Mick’s beard has the coarse look of terrier fur, and his hair hedges over his head in a thickly tangled muddle. Along with his army boots, his shiny fatigues, his jacket and carrier bag of stuff, he looks as if he wrote the book on the etiquette of neglect. And in the context of a voluntary admission to Southview and case notes that begin with the assessment malodorous, it’s difficult to resist the obvious assumptions. But when I introduce myself I’m struck by the clarity of his eyes; beneath all that scrub he carries himself with quiet economy. On the journey into hospital he tells me his story, speaking in a soft Scottish accent.
‘I haven’t been well. I know that. I’m very extreme. One minute it’s party, and the next it’s “where’s the nearest bridge I can throw myself off.” That’s why I’m going in to Southview. I’m hoping they’ll have some ideas.
‘I’ve had a few things happen. My best friend died on me a few years back. He had meningococcal septicaemia, but the paramedic thought he’d taken heroin and gave him adrenalin, which pretty much killed him. I suppose he wasn’t to know. I did tell him, though. I said “Darren smoked some heroin a couple of years ago but that’s it. He’s terrified of needles, for starters.” But there you go. The house was usually filled with people. There was always something going on, it was a really busy place, a hive. But for some reason that particular day there was no-one about. Even the phone had been cut off. So he spent the whole day on his own, going downhill. It all added up to one big mistake. But he probably would’ve died anyway.
‘I was in a band for about ten years. Couldn’t play guitar all that well but Sye took care of that and I wrote the lyrics. We were like Paul McCartney and John Lennon. We balanced each other out. We did alright. But you can’t do it for ever, so I gave it up, pretty much. Concentrated on my novel. Short stories. It’s difficult getting the space to write, though. I need a bit of quiet, and it’s so noisy at home. You know – kids and that. Plus I had a lot else on my plate.
‘You know the FBI are going to release their files on John Lennon? They must be about so high. They were absolutely terrified of him. He had such a power over people. I always thought his peace thing came out of a deep personal anger. He was a tough working class scouse kid. Bit of a bully. I think his mum died, then his aunt looked after him, then she was run over. But he turned it all around, didn’t he? He channelled it. I bet those files’ll make interesting reading.
‘I’ve just been diagnosed with Huntington’s. It’s what killed my grandma and my mum. We all knew how the disease went on because we nursed grandma as long as we could and we saw how it took her. When mum was diagnosed she asked us to promise to kill her before she got to the later stages. Me and my sister talked about it, and we decided that when it came to it we’d give her a big shot of heroin. But then when she went into a home and we talked about it again, we realised that we couldn’t actually go through with it. It wasn’t because we were scared of going to prison. We just couldn’t do it. Funnily enough – although not really that funny – a little while later there was an accident at the home and mum died. That’s the thing about Huntington’s – or one of the things – you end up having trouble swallowing, keeping your airway open. So I think she choked. Not a nice way to go. But I suppose she was spared the worst of it. I mean – she was in a place with all these people with Alzheimer’s. They weren’t giving her the right drugs. It wasn’t nice.
When it comes down to it, I think I’m like Nick Cave. I don’t believe in an interventionist God. But when they told me about it, I must admit I was relieved. It was just like God had intervened. Spared her the worst of it.’
The ambulance parks outside Southview, and Rae opens the door. Mick looks at me and smiles.
‘So, that’s my life story,’ he says. ‘What’s yours?’
Thursday, March 27, 2008
Wednesday, March 26, 2008
the onset of spring
Agnetha has two shelves of bowling trophies, a mini militia of silvered women bending over with arms extended over a series of dates. Beside the shelves are a couple of wedding photos, both with a faded seventies look – shapeless flowery dress, huge sunglasses, thirty five years of sunlight on crumbling photographic paper – both, as far as I can make out, identical. Agnetha herself is sitting on the floor, so drunk that she cannot co-ordinate the lighting of her cigarette, or the closing of her eyes. She pauses momentarily to swear at her carer.
‘You cow. I’m going to shmack you in the mouse.’
‘Netty,’ I say, ‘Please don’t say things like that. It really isn’t nice. We’re all here to help.’
It seems inconceivable that Milly, her home help, could come to this flat every day in the face of such abuse and yet still be as bright and smiling as she is.
‘Such a lovely day today,’ she says, glancing out of the window as she clears up the kitchen and unpacks Netty’s lunch. ‘So Spring-like.’
‘You louse!’ from the floor. ‘Did you call them? Warum?’
Milly raises her eyebrows to us, then gives her pony-tail a little shake, like a horse batting away a fly.
‘I don’t know how you put up with this,’ I tell her. ‘Whatever they’re paying you, it’s not enough.’
She laughs, then hands me the yellow folder with Netty’s care details.
I can see from the records that Netty often ends up on the floor after she’s been drinking. As the level in the bottle of gin sinks, so does she, until she slides forward off the armchair onto the floor. She doesn’t ever hurt herself –is uninjured today – but often refuses help in getting her back into the chair or into the big, white plastic poolside lounger that dominates the centre of the room. Her mobility is okay when she’s sober, but she isn’t looking after herself. A brackish smell of urine lays heavily across the room, cut only by the smell of old smoke.
‘Why won’t you let us help you, Netty?’
‘Shut up.’
‘Netty – are you from Germany originally?’
She stares at me across a deep void of drunkenness, then holds out her right hand to me. When I take it, she tries to hurt it by squeezing as hard as she can. But her little yellowed claws are like her words, full of intent, but powerless.
‘What are you trying to do, Netty?’
She drops her hand back onto her lap, inadvertently crushing the unlit cigarette in her left. She gives a couple of nods - then suddenly seems to wake up.
‘Prussia. I come - from Prussia.’
‘My mother in law originally came from Prussia.’
But she nods forwards again, this time for longer, and it seems she may now actually be asleep.
‘Stolp,’ I say. ‘Poland now, but Prussia before the war.’
Those heavy lids lever themselves open a crack.
‘Was?’
We lift her into the lounger, and notify her GP that we have some concerns about her welfare, the fact that she doesn’t seem to be taking care of herself effectively, pointing out the fire risk she poses to the rest of the block. There’s nothing else to be done. We say goodbye to Milly, who needs to be heading off to her next client as soon as possible.
‘Have a great day,’ she says.
‘You cow. I’m going to shmack you in the mouse.’
‘Netty,’ I say, ‘Please don’t say things like that. It really isn’t nice. We’re all here to help.’
It seems inconceivable that Milly, her home help, could come to this flat every day in the face of such abuse and yet still be as bright and smiling as she is.
‘Such a lovely day today,’ she says, glancing out of the window as she clears up the kitchen and unpacks Netty’s lunch. ‘So Spring-like.’
‘You louse!’ from the floor. ‘Did you call them? Warum?’
Milly raises her eyebrows to us, then gives her pony-tail a little shake, like a horse batting away a fly.
‘I don’t know how you put up with this,’ I tell her. ‘Whatever they’re paying you, it’s not enough.’
She laughs, then hands me the yellow folder with Netty’s care details.
I can see from the records that Netty often ends up on the floor after she’s been drinking. As the level in the bottle of gin sinks, so does she, until she slides forward off the armchair onto the floor. She doesn’t ever hurt herself –is uninjured today – but often refuses help in getting her back into the chair or into the big, white plastic poolside lounger that dominates the centre of the room. Her mobility is okay when she’s sober, but she isn’t looking after herself. A brackish smell of urine lays heavily across the room, cut only by the smell of old smoke.
‘Why won’t you let us help you, Netty?’
‘Shut up.’
‘Netty – are you from Germany originally?’
She stares at me across a deep void of drunkenness, then holds out her right hand to me. When I take it, she tries to hurt it by squeezing as hard as she can. But her little yellowed claws are like her words, full of intent, but powerless.
‘What are you trying to do, Netty?’
She drops her hand back onto her lap, inadvertently crushing the unlit cigarette in her left. She gives a couple of nods - then suddenly seems to wake up.
‘Prussia. I come - from Prussia.’
‘My mother in law originally came from Prussia.’
But she nods forwards again, this time for longer, and it seems she may now actually be asleep.
‘Stolp,’ I say. ‘Poland now, but Prussia before the war.’
Those heavy lids lever themselves open a crack.
‘Was?’
We lift her into the lounger, and notify her GP that we have some concerns about her welfare, the fact that she doesn’t seem to be taking care of herself effectively, pointing out the fire risk she poses to the rest of the block. There’s nothing else to be done. We say goodbye to Milly, who needs to be heading off to her next client as soon as possible.
‘Have a great day,’ she says.
Sunday, March 23, 2008
kinder surprise
Hardly any of the flats in this block seem to have numbers on their doors, and the landing light clicks off too soon again. Who lives here? Sprinters? But we can hear a big-footed voice behind the door, and when Rae calls out ‘ambulance’ it stops, there is a pause, and then the door opens.
‘Blimey! Hello, Steve’, she says to the bulky policeman, and then: ‘I didn’t recognise you with your clothes on.’ I stand behind her, nodding and eyebrow raising like a hapless comedy stooge. But what can she mean?
‘Hello, Rae! How are you? Haven’t seen you in a long time!’ He steps back for us to come in, looking in his black leather gloves and body armour, and with the harsh bed-sit light haloing his bony head, like an estate agent from hell.
We go in.
As well as the usual squalid leitmotif of cans and bottles, over-spilling ashtrays and thrown clothes, there is a folk guitar smashed on a rug in the centre of the room, an electric guitar and a practice amp junked in a corner, the poster of a naked woman draped in a python curling off the wall above a portable TV, and sellotaped to the door of a kitchen cupboard, a faded, oddly colourized photo of a smiling old man demonstrating a folk guitar in a sunny garden. On the sofa in front of the smashed guitar sits the patient, a bare chested young man, fixed in a pose of readiness. His right hand, still clutching a little tuft of rolling tobacco, is placed on his right knee; on his left, a slashed and bloody forearm. A younger man stands on the other side of the room, next to the second policeman. Whilst the patient is half-naked, lean and furious, his friend is bundled up in a parka and woolly hat. His glittering eyes flick about as he tries not to cry.
The second policeman – a tall, pale figure who looks as if he was issued with a moustache at the same time as his uniform, speaks.
‘Guys, this is Mal. Mal has cut himself tonight - as you can see - and we wondered if you could tell us whether he needs to go to hospital or not?’
‘I do not want to go to hospital. I want to go to Southview.’
‘You know we can’t take you there just like that, Mal,’ says Steve. ‘You know how it works.’
‘I’m going to do something terrible if I don’t get some help.’
‘One step at a time, Mal,’ says the second policeman. ‘Guys – over to you.’
As the two policemen move closer to each other to chat about stuff, Rae goes to kneel down next to Mal. I fetch out some saline and some swabs from the dressings bag. She asks him the usual health questions as she cleans his arm. He is as immobile as ever. The patient’s friend moves over to the door.
‘Is he going to be alright?’ he asks.
‘Yep. But this middle cut will need stitching.’ She dumps the bloody swab into the bowl of red water and asks Mal if he meant to kill himself when he did this. He snorts. ‘If I meant to kill myself I would be dead now,’ he says. ‘But I was interested to see what would happen if I made the cuts downwards rather than across-wards.’
He looks over to the two policemen.
‘Take me to Southview.’
‘Mal. As I’ve explained – lots of times – that’s not the way it works, mate.’
‘Take me to Southview.’
‘Calm down, Mal. First things first,’ says Rae. ‘You need to have a stitch or two at the hospital.’
Mal looks at her as she stands up. ‘My eldest sister is marrying her boyfriend next week,’ he says. ‘The same boyfriend that abused me for years.’ The statement is curiously flat, as if even he doesn’t believe it.
As we pack away our things ready to go and the policemen discuss logistics, Mal says: ‘You haven’t asked me what I cut myself with.’
Steve looks up: ‘Okay, Mal. Tell us. What did you cut yourself with?’ and turning to the second policeman adds: ‘I just assumed it was the glass over by the sink.’
‘Nope,’ and then ‘I cut myself with a razor.’
‘Okay, mate.’
Mal does not move. ‘You haven’t asked me what I did with the razor.’
‘Mal – what did you do with the razor?’
‘I’ll give you three guesses.’
‘Threw it in the sink?’
‘That’s one.’
The second policeman takes a step forward and looks around on the floor. ‘Dropped it on the floor?’
‘That’s two.’
I notice a kinder chocolate egg on the cushion next to him on the sofa, so I say: ‘You hid it in the kinder egg.’
‘That’s three.’
Mal smiles at us, but his eyes remain unchanged.
‘I’m still holding it.’
In the time it takes for me to look down at the tobacco in his hand, Steve has crossed the room, grabbed his arm and is shouting at him to drop the blade, drop the blade. Mal drops it. Steve plants his big black boot on top of it, then orders Mal to move to the other end of the sofa. When Mal does this, Steve picks up the blade and throws it across the room.
‘You idiot,’ he shouts. ‘Right. Enough fucking around. Let me tell you what’s going to happen now, my friend. And I want you to listen very carefully, because if you do not do exactly what I say, you are going to find yourself in a world of pain. Do I make myself clear?’
Mal re-collects himself on the sofa with much the same expression as before.
‘Take me to Southview. I’m telling you…’ he says.
‘No. I’m telling you. So shut up and listen. No more tricks. No more cute shit. We’re here to help you and you take the piss. You put my colleagues in danger and I am not having that. So not another word.’
From his dirty brown sofa at the centre of the universe, Mal looks around him.
‘You,’ he says, nodding at the second policeman, ‘you’re new to the job, and he’s showing you the ropes. You,’ looking at Rae, ‘you cleaned my arm; you want to help me. You,’ he says to me, and then pauses. I unfold my arms. ‘You’re some kind of nurse,’ he says. ‘But you,’ to Steve, ‘I know exactly what you are and what you stand for.’
‘Do you? Do you really? How fascinating,’ Steve says. ‘Now I want an end to this bullshit. I want you to get your shoes on and something on your top. And then I want you to walk down those stairs like a lamb, my friend. I am not in the mood.’
The only move Mal makes is to touch his cut arm absently. A small trickle of blood starts to run along his forearm again as he disturbs the edges of the wound.
‘I could lose it now and take you out,’ he says, staring at Steve. ‘I can’t take you all on, but I can certainly take you. I could be on you before anyone could do anything about it. I could rip your throat out.’
‘Come on, Mal,’ says Rae. ‘This is silly.’
Steve puts his gloved hand out to her. ‘No, no, Rae. It’s fine.’ And then back to Mal: ‘I’m not scared of a little prick like you. You child. But I’m warning you. Don’t be saying any of this.’
‘I’ve got a hammer and I’m going to smash your fucking skull.’
The second policeman steps forward.
‘Where is the hammer, Mal?’ – but before he has finished the question, Mal has launched himself out of the sofa, scrabbled on all fours across the room, pulled a hammer from a pile of clothes – but then the second policeman lands on top of him, and then Steve, too, and they all desperately wrestle for control in a heap up against a filthy divan. The second policeman twists Mal’s arm behind him, forcing him to drop the hammer; he throws it away from them, and it lands on the floor with a sickening clunk. Now Steve has Mal’s other arm and manages to twist it out behind him; eventually they handcuff his hands behind his back, then strap his legs together. With Mal trussed and subdued, they release their hold, stand up and get their breath. Steve puts a call out for a wagon to transport. Rae leads the friend outside, who is crying now.
‘Sorry you had to see that,’ Steve says to me, attempting a smile.
‘Uncuff me so I can have a cigarette,’ shouts Mal. ‘If I don’t have a cigarette I’ll really lose it.’
‘No you won’t. I’m going to be telling you what you can and can’t do from now on.’ says Steve. ‘And at the moment, no cigarettes.’
Mal’s tone changes. ‘Please don’t take me to the cells,’ he says. ‘I can’t stand to be on my own in there again. I won’t make it out alive.’
‘You should have thought about that before you tried to brain us with a hammer, mate.’
The second policeman straightens his uniform. ‘Maybe if you co-operate we can think about favours,’ he says. ‘But we have to see that you’re genuine. We can’t afford to take any more risks.’
**
Ten minutes later we are standing in the room waiting for the wagon and reviewing our options. Mal lies face down on the floorboards, sporadically tensing and testing the cuffs and straps, breathing noisily like a captured animal. The rest of the room is quiet around us; it has easily absorbed the violence of the last five minutes.
Mal’s wound still needs stitching, and that’s something that can only be done at the hospital. He seems to calm down markedly over the next ten minutes, answering questions rationally enough, and making assurances with what seems like a genuine desire to keep to them. With those dark flights of stairs in everyone’s thoughts – carrying him down would not be easy - the policemen agree to reposition his cuffs so he can smoke a cigarette before he goes.
Ten minutes later, Mal hobbles down to the ambulance. There is a police wagon parked with its hazards on behind us, and a group of policemen stamping their feet to keep warm, chatting on the pavement. The second policeman goes over to them to let them know what’s happening. Mal is shivering, but it seems more with fear of what’s to come than the bitter cold.
‘Please – I beg you – don’t take me to the cells.’
‘One step at a time, mate,’ says Steve, strapping him into the ambulance seat and sitting down next to him. He takes his gloves off and stuffs them inside his stab vest. ‘One step at a time.’
‘Blimey! Hello, Steve’, she says to the bulky policeman, and then: ‘I didn’t recognise you with your clothes on.’ I stand behind her, nodding and eyebrow raising like a hapless comedy stooge. But what can she mean?
‘Hello, Rae! How are you? Haven’t seen you in a long time!’ He steps back for us to come in, looking in his black leather gloves and body armour, and with the harsh bed-sit light haloing his bony head, like an estate agent from hell.
We go in.
As well as the usual squalid leitmotif of cans and bottles, over-spilling ashtrays and thrown clothes, there is a folk guitar smashed on a rug in the centre of the room, an electric guitar and a practice amp junked in a corner, the poster of a naked woman draped in a python curling off the wall above a portable TV, and sellotaped to the door of a kitchen cupboard, a faded, oddly colourized photo of a smiling old man demonstrating a folk guitar in a sunny garden. On the sofa in front of the smashed guitar sits the patient, a bare chested young man, fixed in a pose of readiness. His right hand, still clutching a little tuft of rolling tobacco, is placed on his right knee; on his left, a slashed and bloody forearm. A younger man stands on the other side of the room, next to the second policeman. Whilst the patient is half-naked, lean and furious, his friend is bundled up in a parka and woolly hat. His glittering eyes flick about as he tries not to cry.
The second policeman – a tall, pale figure who looks as if he was issued with a moustache at the same time as his uniform, speaks.
‘Guys, this is Mal. Mal has cut himself tonight - as you can see - and we wondered if you could tell us whether he needs to go to hospital or not?’
‘I do not want to go to hospital. I want to go to Southview.’
‘You know we can’t take you there just like that, Mal,’ says Steve. ‘You know how it works.’
‘I’m going to do something terrible if I don’t get some help.’
‘One step at a time, Mal,’ says the second policeman. ‘Guys – over to you.’
As the two policemen move closer to each other to chat about stuff, Rae goes to kneel down next to Mal. I fetch out some saline and some swabs from the dressings bag. She asks him the usual health questions as she cleans his arm. He is as immobile as ever. The patient’s friend moves over to the door.
‘Is he going to be alright?’ he asks.
‘Yep. But this middle cut will need stitching.’ She dumps the bloody swab into the bowl of red water and asks Mal if he meant to kill himself when he did this. He snorts. ‘If I meant to kill myself I would be dead now,’ he says. ‘But I was interested to see what would happen if I made the cuts downwards rather than across-wards.’
He looks over to the two policemen.
‘Take me to Southview.’
‘Mal. As I’ve explained – lots of times – that’s not the way it works, mate.’
‘Take me to Southview.’
‘Calm down, Mal. First things first,’ says Rae. ‘You need to have a stitch or two at the hospital.’
Mal looks at her as she stands up. ‘My eldest sister is marrying her boyfriend next week,’ he says. ‘The same boyfriend that abused me for years.’ The statement is curiously flat, as if even he doesn’t believe it.
As we pack away our things ready to go and the policemen discuss logistics, Mal says: ‘You haven’t asked me what I cut myself with.’
Steve looks up: ‘Okay, Mal. Tell us. What did you cut yourself with?’ and turning to the second policeman adds: ‘I just assumed it was the glass over by the sink.’
‘Nope,’ and then ‘I cut myself with a razor.’
‘Okay, mate.’
Mal does not move. ‘You haven’t asked me what I did with the razor.’
‘Mal – what did you do with the razor?’
‘I’ll give you three guesses.’
‘Threw it in the sink?’
‘That’s one.’
The second policeman takes a step forward and looks around on the floor. ‘Dropped it on the floor?’
‘That’s two.’
I notice a kinder chocolate egg on the cushion next to him on the sofa, so I say: ‘You hid it in the kinder egg.’
‘That’s three.’
Mal smiles at us, but his eyes remain unchanged.
‘I’m still holding it.’
In the time it takes for me to look down at the tobacco in his hand, Steve has crossed the room, grabbed his arm and is shouting at him to drop the blade, drop the blade. Mal drops it. Steve plants his big black boot on top of it, then orders Mal to move to the other end of the sofa. When Mal does this, Steve picks up the blade and throws it across the room.
‘You idiot,’ he shouts. ‘Right. Enough fucking around. Let me tell you what’s going to happen now, my friend. And I want you to listen very carefully, because if you do not do exactly what I say, you are going to find yourself in a world of pain. Do I make myself clear?’
Mal re-collects himself on the sofa with much the same expression as before.
‘Take me to Southview. I’m telling you…’ he says.
‘No. I’m telling you. So shut up and listen. No more tricks. No more cute shit. We’re here to help you and you take the piss. You put my colleagues in danger and I am not having that. So not another word.’
From his dirty brown sofa at the centre of the universe, Mal looks around him.
‘You,’ he says, nodding at the second policeman, ‘you’re new to the job, and he’s showing you the ropes. You,’ looking at Rae, ‘you cleaned my arm; you want to help me. You,’ he says to me, and then pauses. I unfold my arms. ‘You’re some kind of nurse,’ he says. ‘But you,’ to Steve, ‘I know exactly what you are and what you stand for.’
‘Do you? Do you really? How fascinating,’ Steve says. ‘Now I want an end to this bullshit. I want you to get your shoes on and something on your top. And then I want you to walk down those stairs like a lamb, my friend. I am not in the mood.’
The only move Mal makes is to touch his cut arm absently. A small trickle of blood starts to run along his forearm again as he disturbs the edges of the wound.
‘I could lose it now and take you out,’ he says, staring at Steve. ‘I can’t take you all on, but I can certainly take you. I could be on you before anyone could do anything about it. I could rip your throat out.’
‘Come on, Mal,’ says Rae. ‘This is silly.’
Steve puts his gloved hand out to her. ‘No, no, Rae. It’s fine.’ And then back to Mal: ‘I’m not scared of a little prick like you. You child. But I’m warning you. Don’t be saying any of this.’
‘I’ve got a hammer and I’m going to smash your fucking skull.’
The second policeman steps forward.
‘Where is the hammer, Mal?’ – but before he has finished the question, Mal has launched himself out of the sofa, scrabbled on all fours across the room, pulled a hammer from a pile of clothes – but then the second policeman lands on top of him, and then Steve, too, and they all desperately wrestle for control in a heap up against a filthy divan. The second policeman twists Mal’s arm behind him, forcing him to drop the hammer; he throws it away from them, and it lands on the floor with a sickening clunk. Now Steve has Mal’s other arm and manages to twist it out behind him; eventually they handcuff his hands behind his back, then strap his legs together. With Mal trussed and subdued, they release their hold, stand up and get their breath. Steve puts a call out for a wagon to transport. Rae leads the friend outside, who is crying now.
‘Sorry you had to see that,’ Steve says to me, attempting a smile.
‘Uncuff me so I can have a cigarette,’ shouts Mal. ‘If I don’t have a cigarette I’ll really lose it.’
‘No you won’t. I’m going to be telling you what you can and can’t do from now on.’ says Steve. ‘And at the moment, no cigarettes.’
Mal’s tone changes. ‘Please don’t take me to the cells,’ he says. ‘I can’t stand to be on my own in there again. I won’t make it out alive.’
‘You should have thought about that before you tried to brain us with a hammer, mate.’
The second policeman straightens his uniform. ‘Maybe if you co-operate we can think about favours,’ he says. ‘But we have to see that you’re genuine. We can’t afford to take any more risks.’
**
Ten minutes later we are standing in the room waiting for the wagon and reviewing our options. Mal lies face down on the floorboards, sporadically tensing and testing the cuffs and straps, breathing noisily like a captured animal. The rest of the room is quiet around us; it has easily absorbed the violence of the last five minutes.
Mal’s wound still needs stitching, and that’s something that can only be done at the hospital. He seems to calm down markedly over the next ten minutes, answering questions rationally enough, and making assurances with what seems like a genuine desire to keep to them. With those dark flights of stairs in everyone’s thoughts – carrying him down would not be easy - the policemen agree to reposition his cuffs so he can smoke a cigarette before he goes.
Ten minutes later, Mal hobbles down to the ambulance. There is a police wagon parked with its hazards on behind us, and a group of policemen stamping their feet to keep warm, chatting on the pavement. The second policeman goes over to them to let them know what’s happening. Mal is shivering, but it seems more with fear of what’s to come than the bitter cold.
‘Please – I beg you – don’t take me to the cells.’
‘One step at a time, mate,’ says Steve, strapping him into the ambulance seat and sitting down next to him. He takes his gloves off and stuffs them inside his stab vest. ‘One step at a time.’
Thursday, March 20, 2008
do you fight?
There are several reasons why we decide to go down the crumbling basement steps and not wait for the police. The first is that we’ve been out to Robert, the guy who lives here, several times before, and although each time there has been a different derelict amongst the cans and ashtrays, the atmosphere has never felt dangerous. The second reason is that even though this particular call is given as an assault, the follow-up message assures us that the assailant has left the scene; there is an implicit understanding that although the police are aware of the situation, it won’t be high on their list of responses, so we’d be waiting a long time for them to show. The third and deciding reason is that we are due to finish our shift in thirty odd minutes, and if he needs to go into hospital it’s going to have to be now.
Robert answers the door. I’m only ever used to seeing him in bed – he never travels to hospital - and I’m surprised by how tall he is. He looms above me, stinking on a cigarette, the lower half of his head hinging backwards in a welcoming smile like a garbage crusher.
‘Someone’s attacked Ralph,’ he says, and leading us along the crudely painted red hallway and into his bedroom.
Ralph is slumped in a ruined wicker chair by the window. He looks like a rock star waiting in a hotel to be interviewed, except the interview is delayed, and he’s sat there five years whilst the room, his clothes, his face decayed.
‘What’s happened, Ralph?’
Robert goes to light another cigarette and I ask him not to.
‘Oh. Sorry,’ he gapes, then adds ‘We’ve known each other since we were babies.’
Rae is hugging the clipboard to her and smiling professionally. ‘Ralph. Sorry. Go on.’
‘I’ve been attacked,’ he says, and rubs the side of his face by illustration. There is a small splash of blood just above his left eyebrow, but when we look at it we decide it doesn’t need gluing.
‘Were you knocked out at all?’ she asks him.
‘Yep. Clean out,’ he says. Then with more animation: ‘He grabbed me and pushed me back against the wall, man. I don’t deserve that. No-one deserves that.’ He looks across at Robert, who is lying back on the bed, propped up on his elbows, staring at me. He carries on. ‘He grabbed me by the hair. He tore loads out. I put it on the table.’
There is a great clump of hair beside a two litre bottle of cider.
‘That’s awful,’ Rae says, then ‘Ralph – you really need to come with us to hospital. If you were knocked out it means you’ve had a significant head injury and need to be seen.’ Ralph says nothing, so she makes things clearer. ‘Ralph? Do you want to go to hospital?’
He blows his cheeks out like a bored child. ‘Do I have to?’
‘No. You don’t have to. But we think you should come with us. That’s what we’re advising you to do.’
‘I don’t want to come, though,’ he says.
Robert snaps out of his reverie and chips in: ‘I called the ambulance. I was very worried.’
‘So who was the guy who attacked you?’, I ask Ralph.
‘Some idiot who’s been coming round here sponging off Bobby.’ Robert smiles at this and raises his eyebrows at me. Ralph rubs the side of his face. ‘He’s been round here a lot lately “Can I have something to drink, Rob? Can I have something to smoke, Rob?” Then today, when I answer the door, he pushes his way in and starts having a go. He calls Bobby a doo-dah. Then he calls me a doo-dah. Then when I say to him “You can’t call me a doo-dah” he says “Do you fight?” and I say “What do you mean, do I fight? No! I do not fight.” Then he grabs me by the hair, holds me against the wall, whacks me, then runs out.’
‘Ralph – this is really a police matter. You should come into hospital, but if you refuse to come in that’s your decision. Other than that, speak to the police.’
‘Yeah. I think I will,’ he says, but we all know he won’t.
‘Is that it?’ says Robert, flailing up from the bed.
We follow him out. We pass two pictures on the darkly stained wall –a family of geese feeding by a beautiful river, and Christopher Robin dragging Pooh bear backwards down the stairs.
Robert answers the door. I’m only ever used to seeing him in bed – he never travels to hospital - and I’m surprised by how tall he is. He looms above me, stinking on a cigarette, the lower half of his head hinging backwards in a welcoming smile like a garbage crusher.
‘Someone’s attacked Ralph,’ he says, and leading us along the crudely painted red hallway and into his bedroom.
Ralph is slumped in a ruined wicker chair by the window. He looks like a rock star waiting in a hotel to be interviewed, except the interview is delayed, and he’s sat there five years whilst the room, his clothes, his face decayed.
‘What’s happened, Ralph?’
Robert goes to light another cigarette and I ask him not to.
‘Oh. Sorry,’ he gapes, then adds ‘We’ve known each other since we were babies.’
Rae is hugging the clipboard to her and smiling professionally. ‘Ralph. Sorry. Go on.’
‘I’ve been attacked,’ he says, and rubs the side of his face by illustration. There is a small splash of blood just above his left eyebrow, but when we look at it we decide it doesn’t need gluing.
‘Were you knocked out at all?’ she asks him.
‘Yep. Clean out,’ he says. Then with more animation: ‘He grabbed me and pushed me back against the wall, man. I don’t deserve that. No-one deserves that.’ He looks across at Robert, who is lying back on the bed, propped up on his elbows, staring at me. He carries on. ‘He grabbed me by the hair. He tore loads out. I put it on the table.’
There is a great clump of hair beside a two litre bottle of cider.
‘That’s awful,’ Rae says, then ‘Ralph – you really need to come with us to hospital. If you were knocked out it means you’ve had a significant head injury and need to be seen.’ Ralph says nothing, so she makes things clearer. ‘Ralph? Do you want to go to hospital?’
He blows his cheeks out like a bored child. ‘Do I have to?’
‘No. You don’t have to. But we think you should come with us. That’s what we’re advising you to do.’
‘I don’t want to come, though,’ he says.
Robert snaps out of his reverie and chips in: ‘I called the ambulance. I was very worried.’
‘So who was the guy who attacked you?’, I ask Ralph.
‘Some idiot who’s been coming round here sponging off Bobby.’ Robert smiles at this and raises his eyebrows at me. Ralph rubs the side of his face. ‘He’s been round here a lot lately “Can I have something to drink, Rob? Can I have something to smoke, Rob?” Then today, when I answer the door, he pushes his way in and starts having a go. He calls Bobby a doo-dah. Then he calls me a doo-dah. Then when I say to him “You can’t call me a doo-dah” he says “Do you fight?” and I say “What do you mean, do I fight? No! I do not fight.” Then he grabs me by the hair, holds me against the wall, whacks me, then runs out.’
‘Ralph – this is really a police matter. You should come into hospital, but if you refuse to come in that’s your decision. Other than that, speak to the police.’
‘Yeah. I think I will,’ he says, but we all know he won’t.
‘Is that it?’ says Robert, flailing up from the bed.
We follow him out. We pass two pictures on the darkly stained wall –a family of geese feeding by a beautiful river, and Christopher Robin dragging Pooh bear backwards down the stairs.
Tuesday, March 18, 2008
lost languages
The drunk who has fallen down a flight of stairs at the hostel is propped up against the railings outside. He folds and unfolds his arms, wipes his face with rough hand-strokes, shakes his head and mutters; he seems to be scolding himself with the asocial carelessness of drunks the world over. As Eric, the paramedic in the response car who we are backing up, walks across to us, I notice three scaffolders in the front of their lorry cramming sandwiches into their mouths and laughing, this whole scene an unexpected mid-morning cabaret.
‘Jim has had a drink or two this morning,’ Eric tells us. ‘He’s fallen down about six stairs and banged his head. He wasn’t KOed, C-spine seems fine, no back pain, so I don’t think he needs boarding, but he does have a little skin-flap on the top of his head that needs seeing to. No other injuries, no medical conditions other than a touch of asthma. He’s a bit down on his luck by the sound of things. He’s living in the hostel, estranged from his wife, doesn’t see his children, has a stormy relationship with his mother, blabbedy-blah-blah…’ Eric looks over to the patient and waves. ‘Apart from that – all kosher, all yours.’
When I go up to Jim and introduce myself he snaps off a volley of swear words.
‘Easy, mate,’ I say to him. ‘We’re here to help you.’
‘I know. I’m sorry,’ he says, with surprising clarity. ‘I’m just cross with myself. It’s so stupid. Stupid.’
We help him into the ambulance, dress his wounds and set off for the hospital.
Walking through the automatic doors at A&E, Jim’s mobile phone rings. He pulls it out and looks at it.
‘It’s my mother,’ he says, ‘I’d better answer it.’
So we back-track a few steps to allow him to use the phone just outside.
‘Hello?’ he shouts. ‘Yes, mother. Yes, yes.’ Then he looks at me and nods. ‘I’m just at the library researching the Picts. Bye.’
He snaps it off and then struggles to put it back in his pocket.
‘She’d only worry,’ he says.
Inside, I wait with Jim whilst Rae goes to handover to the Charge Nurse. There is no chair to sit him on, so we both lean against a cupboard.
‘How are you feeling?’ I ask him.
‘Me? Oh, well..’ he trails, folds his arms and looks down at his shoes. Nearly topples forwards.
‘The Picts?’, I say, when I’ve re-centred him. ‘Isn’t that why the Romans built Hadrian’s Wall?’
Jim smacks his lips together as if he’s just tasted something unusual, and frowns.
‘Well, yes, you see, it’s so interesting,’ he booms. The other ambulance cases just ahead of us - a red and rather inflated looking woman; a young girl slouched over a vomit bowl – and the technicians with them, all look up.
‘They’re quite a mysterious bunch, the Picts. There are so many theories about where they came from originally –Scandinavian? Did they come over in the early Bronze age? But they certainly dominated northern Scotland from very early on. That’s where I’m from – around Fife,’ he says, taking off his glasses. ‘Look how filthy these are.’ He tugs out his vest and begins cleaning them. ‘Oh yes, I had a lovely childhood. Bliss. My father was one of the first people ever to have a camper van. It was so unusual, if you passed another on the roads you’d pull over and chat. Sometimes we’d just throw some food and clothes into the back, jump in, and drive and drive until the road simply ran out. Then we’d stop there for a few days.’
He puts his smeary glasses back on.
‘Did you know the last person to speak Cornish – Dolly Pentreath – died in 1768. Mousehole, I think.’ He looks around him. ‘Lost languages. So interesting.’
Rae waves to us, so I lead him to his cubicle.
‘Jim has had a drink or two this morning,’ Eric tells us. ‘He’s fallen down about six stairs and banged his head. He wasn’t KOed, C-spine seems fine, no back pain, so I don’t think he needs boarding, but he does have a little skin-flap on the top of his head that needs seeing to. No other injuries, no medical conditions other than a touch of asthma. He’s a bit down on his luck by the sound of things. He’s living in the hostel, estranged from his wife, doesn’t see his children, has a stormy relationship with his mother, blabbedy-blah-blah…’ Eric looks over to the patient and waves. ‘Apart from that – all kosher, all yours.’
When I go up to Jim and introduce myself he snaps off a volley of swear words.
‘Easy, mate,’ I say to him. ‘We’re here to help you.’
‘I know. I’m sorry,’ he says, with surprising clarity. ‘I’m just cross with myself. It’s so stupid. Stupid.’
We help him into the ambulance, dress his wounds and set off for the hospital.
Walking through the automatic doors at A&E, Jim’s mobile phone rings. He pulls it out and looks at it.
‘It’s my mother,’ he says, ‘I’d better answer it.’
So we back-track a few steps to allow him to use the phone just outside.
‘Hello?’ he shouts. ‘Yes, mother. Yes, yes.’ Then he looks at me and nods. ‘I’m just at the library researching the Picts. Bye.’
He snaps it off and then struggles to put it back in his pocket.
‘She’d only worry,’ he says.
Inside, I wait with Jim whilst Rae goes to handover to the Charge Nurse. There is no chair to sit him on, so we both lean against a cupboard.
‘How are you feeling?’ I ask him.
‘Me? Oh, well..’ he trails, folds his arms and looks down at his shoes. Nearly topples forwards.
‘The Picts?’, I say, when I’ve re-centred him. ‘Isn’t that why the Romans built Hadrian’s Wall?’
Jim smacks his lips together as if he’s just tasted something unusual, and frowns.
‘Well, yes, you see, it’s so interesting,’ he booms. The other ambulance cases just ahead of us - a red and rather inflated looking woman; a young girl slouched over a vomit bowl – and the technicians with them, all look up.
‘They’re quite a mysterious bunch, the Picts. There are so many theories about where they came from originally –Scandinavian? Did they come over in the early Bronze age? But they certainly dominated northern Scotland from very early on. That’s where I’m from – around Fife,’ he says, taking off his glasses. ‘Look how filthy these are.’ He tugs out his vest and begins cleaning them. ‘Oh yes, I had a lovely childhood. Bliss. My father was one of the first people ever to have a camper van. It was so unusual, if you passed another on the roads you’d pull over and chat. Sometimes we’d just throw some food and clothes into the back, jump in, and drive and drive until the road simply ran out. Then we’d stop there for a few days.’
He puts his smeary glasses back on.
‘Did you know the last person to speak Cornish – Dolly Pentreath – died in 1768. Mousehole, I think.’ He looks around him. ‘Lost languages. So interesting.’
Rae waves to us, so I lead him to his cubicle.
Monday, March 17, 2008
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?’
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?’
Wednesday, March 12, 2008
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.
‘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.
Tuesday, March 11, 2008
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.
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.
Friday, February 29, 2008
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.’
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.’
Wednesday, February 27, 2008
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.
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.
Thursday, February 21, 2008
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.
‘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.
Thursday, February 07, 2008
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.
‘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.
Monday, February 04, 2008
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.
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.
Monday, January 28, 2008
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.’
‘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.’
Saturday, January 26, 2008
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.’
‘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.’
Wednesday, January 23, 2008
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.’
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.’
Monday, January 21, 2008
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.
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.
Thursday, January 17, 2008
Thanks for reading!
I just wanted to say a big thank you for all the encouraging comments you’ve posted about Siren Voices. I feel quite overwhelmed by the positive feedback, and I really appreciate it.
I’ve been an EMT now for just a year and a half, (on the patient transport side for a couple of years before that). Aside from all the work-life attractions of the job, the real reason I think I’ll be in the ambulance for a while is the daily potential for drama.
Admittedly, most of the work is routine. And I know I’m more likely to write up something emotionally bloody rather than a drunk or an abdo pain, making it look more like a bad night in Baghdad than a Thursday afternoon in an English town by the sea. But even when the jobs are straight obs and nothing more, you can still have a good old chat, and look around for the little details that might distinguish a person or a place.
And if it’s really quiet – read a book.
So anyway – thanks again for reading the blog, and for all your comments. And a big thank you to Mark from neenaw for mentioning Siren Voices and pulling in the business!
Regards,
S.
I’ve been an EMT now for just a year and a half, (on the patient transport side for a couple of years before that). Aside from all the work-life attractions of the job, the real reason I think I’ll be in the ambulance for a while is the daily potential for drama.
Admittedly, most of the work is routine. And I know I’m more likely to write up something emotionally bloody rather than a drunk or an abdo pain, making it look more like a bad night in Baghdad than a Thursday afternoon in an English town by the sea. But even when the jobs are straight obs and nothing more, you can still have a good old chat, and look around for the little details that might distinguish a person or a place.
And if it’s really quiet – read a book.
So anyway – thanks again for reading the blog, and for all your comments. And a big thank you to Mark from neenaw for mentioning Siren Voices and pulling in the business!
Regards,
S.
Wednesday, January 16, 2008
above the living room
We are the second crew on scene, but only by a couple of minutes. Their ambulance lights are still on, the urgent sparkling gradually drawing people through their front doors and into their gardens to look.
As the first crew will have already taken in most of the equipment, and following the usual pattern of these things, we simply pull on some blue gloves and hurry in through the open door.
A straight flight of stairs in front of us, and a living room off to the right, desperate words and sobs behind a frosted glass door. A man’s angry voice. Above us we can hear the beep beep beep of the defib’s metronome as the crew works on the patient. We carry on up.
A large elderly man is lying on his back, half in and half out of a bathroom. His head is bloody, gashed above his right eye, and moves slightly from side to side as Lisa pumps his chest; Max has already cut off the man’s vest and attached the defib pads, and now she is putting in an airway. She immediately asks Frank if he’ll go back and fetch an aspirator from the vehicle, as the man has vomited and his airway is compromised. It’s not looking good. Max tells me that the patient had probably been down for about twenty minutes before anything was done. He had collapsed in the bathroom right behind the door, and his wife hadn’t been able to get to him. The first person she’d called was her son who lives a few streets away. He had managed to break the door open, and it was only after that an ambulance was called. When Max had come up the stairs no-one was doing any CPR. A daughter had also turned up, and now they were all together in the sitting room. As if on cue, a keening cry drifts up from below, followed by a crash and some heavy footsteps. A huge man with a boiled face and a dirty brown fleece clumps up the first few stairs and looks up at us:
‘Save my Dad!’ he says, and then shouts ‘Please!’ He pokes his thick black glasses back up his nose, and pauses, as if he was expecting to say something else and is surprised by what actually came out. Then he reverse clumps back down the stairs again and his sounds are reabsorbed into the living room.
I take over the chest compressions to give Lisa a break. Whilst I’m bobbing up and down I look past her into the toilet. The pine seat is in the up position but the top of it has been smashed right across. There is a smear of blood on each broken side, and a sizeable pool on the lino.
Frank appears with the aspirator.
‘It’s all going to kick off downstairs,’ he says, setting the kit up and starting to suck out the vomit from the patient’s airway. His actions are as casual as a maid vacuuming yet another room.
Frank also tells us that he’s called for paramedic back-up and the ETA is only a couple of minutes. All four of us are technicians, which means none of us can intubate the patient or give them the drugs that might make a difference.
After every couple of minutes we check the defib screen for rhythm, but each time it is the same – asystole, or flat-line. Non-shockable, and a poor prognosis.
Alistair the paramedic arrives. Max describes the situation so far, and after a brief review, Alistair starts in by intubating the patient, expertly wielding his laryngoscope: Obese patient? No neck? – No problem. Then he’s busy with his intra-osseous drill, whistling into the patient’s tibia, and ready in seconds to push through the usual sequence of atropine and adrenaline. After the drugs have gone in for the first round, we settle in to monitor the final phases of the resus. And now the contrast between upstairs and downstairs is profound: shouts from the living room, polite technicalities on the landing. With some quiet gossip. Did you know so-and-so’s suspended? Going out with who? How’s that mad dog of yours? Now and again checking the screen; taking it in turns on the chest. I notice a toilet roll cover on the cistern – Little Bo Peep, one china hand to her eye line, one hand holding up a crook. As if that will help. But the roll under her dress might.
The resus protocol rolls along its allotted path, but after twenty minutes the patient is only showing a dead heart synthetically jerked by drugs. Alistair consults with us all, and we start turning things off. He goes down to break the news to the family.
‘Watch the son,’ says Frank.
Now our efforts are aimed at making the patient more presentable. I hoist Bo Peep off her perch and place her beside the toilet roll, where she deflates sideways into a chintzy faint. I tear off wads of tissue to clean the blood and vomit from the patient’s face, and then stuff them into the yellow waste bag. We put his arms along his sides and drape a blanket over him.
There’s a shout from downstairs, more urgent than anything so far. Max is already down there and she calls for help; the mother has collapsed in the kitchen. Lisa takes up the oxygen cylinder and runs down. She passes the daughter coming up the stairs two at a time, a fifty year old woman as narrow as her brother is wide, hugging a large teddy bear, which she dumps amongst all the equipment, drops to her knees, and hugs her father’s head instead.
We stand to one side and give them some space, but eventually I touch her on the shoulder. When she looks up at me I ask if we can have a little time to get rid of all our gear, so everyone can have the room and time they need to be with her father. She wipes her nose on her sleeve and nods. I hand the teddy bear back to her, and she trudges back down the stairs.
Once the landing is clear, we have a final chat to the first crew. Max tells us that the patient’s wife has come round. It was a simple faint, and she’s recovering nicely. They’re happy to stay on scene until the police arrive to take over, so we are free to go. Outside we see Alistair slamming the boot shut on his response car. He comes over to us.
‘The son – what a case!’ he says. ‘He came barrelling past when I went into the living room. There was a guy outside on the pavement, a neighbour or something, and when he asked him what was going on, what all the ambulances were for, the son punched him in the face and then ran off.’
‘Where’s the guy he hit?’
‘He ran after him.’
Frank snorts, shakes his head, then gives a little stretch. ‘Come on,’ he yawns. ‘Lunch time. Gotta be.’
As the first crew will have already taken in most of the equipment, and following the usual pattern of these things, we simply pull on some blue gloves and hurry in through the open door.
A straight flight of stairs in front of us, and a living room off to the right, desperate words and sobs behind a frosted glass door. A man’s angry voice. Above us we can hear the beep beep beep of the defib’s metronome as the crew works on the patient. We carry on up.
A large elderly man is lying on his back, half in and half out of a bathroom. His head is bloody, gashed above his right eye, and moves slightly from side to side as Lisa pumps his chest; Max has already cut off the man’s vest and attached the defib pads, and now she is putting in an airway. She immediately asks Frank if he’ll go back and fetch an aspirator from the vehicle, as the man has vomited and his airway is compromised. It’s not looking good. Max tells me that the patient had probably been down for about twenty minutes before anything was done. He had collapsed in the bathroom right behind the door, and his wife hadn’t been able to get to him. The first person she’d called was her son who lives a few streets away. He had managed to break the door open, and it was only after that an ambulance was called. When Max had come up the stairs no-one was doing any CPR. A daughter had also turned up, and now they were all together in the sitting room. As if on cue, a keening cry drifts up from below, followed by a crash and some heavy footsteps. A huge man with a boiled face and a dirty brown fleece clumps up the first few stairs and looks up at us:
‘Save my Dad!’ he says, and then shouts ‘Please!’ He pokes his thick black glasses back up his nose, and pauses, as if he was expecting to say something else and is surprised by what actually came out. Then he reverse clumps back down the stairs again and his sounds are reabsorbed into the living room.
I take over the chest compressions to give Lisa a break. Whilst I’m bobbing up and down I look past her into the toilet. The pine seat is in the up position but the top of it has been smashed right across. There is a smear of blood on each broken side, and a sizeable pool on the lino.
Frank appears with the aspirator.
‘It’s all going to kick off downstairs,’ he says, setting the kit up and starting to suck out the vomit from the patient’s airway. His actions are as casual as a maid vacuuming yet another room.
Frank also tells us that he’s called for paramedic back-up and the ETA is only a couple of minutes. All four of us are technicians, which means none of us can intubate the patient or give them the drugs that might make a difference.
After every couple of minutes we check the defib screen for rhythm, but each time it is the same – asystole, or flat-line. Non-shockable, and a poor prognosis.
Alistair the paramedic arrives. Max describes the situation so far, and after a brief review, Alistair starts in by intubating the patient, expertly wielding his laryngoscope: Obese patient? No neck? – No problem. Then he’s busy with his intra-osseous drill, whistling into the patient’s tibia, and ready in seconds to push through the usual sequence of atropine and adrenaline. After the drugs have gone in for the first round, we settle in to monitor the final phases of the resus. And now the contrast between upstairs and downstairs is profound: shouts from the living room, polite technicalities on the landing. With some quiet gossip. Did you know so-and-so’s suspended? Going out with who? How’s that mad dog of yours? Now and again checking the screen; taking it in turns on the chest. I notice a toilet roll cover on the cistern – Little Bo Peep, one china hand to her eye line, one hand holding up a crook. As if that will help. But the roll under her dress might.
The resus protocol rolls along its allotted path, but after twenty minutes the patient is only showing a dead heart synthetically jerked by drugs. Alistair consults with us all, and we start turning things off. He goes down to break the news to the family.
‘Watch the son,’ says Frank.
Now our efforts are aimed at making the patient more presentable. I hoist Bo Peep off her perch and place her beside the toilet roll, where she deflates sideways into a chintzy faint. I tear off wads of tissue to clean the blood and vomit from the patient’s face, and then stuff them into the yellow waste bag. We put his arms along his sides and drape a blanket over him.
There’s a shout from downstairs, more urgent than anything so far. Max is already down there and she calls for help; the mother has collapsed in the kitchen. Lisa takes up the oxygen cylinder and runs down. She passes the daughter coming up the stairs two at a time, a fifty year old woman as narrow as her brother is wide, hugging a large teddy bear, which she dumps amongst all the equipment, drops to her knees, and hugs her father’s head instead.
We stand to one side and give them some space, but eventually I touch her on the shoulder. When she looks up at me I ask if we can have a little time to get rid of all our gear, so everyone can have the room and time they need to be with her father. She wipes her nose on her sleeve and nods. I hand the teddy bear back to her, and she trudges back down the stairs.
Once the landing is clear, we have a final chat to the first crew. Max tells us that the patient’s wife has come round. It was a simple faint, and she’s recovering nicely. They’re happy to stay on scene until the police arrive to take over, so we are free to go. Outside we see Alistair slamming the boot shut on his response car. He comes over to us.
‘The son – what a case!’ he says. ‘He came barrelling past when I went into the living room. There was a guy outside on the pavement, a neighbour or something, and when he asked him what was going on, what all the ambulances were for, the son punched him in the face and then ran off.’
‘Where’s the guy he hit?’
‘He ran after him.’
Frank snorts, shakes his head, then gives a little stretch. ‘Come on,’ he yawns. ‘Lunch time. Gotta be.’
Monday, January 14, 2008
on the edge
I feel like I’m standing in the lobby of a giant wasp’s nest. It is the thin end of the morning, and a girl in dirty sweats and a sports bra is stinging everyone within range.
To me: ‘You take her in! You’re taking her in, aren’t you?’
To her mum: ‘You’re fucking going with them.’
To me again: ‘You’re fucking taking her.’
She hauls on her mum’s arm, which has become melodramatically floppy again. The son, markedly less reasonable than his sister, has focused both eyes on me; they merge dangerously either side of his nose into one single eye of hate.
‘You fucking do something for my mum’, he says, and takes a drag on his cigarette.
We should have realised this was going to be difficult. The block of flats is well known, and an early hours call to an overdose here is not a happy prospect. Our spirits are eased, though, when we pull up in the street and see a police car already there.
‘That’s something, then,’ I say to Rae. We sort out the bags to take up, lock the vehicle, and then make our way into the courtyard. I can hear shouts from one of the balconies that overlook the courtyard, but I ring the flat number and we wait for a response. Nothing. We ring again. A face looks down on us from a parapet above and shouts down:
‘Who’s that?’
‘The ambulance.’
‘What do you want?’
(pause)
‘Someone called for an ambulance?’
(Muted sounds of swearing and bargaining.)
‘Could someone let us in, please?’
‘I can’t leave my Mum.’
(pause)
‘Well – someone’s got to let us in, otherwise we’re stuck down here.’
After waiting for a reply that doesn’t come, I call up, helpfully – ‘…and – er - we won’t be able to do much.’
‘I can’t leave my Mum,’ he shouts down again. I look at Rae and she looks at me. But just before we buzz again to make a full and final offer, someone else releases the door, and we go on up.
The concrete stairwell has the welcoming smell of concrete stairwells the world over. The echoes of our progress upwards add to the ominous screams and bumps from the seventh floor. And still – despite all our experiences in the past – we are assuming that the police are on scene. I haven’t even got my radio on me. We are the equivalent of a sleepy but doomed vanguard blundering over the top of the trench.
When we emerge onto the balcony, my error is horribly plain. There is a man standing by a woman on the floor. He is holding her hand, so that her arm is up to him at full stretch. Aggression spikes out of his head like cartoon lightning.
‘You fucking help my mum,’ he says to us.
Three others come out of the flat – unshepherded by police. They swarm around us on the balcony, saying things like: ‘She’s dying’ and ‘Bitch’ and ‘She needs her stomach pumped out.’
‘Hello,’ I say. ‘My name’s Spence and this is Rae.’ God knows this introduction never sounded so lame, but in difficult situations it sometimes helps to follow the script. ‘What’s happened?’
I can see that the woman’s ABC’s are fine: she’s breathing and talking and moving her head around. When I go closer to her I can smell the alcohol. There are no signs of violence, and in the sickly light of the emergency overheads she seems a normal colour. I speak as firmly as I can to the man.
‘I need to speak to your mum on her own, if that’s okay. I just need to find out what she’s done and how we can help. Okay?’
Amazingly, he drops her hand. He pulls a mobile phone out of his pocket and walks off with a grunt. In a speed-dialling second I overhear him say: ‘It’s my mum. She’s taking a load of pills and she’s going to fucking die…’ The others follow him back into the flat, which is an enormous relief to us.
We sit her up and help her lean against the balcony wall. We make out that her name is Sandra, and she’s taken all her medication for pain relief because she didn’t want to go on like this. With the rest of the family temporarily back in the flat, I ask Sandra as firmly as possible if she’ll come down to the ambulance with us, as I think she needs to go to hospital. I don’t actually know at this point if she does need to go; my main concern is to get us away from this environment.
‘Fuck off,’ she drawls. ‘Fucking leave me alone.’
We hold a hurried war cabinet over her head: Rae agrees to go back down to the ambulance and call for urgent police back-up, just in case we really can’t persuade Sandra to come down to the vehicle. Other than that, it’ll be a question of withdrawing as best we can if things get worse. Rae exits just as one of the women comes out, obviously the first man’s sister, sharing his one-eyed intensity. Her hands are cupped around a mess of bottles and packets.
‘She’s taken all this,’ she says, and throws them on the floor. Walks off again.
I poke through the medication. There’s everything here, from iron tablets and senna to dihydrocodeine and zopiclone.
‘Sandra – what have you taken tonight?’
Sandra makes a curiously delicate gesture with her finger: ‘Those – those – all of those.’
At this point, the whole family tips back out onto the balcony.
‘Well?’
I gauge the distance between me and the stairwell door. But before I can begin to try to reason things through – incredibly – two policemen come striding along the balcony from the other direction.
‘Right,’ one of them says, ‘What’s going on here?’
**
Only later, when the family has been corralled back in the flat and the mother is on her own in the kitchen do I find out quite how lucky we’ve been tonight. The police were here at another flat on something quite unconnected. They heard all the fuss and eventually came out to see what it was about.
In a private word out on the balcony one of the policeman asks me if I think Sandra’s in danger. I tell him that her obs are fine, that I don’t believe she’s taken as many of the drugs as we’re being told, and that much of what’s happened tonight is due to alcohol and melodramatics. But as a rider to that I have to say that without a blood test…
Back in the kitchen Sandra still refuses to travel to hospital, even though I explain to her that we think she needs medical help. Her son shouts in at the door that we have to take her, but the policeman explains to him that if she doesn’t want to go, we can’t force her. Sandra signs our form to say that she’s staying against our advice, and once it’s witnessed, we go to leave.
‘Bye,’ I offer to the family as we excuse our way past them in the hall. Their silence is appalling.
To me: ‘You take her in! You’re taking her in, aren’t you?’
To her mum: ‘You’re fucking going with them.’
To me again: ‘You’re fucking taking her.’
She hauls on her mum’s arm, which has become melodramatically floppy again. The son, markedly less reasonable than his sister, has focused both eyes on me; they merge dangerously either side of his nose into one single eye of hate.
‘You fucking do something for my mum’, he says, and takes a drag on his cigarette.
We should have realised this was going to be difficult. The block of flats is well known, and an early hours call to an overdose here is not a happy prospect. Our spirits are eased, though, when we pull up in the street and see a police car already there.
‘That’s something, then,’ I say to Rae. We sort out the bags to take up, lock the vehicle, and then make our way into the courtyard. I can hear shouts from one of the balconies that overlook the courtyard, but I ring the flat number and we wait for a response. Nothing. We ring again. A face looks down on us from a parapet above and shouts down:
‘Who’s that?’
‘The ambulance.’
‘What do you want?’
(pause)
‘Someone called for an ambulance?’
(Muted sounds of swearing and bargaining.)
‘Could someone let us in, please?’
‘I can’t leave my Mum.’
(pause)
‘Well – someone’s got to let us in, otherwise we’re stuck down here.’
After waiting for a reply that doesn’t come, I call up, helpfully – ‘…and – er - we won’t be able to do much.’
‘I can’t leave my Mum,’ he shouts down again. I look at Rae and she looks at me. But just before we buzz again to make a full and final offer, someone else releases the door, and we go on up.
The concrete stairwell has the welcoming smell of concrete stairwells the world over. The echoes of our progress upwards add to the ominous screams and bumps from the seventh floor. And still – despite all our experiences in the past – we are assuming that the police are on scene. I haven’t even got my radio on me. We are the equivalent of a sleepy but doomed vanguard blundering over the top of the trench.
When we emerge onto the balcony, my error is horribly plain. There is a man standing by a woman on the floor. He is holding her hand, so that her arm is up to him at full stretch. Aggression spikes out of his head like cartoon lightning.
‘You fucking help my mum,’ he says to us.
Three others come out of the flat – unshepherded by police. They swarm around us on the balcony, saying things like: ‘She’s dying’ and ‘Bitch’ and ‘She needs her stomach pumped out.’
‘Hello,’ I say. ‘My name’s Spence and this is Rae.’ God knows this introduction never sounded so lame, but in difficult situations it sometimes helps to follow the script. ‘What’s happened?’
I can see that the woman’s ABC’s are fine: she’s breathing and talking and moving her head around. When I go closer to her I can smell the alcohol. There are no signs of violence, and in the sickly light of the emergency overheads she seems a normal colour. I speak as firmly as I can to the man.
‘I need to speak to your mum on her own, if that’s okay. I just need to find out what she’s done and how we can help. Okay?’
Amazingly, he drops her hand. He pulls a mobile phone out of his pocket and walks off with a grunt. In a speed-dialling second I overhear him say: ‘It’s my mum. She’s taking a load of pills and she’s going to fucking die…’ The others follow him back into the flat, which is an enormous relief to us.
We sit her up and help her lean against the balcony wall. We make out that her name is Sandra, and she’s taken all her medication for pain relief because she didn’t want to go on like this. With the rest of the family temporarily back in the flat, I ask Sandra as firmly as possible if she’ll come down to the ambulance with us, as I think she needs to go to hospital. I don’t actually know at this point if she does need to go; my main concern is to get us away from this environment.
‘Fuck off,’ she drawls. ‘Fucking leave me alone.’
We hold a hurried war cabinet over her head: Rae agrees to go back down to the ambulance and call for urgent police back-up, just in case we really can’t persuade Sandra to come down to the vehicle. Other than that, it’ll be a question of withdrawing as best we can if things get worse. Rae exits just as one of the women comes out, obviously the first man’s sister, sharing his one-eyed intensity. Her hands are cupped around a mess of bottles and packets.
‘She’s taken all this,’ she says, and throws them on the floor. Walks off again.
I poke through the medication. There’s everything here, from iron tablets and senna to dihydrocodeine and zopiclone.
‘Sandra – what have you taken tonight?’
Sandra makes a curiously delicate gesture with her finger: ‘Those – those – all of those.’
At this point, the whole family tips back out onto the balcony.
‘Well?’
I gauge the distance between me and the stairwell door. But before I can begin to try to reason things through – incredibly – two policemen come striding along the balcony from the other direction.
‘Right,’ one of them says, ‘What’s going on here?’
**
Only later, when the family has been corralled back in the flat and the mother is on her own in the kitchen do I find out quite how lucky we’ve been tonight. The police were here at another flat on something quite unconnected. They heard all the fuss and eventually came out to see what it was about.
In a private word out on the balcony one of the policeman asks me if I think Sandra’s in danger. I tell him that her obs are fine, that I don’t believe she’s taken as many of the drugs as we’re being told, and that much of what’s happened tonight is due to alcohol and melodramatics. But as a rider to that I have to say that without a blood test…
Back in the kitchen Sandra still refuses to travel to hospital, even though I explain to her that we think she needs medical help. Her son shouts in at the door that we have to take her, but the policeman explains to him that if she doesn’t want to go, we can’t force her. Sandra signs our form to say that she’s staying against our advice, and once it’s witnessed, we go to leave.
‘Bye,’ I offer to the family as we excuse our way past them in the hall. Their silence is appalling.
Subscribe to:
Posts (Atom)