saturday night square dance

A-One, two, three, four…. (drums, bass, guitar and fiddle) …. Well, good evening Ladies and Gentlemen, boys and girls. Please don’t be shy now - let’s fill the floor right up, now, so we can see how you’re made, how you parade, if you’re two-tone, free-fone certifiably dismayed. Because Ladies and Gentlemen, boys and girls, tonight, live all night, you’ve got the quick blue straight to you Old Time Amb’lance Aiders. The cruel wind may be a blowin’ and the storm clouds may be a growin’, but we’ve got the attitude if you’ve got the gratitude, we’ve got the bus if you’ve got the fuss, we’ve got the croppers if you’re down on your uppers, we’re the team can take you places you only ever dreamed of on your little ol’ TV screen – yes, folks, it’s a big wah-wah welcome to another sensational Saturday spelt S-A-T, A and E and I don’t know about you but we’re itchin’ for another hot n’ handy all-nighter …..

Ready? Well, come on and Dosado!

The call is given as Cat A unconscious female overdose, downgraded to a Cat B conscious and breathing two minutes into the run. We’re told she’s outside a seafront hotel with some friends; we’ll be flagged down. We cut through the stuffed up streets and make it there as fast as we safely can. I see the group waving to us. We sweep round and jump out to see what’s happening.

A teenage girl in a white denim cut-off jacket and skirt is leaning against a van. She bats her friend away as she tries to make her stand up straight, catches us with a feral look as we approach. There are two teenage boys to make up the pairs. The one closest steps in front of me and starts telling me what he wants me to do. I ask him to stand aside whilst I talk to the patient. He keeps close to my shoulder, rolling a toothpick round in his mouth, a baby gangster in a bad movie. The other boy and girl waylay Rae and lobby her to take action. Meanwhile, the patient tells me that no, she does not have any medical conditions, no,she’s not sick in any way, yes, she has had a drink, no, she doesn’t want or need to go to hospital, she’s just tired and wants her bed. BabyGangster steps in front of me again.
‘Are you going to take her home or what?’ he says. The matchstick swirls in his mouth. He does not meet my eyes, but looks past my shoulder. This is a very poor script.
‘Okay. You tell me what’s happened tonight.’
‘What you mean – what happened? It’s obvious, mate. The taxi won’t take us with her like that, so how we supposed to get home?’
‘You do know what an ambulance is for, don’t you? Heart attacks? Broken legs? That kind of thing? Your friend is drunk. It is not a medical emergency.’
‘You’re not listening to me. I told you. The taxi won’t take us. If she falls down and cracks her head on the pavement it’ll be your fault.’
I look across to Rae to catch her eye, but she’s getting much the same treatment from the others and is struggling to make them understand. BabyGangster is getting angrier. He makes big gestures close to my face and his voice gets louder. I try reason once more, without any hope of success.
‘If the taxis won’t take you, you’ll have to go home on the bus.’
‘No. No, mate. It’s too far.’
‘We are an emergency vehicle. We’re not a taxi. What arrangements did you make for getting home before you came out tonight?’ I ask him, realising how ludicrous this sounds in the light of what he’s said so far. He shakes his head and his chin drops, as if he’s reaching the end of his tether with me. It seems as if this could get physical soon.
‘Just a minute,’ I say to him, then call over to Rae. ‘Can you come to the vehicle, please?’ She follows me.
BabyGangster thinks I am going to get some kit, but then it dawns on him that we may be leaving.
‘Where are you going?’, he shouts, throwing his matchstick on the ground. But we’re already in the cab and securing the vehicle with the central locking button. He strides over and begins banging on the door and pulling on the handle. ‘You can’t fucking drive off. I’m calling the police.’
‘It’ll save me the trouble,’ I say through the glass, and Rae puts the ambulance in gear. ‘Stand away from the vehicle, please.’
The other guy has come round the back and is trying to force the doors. The other girl is shrieking at us: ‘I want your names! I want your names!’, kicking the door. We drive off, pull over in a quiet spot, report what happened to Control, and clear up.

Half sashay family!

The call is given as a Cat A unconscious 1 year old boy, but a couple of minutes from the scene and it’s downgraded to a Cat B - sick, unspecified illness. The block of flats looms above us in the drizzling rain. We can’t make out how the numbers are running, but a guy coming along with a carrier bag filled with cans points out the way.

We are met at the flat door by the father, a middle-aged Bengali man in a smart arran knit jumper and leather jacket. He shows us into the living room where his wife is sitting on the sofa with a little boy on her lap. The boy is dressed in a perfect, scaled-down version of his father’s outfit. He gives us a wide smile as we settle down in front of him with our bags. The father is the only one who has any English. He tells me that his son vomited, once, about two hours ago. And this seems to be it – no breathing problems, no fits or floppy episodes, no diarrhoea, rashes or anything that might be taken as a sign of anything. No calls to the doctor for advice, no NHS Direct. No popping down to A&E – about a five minute walk away. It seems the only thing they have done is to dress the child formally, and brush his hair, which lies neatly and thickly across his perfect little head.

He child smiles at me, alert and enjoying everything.

We lead them out to the ambulance and make them comfortable in the back. Just before we set off, the child vomits once more – a tiny amount, almost apologetic – and then resumes his contented enjoyment of events. His mother wails.

Split the outside couple!

‘We were stood on the pavement having a lover’s tiff, when this black geezer comes past and says to me: white scum. So I says to him ‘You what?’ and he says to me ‘Sorry mate, I didn’t mean anything’. So we carried on. Then a little bit later he turns up again, pushes Janine over, and she whacks her head on the pavement. So I absolutely lost it. I pummelled the shit out of him – look at my knuckles. He was down in one hit. I beat him to shit and back. Then the police came and arrested him. He was lucky they did, ‘cos I was set to kill him. I mean – why do some people feel like they have to get involved?’
We are standing in the lobby of a smart hotel, which uncharacteristically has allowed this couple in to wait for the ambulance. There are no police, which is strange. Only a massive doorman standing discretely just a little way off. He waved us to the entrance and conducted us through the revolving doors to the patient, a young woman in a smart black suit who sits stiff and straight in one of the lobby chairs.
‘I mean, we all have tiffs, right? But why do some people feel the need to get involved?’
His girlfriend had not been knocked unconscious, but she does have a significant bump on the back of her head, and we agree with her partner that she should go into hospital for observation. She groans her assent, but it seems that the groan is more to do with the general run of events than her condition.
‘I’ll bring her shoes and bag,’ he says, gathering her things to him in a tidy fashion.

…and then Box the Gnat!

‘Josh went a bit vacant and then lay down on his bed and didn’t say anything – didn’t respond to us – and then he started twitching, his left leg was jerking a bit – and he went really white – and then he threw up.’
Josh sits on the edge of his bed, his face in his hands. His younger sister peers round the door, and his stepdad crashes around in the kitchen.
‘How do you feel now, Josh?’, I ask him, sitting beside him and feeling his pulse.
He looks at me, and his pupils are like little black saucers.
‘I feel fine.’
His pulse clatters away as if he’s just run in from outside after being chased round the garden by a lion.
‘So have you any idea what could be the matter, Josh?’
‘No. Not a thing. I had a few drinks with friends last night and I felt a bit hungover this morning. I haven’t had much to eat today. But other than that – no idea.’
‘Well – let’s go out to the vehicle, run a few more tests, and then take it from there. Okay?’
I’m hoping that his mum won’t follow us immediately, but she comes straight out with us.
On the vehicle, after wiring Josh up to the ECG and noting other obs – including an elevated BP – I ask Josh if he’s had any recreational drugs today.
‘No! God, no!’ he says, with his dark side of the moon eyes absorbing all the light in the vehicle. ‘Some of my friends were smoking dope, but I’d never do anything like that.’
‘Josh is a good boy,’ his mum tells us, hugging his jacket to her. ‘What do you think it could be?’

the voluntary visitor

The door opens a crack and a wizened old face peers round.
‘Ye-es? Who is it?’
‘It’s the ambulance.’
‘Oh. I suppose you’d better come in. She’s in the front room.’
There are three of us; Eric pulled up on scene in the car at exactly the same time, so we are two paramedics and a technician – the ideal team for a resus. We busy in with all our bags like champion shoppers home from the sales.
‘I’m afraid I’m no use to you,’ the old man says. ‘I’m blind, you see.’
I ask him to take a seat in the kitchen whilst the other two dump their bags around a female figure prone on the carpet.
I help the man sit on a wooden yellow chair. I ask him what happened.
‘Absolutely no idea. One minute she’s talking about roses or something – could have been box – no, definitely roses, because I remember…’
‘Sorry to interrupt, but I just need to know what happened to your friend.’
‘She is not my friend. She’s a voluntary visitor. I had nothing to do with it.’
‘Okay. Whoever she is. Did she complain of feeling unwell? Did she cry out? What happened?’
‘As I was just explaining to you – we were talking – she stopped – I asked her what she was doing – she fell out of the chair. I couldn’t do anything as I’m blind, you see. So I called you. And there you are.’
He places his left hand on the melamine tabletop and touches a wristwatch with his right.
‘You won’t be long, will you? She was only supposed to be here for half an hour and it’s already a quarter to.’
‘We’ll certainly be as quick as we can.’
‘Do I just sit here then?’
I tell him I’ll be back with an update in a few minutes. He sighs as I hurry out.

Back in the sitting room, Eric and Rae have turned the woman over, cut her top off, stuck defib pads on; Eric is cannulating whilst Rae compresses her chest. I join in, prepping drugs, helping Eric intubate, taking over the compressions. The woman is only about sixty, fit and trim. She has no health bracelets or anything on her that suggests any kind of illness.
After ten minutes of The Works – fantastically – we have plumped her up into a shockable heart rhythm. Two zaps later and her heart is beating again, and she is making some respiratory effort. Whilst Eric and Rae continue treating the woman, I set to making ready our escape.
The front room is tiny and cluttered with years of accumulated junk. There is barely room for us to work around the patient, but getting her out horizontally – to maintain what feeble blood pressure she has at the moment – is going to be a challenge. I clear as much of a space as I can, dumping an antique rocking-chair onto a settee, nests of tables and footstools onto the sofa, pushing the magazine racks, piles of books and the television as far as I can into a corner. Eric and Rae are already zipping up the resus and drugs bags; I pick them up and haul them out to the ambulance, which I prepare for take-off. I unload the trolley and make it ready just in the street by the front gate, then come back into the house with the orthopedic stretcher. The plan is to scoop her up on that, manoeuvre her through the sitting room door and tiny hallway out to the trolley.
It all goes to plan, although it is a struggle in such a confined space. We have her out on the vehicle pretty quickly. She still has an output, and I hurry back inside to gather the last of the bags and to tell the man what’s happening.
He’s still sitting at the kitchen table.
‘I’m afraid we’re going to have to hurry away now. Your – er – the woman – is very unwell and needs to go to hospital right away.’
He turns his face up to me, rucked up and livery with discontent.
‘First you must put my room back exactly how it was.’
‘Sorry,’ I say, ‘We really have to go.’
I can feel his outrage boring holes in my back as I shut the front door.

storm calls

All day I have been aware of the coming storm. The clear blue skies seem unusually clear, suspiciously blue. Are the birds quieter than normal? Where is the cat? I am morbidly drawn to each on-the-hour news bulletin, sipping tea by the radio and mentally flipping each hard phrase into My Little Well of Doom: damaging gusts, stay away from the coast, no journey unless absolutely necessary. Not a great career decision, to find yourself working a night shift at an ambulance station by the sea with a hurricane approaching. I lather up some morbid fantasies involving scaffolding, buses, planes, a tanker or two, rolling out catastrophes like a scriptwriter on Casualty, with me as a lovable but expendable technician, my last seconds captured on a camera phone from the pier, a blurred figure on the shore, his flapping fluorescent jacket the last little bit of colour beneath the wave.

I put together a packed lunch, though, just in case I live long enough for a break.

Our first call is to a frequent flier. Not one I’ve been to before, so I am pleased to tick her off the list. Control tells us that they have tried to avoid sending anyone out to Joy, but she has told them that she has had a fit, so we are duty bound to attend. Consequently, we find ourselves huddled amongst some bins as Joy fiddles around with the locks on her back door. Eventually she tells us that she can’t remember how to open it.
‘Can you remember how to lock it?’ Frank shouts to her above the wind.
‘Yes.’
‘Well do the opposite to that and you’ll be fine.’ He looks at me. He’s impassive, but his moustache looks like it might spark.
She fiddles with the locks some more. Nothing happens.
‘You’ll have to break in,’ she says.
‘Joy. We are not going to break in, darling. Come round to the front room and pass us the keys through the window.’
‘Okay then.’
We make our way to the little front garden and wait. At least it’s not raining. Frank warns me: Don’t agree to look at her chinchillas. A light goes on. We see her shuffle into the room, and then begin sorting through some papers on a sofa, obviously forgetting what the mission was. Frank reminds her with a sharp rap on the window. She jumps, then shuffles over to us and moves the curtains aside. Her face is bleach white and blank. A frail woman of about fifty, in teddy bear PJs. She smiles out at us.
‘The keys, Joy?’
‘Oh. Yes.’
She drops the net curtains and shuffles back out of the room to the back door. We wait. Eventually she comes back into the room with the keys. Frank has to perform a brutal little mime to make her see that the window is on a latch and needs undoing. Finally she manages to spring the window and pass us the keys. We march round the back again and open the door – mortice, then yale – and go inside.
It looks as if the place has been methodically randomised, with papers and medicine bottles on the floor, cushions on the table and cutlery on the stairs. Joy is standing waiting for us in the doorway between the kitchen and the sitting room.
‘I used to be a ballet dancer,’ she says, helpfully. I can see several empty bottles of strong cider in the sink, but Joy’s breath makes the check redundant.
‘Joy – Just take a seat for me, please.’
I clear a chair for her and she sits down.
‘Why have you called an ambulance tonight? What’s happened?’
She pulls up her right pyjama leg. ‘My foot’s swollen.’
It is slightly fuller and redder than the left, but nothing awful. She can obviously weight bear, and doesn’t seem in pain.
‘Is there anything else the matter?’
‘No. Just my foot.’
Frank shows me a referral letter he’s found - a foot appointment the next day.
‘You’re already seeing someone about your foot, Joy.’
‘Yes. Yes. You’d never believe I used to be a ballet dancer, would you?’
‘Joy – when are you due to see your CPN next?’
‘The day after tomorrow.’ She stretches out her bad foot and taps a calendar lying on the floor by the chair. It carries a glossy photo of a ballet dancer with her leg up on a barre.
‘Joy – you know you shouldn’t be calling out the ambulance when there’s nothing really wrong, don’t you? Whilst we’re here with you, someone else might have fallen down and hurt themselves, or had a heart attack. Wouldn’t you feel bad if you’d stopped them getting the help they needed because we were tied up here?’
She nods and bites her lower lip, looking about twelve. Then she brightens.
‘Would you like to see my chinchillas?’

Our second call is to transport a Section 131 voluntary admission to a psychiatric ward in a hospital about twenty miles from our home base. I’m the attendant in the back with Geoff, a scooped-out man in his thirties who took an overdose the previous night, one of several in recent months. Geoff sits crouched over in the seat, guarding himself like an abused pet, taking up as little room as possible. I try to put him at his ease, but he’s crouching at the edge of any normal interaction. The journey seems to take years, the noisy wind outside the ambulance emphasising the tense silence inside. When we pull up outside the ward and help Geoff out of the back, there is a black coated figure standing flat against the wall, trying to smoke a cigarette. We can barely keep our feet. Inside the ward, a member of staff leads Geoff away.

The night roars on.

A couple of genuine falls, an assault, nothing taxing. A chest pain that turns out not to be cardiac, but centred on the liver. Then a final call at half past five. A woman waves us round to a side entrance as the wind clatters on around us scattering bins across the road. She says: ‘Thanks for coming. Awful weather!’ and then in to a well-lit room and a man sitting on the edge of his bed with his legs apart and his blown-out belly hanging pregnantly between them. It is what it appears to be on first glance: gross fluid retention associated with ascites. The man is massively distended – so much so that his diaphragm cannot work properly, making breathing difficult. Despite his condition the man is quite sanguine about it.
‘Excuse my directness,’ he wheezes, ‘but I can’t move without messing myself. Have you got any pads?’
We help him out to the vehicle. As we make our way past some rose bushes in his front garden – and in my early morning torpor - I imagine him snagging on a thorn, bursting and whooshing up into the storm, his dressing-gown cord snapping and coiling behind him like the tail on an enormous kite.

a bit of a tumble

‘My name is Peter. I’m absolutely fine. A bit of a tumble, but - believe me, I just need a hand to get up.’
This from a man wearing only a thong, lying curled around a parking sign at the bottom of a steep, scrub-covered embankment.
‘I don’t want you to move anything just yet, Peter. I’m going to check you over a bit at a time just to make sure you’re okay. Okay?’
‘Oh for goodness sake. Go on, then.’
I check him over from the neck down, and apart from some superficial scuffs and scratches, he seems intact. Between Rae, Jess – who has just turned up to help on the car - and me, we gently prise Pete away from his perch and help him onto the trolley which we’ve put alongside and raised up. He settles back and puts his hands up behind his head as if he’s decided to take his ease in a deck chair.
‘Ah. That’s better. Thank you so much.’
With his great, grey Zapata moustache accentuating the downward tilt of his mouth, his crossed blue eyes and his shaggy hair, he looks exactly like the cowardly lion from The Wizard of Oz.
‘So, Peter – what happened, exactly?’
‘Well good grief. I was taking a stroll along the cliff garden walk when these two rough looking lads came up to me, pinned me by the shoulders, and demanded that I took some Viagra. When I told them that I certainly didn’t need to take Viagra, they threw me down the cliff, and I landed where you found me.’
‘But you’re only wearing a thong.’
‘All my clothes must have been torn from me as I fell through the bushes.’ He yawns, and it’s like a door swinging open at a distillery.
‘How much have you had to drink today, Pete?’
‘A constitutional snifter,’ he says, only just making the words. ‘Look at me. What a mess.’
Whilst we clean up his grazes, Jess goes off up to the top of the cliff walk to see if she can find Peter’s clothes. She comes back ten minutes later with a carrier bag.
‘Are these yours?’
‘Yes! Oh – thank you so much, dear. I didn’t want to spend the whole day showing myself off like this.’ He looks at me and gives a coquettish squint.
‘I thought you said your clothes were torn off you as you fell?’
‘Well, yes, indeed – but some kind person has obviously collected them all back up again for me.’
He sneezes. He is so like the lion I expect him to make his hands into paw-like fists and growl: ‘Put ‘em up! Put ‘em up!’ But he seems content to relax back on the trolley.
‘What are we going to do with you, Peter?’
‘Whatever you like,’ he says, blowing his nose on the tissue I gave him – and then handing it back. ‘After a day like today, I really don’t care.’

big drinker

‘No. I don’t know him, as such. He’s my boss. In fact, he owns the company. This was just a little works outing. I don’t know where anyone else is. All I know is – his name’s John, and he’s about forty-three.’
We’re all standing around the man lying on the pavement outside the hotel: an inner circle made up of me and Frank, the witness and two police officers, and then an outer circle of Thursday night survivors, insulated and indestructible through the magic of alcohol. They smile and shout stuff, strutting around.
‘How did he fall? Did you see him go down?’
‘It wasn’t a fall. He kind of – leant against the railings – like this – then slid down on to his arse – like this – and then out.’ The guy stares down at the hulking figure sprawled on his side on the pavement. He looks like a slaughtered pig dressed in someone’s best blue suit and a curly black wig for the craic and the phone cameras. Awash from head to foot in what looks like minestrone soup, but probably isn’t.
‘You don’t know if John’s got any health problems, do you?’
‘Nope.’ The guy pauses, gives a little nod and a sniff. ‘He’s not very well now, though, is he?’
‘Nope.’
But at least he has the basics – breathing, pulse, responds to pain, no blood anywhere, no limbs awry. He was probably asleep when he reached the pavement, rolled flat by a barrel of pints, tucked up amongst the cosy slabs, awaiting collection.
And this is the problem. As soon as we pulled up on scene we saw the problem. Not so much medical as removal. It’s a while now since I looked, but I don’t remember the section in the manual describing the Safe Four Man Lift of the Doubly Incontinent and Vomit-Covered Drunk.
But we’ve managed it before.
We thank the witness, who stumbles off to find a taxi. Working like green, skilled spiders, we wrap the patient in blankets, use a scoop stretcher and the two police officers to lift the patient on to our trolley, load the trolley back on to the vehicle. As I’m putting the tail lift back up I wave to the dustcart that’s just arrived and standing off scene, its flashing orange lights an interesting change to blue. It wants access to the hotel, so I hop in the cab and we move off.

Lazarus

A girl waves to us from the front door and waits for us there, jiggling impatiently from foot to foot and sucking on a cigarette, watching whilst we haul our bags out of the truck.
‘Come on! He’s upstairs,’ she says, flicking the cigarette off into the garden and hurrying inside. As we cross the threshold the contrast between the crystalline Sunday morning and the muted interior is awful; the air seems to have congealed into a fatty grey smog that barely stirs as we move through it. We pass an empty room – snapshot of a mattress on the floor, rucked grey sheets, bottles – then up into another where a skinny man is lying flat on his back. His t-shirt is pulled up and I can just see from here some trembling movement in his abdomen as he makes tiny efforts to breathe. The woman kneeling beside him sits back on her heels and pushes her beany hat up to look at us.
‘He’s breathing some, but not much,’ she says. ‘He’s injected heroin.’ But his pinpoint pupils and the marks on his arm are clear enough.
I take an airway out of the bag and put it into his mouth whilst Rae hooks a BVM up to the oxygen.
‘When did he inject?’
‘Not long ago. I’m not sure. I wasn’t with him.’
Rae hands me the breathing kit and I start supporting his feeble respirations. She puts together a syringe of narcan – the drug we use to reverse the effects of opiates – pinches up the skin of his upper arm, and jabs him.
‘He wasn’t breathing at all when we found him. He was all horrible and blue. We got him going again, though. I had to give him the kiss of life. I only know how to do it because my baby died and I did it on her.’
Both the girls look sickly, but the one in the beany hat has a truly awful complexion, scooped out and hollow like a teenager raised in the dark. Around us the room is trashed, cans standing on the bare floor where they were placed, clothes in tangled corners, carrier bags of foraged food in various stages of decay – a rotten room junked, every human comfort or effort of control subordinated to the needle.
‘Is he going to die?’
Rae gives him another dose of narcan. Gradually his breathing quickens enough for me to stop bagging him; in another minute or two he moves his head slightly from side to side and starts to gag on the airway. I pull it out. Suddenly he opens his eyes.
‘Hello. It’s the ambulance,’ I say. He stares up at me and frowns, then makes an effort to sit up. We help him. He leans against the bed.
‘Wow,’ he says, then ‘Who are you?’
The woman in the beany hat stands up.
‘We saved your stupid life, you bastard,’ she says, then pushes out of the room and into the bathroom, slamming the door behind her.
‘What’s the matter with her?’ he says, jerking his thumb in her direction like he’s sitting with friends in a pub and someone has just caused a scene.
‘What do you think?’, the other girl says. ‘She lost her baby and now you go off on us.’ She follows her out of the room and starts trying to talk to her through the bathroom door.
‘I don’t even know them,’ he says to us, rubbing his face.
He tells us, without a hint of irony, that he doesn’t do heroin and this was his first hit. He says he doesn’t want to go to hospital, even though we tell him that the effect of the narcan is short-lived, and he might well go unconscious again. Rae completes the paperwork, he signs to say he refuses further treatment, and we pack our kit away. We leave him propped up against the bed.
Back out in the hallway, the bathroom door is open and the first girl is sitting on the side of the bath hugging the second.
‘He says he doesn’t want to go to hospital,’ I say.
‘Surprise, surprise.’
‘He’ll still be at risk for a few hours, so you might keep an eye on him. Give us a call again if anything happens. Apart from that…’ I shrug. The first girl makes an effort of a smile.
‘Thanks for coming so quickly,’ she says.
I tell them I thought they did a good job getting his breathing back. I tell them they probably saved his life.
‘Like he cares,’ she says.
We see ourselves out.

early hours stupid

‘So you were in the navy then, Reg?’
‘National Service on a survey ship. Loved it.’
He straightens in the chair we have helped him up into, then sags into a slump.
‘I feel so damned stupid.’
He has an impressive old sea dog’s silvery mane, but the rest of his body is giving out on him. From the tops of his calves down to his feet, the flesh is dark and leathery with dermatitis; it’s like a rising tide line of incapacity. He doesn’t get about like he used to.

It is two o’clock in the morning and we found him on his knees by the side of the bed, unable to get up. His wife had called the ambulance. She tells us that Reg has been averaging a fall a week for a little while now, but the Falls Assessment team have been round and done what they can.
Reg rubs his knees and gives a wide, leonine yawn whilst I take his blood pressure, temperature, the usual checks.
‘Seen my certificates, lads?’
His wife is rubbing her eyes to stay awake, but she brightens and points to one of them, an impressively cursive document with a photograph alongside it.
‘Wasn’t he cute?’ she says.
‘So – can you remember falling out of bed, Reg?’
‘No. I have no memory of it whatsoever. I woke up, and I was on my knees. I must have simply rolled out.’
There are bars along his side of the bed, but it is possible that he had slipped down before rolling. He does not have any new injuries or symptoms. It is a simple falling out of bed.
‘Maybe you had a dream you were manning the lifeboats,’ Jack says. ‘Hard to starboard!’
We all laugh. I finish the paperwork, and then we help Reg back into bed and tuck the yellowing quilt around him. He curls both hands up around the top edge of the quilt, and then shuts his eyes.
‘Full steam ahead!’
Reg’s wife thanks us for coming and walks us to the door. Outside the purple morning air is icy, and she clutches her dressing gown to her.
‘Bye now. Thank you very much. Don’t take this the wrong way, but I hope I don’t see you again soon.’

***

An hour later we are standing outside a pizza place, with what looks like gouts of tomato puree on the pavement and a cyclone of spite circling around us. Without this significant police presence, I would be in the cab and away, but as it is, we identify the two patients and get them onto the ambulance to assess them.
Pencil stub outlines: two whippet thin white guys in their late teens, number one in a white shirt and cheap satin waistcoat, the left side of his face bulging out to the side and a gash in the middle of his forehead that trails blood down over his face and front; number two, dressed in a spivvy black suit, holding his right arm and grinding his teeth. The mother of number two comes onto the vehicle as well. Where she has appeared from I have no idea – and never find out. She is a raddled version of her son, but with longer hair and nails.
More shocking by far than the boys’ injuries is their intense anger. In the same way that a flame will burn what and whoever comes within range, these two arc with violence. Their words are so fierce that it’s as if we and the police have to snap down welding masks to filter out the invective, to see any useful information that might be behind it.
‘So what’s happened to you?’
Filtered view of 1: ‘We had a fight with an Asian gang. They attacked us with baseball bats.’ He licks the blood from his front teeth, then carries on: ‘You can’t hold me. I haven’t done anything wrong. I don’t have to be here. I know my rights. I can walk if I want to.’
Police: ‘Moderate your language, please. We will certainly nick you for affray and breach of the peace if you don’t.’
Ambulance: ‘Look. Let’s try and sort out what’s happened to you. We need to clean you up a bit and see if you need to go to hospital.’
Filtered view of 1: ‘Go away. Leave me alone.’
Filtered view of 2: ‘Let’s go and burn down their house.’
When the policeman in the doorway tells him to be very careful not to swear at us and make threats, or face being nicked, number two bares his bloody teeth and spits his words out through them:
Filtered view of 2: ‘You’re enjoying this, aren’t you? Look at you. Go on, lap it up.’
But then, weirdly, he starts crying, doubling over and letting out a ghastly mewl like an injured puppy.
The mother tells her son to stop swearing at everyone.
Filtered view of mother: ‘They’re only doing their job. They think you should go to hospital. So go to hospital.’
At this point I would be happier if they didn’t go to hospital. I can’t imagine that they will be able to submit to treatment for longer than a minute without being thrown out by security. But they seem now to want to go. A policeman nods to me from outside the vehicle; I jump down to speak to him.
‘I’ll ride in the front with you, if that’s okay,’ he says. ‘I don’t want to make the situation worse. There’ll be a squad car following. If that’s okay with your colleague of course.’
Jack is hanging out of the door. He looks down at us and nods. We were talking about his surname earlier – how unusual it is, the Scandinavian derivation. He looks at me and smiles like I imagine a vast Viking champion would smile, strapping on an axe. ‘I’m fine with that,’ he says. I slam the doors shut and drive to A&E.

When we get there, I lead the three of them in through the main doors.
Filtered view of 1: ‘Where’s the hospital then? You said we were going to the hospital.’
Me: ‘We are there. This is the hospital - this big building in front of you. Let’s go in and talk to the nurses. But I have to tell you – if you carry on talking like this you will get thrown out.’
Filtered view of 1: ‘I don’t want to see any nurse. I don’t have to. You can’t make me.’
Filtered view of 2: ‘My arm hurts. I want to go home and kill those Asian gang members.’
Me: ‘You are in the hospital now, so you have to moderate your language. If you carry on talking like this, you won’t get seen. And I think you probably need to be seen.’
Filtered view of 1: ‘What do you know? You didn’t do anything. You’re just a taxi man.’
Me: ‘We need to wait just here whilst my colleague goes and talks to the Charge Nurse. Have a seat.’
Jack walks off to the nurse’s station. Another crew is preparing their trolley nearby. I have a discrete word with them to watch themselves, and they make some space. The police hover in the background.
Filtered view of 2: ‘We are seriously going to inflict damage on that crew.’
Policeman: ‘This is your last warning. If you continue to talk in this way you will be nicked.’

The Charge Nurse comes over.
‘What’s happened here, then?’, she says, with a bright, professional smile. ‘You first. Tell me what’s happened to you tonight?’
Unfiltered view of 1: ‘Well what the fuck do you think has happened to me tonight? You’re the cunt with the answers. Do something. Stupid.’
She turns briskly and says: ‘Throw them out.’

The police wade in and drag them all away.

big

As we pull up to the kerb there is a thin, grey man meticulously folding away an orange lawn mower lead. He doesn’t even look up as I open the door of the ambulance to climb out, and when I smile at him and ask if the patient is inside – a dumb question, I know, but the first thing that comes to mind as a conversation opener – he merely shrugs in the direction of the house, and carefully clips the lead to the back of the mower.

We discount this man as a source of information, and carry on into the house. At the open doorway I can hear animalistic snorts and howls.

A frail looking woman appears in the hallway. Her eyes are bleach blue, and she seems so brittle that beneath her practical clothes she could easily be made of twigs.

‘He’s just through here,’ she says, scooping her hair back from her face and finding something that approximates a smile. ‘What have you been told?’

‘Nothing much,’ I say. We’ve been given this as an Urgent journey, eighteen year old male with query fractured ankle. The GP has seen this patient and ordered an ambulance to convey the patient within four hours. I’m already suspicious that there’s very much more to say than that, but we follow on in silence.

She leads us along a hallway into a dimly lit lounge area, with a large TV playing a video of Trumpton. Dominating the opposite side of the room is a plush, four-seater brown leather sofa, and occupying the entire length of this, a figure so massively pale and naked it’s difficult not to stop still and say ‘Whoa!’

The boy’s huge arms are crooked above his head, like a gorilla in a bower. He grunts, scratches himself, and lies there breathing massively.

He is astonishing. He is the fattest, barest, most abundantly fleshy human being I have ever seen. His abdomen rises upwards with the hyper-inflated tension of a space hopper, and his breasts lie slung either side of his chest like saddlebags filled with jelly. When he kicks his legs out straight, his entire being – from the hanging folds of his thighs to the multiple layers of his chin – ripples and jiggles, whilst his brave little penis waggles up like a hitchhiking sea creature on the underside of a great albino whale.

His mother sits down next to him on the sofa. Immediately the boy gives her a whumping great palm slap on the back, which she absorbs with a little forced exhalation and a leaning forward onto her knees. He follows it up by grabbing a handful of the skin under her upper arm, which she can only release by using a few key words. Her arms are patterned with bruises. It’s difficult to believe she could last five minutes in this boy’s company.

‘As you can see, Simon is quite demanding,’ she says, stroking his forehead. His dark eyes slide from side to side and he groans again.

‘He has some behavioural issues. We look after him full time because there was no way I was going to put him into a home.’

I wonder about the ‘we’ in this, but at that moment two other large people come down the stairs and into the lounge. They smile at us, and then stand watching with their arms folded. They are Simon’s elder brother and sister.

‘Simon gets frustrated sometimes and runs about the house shouting and stamping his feet. Yesterday he put his foot through the floor and fell over. We think he may have broken his ankle.’

The brother laughs. ‘Look around you. He’s always putting his foot through the floor.’

He is right. The carpet dips in many places around the room, a lunar landscape laid out in caramel shag pile. Meanwhile, the TV booms on – Windy Miller standing outside his windmill, shocked at something.

‘Could we put the telly off for a moment?’, I ask them.

‘No. Sorry. Simon has to have the telly on constantly.’ The woman’s tone is even, a simple laying out of rules.

The brother laughs again. ‘He has to have the same video. It’s on endless repeat. He’ll have this one on for a day or two, and then he’ll let us put a different one on.’

‘And the curtains must always be closed,’ says the sister. ‘He doesn’t like daylight.’

I ask if Simon will mind if I take a look at his ankle. The woman says that with her help he’ll let me touch it, so I warily move closer.

After a few judicious prods, I tell the mother that I think he probably sprained the ankle. The fact that he bore his weight for a while after the accident would seem to support that, but without an x-ray it’s impossible to say for sure. But the mother says that he will not take any weight on the injured foot now. Which leads us to the problem that was obvious from the second we entered the room – how do we transport this patient? I can tell immediately that the trolley will not get through the front door, and even if it could, we would need at least six people to get him off the sofa. But even then, his volatile temper is going to be difficult to manage.

I wonder to myself why the GP neglected to mention any of this.

But the mother has a plan.

‘You carry diazepam, don’t you? Well, why don’t you load him up with that, so he’s nice and docile. Then it’s just a question of hauling him outside onto the vehicle.’

Frank is the paramedic and he speaks up. ‘That’s not what we use it for, madam. It’s for fitting patients. We don’t go around tranquilizing people.’

The mother rubs her forehead, stands up stiffly, and goes over to a sideboard where there is a big white bowl of imperial mints. She pops one in her mouth, and then says: ‘But what else can we do? I don’t know what else to do.’

‘No. It’s not going to happen. Absolutely not. I’d be struck off.’

The brother and sister look on with their arms folded as benevolently as before.

‘Simon does leave the house occasionally,’ the sister says brightly. ‘In fact, he tells us when he wants to go out.’

‘He doesn’t tell us. He just charges outside and climbs in the wagon,’ chips in the brother.

‘But that’s was when he could walk,’ she says. ‘Would you like a cup of tea?’

***

Half an hour later we are still in this twilight room. Frank is slumped on a kitchen chair with a cup of tea cradled in his hands, his expression as deadpan as Windy Miller in the video, who continues to march in and out of his windmill with a suicidal disregard for the blades that slice past the doorway. Meanwhile, I have made phone calls to Control and the GP and passed the phone to the mother a few times, and haggled with everyone, whilst Simon snorts and groans a few feet away, an amplified version of my own frustration.

‘So here’s where we are,’ I say, finally. ‘You need to decide whether or not you want Simon to stay at home, take anti-inflammatory drugs, keep the foot rested up with cold compresses, and see if the ankle gets better – which it very well might – or go to A&E for a x-ray. If you decide to go to hospital, it’s going to need some special arrangements. The GP will have to be here beforehand to give a sedative, and then we’ll need at least three ambulance crews and a wide, patient transport vehicle with a specially adapted wheelchair.’

The mother stares at me, and crunches her mint.

‘Whatever you decide, it won’t be happening in the next hour or so. Which means we really ought to be going. I'm sorry.’

The mother signs our form to release us. Frank hands back the cup of tea with a stretch and a thanks-very-much. We leave, and the door closes on some throaty lowing from the sofa.

Outside, the smell of cut grass is intoxicating.

four o'clock

Bill is twenty-one stone. Even his beard looks heavy. He is sitting on the floor of his narrow hallway, wedged like an elephant in a box, with one of his vast, bandaged legs bent underneath him. He can’t get up.

‘Can you be quick, boys? I’m getting pressure sores on my arse.’

I go back to the vehicle to fetch the mangar – an inflatable lifting aid, its stack of four cushions designed to gradually raise the patient up to a standing position, or at least to a height where we can help them transfer to a chair. I also grab the manual handling bag, full of straps, sliding sheets and other stuff that we might need in this case.

Back in the overheated flat, Frank has managed to free up Bill’s bent leg, and untangle the catheter and bag.

‘You wouldn’t want that to burst,’ he says. It certainly is full. Frank finds a jug from the bathroom and empties the noxious brown fluid into it whilst I start unpacking all the kit.

‘It’s my own stupid fault for getting up to go for a shit,’ Bill says amiably, to fill the time. ‘Pardon my French. I don’t go that often. Once every five days or so. But when I go – well, it’s like the world falling out of my arse. The Old World. Gondwana. Dinosaurs, volcanoes and all.’

We stand discussing the best way of getting him up. Like so many of the jobs we go to, it’s an exercise in improvisation. Bill tells us that he can’t rock from side to side and shuffle himself backwards onto the mangar, so we decide to get the sliding sheet underneath him, and then use that to drag him onto the cushions.

‘So I had an unenviable choice to make. Either lay in bed and shit myself, or try to make it to the loo.’ He thinks about this as we grunt and sweat trying to get the sliding sheet into position. ‘The other thing that crossed my mind was – I might get halfway, collapse in the corridor, and then shit myself.’

The sheet is in place. We agree that this option was probably the cleanest, if not the easiest.

We step over Bill and each other and fumble around for hand grips, and then one, two, three – haul him back onto the cushions.

‘There she blows,’ he says. I plug in the air hoses to the four cushions, and when Frank has himself in a position where he can stabilise Bill, I start inflating. He rises up.

‘It’s a miracle!’, he says, ‘A levitating saint! God, that’s easier on my arse.’

The cushions reach their maximum height and the job is looking more manageable. Bill says he doesn’t feel confident about standing up and walking just yet, but he doesn’t want to go back to bed, either. He says he wants to go into the front room and sit at his computer. He says the best way to do this would be to bring his office chair through. He can transfer onto that, and we can wheel him in.

When we get him into the office chair, it bends precariously.

‘Are you sure this is a good idea, mate?’, says Frank. ‘I don’t think this chair was ever designed to cope with – er – loads like this.’

‘Are you saying I’m fat?’, he says with mock indignance. ‘Well of course I’m fat. I’m a rotten old tub. But there you are. Things are what they are. Wheel me in, then. Mush!’

We pull and push the chair, which creaks alarmingly but holds. In a minute or two, he is in position before a well-ordered computer desk. I go back into the hallway to pack away the equipment. When I re-join them in the front room, Frank is completing the paperwork and Bill is telling him about his life.

‘I used to teach the trumpet. Played in bands, taught, travelled the world. But age and this fucking arthritis took over and gradually, gradually…’ he holds up his right hand, whose fingers are quite grossly deformed. He wiggles them a little, then puts his hand back on his lap. ‘I had a beautiful instrument. Made in 1911. Worth quite a bit. The last time I played it was May the eleventh, nineteen ninety six. Four o’clock in the afternoon. Then I put it in its case and gave it to a good friend of mine. Because an instrument like that was built to be played, not just dusted off now and again.’

Frank gets a signature on the form and we stand to leave.

‘Thank you gentlemen,’ he says, ‘I know you’re busy. I hope I shan’t be needing you again.’

the irresponsible tipster

Fiona’s face is doughy, like an under-cooked cake; her cheeks sag beneath the weight of her eyes, moon-sized through drink and pills. She sits on the ambulance chair, her arms folded too carefully, staring back at me as I ask my questions.
‘How old do you think I am?’
She pushes her hair back from her face, then adds with a coquettish simper: ‘I have to have a cigarette – but not here, of course.’
Her words are as puffy as her face.
‘That little bitch. She wrecked my house.’
She starts to cry, but before I have torn off a wad of tissue paper to give to her, the crying fit passes. She smiles at me as she takes the tissue.
'They hate me at the hospital, you know', she says.

***

Six months earlier, we are pulling up outside a terraced house in a part of town that crews sometimes mispronounce in a French accent, irony at the awfulness of it.
Overdose / Poisoning. 42 year old woman. Overdose on medication. Cat B.
I climb out of the cab and go to the front door. It’s lying open, and there are no lights on inside. A CD is playing, skipping and repeating one line at full volume. If I had been watching this drama on TV I would have thought: crude psycho scene - too many clichés. But here? I put my response bag and the clip board down so both hands are free, and nervously I edge forward into the house.
‘Ambulance?’
Nearer to the living room and the noise gets louder. I flatten myself against the wall and push the door fully open so that it bangs against the wall, in case there’s anyone hiding behind it. Nothing and no-one. I move into the room, with Rae behind me patting on lights whenever she feels a switch.
‘Hello?’
Brutally illuminated - a woman lying on a sofa, raising her head to see who's coming in.
‘What? Who?’
Leather jacket and black bra. Silky black chemise. Remains of a takeaway on plates, on her. It slides to the floor as she hauls herself into a sitting position. I turn the music off. The silence and light are as shocking as her trashy red lipstick. She wipes her nose with the back of her hand, and then says:
‘What do you want?’
‘Someone called an ambulance. Was it you? Or is there anyone else here?’
‘They’ve gone out.’ She starts fumbling around for a cigarette, and finding a bent one in her pocket, stuffs it in her mouth. It’s all too pathetic to quite believe.
‘Someone reported that you’d taken an overdose. Is that right?’
She laughs once, Swanson-style, and the cigarette tumbles out of her mouth. She tries to catch it and almost falls off the sofa. It’s amazing to think how wired I’d been coming into this house just moments earlier.
I start to ask Fiona exactly what she’s taken and when, but at my change of tone she suddenly stops floundering around on the sofa.
‘I’ll tell you all about it,’ she says to Rae, touching her on the hand, her eyelids narrowing weightily, ‘but I want him out of the room.’ As I hand over the clip board to Rae, Fiona announces in a stage-whisper: ‘I was raped last year.’ And she leans back, straightens her slip over her knees, and looks at me accusingly as I leave the room.

I walk out into the hallway and pace about. Look at my watch. We’ve already been here quarter of an hour, and it could be a lot longer. Bubbling flowered wallpaper, jagged tears, brown stains. A print of Edwardian ladies and gentlemen promenading along the front. An old News of the World dumped at the foot of the stairs. I check my watch again, and just as I do, a slight, quick figure bundles in through the front door and starts shouting at me from the depths of its upturned hood:
‘What the fuck is going on? What are you doing here?’
I guess this is the daughter. Her boyfriend is staring in from outside. He is thin and pale, dressed in a white tracksuit; the weight of all the chains around his neck seem to be slowly bending him in half. He talks constantly into a mobile phone, and watches me.
With as much calm authority as I can manage, I tell the girl that we are the ambulance, and that we are here to help her mother. But before I can go on to ask her for some information, she barges past me and on into the living room, where she pushes her mother back onto the sofa and begins shouting at her.
‘What the fuck have you been doing?’ she shouts.
It looks as if she’s going to hit her, so I grab her shoulders and move her backwards. She spins round on me.
‘Take your hands off me,’ she spits. And then ludicrously, starts shouting for help. Her boyfriend wanders in, still on the phone, and with no change of expression.
To Rae: ‘That’s it. We’re going.’
To the girl: ‘We’re here to help your mum but you’re getting in the way. We’re going outside to call for the police, and they’ll come and arrest you.’
The word ‘police’ has a magically subduing power on her. She eases off, and says: ‘No. Don’t do that. I promise I won’t do anything else.’
‘Go and sit on the stairs in the hallway,’ I say, immediately realising that this is ludicrous, like saying go to the naughty step. But I’m committed to following through with it. Amazingly, though, it does seem to be working. She goes out of the room, gathering her boyfriend to her, and they both sit on the fourth step up.
At first it looks as if the girl is going to cry. Her boyfriend – his phone away now – hugs her to him like a big white insect. Her shoulders start shaking. When I go closer to them to say a few, more conciliatory, words, I realise she is laughing.
The only thing I want to do now is leave the house as quickly as possible. I nod to Rae as I re-enter the room. ‘Definitely time to go.’

***

‘Do you recognise me?’
Fiona stares for a second, then waves the air in front of her. ‘You could be anyone,’ she says.
The ambulance sways along.

***

We pick her up from the Police Custody Suite on the outskirts of town. After we’d been buzzed through its heavy security gate, we park in one of the receiving bays and climb out of the vehicle. A policeman is standing there, smoking a roll-up.
‘All right, fellas,’ he smiles. ‘Come for Ms Ferrero?’
He drops his fag to the ground and grinds it out.
‘What a pain in the arse. How many times? Anyway – I’m sure you’ll recognise her. What happened was – she was arrested after a domestic disturbance, and charged with assaulting her daughter. When we got her here she says she’d taken an overdose of ibuprofen – about twenty, 400 mg. Apart from that,’ he shrugs and laughs, ‘she’s not as bad as last time.’

We follow him to a thickly painted green steel door.

‘Last time she shoved her mobile phone and her house keys up her cunt.’

***

‘How much longer?’
‘Almost there.’
Fiona smiles at me.
I ask her what line of work she’s in.
‘I’m a tipster,’ she says, pushing her hair away from her face again, and then, after a lofty pause, ‘Don’t you know what a tipster is? A tipster finds things out, and then rings the news desk to tell them all about it.’
‘What kind of things?’
‘I had a big splash last year with It’s a dog’s wife. Horrible title, but I can’t help that. All about a man who kept greyhounds in the house, and his wife got fed up with them lolling all over the furniture, so she divorced him, and the dogs were cited in court. Did you ever read it? It was everywhere. And once I was on a train and I saw a helicopter crash onto a tractor in a field. And another time, my brother in law, who’s a taxi driver, heard something very juicy about the royal family that I couldn’t possibly tell you – yet.’

The ambulance pulls into the A&E car park.

She frowns. ‘Is this it?’
Then she says: ‘Do you know the great thing about hearing voices?’
‘You hear voices?’
‘Yes. I do. I hear voices…’ she wiggles her right hand in the air above her head. ‘And they tell me to do all kinds of things. Cut your arm, Fiona. Bang your head against the wall, Fiona. Swallow these pills.’
The door opens. Rae smiles and looks inside. ‘Chair or walking in?’
I ask for a chair. As Rae goes to fetch one, Fiona leans forward, conspiratorially
‘But the great thing is – the wonderful thing is – I’m not responsible.’

two sons

Son #1
As we pull up outside the house, I read the patch of garden like some brave domestic flag, the trampled borders and dump of children’s bikes hinting at an on-going battle between family order and chaos. A woman waves to us from the brightly-lit doorway, then folds her arms against the chilly early evening as we climb out and go to her. She smiles, thanks us for coming. A scruffy old terrier waddles out to sniff our trousers. Together with the woman it leads us through to the living room.

A fire flapping busily in a grate. A teenage girl at a laptop. A heavy grey cat draped over the back of a sofa, and a boy of about eleven lying on the sofa, surrounded by cushions, his legs drawn up. He has a mop head of pure white hair, which – along with the rich brightness of his surroundings – makes his pallor seem all the more striking. He smiles and waves. The cat looks up, licks a paw once, then settles down again.

The girl stops emailing at the laptop, swivels round on her chair and says: ‘I gave him a magic shell, but it hasn’t worked.’

The boy holds the shell up so I can see it. A dog whelk. I examine it.

‘Hmm. That’s a great shell. You must be poorly.’

The father comes over and kneels beside his son. Two more girls come pushing each other and giggling into the room. The mother puts her arms round them and then they all stand quietly as the father brushes some loose strands of hair from the boy’s face. Even the dog comes and sits down to the side of him, a storybook family gathering to bear witness to the story of Edward’s illness - the central abdo pain, first in the morning, some nausea, easing off, then coming back on strongly this evening. It could well be appendicitis, but whatever the cause, a trip to the hospital is in order.

The family disperse noisily to get what needs to be got. The boy groans, but does everything he can to help.

Only the cat remains in place.


Son #2
Seven hours later. We are flying through the early morning, a low strobing swoop through darkness. The wheels of the ambulance give little skips around the bends as I push the vehicle on. We are the nearest vehicle to this cardiac arrest, and we are eight miles away.

Our satnav has given up; Tony is reading the map like a rally driver.
‘Left! Left! Left!’
‘At the next junction – right!’

Finally, the block of flats appear along to our left, set up from the road on a steeply raking bank of concrete steps. Access must be round the back, but just as I decide to carry on round, a woman comes double-stepping down, waving her arms, so I stop. Tony buzzes the window.

‘Come up this way. It’s a little bit quicker,’ she says. Calm and controlled.

Gloves. KRS and key out. Obs bag and chair. Tony hauls out the resus and drugs bags. Laden like pack mules we climb the stairs behind the woman as she tells us the story. She lives next door. Her friend knocked her up and said they were having trouble with Peter. Peter is thirty-six and suffers with epilepsy occasionally, but that’s all as far as she knows. Peter’s friend John had been sleeping with him tonight, got up to go to the loo. When he came back he realised Peter wasn’t breathing. Nobody knows for how long. As she shows us into the front door of the building, held open with a welcome mat, she tells us the father is on his way and should be here in about half an hour.

Inside the flat we negotiate a route through heaps of boxes and bin bags to the bedroom. Familiar signs and smells of neglect. Two men sitting on a sofa in the living room – both smoking, both looking out at us with a mildly disappointed air, like we’re simply the latest damned thing to happen.

We see Peter lying on his back on the double bed next door, his arms outstretched and his legs crossed, sheets rucked up, a ghastly figure, the pastiche of a sulky sleeper looking for five more minutes and finding an abyss.

We go in - and then the resus progresses as they always do, moment through moment, action on action, as familiar but still unique as a new hand of cards: we play the dragging to the floor, the compressions; the read-outs; the ventilations; the drugs; the second crew arriving on scene (our most valuable card) – laying out each move as best we can as the digital clock on the defib relentlessly marks time and the cardiac readout rolls out each assessment – flat, flat, flat. This was a bad hand from the start. And to make things worse, the patient had aspirated significantly before we arrived. Awful, underground gurgles sound ominously with every compression. It’s like pumping up and down on a water bottle – which suddenly blows. A quantity of blood bursts from the patient’s nose and mouth; it sprays out from under the mask, and despite Tony’s quick pulling back, splashes onto his trousers. Where is it all coming from?

‘Eurgh!’, he says, and holds off, partly in shock, and partly because this would seem to be the final show – if one were needed – that this resus is terminal. Blood pools in one of Peter’s half-opened eyes. Twenty minutes have passed. We agree between us that we should stop.

Then the woman who showed us up to the flat comes in to the room. She says she has Peter’s father on the phone again. He says he wants to talk to a paramedic before he sets off. One of the second crew takes the phone from her and walks into another room to tell him that his son has died. When he comes back into the room, he tosses the phone onto the bed.

‘He says there’s no point in coming now. He’ll wait for the inquest.’

stuffed

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.

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.

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.’

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.

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.

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.

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.

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.