The eagle suspended from the hallway ceiling sways as we barge in with all our bags, the tip of one fixed yellow wing brushing the uppermost plastic rose of the plastic bush tacked up along the doorframe. We follow the dead bird’s gaze into the room.
There is a man in a hand-to-knee position of pain on an office chair in the centre of the room. He waves over to us with a fagged left hand, takes advantage of the movement to haul in another litre of smoke, then resumes his vigil. The white of his cigarette is striking, the one clean inch in this ruined space.
At first glance it seems he has modelled his living room on the bridge of a ship. The desk that occupies the centre of the room is a crudely extemporary structure, nailed shelves for a computer, hooks for notes, sections for video tapes, dead electronic components, diaries, letters, a watch. Piled up around the desk, a tidal dump of stuff - dark jigsaws finished and fixed in frames, model trucks, imitation firearms, faux deco lamps, signed photos, metal advertising signs, and rows of videos coded and logged in sequences as foxed and fucked as the originator. He smiles up at us as we come to him.
‘Can you put your fag out, please?’ I say. I don’t want to stink of smoke for the rest of the shift, but as I’m talking, my eyes pick out a broken electric fan on a pile of books. It looks as if the fan has been dipped in a vat of yellow sludge. In fact, the whole room is smeary and indistinct. The grey smoke from the cigarette he crushes out in the brass ashtray is as fresh as I can expect to be tonight.
‘What’s happened, Henry?’
He says that he had his usual plate of fish and chips for tea. He lay on the carpet to have a nap straight after. He woke up feeling fine and resumed his seat, then was hit by a sharp pain in his groin ‘as if I’d sat on one of me nuts’. It was unbearable for about half an hour, so much so that he banged on the wall and called out for help. But it eased off, and now he feels okay.
Rae examines Henry’s abdomen. ‘Does this hurt? Tell me if I’m hurting you.’ She begins sensitively enough, but without any reaction, her pressings become more exaggerated, until she looks like a vet burying her arms in a cow.
‘Nothing. No,’ he says, and looks affectionately down at the smouldering remains of his cigarette.
All his obs are fine, but we tell him that with everything he’s said about the incident, we think it wise he comes with us to hospital.
‘I’ll get my coat and keys then,’ he says, jauntily, and expertly locates these things.
He walks down the four flights of stairs to the ambulance, but outside in the street he folds over. On the vehicle he begs us for pain relief, but as technicians we can only offer gas and air, and this isn’t allowed for abdo pain. He is screaming by the time we reach the hospital. A nurse frowns at me as she comes back into the A&E from coffee break.
‘They’ll sort you out with pain relief in a minute, Henry,’ I say, patting his arm.
‘I’m not – interested – in any – of your – bastard minutes,’ he gasps. ‘I want it now.’
He gets it soon after.
Monday, January 21, 2008
Thursday, January 17, 2008
Thanks for reading!
I just wanted to say a big thank you for all the encouraging comments you’ve posted about Siren Voices. I feel quite overwhelmed by the positive feedback, and I really appreciate it.
I’ve been an EMT now for just a year and a half, (on the patient transport side for a couple of years before that). Aside from all the work-life attractions of the job, the real reason I think I’ll be in the ambulance for a while is the daily potential for drama.
Admittedly, most of the work is routine. And I know I’m more likely to write up something emotionally bloody rather than a drunk or an abdo pain, making it look more like a bad night in Baghdad than a Thursday afternoon in an English town by the sea. But even when the jobs are straight obs and nothing more, you can still have a good old chat, and look around for the little details that might distinguish a person or a place.
And if it’s really quiet – read a book.
So anyway – thanks again for reading the blog, and for all your comments. And a big thank you to Mark from neenaw for mentioning Siren Voices and pulling in the business!
Regards,
S.
I’ve been an EMT now for just a year and a half, (on the patient transport side for a couple of years before that). Aside from all the work-life attractions of the job, the real reason I think I’ll be in the ambulance for a while is the daily potential for drama.
Admittedly, most of the work is routine. And I know I’m more likely to write up something emotionally bloody rather than a drunk or an abdo pain, making it look more like a bad night in Baghdad than a Thursday afternoon in an English town by the sea. But even when the jobs are straight obs and nothing more, you can still have a good old chat, and look around for the little details that might distinguish a person or a place.
And if it’s really quiet – read a book.
So anyway – thanks again for reading the blog, and for all your comments. And a big thank you to Mark from neenaw for mentioning Siren Voices and pulling in the business!
Regards,
S.
Wednesday, January 16, 2008
above the living room
We are the second crew on scene, but only by a couple of minutes. Their ambulance lights are still on, the urgent sparkling gradually drawing people through their front doors and into their gardens to look.
As the first crew will have already taken in most of the equipment, and following the usual pattern of these things, we simply pull on some blue gloves and hurry in through the open door.
A straight flight of stairs in front of us, and a living room off to the right, desperate words and sobs behind a frosted glass door. A man’s angry voice. Above us we can hear the beep beep beep of the defib’s metronome as the crew works on the patient. We carry on up.
A large elderly man is lying on his back, half in and half out of a bathroom. His head is bloody, gashed above his right eye, and moves slightly from side to side as Lisa pumps his chest; Max has already cut off the man’s vest and attached the defib pads, and now she is putting in an airway. She immediately asks Frank if he’ll go back and fetch an aspirator from the vehicle, as the man has vomited and his airway is compromised. It’s not looking good. Max tells me that the patient had probably been down for about twenty minutes before anything was done. He had collapsed in the bathroom right behind the door, and his wife hadn’t been able to get to him. The first person she’d called was her son who lives a few streets away. He had managed to break the door open, and it was only after that an ambulance was called. When Max had come up the stairs no-one was doing any CPR. A daughter had also turned up, and now they were all together in the sitting room. As if on cue, a keening cry drifts up from below, followed by a crash and some heavy footsteps. A huge man with a boiled face and a dirty brown fleece clumps up the first few stairs and looks up at us:
‘Save my Dad!’ he says, and then shouts ‘Please!’ He pokes his thick black glasses back up his nose, and pauses, as if he was expecting to say something else and is surprised by what actually came out. Then he reverse clumps back down the stairs again and his sounds are reabsorbed into the living room.
I take over the chest compressions to give Lisa a break. Whilst I’m bobbing up and down I look past her into the toilet. The pine seat is in the up position but the top of it has been smashed right across. There is a smear of blood on each broken side, and a sizeable pool on the lino.
Frank appears with the aspirator.
‘It’s all going to kick off downstairs,’ he says, setting the kit up and starting to suck out the vomit from the patient’s airway. His actions are as casual as a maid vacuuming yet another room.
Frank also tells us that he’s called for paramedic back-up and the ETA is only a couple of minutes. All four of us are technicians, which means none of us can intubate the patient or give them the drugs that might make a difference.
After every couple of minutes we check the defib screen for rhythm, but each time it is the same – asystole, or flat-line. Non-shockable, and a poor prognosis.
Alistair the paramedic arrives. Max describes the situation so far, and after a brief review, Alistair starts in by intubating the patient, expertly wielding his laryngoscope: Obese patient? No neck? – No problem. Then he’s busy with his intra-osseous drill, whistling into the patient’s tibia, and ready in seconds to push through the usual sequence of atropine and adrenaline. After the drugs have gone in for the first round, we settle in to monitor the final phases of the resus. And now the contrast between upstairs and downstairs is profound: shouts from the living room, polite technicalities on the landing. With some quiet gossip. Did you know so-and-so’s suspended? Going out with who? How’s that mad dog of yours? Now and again checking the screen; taking it in turns on the chest. I notice a toilet roll cover on the cistern – Little Bo Peep, one china hand to her eye line, one hand holding up a crook. As if that will help. But the roll under her dress might.
The resus protocol rolls along its allotted path, but after twenty minutes the patient is only showing a dead heart synthetically jerked by drugs. Alistair consults with us all, and we start turning things off. He goes down to break the news to the family.
‘Watch the son,’ says Frank.
Now our efforts are aimed at making the patient more presentable. I hoist Bo Peep off her perch and place her beside the toilet roll, where she deflates sideways into a chintzy faint. I tear off wads of tissue to clean the blood and vomit from the patient’s face, and then stuff them into the yellow waste bag. We put his arms along his sides and drape a blanket over him.
There’s a shout from downstairs, more urgent than anything so far. Max is already down there and she calls for help; the mother has collapsed in the kitchen. Lisa takes up the oxygen cylinder and runs down. She passes the daughter coming up the stairs two at a time, a fifty year old woman as narrow as her brother is wide, hugging a large teddy bear, which she dumps amongst all the equipment, drops to her knees, and hugs her father’s head instead.
We stand to one side and give them some space, but eventually I touch her on the shoulder. When she looks up at me I ask if we can have a little time to get rid of all our gear, so everyone can have the room and time they need to be with her father. She wipes her nose on her sleeve and nods. I hand the teddy bear back to her, and she trudges back down the stairs.
Once the landing is clear, we have a final chat to the first crew. Max tells us that the patient’s wife has come round. It was a simple faint, and she’s recovering nicely. They’re happy to stay on scene until the police arrive to take over, so we are free to go. Outside we see Alistair slamming the boot shut on his response car. He comes over to us.
‘The son – what a case!’ he says. ‘He came barrelling past when I went into the living room. There was a guy outside on the pavement, a neighbour or something, and when he asked him what was going on, what all the ambulances were for, the son punched him in the face and then ran off.’
‘Where’s the guy he hit?’
‘He ran after him.’
Frank snorts, shakes his head, then gives a little stretch. ‘Come on,’ he yawns. ‘Lunch time. Gotta be.’
As the first crew will have already taken in most of the equipment, and following the usual pattern of these things, we simply pull on some blue gloves and hurry in through the open door.
A straight flight of stairs in front of us, and a living room off to the right, desperate words and sobs behind a frosted glass door. A man’s angry voice. Above us we can hear the beep beep beep of the defib’s metronome as the crew works on the patient. We carry on up.
A large elderly man is lying on his back, half in and half out of a bathroom. His head is bloody, gashed above his right eye, and moves slightly from side to side as Lisa pumps his chest; Max has already cut off the man’s vest and attached the defib pads, and now she is putting in an airway. She immediately asks Frank if he’ll go back and fetch an aspirator from the vehicle, as the man has vomited and his airway is compromised. It’s not looking good. Max tells me that the patient had probably been down for about twenty minutes before anything was done. He had collapsed in the bathroom right behind the door, and his wife hadn’t been able to get to him. The first person she’d called was her son who lives a few streets away. He had managed to break the door open, and it was only after that an ambulance was called. When Max had come up the stairs no-one was doing any CPR. A daughter had also turned up, and now they were all together in the sitting room. As if on cue, a keening cry drifts up from below, followed by a crash and some heavy footsteps. A huge man with a boiled face and a dirty brown fleece clumps up the first few stairs and looks up at us:
‘Save my Dad!’ he says, and then shouts ‘Please!’ He pokes his thick black glasses back up his nose, and pauses, as if he was expecting to say something else and is surprised by what actually came out. Then he reverse clumps back down the stairs again and his sounds are reabsorbed into the living room.
I take over the chest compressions to give Lisa a break. Whilst I’m bobbing up and down I look past her into the toilet. The pine seat is in the up position but the top of it has been smashed right across. There is a smear of blood on each broken side, and a sizeable pool on the lino.
Frank appears with the aspirator.
‘It’s all going to kick off downstairs,’ he says, setting the kit up and starting to suck out the vomit from the patient’s airway. His actions are as casual as a maid vacuuming yet another room.
Frank also tells us that he’s called for paramedic back-up and the ETA is only a couple of minutes. All four of us are technicians, which means none of us can intubate the patient or give them the drugs that might make a difference.
After every couple of minutes we check the defib screen for rhythm, but each time it is the same – asystole, or flat-line. Non-shockable, and a poor prognosis.
Alistair the paramedic arrives. Max describes the situation so far, and after a brief review, Alistair starts in by intubating the patient, expertly wielding his laryngoscope: Obese patient? No neck? – No problem. Then he’s busy with his intra-osseous drill, whistling into the patient’s tibia, and ready in seconds to push through the usual sequence of atropine and adrenaline. After the drugs have gone in for the first round, we settle in to monitor the final phases of the resus. And now the contrast between upstairs and downstairs is profound: shouts from the living room, polite technicalities on the landing. With some quiet gossip. Did you know so-and-so’s suspended? Going out with who? How’s that mad dog of yours? Now and again checking the screen; taking it in turns on the chest. I notice a toilet roll cover on the cistern – Little Bo Peep, one china hand to her eye line, one hand holding up a crook. As if that will help. But the roll under her dress might.
The resus protocol rolls along its allotted path, but after twenty minutes the patient is only showing a dead heart synthetically jerked by drugs. Alistair consults with us all, and we start turning things off. He goes down to break the news to the family.
‘Watch the son,’ says Frank.
Now our efforts are aimed at making the patient more presentable. I hoist Bo Peep off her perch and place her beside the toilet roll, where she deflates sideways into a chintzy faint. I tear off wads of tissue to clean the blood and vomit from the patient’s face, and then stuff them into the yellow waste bag. We put his arms along his sides and drape a blanket over him.
There’s a shout from downstairs, more urgent than anything so far. Max is already down there and she calls for help; the mother has collapsed in the kitchen. Lisa takes up the oxygen cylinder and runs down. She passes the daughter coming up the stairs two at a time, a fifty year old woman as narrow as her brother is wide, hugging a large teddy bear, which she dumps amongst all the equipment, drops to her knees, and hugs her father’s head instead.
We stand to one side and give them some space, but eventually I touch her on the shoulder. When she looks up at me I ask if we can have a little time to get rid of all our gear, so everyone can have the room and time they need to be with her father. She wipes her nose on her sleeve and nods. I hand the teddy bear back to her, and she trudges back down the stairs.
Once the landing is clear, we have a final chat to the first crew. Max tells us that the patient’s wife has come round. It was a simple faint, and she’s recovering nicely. They’re happy to stay on scene until the police arrive to take over, so we are free to go. Outside we see Alistair slamming the boot shut on his response car. He comes over to us.
‘The son – what a case!’ he says. ‘He came barrelling past when I went into the living room. There was a guy outside on the pavement, a neighbour or something, and when he asked him what was going on, what all the ambulances were for, the son punched him in the face and then ran off.’
‘Where’s the guy he hit?’
‘He ran after him.’
Frank snorts, shakes his head, then gives a little stretch. ‘Come on,’ he yawns. ‘Lunch time. Gotta be.’
Monday, January 14, 2008
on the edge
I feel like I’m standing in the lobby of a giant wasp’s nest. It is the thin end of the morning, and a girl in dirty sweats and a sports bra is stinging everyone within range.
To me: ‘You take her in! You’re taking her in, aren’t you?’
To her mum: ‘You’re fucking going with them.’
To me again: ‘You’re fucking taking her.’
She hauls on her mum’s arm, which has become melodramatically floppy again. The son, markedly less reasonable than his sister, has focused both eyes on me; they merge dangerously either side of his nose into one single eye of hate.
‘You fucking do something for my mum’, he says, and takes a drag on his cigarette.
We should have realised this was going to be difficult. The block of flats is well known, and an early hours call to an overdose here is not a happy prospect. Our spirits are eased, though, when we pull up in the street and see a police car already there.
‘That’s something, then,’ I say to Rae. We sort out the bags to take up, lock the vehicle, and then make our way into the courtyard. I can hear shouts from one of the balconies that overlook the courtyard, but I ring the flat number and we wait for a response. Nothing. We ring again. A face looks down on us from a parapet above and shouts down:
‘Who’s that?’
‘The ambulance.’
‘What do you want?’
(pause)
‘Someone called for an ambulance?’
(Muted sounds of swearing and bargaining.)
‘Could someone let us in, please?’
‘I can’t leave my Mum.’
(pause)
‘Well – someone’s got to let us in, otherwise we’re stuck down here.’
After waiting for a reply that doesn’t come, I call up, helpfully – ‘…and – er - we won’t be able to do much.’
‘I can’t leave my Mum,’ he shouts down again. I look at Rae and she looks at me. But just before we buzz again to make a full and final offer, someone else releases the door, and we go on up.
The concrete stairwell has the welcoming smell of concrete stairwells the world over. The echoes of our progress upwards add to the ominous screams and bumps from the seventh floor. And still – despite all our experiences in the past – we are assuming that the police are on scene. I haven’t even got my radio on me. We are the equivalent of a sleepy but doomed vanguard blundering over the top of the trench.
When we emerge onto the balcony, my error is horribly plain. There is a man standing by a woman on the floor. He is holding her hand, so that her arm is up to him at full stretch. Aggression spikes out of his head like cartoon lightning.
‘You fucking help my mum,’ he says to us.
Three others come out of the flat – unshepherded by police. They swarm around us on the balcony, saying things like: ‘She’s dying’ and ‘Bitch’ and ‘She needs her stomach pumped out.’
‘Hello,’ I say. ‘My name’s Spence and this is Rae.’ God knows this introduction never sounded so lame, but in difficult situations it sometimes helps to follow the script. ‘What’s happened?’
I can see that the woman’s ABC’s are fine: she’s breathing and talking and moving her head around. When I go closer to her I can smell the alcohol. There are no signs of violence, and in the sickly light of the emergency overheads she seems a normal colour. I speak as firmly as I can to the man.
‘I need to speak to your mum on her own, if that’s okay. I just need to find out what she’s done and how we can help. Okay?’
Amazingly, he drops her hand. He pulls a mobile phone out of his pocket and walks off with a grunt. In a speed-dialling second I overhear him say: ‘It’s my mum. She’s taking a load of pills and she’s going to fucking die…’ The others follow him back into the flat, which is an enormous relief to us.
We sit her up and help her lean against the balcony wall. We make out that her name is Sandra, and she’s taken all her medication for pain relief because she didn’t want to go on like this. With the rest of the family temporarily back in the flat, I ask Sandra as firmly as possible if she’ll come down to the ambulance with us, as I think she needs to go to hospital. I don’t actually know at this point if she does need to go; my main concern is to get us away from this environment.
‘Fuck off,’ she drawls. ‘Fucking leave me alone.’
We hold a hurried war cabinet over her head: Rae agrees to go back down to the ambulance and call for urgent police back-up, just in case we really can’t persuade Sandra to come down to the vehicle. Other than that, it’ll be a question of withdrawing as best we can if things get worse. Rae exits just as one of the women comes out, obviously the first man’s sister, sharing his one-eyed intensity. Her hands are cupped around a mess of bottles and packets.
‘She’s taken all this,’ she says, and throws them on the floor. Walks off again.
I poke through the medication. There’s everything here, from iron tablets and senna to dihydrocodeine and zopiclone.
‘Sandra – what have you taken tonight?’
Sandra makes a curiously delicate gesture with her finger: ‘Those – those – all of those.’
At this point, the whole family tips back out onto the balcony.
‘Well?’
I gauge the distance between me and the stairwell door. But before I can begin to try to reason things through – incredibly – two policemen come striding along the balcony from the other direction.
‘Right,’ one of them says, ‘What’s going on here?’
**
Only later, when the family has been corralled back in the flat and the mother is on her own in the kitchen do I find out quite how lucky we’ve been tonight. The police were here at another flat on something quite unconnected. They heard all the fuss and eventually came out to see what it was about.
In a private word out on the balcony one of the policeman asks me if I think Sandra’s in danger. I tell him that her obs are fine, that I don’t believe she’s taken as many of the drugs as we’re being told, and that much of what’s happened tonight is due to alcohol and melodramatics. But as a rider to that I have to say that without a blood test…
Back in the kitchen Sandra still refuses to travel to hospital, even though I explain to her that we think she needs medical help. Her son shouts in at the door that we have to take her, but the policeman explains to him that if she doesn’t want to go, we can’t force her. Sandra signs our form to say that she’s staying against our advice, and once it’s witnessed, we go to leave.
‘Bye,’ I offer to the family as we excuse our way past them in the hall. Their silence is appalling.
To me: ‘You take her in! You’re taking her in, aren’t you?’
To her mum: ‘You’re fucking going with them.’
To me again: ‘You’re fucking taking her.’
She hauls on her mum’s arm, which has become melodramatically floppy again. The son, markedly less reasonable than his sister, has focused both eyes on me; they merge dangerously either side of his nose into one single eye of hate.
‘You fucking do something for my mum’, he says, and takes a drag on his cigarette.
We should have realised this was going to be difficult. The block of flats is well known, and an early hours call to an overdose here is not a happy prospect. Our spirits are eased, though, when we pull up in the street and see a police car already there.
‘That’s something, then,’ I say to Rae. We sort out the bags to take up, lock the vehicle, and then make our way into the courtyard. I can hear shouts from one of the balconies that overlook the courtyard, but I ring the flat number and we wait for a response. Nothing. We ring again. A face looks down on us from a parapet above and shouts down:
‘Who’s that?’
‘The ambulance.’
‘What do you want?’
(pause)
‘Someone called for an ambulance?’
(Muted sounds of swearing and bargaining.)
‘Could someone let us in, please?’
‘I can’t leave my Mum.’
(pause)
‘Well – someone’s got to let us in, otherwise we’re stuck down here.’
After waiting for a reply that doesn’t come, I call up, helpfully – ‘…and – er - we won’t be able to do much.’
‘I can’t leave my Mum,’ he shouts down again. I look at Rae and she looks at me. But just before we buzz again to make a full and final offer, someone else releases the door, and we go on up.
The concrete stairwell has the welcoming smell of concrete stairwells the world over. The echoes of our progress upwards add to the ominous screams and bumps from the seventh floor. And still – despite all our experiences in the past – we are assuming that the police are on scene. I haven’t even got my radio on me. We are the equivalent of a sleepy but doomed vanguard blundering over the top of the trench.
When we emerge onto the balcony, my error is horribly plain. There is a man standing by a woman on the floor. He is holding her hand, so that her arm is up to him at full stretch. Aggression spikes out of his head like cartoon lightning.
‘You fucking help my mum,’ he says to us.
Three others come out of the flat – unshepherded by police. They swarm around us on the balcony, saying things like: ‘She’s dying’ and ‘Bitch’ and ‘She needs her stomach pumped out.’
‘Hello,’ I say. ‘My name’s Spence and this is Rae.’ God knows this introduction never sounded so lame, but in difficult situations it sometimes helps to follow the script. ‘What’s happened?’
I can see that the woman’s ABC’s are fine: she’s breathing and talking and moving her head around. When I go closer to her I can smell the alcohol. There are no signs of violence, and in the sickly light of the emergency overheads she seems a normal colour. I speak as firmly as I can to the man.
‘I need to speak to your mum on her own, if that’s okay. I just need to find out what she’s done and how we can help. Okay?’
Amazingly, he drops her hand. He pulls a mobile phone out of his pocket and walks off with a grunt. In a speed-dialling second I overhear him say: ‘It’s my mum. She’s taking a load of pills and she’s going to fucking die…’ The others follow him back into the flat, which is an enormous relief to us.
We sit her up and help her lean against the balcony wall. We make out that her name is Sandra, and she’s taken all her medication for pain relief because she didn’t want to go on like this. With the rest of the family temporarily back in the flat, I ask Sandra as firmly as possible if she’ll come down to the ambulance with us, as I think she needs to go to hospital. I don’t actually know at this point if she does need to go; my main concern is to get us away from this environment.
‘Fuck off,’ she drawls. ‘Fucking leave me alone.’
We hold a hurried war cabinet over her head: Rae agrees to go back down to the ambulance and call for urgent police back-up, just in case we really can’t persuade Sandra to come down to the vehicle. Other than that, it’ll be a question of withdrawing as best we can if things get worse. Rae exits just as one of the women comes out, obviously the first man’s sister, sharing his one-eyed intensity. Her hands are cupped around a mess of bottles and packets.
‘She’s taken all this,’ she says, and throws them on the floor. Walks off again.
I poke through the medication. There’s everything here, from iron tablets and senna to dihydrocodeine and zopiclone.
‘Sandra – what have you taken tonight?’
Sandra makes a curiously delicate gesture with her finger: ‘Those – those – all of those.’
At this point, the whole family tips back out onto the balcony.
‘Well?’
I gauge the distance between me and the stairwell door. But before I can begin to try to reason things through – incredibly – two policemen come striding along the balcony from the other direction.
‘Right,’ one of them says, ‘What’s going on here?’
**
Only later, when the family has been corralled back in the flat and the mother is on her own in the kitchen do I find out quite how lucky we’ve been tonight. The police were here at another flat on something quite unconnected. They heard all the fuss and eventually came out to see what it was about.
In a private word out on the balcony one of the policeman asks me if I think Sandra’s in danger. I tell him that her obs are fine, that I don’t believe she’s taken as many of the drugs as we’re being told, and that much of what’s happened tonight is due to alcohol and melodramatics. But as a rider to that I have to say that without a blood test…
Back in the kitchen Sandra still refuses to travel to hospital, even though I explain to her that we think she needs medical help. Her son shouts in at the door that we have to take her, but the policeman explains to him that if she doesn’t want to go, we can’t force her. Sandra signs our form to say that she’s staying against our advice, and once it’s witnessed, we go to leave.
‘Bye,’ I offer to the family as we excuse our way past them in the hall. Their silence is appalling.
Friday, January 11, 2008
deus ex machina
Act One: We take a call to a man collapsed in the street. The location is given as o/s Co-op beside bench – and this is enough to tell me that Michael has made it up town again.
Michael is in the Top Ten of our regular callers. I know all his details off by heart; I hardly need ask him any questions at all these days. Fifty-seven years old. Suffers from Motor Neurone Disease and alcoholism, is (approximately) mobile with a zimmer. Once a week he will buy a packet of sandwiches, some crisps and a bottle of vodka, drag himself either to the bench in front of the Co-op or a bus stop outside the railway station, drink the bottle of vodka, eat the sandwiches and fall to the floor. His difficulty in speaking is made worse by the alcohol, of course, and by the vast, twiggy hedge of a beard that obscures the lower half of his face and the top half of his body. He can be aggressive, but the punches, should he be in a bad mood and throw one, are like his words – without focus or real intent. He tries his best to insult you. The swear words come spittling out through his crooked yellow teeth, and his eyes flicker from side to side.
A teenager waves us over to the bench and I can see – yes – it is Michael lying there. Today he is wearing pyjamas under his ex-army greatcoat, which is a variation. I thank the boy for calling us, and then we set to picking Michael up and on to the bench. Rae fetches a blanket from the vehicle and drapes it over his shoulders. He sits Rae like a doomed prophet, white robed and bearded on the bench, grinding out his profane prayers to anyone close enough to listen.
And so we face the usual problem. This is not a medical emergency. This is really a matter for the police – drunk and disorderly. But we know that if we request the police via Control, we could be waiting here for a long time. And if Control let the police know who the patient is, we could be waiting here for ever. But the other option of a trip to hospital and a seat in the waiting room until such time as the patient sobers up and makes his own way home – well, this has been done so many times in the past, I’m worried that the A&E charge nurse will have security throw us all out. However, if we leave Michael here as he is, he will only fall over again, someone else will call for an ambulance, and resources will be tied up even more. So, making the best of a rather tedious job, we decide to take him in. When we get to hospital I talk up the fact that Michael was borderline hypothermic. The charge nurse gives me a look that even the most optimistic interpretation would be: ‘I’m watching you’. But they accept him. What else can they do? Michael has a social worker, and various carers have tried their hand and left in tears soon after, but short of a miracle, or a ball and chain, this expensive routine looks set to play over and over without relief for years.
Act Two: A week later we take a call to a man collapsed in the street. The location is given as o/s Railway station, bus stop. Rae says it’s Michael, but I say I’m not so sure. I say I have a feeling that this will be a resus in the street. I snap my gloves heroically. The station comes into view. It is Michael. Two off-duty nurses have called the ambulance. One of them even works in A&E. ‘What else could I do?’ she says, helplessly. And this is, of course, the problem. We take him in without even considering the police, as he seems less responsive than normal. But all his observations are fine. We pass him on a corridor trolley throughout the day as we come and go in the hospital, snoring.
Act Three: Two months later we take a call to a man collapsed at home. The call has originated from social services, and the address seems familiar. Neither Rae nor I have been there before, but it just seems to ring a bell. As we turn into the courtyard of the block of flats, Rae says: Michael. Of course – and then I think: This is a first, collapsing at home. We jump out of the vehicle and go over to the two people standing by the door. One is a carer, and the other is a manager from Social Services.
‘The last contact we have with Michael is two weeks ago,’ says the manager, fiddling with a knob on her radio. ‘I’m just waiting for someone to get back to me about key holders. But the police should be here soon.’
The carer tells us this is her first day. She says she knocked on the door, looked through the window, but then wasn’t sure what to do. She bites the quick of her thumb. ‘He’s supposed to be here.’
Rae gets on the radio and tells Control the situation. I have a look through the window but a filthy set of curtains hides everything. Rae comes over and says that Control have given the go-ahead to break in, and confirms that the police will be here in about five minutes.
I love pushing doors in. It’s a perk of the job. I draw myself up and back, and then give it a good kick. It bows impressively. On the second kick it flies backwards in a satisfying crack of splintering wood, and we go in. The smell wraps around us along the filthy hallway before we see the legs just poking around the side of the bedroom door. He is lying on his side on the floor. He has been dead for some time – at least for the two weeks the manager mentioned. If the flat had been properly heated the smell would have been a lot worse, but as it is, Michael has been doggedly pursuing the various stages of decay, as slowly but inevitably as his shuffling walk up town with the vodka and sandwiches. The social services manager has followed us in with her radio crackling loudly, but she about turns and strides back out with an ‘Urph’. We follow her. Back outside in the yard the carer asks me: ‘Is he all right?’ and I tell her that unfortunately, no, he’s died. A police car turns into the yard. The carer says: ‘What do I do now? This is all new to me.’
I tell her, I’m as surprised as she is.
Michael is in the Top Ten of our regular callers. I know all his details off by heart; I hardly need ask him any questions at all these days. Fifty-seven years old. Suffers from Motor Neurone Disease and alcoholism, is (approximately) mobile with a zimmer. Once a week he will buy a packet of sandwiches, some crisps and a bottle of vodka, drag himself either to the bench in front of the Co-op or a bus stop outside the railway station, drink the bottle of vodka, eat the sandwiches and fall to the floor. His difficulty in speaking is made worse by the alcohol, of course, and by the vast, twiggy hedge of a beard that obscures the lower half of his face and the top half of his body. He can be aggressive, but the punches, should he be in a bad mood and throw one, are like his words – without focus or real intent. He tries his best to insult you. The swear words come spittling out through his crooked yellow teeth, and his eyes flicker from side to side.
A teenager waves us over to the bench and I can see – yes – it is Michael lying there. Today he is wearing pyjamas under his ex-army greatcoat, which is a variation. I thank the boy for calling us, and then we set to picking Michael up and on to the bench. Rae fetches a blanket from the vehicle and drapes it over his shoulders. He sits Rae like a doomed prophet, white robed and bearded on the bench, grinding out his profane prayers to anyone close enough to listen.
And so we face the usual problem. This is not a medical emergency. This is really a matter for the police – drunk and disorderly. But we know that if we request the police via Control, we could be waiting here for a long time. And if Control let the police know who the patient is, we could be waiting here for ever. But the other option of a trip to hospital and a seat in the waiting room until such time as the patient sobers up and makes his own way home – well, this has been done so many times in the past, I’m worried that the A&E charge nurse will have security throw us all out. However, if we leave Michael here as he is, he will only fall over again, someone else will call for an ambulance, and resources will be tied up even more. So, making the best of a rather tedious job, we decide to take him in. When we get to hospital I talk up the fact that Michael was borderline hypothermic. The charge nurse gives me a look that even the most optimistic interpretation would be: ‘I’m watching you’. But they accept him. What else can they do? Michael has a social worker, and various carers have tried their hand and left in tears soon after, but short of a miracle, or a ball and chain, this expensive routine looks set to play over and over without relief for years.
Act Two: A week later we take a call to a man collapsed in the street. The location is given as o/s Railway station, bus stop. Rae says it’s Michael, but I say I’m not so sure. I say I have a feeling that this will be a resus in the street. I snap my gloves heroically. The station comes into view. It is Michael. Two off-duty nurses have called the ambulance. One of them even works in A&E. ‘What else could I do?’ she says, helplessly. And this is, of course, the problem. We take him in without even considering the police, as he seems less responsive than normal. But all his observations are fine. We pass him on a corridor trolley throughout the day as we come and go in the hospital, snoring.
Act Three: Two months later we take a call to a man collapsed at home. The call has originated from social services, and the address seems familiar. Neither Rae nor I have been there before, but it just seems to ring a bell. As we turn into the courtyard of the block of flats, Rae says: Michael. Of course – and then I think: This is a first, collapsing at home. We jump out of the vehicle and go over to the two people standing by the door. One is a carer, and the other is a manager from Social Services.
‘The last contact we have with Michael is two weeks ago,’ says the manager, fiddling with a knob on her radio. ‘I’m just waiting for someone to get back to me about key holders. But the police should be here soon.’
The carer tells us this is her first day. She says she knocked on the door, looked through the window, but then wasn’t sure what to do. She bites the quick of her thumb. ‘He’s supposed to be here.’
Rae gets on the radio and tells Control the situation. I have a look through the window but a filthy set of curtains hides everything. Rae comes over and says that Control have given the go-ahead to break in, and confirms that the police will be here in about five minutes.
I love pushing doors in. It’s a perk of the job. I draw myself up and back, and then give it a good kick. It bows impressively. On the second kick it flies backwards in a satisfying crack of splintering wood, and we go in. The smell wraps around us along the filthy hallway before we see the legs just poking around the side of the bedroom door. He is lying on his side on the floor. He has been dead for some time – at least for the two weeks the manager mentioned. If the flat had been properly heated the smell would have been a lot worse, but as it is, Michael has been doggedly pursuing the various stages of decay, as slowly but inevitably as his shuffling walk up town with the vodka and sandwiches. The social services manager has followed us in with her radio crackling loudly, but she about turns and strides back out with an ‘Urph’. We follow her. Back outside in the yard the carer asks me: ‘Is he all right?’ and I tell her that unfortunately, no, he’s died. A police car turns into the yard. The carer says: ‘What do I do now? This is all new to me.’
I tell her, I’m as surprised as she is.
Thursday, January 10, 2008
Stella and the whippet
The black winter streets resound with our sirens, two ambulances nose to tail through the commuter traffic. Before I joined the service I would have thought this level of noise meant a plane crash, but in this case it means that someone has suffered a cardiac arrest; there’s so much equipment and so much to be done that four people is the optimum number to cope.
Our sat nav takes us to the square, but we have trouble finding the actual flat entrance. There is a moment when we circle in the middle of the wide main road, holding up traffic whilst we consult with each other – where could this be? We’re forced to drive round the square illuminating the numbers with our powerful side lights, but they don’t seem to run consecutively and it’s difficult to work out where the address is. We hear the second crew on the radio ask Control to get the caller to send someone to the door to wave, and after a frustrating couple of minutes the second ambulance picks them out. They go in first with all the bags, and we follow after, pulling on our gloves. The traffic moves on around us as best it can.
The flat is at the top of a narrowly winding flight of stairs. Voices just above us, modulated and calm, both ambulance and family. A man holds a door open for us as we reach the top landing. He has the demeanour of an off-duty priest, his bald head and glasses glinting in the dusty light. He nods and smiles us in the direction we should go, but there’s a rough, gang-like impetus to our progress, and we quickly find ourselves in a square little room with an unmade bed and an elderly woman lying flat on her back on the floor. A middle-aged woman is kneeling beside her holding a phone to one ear whilst with her free hand she presses ineffectually on the woman’s chest like she’s being given directions on how to make a pizza. Steve helps her up and out of the room, whilst Nigel pulls out the defibrillator and I cut her upper clothes away and get down to some chest compressions. After two or three her ribs creak and crack like a dusty wicker basket, and her chest takes on a horribly ruined character. The pads go on and the rhythm identified: fine VF. More compressions for a minute, and the second analysis reveals asystole. The woman’s prospects are bleak, but we go through the twenty minute algorithm. Anne cannulates the patient, and after I’m relieved by Steve on the chest compressions, I put together the drug syringes, flipping off the colour-coded caps and screwing the different cylinders together. Twenty minutes later the woman is still flat, and after a brief consultation we decide that there is nothing more we can do for her.
Anne and Steve finish work in a minute or two, so Nigel and I agree to stay behind, clean up and do the paperwork. Before they go they help us to lift the woman into the bed and straighten the blankets around her. Then as we gather up all the detritus of our rescue attempt and stuff them into a yellow waste bag, they go next door to break the news and make their farewell. Above the bed I notice a simply framed photo of the patient, taken when she was a young woman. She’s looking off to her right, her chin up, ready to engage with life.
I close her eyes.
**
‘Do you want a cup of tea?’ Then she puts one hand to her forehead and turns to her husband. ‘I can’t believe all this, Brian. Can you believe it? No-one said anything about her heart. It was her brain that was supposed to kill her.’ He nods, raises his eyebrows, smiles across at us. Folds his arms.
The daughter’s name is Stella. She has an intensity about her that her black and white stripy top and her red lipstick only magnifies. All her movements are like the lines on her face, precise but surprising. She is struggling to hold a small, pale whippet under her arm, up on the back of the sofa. It wags its tail so enthusiastically, the only motionless parts of its body are the dark centres of its eyes. I pat its head, then realise I still have my gloves on, and quickly take them off.
‘I took her tea in and she seemed fine. It wasn’t too hot. She usually complains. Doesn’t she, Brian? Then next thing you know, twenty minutes later – it couldn’t have been more than twenty minutes – ‘ (smile confirmation from the husband) ‘twenty minutes later, she’s slumped over. Like this.’ (mimes a slump, then, to the dog) ‘Just look at him! He knows what’s happening. He’s not stupid. Oh, Snuffy, what are you going to do now your mummy’s gone?’
I straighten my form out on a little walnut side table, and click my pen.
‘I just have a few questions to ask you, Stella.’ Then I’m off through the form, getting name, date of birth, GP. ‘Can you tell me your mum’s past medical history?’
‘I’ve got it all written down.’
Stella strides across to a cabinet. When she opens it, a cascade of papers slides out and on to the floor. Brian slowly gets up to help her. After a minute or two of one-sided squabbling about which papers are where, Stella triumphantly extracts a wad of handwritten sheets. She bounds back across to me, followed by the dog.
‘Nine years ago she had a massive sub-arachnoid bleed. It’s all there, look. (Jab. Jab.) They told us it was all over. But she got better – well, I say better. She was in nine weeks and then came home. She was never supposed to make it this far.’
Brian quietly resumes his position over by the window, whilst the dog carries on sniffing my trousers and bullying me to stroke it.
The notes that Stella has kept on her mother’s help are something like a diary. Page after page of closely written lines, a startling mixture of technical jargon and trivial entries. Nine years. It seems too that her mother had quickly developed dementia, and caring for her in the flat must have been incredibly stressful.
Brian clears his throat and then speaks up. ‘What happens next?’ he says.
I tell him that the police will need to be called as this is an unexpected death at home. I tell him that they will stay with them until either the coroner’s office or an appointed undertaker arrive to take the patient to the mortuary or to a chapel of rest.
‘Ah. Thank you,’ he says. ‘You’ve been very kind. Thank you for all your help.’ And he stands up to shake our hands.
‘It reminds me of some words by Leonard Cohen,’ Stella says. ‘What’s that Leonard Cohen song, Brian? Not one of the old ones. One of the new ones. We’re a big fan of Leonard Cohen in this house. Off one of his new albums.’
She hums a few nondescript bars.
‘Lah-dih Lah-dih something, something. Purple … er …. Brian? You know the one?’ Then to us: ‘Leonard Cohen was ever so good.’
‘He’s still with us!’ I say to her.
‘I know – but…’ she trails off. There is a knock on the door and two policeman walk in. They seem enormous in this little flat. I stand up to go and explain the situation to them. As I do so, Brian shakes me by the hand again. ‘Thanks for coming, doing what you could,’ he whispers, as Stella and the dog turn their attention to the police.
Our sat nav takes us to the square, but we have trouble finding the actual flat entrance. There is a moment when we circle in the middle of the wide main road, holding up traffic whilst we consult with each other – where could this be? We’re forced to drive round the square illuminating the numbers with our powerful side lights, but they don’t seem to run consecutively and it’s difficult to work out where the address is. We hear the second crew on the radio ask Control to get the caller to send someone to the door to wave, and after a frustrating couple of minutes the second ambulance picks them out. They go in first with all the bags, and we follow after, pulling on our gloves. The traffic moves on around us as best it can.
The flat is at the top of a narrowly winding flight of stairs. Voices just above us, modulated and calm, both ambulance and family. A man holds a door open for us as we reach the top landing. He has the demeanour of an off-duty priest, his bald head and glasses glinting in the dusty light. He nods and smiles us in the direction we should go, but there’s a rough, gang-like impetus to our progress, and we quickly find ourselves in a square little room with an unmade bed and an elderly woman lying flat on her back on the floor. A middle-aged woman is kneeling beside her holding a phone to one ear whilst with her free hand she presses ineffectually on the woman’s chest like she’s being given directions on how to make a pizza. Steve helps her up and out of the room, whilst Nigel pulls out the defibrillator and I cut her upper clothes away and get down to some chest compressions. After two or three her ribs creak and crack like a dusty wicker basket, and her chest takes on a horribly ruined character. The pads go on and the rhythm identified: fine VF. More compressions for a minute, and the second analysis reveals asystole. The woman’s prospects are bleak, but we go through the twenty minute algorithm. Anne cannulates the patient, and after I’m relieved by Steve on the chest compressions, I put together the drug syringes, flipping off the colour-coded caps and screwing the different cylinders together. Twenty minutes later the woman is still flat, and after a brief consultation we decide that there is nothing more we can do for her.
Anne and Steve finish work in a minute or two, so Nigel and I agree to stay behind, clean up and do the paperwork. Before they go they help us to lift the woman into the bed and straighten the blankets around her. Then as we gather up all the detritus of our rescue attempt and stuff them into a yellow waste bag, they go next door to break the news and make their farewell. Above the bed I notice a simply framed photo of the patient, taken when she was a young woman. She’s looking off to her right, her chin up, ready to engage with life.
I close her eyes.
**
‘Do you want a cup of tea?’ Then she puts one hand to her forehead and turns to her husband. ‘I can’t believe all this, Brian. Can you believe it? No-one said anything about her heart. It was her brain that was supposed to kill her.’ He nods, raises his eyebrows, smiles across at us. Folds his arms.
The daughter’s name is Stella. She has an intensity about her that her black and white stripy top and her red lipstick only magnifies. All her movements are like the lines on her face, precise but surprising. She is struggling to hold a small, pale whippet under her arm, up on the back of the sofa. It wags its tail so enthusiastically, the only motionless parts of its body are the dark centres of its eyes. I pat its head, then realise I still have my gloves on, and quickly take them off.
‘I took her tea in and she seemed fine. It wasn’t too hot. She usually complains. Doesn’t she, Brian? Then next thing you know, twenty minutes later – it couldn’t have been more than twenty minutes – ‘ (smile confirmation from the husband) ‘twenty minutes later, she’s slumped over. Like this.’ (mimes a slump, then, to the dog) ‘Just look at him! He knows what’s happening. He’s not stupid. Oh, Snuffy, what are you going to do now your mummy’s gone?’
I straighten my form out on a little walnut side table, and click my pen.
‘I just have a few questions to ask you, Stella.’ Then I’m off through the form, getting name, date of birth, GP. ‘Can you tell me your mum’s past medical history?’
‘I’ve got it all written down.’
Stella strides across to a cabinet. When she opens it, a cascade of papers slides out and on to the floor. Brian slowly gets up to help her. After a minute or two of one-sided squabbling about which papers are where, Stella triumphantly extracts a wad of handwritten sheets. She bounds back across to me, followed by the dog.
‘Nine years ago she had a massive sub-arachnoid bleed. It’s all there, look. (Jab. Jab.) They told us it was all over. But she got better – well, I say better. She was in nine weeks and then came home. She was never supposed to make it this far.’
Brian quietly resumes his position over by the window, whilst the dog carries on sniffing my trousers and bullying me to stroke it.
The notes that Stella has kept on her mother’s help are something like a diary. Page after page of closely written lines, a startling mixture of technical jargon and trivial entries. Nine years. It seems too that her mother had quickly developed dementia, and caring for her in the flat must have been incredibly stressful.
Brian clears his throat and then speaks up. ‘What happens next?’ he says.
I tell him that the police will need to be called as this is an unexpected death at home. I tell him that they will stay with them until either the coroner’s office or an appointed undertaker arrive to take the patient to the mortuary or to a chapel of rest.
‘Ah. Thank you,’ he says. ‘You’ve been very kind. Thank you for all your help.’ And he stands up to shake our hands.
‘It reminds me of some words by Leonard Cohen,’ Stella says. ‘What’s that Leonard Cohen song, Brian? Not one of the old ones. One of the new ones. We’re a big fan of Leonard Cohen in this house. Off one of his new albums.’
She hums a few nondescript bars.
‘Lah-dih Lah-dih something, something. Purple … er …. Brian? You know the one?’ Then to us: ‘Leonard Cohen was ever so good.’
‘He’s still with us!’ I say to her.
‘I know – but…’ she trails off. There is a knock on the door and two policeman walk in. They seem enormous in this little flat. I stand up to go and explain the situation to them. As I do so, Brian shakes me by the hand again. ‘Thanks for coming, doing what you could,’ he whispers, as Stella and the dog turn their attention to the police.
Tuesday, January 01, 2008
how like a god
The message is as direct as it usually is: Serious haemorrhage / lacerations – injury to hand – Cat B. We machete our way through the heavy traffic with our sirens; town is packed, with crowds massing around the shops for the post Christmas sales.
The follow-up message lowers our expectations somewhat: fire brigade on scene. Patient cut hand whilst striking fire alarm. We wonder how you can seriously injure your hand punching out the little glass panel from a fire alarm, but the category remains at B, so we hustle onwards.
Turning into the street we are confronted by two fire engines with their blue lights on and a bunch of fire-fighters milling around on the pavement. No sense of urgency and, crucially, no smoke. We pull up behind the last tender and jump out to meet the Incident Officer.
‘Nothing much here, lads. A candle got a bit smoky, and one of the residents punched the alarm. She says her hand is injured, but I’ll leave it up to you.’ We follow him to the high wooden fence at the side of the house. ‘She’s in the flat round the back.’
‘What is this place?’ I ask him.
‘Some kind of psych residential. Just through there, mate. You can’t miss her.’
We pick our way through piles of junk towards an open door. There is a large woman in a black coat smoking a cigarette in the garden. For a moment I wonder if she’s the patient, but she doesn’t acknowledge us at all. I hear voices from the room beyond the door, so we head for those.
We step into a small, square room, as congested with stuff as the alleyway that led here. Another fire-fighter is standing over by the only window. To his left, a vast woman is sitting quietly in an armchair facing us, so shapelessly huge it looks as if the chair is a mould and the woman has been poured into it. She is wearing a silky chemise, her bare arms and legs trunking out of the delicate lacy frills at the four corners. She has painted a thick war stripe of blue eye shadow that runs across the top of her face. Her lips are grey, and as Adam negotiates a path to her to take a closer look, she pre-empts our concern by saying:
‘I’ve painted my lips with ash.’
Adam looks at the fire-fighter, who shrugs, and looks at his watch.
‘Why have you painted your lips with ash?’
‘Because I’m a god.’
‘Oh. Okay. Well, first things first. What’s your name?’
‘Ellie. Ellie Sparrow.’
‘What’s happened here, Ellie? Was there a fire?’
The fireman reports the facts: ‘A Christmas candle with a leather base was put on the radiator and gave off some fumes. Ellie punched the fire alarm, and she says she’s hurt her hand.
Ellie holds up her hand. The fingers are swollen, the nails bitten right back and painted different colours, the knuckles covered with scabs of different ages. In other words, entirely like the uninjured hand, and normal for the patient. Adam examines the hand for movement, sensitivity, cap refill, and everything seems fine.
‘Do you have any medical conditions?’ he asks her, reaching for the paperwork.
‘I’m bi-polar. Where’s my bag? I have to show you something.’
Adam hands her a huge canvas bag. Ellie begins rummaging through it. She pulls out a ceramic pyramid-shaped incense holder. ‘I take that with me everywhere I go.’ She pulls out letters and CDs and a book jacket with a photo of Sting on it. ‘Do you like Sting?’ she says.
‘Ellie – we need to ask you a few questions and do a few tests just to make sure you’re okay. Can we do that?’
She looks up at him. ‘I just want to show you my fake saliva.’ And then – incredibly – she pulls out some medication that clearly says on the box synthetic saliva.
‘I need to have some chocolate.’ Before we can stop her, she produces a big glass bowl from the side of the chair, filled with bars of chocolate, pulls one out, opens it and has it in her mouth with practised economy.
We quickly make the observations that we are duty bound to make. Adam says to her:
‘Ellie. From all that we can see there’s no medical need for you to go to the hospital today.’
‘But I want to go,’ she slurps, wiping her chocolaty mouth with the back of her hand. ‘I’m on my own here. There are voices in the garden. I’m bored.’
‘I’m sorry to hear that,’ he goes on. ‘But none of these are reasons to go to A&E today. The best thing to do would be to make an appointment to see your GP in a day or so.’
‘I’m barred.’
He pauses, then tries another tack. ‘Casualty is full up today, absolutely crammed with drunks because of the New Year. You’ll be waiting for hours if you do go. I really don’t advise it. Plus, you’ll be depriving someone of an ambulance who might really need it.’ She stares up at him, and stops chewing briefly.
‘You know – heart attacks. That kind of thing.’
‘Haven’t you got a lovely speaking voice,’ she says, and gives him a dreadful smile.
‘Okay, Ellie. Do you want to sign the form to say you’re not going in?’
Incredibly, she takes the pen and form, and then makes a signature that’s more like a furious crossing out. She chucks it back at him.
‘Happy Christmas,’ she says, and looks at the fire-fighter, but he is following us out with the same sense of urgency.
We make our way back outside to the truck. The fire crews wave and move off. We sit in the cab, listening to music whilst Adam finishes the paperwork.
After about five minutes Control calls us on the radio. They tell us that Ellie is back on the phone. She says that she needs an ambulance for her hand. Reluctantly we agree to go back in to see her, but before we can get out of the cab she is there on the pavement, staring across at us. We climb out to let her in to the back. The whole ambulance rocks from side to side as she makes her way to the seat. The seat belt will not go round her. I slam the door shut and we set off.
At the hospital we show Ellie to a seat in the minors waiting area. We apologise to the staff nurse for bringing her in, and she accepts our reasons with commendable sangfroid. But A&E is already bursting, and we all know that Ms. Sparrow may well be the (gigantic) straw that breaks the camel’s back.
The follow-up message lowers our expectations somewhat: fire brigade on scene. Patient cut hand whilst striking fire alarm. We wonder how you can seriously injure your hand punching out the little glass panel from a fire alarm, but the category remains at B, so we hustle onwards.
Turning into the street we are confronted by two fire engines with their blue lights on and a bunch of fire-fighters milling around on the pavement. No sense of urgency and, crucially, no smoke. We pull up behind the last tender and jump out to meet the Incident Officer.
‘Nothing much here, lads. A candle got a bit smoky, and one of the residents punched the alarm. She says her hand is injured, but I’ll leave it up to you.’ We follow him to the high wooden fence at the side of the house. ‘She’s in the flat round the back.’
‘What is this place?’ I ask him.
‘Some kind of psych residential. Just through there, mate. You can’t miss her.’
We pick our way through piles of junk towards an open door. There is a large woman in a black coat smoking a cigarette in the garden. For a moment I wonder if she’s the patient, but she doesn’t acknowledge us at all. I hear voices from the room beyond the door, so we head for those.
We step into a small, square room, as congested with stuff as the alleyway that led here. Another fire-fighter is standing over by the only window. To his left, a vast woman is sitting quietly in an armchair facing us, so shapelessly huge it looks as if the chair is a mould and the woman has been poured into it. She is wearing a silky chemise, her bare arms and legs trunking out of the delicate lacy frills at the four corners. She has painted a thick war stripe of blue eye shadow that runs across the top of her face. Her lips are grey, and as Adam negotiates a path to her to take a closer look, she pre-empts our concern by saying:
‘I’ve painted my lips with ash.’
Adam looks at the fire-fighter, who shrugs, and looks at his watch.
‘Why have you painted your lips with ash?’
‘Because I’m a god.’
‘Oh. Okay. Well, first things first. What’s your name?’
‘Ellie. Ellie Sparrow.’
‘What’s happened here, Ellie? Was there a fire?’
The fireman reports the facts: ‘A Christmas candle with a leather base was put on the radiator and gave off some fumes. Ellie punched the fire alarm, and she says she’s hurt her hand.
Ellie holds up her hand. The fingers are swollen, the nails bitten right back and painted different colours, the knuckles covered with scabs of different ages. In other words, entirely like the uninjured hand, and normal for the patient. Adam examines the hand for movement, sensitivity, cap refill, and everything seems fine.
‘Do you have any medical conditions?’ he asks her, reaching for the paperwork.
‘I’m bi-polar. Where’s my bag? I have to show you something.’
Adam hands her a huge canvas bag. Ellie begins rummaging through it. She pulls out a ceramic pyramid-shaped incense holder. ‘I take that with me everywhere I go.’ She pulls out letters and CDs and a book jacket with a photo of Sting on it. ‘Do you like Sting?’ she says.
‘Ellie – we need to ask you a few questions and do a few tests just to make sure you’re okay. Can we do that?’
She looks up at him. ‘I just want to show you my fake saliva.’ And then – incredibly – she pulls out some medication that clearly says on the box synthetic saliva.
‘I need to have some chocolate.’ Before we can stop her, she produces a big glass bowl from the side of the chair, filled with bars of chocolate, pulls one out, opens it and has it in her mouth with practised economy.
We quickly make the observations that we are duty bound to make. Adam says to her:
‘Ellie. From all that we can see there’s no medical need for you to go to the hospital today.’
‘But I want to go,’ she slurps, wiping her chocolaty mouth with the back of her hand. ‘I’m on my own here. There are voices in the garden. I’m bored.’
‘I’m sorry to hear that,’ he goes on. ‘But none of these are reasons to go to A&E today. The best thing to do would be to make an appointment to see your GP in a day or so.’
‘I’m barred.’
He pauses, then tries another tack. ‘Casualty is full up today, absolutely crammed with drunks because of the New Year. You’ll be waiting for hours if you do go. I really don’t advise it. Plus, you’ll be depriving someone of an ambulance who might really need it.’ She stares up at him, and stops chewing briefly.
‘You know – heart attacks. That kind of thing.’
‘Haven’t you got a lovely speaking voice,’ she says, and gives him a dreadful smile.
‘Okay, Ellie. Do you want to sign the form to say you’re not going in?’
Incredibly, she takes the pen and form, and then makes a signature that’s more like a furious crossing out. She chucks it back at him.
‘Happy Christmas,’ she says, and looks at the fire-fighter, but he is following us out with the same sense of urgency.
We make our way back outside to the truck. The fire crews wave and move off. We sit in the cab, listening to music whilst Adam finishes the paperwork.
After about five minutes Control calls us on the radio. They tell us that Ellie is back on the phone. She says that she needs an ambulance for her hand. Reluctantly we agree to go back in to see her, but before we can get out of the cab she is there on the pavement, staring across at us. We climb out to let her in to the back. The whole ambulance rocks from side to side as she makes her way to the seat. The seat belt will not go round her. I slam the door shut and we set off.
At the hospital we show Ellie to a seat in the minors waiting area. We apologise to the staff nurse for bringing her in, and she accepts our reasons with commendable sangfroid. But A&E is already bursting, and we all know that Ms. Sparrow may well be the (gigantic) straw that breaks the camel’s back.
Monday, December 24, 2007
Ralf's room
The elderly mother appears before us in the hallway, as flattened and fixed by her pain as the cardboard figure of a wraith in a Victorian toy theatre.
‘They’re upstairs’, she whispers. ‘Please hurry. Please help them.’ Her husband wraps her to him and manages a smile as I excuse myself past them and struggle up the narrow staircase.
My bags catch on the crudely wrought statues, dusty fossils and stacks of books that are piled on every step. Annuals and encyclopaedias on each level, a precariously balanced collection with no book published later than the 1960s, and the drawings and paintings on the wall looking like the work of a precocious ten year old.
The message on our terrafix had read: ?Cardiac arrest. Male, aged 53.
On the landing I can hear a woman calling ‘Hello? Over here. In this room.’ I follow the voice into a close and cluttered place. It feels like I’m entering a big red nest spun from raw information, every smallest inch covered with collages, maps and portraits, every standable space occupied by a crudely designed piece of furniture, a statue or a little pile of rocks.
The voice comes from the other side of the unmade bed. A middle-aged woman is kneeling beside the body of a bearded man, his arms raised up in front of him like the pastiche of a sleepwalker.
‘They’re here now’, she says into the phone she is holding, and immediately throws it onto the bed, of no more use to her. She stands up and looks at me.
‘I don’t think you’ll be able to do anything.’
I touch her on the shoulder as I move to take her place. She hooks a loose strand of hair back behind her ear and steps aside for me to have a closer look.
Her brother has been dead for some hours. Even though his torso is still slightly warm, peripherally he is mortally cold; where his pyjamas have ridden up you can see that his skin is adopting the blotchy patches of post mortem staining as his blood pools. Rigor mortis has fixed his arms and legs in position, and his neck holds his head straight back on the pillow. His face has the colour of ruined sausage - a dreadful, mottled puce, and his tongue pokes out between his lips.
‘When was the last time you saw your brother?’ I can’t quite bring myself to say ‘alive’. Not yet.
‘Last night. About eleven. Then when he didn’t come down for breakfast…’ She looks at me and presses her lips together. ‘He’s dead, isn’t he?’
‘I’m afraid he is.’
‘I thought he might be.’
She turns round and brushes her skirt. Then she adds, quite matter of factly, ‘Mother is going to take this hard. She buried her sister last week.’
At that point the mother comes into the room, and the father peers round the door behind her. A delicate, desiccated couple, they stare over at me kneeling beside the bed as if I were the strangest thing, a polite but terrible angel come to visit from the future to pray beside their child.
‘Can you - help him?’ she asks me.
‘I’m very sorry – but there’s nothing we can do. Your son is dead.’
She shapes her mouth around a fathomless howl and shrinks a little into herself. I look away, and stroke the hair from her son’s face. ‘I’m very, very sorry for your loss.’
My colleague tells her that we will put her son back to bed and make him comfortable. The mother has to be supported out of the room by her husband and daughter. We lift her son back onto the mattress, arrange the sheets around him, close his eyes and reposition his arms as best we can. I find a chair and place it beside the bed. I go out onto the landing and ask if the mother wants to come and sit with her son. She lets me lead her to the chair. The father stands beside her, and steadies her as she leans forward to stroke her son’s face. I go downstairs to get some more details from the daughter.
‘They’re upstairs’, she whispers. ‘Please hurry. Please help them.’ Her husband wraps her to him and manages a smile as I excuse myself past them and struggle up the narrow staircase.
My bags catch on the crudely wrought statues, dusty fossils and stacks of books that are piled on every step. Annuals and encyclopaedias on each level, a precariously balanced collection with no book published later than the 1960s, and the drawings and paintings on the wall looking like the work of a precocious ten year old.
The message on our terrafix had read: ?Cardiac arrest. Male, aged 53.
On the landing I can hear a woman calling ‘Hello? Over here. In this room.’ I follow the voice into a close and cluttered place. It feels like I’m entering a big red nest spun from raw information, every smallest inch covered with collages, maps and portraits, every standable space occupied by a crudely designed piece of furniture, a statue or a little pile of rocks.
The voice comes from the other side of the unmade bed. A middle-aged woman is kneeling beside the body of a bearded man, his arms raised up in front of him like the pastiche of a sleepwalker.
‘They’re here now’, she says into the phone she is holding, and immediately throws it onto the bed, of no more use to her. She stands up and looks at me.
‘I don’t think you’ll be able to do anything.’
I touch her on the shoulder as I move to take her place. She hooks a loose strand of hair back behind her ear and steps aside for me to have a closer look.
Her brother has been dead for some hours. Even though his torso is still slightly warm, peripherally he is mortally cold; where his pyjamas have ridden up you can see that his skin is adopting the blotchy patches of post mortem staining as his blood pools. Rigor mortis has fixed his arms and legs in position, and his neck holds his head straight back on the pillow. His face has the colour of ruined sausage - a dreadful, mottled puce, and his tongue pokes out between his lips.
‘When was the last time you saw your brother?’ I can’t quite bring myself to say ‘alive’. Not yet.
‘Last night. About eleven. Then when he didn’t come down for breakfast…’ She looks at me and presses her lips together. ‘He’s dead, isn’t he?’
‘I’m afraid he is.’
‘I thought he might be.’
She turns round and brushes her skirt. Then she adds, quite matter of factly, ‘Mother is going to take this hard. She buried her sister last week.’
At that point the mother comes into the room, and the father peers round the door behind her. A delicate, desiccated couple, they stare over at me kneeling beside the bed as if I were the strangest thing, a polite but terrible angel come to visit from the future to pray beside their child.
‘Can you - help him?’ she asks me.
‘I’m very sorry – but there’s nothing we can do. Your son is dead.’
She shapes her mouth around a fathomless howl and shrinks a little into herself. I look away, and stroke the hair from her son’s face. ‘I’m very, very sorry for your loss.’
My colleague tells her that we will put her son back to bed and make him comfortable. The mother has to be supported out of the room by her husband and daughter. We lift her son back onto the mattress, arrange the sheets around him, close his eyes and reposition his arms as best we can. I find a chair and place it beside the bed. I go out onto the landing and ask if the mother wants to come and sit with her son. She lets me lead her to the chair. The father stands beside her, and steadies her as she leans forward to stroke her son’s face. I go downstairs to get some more details from the daughter.
Thursday, November 08, 2007
coming up for air
I slow down as I turn from the main drag into the street, shut the blue lights off, creep along on the lookout for a man on the pavement. Then up ahead, the familiar one hand waving, one hand holding a mobile phone to the ear; I sprint up to him, grab the torch, and we both climb out to see what’s happened.
The man who is patting his mobile phone away has the sharp chin and tailored suit of a model. This could be a photo shoot, if it was not past three in the morning, in the freezing dark, by a figure groaning up against a wall. The man’s demeanour is equally clean.
‘Thank you so much for coming. This is how I found him. It looks as if he has a nasty head injury. He keeps saying he’s been assaulted.’ And then he adds, as a favour: ‘I’m sorry, but would you mind if I carried on my way? I’m already disastrously overdue.’
I wonder where he could possibly be headed – but smile and thank him for his help. He clips smartly away, and we turn our attention to the patient.
He is curled on his side in a semi-foetal position, making a mewling noise, and screwing his features up into a childish expression of the hurt done to him. Rae tries to get him to talk, whilst I use the torch to look him over and establish the nature and extent of his injuries. He has a small gash on the crown of his head and some minor abrasions on his torso, but nothing serious. He reeks of alcohol and unwashed clothes; on the face of it, here is a drunk who has fallen and caught his head on the wall, but we need to find out more.
‘They beat me up! They beat me up! Why would they do that?’ he cries. But, strangely, his tone then turns completely around in an instant and he says, quite conversationally, ‘You seem nice. Do you like what you do for a living?’
We help him to his feet, and he stands competently enough.
At this point the police arrive in two cars, and the scene takes on a much brisker, more official demeanour, with blue and white police tape around where the man had been lying, and someone with a notebook writing things down.
‘What are the nature of the patient’s injuries?’, a policewoman asks me. ‘Was he attacked? Is he going to hospital?’
I tell her that we’ve found out his name – Darren – but apart from a rough outline of his injuries, we haven’t found out exactly what happened to him yet. I tell her that we’ll give him a thorough examination on the vehicle and let her know. We half prop, half pull him up the stairs of the ambulance and sit him in a side seat.
He is effusively grateful. I keep having to tell him to keep still whilst I take some obs and begin cleaning his head wound. His behaviour is bizarre – obviously influenced heavily by alcohol, but something else, too. Drugs? Head Injury? He certainly struggles to answer any of our questions, but instead repeats himself constantly, telling Rae she’s nice and asking her if she likes her job. He also drops into a clownish version of despair every now and again.
‘Why would anyone want to beat me up?’ he wails. ‘Why? Why?’
And then, smiling, as an afterthought, brushing some bloody hair from his face: ‘It’s so important to like what you do.’
Just then another policeman knocks on the door, and asks me to step outside for a moment. Rae is happy to carry on with the examination, but as I get up the policeman gestures for the policewoman to take my place. He obviously has some concerns, so I swap places and jump down to talk to him.
‘I know this guy. He’s a piece of work. He lives in a lovely house just round the corner. Absolutely loaded. Used to be a diver, working rigs in the Far East, Africa – you name it. I’ve been out to him a couple of times, always domestic violence. He’s got several convictions for assaults and generally drunk and disorderly.’
When I re-open the back of the vehicle, Rae gives me a look to let me know that although she hasn’t got the whole picture, she understands that a police escort in the back is necessary. I shut the door again and we set off for the hospital. I can hear Darren telling the policewoman how beautiful she is, and then in a moan that he hasn’t done anything wrong.
At the hospital it transpires that Darren is known to the staff. Another regular to add to the list. One of the nurses tells me that I should see the CT Scan of his head one day. Apparently his ventricles are so dilated by the effects of alcohol abuse it’s like someone’s been at his brains with an ice-cream scoop.
‘It’s a wonder he can function at all,’ she smiles.
As we wheel him into a cubicle, Darren raises himself up on his forearms. He looks up at the policewoman and squeezes one eye shut in the gross approximation of a wink.
‘We had a job once. In Japan. No-one knew a thing about it. We had to locate four hundred tonnes of gold bullion. We stayed in that chamber a month.’
He settles himself back down onto the trolley.
‘You’ve got some stories,’ the policewoman tells him. But he looks back up at her, without the slightest recognition at all.
The man who is patting his mobile phone away has the sharp chin and tailored suit of a model. This could be a photo shoot, if it was not past three in the morning, in the freezing dark, by a figure groaning up against a wall. The man’s demeanour is equally clean.
‘Thank you so much for coming. This is how I found him. It looks as if he has a nasty head injury. He keeps saying he’s been assaulted.’ And then he adds, as a favour: ‘I’m sorry, but would you mind if I carried on my way? I’m already disastrously overdue.’
I wonder where he could possibly be headed – but smile and thank him for his help. He clips smartly away, and we turn our attention to the patient.
He is curled on his side in a semi-foetal position, making a mewling noise, and screwing his features up into a childish expression of the hurt done to him. Rae tries to get him to talk, whilst I use the torch to look him over and establish the nature and extent of his injuries. He has a small gash on the crown of his head and some minor abrasions on his torso, but nothing serious. He reeks of alcohol and unwashed clothes; on the face of it, here is a drunk who has fallen and caught his head on the wall, but we need to find out more.
‘They beat me up! They beat me up! Why would they do that?’ he cries. But, strangely, his tone then turns completely around in an instant and he says, quite conversationally, ‘You seem nice. Do you like what you do for a living?’
We help him to his feet, and he stands competently enough.
At this point the police arrive in two cars, and the scene takes on a much brisker, more official demeanour, with blue and white police tape around where the man had been lying, and someone with a notebook writing things down.
‘What are the nature of the patient’s injuries?’, a policewoman asks me. ‘Was he attacked? Is he going to hospital?’
I tell her that we’ve found out his name – Darren – but apart from a rough outline of his injuries, we haven’t found out exactly what happened to him yet. I tell her that we’ll give him a thorough examination on the vehicle and let her know. We half prop, half pull him up the stairs of the ambulance and sit him in a side seat.
He is effusively grateful. I keep having to tell him to keep still whilst I take some obs and begin cleaning his head wound. His behaviour is bizarre – obviously influenced heavily by alcohol, but something else, too. Drugs? Head Injury? He certainly struggles to answer any of our questions, but instead repeats himself constantly, telling Rae she’s nice and asking her if she likes her job. He also drops into a clownish version of despair every now and again.
‘Why would anyone want to beat me up?’ he wails. ‘Why? Why?’
And then, smiling, as an afterthought, brushing some bloody hair from his face: ‘It’s so important to like what you do.’
Just then another policeman knocks on the door, and asks me to step outside for a moment. Rae is happy to carry on with the examination, but as I get up the policeman gestures for the policewoman to take my place. He obviously has some concerns, so I swap places and jump down to talk to him.
‘I know this guy. He’s a piece of work. He lives in a lovely house just round the corner. Absolutely loaded. Used to be a diver, working rigs in the Far East, Africa – you name it. I’ve been out to him a couple of times, always domestic violence. He’s got several convictions for assaults and generally drunk and disorderly.’
When I re-open the back of the vehicle, Rae gives me a look to let me know that although she hasn’t got the whole picture, she understands that a police escort in the back is necessary. I shut the door again and we set off for the hospital. I can hear Darren telling the policewoman how beautiful she is, and then in a moan that he hasn’t done anything wrong.
At the hospital it transpires that Darren is known to the staff. Another regular to add to the list. One of the nurses tells me that I should see the CT Scan of his head one day. Apparently his ventricles are so dilated by the effects of alcohol abuse it’s like someone’s been at his brains with an ice-cream scoop.
‘It’s a wonder he can function at all,’ she smiles.
As we wheel him into a cubicle, Darren raises himself up on his forearms. He looks up at the policewoman and squeezes one eye shut in the gross approximation of a wink.
‘We had a job once. In Japan. No-one knew a thing about it. We had to locate four hundred tonnes of gold bullion. We stayed in that chamber a month.’
He settles himself back down onto the trolley.
‘You’ve got some stories,’ the policewoman tells him. But he looks back up at her, without the slightest recognition at all.
Friday, November 02, 2007
moving on
Red car. Man slumped at wheel sounds interesting. It’s a minute from the ambulance station, too – a rough strip of road that cuts through a spread of allotments just above the cemetery, a rat-run between main routes. It’s the city’s shabby little version of Mulholland Drive, with sheds instead of penthouses; at night it’s like flying out above the city towards the sea.
Just as Rae turns the engine over and I write down the incident number and location, Control tells us that the police will be attending. At the same moment a patrol car rushes past the station exit up the hill.
‘Damn’, says Rae. ‘I wanted to get there first.’ She slams out of the car park and away after them.
Turning into the Drive I can see the splashing blues of the police car a little way off in the distance. As we careen along the poorly lit road, our blue lights tag after theirs, and we become mad paparazzi in the dark, wasting our film on some chain fencing, a group of kids, that tree.
They pull over behind a sports car without lights on the right hand side of the road. Rae hauls up immediately alongside. If the man has had a heart attack, time is everything, and we can worry about parking niceties afterwards. We both jump out. There’s a policewoman standing at the driver’s door. Rae goes to that one, and I pull open the passenger door and look inside.
As always on an incident – especially with high adrenalin calls, and especially at night – the details come to you in bursts. The challenge is to make sense of the scene as calmly and quickly as you can. Simple questions: Is there danger here? What’s happened? But although simple questions work best with simple answers, it’s an effort of concentration to ignore the peripheral and make straight to the essential.
In this case, the essential seem to be: a middle-aged man with facial injuries, conscious and breathing; car cold and not smelling of fumes; no sign of weapons.
Rae is the other side of him, now. We have him in a cramped little cross-fire of inquiry, both verbal and non-verbal. A torch to have a good look.
He smells of drink. I’m about to kneel in a pizza box. The back seat is rammed with clothes, other stuff. He can tell us his name, but is disorientated and slurred. Drunk? Or head injury? Is he sleeping rough in this car and has been beaten up? By those kids we passed?
A second patrol car has arrived. They are standing outside the car, one on the radio trying to get information on the licence plate, the others chatting about other things. There is a palpable sense of stepping back two or three levels from screaming emergency to Thursday night mystery. Who is he?
We help him out of the car. He is a heavily built man with a coarse goatee beard and an Eastern European accent. He is dressed like a shabby professor in a T-shirt that says: Don’t ask me to do anything. I’m retired, beneath a brown corduroy jacket.
‘I’m okay,’ he slurs, almost falling backwards as we manoeuvre him up the back step into the ambulance. We sit him down, shut the door, and take a breath.
‘Now then, let’s have a good look at you.’
His facial injuries are old, probably a few days, but it does look as if he had a beating. His nose is certainly broken. And he is definitely drunk. He has that slow, deep-and-off-to-the-side detachment from everything. He looks at his hands to move them. When I ask him for his surname he spells it out one fat letter at a time as if this is the first time he has ever really considered what his surname was or could mean.
‘B-u-r-o-w-s.’
‘Burows?’ I say, just as he continues with a K and an I.
‘Burowski?’
He nods. We have arrived somewhere awful and he squeezes his eyes. Another policewoman looks into the back and tells us that they have to go off on another call and are we okay? I tell her we are. She shuts the back door again, and we are left to piece his story together.
He is from Poland. He has been living in the city for ten years. His girlfriend has left him. His friends – he shrugs. His life – he makes a sad little gesture with both hands down towards the floor, like a man in handcuffs being dragged down a well. He had an accident three days ago and was in hospital until this morning. He is sleeping in the car. He thinks he’ll call his brother in Poland in the morning. Maybe he should move back there.
He looks steadily at me as I undo the blood pressure cuff.
‘You came at the wrong time,’ he says.
I tell him that we think he should come with us to hospital for observation, because he’s had a recent head injury and we can’t be sure that his current condition is solely due to alcohol. But he does not want to go to hospital. He wants to get back into his car and go to sleep. So reluctantly we end up helping him back off the vehicle, and when we say goodbye he is standing with his driver’s door open, nodding a farewell – which would, in any other circumstance, be a normal scene, except here when we leave it will be very dark, and the night is coming down cold, and all four tyres on his little red sports car are flat.
Just as Rae turns the engine over and I write down the incident number and location, Control tells us that the police will be attending. At the same moment a patrol car rushes past the station exit up the hill.
‘Damn’, says Rae. ‘I wanted to get there first.’ She slams out of the car park and away after them.
Turning into the Drive I can see the splashing blues of the police car a little way off in the distance. As we careen along the poorly lit road, our blue lights tag after theirs, and we become mad paparazzi in the dark, wasting our film on some chain fencing, a group of kids, that tree.
They pull over behind a sports car without lights on the right hand side of the road. Rae hauls up immediately alongside. If the man has had a heart attack, time is everything, and we can worry about parking niceties afterwards. We both jump out. There’s a policewoman standing at the driver’s door. Rae goes to that one, and I pull open the passenger door and look inside.
As always on an incident – especially with high adrenalin calls, and especially at night – the details come to you in bursts. The challenge is to make sense of the scene as calmly and quickly as you can. Simple questions: Is there danger here? What’s happened? But although simple questions work best with simple answers, it’s an effort of concentration to ignore the peripheral and make straight to the essential.
In this case, the essential seem to be: a middle-aged man with facial injuries, conscious and breathing; car cold and not smelling of fumes; no sign of weapons.
Rae is the other side of him, now. We have him in a cramped little cross-fire of inquiry, both verbal and non-verbal. A torch to have a good look.
He smells of drink. I’m about to kneel in a pizza box. The back seat is rammed with clothes, other stuff. He can tell us his name, but is disorientated and slurred. Drunk? Or head injury? Is he sleeping rough in this car and has been beaten up? By those kids we passed?
A second patrol car has arrived. They are standing outside the car, one on the radio trying to get information on the licence plate, the others chatting about other things. There is a palpable sense of stepping back two or three levels from screaming emergency to Thursday night mystery. Who is he?
We help him out of the car. He is a heavily built man with a coarse goatee beard and an Eastern European accent. He is dressed like a shabby professor in a T-shirt that says: Don’t ask me to do anything. I’m retired, beneath a brown corduroy jacket.
‘I’m okay,’ he slurs, almost falling backwards as we manoeuvre him up the back step into the ambulance. We sit him down, shut the door, and take a breath.
‘Now then, let’s have a good look at you.’
His facial injuries are old, probably a few days, but it does look as if he had a beating. His nose is certainly broken. And he is definitely drunk. He has that slow, deep-and-off-to-the-side detachment from everything. He looks at his hands to move them. When I ask him for his surname he spells it out one fat letter at a time as if this is the first time he has ever really considered what his surname was or could mean.
‘B-u-r-o-w-s.’
‘Burows?’ I say, just as he continues with a K and an I.
‘Burowski?’
He nods. We have arrived somewhere awful and he squeezes his eyes. Another policewoman looks into the back and tells us that they have to go off on another call and are we okay? I tell her we are. She shuts the back door again, and we are left to piece his story together.
He is from Poland. He has been living in the city for ten years. His girlfriend has left him. His friends – he shrugs. His life – he makes a sad little gesture with both hands down towards the floor, like a man in handcuffs being dragged down a well. He had an accident three days ago and was in hospital until this morning. He is sleeping in the car. He thinks he’ll call his brother in Poland in the morning. Maybe he should move back there.
He looks steadily at me as I undo the blood pressure cuff.
‘You came at the wrong time,’ he says.
I tell him that we think he should come with us to hospital for observation, because he’s had a recent head injury and we can’t be sure that his current condition is solely due to alcohol. But he does not want to go to hospital. He wants to get back into his car and go to sleep. So reluctantly we end up helping him back off the vehicle, and when we say goodbye he is standing with his driver’s door open, nodding a farewell – which would, in any other circumstance, be a normal scene, except here when we leave it will be very dark, and the night is coming down cold, and all four tyres on his little red sports car are flat.
Thursday, November 01, 2007
drain
‘Don’t you dare look at me – aren’t you nice? – you’ve seen worse - I haven’t got my teeth in – toy boy like you – what’s your name? – I had a man who wanted to see me again – he was only forty four – I said I’m seventy three – he said I don’t care - just don’t look at me – oh, I do feel dizzy...’
We are sitting like disciples around her, Rae, me and the psychiatric nurse who called us out this morning. We nod and smile sympathetically, but we are mutely aware that our collective life force is being leached away by this woman. If people can really be classified as either radiators or drains, this woman is an oceanic trench. Her monologue is a hypnotically plosive drone, her wrinkled mouth wobbling around the words, her light blue eyes flicking open only occasionally to see if there are still people alive in the room.
The psychiatric nurse smiles at us, and taps her diary encouragingly, directing us back to the idea that time still exists outside this room.
‘Dotty did seem a little breathless and out of sorts when I got here. Sorry if I’ve called you out unnecessarily.’
She opens her diary and writes something in it. I hand Rae the blister pack that contains all Dotty’s medication so she can write it down on the patient report form. There is a crudely written note by the pack – a list of things to do. At the top of the list is 'put teeth in mouth'.
I stand up and approach Dotty to make the serial observations; I feel like an astronaut, bravely alone, moving towards the thrumming source.
‘…That’s the first time I’ve been touched by a man in a long while – oh, I’m getting a funny feeling in my arm – should I take my top off? - my first husband didn’t want to know – left me alone – not this house, another one - when I had my first he was nowhere – it was supposed to be the last baby on Christmas Day – they said ‘when’s it coming then, Dotty?’ – I said, 'there’s something not right,' – I could feel the elbows digging in – then it was the next day – and the next – no-one listened to me – no-one believed me – and then when it came out it took most of me with it – I was in for weeks – stitched me up with an infection and everything turning black…’
Occasionally Dotty pats her head, which is tightly wrapped in a transparent plastic bonnet. It’s as if you can see her brains – yellowing, tightly curled. Her hands are a puffy red, because she spends most of her day at the sink continually washing them.
I finish the health check and everything is fine. Rae patiently begins the build-up to our leaving, weaving in little encouragements and pieces of advice between Dotty’s constant output.
‘….what if I go unconscious? – what happens if I fall over? – at least you didn’t leave the door open – I used to have a dog, but he ran away – the last ambulance who came out left the door open – they pulled faces at me and didn’t give a damn – you’re all nice, though – especially you – oh, listen to me – did I say that? - everything’s swimming – I suppose you’re going, too, now….?’
I pack our equipment away and back away, nodding and smiling, through the door. The psychiatric nurse, clutching her diary like a bible, throws us a brave smile as we go.
We are sitting like disciples around her, Rae, me and the psychiatric nurse who called us out this morning. We nod and smile sympathetically, but we are mutely aware that our collective life force is being leached away by this woman. If people can really be classified as either radiators or drains, this woman is an oceanic trench. Her monologue is a hypnotically plosive drone, her wrinkled mouth wobbling around the words, her light blue eyes flicking open only occasionally to see if there are still people alive in the room.
The psychiatric nurse smiles at us, and taps her diary encouragingly, directing us back to the idea that time still exists outside this room.
‘Dotty did seem a little breathless and out of sorts when I got here. Sorry if I’ve called you out unnecessarily.’
She opens her diary and writes something in it. I hand Rae the blister pack that contains all Dotty’s medication so she can write it down on the patient report form. There is a crudely written note by the pack – a list of things to do. At the top of the list is 'put teeth in mouth'.
I stand up and approach Dotty to make the serial observations; I feel like an astronaut, bravely alone, moving towards the thrumming source.
‘…That’s the first time I’ve been touched by a man in a long while – oh, I’m getting a funny feeling in my arm – should I take my top off? - my first husband didn’t want to know – left me alone – not this house, another one - when I had my first he was nowhere – it was supposed to be the last baby on Christmas Day – they said ‘when’s it coming then, Dotty?’ – I said, 'there’s something not right,' – I could feel the elbows digging in – then it was the next day – and the next – no-one listened to me – no-one believed me – and then when it came out it took most of me with it – I was in for weeks – stitched me up with an infection and everything turning black…’
Occasionally Dotty pats her head, which is tightly wrapped in a transparent plastic bonnet. It’s as if you can see her brains – yellowing, tightly curled. Her hands are a puffy red, because she spends most of her day at the sink continually washing them.
I finish the health check and everything is fine. Rae patiently begins the build-up to our leaving, weaving in little encouragements and pieces of advice between Dotty’s constant output.
‘….what if I go unconscious? – what happens if I fall over? – at least you didn’t leave the door open – I used to have a dog, but he ran away – the last ambulance who came out left the door open – they pulled faces at me and didn’t give a damn – you’re all nice, though – especially you – oh, listen to me – did I say that? - everything’s swimming – I suppose you’re going, too, now….?’
I pack our equipment away and back away, nodding and smiling, through the door. The psychiatric nurse, clutching her diary like a bible, throws us a brave smile as we go.
Wednesday, October 10, 2007
start to finish
‘Help me!’
As we push our way into the cluttered bedroom the elderly woman slumped on the edge by the head end throws us a look pressed with fear. She is such a ghastly white colour, and the sheen of sweat on her face and body is so immediately apparent, that without saying anything to each other Rae and I cut the usual preambles and set to work more quickly. The woman has cans of oxygen – trendy looking things advertising pastel peach and jasmine flavours – scattered around her across the rumpled duvet. I ask the intensely worried man who gestures for us to go ahead of him into the room what his wife’s name is.
‘Elsie’
‘And how long has Elsie been like this?’
‘Fifteen years.’ Then he realises what he has said. ‘But not as bad as this, of course.’
‘Help me, please!’, she gasps.
Simply getting round to her is difficult; getting her into the chair will be a struggle. And from the way her abdomen balloons out underneath her soaked nightie, the two flights of stairs and the dark jaunt across the lawn will be a serious challenge.
I pull out our oxygen cylinder from the resus bag and fit a mask together as quickly as I can. Rae establishes that Elsie does not have chest pain at the moment, does suffer with angina, has been breathless all day but acutely short of breath for about half an hour. I step over the piles of clothes, books and boxes to put the mask on her, but she wrests it away, saying that she can’t have her face covered.
‘I’m scared,’ she whispers. ‘Please!’
Rae holds the mask back up and insists she wear it. Meanwhile I put the carry chair together and get in as close to her as I can; Elsie looks at the chair, gathers up a clutch of bedclothes around her and refuses to move. Rae talks to her severely, parent to child.
‘Listen to me, Elsie. Listen, now. You must do as we tell you. If you want help, you have to get into the chair and let us take you down to the vehicle. The sooner you move, the sooner we can get you the help you need.’
Despite her whimpering, and with anxious entreaties from her husband the other side of the bed, we haul her up and into the chair. She has pulled the mask off again. The oxygen hisses vainly into the air. Rae wrestles it back onto her face as I blanket her as best I can from behind. We know that Elsie is combative because her brain is being starved of oxygen. It’s a struggle to move this situation along, and we are aware of the clock ticking.
‘Can you take the bags down for us?’ I ask the husband. His big, crescent moustache, yellow with nicotine, emphasises the mournful expression in his eyes.
‘No. They look heavy. I’m not well myself, you know.’
‘Okay. Don’t worry,’ I tell him, measuring out this effort of control word by word.
Rae grabs the bags, takes them to the head of the stairs, throws them down to the first landing, then comes back to help move the chair. Elsie is at the limit of our lifting ability, but the adrenalin of the situation gives us the extra power we need. Down onto the first landing, I steady the chair whilst Rae throws the bags down into the lobby. A neighbour has come out to see what all the noise is about.
‘Can you collect our bags and carry them out to the vehicle for us?’ I shout down to him.
‘Sure. I’ll just get my shoes on.’
Every little detail is in sharp focus. How each factor may help or hinder us.
We have Elsie outside now. When her breath allows she gives fearful moans. I drag the chair backwards across the lawn. It’s good to be outside; my shirt is already sticking to me. At the back of the vehicle I move the chair into position, climb into the back, and we dead lift Elsie inside. Alongside the trolley, Elsie refuses to move out of the chair.
‘Look at me, Elsie. We can’t go anywhere until you get onto the trolley. You have to do this. We’ll help.’
We count one, two, three, I tilt the chair forwards, and we manhandle Elsie’s bulk onto the trolley. I pull the chair off to the side and then with shaking hands find a nebulising mask and a couple of vials of salbutamol and atrovent to help ease her breathing.
Rae says: ‘She’s gonna go on us.’
I fumble, trying to work even more quickly, but then:
‘She’s gone.’
At the same time Rae has dropped the trolley into a flat position and thumped Elsie in the middle of the chest. The back of the vehicle opens and the husband peers inside.
‘Can you shut the door please?’ Rae shouts over her shoulder. He retreats.
I throw the mask and drugs to the side and pull an airway out of a side drawer whilst Rae rips Elsie’s nightie apart and slaps some defib pads on her. I try to get the airway into Elsie’s mouth, but her jaw is locked tight – probably a hypoxic fit. I toss that aside in favour of an airway that goes down through the nose, as Rae looks at the ECG – some waveforms, but there is no pulse, a condition called PEA, or pulseless electrical activity, which is, in effect, no activity at all. I pull the BVM out of the resus bag and start trying to force air into Elsie, but her airway is blocked. Rae interrupts the chest compressions she has been doing to flick the aspirator on so that we can suck out the vomit that’s clogging up her airway. As we do all this we discuss our options – Rae needs to cannulate so she can start up with the necessary drug therapy; she also needs to intubate, which we know will be difficult as Elsie has such a short, fat neck. We also need to call for back up. I take over compressions and ventilations whilst Rae gets her equipment out. She cannulates quickly, blood spilling onto the floor. These are hurried, pressurised moves. We are aware of Elsie’s husband waiting outside the vehicle, but awareness is all that we have at the moment. There is no time for sympathy. I interrupt CPR just briefly to help Rae try to visualise the vocal chords, but two attempts both fail – the tube goes down into Elsie’s stomach, and trial ventilations only serve to drive up more vomit – more to suck out. Rae takes on the CPR whilst I jump out of the side door and climb into the cab to radio for assistance. I punch the priority button, and when Control answers I simply say:
Resus in progress on the back of the vehicle. Back up to this address, please.
As we push our way into the cluttered bedroom the elderly woman slumped on the edge by the head end throws us a look pressed with fear. She is such a ghastly white colour, and the sheen of sweat on her face and body is so immediately apparent, that without saying anything to each other Rae and I cut the usual preambles and set to work more quickly. The woman has cans of oxygen – trendy looking things advertising pastel peach and jasmine flavours – scattered around her across the rumpled duvet. I ask the intensely worried man who gestures for us to go ahead of him into the room what his wife’s name is.
‘Elsie’
‘And how long has Elsie been like this?’
‘Fifteen years.’ Then he realises what he has said. ‘But not as bad as this, of course.’
‘Help me, please!’, she gasps.
Simply getting round to her is difficult; getting her into the chair will be a struggle. And from the way her abdomen balloons out underneath her soaked nightie, the two flights of stairs and the dark jaunt across the lawn will be a serious challenge.
I pull out our oxygen cylinder from the resus bag and fit a mask together as quickly as I can. Rae establishes that Elsie does not have chest pain at the moment, does suffer with angina, has been breathless all day but acutely short of breath for about half an hour. I step over the piles of clothes, books and boxes to put the mask on her, but she wrests it away, saying that she can’t have her face covered.
‘I’m scared,’ she whispers. ‘Please!’
Rae holds the mask back up and insists she wear it. Meanwhile I put the carry chair together and get in as close to her as I can; Elsie looks at the chair, gathers up a clutch of bedclothes around her and refuses to move. Rae talks to her severely, parent to child.
‘Listen to me, Elsie. Listen, now. You must do as we tell you. If you want help, you have to get into the chair and let us take you down to the vehicle. The sooner you move, the sooner we can get you the help you need.’
Despite her whimpering, and with anxious entreaties from her husband the other side of the bed, we haul her up and into the chair. She has pulled the mask off again. The oxygen hisses vainly into the air. Rae wrestles it back onto her face as I blanket her as best I can from behind. We know that Elsie is combative because her brain is being starved of oxygen. It’s a struggle to move this situation along, and we are aware of the clock ticking.
‘Can you take the bags down for us?’ I ask the husband. His big, crescent moustache, yellow with nicotine, emphasises the mournful expression in his eyes.
‘No. They look heavy. I’m not well myself, you know.’
‘Okay. Don’t worry,’ I tell him, measuring out this effort of control word by word.
Rae grabs the bags, takes them to the head of the stairs, throws them down to the first landing, then comes back to help move the chair. Elsie is at the limit of our lifting ability, but the adrenalin of the situation gives us the extra power we need. Down onto the first landing, I steady the chair whilst Rae throws the bags down into the lobby. A neighbour has come out to see what all the noise is about.
‘Can you collect our bags and carry them out to the vehicle for us?’ I shout down to him.
‘Sure. I’ll just get my shoes on.’
Every little detail is in sharp focus. How each factor may help or hinder us.
We have Elsie outside now. When her breath allows she gives fearful moans. I drag the chair backwards across the lawn. It’s good to be outside; my shirt is already sticking to me. At the back of the vehicle I move the chair into position, climb into the back, and we dead lift Elsie inside. Alongside the trolley, Elsie refuses to move out of the chair.
‘Look at me, Elsie. We can’t go anywhere until you get onto the trolley. You have to do this. We’ll help.’
We count one, two, three, I tilt the chair forwards, and we manhandle Elsie’s bulk onto the trolley. I pull the chair off to the side and then with shaking hands find a nebulising mask and a couple of vials of salbutamol and atrovent to help ease her breathing.
Rae says: ‘She’s gonna go on us.’
I fumble, trying to work even more quickly, but then:
‘She’s gone.’
At the same time Rae has dropped the trolley into a flat position and thumped Elsie in the middle of the chest. The back of the vehicle opens and the husband peers inside.
‘Can you shut the door please?’ Rae shouts over her shoulder. He retreats.
I throw the mask and drugs to the side and pull an airway out of a side drawer whilst Rae rips Elsie’s nightie apart and slaps some defib pads on her. I try to get the airway into Elsie’s mouth, but her jaw is locked tight – probably a hypoxic fit. I toss that aside in favour of an airway that goes down through the nose, as Rae looks at the ECG – some waveforms, but there is no pulse, a condition called PEA, or pulseless electrical activity, which is, in effect, no activity at all. I pull the BVM out of the resus bag and start trying to force air into Elsie, but her airway is blocked. Rae interrupts the chest compressions she has been doing to flick the aspirator on so that we can suck out the vomit that’s clogging up her airway. As we do all this we discuss our options – Rae needs to cannulate so she can start up with the necessary drug therapy; she also needs to intubate, which we know will be difficult as Elsie has such a short, fat neck. We also need to call for back up. I take over compressions and ventilations whilst Rae gets her equipment out. She cannulates quickly, blood spilling onto the floor. These are hurried, pressurised moves. We are aware of Elsie’s husband waiting outside the vehicle, but awareness is all that we have at the moment. There is no time for sympathy. I interrupt CPR just briefly to help Rae try to visualise the vocal chords, but two attempts both fail – the tube goes down into Elsie’s stomach, and trial ventilations only serve to drive up more vomit – more to suck out. Rae takes on the CPR whilst I jump out of the side door and climb into the cab to radio for assistance. I punch the priority button, and when Control answers I simply say:
Resus in progress on the back of the vehicle. Back up to this address, please.
I hear them say that support is on its way from quite a distance. It will be a judgement call whether to run as we are or stay and wait for help.
Fifteen minutes later and the second crew is with us around the patient. The back of the vehicle looks just as if it the ambulance had rolled down an embankment and landed back on its wheels. There are empty syringes, dressings, tubes and blankets scattered around us. Elsie is spread massively across the trolley, arms and legs over the sides. In any other context you would think that this was simply a restless sleeper, but here, in this cramped and clinical chaos, the posture is the undignified sprawl of death.
The second paramedic agrees that the cardiac rhythms we are seeing on the ECG are the random firings of a heart artificially goaded by the chemicals we have shot into her. There is nothing viable here, but we all decide to run to hospital anyway. The other technician says she will take the husband in her ambulance. I jump out into the cab for the second time, pass a brief summary of the situation through to Control, and then drive on blue lights to hospital.
‘My God! This couldn’t be any more difficult!’
The medical registrar at the hospital has climbed on board to assess Elsie. He picks his way through the detritus of the incident with the fastidiousness of someone simply used to more room.
‘I can’t imagine having to intubate in these circumstances. And I have to agree with you – this patient is a definite Category Four.’ This means that even in an operating theatre, using fibre-optics, they would intubate with difficulty. Elsie is declared dead, and the form signed.
When the second ambulance arrives a few minutes behind us, the charge nurse takes the husband to the relatives’ room, gives him a cup of tea, and prepares him for the worst. The nurse tells us afterwards that he had said: ‘I know. I saw them jumping up and down on her chest. I knew it wasn’t good.’
Rae and I realise that the husband will want to see Elsie before we take her off to the Mortuary, so we tidy her up as best we can, and make the vehicle presentable. When we are ready, we send word to the nurse, and he leads him out. We help him onto the vehicle, and he collapses in tears across her. We leave them alone for ten minutes or so, then we help him into a chair to talk about what happened and what we tried to do. We tell him what to expect now, and leave him in the care of the charge nurse.
Fifteen minutes later and the second crew is with us around the patient. The back of the vehicle looks just as if it the ambulance had rolled down an embankment and landed back on its wheels. There are empty syringes, dressings, tubes and blankets scattered around us. Elsie is spread massively across the trolley, arms and legs over the sides. In any other context you would think that this was simply a restless sleeper, but here, in this cramped and clinical chaos, the posture is the undignified sprawl of death.
The second paramedic agrees that the cardiac rhythms we are seeing on the ECG are the random firings of a heart artificially goaded by the chemicals we have shot into her. There is nothing viable here, but we all decide to run to hospital anyway. The other technician says she will take the husband in her ambulance. I jump out into the cab for the second time, pass a brief summary of the situation through to Control, and then drive on blue lights to hospital.
‘My God! This couldn’t be any more difficult!’
The medical registrar at the hospital has climbed on board to assess Elsie. He picks his way through the detritus of the incident with the fastidiousness of someone simply used to more room.
‘I can’t imagine having to intubate in these circumstances. And I have to agree with you – this patient is a definite Category Four.’ This means that even in an operating theatre, using fibre-optics, they would intubate with difficulty. Elsie is declared dead, and the form signed.
When the second ambulance arrives a few minutes behind us, the charge nurse takes the husband to the relatives’ room, gives him a cup of tea, and prepares him for the worst. The nurse tells us afterwards that he had said: ‘I know. I saw them jumping up and down on her chest. I knew it wasn’t good.’
Rae and I realise that the husband will want to see Elsie before we take her off to the Mortuary, so we tidy her up as best we can, and make the vehicle presentable. When we are ready, we send word to the nurse, and he leads him out. We help him onto the vehicle, and he collapses in tears across her. We leave them alone for ten minutes or so, then we help him into a chair to talk about what happened and what we tried to do. We tell him what to expect now, and leave him in the care of the charge nurse.
It’s just after midnight. I ring the on-call Mortuary Attendant. He tells me that we are to admit the patient ourselves. We drive back to base and collect the keys, then head out to the Mortuary, which is located at the end of a discrete driveway inside a large municipal graveyard.
Inside the Mortuary there is bank of fridge cabinets four high and five deep, with a separate section for longer term residents. Each occupied compartment has a label in the door; we identify an empty compartment, then I fetch over the mortuary forklift – something like a pallet truck, with a large white tray suspended in front of it. I raise it up level with our trolley, and with some effort we roll Elsie on to it. Rae goes over to a Victorian-looking ledger, and I shout out the items of jewellery that Elsie is wearing for her to write down. Gold watch, gold chain, wedding ring, ear rings. Her bag of medication, slippers and other things we put in a bag and place this on the tray between her legs. I tie a label to Elsie’s left big toe: her name, date of birth etc. Another label goes in the door. Then I manipulate the forklift into position, and open the door. There is a hard, metallic smell to the fridge, something like a cold, well-cleaned butcher’s stock room. We count to three and then slide her in, feet first. Her arm lolls out to her right, so I reach in to replace it by her side. It lolls back out again. It won’t catch in anything, and I can’t think how to secure it, so I leave it there. The other people in the fridge are all wrapped in white plastic, with only their heads showing, but we haven’t the time or the expertise to do this with Elsie. She will have to wait the few hours till morning. I move the forklift back, and we shut the door. It swings to with a clunk.
Inside the Mortuary there is bank of fridge cabinets four high and five deep, with a separate section for longer term residents. Each occupied compartment has a label in the door; we identify an empty compartment, then I fetch over the mortuary forklift – something like a pallet truck, with a large white tray suspended in front of it. I raise it up level with our trolley, and with some effort we roll Elsie on to it. Rae goes over to a Victorian-looking ledger, and I shout out the items of jewellery that Elsie is wearing for her to write down. Gold watch, gold chain, wedding ring, ear rings. Her bag of medication, slippers and other things we put in a bag and place this on the tray between her legs. I tie a label to Elsie’s left big toe: her name, date of birth etc. Another label goes in the door. Then I manipulate the forklift into position, and open the door. There is a hard, metallic smell to the fridge, something like a cold, well-cleaned butcher’s stock room. We count to three and then slide her in, feet first. Her arm lolls out to her right, so I reach in to replace it by her side. It lolls back out again. It won’t catch in anything, and I can’t think how to secure it, so I leave it there. The other people in the fridge are all wrapped in white plastic, with only their heads showing, but we haven’t the time or the expertise to do this with Elsie. She will have to wait the few hours till morning. I move the forklift back, and we shut the door. It swings to with a clunk.
Thursday, October 04, 2007
manhattan by night
We’ve just cleared up from our first job of the evening, way out in Oldport. A man had been dancing along the pavement outside his house, playing his tin whistle, when he fell down an uncovered manhole and scraped his shin. I was surprised that he escaped with such minor injuries. He lay contentedly sprawled on some tie-dye cushions like some down-at-heel sultan whilst his girlfriend talked – with worrying intensity – about infection, fractures, compartment syndrome. I had cleaned the graze and offered some reassurance whilst the man stroked his wispy black beard and stared down at me lovingly.
Back in the cab, finishing off the paperwork, I put the cab light on. The grey evening sky is plump with rain; thick spots begin to rattle down on the cab. And then a red call comes through on the terrafix: along with the address, the description of the problem reads Man with bag on head. We laugh, just as Control calls up on the radio asking us to advise and assess as this patient is possibly deceased. I ask for the police to attend as well; Control tells me that they are already en route.
Back in the cab, finishing off the paperwork, I put the cab light on. The grey evening sky is plump with rain; thick spots begin to rattle down on the cab. And then a red call comes through on the terrafix: along with the address, the description of the problem reads Man with bag on head. We laugh, just as Control calls up on the radio asking us to advise and assess as this patient is possibly deceased. I ask for the police to attend as well; Control tells me that they are already en route.
‘Are they all like this in Oldport?’ I ask Richard as he puts the blue lights on and we bully our way out into the traffic.
‘Absolutely every last one,’ he laughs. ‘But the houses are affordable.’
We pull up outside the address, one of a long row of light coloured semi-detached houses, each one only differentiated from the other by the colour of the door and the condition of the little white wooden balcony over the living room window. Through the downpour I can see two men standing hunched over mugs in the doorway. I jump out, haul out the resus bag, and then walk over to them.
‘Hello,’ I say briskly, ‘What’s the problem?’
Whilst one of the men stares at me, glassily white as his mug, the other takes a bracing sip and then turns to lead me up the stairs.
‘We’ve been away for the weekend’, he says. ‘We came back and found him like this.’
‘Is he a relative of yours?’
‘A friend.’ And opening the little bedroom door, he stands aside to let me through.
There is a naked man lying on his back on the bed over by the window. He is obviously dead. Even through this sixty watt gloom I can see the post mortem staining – the blotchy tide mark on the underside of his body where the blood has pooled. But then, without this marker, there would still stretch out a profound distance between us, the living ones at the door, and the dead one posed and frozen over there on that bed. The difference resonates on the chill air as the rain rails down outside.
As I walk into the room I check the details: a clutter of little plastic popper bottles and something that looks like a small thermos flask around his feet; his penis lolling darkly up onto his abdomen from its tightened scrotal sack; his arms fixed upright, crooked ninety degrees at the elbow, his hands and fingers delicately curled. I am reminded of Millais’ portrait of Ophelia, drifting off to her doom on a dark river. But whilst that Ophelia wore an expression of sensuous detachment, this one is racked by a monstrous Elvis sneer, and for a second I wonder why - until I understand that he has something stretched tightly over his head, nose and mouth.
Richard stands beside me. ‘Whoa!’ he says.
‘Isn’t that – a condom?’ I say.
The nipple shaped crest, designed to catch his ejaculate but filled here instead with a quantity of stale air and some nitrous oxide, pokes up like the button on a joke policeman’s helmet. Through the translucent rubber bubble the man’s eyes stare out at us, his eyelids half-closed.
Richard nudges me, and gives an infinitesimal shake of the head to let me know that he doesn’t think I should mention the condom again.
‘Could you go to the vehicle and ask for an ETA, please?’ he says, pleasantly. And then leads the friend back out of the room to ask him further questions.
I pick up the resus bag and turn to follow them out. My last impression of the scene is of the picture that hangs above the man’s bed, a cheap, gold-framed print: Manhattan by night.
Friday, September 21, 2007
floored
The woman is doing well, with the phone squashed to her ear with her left shoulder to free up her arms as they push up and down on her friend’s chest.
‘They’re here’, she sobs into the phone, then throws it into the corner of the room where it lands without a sound amongst the piles of clothes, shopping bags and accumulated junk.
‘They’re here’, she sobs into the phone, then throws it into the corner of the room where it lands without a sound amongst the piles of clothes, shopping bags and accumulated junk.
‘Help me.’
There is only just room enough to step over the body on the floor to get to her. I touch the woman on the shoulder; she stands up with difficulty and staggers over to the window, to join a man who is standing there wiping his face vigorously as if he were trying to wake up, pacing to the left and the right.
Malcolm asks them if there are any needles around. The woman says only one, and points to the sofa. The man begins pulling at his hair and groaning.
‘So what can you tell me about him?’ I ask them. ‘What’s happened here?’
The woman says that she spoke to John on the phone about an hour ago. He was fine then. When she got back to the flat with the shopping, she found him slumped back on the sofa, as blue as he is now. The other man was on the mattress in the other room. They had shared a needle of heroin, but she said that John had been off the stuff for a month, and was maybe not as used to it as he once was. He is thirty four. A touch of asthma sometimes, but otherwise fine.
I stop compressions briefly, to help Malcolm visualise John’s vocal chords and introduce the ET tube. He attaches the BVM and oxygen, and we plough on with the resus protocol. Malcolm tries to cannulate him, but has problems finding a useable vein. He swears quite a bit. We have no room to work, the flat is stifling and rank, and the other man is looking increasingly volatile. Although the woman is hugging him by the window, he keeps repeating: ‘Is he breathing yet?, then moaning, and slapping his face.
‘They’ll tell us when he is,’ she says to him, then to us, with much less certainty: ‘You can’t let him die. Please.’
John is completely inert. His face has the shadow of death upon it – a ghastly blue-grey hue, his lips purple. I cut his T-shirt off, straight up the middle, and then as I continue with chest compressions, Malcolm puts the defibrillator pads on. We watch as it prepares itself to monitor, then I come off the chest to watch the pattern it displays.
‘Asystole,’ he says; the flat line that trails ineluctably across the screen, the bleakest horizon imaginable. The prognosis is unlikely to be good.
‘Is he breathing yet?’ The voice grinds metallically with aggression.
We ask them to go into the next room to give us space to do what we need to do. When they are safely out of the way, Malcolm looks at me and asks the time. We work out that we have been struggling with John now for twenty minutes.
‘Let’s give him a couple more rounds, but this isn’t going anywhere.’
The call had come through to us as a cardiac arrest for a young man, but the call taker had no idea that this was drug related and potentially dangerous. For any death at home we have to notify the police, but in this situation we know that his friend could well take the news of his friend’s death badly. To make things worse, we both realise that in the rush to get up here we have left the radio in the truck. Malcolm asks me to go down there – to tell the flatmates that I’m off for an essential bit of kit – but in reality to call for police back-up urgently.
When I come back into the flat carrying my little red bag, the woman throws me a weak smile, as if I’m coming in with something that might finally save her friend. She follows me back into the room, whilst the other man shadows close behind her like he’s waiting for a word or signal. He has a bottle of white wine in his hand and he drinks about a third straight off.
I join Malcolm back on the floor. We make a play of checking the monitor one last time, but nothing has changed. We both stand up. The police will get here as quickly as they can, but we know that we are exposed. The woman has her hand to her mouth.
‘I’m sorry. There’s nothing more we can do.’
She releases one awful, belly-deep cry. The man takes a step to come round her, and for a second I wonder if he is about to attack us. But maybe hearing the definitive news that his friend is dead is some kind of release for him; the volatility we were so wary of seems to ebb. He stares for a moment at his friend on the floor, as if he was amazed that he could sleep with so much going on around him. Then he turns and walks back into the bedroom, slumps down onto the edge of the mattress, and takes another long pull from the bottle. The woman goes to stand beside him. We tell them what to expect next. She begins crying quietly into a filthy handkerchief. We hear heavy footsteps running up the stairs.
--
Down in the street, the afternoon is bright and busy. There are a few people watching the scene, wondering what the ambulance and police cars might mean. I throw the bags of equipment in the back, slam the doors and walk back round to the cab. I notice that the flat is opposite a church, which has a board outside that says: Come, join your prayers with ours.
We return to base, re-stock, then get sent straight back out to deal with an elderly fall at home. He is fine – just needs a hand back into the chair.
There is only just room enough to step over the body on the floor to get to her. I touch the woman on the shoulder; she stands up with difficulty and staggers over to the window, to join a man who is standing there wiping his face vigorously as if he were trying to wake up, pacing to the left and the right.
Malcolm asks them if there are any needles around. The woman says only one, and points to the sofa. The man begins pulling at his hair and groaning.
‘So what can you tell me about him?’ I ask them. ‘What’s happened here?’
The woman says that she spoke to John on the phone about an hour ago. He was fine then. When she got back to the flat with the shopping, she found him slumped back on the sofa, as blue as he is now. The other man was on the mattress in the other room. They had shared a needle of heroin, but she said that John had been off the stuff for a month, and was maybe not as used to it as he once was. He is thirty four. A touch of asthma sometimes, but otherwise fine.
I stop compressions briefly, to help Malcolm visualise John’s vocal chords and introduce the ET tube. He attaches the BVM and oxygen, and we plough on with the resus protocol. Malcolm tries to cannulate him, but has problems finding a useable vein. He swears quite a bit. We have no room to work, the flat is stifling and rank, and the other man is looking increasingly volatile. Although the woman is hugging him by the window, he keeps repeating: ‘Is he breathing yet?, then moaning, and slapping his face.
‘They’ll tell us when he is,’ she says to him, then to us, with much less certainty: ‘You can’t let him die. Please.’
John is completely inert. His face has the shadow of death upon it – a ghastly blue-grey hue, his lips purple. I cut his T-shirt off, straight up the middle, and then as I continue with chest compressions, Malcolm puts the defibrillator pads on. We watch as it prepares itself to monitor, then I come off the chest to watch the pattern it displays.
‘Asystole,’ he says; the flat line that trails ineluctably across the screen, the bleakest horizon imaginable. The prognosis is unlikely to be good.
‘Is he breathing yet?’ The voice grinds metallically with aggression.
We ask them to go into the next room to give us space to do what we need to do. When they are safely out of the way, Malcolm looks at me and asks the time. We work out that we have been struggling with John now for twenty minutes.
‘Let’s give him a couple more rounds, but this isn’t going anywhere.’
The call had come through to us as a cardiac arrest for a young man, but the call taker had no idea that this was drug related and potentially dangerous. For any death at home we have to notify the police, but in this situation we know that his friend could well take the news of his friend’s death badly. To make things worse, we both realise that in the rush to get up here we have left the radio in the truck. Malcolm asks me to go down there – to tell the flatmates that I’m off for an essential bit of kit – but in reality to call for police back-up urgently.
When I come back into the flat carrying my little red bag, the woman throws me a weak smile, as if I’m coming in with something that might finally save her friend. She follows me back into the room, whilst the other man shadows close behind her like he’s waiting for a word or signal. He has a bottle of white wine in his hand and he drinks about a third straight off.
I join Malcolm back on the floor. We make a play of checking the monitor one last time, but nothing has changed. We both stand up. The police will get here as quickly as they can, but we know that we are exposed. The woman has her hand to her mouth.
‘I’m sorry. There’s nothing more we can do.’
She releases one awful, belly-deep cry. The man takes a step to come round her, and for a second I wonder if he is about to attack us. But maybe hearing the definitive news that his friend is dead is some kind of release for him; the volatility we were so wary of seems to ebb. He stares for a moment at his friend on the floor, as if he was amazed that he could sleep with so much going on around him. Then he turns and walks back into the bedroom, slumps down onto the edge of the mattress, and takes another long pull from the bottle. The woman goes to stand beside him. We tell them what to expect next. She begins crying quietly into a filthy handkerchief. We hear heavy footsteps running up the stairs.
--
Down in the street, the afternoon is bright and busy. There are a few people watching the scene, wondering what the ambulance and police cars might mean. I throw the bags of equipment in the back, slam the doors and walk back round to the cab. I notice that the flat is opposite a church, which has a board outside that says: Come, join your prayers with ours.
We return to base, re-stock, then get sent straight back out to deal with an elderly fall at home. He is fine – just needs a hand back into the chair.
Wednesday, September 12, 2007
framed
We can tell from a distance there is an argument going on as both the fluorescent jacketed policeman and the man in the pinstripe suit are leaning in towards each other and gesturing a great deal - the policeman with a notebook and the man with a carrier bag stuffed full of clothes. He also seems to have a large painting in a heavy gilt frame tucked under his other arm. A policewoman is standing off to the side as if she is embarrassed by the whole scene; she chews the aerial of her radio and smiles at me as I climb out of the cab with my clipboard. The policeman makes an exasperated, pacifying wave of his notebook, a gesture I also try to use when I want our dog to sit and be still, then tucks it away and strides over to me. He nods for me to come close so he can tell me something important.
'This gentleman is an arse,' he says. 'We pulled him over because he failed to appear at the station with the correct documents following a traffic misdemeanour earlier in the week, and now he's accusing us of harrassment...'
The man has stepped over to us.
'Don't you try to drag him into your pathetic little conspiracy,' he spits.
'Now, now. Take it easy,' both the policeman and I say together.
The policeman asks me if I would check the man over because at some point during their conversation he appeared to complain of chest pain.
'I'm going to make a very serious and formal complaint about this and you're going to be sacked,' he says, almost dropping the painting. 'This is victimisation, harrassment... this is a police state. It's unbelievable.'
I touch the man on the shoulder to lead him into the ambulance. 'Let's just take things a step at a time,' I say, 'Let's just give you the once over to see you're okay, and then we can think about the rest of it after. What's your name?'
'Alexander.'
'Okay, Alexander. Have you got any chest pain at the moment?'
'No. I'm fine. Well - I say fine.'
He stamps up the steps and throws himself down on the trolley. I take his belongings from him and put them on the floor. The painting is a study of some boats at low tide, in oils. The man pushes his heavy blond hair back from his face and looks up at me. 'They're all absolute bastards.'
He seems as moneyed and unconvincing as his painting. He has a pin striped suit, a tan and a rugged, Captain Hurricaine-style cleft chin, but there is something a little off-balance about the whole ensemble.
'I own an antiques shop in the Quarter,' he says. 'They know that. They know exactly who I am, and they don't like it.'
As he readjusts his fringe, a heavy gold bracelet slides down his thick forearm.
'They cannot accept it.'
And then, incredibly, a tear spills onto his cheek. Rae hesitates as she turns on the blood pressure monitor and looks at me. 'My father died, I've got endless money worries. And now this.' He fumbles with his shirt buttons with his other hand to reveal a broad expanse of chest hair. 'How's my heart? If they've killed me, they're going to pay.'
'Well, no-one's dying at the moment,' Rae says, widening her eyes at him like someone flashing their headlights. 'Your blood pressure is up, but then you're obviously stressed.' She fetches out a razor to shave off some hair for the ECG dots. 'This won't hurt.'
'My blood pressure's up? Right. I want that written down. I want that in writing. They've made me ill.'
There is a knock on the ambulance door and the policeman looks in.
'How are we getting on?'
'You bastards have made me sick. Tell him what you just told me.'
'Alexendar's blood pressure's raised, but nothing you wouldn't expect from someone under stress. Otherwise, everything's looks okay. He doesn't have any chest pain, but we're just doing a quick ECG to make sure it's all fine.'
The policeman nods at us and then makes a gesture at the man.
'After they've finished, we'll talk about what you need to do, and then you can be on your way.'
'What's going to happen to my car?'
'Well, without the correct documentation you won't be able to drive this car any further, sir. It will be impounded, and you can collect it following the usual procedures. I'll explain it all when my colleagues have finished with you.'
The policeman retreats again and shuts the door.
The ECG is completely normal, and we tell Alexander that as far as we're concerned everything has checked out and he's fit enough to go. As he buttons his shirt back up I collect his belongings together and hand them to him. He tucks the painting back under his arm and stands up quickly like a soldier with his orders. Rae opens the door for him and helps him down the steps. I can see the policeman and woman straighten up by their squad car, unfolding their arms as he looks across at them. Then, just before he rejoins this battle, he hesitates and looks back at us.
'Ssh,' he says. The carrier bag swings from his wrist as he puts a finger up to his lips and says in a pantomime whisper: 'I'm taking delivery of a BMW M5 tomorrow.'
'This gentleman is an arse,' he says. 'We pulled him over because he failed to appear at the station with the correct documents following a traffic misdemeanour earlier in the week, and now he's accusing us of harrassment...'
The man has stepped over to us.
'Don't you try to drag him into your pathetic little conspiracy,' he spits.
'Now, now. Take it easy,' both the policeman and I say together.
The policeman asks me if I would check the man over because at some point during their conversation he appeared to complain of chest pain.
'I'm going to make a very serious and formal complaint about this and you're going to be sacked,' he says, almost dropping the painting. 'This is victimisation, harrassment... this is a police state. It's unbelievable.'
I touch the man on the shoulder to lead him into the ambulance. 'Let's just take things a step at a time,' I say, 'Let's just give you the once over to see you're okay, and then we can think about the rest of it after. What's your name?'
'Alexander.'
'Okay, Alexander. Have you got any chest pain at the moment?'
'No. I'm fine. Well - I say fine.'
He stamps up the steps and throws himself down on the trolley. I take his belongings from him and put them on the floor. The painting is a study of some boats at low tide, in oils. The man pushes his heavy blond hair back from his face and looks up at me. 'They're all absolute bastards.'
He seems as moneyed and unconvincing as his painting. He has a pin striped suit, a tan and a rugged, Captain Hurricaine-style cleft chin, but there is something a little off-balance about the whole ensemble.
'I own an antiques shop in the Quarter,' he says. 'They know that. They know exactly who I am, and they don't like it.'
As he readjusts his fringe, a heavy gold bracelet slides down his thick forearm.
'They cannot accept it.'
And then, incredibly, a tear spills onto his cheek. Rae hesitates as she turns on the blood pressure monitor and looks at me. 'My father died, I've got endless money worries. And now this.' He fumbles with his shirt buttons with his other hand to reveal a broad expanse of chest hair. 'How's my heart? If they've killed me, they're going to pay.'
'Well, no-one's dying at the moment,' Rae says, widening her eyes at him like someone flashing their headlights. 'Your blood pressure is up, but then you're obviously stressed.' She fetches out a razor to shave off some hair for the ECG dots. 'This won't hurt.'
'My blood pressure's up? Right. I want that written down. I want that in writing. They've made me ill.'
There is a knock on the ambulance door and the policeman looks in.
'How are we getting on?'
'You bastards have made me sick. Tell him what you just told me.'
'Alexendar's blood pressure's raised, but nothing you wouldn't expect from someone under stress. Otherwise, everything's looks okay. He doesn't have any chest pain, but we're just doing a quick ECG to make sure it's all fine.'
The policeman nods at us and then makes a gesture at the man.
'After they've finished, we'll talk about what you need to do, and then you can be on your way.'
'What's going to happen to my car?'
'Well, without the correct documentation you won't be able to drive this car any further, sir. It will be impounded, and you can collect it following the usual procedures. I'll explain it all when my colleagues have finished with you.'
The policeman retreats again and shuts the door.
The ECG is completely normal, and we tell Alexander that as far as we're concerned everything has checked out and he's fit enough to go. As he buttons his shirt back up I collect his belongings together and hand them to him. He tucks the painting back under his arm and stands up quickly like a soldier with his orders. Rae opens the door for him and helps him down the steps. I can see the policeman and woman straighten up by their squad car, unfolding their arms as he looks across at them. Then, just before he rejoins this battle, he hesitates and looks back at us.
'Ssh,' he says. The carrier bag swings from his wrist as he puts a finger up to his lips and says in a pantomime whisper: 'I'm taking delivery of a BMW M5 tomorrow.'
Tuesday, September 04, 2007
fresh
It is a lovely long blast out along the coast road. The sea is out, flat, crab-boated and crystalline, and the mysterious foreshore of pools and boulders lie baking in the bright sunshine. K. is driving; I’m lounging back in the attendant’s seat as our sirens peg out our progress above these scuttling patterns of traffic and our blue lights sparkle in a hundred rear view mirrors. It’s a beautiful morning, and this is a great job.
We pull up outside the flats. The call is to a fall at home, so I jump out and grab my magic red bag out of the back.
At the main door I ring the flat number, as there is reportedly a carer on scene. She crackles onto the intercom and buzzes the entrance, but for some reason the door will not open. Just as I’m about to push the button again, a woman in a white uniform trudges up the steps behind me toting a face of disapproval.
‘You pushed it too soon,’ she says.
‘Oh. Okay. Have you got a key?’
‘No. Why would I have a key?’
‘Oh.’
‘If you push it before they buzz, it ruins the mechanism.’
‘Shall I buzz again, then?’
‘You can try,’ she says, then looks behind at her and shrugs to some imaginary, incredulous audience.
I push the button again, the door clicks and I open it.
‘You were lucky,’ she sighs, and pushes ahead of us.
‘It’s flat 19 we want,’ I say to her back.
‘Third floor. And the lift’s out.’
‘Thankyou’, I say, and then exchange a look with K. We make our way up to the third floor and find number 19. The door is open. The carer is standing waiting for us, a spherical woman clutching a sheaf of papers and swinging a big bunch of keys.
‘Had trouble getting in?’ she says brightly.
‘It wasn’t too bad. Now – where’s the patient.’
The woman nods around the corner, then retreats into the kitchen for some reason. I walk around the corner and see a white-haired old lady in a nightdress lying on her back on the floor beside her bed. There are ornaments and cosmetics jars all around her, looking as if she cleared the dressing table when she tried to stop herself falling. At first I think she has covered herself in some kind of mud pack, and then realise that this is actually faeces. She has been on the floor for some time, and in her confused state has smeared it over her face, in her hair – everywhere you might touch with your hands over the course of a few incoherent hours. The smell is overpowering, and I realise that I have been standing doing nothing for a minute whilst I took in the scene and wondered how we were going to proceed.
‘Hello, it’s the ambulance,’ I begin, bravely. ‘My name’s Spence, and this is Rae. What’s your name?’
‘Hello, Spence,' she says. ‘I’m Helen. I wonder if you could help me. I seemed to have got a bit stuck.’
I clear a space around her, and check her over to make sure she hasn’t hurt herself in the fall. Then with Rae we help her up and sit her down on the bed, grabbing pillows and her duvet to prop her up and make her comfortable. Rae goes into the kitchen to fetch a basin of warm, soapy water, a flannel and a dishwashing brush, and then we set to a brisk cleaning of her hands and face, at least. The carer hovers uncertainly in the background.
It seems that Helen has been perfectly mobile and self-contained until today. At ninety-three, she still looks after herself in this flat, and only has a carer in a couple of times a week to help with hoovering and the occasional shopping trip.
As I rub away the unspeakable mess from her face, she tells me that she has a flannel wash every morning. In fact, she repeats this several times, further evidence of a confusion that seems with her high temperature to point to a urinary tract infection.
When I tell Helen that I think a trip to the hospital is needed, she is indignant.
‘I have never been to hospital in my life. Not once. Not for either of my children, nor anything else. And I certainly do not intend to start now.’
She looks up at a portrait of a formidable woman in a big straw hat.
‘What would mummy say?’
I finish wiping her face and sit back on my heels like an artist.
‘I think mummy would want you to get help when you needed it.’
It’s a measure of the depth of her confusion that she cannot recognise the extremity of her situation, and twenty minutes of patient repetition to persuade her that a hospital trip would be a good idea fail utterly. Even a phone call with her son does nothing to change her mind. Eventually, Rae says:
‘If you can stand up and take a few steps we’ll leave you in peace. But if you can’t stand up, how on earth are you going to cope?’
Incredibly, Helen seems to recognise the logic in this, and tries to stand up from the bed. Each time she slumps giddily backwards, but each time she says: ‘No! No! I can do this! I will do this! I am not going to hospital!'
She gives up after the sixth attempt, and sits looking utterely dejected.
‘Come on, Helen,’ I say, handing the bowl of filthy water to the carer. ‘Let’s get you to hospital. You’re son can meet you up there. It’s not so bad.’
She looks up at the portrait on the wall, smooths her filthy nightdress across her knees and straightens slightly.
‘I suppose we’d better go, then,’ she says with a sniff.
We put her into our chair and carry her out to the lift which turns out to be working after all.
The day seems fresher than ever.
We pull up outside the flats. The call is to a fall at home, so I jump out and grab my magic red bag out of the back.
At the main door I ring the flat number, as there is reportedly a carer on scene. She crackles onto the intercom and buzzes the entrance, but for some reason the door will not open. Just as I’m about to push the button again, a woman in a white uniform trudges up the steps behind me toting a face of disapproval.
‘You pushed it too soon,’ she says.
‘Oh. Okay. Have you got a key?’
‘No. Why would I have a key?’
‘Oh.’
‘If you push it before they buzz, it ruins the mechanism.’
‘Shall I buzz again, then?’
‘You can try,’ she says, then looks behind at her and shrugs to some imaginary, incredulous audience.
I push the button again, the door clicks and I open it.
‘You were lucky,’ she sighs, and pushes ahead of us.
‘It’s flat 19 we want,’ I say to her back.
‘Third floor. And the lift’s out.’
‘Thankyou’, I say, and then exchange a look with K. We make our way up to the third floor and find number 19. The door is open. The carer is standing waiting for us, a spherical woman clutching a sheaf of papers and swinging a big bunch of keys.
‘Had trouble getting in?’ she says brightly.
‘It wasn’t too bad. Now – where’s the patient.’
The woman nods around the corner, then retreats into the kitchen for some reason. I walk around the corner and see a white-haired old lady in a nightdress lying on her back on the floor beside her bed. There are ornaments and cosmetics jars all around her, looking as if she cleared the dressing table when she tried to stop herself falling. At first I think she has covered herself in some kind of mud pack, and then realise that this is actually faeces. She has been on the floor for some time, and in her confused state has smeared it over her face, in her hair – everywhere you might touch with your hands over the course of a few incoherent hours. The smell is overpowering, and I realise that I have been standing doing nothing for a minute whilst I took in the scene and wondered how we were going to proceed.
‘Hello, it’s the ambulance,’ I begin, bravely. ‘My name’s Spence, and this is Rae. What’s your name?’
‘Hello, Spence,' she says. ‘I’m Helen. I wonder if you could help me. I seemed to have got a bit stuck.’
I clear a space around her, and check her over to make sure she hasn’t hurt herself in the fall. Then with Rae we help her up and sit her down on the bed, grabbing pillows and her duvet to prop her up and make her comfortable. Rae goes into the kitchen to fetch a basin of warm, soapy water, a flannel and a dishwashing brush, and then we set to a brisk cleaning of her hands and face, at least. The carer hovers uncertainly in the background.
It seems that Helen has been perfectly mobile and self-contained until today. At ninety-three, she still looks after herself in this flat, and only has a carer in a couple of times a week to help with hoovering and the occasional shopping trip.
As I rub away the unspeakable mess from her face, she tells me that she has a flannel wash every morning. In fact, she repeats this several times, further evidence of a confusion that seems with her high temperature to point to a urinary tract infection.
When I tell Helen that I think a trip to the hospital is needed, she is indignant.
‘I have never been to hospital in my life. Not once. Not for either of my children, nor anything else. And I certainly do not intend to start now.’
She looks up at a portrait of a formidable woman in a big straw hat.
‘What would mummy say?’
I finish wiping her face and sit back on my heels like an artist.
‘I think mummy would want you to get help when you needed it.’
It’s a measure of the depth of her confusion that she cannot recognise the extremity of her situation, and twenty minutes of patient repetition to persuade her that a hospital trip would be a good idea fail utterly. Even a phone call with her son does nothing to change her mind. Eventually, Rae says:
‘If you can stand up and take a few steps we’ll leave you in peace. But if you can’t stand up, how on earth are you going to cope?’
Incredibly, Helen seems to recognise the logic in this, and tries to stand up from the bed. Each time she slumps giddily backwards, but each time she says: ‘No! No! I can do this! I will do this! I am not going to hospital!'
She gives up after the sixth attempt, and sits looking utterely dejected.
‘Come on, Helen,’ I say, handing the bowl of filthy water to the carer. ‘Let’s get you to hospital. You’re son can meet you up there. It’s not so bad.’
She looks up at the portrait on the wall, smooths her filthy nightdress across her knees and straightens slightly.
‘I suppose we’d better go, then,’ she says with a sniff.
We put her into our chair and carry her out to the lift which turns out to be working after all.
The day seems fresher than ever.
fixed expressions
After a few repeated knocks and a call through the letterbox, Miranda comes to the door. Her usual pose – one hand on the doorframe, one hand on the door, slung pitifully between these two points of connection like a domestic Jesus on the cross. With reading glasses.
‘What do you want?’
‘You called for an ambulance, Miranda. Something about an overdose. Can you tell me what’s happened?’
She bobs her head in a non-committal way, still holding on to the door.
‘Can you tell me what you’ve taken and when?’
Miranda pushes her glasses back up her nose to consider the question. She calls an ambulance many times each night; Control allow her one visit. We’ve all been here a number of times, but so far no-one has made it over the threshold.
She gives a curious facial spasm, then dismisses us with a slap of the air in front of her nose.
‘You can fuck off.’
Then she slams the door. We can hear her crash back into the dark recesses of her bungalow.
We turn back to the vehicle.
My torch picks out the glazed smile on one of her gnomes.
‘What do you want?’
‘You called for an ambulance, Miranda. Something about an overdose. Can you tell me what’s happened?’
She bobs her head in a non-committal way, still holding on to the door.
‘Can you tell me what you’ve taken and when?’
Miranda pushes her glasses back up her nose to consider the question. She calls an ambulance many times each night; Control allow her one visit. We’ve all been here a number of times, but so far no-one has made it over the threshold.
She gives a curious facial spasm, then dismisses us with a slap of the air in front of her nose.
‘You can fuck off.’
Then she slams the door. We can hear her crash back into the dark recesses of her bungalow.
We turn back to the vehicle.
My torch picks out the glazed smile on one of her gnomes.
Sunday, July 22, 2007
partially blind
The rain is finally coming down after a night of menacing flashes out over the sea. Thursday night clubbers are clustering under awnings and in doorways trying to escape the downpour as it scours the pavements. They watch us, giving us whistles and claps, as we jump out of the ambulance and patter squealing over to the old apartment block.
Above the entrance is the name 'Adastra House' picked out in modish black letters; an intricate pattern of bars criss-cross the upper half of each double door. Many of the stained glass panels are missing, replaced by pieces of crudely fixed wood and cardboard. Most of the black and white floor tiles are still in place, with a bouquet of bleach and a finish of urine and dirt.
'Art Deco', says Rae.
'Uh-huh,' but the architects of this doorway to the modern age must surely have had higher aspirations than us.
I ring the bell for Flat 54, wait, and then a young voice tells me to push. Inside, the lobby is deeply shadowed, its curved mahogany desk untended.
We ride the battered brass elevator to the fifth floor. Out along the corridor, each flat door has the stump or more of a cute little electric lamp, many of which are still working. And at the end of this dingy landing-strip, by the furthest door, a woman is standing watching us with her arms crossed.
My first impression is that she has something bulky strapped onto the left side of her head. But when I get closer, I see that where her right eye should be is a ghastly swollen mass. Her left eye is fine and proportionate, but her right is like the cartoon of a sad and sleepy eye thinly scribbled onto the side of an ostrich egg.
'I'm Spence and this is Rae', I say. 'Can we go inside for a minute?' Although as soon as I've said this I wonder whether the assailant is still around. As we follow her in I put my response bag fully onto my back to free up my hands.
'Is the person who did this to you still here?'
'No. He called the ambulance and then went.'
Rae says: 'That was nice of him.'
'Have you called the police?'
'He said I'd better not.'
She stands hugging herself. The stale air stirs in the flat like an alcoholic gruel around the jumble of her furniture and belongings. It would be impossible to tell if a fight had just occurred here; no doubt it always looks like this.
'I can't find my work keys,' she says. 'I absolutely have to go to work in the morning.'
She studies me with her good eye. 'Do you think I'll be able to go to work in the morning?'
'Let's just take this one step at a time,' I say, reverting to cliché reassurance. 'What's your name?'
'Claudia.'
'Tell me what's happened to you tonight, Claudia.'
Claudia starts to cry, clear tears from her left eye and blood stained tears from her right. She tells me she is twenty four, but has the physique and demeanour of a sixteen year old girl.
'Do you know the person who did this to you?'
'My boyfriend.'
'Has he done this before?'
'Not really. He's punched me once or twice, but not hard. Pulled me around by my hair. But he isn't really like this.'
'So tell me what happened.'
'We'd been drinking. Not much. We had an argument, it got out of hand, and he punched me.'
'Were you knocked out?'
'Well, I woke up in the bath. The shock of it - I didn't know what happened. This terrible bang. Then I found myself in the bath looking up at him. And he was saying "My God, your eye", and then he called for an ambulance, and went.'
Rae gives me a look, nods towards the door.
'Claudia - you need to come with us to hospital to get your eye sorted out right now. And that's not the only reason we should go, because to be honest I'm uncomfortable with the idea that the person who did this to you could walk in that door at any time.'
Claudia flinches. 'Oh - you'll be fine. He's really not - that way.'
'Well, excuse me for being blunt, but this is a man who has just punched you in the face as hard as he can. I think it's fair to say he absolutely IS that way.'
Claudia starts to cry again.
'Help me look for my keys,' she says.
Out on the ambulance we try to gently open her right eye to gauge the injury, but it's closed too tightly now. Claudia tells us that he doesn't wear rings, so maybe there isn't a cut. But there is obvious damage here, and the swelling will have to be relieved as soon as possible.
Claudia lies quietly on the trolley as we take her blood pressure and other observations. There is a knock on the door. Rae opens it cautiously, and a policeman looks inside.
'Hello' he says, taking his hat off and tucking it under his arm.
Claudia sits up.
'Who called them?'
'It's okay,' I say, easing her back down. 'Our Control always sends the police along in these situations. But you know, Claudia - I'm glad they're here, for lots of reasons. Despite what your boyfriend says, I think the police should definitely get involved.'
She seems to accept this, and relaxes back.
The policeman pulls out a notebook.
'This is Claudia,' says Rae. 'Claudia's been assaulted by her boyfriend tonight.'
'You can say that again,' he says, but Claudia is thinking about other things and doesn't seem to register this.
'I absolutely have to go to work tomorrow,' she tells me.
'Where do you work?'
'I run the desk part-time for a hotel. I've got the keys. I'm a student at the moment - business and finance. But I need this job, and I had a lot of time off at the end of last year.'
'What happened to you last year?'
'I fell out of a window.'
I look at her. The policeman momentarily stops writing. I hardly dare ask, but do, anyway.
'Did you fall, or was your boyfriend involved somehow.'
She smiles up at me. 'Well - you know.'
Above the entrance is the name 'Adastra House' picked out in modish black letters; an intricate pattern of bars criss-cross the upper half of each double door. Many of the stained glass panels are missing, replaced by pieces of crudely fixed wood and cardboard. Most of the black and white floor tiles are still in place, with a bouquet of bleach and a finish of urine and dirt.
'Art Deco', says Rae.
'Uh-huh,' but the architects of this doorway to the modern age must surely have had higher aspirations than us.
I ring the bell for Flat 54, wait, and then a young voice tells me to push. Inside, the lobby is deeply shadowed, its curved mahogany desk untended.
We ride the battered brass elevator to the fifth floor. Out along the corridor, each flat door has the stump or more of a cute little electric lamp, many of which are still working. And at the end of this dingy landing-strip, by the furthest door, a woman is standing watching us with her arms crossed.
My first impression is that she has something bulky strapped onto the left side of her head. But when I get closer, I see that where her right eye should be is a ghastly swollen mass. Her left eye is fine and proportionate, but her right is like the cartoon of a sad and sleepy eye thinly scribbled onto the side of an ostrich egg.
'I'm Spence and this is Rae', I say. 'Can we go inside for a minute?' Although as soon as I've said this I wonder whether the assailant is still around. As we follow her in I put my response bag fully onto my back to free up my hands.
'Is the person who did this to you still here?'
'No. He called the ambulance and then went.'
Rae says: 'That was nice of him.'
'Have you called the police?'
'He said I'd better not.'
She stands hugging herself. The stale air stirs in the flat like an alcoholic gruel around the jumble of her furniture and belongings. It would be impossible to tell if a fight had just occurred here; no doubt it always looks like this.
'I can't find my work keys,' she says. 'I absolutely have to go to work in the morning.'
She studies me with her good eye. 'Do you think I'll be able to go to work in the morning?'
'Let's just take this one step at a time,' I say, reverting to cliché reassurance. 'What's your name?'
'Claudia.'
'Tell me what's happened to you tonight, Claudia.'
Claudia starts to cry, clear tears from her left eye and blood stained tears from her right. She tells me she is twenty four, but has the physique and demeanour of a sixteen year old girl.
'Do you know the person who did this to you?'
'My boyfriend.'
'Has he done this before?'
'Not really. He's punched me once or twice, but not hard. Pulled me around by my hair. But he isn't really like this.'
'So tell me what happened.'
'We'd been drinking. Not much. We had an argument, it got out of hand, and he punched me.'
'Were you knocked out?'
'Well, I woke up in the bath. The shock of it - I didn't know what happened. This terrible bang. Then I found myself in the bath looking up at him. And he was saying "My God, your eye", and then he called for an ambulance, and went.'
Rae gives me a look, nods towards the door.
'Claudia - you need to come with us to hospital to get your eye sorted out right now. And that's not the only reason we should go, because to be honest I'm uncomfortable with the idea that the person who did this to you could walk in that door at any time.'
Claudia flinches. 'Oh - you'll be fine. He's really not - that way.'
'Well, excuse me for being blunt, but this is a man who has just punched you in the face as hard as he can. I think it's fair to say he absolutely IS that way.'
Claudia starts to cry again.
'Help me look for my keys,' she says.
Out on the ambulance we try to gently open her right eye to gauge the injury, but it's closed too tightly now. Claudia tells us that he doesn't wear rings, so maybe there isn't a cut. But there is obvious damage here, and the swelling will have to be relieved as soon as possible.
Claudia lies quietly on the trolley as we take her blood pressure and other observations. There is a knock on the door. Rae opens it cautiously, and a policeman looks inside.
'Hello' he says, taking his hat off and tucking it under his arm.
Claudia sits up.
'Who called them?'
'It's okay,' I say, easing her back down. 'Our Control always sends the police along in these situations. But you know, Claudia - I'm glad they're here, for lots of reasons. Despite what your boyfriend says, I think the police should definitely get involved.'
She seems to accept this, and relaxes back.
The policeman pulls out a notebook.
'This is Claudia,' says Rae. 'Claudia's been assaulted by her boyfriend tonight.'
'You can say that again,' he says, but Claudia is thinking about other things and doesn't seem to register this.
'I absolutely have to go to work tomorrow,' she tells me.
'Where do you work?'
'I run the desk part-time for a hotel. I've got the keys. I'm a student at the moment - business and finance. But I need this job, and I had a lot of time off at the end of last year.'
'What happened to you last year?'
'I fell out of a window.'
I look at her. The policeman momentarily stops writing. I hardly dare ask, but do, anyway.
'Did you fall, or was your boyfriend involved somehow.'
She smiles up at me. 'Well - you know.'
Monday, July 09, 2007
the game
Fred has been lying on his back on the kitchen floor since he tottered in from the sitting room at ten o'clock this morning, tripped and went down. It is now just after five; his wife came back from an epic expedition into town, found him stretched and helpless, and called the ambulance.
Fred's right leg is lying a good inch shorter than his left and turned slightly outwards - a good indication that he has a fractured neck of femur. The morphine is helping him cope with the pain. It needs to. We will be moving him outside to the ambulance shortly, and it will inevitably aggravate his injury.
'But once we've got you on the vehicle the worst will be over and we'll be on our way to getting your leg sorted out.'
'Will you be needing these?' his wife says, standing with his cardigan in one hand and his slippers in the other. 'I'll be following up later with Rene.'
Fred is ninety four years old, a powerful man blasted by long years and late-stage Parkinson's. In his crumpled white shirt, black braces and trousers he looks like a preacher laid out by the hand of God.
'Thanks for coming,' he says.
On the trolley, easing tentatively away from the horrible pain of the move, Fred comes to himself sufficiently to be able to chat to me. He struggles to make his words clear above the noise of the ambulance and the depradations of accident, illness and age; he rests between phrases, and stares up through the skylight to the sky rushing above us. I piece together this war story:
Fred was the youngest child of a family of six. His parents owned a big garage, and Fred, along with his five sisters, picked up light engineering skills. When the war began, Fred's sisters found work in the new aircraft factory whilst Fred joined the RAF. He became a flight engineer, mostly on Lancaster bombers, stationed up in Lincolnshire. He was twenty-five.
He lasted the entire war, flying seventy missions across Europe. In all that time he crashed just twice, once mid-way when they limped back to the strip in tatters, the young tail gunner dead, and once on the very last mission when the plane was skewered by a German fighter, thirteen millimetre shells ripping through everything but him. The whole crew was wounded, and Fred had to land the plane on his own - the one and only time he took the controls. He managed to ditch safely in the sea, and they were all picked up by a naval frigate.
'I bet the others liked flying with you,' I say to him, adjusting the blood pressure cuff on his arm and taking a final reading before we turn into the hospital. 'I bet they thought you were lucky.'
'Nah,' he says, clearing his throat. 'It's a game. It plays itself out, and there's nothing you can do. One time I was supposed to crew up with a pilot to test a new Mosquito they'd delivered, but I was late coming back from a meeting and he took some other poor fucker up. That one crashed.'
He shrugs, and whinces.
'Will my wife know where to find me?'
I tell him I think she will.
Fred's right leg is lying a good inch shorter than his left and turned slightly outwards - a good indication that he has a fractured neck of femur. The morphine is helping him cope with the pain. It needs to. We will be moving him outside to the ambulance shortly, and it will inevitably aggravate his injury.
'But once we've got you on the vehicle the worst will be over and we'll be on our way to getting your leg sorted out.'
'Will you be needing these?' his wife says, standing with his cardigan in one hand and his slippers in the other. 'I'll be following up later with Rene.'
Fred is ninety four years old, a powerful man blasted by long years and late-stage Parkinson's. In his crumpled white shirt, black braces and trousers he looks like a preacher laid out by the hand of God.
'Thanks for coming,' he says.
On the trolley, easing tentatively away from the horrible pain of the move, Fred comes to himself sufficiently to be able to chat to me. He struggles to make his words clear above the noise of the ambulance and the depradations of accident, illness and age; he rests between phrases, and stares up through the skylight to the sky rushing above us. I piece together this war story:
Fred was the youngest child of a family of six. His parents owned a big garage, and Fred, along with his five sisters, picked up light engineering skills. When the war began, Fred's sisters found work in the new aircraft factory whilst Fred joined the RAF. He became a flight engineer, mostly on Lancaster bombers, stationed up in Lincolnshire. He was twenty-five.
He lasted the entire war, flying seventy missions across Europe. In all that time he crashed just twice, once mid-way when they limped back to the strip in tatters, the young tail gunner dead, and once on the very last mission when the plane was skewered by a German fighter, thirteen millimetre shells ripping through everything but him. The whole crew was wounded, and Fred had to land the plane on his own - the one and only time he took the controls. He managed to ditch safely in the sea, and they were all picked up by a naval frigate.
'I bet the others liked flying with you,' I say to him, adjusting the blood pressure cuff on his arm and taking a final reading before we turn into the hospital. 'I bet they thought you were lucky.'
'Nah,' he says, clearing his throat. 'It's a game. It plays itself out, and there's nothing you can do. One time I was supposed to crew up with a pilot to test a new Mosquito they'd delivered, but I was late coming back from a meeting and he took some other poor fucker up. That one crashed.'
He shrugs, and whinces.
'Will my wife know where to find me?'
I tell him I think she will.
Wednesday, July 04, 2007
on time
At six in the morning the alerter wakes us. Daylight has slid across the world again, low and grey as an aluminium lid, and found us simmering by the TV.
We finish at seven, so we offer to take the job in place of the six thirty crew. They wave us off.
N. smacks his palms, says: 'This should sort us out nicely.'
I climb into the driver's seat and read out the details of the job: Seven Acres Taxi cabs. Woman fallen. Greater than sixteen feet. Status unknown. I wonder whether she's fallen off a ladder or something, and then I wonder what she may have been doing up a ladder at this time of the morning. But you never know till you know, and anyway I am so tired it makes no real difference to me.
As we turn out of the station and head up the road, another message comes through: Patient fallen from cliffs. Lying on walkway beneath. Police on scene.
This is a suicide.
I know the cliffs here very well. Before we moved it used to be one of my favourite fossil hunting places. I would spend hours with the dog stalking and chipping out sea urchins, bivalves and brachiopods amongst the chalk falls and pools. Eighty five million years ago these cliffs were the chalky ooze at the bottom of the sea, lain down at a knuckle's depth every thousand years or so, a slow calcareous rain of microscopic planktonic shells. And then the waters receded, the land rose, was carved by glaciers, picked at by tides and frosts. About sixty feet at this point.
It's still early in the morning, and the scramble to get to work has only just begun, so in no time at all we've passed the taxi offices and are heading up to the car park at the cliff edge. We can see a police car there. The officer there tells us that a man walking his dog found the woman this morning and made the call from the taxi office. The policeman thinks she may still be alive. There is vehicle access to the undercliff walkway, but there's a barrier across the driveway at the moment and a council official coming with a key.
We debate whether to walk down with our gear but the policeman tells us that the woman is about half a mile along from this spot, so it will take us a while. I go back to the ambulance to fetch out a pair of bolt croppers, but just as I'm figuring out how to cut through the padlock the man arrives with a key. We drive down the steep path to the walkway, and then along to where we can see two figures leaning over something on the floor.
The woman is lying on her left side, one leg and one arm drawn up underneath her, as if she were slowly trying to get up. Her tangled hair obscures her face. One shoe has come off and is lying off to the right. There is a discrete halo of blood beneath her head. I kneel beside her, give her a gentle shake, but I quickly see that she is not breathing.
We need to roll her over. N. supports her head whilst the rest of us take a section of arm, leg, hip. We turn her. Immediately it's apparent that the woman's head is lopsided and wrong, pressed in along a line from the crown to the ear. There is little blood; what there was seems to have been caused by the pieces of gravel that have been pushed into her skin. Her eyes are half open, the pupils wide and fixed. Her nose is squashed and her mouth puckered up into a grotesque expression of disdain. I feel for a pulse at her neck but I know she will not have one. She is vaguely warm, though. As N. pulls the defibrillator from the bag I reach for my scissors to cut away her clothes. The first layer is a heavy coat with easy buttons, so I decide to undo those first. Beneath this coat, pinned to her cardigan, is a note: Please do not try to revive me. Sorry. I cut around the note and we attach the pads. But we do not really need the machine to confirm what we can readily see for ourselves here on this concrete walkway with the sea shouldering in on another high tide and the seagulls scrawling through the morning air.
We turn the defibrillator off. I fetch a blanket from the vehicle to cover her. She stares up and beyond us all to the top of the cliffs, as if she's seeing where she came from for the first time.
N. completes the paperwork.
The policewoman tells us about a car she went to that had driven at the cliff edge so fast it ended up on its roof in the sea.
The coroner's van arrives.
We finish on time.
We finish at seven, so we offer to take the job in place of the six thirty crew. They wave us off.
N. smacks his palms, says: 'This should sort us out nicely.'
I climb into the driver's seat and read out the details of the job: Seven Acres Taxi cabs. Woman fallen. Greater than sixteen feet. Status unknown. I wonder whether she's fallen off a ladder or something, and then I wonder what she may have been doing up a ladder at this time of the morning. But you never know till you know, and anyway I am so tired it makes no real difference to me.
As we turn out of the station and head up the road, another message comes through: Patient fallen from cliffs. Lying on walkway beneath. Police on scene.
This is a suicide.
I know the cliffs here very well. Before we moved it used to be one of my favourite fossil hunting places. I would spend hours with the dog stalking and chipping out sea urchins, bivalves and brachiopods amongst the chalk falls and pools. Eighty five million years ago these cliffs were the chalky ooze at the bottom of the sea, lain down at a knuckle's depth every thousand years or so, a slow calcareous rain of microscopic planktonic shells. And then the waters receded, the land rose, was carved by glaciers, picked at by tides and frosts. About sixty feet at this point.
It's still early in the morning, and the scramble to get to work has only just begun, so in no time at all we've passed the taxi offices and are heading up to the car park at the cliff edge. We can see a police car there. The officer there tells us that a man walking his dog found the woman this morning and made the call from the taxi office. The policeman thinks she may still be alive. There is vehicle access to the undercliff walkway, but there's a barrier across the driveway at the moment and a council official coming with a key.
We debate whether to walk down with our gear but the policeman tells us that the woman is about half a mile along from this spot, so it will take us a while. I go back to the ambulance to fetch out a pair of bolt croppers, but just as I'm figuring out how to cut through the padlock the man arrives with a key. We drive down the steep path to the walkway, and then along to where we can see two figures leaning over something on the floor.
The woman is lying on her left side, one leg and one arm drawn up underneath her, as if she were slowly trying to get up. Her tangled hair obscures her face. One shoe has come off and is lying off to the right. There is a discrete halo of blood beneath her head. I kneel beside her, give her a gentle shake, but I quickly see that she is not breathing.
We need to roll her over. N. supports her head whilst the rest of us take a section of arm, leg, hip. We turn her. Immediately it's apparent that the woman's head is lopsided and wrong, pressed in along a line from the crown to the ear. There is little blood; what there was seems to have been caused by the pieces of gravel that have been pushed into her skin. Her eyes are half open, the pupils wide and fixed. Her nose is squashed and her mouth puckered up into a grotesque expression of disdain. I feel for a pulse at her neck but I know she will not have one. She is vaguely warm, though. As N. pulls the defibrillator from the bag I reach for my scissors to cut away her clothes. The first layer is a heavy coat with easy buttons, so I decide to undo those first. Beneath this coat, pinned to her cardigan, is a note: Please do not try to revive me. Sorry. I cut around the note and we attach the pads. But we do not really need the machine to confirm what we can readily see for ourselves here on this concrete walkway with the sea shouldering in on another high tide and the seagulls scrawling through the morning air.
We turn the defibrillator off. I fetch a blanket from the vehicle to cover her. She stares up and beyond us all to the top of the cliffs, as if she's seeing where she came from for the first time.
N. completes the paperwork.
The policewoman tells us about a car she went to that had driven at the cliff edge so fast it ended up on its roof in the sea.
The coroner's van arrives.
We finish on time.
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