typecast

Mrs Wilson is sitting on a Windsor chair in her kitchen, thoroughly and generously settled in a voluminous rose patterned skirt and a hand-knitted lime-green cardigan. Her arthritic hands rest on the handle of a bamboo walking stick she has planted defensively between her legs, the knees of which are as lumpen and bent out of shape as two great plaited loaves.

‘Oh here they are, the Seventh Cavalry,’ she says, rapping the stick twice on the floor, counting us in. ‘I said it was you and I wasn’t wrong was I, Cheryl? I said it’d be the ambulance. My goodness you were quick, though. I haven’t had time to get a thing ready. Not that there’s much to get ready. Is there, Cheryl? Cheryl’s very good, you know. I don’t know what I’d do without her. Well, I know exactly what I’d do without her. The answer is – Not Very Much. Look. She’s packing my bag. I make it a point never to go anywhere without a good book and some glasses to read them with. You can improvise the rest. What time is it? I seem to have been sitting here for approximately one thousand years.’

Cheryl smiles quietly, drifting around the margins of the room like a breed of domestic ghost. The objects she picks up seem to float in mid-air as she approaches, before silently disappearing into a cat-motif shopping bag.

‘Both pairs please, Cheryl,’ says Mrs Wilson. ‘One for reading, one for looking out on the world.’

Mrs Wilson’s silver hair gleams in the fall of light from a standard lamp. It’s like the hairdresser’s equivalent of a sampler – twists, braids, half a bun and a French plait, all in hair so fine it could be raw silk.

‘I like to talk so put your ear plugs in. And then of course when I’m anxious I talk even more. Cheryl will tell you. It’s this wretched knee, you see. Gave out on me when I got back from the club. I went down like the Titanic and was still crawling in to the kitchen to get to the blaming phone when Cheryl came by for her regular visit and came to my rescue. I’ve had enough, I really have. Just take me out and shoot me. I don’t mind. I’m a horse whose race has run.’

Cheryl appears at her shoulder and gives her a reassuring pat. Mrs Wilson lays her hand on top of Cheryl’s, and the moment passes.

‘Like I say, I love to chat. It’s just my nature. I was fifty years on the stage you know. Local Am Dram. They used to cast me as the maid or the woman in the shop, the comedy headmistress, that kind of thing. I absolutely loved it. Gave me a chance to show off a bit. Do you know what my favourite role was? Madame Arcati. Have you heard of her? Blythe Spirit? The Margaret Rutherford role? Absolutely loved it. Thirty years I was with that company. I’d be there now if it wasn’t for these blessed knees. I had a lovely job as a secretary in a solicitor’s office. So if you ever need your will doing, just give me a call. The thing was, though, they moved to these premises more in the centre of town, a lovely old building, but on the first floor, and really, getting up those stairs was like climbing the Matterhorn, and in the end I just couldn’t manage. So they let me go. It was a damned shame, because I loved that job – the shorthand, the typing, you know. Answering the phone. Chatting to people.’

Cheryl puts the cat bag by Mrs Wilson’s feet, and waits. 

caught

The response car is parked round the back of the block, its engine quietly running, its scene light illuminating the side of the building in a vivid splash of white. We go in through a service door into a cool, bare stairwell. We walk up one flight. On that landing, a door stands open.

‘Hello?’

Stan is lying on his back on the floor of the bedroom. Rae is standing over him.

‘Thanks for coming,’ she says. ‘I’ve been out to Stan a couple of times before. He has trouble with mobility, and sometimes he just misjudges sitting down or whatever and ends up on the floor. Tonight he was heading for the commode when he crash landed. Unfortunately that’s not the only thing he misjudged – so we’ll need to clean him up before we put him back to bed. If that’s okay.’

Stan tries to talk, but it’s almost impossible to make out what he’s saying because he hasn’t got his teeth in, and he’s so dry it makes his tongue seem two sizes too big for his mouth.

‘Don’t worry about it, Stan. Honestly. You’d do the same for us if the situation were reversed, I’m sure,’ says Rae. And then to us: ‘I’ve already got a bowl of sudsy water and a flannel, Spence. If we get him up, are you okay to take care of business?’

‘Yep.’

We help Stan to his feet. His legs are extraordinary, fashioned out of creamy-white driftwood. Whilst Frank and Rae support him between them, I set to with the bowl and flannel. Stan is smeared with fudgy brown excrement from the small of his back down into his withered buttocks. I put a towel over the stains and deposits on the carpet beneath him, then start to wash him down. His legs are so bandy his testicles are easily accessible. I feel like an agricultural worker tending to a bull, dabbing at the pendant scrotum with my flannel.

‘Done,’ I say, dropping the flannel into the bowl again.

We locate a pair of pants and put them on him, then whilst Frank and Rae shuffle him over to the bed, I take the bowl away to empty it in the loo and find some cleaning materials for the carpet.

In the hall there’s a photo of Stan holding an enormous fish. It’s early in the morning – or late at night – and the flash of the camera gives the portrait a hectic, hyper-coloured quality. It flares off the steel frames of Stan’s glasses and the flat black eye of the fish. Stan smiles exultantly into the lens; the belly of the fish sags between his hands.

Back in the bedroom, Stan is neatly propped up, tucked in, sipping from a non-spill beaker. We finish cleaning and tidying. Rae is going to stay and finish off the paperwork, so we leave her to it.

*

Outside, the night has moved on, settling into that deepest, stillest part before the upward movement towards dawn. A winding band of cloud extends from the horizon over the sea towards land. I watch it for a moment before climbing back into the cab.

on the sofa

A man and a woman are sitting on a yellow sofa facing Agnes, a hyper-inflated, twenty-four stone woman sweating quietly in a vast, raspberry coloured dressing-gown.  The woman has a folder resting in her lap, the man has his legs crossed and his hands laced around one knee; both have a glossy aura of control around them. In fact, they are so measured, from the encouraging tilt of their heads and their warm, empathetic smiles, I wouldn’t be surprised to see a camera moving in from the edge of the carpet and a floor manager in headphones urgently pointing at the woman with a pen.

‘Hi Guys!’ the woman says. ‘I’m Amanda, this is Paul…’

‘…Hi…Hi…’

‘Thank you so much for coming.’

‘Really appreciate it,’ says Paul. ‘Good to have you here.’

‘So let me fill you in,’ says Amanda, lacing her fingers together and placing her hands neatly in her lap. ‘We work for the Crisis Outreach Team.’

Paul nods, smiles, discretely checks his watch.

‘We had an appointment to come out to see Agnes today as part of our continuing package of home support – didn’t we, Agnes?’

Agnes nods.’

‘We already knew that Agnes had been up to A and E this morning with a stomach complaint, but the doctors were happy for her to come home with some paracetamol for pain relief. Unfortunately Agnes had a bit of an episode in the early afternoon – isn’t that right, Agnes?’

She nods.

‘To the extent that she decided to take her own life by swallowing all the paracetamol. About forty, all told. Is that fair, Agnes?’

She nods.

‘Of course as soon as we found out what had happened, we all had a chat about it and decided the best thing to do would be to call you guys – the experts – and see what you had to say about it. And here we all are!’

Amanda finishes brightly, rattling her nails on the folder cover as if she couldn’t wait to open it up and share some delicious recipe.

 ‘Do you mind if I sit down?’ I say to Agnes.

She nods.

Amanda and Paul budge up; Amanda pats the cushion next to her. I sit down.

‘Agnes?’

She looks at me.

‘How are you feeling?’

She shrugs.

‘Felt sick? Been sick?’

She shakes her head.

‘The thing is, Agnes, that’s a pretty dangerous dose of paracetamol, as I’m sure you’re aware. We need to get you down the hospital so the doctors can treat you for it. I know it’s a nuisance – given that you were only down there this morning. But it’s just one of those things. How would you feel about coming with us to the hospital?’

She purses her lips and closes her eyes.

‘If I have to go, I have to go,’ she says.

‘Excellent!’ says Amanda.

‘Good. Good,’ says Paul. He leans forwards and looks at me. ‘Good,’ he says again.

‘Okay. So. Do you have everything you need? Phone, keys, slippers?’

She nods.

‘And how would you feel about walking out? Nice and slow – and if anything changes and you feel a bit faint we’ll reconsider our options. But for now – a short stroll out to the vehicle? What do you say?’

Agnes begins rocking backwards and forwards to build enough momentum to break free of her chair. When she stands up, her dressing-gown hangs like a circus tent from the dropping-off point of her chest.

 We stand up, too.

‘Well that’s great!’ says Amanda. ‘I’m glad!’

It’s all so measured and pleasant I half expect the phantom floor manager to gesture with his pen again – And we’re OUT!. Congrats all round. Don’t forget to leave your mikes. Debrief upstairs in five.

Amanda throws her folder behind her on the yellow sofa. It opens to reveal empty pages. Paul rips his earphones out and loosens his tie. ‘I swear if I have to do another overdose…’ ‘Did you hear from your agent yet?’… ‘Where’s my double espresso? Don’t make me ask twice.’

Agnes waits by the door.

coming soon!

A little pre-publicity for the ebook of the blog!

I’ve been working on it for a few months now, and it should be formatted  and published by mid-June, available to download onto Kindle &c from Amazon and maybe some other sites. Priced no more than £1.99, probably less.

I’ve taken a range of blog posts from over the years, edited them to sharpen the writing, then arranged them into chapters reflecting different themes – all within the context of me, Spence, starting work in the ambulance service under the guidance of Frank, a paramedic coming up to retirement.

I’ve written extra material to give more personal context, hopefully building into a more complete picture of what it’s like to work on a front-line, UK ambulance.

If you have any questions, I’d love to hear them. I’ll always answer as honestly as I can, as you know.

With thanks for all your support and encouragement over the past few years

SK

scandal

Eleanor sits in the chair with her head resting back on the cushion, her hands lightly clasping the arm rests. The nurse stands beside her with an open folder, and gives us the low-down.

‘Good morning, gentlemen. This is Eleanor. Eleanor is ninety-five. Eleanor has been with us for rehab and physio since two weeks post mechanical fall one month query fractured pubic rami. Formerly of reasonable health other than an arthritic left shoulder replaced two thousand four, hysterectomy post CA bowel resolved ten years approximately, nothing much else. Independent living, good mobility up until the accident, can weight bear now using the gutter frame here. Unfortunately Eleanor has developed a lower respiratory tract infection seven days, increasing haemoptysis for three, not responding all that well to oral antibiotics. The GP came out and said he wanted her back in the hospital for further review.’

She closes the file, leans in and rests a hand on Eleanor’s shoulder. She opens her eyes.

‘Eleanor, love. These gentlemen have come to take you back to the hospital. Okay?’

The nurse smiles and straightens again.

‘Shall we fetch the trolley in? Plenty of room.’

*

Mid-morning and the clouds have finally cleared. The sunshine has freshened everything, drawing crowds out along the front, the outline and colour of everything suddenly distinct, from the sharp white seagulls turning overhead to the deepening blue of the sea.

‘It’s a shame we don’t have better windows,’ I say to Eleanor, opening the blinds as best I can as we ride along in the ambulance. ‘It’s a beautiful day.’

‘Yes. I thought it might be,’ she says. ‘One can taste it.’

She is in the same position on the trolley that she was in on the nursing home chair, her head resting back and her hands holding on to the rails. But every now and again she lifts her head and turns her face slightly left and right without opening her eyes, as if she was sensing some change in the air, like a hyper-sensitive creature responding to tiny movements or sounds.

‘Are we there yet?’

‘No. About another ten minutes or so, I should think. The sun’s brought the traffic out as well.’

‘Has it? Yes. I expect it has.’

She relaxes again.

‘Have you always lived here?’ I ask her.

‘Me? Goodness, no. I was born in London, but then I moved to South Africa with my husband. My second husband, I should say. Around nineteen forty-nine. That caused quite a shock.’

‘Why? What happened?’

‘Well, I had a cloistered kind of childhood, you know? Quite limiting, and so on. My parents were pretty strict about where I went and who I saw. So consequently I had a small circle of friends, and early on they had fixed ideas about who might be suitable for me to marry. An arranged marriage, really. I was young and didn’t know my own mind, you see. One simply finds oneself in these situations and there you are. So I married Peter. He was a charming man, very considerate, but the awful thing was although I liked him and respected him I didn’t love him. Do you see? Hopeless, really. But it wasn’t long after that Geoffrey came over from Rhodesia. He was a businessman, you know? A distant friend of a friend. And he came over to England to watch the West Indies play, for some reason. Anyway, we met at this party, and silly as it sounds – I just knew. One does. One simply does. You meet someone for the first time and there it is, this shock – of recognition, I would say. Here he is, the person I want to spend the rest of my life with. Of course, we didn’t have long. Just a couple of weeks, in fact. The whole family were up in arms about it. My friends – everyone. Outrage. Calamity. The scandal to end all scandals. But when it happens one simply has to act. Anyway, I think it would’ve been harder not to do anything than to weather the storm and jolly well get on and be happy. So I ran away with him back to South Africa. A beautiful, beautiful country with a beautiful, beautiful man. We got married when the divorce finally came through, and when Geoffrey died a couple of years ago we’d been together almost seventy years. Seventy years!’

She raises her head and opens her eyes to look at me.

‘When did I get so old?’ she says.

notorious

Vera is eighty two.

At least once a week for the past six years or more, Vera has been calling 999 for an ambulance. And getting one.

I’ve been out to Vera a half dozen times, but even though I know her personal details off by heart, her motivation is still as incomprehensible as the voice she puts on – a febrile twittering, strangely at odds with her appearance, like hearing a bulldog squeak instead of bark.

To say she does it for attention doesn’t seem enough. I think there must be something else she gets from the whole procedure, from the pressing of the three nines to the sound of the diesel truck pulling up below her window; from the sound of the lift arriving on her floor to the ringing of the bell and the clunking and fumbling as the key safe is opened; from the sound of heavy boots walking in to the medical shtick of the cuff, the monitor, the SATS probe, the thermometer; from the taking of the history to the collecting together of the drugs, the setting up of the carry chair to the three minute ride to hospital, from the wheeling in through the automatic doors to the pat slide onto the bed – something from all that ritual of fuss, something semi-magical, that feeds her ambulance addiction and keeps her coming back for more.

 Vera obviously doesn’t like the hospital side of things, though. She’s barely half an hour on an A and E bed before she’s bum-shuffling down to the end, hopping off, striding through the department, bad-mouthing the staff as she hurries outside to car-jack a taxi home.

Notorious. Prolific. Loathed or loved, depending on your mood.

It’s not as if I don’t understand the loved aspect. If a crew is dealing with Vera, in her well-kempt flat, they’re temporarily sheltered from the potential horrors of other patients. Vera doesn’t live in a crack house. She’s not drunk and throwing up everywhere. She’s continent, cute, biddable. But just lately I’ve stopped thinking about Vera as a quirky character with lovable ways and started thinking about her as a damned nuisance.

Maybe she’s my bellwether, my emotional compass. Maybe Vera is pointing to the exit. Because now when I read her address on the screen I don’t see a lovable rogue. I see a person who is wasting resources that might be needed for a genuine emergency.

I guess she’s unhappy. I wish I could understand what the problem was so I could help come up with a solution. But probably because there is nothing obviously wrong – her flat is warm and comfortable, the doctors have deemed her mentally competent, her health is reasonable and well-provided for, materially she has everything you could want – because it’s difficult to identify the problem, it’s difficult to come up with a solution. And anyway, there isn’t a procedure for dealing with nuisance callers. They’re treated exactly the same as someone ringing for the first time, which flies in the face of common sense, but stands nonetheless. All in all it amounts to an endless procession of ambulances to this address.

Tonight when I step out of the truck I feel as if a valve has been loosened in my heel and all my patience has run out over the road.

‘I don’t think I can do this any more,’ I say to Frank as we walk up to the main entrance.

‘Yes you can.’

‘No I can’t.’

‘Yes you can. Look. Someone told me this technique for dealing with stuff you find difficult.’

‘I can’t wait.’

‘No. Come on. Listen. What you do – you think about someone you admire already, someone you think of as really cool and competent. Okay? Picture them strongly in your mind. Got it? Now – all you do is, you imagine what they would do if they were here, and you do the same.’

‘Right.’

I tap in the code. We let ourselves into the building. Up in the lift, to the front door, to the key safe.

And into the flat.

Vera is in the living room, artfully placed in front of her armchair, kneeling on one leg, squeaking that her legs have given way.

We help her back into the chair, then I drop myself onto the sofa and throw the board aside.

‘You can’t keep doing this, Vera.’

‘What?’

‘You can’t keep calling the ambulance out.’

‘I’m sick. My legs have gone.’

‘No they haven’t.’

‘They have.’

‘I’m not taking you to hospital, Vera.’

She stares at me.

‘I’ll put in a complaint against you,’ she says.

‘I don’t care. I’ll be in good company.’

‘My legs have gone. I’ve got pain all over. My chest hurts.’

‘No it doesn’t, Vera.’

‘How would you know?’

‘Vera. I want you to be happy and well, I really do. But this can’t go on, can it?’

‘What?’

I get out my phone.

‘What are you doing?’ she says.

‘I’m phoning Control. I’m going to speak to an officer.’

‘I will complain,’ she says. ‘You have to help me.’

Frank sits down on another chair, folds his arms and nods pleasantly.

‘Just a minute whilst we find out what’s happening,’ he says.

When I eventually get through to the Duty Manager he asks me how I’m doing.

‘Not well,’ I say. ‘Not well at all. I’m with Vera.’

‘Yes. I saw.’

‘I hardly know what to say.’

‘It’s difficult.’

‘Seriously. I don’t know what to say. I haven’t the words. I think I’m losing my mind. I simply don’t understand why something isn’t done. I don’t understand why we keep sending ambulances.’

‘Yes, yes. I know what you mean. But we have to be sure everything’s okay, because one day she might really be unwell.’

‘So on that basis I could call the Fire Brigade every day from now until I’m ninety, and they’d be happy to attend because one day there might be a fire.’

‘It’s not like the fire brigade.’

‘Why?’

‘It’s just not that simple.’

‘And whilst we’re tied up here we’re not available to help someone who might really need us.’

‘I hear what you’re saying, Spence. And I sympathise. But our hands are tied. Look. I’ll tell you what. Check Vera over. If she seems okay, don’t take her to hospital. If she calls again, we’ll tell her she’s had her attendance today and she won’t be getting anyone else.’

‘That’s something at least.’

‘All right?’

‘Good.’

‘When you get back to base – if you get back to base – put all this in writing and send it to the COM. It’ll all build into a case of sorts, and then maybe something’ll get done.’

‘I’ll do that.’

Vera is frowning at me as I hang up.

‘What’d they say?’ she says.

I open my bag.

‘Vera? I’m giving you a quick check-up, then we’re leaving.’

‘I want to go to hospital.’

‘I don’t think you need to.’

‘But I want to.’

Her obs are fine.

She squeaks as we close the door.

By the time we’re back in the truck, the radio sounds.

‘Guess who’s on the phone?’ says the Dispatcher. ‘But don’t worry. We’ve put her through to the clinical desk.’

‘Finally.’

An hour later we’re at the hospital, handing over our latest patient.

‘Vera’s been on the phone to Reception and the A&E desk,’ says one of the nurses. ‘She’s wild tonight.’

Back outside, the crew that were here before us clear up and get sent a job immediately.

Vera.

I climb back in the cab, ring Control and ask to speak to the Duty Manager.

‘Hi Spence,’ he says. ‘I bet I know why you’re calling.’

‘It’s just that I notice another crew has gone out to Vera. I thought you said you wouldn’t be sending anyone else tonight?’

‘Well – she kept calling and calling and we kept bouncing her into the long grass. But in the end we thought we’d better send someone just to check nothing’s happened since you were there.’

‘I think we should start sub-contracting these difficult cases out,’ says Frank, passing me a cup of coffee through the window. ‘How far west do you suppose the Mafia reach?’

anywhere but here

Vanessa’s friend Sarah comes out to meet us.

‘Promise me you’ll be discrete.’

‘I promise.’

‘I mean it. You can’t tell a soul. Not anyone – it’s very important. And the other thing is, we can’t possibly go to the local A and E. You have to take her somewhere else. Anywhere but here.’

‘Okay. Shall we go inside and say hello?’

‘She’s a nurse. We’re nurses. There. If they see her being wheeled in she can kiss goodbye to that promotion.’

‘No-one need know.’

‘She wouldn’t have let me call you if she thought you were going to take her there. No way.’

‘Where is she?’

‘She’s had a bad year. Her boyfriend dumped her, restricted practice at work, family things – a holy trinity of shit. So you can’t blame her for hitting the skids. But it’s a blip. It’s not the end of the world. You know what management are like, though.  You can’t trust them to see the big picture. So you’ve got to promise me.’

‘I’m sure we can sort something out. Where are we going?’

Sarah leads us past a giant yucca in the lounge-kitchenette to the closed door of the room out back. She knocks, pauses, pushes it open.

The bedroom is so cluttered we have to pick our way in. Vanessa lies face up on the bed, swaddled in a coverless duvet, surrounded by a scattering of possessions – odd pairs of shoes, empty shoe boxes, clothes, underwear, a Netbook – and, crucially, a bottle of vodka and a few ragged strips of Diazepam. Above everything, the pastel painting of an angel hugging his knees on one wall, a blank TV on the other.

With the amber light filtering through the drapes, it’s like we’ve broken through into a modern version of Tutankhamen’s tomb, except instead of a golden flail she holds a remote control, and instead of a cravat, Frank wears a stethoscope round his neck.

‘Hello Vanessa. How are you feeling?’

Her eyelashes tremble as she struggles to open her eyes against a mess of mascara.

‘Oh Jesus!’ she says when she sees us all standing around her bed. ‘How embarrassing is this?’

theseus and the junkie

The lowest level of the underground car park only has a couple of cars left, huddled up close to the barriers. The rest of the space leads off before us, a strip-lit catacomb, resonantly empty, tiny stalactites of gunge quivering from the joints in the concrete ceiling, dripping into puddles of oily water.

‘We need a ball of string and a sword,’ says Frank, playing his torch ahead. ‘Hello? Ambulance?’

A voice from the other side. ‘Over here mate.’

***

Vince has overdosed on heroin. He lies on his side, taking occasional, deep-brain gasps, the very minimum. His girlfriend Sonia stands over him, swaying from side to side with a beer can in her hand, her long hair hanging down partially obscuring her face. Her words are slurred but she’s still able to tell us what we need to know.

‘Where’s the needle, Sonia?’

‘Don’t worry, mate. I’m good about that shit. I dropped it in the can. Listen.’

She gives it a shake. It rattles.

‘How long’s he been like this?’

‘Twenty minutes or so. I tried pinching him out of it but it didn’t do no good. So then I called you. Sorry. Sorry, mate. It’s a fuss about nothing, I know.’

She kneels down by Vince and shakes him by the shoulder. ‘Vince! Vince, you muppet. You o-deed again. Vince!’

We set him up with an airway and oxygen mask. I support his breathing whilst Frank jabs him in the arm with a shot of Narcan.

‘What’s he like when he comes out of these?’ asks Frank.

She shrugs. ‘All right. He’s all right. I mean to be honest with you he won’t be all that happy about it, but he’s all right. Aren’t you? Hey? Vince?’

After a few minutes Vince starts to show signs of movement. He groans, and finally sits up. I take off the mask as he gags and pulls out the airway. Sonia kneels beside him and hugs his head.

‘Vince, mate. You were so out of it. These guys saved your life, man!’

He curses blindly and pushes her away.

‘I’ll feckin’ do yous’ he says. ‘The feck.’

‘Vince! They saved your life.’

He staggers to his feet, his legs planted more than shoulder width apart, swaying forwards and backwards so violently it’s a miracle he stays upright. ‘The feck are yous,’ he says, drool from his lower lip like one of the stalactites has taken root in his mouth.

‘Vince – ease off, mate. You need to go to hospital so they can keep an eye on you. I think you’ve had some of that strong gear that’s going around.’

Vince takes a swing, but all his movements are so thickened by heroin it’s like he’s fighting underwater. Frank could make a cup of tea in the time he has to side-step the punch; Vince topples forwards onto the concrete again.

‘Vince! What’re you doing, man? They’re here to help you. You were proper out of it.’

But Vince is muttering, grunting like an anaesthetised bull, struggling to get back on his feet to attack us again.

We step aside and try to calm him down from a little way off. He needs to understand that the Narcan will wear off, that he’ll be vulnerable again. Sonia does her best to make him understand but he’s too enraged to listen.

Time passes.

We become distracted by some of the grafitti on the walls this end of the car park. Amongst the tags and crude pictures and phone numbers – a love poem, written in green marker pen, whose closing lines are:

So do me a favour and remember what I said

That girl was everything to me – and she was quality in bed

Sonia comes over.

‘He’s not going,’ she says. ‘But I know what to do. I’ll keep an eye on him.’

‘Are you going to be all right down here?’ I ask her. It’s inconceivable that anyone could spend the night in this place, let alone a young woman on her own.

‘Oh yeah,’ she says. ‘It’s normally just me and the dog.’

shop / drop

Mrs Milgram greets us at the door of the flat with a diffident bob of her shoulders. A tall woman in her late forties, she has the lumpen quality of a giant parsnip, her broad hips tapering down to a pair of tiny feet, her head sprouting with a straggle of wet hair. Her thick glasses water down her eyes, which, along with the puffiness of her face and the droop of her chin, gives her a pale and peculiarly passive expression.

‘Hello. Thanks for coming,’ she whispers. ‘He’s in the living room. I’ll go and finish my hair off if that’s okay.’

She turns and hobbles back into the flat along a narrow corridor, waving us past as she goes into the bathroom. Everything comes off the corridor to the left, except for the living room at the far end. We head that way, squeezing past a clothes horse hung with sagging grey underwear, a cat scratching post, and a stack of lager trays, twenty cans per tray, ten trays tall.

Lennie is crouched at the edge of an L-shaped sofa, his arms folded across his middle. Behind him on a ledge is a crowd of empty lager cans; to his right, with its screen turned discretely away, a laptop. On the other side of the laptop there is a towel draped across the cushion of the sofa; on the other side of the towel is a porn magazine – MILFs and Matures. There are two spangly throws draped across the window on a washing line. The room has the fetid atmosphere of a place that has not seen enough sunlight, or had a window opened in a while, or the litter tray changed frequently enough.

Lennie tells us he’s twenty-five, which is about twenty-five short of what I would’ve guessed. Behind his full beard his face has the waxy yellow tinge of a candle that’s been kept at the back of the cupboard. He is so slight, if it wasn’t for the starch in his clothes he wouldn’t be able to sit up at all.  

‘I haven’t eaten in two weeks,’ he says. ‘I haven’t been outside in five years.’

‘And have you been drinking much?’

‘Twenty cans a day, from when I wake up to when I go to bed.’

‘At the moment, Lennie, your chest is hurting because your heart is running too fast. We need to get you to hospital to have that slowed down. Okay?’

‘Not really.’

‘It’s the only option, mate. If you stay here your heart will become exhausted and eventually pack up. So come on – let’s grab your coat, shoes, phone and be on our way.’

‘Tell mum I need a clean pair of trousers. I’ve messed these.’

‘Fine.’

I unpack the chair and make it ready to carry Lennie out. In the minute it takes for Mrs Milgram to find his clean trousers, Frank says: ‘How do you get all that alcohol if you can’t go out? Presumably your Mum would struggle.’

‘No. It’s easy, really. I just shop online.’

‘Haven’t you seen the advert on the side of the truck, Frank?’ I say, wrapping Lennie in a blanket. ‘You shop, we drop.’

‘Mm,’ says Frank. ‘But not in this case.’

the heebeegeebee range

The night lifted away suddenly, cleanly, without anyone noticing, and now the sky rides above us silver and blue. Outside the station the Born Again Christians have almost finished packing away the trestle tables of their soup and sandwich kitchen; a lorry makes a delivery to the All-Night supermarket, its cages booming off the ramp; a Scarab truck with its slow-flashing orange lamp scavenges litter, and the last of the clubbers stagger home as seagulls shriek and wheel above the road.

An ambulance car is parked by an old railway tenement block. Richard, the paramedic, comes out to tell us what he found.

‘Hi guys. Thanks for stopping by. We got a call from a member of the public who’d found Aimee slumped in the doorway looking distressed. He couldn’t get much sense out of her when he asked if everything was okay, so he called us. I’d put her at GCS fourteen. No sign of trauma or anything amiss in her obs but Aimee must have taken a bath in fairy dust or something guys because her pupils are like dinner plates. She’s off orbiting some alien world, freaking out, yeargh! No idea where she is. Completely suggestible. I asked her if she lived here and she said yes, but no-one knows her of course. No ID. I’d guess she was about twenty or so. Don’t know if I heard her name right, but she seems to respond to it. I think it’s just a case of hospital for safety until she splashes down again. Sorry guys. How’s your night been? Pretty crazy, if it’s anything like mine. I’ll bring her out.’

He goes inside and a moment later re-emerges with Aimee following. With her head down, her long hair hanging over her face, the hospital blanket draped over her shoulders, she could be a hermit being led out of a cave after a twenty-year retreat. Her nose pokes out of the fall of her hair; as she emerges from the gloom of the hallway, she gently hooks the hair away and slowly looks around with an expression of existential terror on her face, a hollow-eyed sadness that things should be as they are. She hesitates, appalled that anyone could expect her to go any further into something so ruined, so terrible.

‘Come on Aimee. Let’s get you in the warm.’

I take her gently by the arm and she drifts along beside me, so lightly I may as well have tied a helium balloon to my elbow, a character shape from the new, grimly-realistic Urban Collection: Bad Tripper, from the Heebeegeebee range.

a big night out

The city changes as the night goes on. The seagulls have the best view, skimming like drones across the upper reaches of the street lights, restlessly scavenging the network. Beneath them, the crowds have thinned along the shopping thoroughfares, clotting and spilling around the usual spots, the late-night bars and clubs. Even as we approach we can see this crowd has an unusual focus, though - a figure lying in the road with an epic triangulation of figures around her, crouching, kneeling, standing with a mobile phone and waving. A guy suddenly wrenches my door open just as I’m hitting the At Scene button.

‘Just slow it down, mate,’ I say to him.

‘She’s fitting.’

‘Let’s have a look.’

But even from here I can tell it’s not an epileptic seizure. There’s an artful focus about the way she flops her arms and legs about, the way she arches and relaxes her spine to bang her head comfortably in the lap of the guy on his knees cradling her. The setting could hardly be more public, and the fact that her skirt and top have ridden up, the way her arms are scuffed and dirtied from the road, all these things give the scene a shocking plausibility.

I’m like a street performer claiming his patch. And if the girl is The patient, I must be The patient whisperer, the figure in green with TV-levels of ability to take control, to sort things out. I’ve played this part before and I know how it goes. I have to get her into the ambulance as soon as possible, with the minimum of fuss. I know that the more direct and authoritative I can be, the more chance I’ll have of success. Conversely, I know that the longer we’re on show like this, the more chance there is the trick will be revealed and the scene become unmanageable.

None of the people with her are related; I identify Isaac as the friend sober enough to help. He stands behind me as I squat down, put one hand at her wrist to feel her pulse and one on her shoulder. She stares up at me, and stops thrashing around to listen for her cue.

‘It’s the ambulance. My name’s Spence. Can I ask what your name is?’

‘Gillian.’

‘Gillian – have you fallen down and hurt yourself?’

She shakes her head.

‘Good. Now. We need to get you on the ambulance where it’s warm and safe. Sit up for me.’

She does.

‘Now bend at the knees – good. That’s it. Hold my arm. And stand.’

She stands.

The crowd parts to give us room as we walk over to the ambulance where Frank waits with the door open and everything ready.

As Frank settles Gillian on the trolley, I tell Isaac to wait outside so we can chat in private. I tell him I’ll be out again in five minutes. He looks crestfallen when I slam the door shut.

***

 Inside, the down-lighters above the trolley are warming and good. Gillian lies covered in a white blanket. She picks strands of hair from her face. Her pupils are saucerous and dark, whilst above her the ECG monitor jumps along at a clip.

‘Have you had any recreational drugs tonight, Gillian? We don’t care – we’re not the police. But we need to know so we can get you the appropriate treatment.’

‘No. Just alcohol.’

It’s hardly worth telling her that a blood test will reveal everything, but I’ll let the nurses at the hospital deal with that.

‘Ever happen to you before?’ I ask, writing down the last of the results Frank calls out.

‘A few. I’ve been for scans and stuff but they still don’t know what causes it.’

‘And how old did you say you were?’

‘Nineteen.’

‘Student?’

She nods. 

‘Psychology. Can Isaac come? I want him with me at the hospital.’

‘Okay. Let’s get him on board.’

***

Isaac seems excited at the prospect of a trip to hospital in an ambulance. He sits forward on his chair, jiggling his legs up and down, his jacket on his lap, mobile phone in one hand, Gillian’s hand in the other.

‘This is wild,’ he says, looking around, his eyes as wide as hers. ‘It’s just like Holby City. How are you feeling, hon?’

She squeezes his hand. ‘Oh – you know.’

‘Who shall I call? Jazzer and Stoofus know already. I’ve told The Arch Meister. Crick says he’ll meet you there later. Ellie says hi.’

Gillian is lit up as much by his attention as by the down-lighters.

‘I’m lucky I’ve got such good friends,’ she says, and smiles at me. ‘God, I need a drink.’

‘You greedy bitch,’ says Isaac, thumbing another text. ‘You nearly died on me and now all you care about is booze. Honestly, girlfriend – you!’

He sends the text then looks at me.

‘How long have you been doing this job, then?’ he says.

‘About seven years.’

‘Like it?’

‘Yeah. It’s interesting.’

‘I bet you see some things.’

‘Oh - you know.’

‘Us for example.’

He laughs, stuffs his phone in his jeans pocket, then holds up the jacket he had on his lap.

‘What do you think of that?’ he says to me.

‘Nice.’

‘I found it. Didn’t cost me a penny. It’s a Ben Sherman.’

‘Excellent.’

‘Do you know, I haven’t actually bought a jacket in years. Every one of the last three have been found. Two by me, one by my sister.’

‘That’s lucky.’

‘That is lucky. Three jackets. And look. Not any old shit.’ He turns the jacket inside out and presses the label towards me. ‘Ben Sherman. That’s quality. Look at the lining. Feel it.’

The ambulance rolls as we turn up the hospital slope.

‘We’re here,’ I say.

Isaac puts the jacket on.

‘Come on, girlfriend,’ he says, standing up and slapping her leg through the blanket. ‘Not the big night out I was hoping for, but whatever.’

hyena tale

Miriam, Jennifer’s carer, periodically widens her eyes to emphasise each dramatic point, like a car going from dip to full beam and back again. A short, dark-haired woman, she is economical with her movements. Once she’s done exactly what she needs to do to help us make Jennifer comfortable on the ambulance trolley, she settles herself into her own chair with a minimal wiggle, clutching Jennifer’s bag of clothes and meds securely on her lap.

‘This is my second home now,’ she says as we move off towards the hospital. ‘I’ve only been here five years but I love it. The freedom! You can step outside your front door without looking over your shoulder first. Believe me, South Africa’s finished. A nightmare. I had a comfortable life, there you wouldn’t believe. I was in computers. I could work when I wanted, how I wanted. I had a beautiful apartment on the twentieth floor overlooking the harbour, a beach house – and I mean a beach house – right there on the beach, with bullet-proof glass to cut out the sound of the sea. They don’t sell double-glazing in South Africa. It doesn’t exist. But bullet-proof glass – well, it’s a good insulator, it protects you from noise. And bullets too, of course.

‘I was attacked three – no, four times. Look at these marks. Know what they are? Teeth. I was going to my car and this guy attacked me. He grabbed my right hand because he knew I carried a pistol in a holster on my right hip. But I still had my left hand free so I whacked him straight in the mouth – like this! Because I’m a brown belt Karate and I will always fight back. So he falls back and lets me go, yah? But just before he runs away to find an easier target he swipes me with his knife – here! Not a deep wound, but what I didn’t realise then was they use poison on their weapons. Herbal magic. Muti, a Zulu thing. All kinds of strange preparations from the bush. Wild garlic and other stuff. So he’d smeared that on the blade. I only found out a couple of days later when I was out with friends and suddenly collapsed in the restaurant. I came round in the ER later that night and the doctors told me all about it.

‘It’s a tribal thing, of course. They migrate down to where the money is, the coastal resorts, and take what they can. It’s understandable really, because there’s such dreadful poverty. I suppose they’re only trying to feed their families, and who wouldn’t? But it’s dreadful, all the same.

‘I thought I was safe up on the twentieth floor. Gated entrance. I even had a police chief living in the flat above me, so I felt pretty secure. Secure enough to sleep with the balcony door open. But one night they abseiled down from the roof, going from balcony to balcony, burning hyena’s tail and other stuff to put us all to sleep. Even the dog went out. Then they were free to take what they wanted. They took the keys to my Audi, but luckily the fuel light was on so they left it and took the police chief’s Mercedes instead. Unluckily for them it had tracking, so a couple of helicopters picked them up down the road.

‘I never wore jewellery. I had a friend who was attacked and they just went kerchup! with the blade when the ring wouldn’t come off first time. I’ve had friends shot in the head, abducted, ransomed, dumped in the bush, stabbed. Ach – it’s not good. Not good at all. The last straw was the beach house getting ransacked. I barely escaped with my life. So next thing you know I’m standing at Heathrow with one suitcase and one dog. It was like getting mugged all over again, the exchange rate was so bad, but what can you do? You can’t put too high a price on security, yah?’

a quick fix

Still twenty miles out of town and we’re in a queue of traffic so slow we’d have more chance closing our eyes and wishing ourselves home. There must be an accident up ahead, a sink hole or something because this is terrible. We’re surrounded by drivers on their mobiles, frantically re-entering co-ordinates on their Satnavs, or leaning back in their seats and pressing their hands up into the ceiling like prisoners finally losing it in the cell. I’ve had my knees up on the dashboard for the last five miles. It stopped feeling good at three, but I’m too numb to do anything about it now.
‘Gum?’
 ‘Sure.’
 Frank holds out his palm.
The job screen lights up.
‘What? No. No.’
A job way off in the wilds, so far away the scale of the map has to pull back to satellite view to fit the two red markers on the same screen.
‘What is it?’ says Frank, rolling his head left shoulder to right with an audible crack.
 ‘Intoxicated. Can’t get up.’
I call Control and do my best to get out of attending without actually refusing the job. But we’re out of area, out of leverage, out of luck. The Dispatcher fields my call with a chilliness that would make a polar bear grimace.
‘You are the nearest,’ she says.
Not only is it a long way to run, but if the patient needs to go in, we’ll have to head back the way we’ve just come by another ten miles or so, to a hospital renowned for its handover delays. By the time I eventually finish work my kids won’t recognise me. I’ll knock on the door and some teenagers will answer it. They’ll shout over their shoulder: Mum – there’s some strange bearded guy mumbling something about an overrun.
 But we have no choice.
Frank drives so fast the ceramic tiles are stripped from the chassis and the cab starts glowing red. Technically I’m a month younger when we haul up outside the address.

 An elderly woman is standing waiting for us by the garden gate. She waves us over and starts talking the moment we’re in range.
‘I’d better just tell you…,’ she says. Then she closes her eyes, her chin folds upwards and she presses a handkerchief to her face to hide the rest.
‘Take your time,’ says Frank, looking back at the ambulance, gauging the distance. ‘Tell us what’s happened?’
 Eventually she looks at us again.
‘Peter came back a couple of days ago. Well – he had to, you see. A condition of his bail. So he’s been staying with us because he doesn’t have anywhere else to go. But I’m not well, nor his father. We can’t cope. He’s been drinking the whole time. Sleeping on the floor. Carrying on. We had the ambulance out yesterday. They took him to hospital but all they did was put him on a drip or something and then send him straight back. But we just can’t cope. I don’t know what to do.’
‘And it’s Peter we’ve come to see?’
She nods.
‘He’s on the floor again. Eric can’t get him up, not with his back. Do something, would you? It can’t go on like this.’
‘Let’s go in and say hello,’ says Frank.

 Eric waves as we go into the kitchen. By his feet is his son, Peter, a fifty year old man with a face as rough as a pumice stone. He is on his knees on the lino, sipping from a highball glass of vodka.
‘Thank you,’ I say, taking it from him. His head wobbles as he tries to follow me with his eyes.
‘Here… I need that…’
‘Maybe, but it just seems a little too ironic to be called here because of alcohol and watch you carry on drinking. Doesn’t it?’
He shrugs and reaches out his hand to me as if the shrug was all he needed to win the argument.
‘Just a minute,’ I say.
‘Sorry about this,’ says Eric. ‘We didn’t know what to do.’

 Peter hasn’t fallen or hurt himself. We check him over and apart from a little raised blood pressure – not as much as you’d have thought, given his history – he’s fine. Drunk, but fine. We help him onto the sofa. His legs bounce up and down as he folds his arms to see what we’ll do next.
‘Let’s have a chat in the other room,’ I say to the parents.
 ‘He needs to go on some kind of detox programme,’ says Eric quietly. ‘He’s killing himself.’
‘I think you’re right about the detox, but hospital isn’t the place to do it. He needs to be sober, for one thing. They’ll just keep an eye on him and then send him back – here, probably, if you don’t refuse him.’
‘But we can’t cope.’
‘If you want him out and he refuses to go, you can always call the police.’
His mum uses the handkerchief again.
‘We couldn’t do that,’ says Eric.
‘I know it’s hard. But something’s got to give. And if it takes some police involvement to shake him up a bit, maybe that’s not such a bad thing.’
‘He’s had enough of that already.’
‘He’s got to get on top of the drinking, though, Eric. It’s not helping anyone.’
Frank has been writing out the paperwork. He gives me the board to finish off.
‘If Pete’s out of area at the moment, maybe he could see your GP in the morning? What do you think?’
‘It’s worth a shot,’ says Eric. ‘Otherwise I just don’t know.’
‘Don’t forget – if he gets difficult, if you feel threatened in any way, or you really just can’t think what to do next, call the police. Unless he’s unconscious or having a fit or fallen over and hurt himself or something, it’s not really our domain.’
‘Right. Yes. I will do. Thanks.’
He signs the form.
 We leave.
 They watch at the door as we reverse out of the close, practically a handbrake turn.
‘Seatbelt,’ says Frank. ‘Parachute. Gum. Let’s go.’

raphael

The art deco block sits back from the street behind a pair of substantial iron gates. Rae gets out and rings a number on the entry panel. Eventually the gates swing in. We park up, grab the bags we’ll need and go to the main entrance. There’s no-one there to meet us, so we ring again.
A hesitant voice, sobbing in the background: Yes?
‘Ambulance.’
‘Oh. Yes.’
The door buzzes.
We go through into a wide, bright hallway. Even though the building was converted into flats years ago, the black mosaic floor tiles still reflect the crystal chandelier that hangs from the domed ceiling four storeys above our heads.
A door opens across the hall and a young man waves.
‘Please. Here.’
He goes back inside.

The flat has the conspicuous untidiness of a hotel room, with laptops and keys and fast food cartons on the circular table by the window, and a stack of coats draped over the back of the sofa.
There are two twenty-year-old women sitting at the table, crying and tearing kitchen towel from a roll.
Another, slightly older woman lies unconscious on the sofa.
‘So who’ve we got here then?’ says Rae, leaning over her and taking her hand.
The girls reach out to hold onto each other.
The man says: ‘Repeat, please?’
All the people in the flat are foreign students. The man is the only one who speaks English at all, so we direct our questions to him. It soon becomes apparent that he doesn’t know the patient himself – she’s a friend of his girlfriend, Teresa, staying with them for a few days after splitting up with her partner. But when he relays our questions to Teresa, she’s either too upset or actually not so close to the woman that she can give us much.
‘She is called Luisa,’ he says, flicking the hair out of his eyes and leaning forwards. ‘Teresa say she think she have the low eh-sugar.’
I test her blood. Normal.
The wailing from the two girls increases every time we do any procedure, even innocuous things, like putting on a stethoscope and listening to Luisa’s breathing.
‘What exactly happened with her?’ asks Rae. ‘How did she end up on the sofa like this?’
Raphael spreads his hands wide and shakes his head.
‘She sleepy and very, very sad. She sleep it out for a while before and after we come. I think maybe it is her eh-sugars, yes?’
‘No. But something’s happened. Has she taken any pills you know of?’
Raphael speaks quickly to his girlfriend; still crying, she runs into the bathroom and comes back with a plastic sandwich bag half-filled with yellow and white tablets.
‘She have from Sao Paulo,’ says Raphael. ‘I don’t know for what they are. Teresa say is possible for the heart?’
‘We’ll take them,’ says Rae. ‘And I think we’ll have that chair now, Spence.’
I go back out for it, using my rolled-up gloves to keep the door from closing shut behind me.

When I set it up ready for the transfer from the sofa, Rae goes over the obs she’s made. Everything appears normal, but Luisa’s still flat. Her eyes are half-open, but her pupils scan backwards and forwards like a robot shorting out.
‘I’d put money on an overdose,’ says Rae. ‘Let’s get her out.’
The girls are standing by the window, arms around each other and crying as we strap Luisa onto our chair and manoeuvre her towards the flat door. Raphael hovers around us ineffectively, and has to be guided firmly to open doors, carry bags and so on. Still, he follows us out to the ambulance. I send him back to see if Teresa can find out Luisa’s date of birth at least. Whilst he’s gone and we’re about to transfer Luisa to the trolley, she becomes rigid and starts shaking. Blood jumps and bubbles out of her mouth as she clamps down on her tongue. We keep her positioned so she doesn’t choke, and help her ride out the fit in the chair. It passes quickly; we lift her onto the trolley, clean her face and as Rae preps her for the journey and subsequent fits, I meet Raphael at the door.
‘Teresa thinks Luisa has maybe twenty and four years,’ he says. ‘I’m sorry we don’t know the dates or where she lives, but she make study in London. Her boyfriend also. But she – erm – she came stay for few days because they finish boyfriend girlfriend no more. How is she?’
‘She’s just had a fit. My guess would be she’s taken an overdose of something, but that’s just a guess. We’ve got to get going now, Raphael.’
‘May I come too? Erm – Teresa she ask me to keep with phone and to give people informations at hospital. Is okay?’
‘That’s good of you, thanks.’
‘Okay. No problem.’
He rides with me up front.
‘If she wake, I can translate for you,’ he says.
‘That’s a help. Thanks.’

At the hospital Raphael waits outside making calls whilst we wheel Luisa through to resus. We give the team what we know; I book her in at reception and go outside to tell Raphael what to expect next.

I hop into the back of the ambulance to start tidying up; whilst I’m in there, I hear one of the receptionists come outside to speak to Raphael.
‘Did you come in with that girl? Luisa, is it?’
He lowers his phone, flicks his hair back and leans in, exactly as he did in the flat.
‘Sorry please?’
‘Did you come in with that girl? Only we need her date of birth. Her date of birth? When she was born?’
‘I’m sorry. That is all I have.’
‘So you can’t even tell me her last name?’
‘No. I’m sorry.’
The receptionist lowers her paperwork.
‘Well, what on earth’s the point of you coming in with her then if you can’t even tell me the basics? I don’t know why you bothered.’
The phone rings in his hand. The receptionist gives an irritated little shake of her papers and turns back inside. He pauses, flicks his hair again, uncertainly, then raises his phone to speak.

I go inside to speak to the receptionist.

‘You shouldn’t be so hard on him, you know. He’s only trying to help. He can relay information to us if his friends find anything out, and he’ll be there to translate if she comes round. All that for someone he’s never met before.’
‘Hm,’ says the receptionist. ‘Well. Hm.’

elvis

Malcolm meets us at the door. A short, perfectly round man in white windcheater and brown slacks, it’s like being met by a giant Christmas pudding.
‘She’s in the sitting room,’ he wheezes, struggling to make himself heard over the homicidal barking of a dog locked away in the kitchen. ‘Poor sow. Probably wants shooting, but you’re the experts.’
He shows us in to his wife Pamela, sitting in an armchair, blood trickling from a gash on the bridge of her nose. She holds her left hand out to the side; the other tragically grips on to a handkerchief whilst her head rests back on a cushion.
‘Oh dear. What’s happened to you, then, Pamela?’ says Frank, walking over.
The dog redoubles its efforts to reach us through the kitchen door, which bows and shudders under the impacts.
‘Elvis! No!’ shouts the man. There is a brief pause. Malcolm smiles and licks his lips. The dog click-clicks away from the door, but then there are dragging sounds, as if it’s coming back with heavy equipment.
‘I fell over, that’s what happened to me,’ says Pamela. ‘Ooh – I’ve never known pain like it.’
‘How come you fell over, Pamela?’
‘I don’t know. I just fell over. I didn’t do it for a laugh, you know.’
‘No – no, I don’t suppose you did. But we need to figure out why you fell. Did you trip? Did you feel dizzy?’
‘I told you. I fell over! I went down, there, in the hall. And I banged my head on the floor and everything.’
‘Were you knocked unconscious?’
‘No – I wasn’t knocked unconscious. I fell over, I banged my head and I cut my nose. It’s bleeding. Can’t you see?’
‘I can see. So it was a trip, then?’
‘Yes. I went dizzy and fell over.’
‘So it was a dizzy spell. And apart from your nose, do you have any other injuries?’
‘What d’you mean, other injuries? I cut my nose. Isn’t that enough?’
‘Yep. We’ll get to the nose in a second. But have you hurt yourself anywhere else? What about if I touch your neck here...’
‘Ow!’
‘And here?’
‘Ow!’
‘So all round that area, then?’
‘And my knee. And my back. And I can hardly move my hand at all.’
‘Do you have any health problems?’
‘Yes. I hurt my hand.’
‘When?’
‘Just now, when I fell over.’
‘No. I mean – do you have any health problems from before the fall? Do you suffer with anything? Heart problems, breathing problems, that kind of thing?’
‘Angina. ‘
‘Okay. I think what we need to do, Pamela, is get you out to the ambulance, clean you up and do some checks, then see what’s best to do after that. Is that all right?’
The dog now appears to be tunnelling his way through the floor.
‘He sounds fun,’ I say to Malcolm. ‘Whatever sort of dog is that, then? Ridgeback?’
‘Elvis? He’s a Bichon Frizz. But you wouldn’t want to get on the wrong side of him.’

identical

Olive answers the door at last, the phone still in her hand.
‘We didn’t think you’d be that quick,’ she says. ‘Come in, boys. Come in.’
She shows us through into the lounge where her ninety-five-year-old identical twin sister Oona is stuck in the chair.
‘I just can’t seem to make it out,’ she says, puffing out her cheeks and scuffing her bandaged legs backwards and forwards. ‘I’ve been trying and trying but I’ve run out of oomph.’
‘Do you have any pain anywhere?’
‘What’dya say?’
‘We’re a bit deaf,’ says Olive.
I lean in and speak more loudly.
‘Do you have any pain, Oona?’
‘Pain? No – no pain. Thank the lord.’
‘Good. Excellent. Have you had trouble like this before?’
‘No – we’re pretty good on the whole.’
‘I mean you, Oona. Have you had trouble getting out of the chair before?’
‘We’re ninety-five,’ she says. ‘What do you think of that?’
‘That’s amazing. I tell you what, Oona. Let’s quickly check you over and see what’s what. Are you desperate for the loo or anything?’
‘I am pretty desperate, yes. That’s why we thought we’d better ring.’
‘Well I’m glad you did. Let me just do this then we’ll get you straight to the bathroom.’
Oona’s problem turns out to be more basic physics than anything else; the soles on her slippers don’t have enough grip, and the armchair is a little too low.
‘I was standing behind holding it still whilst she tried to get up but it wasn’t any good,’ says Olive. ‘I almost went over myself. Sorry to drag you out.’
‘It’s no bother.’
We help Oona out of the chair. Once she has a firm grasp of her trolley, she hurries off in a trunk-legged waddle out of the lounge towards the bathroom with me and Frank either side. Olive helps her settle on the loo, and we tactfully withdraw to the sitting room.

The main wall is covered with a dozen or so family portraits. There is an oval Edwardian print of the mother and father, staring back at the camera with a high-collared, straight-backed expression. The others are mostly of the twins on display in various situations, from their first appearance in prams, to little girls of increasing height standing by a garden wall, in front of an ocean, at a fairground, but always dressed identically, their hair worn the same – more like topiary than hairdressing, a spongy mass of dark curls cut into two circular bunches over each ear like the hat on a Mouseketeer. Even in the recent photos, in increasingly vivid colour, and with more and more people around them, the twins stay side by side at the shoulder, the height decreasing, and the hips spreading, the hair flattening and greying, but the expression essentially the same – sparkling eyes, and a warm and confederate grin.
‘Do you like our rogues gallery?’ says Olive, leading her sister back into the room. ‘You know, our father was a lovely man, but I’m not sure he ever really got over it when we were born. Did he, Oona?’
‘No. He wanted a boy and look what came out instead.’
Olive helps her sister back towards the chair.
‘Maybe I’d better put an extra cushion on it first,’ says Frank.
‘Maybe you could move in,’ says Oona.
After a wicked pause, they both laugh; the sound is exactly the same.

the power of mime

A middle-aged figure in denim opens the door to us. There is a rough, buzz-cut angularity to him, as if someone tried to fashion a man out of a block of wood with a chain saw.
‘Shall we have a chat inside for a moment?’ I ask him.
‘Well I’m out now,’ he says. ‘But I’ll sit on the steps if you like.’ He gingerly lowers himself down onto the mosaic tiles. ‘I might not get up again, though. Oof. I want a piss so bad my teeth are floating.’
‘So what’s been happening, Mr Coates.’
He unsnaps the top button of his jeans and shifts uncomfortably.
‘I’ve been passing blood in my piss,’ he says. ‘It’s happened before. Always after sex.’
‘Is your doctor aware?’
‘Oh, yeah. I told her about it four years ago. I’ve had all the tests and dips and whatnot and she’s still not sure. I think I know, though. I had this hernia repair a while ago and I think there’s scar tissue inside. I think when I have rough sex...’ he rocks backwards and forwards on the step with his right arm out in front, a goaty-little mime, something like a galloping jockey, ‘... and all that banging away shakes down a clot or two. And they come out in my piss.’
Frank leans against the balustrade, folds his arms and looks off across the green. With the late afternoon light falling across him like this, he’s the very model of civic forbearance.
‘So why’ve you called us now, Mr Coates?’
‘I can’t piss. I went in the early hours, but only a dribble. And now I’m totally blocked. I think a really big clot must’ve come down and blocked off my pipe.’
Frank looks at me and smiles.
Mr Coates carries on.
‘Not surprised though. I hadn’t had a shag since Christmas and I think I overdid it last night. You know...’
He performs his mime again.
People hurry past in the street.
‘I shouldn’t do that,’ says Mr Coates, grimacing. ‘I might explode. But you get the picture. The other thing I should tell you is if I don’t eat every four hours I can go off.’
‘What do you mean, “go off”? Are you diabetic?’
‘No. Just a high metabolism. But if I don’t have anything to eat I’m liable to collapse.’
‘When did you last eat?’
‘Twelve hours ago.’
‘And why was that?’
The man snorts.
Frank shakes his head.
‘Well,’ says Mr Coates. ‘I had more important things on my mind, didn’t I?’
And he illustrates quite succinctly what they were.