Monday, December 22, 2014

happy christmas

It’s a cliché, but A&E’s in meltdown.
Except meltdown doesn’t quite do it. Meltdown suggests movement, fluidity, a change from one form to another. Obstruction is more like it. Log Jam. The volume of patients coming through the automatic doors overwhelming the channels established to deal with them. With no beds further up the chain, nowhere for the current cubicle occupants to move up to, nowhere for the new ones coming in the door to go, it’s a logistical puzzle with no solution. A simple question of numbers – although as is often the case, the simplest questions are the most difficult to answer. No one round here has any time to debate. Coping has shrunk to a few centimetres of space, a cup of coffee, a clear view of the wipe clean board and the A&E clock.
The staff in A&E – the nurses, consultants, HCAs, cleaners, porters – everyone is doing whatever they can to alleviate the situation. No-one has the psychic or emotional room to do anything else, to see or believe in any kind of long-term plan. Home has retreated to the realm of fairytale. The best anyone can hope for is a chair and a cup of coffee, something to eat and a place to rest their eyes that isn’t occupied and doesn’t demand action.
I’m waiting with our patient, a young guy with a deep abscess on his left buttock that the consultant has just packed out with super-absorbent gauze in the humane but brisk manner of a field-surgeon under fire. The patient is on his back at least, on a trolley, the pressure of his body helping to staunch the blood loss. His wife is with him, wiping his forehead and kissing him now and again. The whole scene only needs straw on the floor to qualify for a Crimean certificate of tragedy, but everyone’s doing their best, the shift is nearly at an end (theoretically), and the pharmacy has antibiotics, for a few more seasons at least.
I’m chatting to the patient about this and that, keeping him distracted from the general scene of woe, when I feel a tug on my elbow. An elderly woman, peering up at me.
‘You look like the person to ask,’ she says.
‘Oh, really? Okay. How can I help?’
‘I’ve been told my taxi is out where the ambulances are parked, but I don’t know where that is. Could you tell me?’
‘Of course. Head for those doors in the far right corner. See them? Just where that guy in the yellow jacket is waving his arms about? Once you make it past him, you’ll see a couple of automatic doors, and about a thousand ambulances nose to tail in the car park just outside. That’s where your taxi will be. Okay? Do you want me to help you through, or are you all right?’
‘I’ll be fine, thank you. I can see you’re busy. I just got a little lost, that’s all.’
‘It’s all very confusing, that’s for sure.’
‘Well – thank you for your help.’
‘You’re welcome.’
She starts excusing her way through the melee; I turn my attention back to my patient.
About a minute later, I feel another tap on my shoulder.
It’s the old woman again.
‘Happy Christmas!’ she says.
‘Oh! Happy Christmas!’ I tell her.
She holds out her hand for me to shake.
‘And a very Happy New Year!’ she says.
Then with a neat little shake of her shoulders, a gracious nod to the patient, the patient’s wife, she releases my hand, turns, and with her head up and beak out, she addresses herself to the task of swimming upstream, and the heavenly prospect of a taxi, waiting with its lights on, somewhere out in the dark.

Sunday, December 21, 2014

smoked carp

It couldn’t be more public. Two street drinkers fighting outside the pizza restaurant overlooking one of the busiest intersections in town. We have a big audience – people eating pizzas just the other side of the glass, Christmas shoppers and lunchtime workers hurrying past on the pavement, people in cars queuing at the lights, and a woman filming us on her phone.
‘Please don’t,’ I say to her. She zooms in.
It’s impossible to know what the fight was about. It seems to have something to do with a tatty, empty Adidas bag, but really that could just be the focus of all the tugging and pushing and ineffectual roaring. The call came through to us as a male, fitting. We wondered if it might have been a mis-type, but one of the cops who’ve stopped by to help says that Paulie, the guy who seems to be the centre of all the fuss, was seen at the start of it all to fall to the ground and start shaking.
‘Apparently he smoked something. A legal high of some description,’ says one of the cops. ‘He looks a bit out of it, but I wouldn’t say he was dangerously intoxicated. What do you think?’
‘Shall we get him on the ambulance and check him out there?’
It’s easier said than done. The scrappiest drinker – a guy with a face that would make an ogre wince – harries us around the second cop as we herd Paulie up the steps into the back. He’s submissive to begin with, enough to get a satisfactory blood sugar reading. Unfortunately the scratch on his finger awakens the beast again. He starts swinging his fists and kicking out, so we let him get off.
‘I won’t fight you, Paulie,’ says one of the cops. ‘Are you listening to me? I won’t fight you. I’ll just tazer you. Do you understand?’
If he does, he hides it well. He crashes out of the door and staggers around outside; we form a moving barrier round him again whilst we review our options.
The cops don’t want to arrest him. They’re supposed to be undercover, chasing sharks not sprats. If they arrest him, they’ll have to take him down the custody suite. The nurse there will be duty-bound to refer on to the hospital, just in case there’s something else going on. The hospital is completely overrun; an aggressive, intoxicated Paulie is the last thing they want. All in all, it would be better for all concerned if Paulie simply refused aid and went on his way, preferably with a sober friend.
Miraculously, the sober friend appears on a bike.
‘Hey!’ says Lance, jumping off and doing a little run to a stop. ‘Paulie? Whassap?’
Lance is as weathered as Paulie, but he’s so perfectly polite and helpful, we couldn’t be happier if St Francis had walked out of the pizza restaurant dabbing the sauce from his chin and politely inquiring if we needed a hand.
‘Mate!’ he says, turning to Paulie and laying a hand on his shoulder. ‘You’re a little bit fucked, aren’t you? Whad’av you been smoking? Not that bad shit again?’
Lance hugs Paulie round the shoulders and smiles at me.
‘It’s called Spice, but I tell you what, it’s not coriander. It’s pure evil. They put it in the water to make Koi carp swim straight.’
It takes a while, but Lance persuades Paulie to go back to the squat with him.
‘He just needs to sleep it off,’ he says. ‘He’ll be fine. I’ve got college this afternoon, but I’ll be with him most of the day.’
‘What are you studying at college?’ I ask him.
‘Me? Catering.’

Saturday, December 20, 2014

hair

The security guard waves us into a parking space, then waits for us by the supermarket door as we fetch out some bags from the ambulance.
‘It is okay,’ he says, leading us in through the automatic doors, along the fruit and veg aisle to the back of the store. ‘This young person he had a fit of the shakings, like this...’ The guard hauls up suddenly and gives us a surprisingly vivid mime, rolling up his eyes and jerking his arms down by his sides, like someone unexpectedly wired to the mains – much to the astonishment of an elderly woman picking over some tangerines – ‘... then he fell down upon the floor.’ The security guard carries on taking us through, talking happily the whole while, waving to colleagues across the store as if to say It’s okay, Don’t worry. I’ve got this.
‘This young person he get better very quickly. We tell him don’t move, the amb’lance is on its way, but he said no no, I am not hurt at all, and he got himself up. We put him out back where it was a bit more private for him, then we gave you a call on the nine nine nines.’
He jabs out a code on the keypad by the back door, then pushes it open and takes us through.
Past shelves of shrink-wrapped trays of tins and packets and jars, the stockroom smelling of plastic and dust and old cardboard, out to an office, where Cameron is sitting on a chair, the hood of his sweatshirt fully up, his legs crossed, arms folded.
‘I’m fine’ he says. Hello. Sorry. I didn’t ask them to call you.’
‘Okay now?’ says the security guard, smiling broadly. ‘I’ll leave you to do it.’ He pushes his cap a little further back on his head, and saunters out.
‘So. Cameron. Tell us what happened.’
‘It’s all perfectly predictable,’ he says. ‘I’ve come down on a visit. I suffer with epilepsy, but it’s all well controlled with drugs. I tried to get a repeat scrip before I came, ‘cos I found I only had one left, and I need three a day, breakfast, lunch and supper, but the doctor was on holiday or some such bullshit and it was all going to take a bit longer to put through. So mum said I should go anyway because otherwise my supersaver ticket wouldn’t work, and I could go to the walk-in centre when I got here, because they’d be happy to give me a scrip, and everything’d be fine. I just popped in here to get a few things when I got off the train, and the next thing I knew I was on the floor. It wasn’t a bad fit or anything. I know my own body – as far as that goes! So I’m fine, really. It’s just I need to get some more Epilim, otherwise it’ll probably happen again.’
‘Did you bash your head at all when you went down? It’s difficult to see with that hood on.’
‘I did a bit, but honestly, it’s fine.’
‘Let’s have your hood down so we can have a good look. Is that all right?’
‘Sure,’ he says.
He flips the hood back.
It’s difficult not to take a step back. Cameron has a full, honey-brown Afro, except the centre has been cut away, front to back. It looks like someone went for a joyride on a lawnmower, crashed through the middle of a topiary hedge, and carried on.
‘What do you think?’ he says.
‘About what?’
‘About getting a scrip from the walk-in centre?’
‘Yep. Worth a try.’
‘Good. Let’s go.’
He stuffs his hair back into the hood, and we lead him out to the ambulance.

The security guard is back on the door. He smiles as we pass, lifting off his cap to reveal a veined, shiningly bald head. He wipes his free hand over it a couple of times, a stage magician proving there’s nothing there, then replaces the cap.
‘Have a wonderful day!’ he says, twitching the peak.
Then nods, turns and goes back inside.

Tuesday, December 16, 2014

jiminy cricket

It’s a novelty to get a call from a telephone kiosk, certainly one with a door. Most of those have either been torn up, turned into email hubs or works of art. Carl has found what must be the last functioning box in town. He’s still on the phone when we pull up. When I knock on the glass, he frowns and turns his back. I walk round the other side, knock again, and point at the badge on my jacket. Ambulance I mouth. He shakes his head and turns again, only this time the cord on the receiver stops him and he has to reverse, ending up facing back in the original direction.
For a moment I wonder if we’ve got the right person. Maybe the patient left and this guy took his place in the box. That would be embarrassing. I get back to Control. Nope. That’s the right location she says.  I’ll get the call taker to speak to the patient.
I wait outside the box. After a while, Carl turns again, squints at me through the glass, shakes his head irritably, and smacks the receiver back on its hook.
I hold the door open for him. He walks out and then stands on the pavement, his arms folded, shivering in the frosty night air.
A sharply pale, ferociously intense young guy in his thirties, Carl looks like the conductor of an orchestra who stepped off the podium, went on a three-week bender, wandered into the zoo and woke up in the lion enclosure. The jacket of his black suit has gone, his white shirt is grimy and untucked, and his black trousers are only held up at the front – at the back, the seat has been ripped away right and left, hanging open, revealing a pair of hideously soggy pants.
 ‘Shall we get you on the ambulance and have a chat there?’ I ask him. ‘It’s warmer and a bit more private.’
‘I need to go on a detox,’ he says, miserably, lurching up the ambulance steps and onto a seat.
Rae wraps him in a blanket and he sits there, shivering, staring at the floor.
‘I’ve drunk an improbable amount of alcohol,’ he says. ‘I’ve got liver failure. I’ve been having hallucinations. I’m really very, very unwell and I absolutely must go on a detox.’
‘We’ll certainly run you up the hospital – to warm you up, and see about these hallucinations. As far as any kind of referral onto a detox programme, that’s the kind of thing that needs to come from your GP.’
He snorts.
‘Who’s your GP?’ I ask him.
‘My GP is immaterial,’ he says. ‘My GP is a spectacularly ineffective individual who doesn’t care whether I live or die.’
‘I’m sorry to hear you don’t get on with your GP,’ I tell him. ‘Who is it, just for the record?’
‘Just for the record? Dr Death. And just for the record? I will never, ever go back.’

* * *

Carl makes quite an impression as he walks between us into the A&E triage area, holding the blanket open like he froze in the process of wrapping it tighter; the effect is of some ragged little bird with a plume of coal-black feathers on his head, walking with its wings outstretched in some tragic mating ritual. He hops up onto a trolley and perches there, staring down at his over-sized feet. His wings slowly lower around him.
‘Oh dear!’ says a nurse in passing.
Carl tuts, and shakes his head bitterly.

* * *

Once I’ve handed over and checked in Carl’s paperwork, I head outside to the ambulance.
It said on the news that tonight was the best night for seeing meteors from the Geminid shower. The sky is perfectly clear, the stars standing out in great number and depth. I lean back against the bonnet of the ambulance and stare up at the sky for a few minutes. It’s so cold I put on my beanie hat, fold my arms, and wait.
And then – there! Just east of Orion’s Belt. A thin swipe of white against the black. I read somewhere these things are only as big as a grain of sand, travelling so fast they burn up in the atmosphere. You wouldn’t think something so small could make such an impression, but really – it’s so exciting to see it. I can’t help thinking of Jiminy Cricket and the whole wish upon a star thing – although with him it might actually have been a star and not a meteor, I can’t remember. Anyway, when he sees it and makes a wish, the Blue Fairy comes down and turns Pinocchio into a real boy, eventually, after the puppet master and Pleasure Island – Da Rough House! Da Rough House! and a whole lot of other stuff. But there’s so much to be done tonight, so much tidying up and putting right, Rough House or otherwise, it’s just too tall an order, even for a fairy. So I don’t pursue my claim. I settle for having seen a meteor, and climb back into the cab.
Rae brings coffee out.
We sip it, listening to the radio.
It’s all good.

Monday, December 15, 2014

alice

The unmade road up to the standby-point has a frontier roughness. You wouldn’t be surprised to see a clapperboard saloon and an undertaker with coffins propped up on the rail; instead, the little magnolia-painted prefab is set between a social club for serial killers and a mean-looking garage with a dozen cut-and-shuts dump-parked out front.

At five o’clock in the morning, it couldn’t be more wonderful.

It’s been another busy night (another night, in other words.). We’re both too tired to say or do or think much of anything. On the drive out of town to the standby-point it starts to rain, a thin, dispiriting drift against the windscreen, irradiated by the street lamps, soft and unrelenting. Rae is so low down, her knees braced on the dash, it’s like she’s being subsumed by her chair. It’s happening to me, too. I can feel the plastic of the steering wheel creeping up my arms, whilst the rain falls and clears against the windscreen. Speckle. Wipe. Speckle. Wipe. Speckle. Wipe.
I slap my face and turn the radio up.
‘Huh?’ says Rae.
‘I’m falling asleep.’
‘Oh.’
But then suddenly, incredibly, I seem to be outside the standby-point watching Rae punch in the door combination.
 I turn to watch a car pass below us along the main drag, and I feel a great bond of sadness with the driver.
What brought us to this? Where did we go wrong?
But Rae is in and I’m following, and suddenly I’m warm and perfect in a beautiful recliner. The TV is as automatic as the lights in this place. A Countdown repeat. It’s all so safe and regular and predictable I could sob. I settle back, and free-fall Alice-style down a very deep hole, peopled with consonants and smiles and self-eating clocks.

* * *

‘Who are you?’
‘The ambulance. You buzzed us through. Who do you think?’
I don’t actually say the last two things but I think them so hard she must have heard.
‘Come on then,’ she says.
Bea tuts and grumps her way ahead of us down the corridor. A thin, middle-aged woman with a demeanour as bracing as a can-opener; if it wasn’t for the zip on her anorak, she’d fly into pieces.
‘They’re here!’ says Bea, tossing the announcement ahead of her into Maggie’s room like a stun grenade.
We follow her in.
Maggie has woken up with a racing heart. She has AF; sometimes it cuts loose and fills her chest with stampeding horses.
‘Calm down!’ says Bea. ‘You mustn’t get like this.’
Maggie is wet with sweat, trembling, clutching onto my left hand as I take her pulse with my right.
‘What have you done with your medication?’ says Bea, rootling around behind us amongst a pile of old newspapers and letters. ‘And where’s your jacket? Are you taking your jacket? You have to take your jacket. Just calm down and think.’
Rae yawns and heads back out to the truck to fetch a chair.
‘Let’s just take a moment,’ I say. ‘Keys, medication, reading glasses. It’s cold outside but we’ve got plenty of blankets. We’ll wrap you up snugly.’
‘Maggie’s got schizophrenia, arthritis and a new hip. And don’t forget to tell him about the gabapentin, Maggie. Maggie! Tell him about the gabapentin.’
‘Just – one step at a time,’ I say to Bea, palming my hand up and down in the space between us. It’s like playing whack-a-mole with a banshee. Every time I pat her down, she pops up somewhere else.
‘Were you … thinking of coming with her?’ I say, adjusting the oxygen mask around Maggie’s face.
‘Me? No. I’ve got things to do. I can’t just come to the hospital. I’ll ring later and find out how she’s doing. Maggie? I say I’ll ring later and find out how you’re doing. Just calm down, will you? You’re getting all worked up.’
I glance at my watch. I count Maggie’s resps, whilst at the same time visualising the distance to hospital, the handover, the transfer, the ride back to base.
‘Everything’s going to be okay,’ I say, releasing her hand.
Rae comes in with the chair and sets it up with an expert flick of her hands.
‘It’s all going to be fine,’ I say to Maggie, helping her to sit up. ‘We’ll be there before you know it.’

Wednesday, December 10, 2014

rain fall

It couldn’t possibly rain any harder, but then suddenly does, much harder, a startling intensification of the storm that obliterates every detail of the street in one furiously grey and undifferentiated pall of water. Luckily, there’s room in the street to park right outside the house. Jane’s partner Paul is waiting for us at the open door, hanging back like a man sheltering in a cave behind a waterfall.
Paul and Jane were late for work. They were hurrying out of their first floor flat together when Jane stumbled at the awkward tuck at the top of the stairs. She was holding a bag and umbrella in her hands, which meant she didn’t have time to grab on to the banister and stop herself falling. She toppled headlong, scrabbling on her front down the entire staircase until she came to a stop face down in the hallway.
Paul turned her on her back to make sure she was still breathing.  
She lay there stunned, staring up at the ceiling.
Paul phoned for an ambulance.
‘My wife’s just fallen down the stairs and she’s thirty-eight weeks pregnant’ he said.

*

Paulo, a Critical Care Paramedic, is also sent to the scene. I tell him that despite it being a long fall, Jane seems to have come off pretty well. There are no distracting injuries, she’s not complaining of any pain, nothing in the neck or back, doesn’t have any neurological deficit, she wasn’t knocked unconscious, has good recall, GCS 15 throughout, hasn’t felt sick or been sick – in fact, doesn’t have any of the signs or symptoms that might worry you. There’s no getting away from the height of the stairs, though, and the fact that she’s thirty-eight weeks’ pregnant. No problems with the pregnancy to date. She’s forty. This is IVF.
And no, she hasn’t felt the baby kick since the fall.
Paulo works quickly, reviewing everything before we think about moving the patient. He clears her neck and back, and together we sit her up. I help Rae take out all the immobilisation equipment we’d brought in, and prep the truck ready to go. A minute or so later Paulo walks out with Jane and Paul. We settle them in the back, and then set off for hospital.

Paul is sitting next to Jane, holding her right hand tightly; her left hand is across her lap, following the curve of her bump. She strokes her hand backwards and forwards beneath the bump as she talks.
‘I can’t believe I did it,’ she says. ‘I’m so sorry. It’s all so stupid.’
‘Don’t worry,’ says Paul. ‘It could’ve happened to anyone.’
‘But me. Why’d it happen to me?’
‘Those stairs are lethal.’
‘We should’ve moved when we had the chance.’
‘Yeah – but that far out of town? C’mon.’
The ambulance is buffeted from side to side and the rain rattles against the side.
‘Hark at that,’ says Paul. ‘It’s like the end of the world.’
They’re quiet for a while.
‘Shall I phone your mum?’ he says, eventually, pulling out his phone..
‘No. Let’s find out how things are first,’ she says.
‘Okay.’
‘I don’t want to worry her.’
‘No.’
He holds the phone without doing anything, then puts it away again, still holding on to her hand.
I don’t ask her if she’s felt the baby kick yet. I know if she had, she’d say immediately, and I don’t want to make too much of it. There’s not much to be done either way.
‘Were you off to work?’ I ask instead.
‘Yep. Not much longer to go and then, you know.’ She looks down at the bump.
‘What do you do?’
‘I’m a primary school teacher. The kids are going to want to know what happened.’
‘That sounds like a nice thing to do, primary teacher.’
‘Yeah. I love it. The kids are great. Well – they can be dreadful. But even when they’re dreadful, they’re kinda brilliant. If you know what I mean.’
‘Sounds like you really love your job.’
‘I do. I love kids.’
She strokes her bump gently.
The lights flicker off and then on again.
‘Dodgy electrics’ I say.
‘Oh,’ says Paul.
And we hurry on through the early morning commuter traffic, the storm, the next five minutes, to the hospital.

Tuesday, December 09, 2014

acronyms

Anyone could tell walking into that room that Adnan is mortally sick. His massive figure is sprawled helplessly on the bed, pale and sweating, a CPAP mask over his face. But if you missed the signs, the long list of acronyms on the discharge summary would make it plain in an instant: CKD4, CBBG, IDDM, CCF, AF, OSA and so on – a long, coded parade of woe with an eloquent line-space before the final four letters: DNAR. He was only discharged three weeks ago, but he’ll need to go back. He’s struggling with chest pain and breathing problems, and the family simply don’t have the resources or expertise to cope at home any longer.
Adnan’s son Bashir tells us what we need to know, translating into his father’s ear, and gripping him by the hand. Adnan’s wife, Rema, meanwhile, comes in and out of the room with a succession of things: a clean pair of inco pants, a fresh linen robe, some velvet slippers, solemnly handing each item to us with such a fixed and sad expression it feels like we’re officiating in some religious ceremony – which, by default, I suppose we are.
Together with Bashir we dress Adnan, and prepare him for the ride in our chair out to the ambulance.

*

Once he’s on the trolley we run through another set of obs. We need to do an ECG, so I undo his robe to the navel. Lying on top of the great, bunched scar that runs down the centre of his chest is a plain wooden cross on a chain. I hesitate to move it aside. It strikes me it’ll probably do him as much good as anything else Still, we go through the motions, sticking on dots, putting in a canula, giving morphine, working around each other in the cramped cabin space.
Adnan groans.
Bashir sits forward on his seat, squeezing his father by the hand and talking low and quickly.
Okay. Good to go?’ says Rae finally, surveying the scene and pulling off her gloves.
‘Yep. Thanks Rae. I’ll pass the ASHICE from the back.’
She jumps out and slams the door.
I press the Priority button and wait.
Bashir leans over, repositions the cross on his father’s chest, strokes his face, then sits back down again as the ambulance moves off.