Michael, sitting bare-chested on a low stool in the middle of it all like a sumo wrestler in a steam room, nods for us to come in.
‘It’s a bit smoky, Michael,’ I say to him. ‘Are you able to come out here and talk to us? Only it’s the beginning of our shift and we’ll absolutely stink of fags if we spend much time in here.’
‘The window’s open,’ he says. But the yellowing net curtains hang straight down, the nicotine equivalent of stalactites.
‘Still – if you wouldn’t mind.’
He sighs, stands and walks out onto the landing. I sit him down on the stairs.
‘So what’s the problem, Michael?’
‘I’m depressed.’
‘We were given the call as an abdo pain. Do you have any pains around there?’
‘This morning. But it’s gone now.’
‘Any other pain anywhere?’
‘No.’
‘Any unusual feelings? Sickness? Dizziness? Shortness of breath?’
A fog bank of fag smoke is sliding out of the flat towards us.
‘No. I feel okay.’
‘So what’s the main reason you wanted an ambulance tonight?’
‘Like I said. I’m depressed.’
‘And is this a new thing?’
‘No. I’m always depressed.’
‘Are you on medication for it?’
‘Yep. These.’ He pulls out a scrip, a comprehensive list of anti-psychotics.
‘You see, Michael, the best person to talk to about these feelings of depression are your doctor. They know you. They’ve got all your notes. If you saw an out of hours GP tonight, they’d be hard pushed to give you anything you’re not currently taking – and they’d be loathe to do that, anyway. My advice would be to get some rest tonight and see your GP in the morning. How does that sound?’
‘Fine.’
A young woman is coming up the stairs. Dressed in a tracksuit top with the hood pulled over her head, she has a stealthy, predatory hunch to her. In this harsh hallway light I expect to see a Nosferatu shadow thrown against the wall. But half way up towards us she stops and calls:
‘Mickey? Are you all right, Mickey?’
‘Yeah. I’m fine. Listen – Leila. Come up here a minute, can you?’
She pads cautiously towards us. When she puts down her hood, her face is a disconcerting mix of ages; she has the eyes of a young teenager, but the skin and hair of a woman in her thirties.
‘Leila? If I give you this money, will you go to the shops and get me some Chinese chips and a bottle of lemonade?’
‘Yeah. Course.’
‘But I want the change. You can’t keep the change.’
‘I won’t keep the change.’
‘You promise you won’t keep the change?’
‘I promise I won’t keep the change.’
Frank looks at me. His face is impassive, but I can feel the power of his impatience trembling in my pen.
‘I’ll just finish this paperwork and we’ll be off.’
‘Yeah. Okay,’ says Mickey, scratching the sparse black hair between his breasts.
Leila leans in to study the two of us.
‘I dated Frank Sinatra. Do you know Frank Sinatra?’
‘Frankie. Oh yes,’ says Frank.
‘What’s your name?’ She squints at his name badge. I can see that he wants to cover it up with his arms, but he reluctantly pulls aside his jacket so she can read it.
‘Frank!’ she says. ‘Frank Sinatra!’
I’m writing as fast as I can.
‘Do you know anything about the shooting in the pub at the end of the road, Frank?’ Leila says to him, moving even closer.
‘No. What shooting?’
‘There was a man shot there.’ She leers horribly and puts two fingers to her temple. ‘Right through the brains. Dead.’
‘Oh. When was that?’
‘I don’t know,’ she says, suddenly dropping her fingers and her tone. ‘Ten years ago? Can I see you again?’
‘Just sign here,’ I say to Mickey, and he takes my pen
‘I’m sure our paths will cross,’ says Frank, picking up the bag and turning to go.
‘But who do I call?’
‘The usual numbers,’ says Frank, helpfully, and starts off down the stairs. I tear Mickey off a copy of the patient form and follow on. At the bottom of the stairs cadaverous man steps out again.
‘What’s happening now?’ he says.
‘Nothing,’ says Frank. ‘Everything’s fine.’
‘So how much does an ambulance man get paid?’ says the man, as Frank hauls open the door.
‘Not enough, mate’ - and he is in the truck with the keys in the ignition before I’ve shut the door behind me.

misunderstanding

Stanley opens the door so quickly he must have been standing right by it. Half past five in the morning but he looks as if he has been up an hour or more. There is an air of silence about him, hanging from his shoulders as thickly as the dark green cardigan he wears. He stands in the doorway with one hand clutching the frame and one hand fiddling with a top button I’m not sure is actually there.
‘Hello. It’s the ambulance. Shall we go inside and have a seat?’
He stares at me slackly.
‘Just for a moment, so we can find out what the problem is.’
He turns and drops back inside the house. We follow him into the sitting room, a gloomy parlour crammed with paintings of racehorses, a trophy cabinet, family portraits. It feels more like a memorial to a former jockey than a place anyone might live. Stanley plumps himself down in a high-backed chair and laces his fingers together.
‘What’s the problem?’
‘I’ve been getting rather a sore throat.’
He makes a tired little stroking movement with one hand up and down his neck.
‘And how long has this been going on?’
‘A few days. I don’t know.’
‘Any other pain?’
‘My knee, but that’s old and best forgotten about.’
‘Dizziness? Shortness of breath?’
I fish about for a while, making sure that Stanley is not in fact having the chest pain described in the message.
‘No. Just this sore throat.’
Stanley has recently been cleared of prostate cancer, still has problems urinating, but other than that seems in remarkably good shape for a man in his mid-eighties. It does look as if he needs to go to hospital, but I want to do an ECG to make sure it isn’t cardiac, so I ask if Stanley will come with us out to the ambulance.
‘I’m sorry to have troubled you,’ he says. ‘If you think it’s nothing then I’ll say no more about it.’
‘Let’s go on the ambulance and do a few more checks, just to be on the safe side.’
I help him up, and guide him out to the vehicle. On the way he coughs a few times, a dry, half-hearted affair, like someone clearing their throat in church.
‘How long have you had that cough?’ I ask him.
‘A few days. I don’t know.’
We settle him onto the trolley, and begin our round of observations. Whilst I’m sticking some dots on him I have to excuse myself and hurriedly turn to the side to sneeze.
‘Oh – look at me!’ I say, pressing my nose with the back of my blue-gloved hand. ‘I think we’ve both got a touch of the sniffles.’
Stanley gives a little jolt and straightens an inch.
‘If you think I’m wasting your time then please say so and I’ll go back inside. I didn’t know what to do. I have no one to ask. My wife’s in a home with Alzheimer’s, my daughter’s in Spain. It’s not easy you know, living alone like this. But I don’t want to be a nuisance. If you think all I have is a cold, then fine, help me up and I’ll get about my business. I will not be a burden and I will not waste anyone’s time.’
‘Stanley! Stanley!’ I say, as shocked by his outburst as if a teddy bear had suddenly reared up and bitten me. ‘That’s not what I meant at all! I don’t think you’re a burden!’
‘If you think all this is just a waste of time then tell me and that’ll be the end of it.’
‘Stanley! It was just that I sneezed – and you were coughing – and I thought we both might have a cold. But I don’t think you’re wasting our time. We’re more than happy to come round this morning and make sure you’re okay. More than happy.’

But Stanley avoids my eyes. Instead, he keeps his head up, uncomfortably looking around the ceiling and overhead lockers, like a tired old donkey sniffing the sky for signs of rain.

the gravity of the situation

An old house in an old part of town. A young girl stands framed in the enormous doorway, an elegant fan light spread above her, two broad steps inlaid with a multi-coloured mosaic pattern leading up. She leans back against the doorframe and smiles shyly, her teeth wired into line by a stout wire gantry. I wave, help Rae pull the resus bag, drugs bag and carry chair out of the back of the truck, then foot the door shut and head up towards her.
I think: I’ll be surprised if this really is a Category A unconscious.
But say: ‘Hello. Where’re we going, then?’
The girl blushes and points up at the sky.
‘Top flat. And no lift,’ she adds pleasantly, shrugging her shoulders, as if the Georgian architect had decided against installing one out of sheer cussedness.
We haul ourselves up the steep staircase, mindful of the rucks and folds of the carpet.
‘We’ll be needing oxygen soon,’ Rae says, repositioning the heavy yellow bag.
‘Not far now,’ laughs the girl from above us, her braces glinting in the light from a tiny landing window.
Another two flights and we step onto a sunny hallway with three doors leading off. One of them stands open, and the girl leads us into a bright bedsitting room, ordered in an ingenious, below-decks fashion, with every space and surface adapted to serve at least two functions, and every article folded, marked and stored neatly away. There are two sofa-beds in the room, but one of them is still in use from the night before. A middle aged woman is sitting on the side of it, her hands placed either side of her and her long black hair hanging straight down like black water from a pump.
‘This is Momma. Momma doesn’t speak English, so I’ll translate.’

The family is from Slovakia. The mother, Emilia, is working as a cleaner; Sara, the daughter, is studying at a local secondary school. Sara called a helpline number for advice when her mother fell ill with a temperature and a headache last night and still felt bad this morning. The helpline advised calling for an ambulance. We examine her carefully, but nothing Emilia says – earnestly reported back via her daughter – and nothing in her observations suggests anything more serious than a viral infection of some sort. The mother had not taken any pain medication, so we give advice about this, along with a recommendation to see her GP if there is still no improvement over the next twenty four hours.

Sara helps with the translation and gives us the information we need with a warmth that does not diminish even when we say that we think she should stay with her mother to keep an eye on her for the rest of the day.
‘Of course,’ she says, tapping her notebook. ‘There’s plenty for me to do.’
We complete the paperwork, pick up the bags and chair, and leave.

Half way down the stairs I turn to Rae and say: ‘At last - gravity working for us, for a change.’ And immediately trip on the carpet.

Instinctively I fling the bags ahead of me and flatten myself against the wall to stop myself toppling head first down the staircase. Amazingly I manage to avoid a catastrophic swallow dive onto my head, and instead end up my arse with my legs pointing upwards, one arm spread up the wall and the other out to the side, five or six steps below Rae. She looks down at me.

‘Are you okay, Spence?’
I flex a couple of things. Everything seems to work. ‘Yep. I think so.’
She looks down at me, sniffs and says: ‘Yep. That’s gravity for you, mate.’

blown away

These air molecules, responding to a steady change in pressure between this stretch of land and the sea, flow down the steepening gradient, and eddy and rush according to the spinning of the earth, and the rising and falling away of the Downland rucks and rills, blindly flow on across the County, hurtle through stands of beech and sycamore, hawthorn, gorse and rhododendron, around the flints of a farmhouse wall, through broken fence slats, between the legs of these cows standing in the field and over the back of this one lying down, and on, through and across towards the town, scythe through an industrial estate, snatch up a strip of pallet wrap, ruffle the hair of a man on a fork lift, nip round the beeping end of a lorry backing up, rattle across the corrugated surfaces of doors and roofs, and then barrel on up a steeply inclined pathway to a group of three old cottages huddled at the top.
The door of the first cottage bangs in its frame.
‘Get that, would you?’
Malcolm, the eldest son, takes the door off the latch, closes it firmly, then rejoins the group in the living room.
‘Here’s a list of the medication she’s on.’
Stephanie, Malcolm’s wife, hands one of the ambulance technicians a prescription sheet. He skims it and nods, then turns his attention again to the old woman sitting in the chair.
‘How are you feeling?’ he says.
She looks at him, then away over his shoulder to the faces of the people standing around.
‘Where’s Barry?’ she says.
‘Barry’s here, Mum. He’s just here.’
Malcolm has his hand on Barry’s shoulder. Barry passively absorbs the attention. He has thick glasses, and his hair looks combed and wetted by someone else.
‘I want Barry,’ says the old woman.
Malcolm leads Barry over to the chair and stands him between the old woman and the fireplace.
‘Barry’s okay, Mum,’ he says.
Stephanie reiterates what the doctor found on his visit earlier that day. Suspected urinary tract infection on top of an existing chest infection, possible renal insufficiency – a general deterioration, not entirely out of keeping in a woman of eighty nine.
‘She was right as rain up until last week. Did everything for herself. Didn’t you, Molly?’
Molly sits at the centre of all this concern, desiccated and pale, her spindly legs drawn up and her arms around them, looking down on the scene like an ancient spider tucked up in the corner of a room.
Malcolm takes the ambulance technician to one side.
‘Of course we have two problems here. One is Mum and her well-being. The other is Barry. Mum's been the main carer for Barry ever since he was born brain damaged, and we simply don’t know what’ll happen to him if it turns out she can’t cope at home any more. We’ll take him for the time being, but after that...’ Malcolm takes off his glasses and cleans them on his t-shirt. ‘It’ll kill Mum to have him put in a home, but honestly – she can’t cope here any more. It’s been coming for some time. We’ve just been putting it off.’
The technician nods. It is a difficult situation, he says, one that will have to be resolved between the hospital, social services and the family doctor. For now the focus is on getting Molly better. The rest will have to follow.
Malcolm puts his glasses back on and thanks the technician for coming out. He asks him if they can all ride with Molly to the hospital.
‘We’ll just about fit you in,’ says the technician. His colleague goes outside to get a carry chair and blankets. As soon as the door is opened, the wind rushes in.
‘Hark at that,’ says Stephanie, wrapping her cardigan tightly around her. ‘We’re all going to get blown away.’

mother's day

The Receptionist, a tall, closely clipped man in his early twenties, stands with his hands planted either side of him on the cherry wood desk, scanning the hall with the proprietary smirk he has developed over the years along with his excellent customer service skills. It is quiet for a Sunday. There is an elderly couple sitting over by the window, studying the drinks menu so closely you would think they were going to be examined rather than asked to place an order. A poor advert for the hotel, he thinks. He must have a word with Gerry about reading the clientele and political steerage vis a vis seating arrangements. And then over in the palm zone, hiding himself amongst the foliage, his business raincoat draped over his business bags, a business man abstractedly tapping a Blackberry on his knee.
A woman appears on the other side of the revolving door. The Receptionist watches as she stands there staring through. Has she not used a revolving door before? This should be good. Although he can see she only has a small holdall – rather masculine, he thinks. Probably her husband’s. Where’s he, then?
As she pushes the door round and makes her way inside, the Receptionist runs a finger down the Expected list and taps it at the likely candidate. Single female, two nights paid, debit rather than credit card. He powers up his welcome smile as she approaches the desk.

**

The basement steps are dark and steep. The two ambulance technicians pause for a moment at the gateway. The one in front pulls a small torch from his jacket pocket, and slinging the bag over his shoulder with his left hand, lights both their way down with his right, until they find themselves in a little square courtyard, crowded with spilling bins and tangled piles of rubbish.
There is a door standing partially open, but the only light visible around it is from deep inside the flat; there is no hall light, and no sounds of life inside.
The first technician puts his foot out to swing the door fully open, but just as he does so his torch illuminates a policeman coming towards them.
‘Whoa!’ the policeman says, putting his hand up against the beam. The technician lowers it. Then: ‘Great. That was quick. Basically, what we’ve got is a forty something guy, very suicidal. He took some heroin today, a bottle of vodka. He’s emotional but not violent. We wondered if you’d mind coming and having a look, see what you think?’
The technicians follow the policeman into the flat, the diffuse circle of light from the torch playing around the hall floor.
‘Sorry about this,’ the policeman says. ‘He’s only got a lamp in the back room for some reason. It’s a dump, basically.’
Walking along the hallway is like walking through a cored, rotten apple, the air mealy with neglect. At the far end the policeman pushes open a door and shows them into a boxy room sparsely furnished with a low sofa, coffee table and a CD radio combo on the floor. The kitchenette that adjoins the room is as chaotic as the bins in the courtyard; in fact, it would be difficult to chose which one would be the safer place to prepare food. Lit as it is by a single standard lamp, the room is a vision of inhumanity. The shadows that rear up from every surface seem more an expression of shock than light.
In the middle of the room there is a man standing, sucking on a tiny, hand rolled cigarette. A powerfully built man, standing rooted in his big black boots, wearing a combat jacket with bulging pockets, at first glance he seems like a workman taking a break. But his mouth is pulled down by the gravity of something lost, and his eyes are rimmed with exhaustion.

**

‘Welcome to the Excelsior, Mrs Plunknett. I do hope you have a pleasant stay. Of course, if you have any questions about the hotel, its services or facilities, or indeed any aspect of your stay with us here today, do please let the desk know, either by using the little white phone in your room or indeed asking down here directly. There’s also lots we can help you with regarding the town, places to go, what’s hot and what’s not…’
The Receptionist nods forward and raises his eyebrows at this point, implying that they both know that what is hot is not at the top of Mrs Plunknett’s agenda. She smiles in a heavy-faced manner. Some people. He remembers with a shudder what it was like when he was holiday rep at that resort, chivvying along the cow-like hordes.
‘O-kay. Breakfast is from half past seven until nine thirty. Between then and throughout the day you’ll find a wide selection of snacks – healthy or otherwise – available from Gerry, our wonderful Bar manager. Gerry’s ham baguettes are world class - and his Banana Daiquiris aren’t bad, either.’
The Receptionist smiles. If it was an attractive woman the other side of the counter, he would say Screaming Orgasm. He is a professional, though. He understands the need for tact.
‘The Silver Leaf Restaurant is open from six thirty with a full a la carte service. I recommend the Fruits de Mer. I would also recommend an early booking, though – particularly today, Mother’s Day … ‘
That was a risk, though. He studies her face to see how she took it. Was she a mother? She was old enough, but what did that mean? He hopes she isn’t here to bury any of her brood. These things happen. He ought to be more careful.
He waits for her to say something. Again she comes back with a lumpy smile.
‘I’m sure you must be very tired and ready to jump in the shower. I see you’ve come from…’ He makes a show of reading her booking entry, but the woman says: ‘Liverpool’
‘Ah – Liverpool.’ He struggles to think of something to say. ‘That’s – a long way.’
‘Yes it is. Thanks.’ She sweeps the room card from the desk and walks off across the lobby towards the lifts. He studies her as she goes, but whilst she waits for a lift to descend she unexpectedly turns to look back in his direction. He lowers his eyes and pretends to be reading something, and when he looks up again she has gone.

**

Richard is sitting on the forward ambulance chair, staring down at his hands as the fingers pick and work at each other.
‘I’ve had enough,’ he says. ‘I’m forty five years old and I’m finished. I just don’t have the energy to carry on. I’d kill myself, but on top of everything else I’m a coward. I can’t even do that right.’
He has been clean of heroin for seven years. He took some training, learned carpentry. Got himself some tools and a job first fixing, got himself a nice little place – not this one. But then work started drying up, he fell in with the old crowd. Took a hit and it all started up again. Today he tried to kill himself with an OD and a bottle of vodka, but incredibly, woke up to hear someone banging on the door.
‘I thought I’d taken enough,’ he says. ‘What have I got to do?’ He looks at the two ambulance people as if they are representatives from an alien civilisation he has no connection with.
‘Throw myself off something, I suppose,’ he says. ‘But how do you do that? Jesus – what a fuck up.’
‘Who called the police?’
‘My mum. She got me on the mobile. She said she was going to come down and see me. From Liverpool. And she’s not well. I’ve fucked her life up and I just keep doing it. I’m no good. Just let me go, guys. I’ll take myself away and no one need ever know.’
The technicians talk to him some more, persuade him to go with them to the hospital to talk to someone there. One last chance. For his mother’s sake if no-one else.
‘I’ll go. But there’s nothing anyone can do. And I don’t want to see my Mum,’ he says. ‘I couldn’t bear it.’
The policeman says he will contact the mother at the hotel and at least let her know that Richard is safe, in the hospital, but doesn’t want to see her just yet.
‘I just don’t have the energy to start over,’ he says.
He looks at the technician, sitting there with his clipboard spread across his knees, surrounded by equipment, light and direction.
‘I just don’t have the energy,’ he says.

ute

Ute is sitting on the floor, half in and half out of the kitchen, a baggy black felt bathrobe plumped up around her.
‘I’d have helped her up but she told me not to. She didn’t want me to see her naked.’
The meals on wheels guy is standing in the hallway looking on as Frank and I squat down beside her. ‘She passed the key through the letterbox.’
‘I tell you I want women ambulance only,’ Ute says in a trembling Germanic accent. ‘Where are the women I had last time?’
‘Ute – have you hurt yourself? Are you in pain?’
She rubs her shin. ‘There perhaps. Here – not so much. My bottom, where I’ve been sitting.’ She looks up at us. ‘And who did you say you were?’
‘The ambulance, Ute. We’ve come to get you up off the floor and see how you are.’
‘I’m not going to hospital. They’ll put me straight in the loony box.’
We help her into a chair, but as soon as she’s settled she says she wants her teeth.
‘I’ll get them for you. Where are they?’
‘In a cup in the bath.’

The flat could not be tidier if it were laid out on a grid. There is a measured distance between the Ercol chairs, the salt and pepper cruet and commemoration tankard, the oil painting of a barge on the sea at sunset, that group of cherubs flying in blessed formation over the gas fire.
Her teeth are where she said they would be, stewing at the bottom of an orange tumbler in the bathtub. The arrangement of teeth seem strangely chaotic; have they worn away into those positions, or did she have an irregular set made for authenticity? Either way, they don’t fit. When she stuffs them into place and tries to talk, she may just as well have crammed a handful of Lego into her mouth.
‘Do what you will – but I’m not going to hospital.’
We thank the meals on wheels man for his help.
‘What would’ve happened if you’d not come round when you did?’ I say to him.
He slaps me on the shoulder.
‘Roast pork and vegetables, Apple pie and custard,’ he says to Ute. ‘See you tomorrow. And stay off the floor.’
‘What did he say?’
‘Roast pork and vegetables,’ says Frank. ‘And if you don’t want it I’ll have it.’
‘Oh.’ She smiles, and her teeth almost pop out.
‘We’ll just give you a check up to see everything’s okay.’
‘Come on then.’ She bunches up her bathrobe.
As I’m taking her blood pressure, she straightens in the chair and points at the door.
‘Who’s that coming in?’
‘No-one. The door’s on the latch and it’s blown open a little.’
‘Oh.’
She settles back as I pump up the cuff. Then she says:
‘I thought it was the nuns.’
‘Nuns? What nuns?’
‘But they only come out at night, so it couldn’t be them.’
Frank brings over Ute’s care folder and points at a section that describes her hallucinations. The list of medications alone are testament to her on-going mental health problems.
‘Where are you from, originally?’
‘Vienna. I came to this country in 1948.’
‘My mother-in-law’s German, too. Prussian.’
‘Really? What part?’
‘Stolp. Of course it’s Poland now.’
‘Ah.’
She frowns at me.
‘Your blood pressure’s absolutely fine, Ute. Everything’s looking good.’
‘Good.’
I roll up the sphyg and pack it away.
‘Yes. She escaped with her life in 1939. She’s Jewish. She just made it out. The British borders were already closed by then, so she ended up in Northern Rhodesia. What’s now Zambia.’
Ute leans forward.
‘Are you Jewish, too?’
‘Me? No.’
‘Of course, Hitler was quite mad, you know,’ she says finally, easing back in the chair. ‘Quite, quite mad.’
Frank writes out the form whilst I make Ute a cup of tea.
‘Thank you,’ she says as I place it on the little wooden table by her side. ‘You’ve even matched the saucer.’
Just behind her on the sideboard is a large old ceramic: an elephant with a tiger on its back. The elephant must have held that expression of terror now for a hundred years or more. Next to it is a small silver picture frame: a man in a yellow t-shirt, grinning massively behind a curly red beard.
‘My son,’ says Ute, replacing the tea cup onto the saucer with barely a click. ‘I haven’t seen him in ten years. Disappeared. Gone. The Salvation Army say he might never be back.’
‘So what happened?’
‘Drugs. The spoon and the candle. And then one day – poof! Not a trace.’
She picks up the tea again.
‘A nice colour, too. You really are kind. I don’t mind a bit you were not women.’

Back outside in the truck, we’ve just closed the door when we hear Rae come on the radio, somewhere the other side of town, updating Control on the outcome of the job they were sent on:

‘The patient was very drunk, abusive, aggressive, declined all assistance, told us to Foxtrot Oscar in no uncertain terms. He’s headed off in the direction of the shopping centre shouting and swearing, and we wondered if you could make the police aware.’
‘Roger to that. Could you pass a description?’
‘Yep. Can’t really miss him. Sixty year old male, big white beard, red skirt, wellington boots, carrying a basket with a toy fox in it.’

standby

Standby in the supermarket car park, four o’clock in the morning.

One day I’ll paint this. One day I’ll hang a wide, windscreen-shaped canvas on the living room wall so any time of day or night I could put myself back in this seat and wallow in the desolation of the scene – the recycling bins, the advertising hoardings, the pay-at-the-pump petrol station, the blasted saplings, the factory units beyond the hedge. But where would you buy the colours you’d need? And if you had them, how would you mix them, how would you spread them out, to even hint at the leached-out, down-lit, washed-up inhumanity of the place?

A car pulls over at the recycling bins. An elderly man gets out and begins popping bottles and cans through the correct holes.
Who does that at four in the morning?
We watch him from the cab. He folds the carrier bags as they become empty and piles them up on the roof of his car. He couldn’t do that if it were windy, I think. What would he do if it were windy? He finishes, rolls the bags up, secures them with an elastic band, stows them in the boot.

He drives off.

The car park is empty again.

Busy? Jesus – worst ever! Non-stop all day, every one a proper job. The last one was an arrest in the street outside a shopping centre. I was on my own for about five minutes until Chas came by off duty and pitched in, thank God. Then a crew turned up, so that was a relief. There were a couple of PCSO’s on scene, but I might as well’ve grabbed two shop dummies out of the window, stuck a yellow jacket on them and stood them up next to us all the crowd control they did. Honestly, there must’ve been about two hundred people milling about. The crush was so bad our bags were getting kicked over. One woman was right at the front with her hand over her mouth like this, like she was going to chuck. I said to her: You don’t have to watch this, love. Why don’t you just fuck off and let us do our job? But anyway – we got a few shocks in, he went down the usual PEA – Asystole route. We collared and boarded him in the end because – that was the other thing – he’d whacked his head on some railings as he went down and had this horrible boggy mass at the back of his head. We ran him in, but it was academic. Resus was crammed when we got there. We were coming in the door just as the porters were coming out with that lovely box trolley they have with the green tarp. I wouldn’t have been surprised if they’d been wheeling a handcart. But it cleared a space for us, and the team were nicely warmed up. Honestly – a fucking war zone.

The radio twitters and beeps. An all-call for a Category A breathing problem. Miles away. I hit the mute button and the cab’s silent again. Rae is slumped forward on the wheel, using her arms as a pillow. There’s a scene in that fifties film of The Time Machine where Rod Taylor is powering forwards through time. Slowly at first, the moon and sun chasing each other across the glass roof of the conservatory, and then more quickly, his house falling away around him as the dial spins on the dashboard and hundreds of years fly past, the scene changing constantly and quickly until suddenly a mountain rises up around the machine and he’s locked deep inside the rock, and it’s dark and cold, and he despairs that it’s his fate to be trapped like that forever, as the dial spins through tens of thousands of years until at last the mountain is eroded away and he’s back in the air again.

I check my watch. We’ve been here twenty minutes.

We had an elderly woman burned up in a fire. Fell asleep in her chair, smoking a fag. Dot dot dot. Trumpton were there and they pulled her out – no mean feat, considering her size. Twenty stone, at least. But there was nothing to be done. She was pretty comprehensively cooked. We took her on the vehicle, out of the public gaze, and then it was down to the mortuary. I had to bin my uniform. That’s our truck out front, all the doors open. I wouldn’t take that one for a while.

The car park seems to stretch on forever, following the curve of the planet. There surely cannot be enough cars in the world to fill all these marked out spaces. Where are the people to drive those cars? Where do they live? Instead of cars I watch as each space fills with people lying down asleep. Fragile, lucent figures, arriving alone and in family groups, drifting along, following the arrows, finding a gap, lying down. The petrol pumps unhook themselves and blow a peppermint scented mist across them. Birds fly over with messages held in their claws. One of them swoops down and in through the open window of the cab. It grabs me by the shoulder and begins to rock me backwards and forwards. I look up. Rae is shaking me. I was snoring.

I’ve never seen so much blood – and I’ve been to a few bloody ones. The kitchen was like a paddling pool. The poor old thing was lying on her back, one leg up on a stool. I thought they’d been a murder with a chainsaw or something, but what it was - she’d tripped as she’d come in from the garden and snagged a varicose vein on the concrete step. Amazing she was still alive, the blood she’d lost. And the air – it had a metally twang I’ve been tasting on and off all day. We were off the road for a good hour cleaning up the truck after that one. And the very next job we get? Breech birth infant resus. I’ve never been so tested in all the years I’ve been here. What can I say? That new kid I was on with? What a Jonah.

Rae hits the call button on the radio. After an age of static, Control gets back to us.
‘Vehicle calling, go ahead.’
‘We’ve been here about a thousand years, Control. Can we request an RTB?’
Another pause. Either end of the conversation studying the clock. We’ve been here forty minutes. They could insist we stay the hour.
But: ‘Return to Base, then. Thank you for your help.’
‘No problem.’
She replaces the handset on the little hook, grips the wheel and stares out across the car park.
‘Much as it pains me to leave this place,’ she says. Then starts the engine.

Movement.

I never appreciated how sweet movement is until now.

falling

The blond woman who took an overdose is not where she is supposed to be. No one down on the beach or the promenade seem to know anything about her, who made the call, where she might have gone, who she is, whether she ever existed. A slow, weekend river of people slips around us, absorbing our fluorescent jackets and over-stuffed bags, casually feeling out the potential for drama in this scene, and then moving on with a shared nod or smile, or an innocent re-pocketing of a camera phone, without dropping a step or a word of conversation, on to the next thing.

I feel like a bad street performer failing to drum up custom. We look east and west along the promenade, but there are no signs of anything going on, any concerned groups, any fallen figures. She really could be anywhere.
Someone taps my shoulder. A soupy-eyed woman leans in close, smelling of vinegar chips and a polo mint.
‘Sorry to intrude,’ she says, ‘but are you looking for an elderly man who’s fallen down some steps?’
‘No – but..’
‘Well, just in case you’re interested, he’s over on the steps of the museum. Just thought I’d let you know. No harm done. Goodbye to you.’
And she’s off before I can ask her any more.
Two policemen, their trousers tucked into their combat boots, appear from out of the crowd and plant themselves in front of us.
‘Blond woman? OD?’
‘Yep.’
They lean back, buttressed by their huge black boots, studying the crowd. It feels as if they should be carrying guns, but it’s just their hands tucked into the little front pockets of their flack jackets.
‘We got that too. But no-one seems to know a thing.’
‘Who made the call?’
‘Third party. Absconded. Hoax? You decide.’
‘We’ve got something else going on over by the museum. I think we’ll head over there and see what’s what. We’re not accomplishing much here.’
‘Later, mate.’

Whilst the blond woman was impossible to spot, this patient may as well be carrying a placard saying: Help Required Here. He is still on his feet, but he clutches on to the black iron railings beside him with the grip of someone who has suddenly lost all faith in the predictability of the world. An elderly woman stands beside him with one hand on his shoulder. With her other hand she raises up her handbag as we approach along the pavement.
‘It’s my fault,’ she says, breathily. ‘I lost my footing and pulled Malcolm down with me.’
Malcolm stands unsteadily, his frame rattling beneath his suit. But it seems they only stumbled down a couple of steps; Malcolm has a graze on his hand and shin, is in no pain.
‘Shall we take a slow walk to the ambulance,’ I tell him.
His eyes are scanning the crowd for something, recognition, direction, I don’t know, but when I repeat my question, he suddenly rests his eyes on me, as if he’s surprised that a response would come from something so close by.
‘We can’t miss the coach,’ his wife says. ‘How’ll we get back to the hotel?’
‘Let’s worry about that in a minute,’ I say. ‘Most important thing is to get Malcolm checked out, so we can be sure everything’s okay.’
‘There’s nothing wrong with him. It was my fault. I tripped and pulled him down.’
‘Let’s just take a minute or two on the vehicle, do all the usual checks, and then we’ll see.’
He takes my arm, and we head for the truck.


Malcolm is lying on the trolley with his chest laid bare and dotted up. There is a great knotted scar running down his sternum where the surgeons cracked his chest and performed a coronary artery bypass last year. Implacably the ECG rolls out its lines and numbers as Malcolm takes a minute to cry out the tears he was restraining on the steps. His wife sits on the seat behind him, looking at her watch, kneading her handbag strap.
‘I’m sorry,’ he says. ‘This is all so stupid.’
‘But it’s my fault,’ his wife says. ‘I’m the one who should be in tears.’
‘Why are you so upset, Malcolm?’
‘It was the fall. I felt myself going and – well, I know it wasn’t far – and it all happened so quickly - but just when I started to go and couldn’t stop myself I felt like I was falling into a great big pit, and when I reached the bottom I’d smash into pieces, I’d just fall apart down the middle, whack, and that would be it.’
He cries into the tissue I give him.
We talk about pragmatic things, grounded things, strategies for getting the couple back to their hotel, numbers we could call, whilst Malcolm gathers himself at the centre of all this, dabbing at his face with a wad of tissue, wired up to our machines, falling into the pit again.

running on empty

Bill does not so much stand in the room as continue to remain upright, like a condemned tower overdue for demolition. With a series of jerky little corrections to the vertical, his eyebrows raised and his eyelids half-lowered - the Stan Laurel School of Concentration - he tightens the cord of his towelling robe and sniffs around the perpendicular a few minutes more.
‘Bill? Hello – it’s the ambulance. How are you feeling, mate?’
An absent, smacking of the lips, the effort of which shutters down his eyelids even further.
‘Do you know where you are?’
The question soaks away without effect. But suddenly he says: ‘Bill.’ And then tightens the belt some more.
‘When we got here, he was standing in the hallway, naked. There’s something very wrong.’
The District Nurse is an active, busily thin woman who leans forward as she talks, whiskering out levels of dedication as vital as her own. She has an assistant, a fleshy faced young guy as squashy as she is sharp edged. He smiles, his ginger hair sticking out all angles, and shows us the blood sugar test he has just taken: normal.
The District Nurse tells us what’s happened.
‘Bill was discharged yesterday following investigations for oesophageal varices. There was also some mention of Korsakoff’s syndrome – you know, that dementia-like thing when heavy drinkers don’t get enough thiamine and lose brain function. But other than that, I don’t have much else to tell you, I’m afraid. I must say it looks as if he was discharged without too much thought to his living situation. It’s weird. He’s lined up all his TTOs on the kitchen table, but he’s thrown all the bedclothes off his bed into the corner. I can’t make it out. And he’s not saying anything to help. He doesn’t smell of drink. His obs are okay. I don’t think he’s had a stroke.’
Bill stands in the middle of all this, as massively absent as before.
‘Do you know who we are, Bill? You see our green uniforms? Who are we, do you think?’
I reach up and tap him on the shoulder. He opens his eyes, tightens his belt.
‘Bill,’ he says.
He does have a slight tremor underneath his eyes, the kind of twitch you get after a few late nights or a stressful difficult weekend. He doesn’t seem to respond to pain in the usual fashion, though, so this, in combination with his lack of orientation, has us mark his GCS down.
‘Let’s see if we can walk him down to the vehicle.’
‘Well this I must see.’
Bill is six feet something, a great hairless bear of a man, and his flat is on the third floor. It will take a second crew to help with the lift if we need to carry him out.
‘Come on, Bill. One foot in front of the other.’
I give him a gentle tug on his robe; the distribution of his weight changes, and somewhere deep inside him, some primitive place intact enough to be able to register gravitational shift and make appropriate compensations, sparks off a message to his left leg. It swings forward. Another tug and another step towards the door. In this way we operate him down the staircase.

When we reach the hallway, Rae goes on ahead to reverse the ambulance nearer to the door, fetch the trolley out and position it at the bottom of the concrete steps.
We step outside the front door. It’s like stepping onto the threshold of a vast world of perspective and movement. The early morning flaps about us; the trees in the park lean over, and volleys of birds don’t fly so much as tumble chaotically through the air. Bill stops and grips hold of the iron banister.
‘Harraph.’ He leans forward, supports himself on his left knee. ‘Harraph.’
We have just enough time to stand further round to the side when he empties his stomach. The watery vomitus splatters down the steps. Holding onto his arms, both me and the District Nurse peer into the mess as if we might divine an answer there. Rae comes hurrying up with a bowl and a wad of tissue paper.
‘Let’s get you on board, Bill.’
We move him down the steps, a machine called Bill, running on empty.

the change

Five o’clock in the morning and the sky has a fuzz of blue about it that marks The Change. I can feel it in me, too, as if my blood and bones are orientating to the same rising point. I’m through the three o’clock subsea numbness, that dead or alive slump that makes shift work so difficult. The only way is up.

I knock again. There are lights on through the house, but all the curtains are closed and nothing moves.

We’ve been called here to help with a lift. Apparently a crew was dispatched to pick a large woman off the floor, and Control has sent us, too, pre-empting a request for help, and because we happened to be passing.

No reply.

I knock again whilst Frank steps across the flower bed and bangs on the window.
The first crew’s ambulance is parked right outside, so I can’t think that we have the wrong number.

‘Maybe they’re mid-manoeuvre and can’t come to the door,’ says Frank, goose-stepping over a desiccated lavender bush. ‘Or trapped under a heavy piece of furniture.’
Just as I reach out to knock again, the door is yanked open. Rich, an EMT from out of town, stands there looking hot.
‘Resus,’ he says, and then turns to go back inside. We follow close on his heels. He gives us the main facts over his shoulder: Ninety year old female. Husband thought she’d fallen over when she got out of bed to go to the loo. Rang for an ambulance to help get her up. Didn’t do any CPR. Doesn’t know how bad she is. Took us twenty minutes to get here. Asystole since we started. No cardiac PMH.

We follow Rich into a room where a woman is lying on her back, rolled flat by the cataclysm that has been visited upon her. Two single beds have been pushed together and a table and chest of drawers piled on top to make space. The woman is naked, her nightie cut in two, flowing out either side of her like trampled wings. Sophie is kneeling beside her, compressing her chest.
‘Here. Let me take over that,’ I say to her.
‘Thanks, mate,’ she says, stiffly getting to her feet. ‘God. My knees are so creaky these days.’
Rich takes over the ventilations.
‘How long have you been going now?’
‘What is it? Ten minutes?’ says Rich.
Frank goes back down the stairs to fetch his para bag; Sophie goes with him to chat to the husband.
‘How’s he taking it?’
‘I don’t think he really understands what’s happened.’
Rich wipes his forehead with the back of his hand.
‘Christ, you know – we weren’t expecting any of this. It came through as an assist back to bed. She was crammed over against the wardrobe. We had a hell of a job to get some space cleared and get her on her back.’
The woman’s body shifts beneath my compressions with lifeless passivity. I hear Frank clumping back up the stairs with his gear.
‘They didn’t tell us this was a resus,’ I say. ‘We were sent by just in case you needed a hand.’
‘That’s lucky, then. We were just about to call for back-up…’

All the drugs and extra equipment are to no avail. The woman is beyond rescue. After more than twenty minutes, we all agree that nothing more can be done. We tidy the woman up, lift her into bed and make her presentable, restore the furniture as best as possible and stuff all our rubbish into a yellow bag. Whilst Rich finishes off, we head off back down the stairs. We stop off in the living room to say goodbye.

An elderly man in tidy blue pyjamas and a dressing gown tied at the waist, is sitting forward on a floral-patterned armchair with his arms resting on his knees, staring down at his hands. Behind him on the wall is a generous spread of framed photographs: weddings, holidays, formal family portraits, a dog looking out from a garden – many of the photos looking leached out now, further away, their greens and yellows and reds and blues drawn up and ghosted by all the bright sunlight this window must have let in over the years.

this glamorous life

We are looking for number three of a row of bungalows set back from the road by steel-railed pathways, a discrete enclave of disability amongst the bullish and bullying tower blocks that surround them on this estate. I wonder if they pre-date everything else; they seem so corralled by the pragmatic stack of life here.
There are men standing by cars, chatting, smoking, not sponging down paintwork, shouting at kids on bikes, looking about. One of them makes a gesture to me – do I want him to move? I thank him as I climb out.
There is a strikingly beautiful carer dressed in black t-shirt and jeans standing waiting for us by the front door. She could be waiting for an appointment with a modelling agency, but rather than a portfolio of shots in her arms she has a yellow folder with the patient’s details.
‘Sorry to be calling you quickly,’ she smiles. ‘Sorry I no pick Frank from floor by myself only.’
She moves inside, leaving just enough room for us to squeeze past a mobility scooter the size of a red tank and into a bedroom where Frank is lying on his side on the floor with a garishly coloured fleece thrown over him. His greasy yellow hair sticks up on his head in distinct rows, like corn in a field.
‘Where’ve you been?’ he shouts. ‘Where’ve you been?’
‘Sorry it took us a while to get here, Frank,’ says Frank. ‘My name’s also Frank – and this is Spence.’
‘What do you mean? I’m Frank. What are you playing at? Help me up.’
The carer smiles down at us as we crouch beside him. She mouths what I think is: very difficult person. Her lips are full and dark. She has a smudge of lipstick on her teeth.
‘We’ll get you up in just a second, Frank. We just need to find out what happened, whether you’ve hurt yourself.’
Frank wrests his head off the floor and tries to get a look at us. ‘I’ll sort you jokers out,’ he says.
‘Whoa – don’t be like that, Frank. Just calm down, and tell us how you came to be on the floor’
Frank produces a fist from underneath the fleece. ‘I’ll land this on you,’ he says, his toothless mouth slack with rage.
‘I think he just slipped from bed,’ says the carer. ‘He got little bit blood on side of his head and some on his finger, but I not think his badly hurt.’
‘Get me off the floor, won’t you?’ says Frank, in a more pleading way, pistoning his legs ineffectually, trying to sit up.
We realise we’re not going to be able to keep him still and examine him like this. Frank concedes defeat and says: ‘Okay mate. Let’s have you up then.’
He is so frail and thin, it’s like re-righting a scarecrow that’s been blown over in the wind. We place him on the corner of the bed.
‘Let’s have a look at you then, Frank,’ says Frank.
The first thing that strikes us is his breathing. Now that he’s upright, Frank quietens right down, subdued by the effort of getting air into his lungs. Each in-going breath sounds like something heavy being dragged along a gravel drive.
‘Oof. How long’s Frank had that?’
The carer looks through the notes.
‘Antibiotic for one week chest infection.’
‘Any other medications?’
‘No. Just cream for leg.’
He’s in a poor state. Cellulitis makes both his legs look like two cured hams on the bone; he is emaciated and sallow; his chest hardly moves – all the effort of breathing comes from his withered stomach.
‘I’m not - going to - hospital,’ he growls.
‘Frank. Don’t be like that. We just want what’s best for you – and that, right now, is coming with us to hospital to see a doctor. It might not be for long. But we can’t just leave you here.’
‘Leave – me – alone!’
He retches, and a rope of phlegm snakes out of his mouth and nose. The effort of expulsion racks his frame.
‘Get a chair for us, Spence,’ says Frank, wiping the old man’s face with a wad of kitchen towel the carer gives to him. ‘How could we leave you here like this?’
I go to fetch the carry chair.
‘Excuse me,’ I say to the carer.
‘Scusi,’ she says, busy pulling some information sheets from the folder.

The chair feels only slightly heavier when Frank is loaded onto it. He is so frail, I have no idea why he has such an enormous mobility scooter, but it makes negotiating the hallway quite a problem.
‘That’s a beast, your scooter’ I say to him, but he does not hear above the spitting and crackling of the nebuliser we now have him on.
Outside on the vehicle we run our usual tests. It looks like Frank may have suffered a heart attack this morning, along with everything else. We treat him quickly and set off, alerting the hospital of our arrival.
I wave goodbye to the carer standing over by the front door with her little black shoulder bag and her document folder.

She waves cheerfully back.

Honestly. I feel like I’m on a motorboat leaving a quayside in Monte Carlo.

late for the party

There are two things we have to step over as we go into the flat: an empty bottle of JD and a pink, iron piggy bank of the same size.
‘He’s in here.’
The man who let us into the flat seems magnified by his concern; even his height strikes me as an expression of anxiety.
‘Are you a relative?’
‘Friend.’
He wears a rucksack, bulgingly heavy. It rattles as he walks.
‘What’ve you got in there? Beer?’
‘It’s my mum’s birthday. I’m supposed to be there, not here. She’ll kill me.’
He leads us into a small sitting room filled up with a double bed, a sofa, and a couple of racks of plain wooden shelving stacked with metal pigs of all sizes and colours.
Paul is lying on his back on the sofa, his arms straight along his sides and his legs crooked over the end of the seat. He is wearing outdoor clothes – a fleece zipped up to the chin, baggy green trousers and rotten trainers. He looks as if someone had dressed him in an outfit then lain him aside whilst they sorted something else out.
‘Paul. Paul.’
He isn’t unconscious. His eyes flicker behind his eyelids, even before I touch his eyelashes. I prise them open and shine a light across. They seem fine.
‘Paul. Come on. Talk to us, mate.’
I pinch his shoulder. When there is no response I pinch him a bit harder. Nothing.
‘Paul. Come on. We need you to talk to us.’
‘He’s taken all these pills,’ says the friend, handing an empty bottle of Temazepam to Rae.
‘Whose prescription is this, then?’
‘His wife’s. His ex-wife’s. They got divorced recently. Hence…’ He shifts his weight uncomfortably, then shucks off the rucksack and dumps it on the bed. ‘I’m supposed to be at my mum’s.’
‘Give her a call.’
‘Do you mind?’
‘Go ahead.’
‘Come on, Paul. We’re not going to leave you alone until you talk to us, so you might as well open your eyes.’
I roll out my repertoire of painful stimuli, keeping myself in a position where I can either dodge or sit on a rising fist. I try The Supra-orbital Notch. The Rolling Pen on the Nail Bed. The Sternal Rub. He’s so thin it’s like running my knuckles over a cycling helmet.
Some wincing, but the eyes remain flutteringly closed.
‘Come on, Paul. Don’t make me carry on with this. It’s stupid and pointless. Why won’t you talk to us?’
Nothing.
I roll out the big guns. I give him The Mastoid Dig. He tries to smack my hand away.
‘Leave me alone,’ he growls, opening his eyes a crack.
‘We can’t leave you alone. What sort of people would you think we were if we did that? Come on, Paul. Just sit up and we’ll see what’s happened today.’
Inert, as before.
‘Let’s sit you up.’
We haul him doll-like into a sitting position. He lolls his head back and begins a half-hearted attempt at pseudo-fitting.
‘Jesus,’ says his friend, taking a step back.
‘It’s okay. He’s not having a fit. It’s just – the situation, that’s all.’
Paul has a long, pushed-back kind of face. With his large eyes slightly off to the side and a prominent pair of yellow incisors, he looks like a giant rabbit.
‘Let’s get you down to the ambulance,’ I say.
Even though I’m sure he can walk, we have to lift him into the chair.
‘Can I come along, too?’ his friend asks.
‘Sure. Maybe you could give us a little more information.’
Paul sits in the chair, passively uncooperative, flopping his arms and legs about and leaning his head back onto my chest.
‘Come on, Paul,’ I say, to no effect. I put a blanket between me and his greasy hair. We set off for the lift.

On the ambulance, nothing has changed. He doesn’t even respond when I cut his jacket sleeve off to take his blood pressure. All his obs are fine, but he will not talk to us.
‘Let’s just go,’ I say to Rae.
Just as she opens the door and jumps out, two police cars come hurling round the corner, pulling up behind and in front of the ambulance.
‘Oh, really?’ I say.
Four police get out. One of them waves at us in a massively friendly fashion and strides across to the vehicle.
‘Hi, chaps,’ he says. And then to the friend of the patient, ‘Would you mind travelling up in one of the police cars, mate? Only I think I’d better travel in the back. Okay? Thanks.’
The friend hauls up his rucksack again.
‘What’ve you got in there?’ says the policeman. ‘Beer?’
‘It’s my mum’s birthday today.’
‘Oh. Well. Many happy returns to your mum,’ he says as they pass, and smiles at me as he climbs inside. The ambulance drops an inch.

I want to step outside the vehicle with him and find out what all this is about, but I can’t leave Paul on his own. The policeman positions himself at the front of the ambulance with his back to the hatch. He pulls on a pair of leather gloves. Then, securely behind the line of sight of the patient, he canters through an emphatic mime, mouthing the significant words:
Points to the patient – psycho – bashes a fist into a hand, makes a stabby-stab motion – very violent – winces and shakes his head – nasty piece of work. Then says out loud, quite pleasantly: ‘Paul was posted as missing today, by his family. They were worried about him. So we’ve come along to make sure everything’s okay.’

I look at Paul. He lies on the trolley bed as lifelessly as he was back in the flat.
I look at the policeman and he smiles as benignly as before.
‘Well – let’s go to the hospital, then’ I say.

When we get there, the triage nurse displays her own techniques for painful stimuli, surrounded by police.
‘Come on, Paul,’ she says resolutely.

Everyone leans in.

one man and someone else's dog

There is light flickering out from around the upstairs curtains, but downstairs is dark, nothing moves and no-one comes to the door. I knock again, more loudly, and step back. There are no obvious neighbours to rouse; all the places round here look hollowed out and neglected. The call is a Cat A breathing difficulty. The patient could be unconscious on the floor – in which case, my next move will be to kick the door in. Just as I’m about to put the resus bag down and foot the door to see what locks he has on, there is the sound of heavy snuffling beneath the door, followed by a voice calling down: ‘Just a minute.’
And it is a full minute before a light snaps on in the hall and we hear heavy, uncertain footsteps descending. Then a latch is turned, the door swings open, and a Staffordshire bull terrier like an overstuffed, animated white footstool launches itself off the step in the direction of my trousers.
‘Down!’ I tell it, whilst at the same time the man says: ‘Don’t mind him. I’m looking after him for a friend. Come in.’
He turns and starts back up the stairs. I follow immediately behind with the dog glued by the nose to my leg.
‘Careful…’ I say to the man, but it’s too late. He steps squarely into a pile of dog crap curled neatly on the third or fourth step up. ‘What?’ he says. He seems pissed.
‘You’ve stepped in some dog crap.’
‘Oh. Okay.’
He carries on walking. I look at Frank. He shakes his head and bends down to fuss the dog behind the ears, his blue gloves contrasting strangely with the nubby white head. The dog transfers its devotion.
After picking our way up the stairs – I scan the treads with a hand torch just to be safe – we finally emerge into a boxy front room, the cliché set of yet another play about social deprivation.
‘Could you turn the TV off for a moment?’
‘What? Yeah. Go on then.’
Frank steps across the carpet like he’s being sent across a minefield. He pushes the button. The enormous screen blinks off, and the room darkens by a hundred candles, quietens by as many decibels.
‘And can we have some lights on?’
Frank obliges. The man and the dog scrutinise us from the sofa.
‘And would you mind putting your cigarette out? Only we don’t smoke, and we’ll just end up stinking the rest of the night.’
The man stubs it out, smashes it right up, scattering dead cigarettes and ash from out of the ashtray to make room for it.
‘Thanks. Sorry to be a nag. So – what’s the problem tonight?’
‘I can’t breathe,’ he says.
I look at him.
‘Forgive me for saying so, but you’re not really coming across as someone who can’t breathe. Their chests are usually heaving, they can’t speak, or only very little, they might look a terrible colour, even quite blue. They don’t usually smoke and move about. Generally speaking they’re struggling to cope. So when you say you can’t breathe, what do you mean?’
‘I’ve got a cough.’
‘And how long have you had a cough?’
‘Three weeks.’
‘Have you seen your doctor?’
‘No.’
‘Why not?’
Even the dog looks at him at this point.
‘Don’t know.’
‘Any health problems normally?’
‘Nope.’
‘Diabetic?’
‘Nope.’
‘Take any medication for anything?’
‘Quetiapine. S’it.’
He leans forward and takes a sip from a filthy pint glass. It is a third full of a viscous, whiskyish liquid. I want to tell him not to drink anything whilst we’re here, but I’ve already made a few demands and I don’t think there’s room for another.
He looks like Action Man after a harrowing tour of duty, except our patient’s eyes are flatter, less humane. There’s a ridge to his forehead so pronounced you could step up onto it. His hands are lumpish and stained, the fingers all gnawed up.
‘What I’ll do is give you the once over, see what your temperature is, your blood pressure, that kind of thing, and we’ll talk about what to do next.’
‘Whatever.’
He places the pint glass back on the table, and a little skip of ash rises around it.
I put a Sats probe on his finger.
‘Good. Your oxygen levels are fine.’
He nods as if he knew that, and abstractedly runs the knuckles of his left hand up and down his right forearm. Janine 2002 in a Gothic script.
I put the probe back onto my belt, and then wrap a BP cuff around his arm.
‘Whoa,’ he says, suddenly stiffening up. ‘What the fuck’s this?’
‘It’s the blood pressure cuff. Don’t worry. I inflate it a bit – it’ll feel a bit tight – then I let it down and see what your BP is? Is that ok?’
‘If you say so, chief.’
I start to inflate it.
He stands up and yanks back his arm.
‘What the fuck….? What’re you doing?’
He stands there, swaying slightly, his legs apart, one arm bent slightly, the other one raised up in the air with the cuff swinging from it.
I step up to him, unwrap the cuff – because although he looks ready to fight, I bought this kit myself – grab the resus bag and say ‘Actually, I think what we need to do is just go.’
And then to Frank: ‘Come on, mate.’

We walk out of the door without another word, even in retreat still careful to light the stairs for crap. Outside in the truck Frank drives us to safety round the corner. I phone Control to let them know the situation. I especially don’t want a single responder pitching up alone there tonight.
Frank says: ‘Can I smell something?’
I look at him. He looks at me.

Anyone passing along that street at one in the morning would have seen two ambulance men either side of their truck looking at their boots.

viewpoint

The docks are lit up with arcs of hard white light. Two great LPG containers stand side by side, laddered and banded with steel hoops, vents of steam drifting upwards from their sides like stubby little rockets on a launch pad. A ship stands at the quayside, chaotic squares and jabs of light along its bulk. The dock looks busy, but there’s no one about and nothing moving apart from a radar arm turning, a flag flapping, steam rising.
The flat we want is in a block overlooking the docks.
‘Great view,’ says Frank, blowing his nose whilst I ring the buzzer.
‘Yeah,’ I say. I know he’ll think I’m being sarcastic, too, but I wouldn’t mind living opposite the docks. I’d sit at the window for hours, watching the timber being unloaded, or a sailor smoking against a rail. At least I think I would.
A young woman skips down the concrete steps into the hallway and opens the door.
‘Hi,’ she says. Her demeanour hangs from her like her dress: bright, but fading after repeated use. ‘He’s upstairs.’
We follow her up two flights and into a flat that smells of dog and toast and sickness. There are two huge metal dishes on the sticky floor of the galley kitchen, both of them the size of mixing bowls.
‘However big are your dogs?’
‘Huskies.’
‘They’re well behaved. They haven’t made a sound.’
‘They don’t bark. The worst they do is mumble.’

She leads us into a sitting room dominated by a deep leather sofa and a widescreen TV. There is a Guitar Hero controller propped against it, and a pile of other games stacked neatly alongside. On the wall there are posters tacked up, arty blue prints of American Indians in profile, dreaming of wolves, forests, galloping horses and low moons.
There is a groan from another room.
‘He’s on the toilet. He’s been there for hours.’ She shows us through. As we turn the corner she gives a vapid little spread of her fingers and says: ‘Ta-dah!’

Her partner is sitting on the toilet, bent forward at the waist and supporting the weight of his skinny torso with his hands flat on the floor. His legs and arms are so long and thin, the angles so oddly inhuman, it could almost be a giant insect cramped up over there. A pile of vomit lies between his hands that someone – presumably his girlfriend – has draped over with a square of plain white kitchen towel. He looks up briefly, gives us a pale smile, then tucks his head down again.
‘I hope I don’t get it,’ she says, then walks back into the sitting room to let us check him over.

When we rejoin her in the sitting room she’s standing smoking a spitty little roll-up by the window.
‘I’ve only been going with him a year,’ she says, picking a piece of tobacco off her tongue. ‘Well? Is he going to live?’
I tell her that he has a bout of diarrhoea and vomiting – unpleasant, but nothing that needs hospitalisation. As the vomiting has been going on for a while, we’ll ring for an out of hours GP to come and assess him, maybe even give an anti-emetic. Other than that, the best thing is to let it take its course, keep drinking fluids, start back on little amounts of plain food when he’s ready.
She listens, and re-lights her cigarette.
‘Is that it?’
‘Yep. That’s it.’
There is another groan from the toilet.
‘And how much longer do I have to put up with this?’
‘It’s hard to tell. It could be a few more hours. But like I say – we’ll get a doctor out to help with his sickness and give you some more reassurance.’
‘It’s not reassurance I want, it’s a bigger flat.’

Back outside in the truck, Frank sits leaning forward with his arms folded on the steering wheel whilst I finish the paperwork. Suddenly there is the sound of a great whumping crash from the docks.
‘Oops,’ he says. ‘There’s our next job.’
But nothing comes on the radio, and no-one comes running. The lights blaze on as before, and the white vapour drifts up from the tanks, and the arm of the radar on the ship at anchor spins slowly, round and round and round.

quiet, elephants

Geoffrey is sitting on a carved hardwood stool just by the front door. His wife Gwen, a square-jawed woman, the determined set to her mouth undermined by the wateriness of her eyes, stands aside to give us some room in the hallway. Geoffrey is wearing a curious, native silk wrap, its bright pattern complicated by bloodstains. There is a constantly replenished drop of blood trembling and then falling from the end of his nose.
‘Dreadfully sorry, chaps,’ he says, and then clears his throat, hawking up a clot of blood and spitting it into a sodden facecloth. ‘I just can’t seem to get it to stop.’
I show him where to pinch his nose, and tell him not to tip his head back.
‘It’s been like this since yesterday,’ says Gwen. ‘We’ve reached the end of our tether.’
‘Let’s just see if this works,’ I tell him. ‘We’ll give it fifteen minutes. If not, I’m afraid we’ll have to take you to hospital.’
‘It’s awfully kind of you to come - out like this,’ says Geoffrey, retching on a consonant.

But his nose will not stop bleeding.
‘I’m afraid we will need to go in, now,’ I say, tying a bolster to the end of it. Gwen has already put a little bag of things together.
‘Should I come, too?’ she says.
‘No, darling. It’s late. You stay here and get some rest,’ says Geoffrey. There is a steadying, old-school timbre to his voice, an amused set to his old gray eyes, that counteracts the effect of the ludicrous dressing on his face, the whole bloody affair. ‘I’ll only be dozing at the hospital. You’re better off here.’
‘If you’re sure.’

He walks out to the ambulance, shuffling along in a pair of hand-stitched leather sandals. A tall man now, he must once have been a striking figure. Six foot six, broad shouldered. I can imagine him striding out into the wilderness with a big forked stick; now, he leans on an aluminium walking aid.
The moon is full in a sky thrown with stars. It is glassily cold.
‘That’s better,’ he says. ‘That’s much better.’

On the truck he sits on a forward facing seat, resting his hands on the handle of the stick that he places in front of him. The bolster is sodden with blood so I change it for a fresh one. We set off for the hospital.

‘You’d never think to look at me now,’ he says, ‘but I used to run a game reserve. Out in Tanganyika. I had been working for an oil company in the middle east, doing all right, you know, but really looking for something different. Well I heard via the friend-of-a-friend route about a place going in Tanganyika, as it was then, middle of nowhere, nothing at all, was I interested? So we headed out there, built a house out of mud and straw, and lived there ten years. Amazing place. Incredible. You could walk for two hundred miles across what was actually the crater of a defunct volcano and not see anyone at all. Just animals – the most extraordinary range. One thing that always struck me: how quiet elephants are. There you were, sitting outside your hut, busy fixing something or other, you’d hear a faint little snap of a twig or some such, you’d look up idly – you know – hardly aware you were doing it – and there you were, face to face with an elephant.’

pink pills

These are the thin and early hours, when your spirit pools, leaches from your heels, runs off down the drain and leaves you cracking your jaws with enervation. Even the streetlamps lean. As we pass along the street I watch whole building frontages thin, the glass in their windows spreading outwards, infecting the brick, until great horizontal lines of bodies are revealed, asleep in mid-air. We splash beneath them, the ambulance dutifully steering itself, along and up to the young guy over by the phone box who is leaning out into the road and hailing us like a cab.

We pull up.
We get out.
‘Hello,’ Rae says. ‘What’s up?’

‘Well I went to Camden, knocked around there for a bit, fell asleep on the train and ended up in Birmingham. When I was in Birmingham I went to the toilet and amongst some needles and cans and shit on a little shelf I found a sachet of pink pills, about sixty of them. I thought they were ecstasy, so I put them in my pocket. I came down here to see a friend. We had a bit to drink – let’s see: Jack Daniels and coke, about ten of those, half a bottle of vodka with orange juice, and then I helped him finish off a bottle of port at his flat. Then he went out and I felt a bit down, like I wanted to kill myself? Then I remembered the pills. So I swallowed them.’ He looks at us. ‘But I regret it now. That was about half an hour ago.’

‘Why did you take the pills?’
He looks at her, frowns, then says: ‘I couldn’t find a razor.’
He pushes up a sleeve of his raincoat and displays a sequence of angry cuts up his arm. ‘Otherwise that would’ve been my preference.’
Rae straightens. ‘Do you have a blade on you now?’
‘No. Like I said – I couldn’t find one. I must admit I am feeling a bit strange.’
He has a lumpy, scrunched-up look about him, as if the laptop bag hanging from his shoulder is filled with the heaviest substance in the universe. His greasy black hair lies in spikes across his forehead, and the t-shirt beneath his raincoat is artfully torn in places. There is a raw, thimble sized hole in one of his earlobes.
‘Let’s get on the ambulance and talk a bit more about these pills,’ says Rae. I slide the door open for them.
‘Thanks,’ he says, sighing and settling himself down in a chair, placing his laptop neatly on his knees like a commuter. ‘I don’t think they were ecstasy, though.’ He retches a little, and does a dyspeptic little pardon-me mime by tapping his fist lightly on his chest. ‘They certainly don’t feel like ecstasy.’

At the hospital, I park up and walk round to the door. When I slide it open, the man is in mid-monologue.
‘…I’m just crazy, me. I like to get out and about and have adventures. I like to take off and go wherever – I don’t care where. I didn’t want to call you people out because I know you have your work cut out for you, what with people dropping down dead or jumping off buildings and the rest. But I didn’t know what else to do. I feel so stupid and I’m very grateful.’
I help him off the ambulance. He steps down with the exaggerated care of Neil Armstrong stepping off the Lunar Module.
‘There!’ he says, readjusting the laptop on his shoulder. ‘Made it!’
Rae goes on ahead whilst I walk with him. We pass behind the back of another ambulance, its door open. There are two of my colleagues busy in the back, tidying up. The patient stops and looks in.
‘Hiya!’ he shouts. ‘I thought it was you! Last time I saw you, you were oiled up and naked between two Turkish hunks! Well – got to go. See you later!’

‘That’ll get some rumours started,’ he says, turning away. He smiles smugly, closing his eyes, and I have to steer him away from walking into a post.

the dressing gown

Mr Clarke is sitting on the floor of the hallway with his long spindly legs stretched out in front of him and his face in his hands.
‘Thanks for coming so quickly,’ he says in a conversational tone as I peer round the door. ‘Really, that was most quick.’ He puts his hands down either side of his blue boxer shorts, and feebly tries to shuffle backwards a little. The bright overhead light exposes a body slack with age and illness.
‘Have you hurt yourself, Mr Clarke?’
‘What? No, no. I’m fine. I banged my head a little but nothing really. I just need a hand getting back up.’ Then – quite unexpectedly – he leans forwards, puts his face in his hands again and gives a muffled sob. ‘I don’t know what’s happening to me. I really don’t.’
I crouch down next to him.
‘Come on Mr Clarke. Let’s get you off the floor and sitting comfortably. Then we’ll have a chat and see what’s what.’
Frank finds a white metal perching chair, positions it behind Mr Clarke, then we help him to his feet.
‘So tell me how you came to be on the floor?’
He looks straight at me.
‘I haven’t slept a wink. There are people in the flat. Horrible people. They’re terrorising me.’
‘What people? What do you mean?’
‘They’re up all night playing spiteful tricks and games. They run around, tip me out of bed, trip me up. I can’t go on like this. I can’t get any rest.’
‘But there’s no-one else in the flat, Mr Clarke. Who are these people?’
He studies me carefully.
‘I say people. More like creatures, really. Oh I know what you’ll think. But - see that dressing gown over there?’
He nods towards a pale cream gown draped over the arm of a chair in the sitting room.
‘Any clothes like that, dropped on the floor or around. These filthy creatures come in the night, and any discarded clothes they wriggle into and bring to life. It’s the clothes – the clothes with the creatures inside them. That’s what’s doing all the damage. And I can’t go on!’ He covers his face again. ‘Am I losing my mind?’
‘Well, it sounds to me as if you’re suffering hallucinations for some reason. I think you should come with us to hospital so you can see a doctor and get the once over.’
I take his temperature – a point up. He says his urine has been stinging lately, so I tell him that urinary tract infections can play havoc with your sense of what’s real or not. It seems to calm him. He blows his nose on some kitchen towel and waits with me whilst Frank goes to fetch our carry chair. Occasionally he throws an uneasy look over to the dressing gown, as if he expects it to jump up and run at us.

There are two large pictures on the wall facing us, both aerial photographs of London and Venice. Next to them, amongst a spread of family photos, gappy school prints, faded letters and graduation mementoes, there is a group of three little studio portraits of Mr Clarke, all apparently taken at the same time. I flick between them, trying to spot the difference, but each appears to be identical: the study of a middle-aged man in three-quarter profile, his full black hair clipped, greased and combed, his mouth slightly parted and his even white teeth on display, looking out onto the world with professional containment.

passing through

I take the large green nylon rucksack, Frank takes the wicker Moses basket and a couple of carrier bags stuffed with clothes, books, coats. The mother, a frail young woman who holds herself perfectly upright in the way that dancers or medicated people do, blows her nose into a chequered handkerchief. The father picks up the child’s car seat with their twelve week old son bundled up in a fleecy white baby-grow.
‘I never know which way to carry these things,’ he says. His eyes are sore and red.
We decide that over the arm, like a basket, might be easiest.
We make our way to the lifts, along a quiet, aseptic yellow corridor hung with brightly coloured kites and aerial fish that stir gently as we pass. A couple of porters struggle in with an incubator. We hold the double doors open for them, and they hold them open for us. We pass through.

Outside the sky is low and blurry with snow. It falls steadily; at times it feels as if we are actually flying upwards through it. Everyone but the woman hunches over as we pick our way over to the ambulance. She moves through the snowflakes as if either they or she were not real. Frank helps stash the luggage in a safe place. We load the child seat onto the trolley and make it fast. I swing the passenger seats into position and sit the family down. Frank takes up position in the jockey seat, and I go to the cab. The traffic noses around us irritably.
‘It’s always a battle, leaving this bit of the hospital at this time of day,’ I hear Frank say in the back. But I bully out a path. A security guard stops an oncoming van; he waves, I wave.

It feels later than it is. The city is impatiently sloughing off another day of work. Cupped in the freezing hands of the snow storm, people are hurrying on to the next place on well lit buses, along slushy wet streets, swinging shopping bags, queuing at cash points, talking on phones. Everyone is heading somewhere. I follow the main road out of town, moving and stopping and moving forwards again a hundred times in five minutes. A bus brakes to leave a gap for me. He flashes me on.

The windscreen wipers slop to the left, scrape to the right, marking out the miles. I follow in the wake of the red lights in front of me. I try to get better reception on the radio but there is too much interference so I turn it off. I steal one of Frank’s mints and try to keep it going for as long as I can, but I forget almost immediately and only remember again when it’s all crunched up. The other side of the central barriers is an unbroken chain of light, but it’s not as busy our way.

The ambulance fizzes along. We could be a ship flying through space, the flakes in our lights the stars we rush amongst. But then the storm lifts. It has a leading edge that suddenly announces a clearer run. The dark motorway cedes to well lit city streets, and the traffic thickens. Buildings cluster up either side, and there are great crowds of people surging forwards at every opportunity. I haven’t driven around here in a few years, but I used to live in town, and the old routes - the lanes to take, the cute little nicks and tucks, the sense of where things lie – it all comes back to me with a nostalgic tug. Then, after twenty minutes of city driving, I’m pulling onto the ramp that leads up to the A&E department.

We help the man, the woman and their baby down from the ambulance. The man takes the baby in the car seat on his arm as before, whilst Frank and I shoulder the rest of the bags. The woman looks as if she may be sick, so we give her five minutes in the toilet just inside the entrance. When she comes out, we lead them through some heavy black rubber doors and pick up the coloured indicators for the children’s hospital out back.

The sound of a piano being played drifts towards us as we walk along a corridor. I recognise the tune; eventually I think of the words that would be sung here: Hold my hand, I’m a stranger in paradise. The music grows in volume, we turn a corner and find ourselves in the preserved foyer of the old hospital. There is a baby grand at one end. Under its raised lid I can see the face of a tortured looking guy, dividing his attention between the sheet music and the actions of his hands. He rocks about on his stool knocking out the melody with his right hand and rolling in a bunch of other notes with his left. The song resounds over everything, over the heads of the white alabaster scientists on their plinths along the edges of the space, around the dark marble pillars and the tessellated floor. An elderly man is sitting on a wooden pew with his eyes closed, both hands resting on the crook of a walking stick upright in front of him, his cream trilby hat angled back on his head. On a table next to him, a couple of young executives are shuffling through papers and examining spreadsheets. Everyone else is hurrying on in all directions. We follow the signs to the children’s wing, and pass through.

We follow the colour coded lines on the floor along a corridor lined with a series of preserved tiles illustrating scenes from children’s books. One of the panels shows Little Red Riding Hood. She is standing by a fat and twisting oak, her basket slung over her arm, talking to a wolf. He is standing upright, dressed in a sheepskin coat and flowerpot hat, supporting himself on a staff, with his front paws draped over the grip. He reminds me of the old man in the foyer. We can still just about hear the music drifting back from there towards us. The father shifts the weight of the baby seat on his crooked arm.
‘Nearly there,’ says Frank.
He leads us up to a set of doors that open onto a lit pathway and up to an automatic glass cylinder that opens to admit us.

The new children’s hospital is built around a cavernous foyer, its vaulted space a web of white tubular steel and glass. We walk to the central lift bank, looking around us like country mice. The lift zooms us up to our floor, disgorging us efficiently onto a mezzanine. A nurse intercepts us, leads us with a warm handshake past units and rooms to a station where a more senior nurse takes over. She accepts the paperwork and shows the couple to a neat little cot, discretely stood about with complicated machinery. She takes the little baby out of the child seat and puts him into the cot, stripping him down, as we shake the couple’s hands and turn to go.

On the way back to the ambulance I ask Frank what the situation was with the baby.
‘PKD. At that age, there’s nothing to be done. Palliative care only, I’m afraid.’

Outside we stand behind the ambulance so Frank can have a cigarette.
The city has never looked so big, so energised, so renewing. There is another massive block going up. There are cranes half way up the cylindrical building, illuminated with a warm orange glow that seems to draw its power not from the ground but from the belly of the snow front, massing darkly above us.
‘We’re going to get some of that on the way back,’ says Frank. He blows out a quantity of smoke as we both look about us, and the smoke turns and thins to nothing on the chill night air.