- whatever it takes
- the red house
- who pays the ferryman
- three sketches
- occupational hazard
- the bed people
- glamour shoot
- pellets - a tragedy in one act
- his night from hell
- off by heart
- dog shorts
- the spirit of damnation
- no rush
- film night
- completing the circle
- a wash and brush-up
- the cuddly toy conspiracy
- charles and emma
- definitely dumped
- born before arrival
All the houses in the crescent are set back behind high flint walls and wooden gates that go all the way up to arches of brick. Through the gate, into a courtyard garden, with an antique, two-seater iron bench and table over a neat circle of slabs in the middle; around it, branching off with studied irregularity, containers of shrubs and palms, a Laburnum and a raised bed of flowers. The sunlight filters through its branches as we pass along a narrow pathway, brushing past rosemary and lavender, to a large ammonite by a boot-scraper at the front door.
The door is as perfect as the garden, each pane delicately inscribed with flowers, stars, fleur-de-lys, with a weathered lion’s head knocker in the centre of it all, and a bell-pull to the side.
When Rae raps with the knocker, the sound is indecently loud.
Mr Ravenscroft must have been waiting in the hall because the door opens almost immediately. I imagine thirty years ago he would have filled the doorway, pushing his thick hair back in exactly the same way, but age has taken inches off his considerable height, and his hair is grey.
‘Thank you for coming,’ he says. ‘Look – we didn’t really want to call but frankly we’ve run out of ideas. My wife June had an operation on her back a week ago, and she’s been very fragile. Getting about is a problem for her, using the loo and so on. This morning she fell over and banged her hip. I was out shopping at the time, so she had to get herself up somehow and put herself back to bed. And she hasn’t moved since. Her hip’s giving her an awful lot of pain, the analgesia she was discharged with doesn’t seem to be helping all that much, and what with one thing and another we seem to have come to the end of our rope. Would you mind taking a look? Sorry to bother you and all that.’
He leads us inside, to the bottom of an elegant flight of stairs.
The interior of the house is even more striking than the garden. Every inch of wall space is taken up with beautiful pictures. There are delicate, vividly-coloured woodcuts of birds and trees and landscapes, abstract tapestries, designs for theatre posters, collages, wooden panels painted with cherubs and devils, simple life studies in charcoal and china pencil. It’s a riotous gallery. You could spend a day in the hallway alone
‘My wife,’ says Mr Ravenscroft. ‘That’s another thing she finds frustrating, of course. Not being able to work.’
June is lying on her back in the bedroom upstairs, itself an exuberantly decorated place, with marionettes dangling from the chiffonier, carved wooden hands, dancing skeletons, butterfly mobiles, masks, painted mirrors– in fact, so much, it’s hard to concentrate on what’s being said. Luckily, Rae is the attendant. I can just stand there, ready to act, discreetly looking round.
It’s clear that June needs to go in to hospital for an X-ray. Even though she doesn’t show any obvious signs of a fractured hip, the fact that she can’t weight-bear, can’t lift her leg up off the mattress, can’t even push herself up the bed without an extraordinary amount of pain, inevitably means an X-ray is the next step.
‘Can’t I go private?’ she says. ‘I have insurance.’
‘Well – this counts as trauma, and the private hospital doesn’t have an A and E so probably wouldn’t accept you. I’m afraid it means a trip down the road with us. Maybe after they’ve run some tests and know what the problem is, you’ll have the option of transferring privately.’
‘I really don’t want to go to the _A and E_,’ she says, looking appalled. ‘I’ll be there for hours. Won’t I? Hours and hours? And what about all the bugs you read about?’
‘Don’t worry about that,’ says Rae. ‘They’re getting on top of the bug situation.’
June holds her hand out to her husband.
‘Oh Simon,’ she says. ‘Please don’t let them take me.’
‘We don’t have to take you,’ says Rae. ‘It’s your choice. All we can do is give our opinion – which in this case is for you to come with us to hospital for an X-ray. The alternative is to stay at home and have your doctor out. But I’m almost certain he’ll say the same as us. It’ll just be delaying the inevitable.’
‘I don’t see what else we can do, darling,’ says Simon. ‘We’ve tried everything else.’
‘But the _hospital_ darling. You’ve read those stories, too.’
‘Yes, I know, but look here - you may have broken your hip.’
‘Can’t I just stay in bed and rest? I’ll be fine.’
‘Darling – you haven’t been all that fine so far, have you? Be realistic.’
‘But the _hospital_?’ She turns her head and looks at Rae again. ‘How on earth am I to get there?’
‘We’ll take you.’
‘How will I get down stairs?’
‘We’ll carry you.’
‘Yep. On a special chair.’
‘If you think it’s absolutely necessary, I’ll go. But I’ll need my foam mattress for the ambulance. And my lucky shawl. And a little pillow for the carry chair. I’ve just had an operation, you know.’
‘Yes, Simon told us.’
June looks at me.
‘What does that say on your uniform? There – in blue and white.’
‘NHS’ I tell her.
‘And you work for the NHS?’
‘I do, yes.’
‘I see. Well, look. I _am_ prepared to come with you, on the understanding that I travel on my foam mattress, because otherwise I really won’t be able to stand it. And I’ll need my big sunglasses, because it’s bright outside and my eyes aren’t used to it. And please do let me take my lucky shawl. It’s been most places with me and I really can’t be without it.’
I go over to an antique chair and pick up what I think is the lucky shawl.
‘No, not that one. _That _one.’
I try another.
‘_That _one! Show him, won’t you, Simon?’
Without really looking he pulls one out and hands it to her, then whilst Rae helps her put it on, shows me back downstairs to where the foam mattress lives.
It’s in a room that’s been turned into a studio, with a kettle and a sink, a printing press and a washing line across the ceiling for hanging prints up to dry. He struggles to keep the mattress folded in half without it springing open and sweeping all the pots of brushes and jars of pencils and things off the work surface.
‘There you are. Got it?’ he says. ‘Sure? Good.’
He breathes heavily, pushes his hair back again. ‘I hope we’re not putting you out too much.’
‘No, no. June needs to go in. Whatever it takes.’
Squeezing the mattress to my chest, struggling to see over the top of it, I waddle back outside, knocking paintings askew, back through the garden, ineffectually paddling around with the latch on the garden gate, blundering on across the street to the ambulance. When I let go of the mattress in the cabin, it springs open, filling the space. I stand there for a moment, seeing June lie on it, flying up in the air whenever we go over a bump. We may as well put her on a trampoline. And I can well imagine the looks from the nurses and the other crews at hospital when we come through the doors.
The NHS. Whatever it takes.
Betty is holding the phone a little way away from her ear, frowning.
‘Shall I have a quick word?’ I say to her.
‘Please! She’s asking all these questions and I just want some help.’
The ambulance call taker on the other end is relieved to speak to me.
‘Thank god you’re there,’ she says. ‘Is this a cardiac arrest? I can’t seem to get anywhere with the lady.’
I glance over at Betty’s husband Lou, slumped over in his armchair. Rae has pulled the blanket off him and his breathing is plain to see, even from here.
‘No. We’re good. We don’t need anyone else at the moment.’
‘Excellent. Thanks. And er... Good luck!’
I hang up.
The click galvanises Betty, pitching into a jowly, endlessly complaining monologue that’s more like a function of the weather than a coherent description of her woes.
_I’ve had a stroke... he can’t cope... the lift doesn’t work... look at my legs... his daughters don’t care... my son’s in Denmark... the nurses say they’re coming round but they don’t... he drinks... I haven’t had any breakfast..._’ and on and on, apparently without breath.
I try to get Betty just to hold off for a second whilst we assess Lou. After all, he’s the reason we’ve come this morning. But she’s incapable of being quiet, only pausing to answer the questions Rae asks Lou, mixing in all kinds of irrelevant detail.
Meanwhile, Lou has ended his stagey collapse in the chair and sits with his face in his hands, sobbing.
‘I can’t cope! I just can’t. It’s all too much.’
Rae tries to figure out exactly what’s happened whilst I sit down with a care folder and start getting some details.
‘I’m sorry,’ sobs Lou. ‘The place is a shit hole.’
We reassure him that it’s not. And it isn’t. Even the TV magazines on the coffee table are aligned, corner to corner, the pen that marks out the evening’s viewing neatly capped and set parallel with the edge. On the opposite wall are a spread of family photos, surrounded by a brace of lurid royal plates, Princess Diana at the top. On the floor by the gas fire is a large ceramic biscuit barrel in the shape of a bear.
Betty continues her monologue from her armchair across the room, even though I try to get her to stop. At one point, Rae holds the flat of her hand out in her direction, like she’s been forced to use a magic spell. The magic doesn’t work.
_We can’t go on like this... the doctor’s no good... I haven’t been out in five years... the dog downstairs barking all hours... my daughter would be the first to be round for money if we dropped dead... I can’t sleep... the lift doesn’t work...’_
‘Yes it does. We came up in it.’
In fact, it was the most bizarrely over-engineered lift I’ve ever been in. It had a neon button console like something out of the space programme, and an enthusiastic voice commenting on every last action: ‘lift door opening! lift doors about to close! lift doors closing! proceeding to floor number _four _in five, four, three, two, one... proceeding to floor number _four...’_
Betty narrows her eyes at me.
_It didn’t work for a long time._
Lou has stopped crying. He dabs at his eyes, examines the handkerchief, then turns to look at me.
‘Married?’ he says.
Suddenly he laughs, his face squashing up livid and red, the funniest thing he’s heard in years. When he quietens down, he leans forward in the chair and talks to me again. Even Betty is quiet now.
‘Heard of the Red House?’ he says.
‘The Red House? No.’
‘Used to be a coffee place. ‘Course, I’m going back a few years. A girl I saw used to hang around with the guy who lived in the flat above it. D’you follow? Anyway, he was a bit of a local chancer, if you get my drift. Into this and that. Well – it turns out, so was she! So what did he do? He got himself a shotgun and _boom! _That was that.’
He raises his eyebrows and smiles at me.
‘He got eight years for that.’
‘Eight? That’s not much.’‘I know, I know’ says Lou, resting back in the armchair, looking tearful again. ‘Things were different then.’
Jimmy is lying in bed, rolling a fag.
‘I’m not going in, so don’t ask.’
‘Please don’t smoke whilst we’re in the room, Jimmy. We’ll stink of fags all night.’
He leans over and takes a swig from his vodka and coke instead.
I can’t help laughing.
‘What’s so funny?’
‘It’s not exactly funny, Jimmy. It’s more bizarrely frustrating. You’ve got chest pain. You call the ambulance. We come and have a look at you, we say: yes, you’ve had an MI in the last twenty-four to forty-eight hours and you need to come to hospital, and you say _no. _I must admit I don’t get it. Why did you call if you didn’t want help?’
He shrugs, puts the fag in his mouth, then remembers what he’d said and takes it out again.
‘I don’t know,’ he says. ‘I thought maybe you could do the bloods here and that’d be that.’
Jimmy had an MI last year. He knows exactly what’s involved.
‘That’s not something we can do on the ambulance,’ I tell him.
He smiles and shrugs again. ‘Then I’m sorry for wasting your time.’
He closes his eyes, laces his fingers behind his head, and leans back against the headrest. His expression is one of complete satisfaction, like a giant cat that’s just finished snacking on a delicious bird. He’s infuriating and entertaining in equal measure.
‘Look. Jimmy. Let me be as clear as possible.’
‘Fire away,’ he says. ‘It won’t make a blind bit of difference.’
‘You’ve got a history of MI. You’ve had chest pain and shortness of breath for the last day or so, and the GTN hasn’t helped.’
He nods, but keeps his eyes closed.
‘Now you’ve started getting pins and needles in your left arm and a funny feeling in your neck and chin.’
‘Yeah, it’s weird. That’s what freaked me out a bit. I didn’t get that last time.’
‘Okay. Fine. Our ECG shows you’ve recently had an anteroseptal MI. We haven’t picked up anything more acute than that, but like I’ve said, this ECG isn’t definitive. You need to go to hospital for bloods and further tests. Otherwise…’
‘How will I get back?’
‘How will you get _back?’_
‘Yeah. I know for a _fact _those tightwads won’t get me a taxi.’
‘Jimmy – that’s the least of your worries. You’re heart’s under a lot of strain at the moment. You could have a cardiac arrest and die. I don’t mean to worry you…’
‘Oh! I’m going to die! Thanks for not worrying me.’
‘I’m just trying to be clear, Jimmy. If you don’t come to hospital you might well suffer a cardiac arrest and die. So what do you think about that?’
‘About staying here and dying.’
‘Fine by me.’
‘It’s not though, is it, Jimmy?’
‘Look. Thanks for coming out and everything. I appreciate it. But I just thought you could do the bloods here and I wouldn’t have to go to the hospital. I’m not hanging about for hours with the doctors coming by every so often scratching their nuts going _hmm _and _ok-aay _and _interesting _and all that, just to turf me out in the middle of the night to walk home in my onesie.’
‘The thing is Jimmy…’
‘Go on, then. Tell me the thing.’
‘…the thing is, our jobs are on the line.’
‘You’re having a heart attack…’
‘You just said I wasn’t.’
‘No I didn’t. I said you’d had one recently and you might well be brewing another.’
‘In your opinion.’
‘In my opinion.’
‘So how’s your job on the line?’
‘Because we’re the last clinicians to see you. And when we’re called up in front of the Coroner to explain why we didn’t take you to hospital, he’s not going to be too interested in us saying _Oh, well, Jimmy didn’t really want to come because he was worried about getting home again. _He’ll say M_aybe Jimmy didn’t understand what you were saying, God rest his soul. Maybe you could’ve tried harder to convince him. Maybe you should try some other line of work. _And he’ll throw us out on our ear. For what? For a ten pound taxi fare?’
‘You’re not going to give me ten pound, are you?’
‘No. I’m not.’
Jimmy shrugs.‘I’m staying put, then.’
Ruth doesn’t answer the buzzer, but it’s so early in the morning the tradesman button works and we let ourselves in. Her flat is up on the first floor, a complicated and bizarre route up half-stairways to mezzanines, the numbers running randomly through the block, but we’ve been here so many times we don’t need to think about it overmuch.
Her door isn’t locked. I knock and gently push it open.
She’s standing securely planted in the middle of the room, crutches in either hand and a fag in her mouth. ‘What the fuck do you want?’ she says, then shrugs off the crutches, tosses them into a corner, and throws herself just as carelessly into an armchair.
‘It’s my birthday today,’ she says. ‘Happy fucking birthday.’
For some reason I’m immune to Ruth. Control always send extensive notes about Ruth – block caps in red, warning about her abusive, threatening, sometimes violent behaviour – but for some reason it always passes me by. It’s just one of those things, a bizarre and particular immunity, like a bee keeper who can draw out a comb of honey covered in bees and not get stung. Added to which, I’m so exhausted I could probably wear the bee swarm as a beard and still go home whistling.
‘How are you, Ruth?’
‘How am I? Brilliant, mate. Just brilliant. How the fuck do you _think_ I am? Suicidal. I want to die. It’s my birthday today and that’s what I want. _Death_. Thank you. Happy fucking birthday.’
‘I’m sorry to hear that.’
Ruth is a middle-aged woman who could pass for elderly. Her hair is ash-grey, the skin of her face pouchy and slack, cruelly undermined by years of smoke and the loss of all her teeth. It feels like the vital sap of her has turned tarry by long years of struggle with mental health problems, alcohol abuse, social and domestic troubles. She’s alone in this flat, but it feels crowded.
‘I’ll see you in heaven, Mum,’ she says to the photo of an elderly couple pressing their heads together and smiling in a silver frame with a diamante butterfly in the corner. ‘You too, pops.’ Then she looks up at me. ‘You think I’m crazy, talking to my mum and dad like that, don’t you? You’re thinking _Crazy Bitch._’
‘No. Not at all. I think it’s nice you still talk to them like that.’
‘Yeah? Nice? You think that’s nice?’
‘Yes. I do think that’s nice.’
I could lie down and nap on that word _nice. _
‘Keeping you up?’ she says.
‘I’m really tired,’ I tell her. ‘But the shift’s almost done. Anyway – how are things? We’ve been sent by the crisis team. They’re worried about you?’
‘Are they? Are they really?’
‘Yep. They want you to come in for a chat.’
‘I’m finishing my fag first.’
She takes a long, contemplative drag, then watches the smoke as it streams out into the room.
‘It’s my birthday today,’ she says.
‘Happy Birthday, Ruth.’
‘I’ll just finish this and I’ll be out.’
On the vehicle Ruth rubs her arm. She’s scored it lightly with a piece of broken glass, but not so it’s bled over-much.
‘That’ll be sore,’ she says. ‘I shouldn’t have done that. You haven’t asked me where the glass is. Aren’t you worried?’
‘Have you still got it on you?’
The ambulance jolts from side to side.
‘Fucking hell,’ says Ruth. ‘If you weren’t sick before you got on you would be now.’
‘Ruth – have you got a CPN?’
‘Yes I have, fucking bitch. Gone on holiday.’
‘Oh? Well everyone needs a holiday sometimes, don’t you think? I know I do.’
‘What about me? When do I get a holiday?’
‘Can’t you sort one out?’
‘My fucking sister’s going on holiday next month. She hasn’t fucking invited me, the bitch.’
‘Maybe this is something you could talk to your CPN about when she gets back?’
‘She’s a social worker. Not a fucking travel agent.’
The ambulance pitches from side to side.
‘Jesus Christ. I can’t take much more of this.’
She grimaces, rubs her arm, looks at me.
‘And it’s my fucking birthday today, you know?’ she says.
‘Happy Birthday, Ruth.’‘Whatever.’
We ring Keith’s bell, but it’s Kathy his neighbour who comes to the door.
‘I saw the truck’ she says. ‘He’s asleep. I’ve got the paperwork.’
Kathy stands aside and lets us in to the apartment lobby, a cool, high-ceilinged, ornately-plastered affair, one of those Georgian town houses converted into flats sometime in the fifties and hanging on ever since.
‘Is the social worker here?’
‘The social worker? No.’
‘He needs to be. It’s a Section Two. I’m guessing Keith doesn’t want to go in.’
‘No. He’ll fight.’
‘So we need the social worker. Maybe the police.’
Kathy hesitates. She has the lank, slightly doughy look of someone who’s been coping for a while in the face of things. She’s _involved, _has _routines._
‘I’ll find out where the social worker is,’ I tell her, reaching for my radio.
The social worker is a tall, ascetic man in a woollen waistcoat and shabby/smart two-piece suit. He reminds me of James Cromwell in _L A Confidential_, a man made thin by years of unpleasant but necessary administrative control. He works his chewing gum quickly and methodically, with his front teeth, mostly.
‘He’s very weak, poor fella,’ he says. ‘Taken to his bed these past weeks, refusing all help. His problems are all down to the drink. He’s a chronic alcoholic with everything you might expect, and now it’s tipped over into depression and self-neglect. He’s got to go in, guys. He’ll not see the weekend at this rate.’
‘Will we need the police?’
The social worker stops chewing for a second.
‘The police? No, I don’t think so. See for yourself. He doesn’t want to go, but he’s so weak you could tuck him under your arm.’
Kathy is waiting for us in the hallway again. She has a Crawford’s biscuit box full of meds, the complex regime shakily written out on a stack of recycled envelopes.
‘I’ll show you in.’
Keith’s flat is surprisingly well looked-after, but I’m guessing Kathy has taken care of that.
Keith is lying on his back in bed with the covers pulled up to his chin.
‘Hello Keith,’ says the social worker. ‘We’ve come to take you to hospital.’
‘I want a drink first.’
Kathy has already prepared it. Vodka in a bottle of Lucozade, with a straw. She bends the straw and holds the bottle so he doesn’t have to turn his head, or lift it.
‘And a cigarette,’ he says.
She taps one out of the pack and lights it for him from the cooker.
We wait just outside the room.
‘So I’m guessing Kathy fetches in the drink?’
The social worker puts his hands in his pockets and leans against the wall.
‘I think the off-licence delivers. But to be honest, if he didn’t drink he’d fit, so…’
He sighs, and closes his eyes for a moment.
‘Makes you re-evaluate your drinking habits, doesn’t it?’
I laugh, but actually it doesn’t. It feels completely different, but I’m too tired to put that into words.
Kathy comes back out.
‘He’s ready now,’ she says.
He screams as we put him in our chair, making his body go rigid. We can’t get the trolley into the flat, so we have to manage as best we can. I make sure the blanket loops over his head so his greasy hair doesn’t rest against my shirt, and we bundle him tightly so he can’t grab out. His body is emaciated, caked in dirt. But amongst all the dreadful details of his self-neglect, his legs are the things that hold my attention the most. Maybe it’s because he’s holding them straight out, and the blanket has fallen away there. I think it’s their extraordinary shape and colour – bone thin, bone white, but pinched-off at the ankles, the feet like a pair of red rubber gloves filled with water, toes all-angles, rotten to the nail.
He screams as we wheel him to the ambulance, but it’s dark outside, there’s a freshening wind; I don’t think anyone notices much.
A heavily-built man in his sixties, sun burnt arms folded across a bulging vest. There’s a punchy, ill-focused hostility to him that the bottle of whisky he drank has fed but not created. The open fracture to his ankle has been dressed and stabilised. His family smoke and look in at the ambulance steps.
_Let me off. I’m not going nowhere. I’m getting off and going home. Broken, you say? What - are you, a doctor? I don’t give a fuck if it’s broken, pal. S’all right. I’ll do somepin’ about it in the morning. I’ve got diabetes you know. Did you know that? Diabetes. So fuck you, fuck your broken leg. I’m off._
A tall, middle-aged man, lying on his side in a pool of blood, kicking his feet, half-rising then collapsing back and banging his head back against the skirting board. His face is a raging mask of blood, each tooth individually described in red. His eyes, his bare torso, his hair – every aspect of him covered. We were told he cut his ear off with a razor, but it’s all such a mess and he’s so violent and spraying and spitting it’s impossible to get close enough to tell.
_What about my son? Hmm? Yeah? What are you doing about my son? Yeah? You? What are you doing? You fucking get away from me. All right? I’m okay. I’m okay. All right? I’m okay. Just – fucking – leave me alone. Aaaargh!_
A six year old girl, pale, shadowed eyes, lying on the ambulance trolley on her side. She is hugging a toy rabbit and staring up at her father who is leaning forwards so he can stroke her forehead.
_The water’s so cold it takes your breath away, but then I suppose it is the South Atlantic, coming straight at you from the Antarctic. I was a bit worried about sharks, but the guy said they didn’t come any further than Robben Island. And I said where’s that? And he pointed to this place just a little way off shore. I mean, it was really close. Like the Isle of Wight. And I said ‘What – you mean, that’s Robben Island? Just there?’ And he said ‘Yeah, but that’s where the water starts warming up so they prefer it.’ Ssh. You’ll be fine, darling. You’ll be fine._
A pale, skeletally thin woman shows us round the back of the flats.
‘He’s the one in the corner,’ she says, a dull glint from somewhere down in the shadows of her sockets.
She drifts away, smoking.
It’s such a bright day everything’s been cast into black and hard white. The courtyard is baked, absolutely still, no sign of the _violent disturbance – stand off for police_. Nothing, except for a dog barking in the distance.
As we approach the door that’s open in the corner, a police officer strolls out.
‘Oh!’ he says, so relaxed he may as well be in shorts and flip flops. ‘He’s in there. Mad as a box of frogs.’
Graham is sitting on the edge of his armchair watching _The Hairy Bikers_make a pie on TV. He’s joining in with their conversation, in a grunting, hyper-manic way, bellowing delightedly, swearing, shouting out, or bouncing up and down. There’s something crude and cartoon-like about Graham, his crayon teeth, his lumpish movements, but most of all his laugh – a _mwa-ha-haaa _that only needs a cloak, mask and Parisian sewer to complete the effect.
‘Mwa-ha-haaaa! Through the telly to _tell you_, hah? To _tell you...’ _
The police sergeant nods at us and takes a discreet step in our direction.
‘This is Graham,’ he says. ‘Graham has been acting pretty strangely this afternoon. The neighbours were worried because – well, you can see for yourself. He’s calmed down a lot, I have to say. A bit grabby, but nothing too serious. Over to you for the assessment!’
He smiles, and takes a step back again.
‘The paramedics are going to ask you a few questions,’ he says to Graham, who suddenly shuts up and frowns. ‘Just answer their questions and then we can figure out what we need to do next.’ Graham suddenly jumps out of his chair and scuttles up to the officer, who takes his hands out of his stab vest just in case. Graham pauses a moment, then reaches out and tries to grab the officer’s radio, babbling something about _signals _and _light_.
‘No, no,’ says the officer, batting Graham’s hand aside. ‘What have I told you about touching my radio?’
Graham holds his hand in mid-air, then gives another Phantom laugh.
‘Mwa-ha-haaa! _Graham!_’ Then sits back down again.
Our line of questioning gets us nowhere. We need to check him over, and figure it’ll be best to do it on the ambulance. Amazingly, Graham gets his keys and coat and follows us out quite meekly.
The sunlight in the courtyard hurts my eyes.
Even though all his physical obs are normal, his behaviour is still a cause for concern. There’s a possibility it has an organic basis, so we persuade him to come to hospital with us. The police officers seem relieved.
‘Good luck!’ They slam the door, and we move off.
A&E is as busy as ever. I dread to think how disruptive Graham might be, but for the moment he’s calm and pliable, so we take a risk and lead him in with us, sitting him on a chair as far away from the other patients waiting to be assessed in the triage area.
After ten minutes or so, Graham suddenly announces that he’s having a fit. He starts to slide off the chair to the floor.
‘Come on, Graham. You’re not having a fit. Stay in the chair, mate.’
‘I’m having a fit!’ he shouts, taking off his glasses and flinging them across the lobby.
‘Graham! Stay in the chair!’
‘I’m having a fit! I’m – having – a – _fit_...’
He lands on his bottom on the floor, pulls off his watch, throws that in the other direction, then starts a peculiar round-and-round scuttling motion, paddling with his hands and feet, shouting out for help. I stand in front of him to stop him doing anything else, and to screen him from the nearer patients. But that puts me within reach. He lunges forward and wraps his arms around my left leg. It’s like being attacked by a giant koala bear. I try to unlock his fingers. The A&E lead consultant has hurried over and is with me now. He grabs one of Graham’s arms, and using some kind of Aikido lock, turns Graham away from me. Once he has his attention, the Consultant addresses Graham directly.
‘No! You do _not _do this! You are _not _having a fit, and you are _not _to behave like this in my department! Understand? Do you?’
Security have arrived, two guys so massive they would punch out the supporting columns if they missed your head. Graham gives one, last, very much less convincing _mwa-ha-haa_, and gets back into his chair.
A nurse gives him a sedative.
‘I know Graham,’ she says, as he swallows the pill. ‘He was in a little while ago. How’s your leg?’
‘Fine, fine. Maybe I should take the rest of the shift off with stress.’
‘Yeah?’ She laughs. ‘Maybe you should. Last time Graham was in he said _he _used to be a paramedic.’
The bed people are in the bedroom, setting up the bed.
‘How long will it take for the mattress to inflate?’ I ask them.
‘Half an hour or so. You get a green light at the bottom when it’s ready. Not something you can rush, unfortunately.’
I knew this was going to be trouble. I knew it when the job came through: _Pressure relief mattress due for delivery. Help required with transfer. Wife on scene for access. _An address way over the other side of town. Barely half an hour from our finishing time. And a journey back against the rush hour traffic. Querying the need for us to attend was fruitless. It was unusual, but for whatever reason Control had committed a resource, and we had to go. Half-way there we thought we’d escaped, diverted to a _male, unco_, _in the street_. But the male turned out not to be quite as unco as first thought, and ran off before we got there.
They sent the bed job straight back through again.
When Mrs Chastain answers the door her manner is so chilly I wonder if she thinks we’re bed people, too. Which in a way, I suppose we are.
‘Can I ask your name?’ I say, stepping into the lobby.
‘Mrs Chastain,’ she clips. ‘Well you’re here now, so that’s something. When I spoke to your people they said it might be _four hours_, and even then they couldn’t guarantee it.’
‘I know. You see, we’re an emergency ambulance, so other calls take priority. In fact, we were diverted to an unconscious male on the way here…’
She sighs. ‘Anyway, you’re here. The bed people are just setting up the new bed now. Apparently it takes a little while for the mattress to inflate.’
‘You’ve let a fly in.’
‘A bluebottle. I can’t stand them. Open the door and pray it makes its own way out.’
‘I’ve got a self-closing fly-screen on the back door,’ she says. ‘This one shouldn’t need it because it’s got the lobby. But you left the outside door open when you came through.’
She goes back into the bedroom to superintend the bed people. We exchange a look, then follow.
The bed people are hot and exhausted. But despite all this, they still manage to be scrupulously polite. Mrs Chastain responds with glacial suspicion.
‘Make sure it’s all properly connected,’ she says. ‘All the bolts tightened up.’
‘No worries. Oh – by the way. Don’t use a fitted sheet on the mattress,’ says the Leader of the Bed People. ‘It interferes with the action.’
‘I don’t use fitted sheets. I used to be a nurse. I know all this.’
‘Lovely. There. Now. All set up. Just got to wait for the mattress to fill.’
He gives us a wild look, the kind of thing you might see in a wrecked sailor struggling ashore.
‘We’ll just be outside getting some air,’ he says.
Mr Chastain is asleep in the old bed. None of the activity has roused him at all, a combination of his medication and general infirmity. He’s propped up on a dozen cushions, his swollen arms out on the coverlet. Mrs Chastain sighs, and ushers us back out into the lobby.
‘I can make you tea if you’d like?’ she says.
That would be great.
Whilst she goes into the kitchen, Rae radios Control to ask if there’s a more local crew who could take this job on. They tell her that things are so busy, if we clear up now we’d only cop something else and be late off. Our fate is sealed.
We wait for our tea, and for the mattress to fill.
There’s a large porcelain figurine on an ornate stand in the lobby – a Twenties flapper struggling to hold her hat on with one hand and the lead of an Afghan hound in the other. I copy the pose just as Mrs Chastain comes back in with the tea. I pretend to be stretching my back. She frowns, then hands me a delicate china cup. The handle is so small I have to pinch it between my index finger and thumb.
‘There are some coffee grounds in there, too. They fell in accidentally. Anyway. This is most important. Whatever you do, do _not_disturb Mr Chastain,’ she says. ‘He’s in a _very_delicate state and I don’t want him upset in any way.’
‘No harsh moves. Nothing sudden or rough.’
‘Okay. We’ll do our best. Thanks for the tea.’
There’s a knock on the door.
Mrs Chastain starts, then smoothes her skirt and goes to answer it.
It’s Bunny and Deidre, come to help.
‘We saw the Bed People outside. Anything needs doing?’
‘No, dear, thank you. Although – I might need a hand moving some furniture from the front room.’
They smile at us; we raise our cups to them.
‘I’ve just had a thought,’ says Mrs Chastain. ‘Have you still got the sliding sheet William had?’
‘Yes, I think I do.’
‘You couldn’t fetch it across, could you? Only we’ll be moving him soon.’
‘We’ve got all that stuff,’ I say to her, but Mrs Chastain doesn’t seem to hear, turning on the spot and swishing back into the bedroom again. But just as she reaches the bedroom door, she suddenly turns and strides back into the lobby again, sticking both fingers in her mouth and giving a piercing whistle, right by Rae’s ear, who almost throws her tea in the air.
‘Found one!’ says Mrs Chastain. ‘Don’t worry!’
Into the hallway of the flat, two doors closed left and ahead, one door open to the right.
We go through.
Mr Crosier is naked, lying on his side on a bed of soiled, green satin sheets. On the wall behind him is a poster for a burlesque show. The dancer is striking a sensuous pose in her corset and suspenders, one gloved hand on her hip, one held flat beneath her chin as she blows a kiss. It passes over Mr Crosier’s head, missing his clumps of ash gray hair, bumping uncaught against the large plasma screen on the opposite side of the room. Mr Crosier has other, more desperate concerns, though, utterly focused as he is on the meagre trail of oxygen trickling up through his nasal specs. The great slope of his chest sinks and pulls with the effort of each breath.
It’s an appalling scene. The place looks more like a culture grown from a dirty carpet rather than a place anyone could live. Everything glistens beneath a white crust, as if Mr Crosier was a giant species of slug that spent the night crawling over it all. Especially the DVD player, which rests on a little pine table just in front of him, along with a bank of remote controls and a carelink button. In fact, a pattern becomes apparent. All Mr Crosier’s necessaries are within easy reach: a catering pack of Maltesers, a crate of weissbier, a packet of baby wipes, an encrusted plastic pitcher to piss in.
A large floor fan spins just in front of the table. It stirs up the noisome atmosphere, a-wisher-wisher-wisher.
We put him on our oxygen, then Rae takes some obs whilst I investigate our options. Would a trolley fit? Perhaps if this door were open...?
A dark room, a mattress with a throw, a lighting rig, a tripod and camera.
An EMT single-responder
Mrs Taylor, seventy-four
Mr Taylor, eighty-two
Benjamin, their middle-aged son
Lilly, sixty-seven, neighbour to the Taylors
_Scene: A suburban street._
_Half-past seven in the morning. _
_An ambulance car turns in to the top of the street with its blue lights on. It slows as it makes its way down, coming to a stop outside the house where Benjamin Taylor is standing, waving. The EMT gets out, opens the boot and begins pulling out the bags he needs. Benjamin goes over, talking the whole time, his fleshy hands resting one on top of the other in front of him, like the paws of a giant, solicitous rabbit. _
BENJAMIN: Thanks for coming so quickly. Thank you. I know how busy you are. I’ve been reading about all this trouble at the A and E. So thank you for coming to see Mum. I really appreciate it. She’s not been herself since she had her shoulder done. The operation was a success, don’t get me wrong. We’ve had all the physio, all the home care you could wish for and we’re grateful for everything. But the thing is, as I say, Mum’s not been quite right since they sent her home five days ago. She...
EMT: Shall we go in and see her?
BENJAMIN: Yes, of course. Sorry. Thank you. Thanks. This way.
EMT: The call was for chest pain, palpitations...
BENJAMIN: Just through here. Thank you.
_A sitting room as bright and tidy as the front garden. Magazine supplements – the Queen’s Diamond Jubilee. Watercolours of country scenes. A dish of toffees. Mrs Taylor is sitting surrounded by cushions on a scallop-backed armchair, her head resting back, her mouth a deeply carved, downward curving arc. Mr Taylor is asleep in the armchair next to her. Breakfast news is running quietly in the background. _
_The EMT puts his bags on the floor at her feet, draws up a stool and touches her lightly on the hand._
EMT: Hello, Mrs Taylor? It’s the ambulance. What’s happened today?
MRS T: _(Speaking in a measured way, as if she were describing a particularly disappointing caravan holiday where it rained the whole time). _Oh. You’re here. Thank you for coming. I didn’t want to call you but I had such a restless night and I wasn’t sure what to do.
EMT: Do you have any pain at the moment?
MRS T: Only in my shoulder, but it’s not too bad.
EMT: Chest pain?
MRS T: No, no chest pain. Thank goodness.
EMT: Shortness of breath? Dizziness, nausea, that kind of thing?
MRS T: No, nothing like that. I’m pretty good, really.
EMT: Okay. So what seems to be the problem?
MRS T: I don’t like to make a fuss. I know how busy you are what with one thing and another. I like to cope with these things by myself.
BENJAMIN: Mum doesn’t like to cause a fuss. You soldier on, don’t you, mum? Would you like me to move any furniture whilst you carry out your examinations? Would you like to see Mum’s medications?
MRS T: I don’t take much. I’m not one for popping pills. I like to cope with things naturally, if I can. I don’t hold with all this medical _razzmatazz_.
EMT: So let’s start from the beginning. How were you when you went to bed last night?
MRS T: Not good.
EMT: In what way, not good?
MRS T: Restless, you know. I couldn’t get comfortable. Half my problem is I’m bunged up. I’m taking these codeine pills for the pain, and they’ve pretty much stopped me going. I’m taking Lactulose, I’m drinking glasses of water, eating fruit, you know, but it’s still all – _pellety. _Do you know what I mean? Little round hard things. I manage to go a bit, but there’s always some left in there. And I don’t want to strain too hard in case I give myself a stroke. I mean, I eat a healthy diet, don’t I, Benjamin? They’ve always said I had a touch of anaemia, so I try to eat as well as I can. Liver, watercress, broccoli. They’re all good, aren’t they? Broccoli. Oh, I’ve said broccoli, haven’t I? Oranges I like. Figs. Now _figs _are _definitely_ good for you.
BENJAMIN: Mum loves her figs. And prunes. You like prunes, too, don’t you Mum?
MRS T: They’re all right.
EMT: So you had a restless night. You’re a bit constipated. Anything else out of the ordinary?
MRS T: The physiotherapist has been coming round a lot. A little Chinese girl, you know. Very quiet. Big hands. She said she’s happy with the way the operation’s gone. I’ve almost got full movement back, it’s just that last little bit. It’s quite sore when she shoves it about, but she says if we don’t it might not knit properly or sit properly or something. Anyway, I might have to have it done again and I don’t think I could. I’m regretting it as it is. I sit here thinking _bloody shoulder_. I wish I’d never agreed to have it done.
BENJAMIN: Oh Mum! She’s never normally like this. She never normally complains. Do you Mum?
MRS T: I don’t like to make a fuss. I know you’re busy.
_(The EMT carries out a thorough set of obs, including a twelve lead ECG. He explains that the dots need to go across Mrs T’s chest, and would Benjamin like to step out of the room? He stays put, though, hugging his knee and rocking backwards and forwards a little. Mrs T doesn’t seem to care, so the EMT carries on. Mr T remains asleep in the armchair next to her.)_
BENJAMIN: It’s incredible, all the equipment you have these days. Isn’t it, Mum? Just amazing. We’re so lucky. Thank you. Thanks for all you’ve done.
MRS T: Funnily enough we were just watching one of those casualty programmes on the telly last night. Now this.
BENJAMIN: I know you’re very busy. You must get a lot of aggravation, what with the drunks and everything. Do you get attacked much? I don’t know why people have to be so unpleasant. You’re only doing your job.
MRS T: People are animals. Especially when they’ve had a drink. I stick to orange juice. That’s good for you, isn’t it? Vitamins and so on. Almost as good as spinach.
EMT: _(covering her chest back up with her dressing gown). _No talking for the ECG, now.
MRS T: Right you are.
_(Suddenly there’s a knock on the door. Benjamin gets up to answer it. In comes Lilly the next door neighbour, a bird-like woman in her sixties with spiky hair, tiny eyes and a short beak.)_
LILLY: Coo-ee! Only me! I saw the ambulance. I thought gosh! What’s wrong? Can I help?
_(Mrs T adopts the same tragic face she was wearing when the EMT first came in. She waves feebly at Lilly)_
MRS T: I can’t talk now, Lilly. I’m being examined. I’ll see you later.
_(Lilly makes no sign that she understands or is prepared to leave.)_
LILLY: I’ve only just got out of hospital. A big heart attack. Out of the blue. Two months ago. Stent fitted. A serious operation, but it did the trick. I’m completely back to normal.
BENJAMIN: Mum can’t really talk now, Lilly. She’s had a difficult night and the paramedic’s just assessing her to see whether she needs hospital or not. Shall we see you later?
LILLY: If there’s anything I can do. You know! Just next door...
MRS T: _(feebly) _Thank you, Lilly. Maybe later.
BENJAMIN: _(standing and ushering her to the door) _Thanks Lilly. See you in a little while. _(Shutting the door firmly behind her). _A wonderful woman, Lilly. We’ve got the best neighbours in the world. We’re very thankful.
MRS T: What do you think’s wrong with me?
EMT: Well I’m not sure, Mrs Taylor. All your observations are normal. It had come through as a chest pain for some reason...
MRS T: _(putting her hand on her chest) _I just didn’t feel _right _in myself_._ Do they still do suppositories, do you know? I just think if I could have a suppository, I could have a really good clear out. Because at the moment it’s just pellets, and it always feels as if there’s one or two left. And as I say, if I strain too hard I might have a stroke.
EMT: Codeine can bung you up a bit. I think it’s really a balancing act between pain relief and managing the side-effects.
MRS T: Maybe I shouldn’t take the codeine, then. Is that what you think?
EMT: I think it’s something you need to talk to your GP about. Maybe you should go and see your GP for a general review of your meds and how things are going.
MRS T: I don’t like to bother him.
EMT: But you were worried enough to call an ambulance...
MRS T: Do you think he’ll give me a suppository?
EMT: See what he says.
BENJAMIN: Thanks for all you’ve done. Marvellous!
EMT: I’ve just got to complete my paperwork.
BENJAMIN: It’s all paperwork nowadays. I suppose you must get used to it.
EMT: Who shall I put down as next of kin?
_(Mr Taylor suddenly opens his eyes and sits forward, raising his hand in the air. Mrs Taylor glances at him, then sighs.)_
MRS T: No. Best put Benjamin down.
_(Benjamin leans over the EMT and spells out his name, slowly, like he was writing it out with crayon)._
EMT: I don’t think you need to go to the hospital, Mrs Taylor.
MRS T: The hospital? No thanks. I’d rather try to cope here at home where I’m comfortable. If there’s no need for me to go, I won’t. I like to do as much for myself as possible.
BENJAMIN: Thank you so much for coming. Can I get you a cup of tea or something?
EMT: No – Actually I’ve pretty much finished now. Thanks all the same.
BENJAMIN: It’s no trouble at all. You’re very welcome. We’re just grateful you’ve come out to us this morning. Thanks for all you’ve done.
_(The EMT struggles out of the door with all his bags. _
_Lilly the neighbour is standing waiting for him by the car.)_
LILLY: I had a proper ambulance when I had my heart attack. ECG. X-Ray. Blood tests. You name it. I had a stent fitted. You know what that is, don’t you? And it worked! I’m one hundred per cent back to normal. So – Mrs Taylor? Is she, erm...?
EMT: She’s fine. She’s going to see her doctor.
LILLY: Her _doctor? _Nothing serious, then?
EMT: _(Closing the boot and moving past Lilly to the driver’s door. He hesitates before getting in the car, then smiles at her.) _You could go back inside and have a chat about it.
_(She raises her eyebrows, turns round and hurries back through the Taylor’s gate. The EMT hears her knocking on the door as he drives quickly away. Just round the corner, he parks up, turns the engine off, rests his elbows on the rim of the steering wheel, plants the heels of both hands firmly in each eye socket, and stays like that, breathing quietly, rapping his fingers on his forehead, little finger through to index, one-two-three-four, followed by a quick rattle-tat, and then on again, just like that. Over and over. About a minute.)_
Malcolm is sitting on the crumpled bonnet of his car with his arms folded, like a man taking his ease in the moonlight.
‘Halloo!’ he says as we walk over. His teeth are wine-gray.
‘Hello. What’s happened?’
‘Life. Life has happened. I was just turning the car round when this other chap appeared out of nowhere and I went into the side of him. All terribly low speed, but there we are.’
In his long goatee beard, straggly hair, shapeless earth-pattern cardigan, shorts and flip-flops, he is the spit for the Big Lebowski. I ought to be handing him a White Russian, but feel his neck instead.
‘Nope. No pain. I’m completely fine, honestly. This is all very embarrassing. Is the other chap okay?’
Malcolm’s face is pretty banged up for someone who had a low speed crash, wearing a seat belt. It was a frontal impact but the air-bag didn’t go off, which means it was all probably slower than fifteen miles an hour.
‘You _were _wearing a seatbelt, Malcolm?’
‘And you weren’t knocked out?’
‘So how did you get these injuries? You’ve got a cut on the side of your head. Your nose is swollen and cranked over. You’ve got a black eye. Is anything coming back to you now?’
The police arrive. An officer knocks and comes on board the ambulance. When he takes his cap off he looks absolutely hairless in the bright cabin lights, like a plastic baby with a glowing core of enthusiasm.
I make the introductions, describe the situation.
‘Hmm,’ the officer says, peering at Malcolm.
Malcolm smiles back.
‘I’m required to ask you to complete a breath test. Have you consumed any alcohol tonight, sir?’
‘Oh – but that was hours ago!’
‘No worries. Just a moment,’ he says, unwrapping a mouthpiece and snapping it in to the top of the alcometer. Once it’s in, the officer gives his spiel, then holds it out for Malcolm to blow into.
‘Keep going… keep going… keep going … and stop. Good. Thank you.’
The machine beeps. The officer shows the read-out to Malcolm.
‘As you can see you’ve _failed _the breath test, which means I’m arresting you for drink driving.’ More spiel, whilst Malcolm says _Well that’s just great _and _Unbelievable _and _I crash my car and now I’m being arrested. Arrested? I’m supposed to be starting a new job on Monday. I’m best man at a wedding tomorrow! Unbe-fucking-lievable. _And so on.
It all slides over the officer’s shining head.
He makes himself comfortable in the seat opposite.
‘Tell me how you got those injuries,’ he says, when Malcolm calms down.
‘It’s nothing. Really. Let’s just – get on and get it over with.’
The officer looks at me and shrugs. Then back at Malcolm.
‘It wasn’t from the accident, was it?’ he says. ‘Have you been in a fight tonight, Malcolm?’
Malcolm sighs, shakes his head a little, as if the words are building up inside him but he’s still reluctant to let them out. He folds his arms. Taps his foot. Sighs again. Then looks straight at the officer.
‘Yes, _yes_. Okay? I _was_ assaulted tonight. But I don’t want to press charges. It’s not going to come to anything. But yes – I had a stupid disagreement with a very good friend of mine. It got out of hand, we exchanged – _blows _– apparently. He went off, and now here I am, being arrested. Can I just say, officer, this is officially, unequivocally, without any doubt _whatsoever_, my night from hell. I’ve just got myself a job, starting Monday, but how I’m to supposed to get there once I’ve lost my licence I have no idea. I’ve had a fight with an old friend of mine. I’ve got a broken nose and a black eye and I’m the best man at a wedding tomorrow – no – _today,_actually. _Tonight_. So yes, I can quite honestly say that today is the worst day of my entire life. This is it. Here, now. With you two fine people. I’m sorry, but there you are. It’s fabulous. It’s absolutely marvellous. It’s happened, and there’s nothing to be done about it. So now, why don’t we just crack on? Because you know what? I’m genuinely interested to see what’ll happen next.’
The officer soaks it all up with radiant good humour.
Flips open his notebook.
‘I should be a detective,’ he says. ‘Straight in there.’
Reece is lying on his side in the lobby of the homeless shelter.
‘I’m going to fit,’ he says. ‘I’ve been throwing up blood, man.’
There are two support workers standing over him.
‘Reece came down to us today from up-country. Do you want us to make contact with the rough sleepers initiative team there to get more information?’
I tell them not to worry for the moment, and squat down next to Reece.
He’s a slight, wizened figure of anywhere between thirty and fifty, so intensely worn through he must have spent the majority of his life on the road. ‘Don’t take me shoes off, mate, you’ll be sick.’
‘Well we’ll leave them on for the minute, then, Reece. Tell us why you’re lying on the floor?’
‘Mate – my vision’s all to cock. If I look at you, yeah, like _straight on_, yeah? it’s not too bad, but when I go like _that_…’ he slants his eyes up to the left, ‘…you go out of focus.’
‘Okay. So why have we been called today, Reece? What’s the problem, exactly?’
‘What’s the problem? How much time’ve you _got_? My knees are fucked, I’ve got cirrhosis of the liver, hepatitis C, my lungs are shot, yeah? I’ve got bi-polar, acute anxiety disorder, short term memory loss. I’ve got alcohol dependency, substance abuse and alcohol related seizures. And I got attacked yesterday.’
‘What happened when you were attacked yesterday?’
‘This geezer, right, he didn’t like my Spurs tattoo. So he says: “Tottenham’s are well batty, man” and grabs me round the neck. So we had a bit of a tussle, yeah? And I fell over and banged my head.’
‘Were you knocked out?’
‘It’d take more than that to put me out!’
‘So then what happened?’
‘This old lady called me an ambulance, yeah? And they rush me up the hospital. And I was waiting in the waiting room when suddenly I started vomiting blood. Tons of it, yeah? Like a volcano erupting. And they all come running. This doctor, right, he pulls me up and bundles me in the emergency room, and he sticks a big tube down me neck, and gets it all out. Yeah. I was there three days, and then I came down here.’
‘Three days, yeah.’
‘But you said this happened yesterday.’
Reece squints at me.
‘Why’re you being like this?’ he says. ‘Why’re you giving me the three degrees? I’m sick, man. I can’t remember this shit.’
The staff have never met Reece before so they can’t help, either. They certainly don’t want him in the shelter if he’s unwell, so I’m driven to make the offer.
‘Do you want to go to hospital?’
‘Yeah. Yeah, I think I need getting sorted out, man, ‘cos I can’t go on like this.’
He wants to be carried out, and makes a fuss when we encourage him to walk. He goes to grab on to our shoulders, and takes it badly when we guide his hands away.
‘I’m not getting fresh, man. I just need support.’
‘Fine. We’ve got your arms. You’re perfectly safe.’
We make it out to the truck.
The lobby of A&E is as crowded as ever, but it’s a chance to catch up with our colleagues. We chat and joke whilst we keep our various patients happy.
Eventually the triage nurse makes it round to us. She stops at the foot of the bed and shakes her head. Reece looks up.
‘Hey! Are y’all right, sister?’
‘What’s _he_ doing back here?’
‘You’ve met Reece before, then? He said he’d just come down to us today from up country.’
‘He said that yesterday. And the day before.’
‘He’s been in five times in five days. Are you going for some kind of record, Reece?’
‘Record? What’s she on about, record?’
The nurse sighs and starts filling out an admission sheet.
She smiles at me when I show her my form. ‘Don’t worry,’ she says, tapping herself on the chest with her pen. ‘I’ve got it all here, _off by heart._’
Mr Loesser lies propped up in bed, a plastic basin on the floor, a box of tissues and a child’s beaker of water on a side table. He barely stirs when we come into the room; his voice, when he talks, is so thin and indistinct it could be coming from his reflection in that dressing table mirror on the other side of the room.
‘So sorry to be a nuisance,’ he says. ‘But I feel so wretched.’
His son is sitting on the bed next to him.
‘Dad hasn’t been well the last few days,’ he says, stroking his hand. ‘Nausea and vomiting, possibly haemetemesis, some epigastric pain, constant, non-radiating, a bit of a temperature, general lassitude and general all-round fed-up-ness.’ He pulls a grumps face, then adds: ‘I’m a GP, by the way.’
‘And a good one, too,’ says Mr Loesser with a weak smile.
We read the notes the out of hours doc left, then help Mr Loesser into our chair.
‘Can you believe I used to be a rower?’ he says, then retches into the bowl.
Outside in the corridor, a group of elderly women are lined up. They’ve heard the ambulance arrive and have come to see him off.
_Bye, bye, Eric._
_All the best, love._
_You’ll be back in no time._
_Don’t forget we need you for the bridge match on Wednesday._
He gives them all a royal wave as we process towards the lift.
I pull up at A&E just as a massive fireworks display kicks off nearby. A hundred brilliant points of light rush up into the sky above the hospital, booming and crackling, flowering, scattering, then drifting away on long tendrils of smoke before the next burst takes their place. The noise of it all reverberates through the air.
When I open the back door, Mr Loesser Jnr. pauses on the top step, looking up, then jumps down and moves to the side as I lower the tail lift.
‘Do you know what the fireworks are for?’ I ask him.
‘They’re for my father!’ he says. ‘They’re for my father, coming to hospital!’
* Mr H passes Mrs H another piece of toast. She’s just finished buttering it when she drops her knife with a crash and slumps over to the right. Mr H calls the ambulance. When he opens the door to us, a small, light brown poodle scampers out and runs around our legs, barking. Whilst I attend to Mrs H, Rae says to Mr H: ‘Can you put your dog away please?’ He seems affronted. The dog has stuffed its nose in my response bag; he’s about to run off with my stethoscope like a string of sausages. ‘Can you put your dog away please?’ ‘Oh. Sorry.’ He turns round, shuffles off to the bedroom, goes in, quietly shuts the door. Even the dog seems temporarily confused. Rae sighs, goes up to the bedroom, knocks on the door. Mr H opens it. ‘Not you. The dog.’ * Mr C lives with his elderly mother in a dark and cluttered basement flat – just the two of them, and six terriers. There’s no room for the humans, let alone the dogs, but they do their best (the dogs, not the humans), jumping up on the table, the sofa, fighting each other for top-dog spaces, only stopping to hurl themselves across the room and up on to the window ledge to bark as loudly as they can whenever a person or a car passes in the street. Which is all the time. ‘Sorry about the dogs,’ says Mr C, scratching his porcine belly. ‘They said put them away but I told them I didn’t have a room where the door shuts.’ Mrs C isn’t too bad; it appears she’s had a few crews out before. We go through the motions, get the information, make the referral. ‘Do you want to see my babies?’ says Mr C. Tired of throwing dogs off my lap, and in an effort to get away from the heater Mrs C has in front of her chair, I say yes, I would very much like to see his babies. He leads me through the undergrowth of their living space to a room out back. In contrast to the rest of the house, it’s pretty clear, with a workbench, modelling tools, lamp – and a dozen or so beautifully detailed submarines displayed on the walls or hanging from the ceiling. ‘That’s my favourite,’ he says, stroking the conning tower of something German. The dogs mass at the doorway, but they don’t come in.
Ten past six in the morning. A late job. Shit.
‘Load and go,’ says Rae. ‘Okay? Load and go.’
An attack helicopter wouldn’t be quicker.
Police cars in the street.
Up on the landing to the door with the fist-sized holes and a police battering ram resting on its end amongst the debris.
Shouts and wild screaming beyond.
I knock and push the door open.
A police officer just inside.
‘Great,’ he says, moving towards us. ‘This is mad, mate. Absolutely crazy. It’s difficult to make out, but what we’ve got are three people, a guy, two girls, all naked. They came back to the hostel for a threesome or something, who knows? But this girl, Belle, she started to freak out and smash the place up. Neighbours called us, we called you ‘cos she’s obviously on something. She’s possessed, mate, completely out of her box, rolling round on the floor, cuts from all the glass, vomiting, just terrible, basically. Prepare yourself, ‘cos it’s not easy in there.’
We follow him into a sparsely-furnished room. Four other officers are struggling to restrain a young girl on her back on the floor. She breathes heavily, her black hair in a tangled sweat, her cheeks flushed, her eyes rolling like she’s crashed into the room from the core of a tornado. Her pale flesh is smeared with blood from the little cuts she’s sustained rolling around in all the broken glass. She’s quiet only for as long as it takes to build up enough energy, but then her screams are truly appalling –open-throated, her tongue straining out from the root, tinted copper green like the organ of a hellish parrot. Even the police are struggling for control; as it is, the quilt they’ve thrown over her gets wrested aside. In her nakedness, she is the embodiment of pure rage, a devil baby, primal, formidable, terrible. She would kill us all if she could.
‘Belle! Belle! Calm yourself! Be calm! We’re here to help, okay?’
The guy part of the trio appears at the door.
‘Leave her alone, you _cunts_,’ he says. ‘Leave her alone, yeah? All you big guys for one girl. How’s that right? Just leave her alone.’
The officer who showed us in tries to move the guy back out of the room and along the corridor to the other woman who is screaming in the background. He only gets half-way when the guy attacks him. Belle has fallen quiet again, so the four officers pile out of the room and there’s a huge fight. We lift Belle into our carry chair, swaddle her in blankets, strap her legs onto the foot rest, buckle her up, and head for the door, making vague, soothing noises as we go, like we’re kidnapping the ogre’s baby and we’ll be killed if she wakes up and screams.
A neighbour, appalled, on the landing.
‘Hi!’ I say, trying to sound reassuring. ‘You couldn’t do me a huge favour, could you? You see that ambulance bag and clipboard just inside the door?’
The neighbour nods.
‘You couldn’t grab that for me and bring it out to the ambulance? That’d be great. Thanks a lot. Cheers.’
The neighbour goes inside, whilst a little further down the corridor the police fight with the other guy.
‘Thanks a lot. That’s kind of you. Great.’
He follows us down the stairs.
Belle comes to again and struggles madly to get out of the chair. By some miracle of balance – strengthened by our desperation to get out of there – we make it down the stairs and out into the street.
Belle writhes and screams and curses like the very spirit of damnation.
There are a group of elderly people waiting at a bus stop, nicely dressed, maybe on their way to church. They watch as we struggle on one wheel over to the ambulance. I wouldn’t be surprised if they crossed themselves. Who knows – maybe it would help? I’m open to anything at this point.
Belle has almost made it out of the chair now, her arms and legs thrashing around. I wrestle with her on the ramp as it goes up. I don’t know how I manage to keep upright but by luck and main effort we get her inside. Top and tail on to the trolley. More blanketing, straps. All the while Belle screaming, cursing, laying those frantic black eyes on us like she’s being abducted by a team of sulphurous goats.
I call ahead to the hospital.
We’re met by security, who help restrain her.
The consultant leads the handover in resus.
‘So. Who do we have here?’ he says.
I’m sweating, breathing as hard as Belle.
His urbane, early morning savoir faire is extraordinary, wonderful, and utterly stalls me.
For a moment I look at him much as Belle does.
Then she starts screaming again.
‘Oh-_kay_!’ he says. ‘A mattress on the floor, I think, people. And let’s not bother with needles and things _just _yet.’
‘Have you come for me?’ says Lionel. ‘Well. Bye, bye, dear.’
We help him out of his chair. As soon as he’s up and stable, his wife June gives him a kiss on the cheek, then stands back, anxiously smoothing her apron.
‘You don’t mind if I stay, do you?’ she says.
‘No. Of course not. You’ve only just come out yourself. You don’t want to be going back to that place. No, no – you stay here and get an early night. I’ll be okay. Maybe David will come up later? Anyway – bye, bye, dear. Bye, bye.’
I pass him his walking stick. The hallway of their flat is bare, just a couple of framed pictures on the wall, and a row of energy-saving light bulbs glowing without shades above our heads.
We start the long shuffle out to the ambulance.
Lionel has an extraordinary mouth. The upper jaw is tight, rounded out like a quarter of coconut, utterly immobile. The lower jaw hardly moves much, either – just enough to get the words out, past a row of pointed, grey and fish-like teeth. In fact, hunched over in that grimy raincoat, flicking a sideways look in my general direction every now and then, he might easily be an ancient species of land-dwelling fish, in old man-disguise for a trip to the vet. He speaks softly and rapidly without much pause for breath, none for questions. All he needs from me is the occasional grunt to show I haven’t wandered off.
‘When I came out of the army I had no idea what I was going to do next. My father didn’t help all that much. He wasn’t any good. He used to say “What nonsense have you been thinking now, Lionel?” In some ways he was right, I suppose. I didn’t apply myself, you see. I thought I could do all kinds of things, but they just didn’t seem to go my way. So when I got out of the army I found myself a job in the stores department of an engineering firm. That was a good job. I liked that job. But then after seven years I got made redundant. So I gave myself a jolly good talking to and I said: “Right! On with the new!” And I came to London. And I went in to the Labour Exchange there, and I said: “What have you got for me?” And in turns out, what they’d got for me was another job in stores. In a… in a fabrication place. You know. A place where they make things. Anyway, I was there for seven years, I think. And then I got made redundant. But by that time June had got her eye on me. I used to work with her brother, you see. That’s how we met. Well one day she came up to me and she said “I’ve got tickets for a show. At the Royal Albert Hall.” And I said “Oh?” And she sort of waved them in my general direction. Well – we went to that show, and it was very good. But we took things slow, d’you follow? I don’t like to rush things. We didn’t even hold hands until a week later. And stuck at that for a month. But anyway, things happened, and here we are now, forty years later.’
He pivots in the chair and tries to look at me.
‘Do you think David might be up later?’ he says.
Stephen is being sent to a psych unit in another town because there are no beds here.
‘Sorry it’s such a long way,’ says Rae. ‘And so late.’
‘It’s not your fault,’ says Stephen, hauling an enormous black sports bag onto his shoulder.
‘Can we help with that?’
‘No. Thanks. I’m fine.’
A nurse comes over with a file of notes, but it turns out they’re the wrong ones –Ste_ven_, not Ste_phen_. She tuts and goes away again.
The idea that we might take the wrong person hangs unspoken on the air between us. We make other, safer comments.
The nurse comes back, apologises – she has to go to the office to do some photocopying.
Stephen puts his bag down again.
The person in the opposite bed has been staring at us all this time; he doesn’t acknowledge me when I nod in his direction. I wonder if it’s Ste_ven._
Ste_phen_ pushes his huge steel glasses up his nose, tips his head back slightly, and stares in the direction of the nurses’ station. Picks his bag up, puts it down again.
A long drive out, but easy enough. After midnight, and this busy commuter route has been cleansed of traffic. The moon is low and full, more like a ghostly sun. Its light has a strange effect on everything, on me.
I’m dreaming about driving.
I open the window and take deep breaths.
I’ve not been to this unit before. Even the sat nav seems vague. But after some last minute adjustments, I pull up outside.
The lobby is empty, hard-lit. When I buzz the ward there’s a long wait before anyone comes to let us in. Stephen waits anxiously between us.
‘It’s a long way for anyone to come and visit,’ he says.
‘It’s not your fault,’ he says again. And then: ‘I’m a bit nervous. I don’t know what to expect.’
‘That’s natural,’ says Rae, looking around. ‘But it looks like a nice place.’
Two women come down to greet us, both in their early twenties, both dressed in jeans and t-shirts. They introduce themselves, shake Stephen’s hand, lead us back upstairs. In the ward itself one of them shows Stephen to his room whilst the other asks us if we want a coffee. She swipes us into a room, and goes off to make it.
The room has a stack of chairs in one corner, a bookshelf of DVDs, and a wide, beech veneer conference table in the centre. Rae sits one side of it, I sit the other. I put my feet up on a chair.
‘Thanks for coming,’ I say. ‘Shall we begin?’
The chair cuts into my back so I put my feet down again.
_How are you feeling?_ she says.
The outside windows are more like panels in an aquarium – thick Perspex panels secured with rivets.
The nurse comes back with two plastic cups of coffee.
‘Take your time,’ she says with a smile, and goes out again.
We sip our coffee, yawn, chat.
Suddenly Rae nods at something she’s seen behind me.
I turn round and see someone pressed up against the security glass, a middle-aged man in a zipped-up top. Because he’s standing so close to the glass, and because his hood is pulled low over his forehead, I can only make out the smallest fragment of light reflected in his eyes. He doesn’t acknowledge that we’ve seen him. His breath mists up the glass.
After a moment, I turn back to Rae. Raise my eyebrows. Finish my coffee.
The man has gone when the nurse returns to let us out again.
Suddenly there are screams and ripping sounds from a room across the way.‘Don’t worry,’ she says. ‘Film night.’
‘It’s dead boring, mate. The same fookin’ questions over and over and over. For what? For the paperwork, thassall. And you get treated like shit as soon as they find out you used to do a little gear. You can see it when they read them fookin’ letters: I V D U. Snigger. Point. Yeah? But that was years ago. I’m clean now, man. I’ve not touched the stuff in ten years. That’s what you get though. That’s what you get for being different.’
Alex _is_ different. You can see it in the jaundiced glow of his face, like a solarised photo; you can see it in the way he walks, crabwise, jabbing at the ground with a stick, crooked over to one side with the drag of a leg that was damaged when gangrene set in from a filthy injection; you can feel it in the drum-tight swelling of his belly; you can hear it in his accent, a tight, Mancunian drawl, case-hardened in smoke and rage, and you can see it in his eyes, when he opens them wider than a slit. Pinned through Subutex.
Mary isn’t being straight. Not with her doctor, not with her friend, certainly not with us. Even her cat Bob takes the long way round to the kitchen.
‘No. I haven’t had a drink tonight? What do you take me for?’
‘It’s just that your speech is a bit slurred, Mary. And there’s a carrier bag of empty vodka bottles just inside the door.’
‘Yes, well, I gave up drinking a long time ago, thank you very much. An’ the reason I might possibly-be-slurring....’ (she exhales down the three words with her eyes half closed) ‘... is because I’m very, _very_tired. Okay? Officer? I’ve had a busy day, what with one thing or another. Now then. What are you going to do about my back?’
Mary’s next door neighbour Janet came round as soon as she got in from work and picked up the message on her answer machine. She’s still got her coat on, and the spare set of keys in her hand. Caught between wanting to help Mary and wanting to go home, she sits perched on the edge of the armchair, periodically glancing at the door.
‘Mary’s had trouble with her back before,’ she says. ‘Haven’t you, Mary? She saw the doctor last week and he gave her some different pills, but they haven’t really agreed with her. And then of course she had that fall.’
‘When did you have the fall, Mary?’
She shrugs. ‘Last week.’
‘Did you see anyone about it?’
‘The doctor! Keep up.’
She tuts and closes her eyes.
‘And what did the doctor say?’
‘He gave me some more pills.’
Janet hands me a paper bag.
‘I think this is everything.’
It’s obvious from the blister packs that Mary hasn’t taken her full complement.
‘It’s no wonder you’ve got pain if you’re not taking your meds,’ I say to her.
‘You don’t like me, do you?’ she says.
‘Do you know, you’re the second person who’s said that to me recently.’
‘Oh? Coincidence, you think?’
‘Maybe. Maybe not. But that’s beside the point. Let’s see how we can help you tonight. Are these the only meds you take?’
‘She has diazepam, too,’ says Janet.
‘Really? So where are they?’
‘I told you, Janet. I don’t like taking them things. They make me go funny in the head.’
‘But were they prescribed for your back pain?’
‘I don’t like them.’
She starts to cry.
Bob looks in from the kitchen, hesitates, then turns and goes out through the flap in the back door. I have a strong urge to follow him, but I take a steadying breath and carry on.
We’re there some time.
We refer her to the out of hours.
Much later, we get a call to an elderly fall. I’ve been to this address before – some time ago, but I know the ambulance makes frequent visits here. Agnes is ninety something, unsteady on her feet, but still living with her husband Norman, who has Parkinson’s.
We use the keysafe to gain entry and find Agnes sprawled half on and half off the bed. Agnes has activated her careline button – not so much because of her position on the bed, but because of Norman – and I can see why. He seems flushed and confused, wandering about the bungalow on some obscure mission. We can see from an ambulance sheet that a crew’s already been out tonight. All things considered we can’t leave them alone. We take them both in, as a job lot.
I park alongside another ambulance at the entrance to A&E. Dermot is round the back of his truck, putting the ramp up.
‘We just brought in someone you know,’ he says.
‘Oh? Who’s that?’
‘Yep. The out of hours went round, saw her slumped on the sofa, banged on the window but got no response, so he called the police who smashed down the door with their big red key.’
‘Is she all right?’
‘Pissed, is all. Complaining of back pain but we couldn’t get much sense out of her so we brought her in.’
I start to open the back of our truck.
‘Funnily enough, we’ve got one of yours.’
‘Agnes! So what about...?’
‘Yep. Norman, too.’
I swing the door open to reveal the bright interior, Agnes on the trolley, Norman on a side seat. They both look out, see Dermot, and wave.
He waves back.‘_And so the circle is complete_,’ he says, in a mock heroic voice. ‘_Our work here is done_.’
Mr & Mrs Taylor live in a house on a hill served by a system of concrete stairs so complex you’d think you’d blundered into a landscape by Escher. We go up to go down to go up again. None of it makes sense.
‘And I bet he’s upstairs,’ says Rae.
Early morning, last hour of the night shift. A heavy lift will probably kill us.
I ring the bell.
An elderly woman shuffles to the door with her zimmer.
‘Can you come in and help him, please?’ says Mrs Taylor. ‘Only I can’t get him up. I’m not good myself.’
Stan is sitting scrunched up on the floor of the little downstairs bathroom. He fell over when he went to spend a penny at eleven o’clock at night, and he’s been there ever since. But Stan is a heavy man; at least eighteen stone, his torso a great conical lump with a couple of stringy legs hanging from the base.
‘Get me back to my chair’ he says, puffing and blowing.
We have to slide him backwards to give ourselves some room. He yelps and swears.
‘Where’s that hurting?’ I ask him.
But he ignores the question and waves his hands speculatively in the air.
‘Why won’t you put me back in my chair?’
‘Oh, no, don’t put him back in his chair,’ says Mrs Taylor, watching from the sitting room doorway. ‘He’s stuck in that thing all day, all night. He won’t even use the bathroom. He just sits there and wets.’
‘Get me back to my chair,’ says Stan.
‘I can’t cope,’ she carries on. ‘I can’t. He won’t have the doctor in. He won’t take his pills. He won’t use his frame. He just sits and sits and sits. And wets. I think he’s going a bit...’ she taps her forehead with a bony finger. ‘You know.’
‘I’m not going to hospital,’ Stan puffs. ‘Just get me up, will you? What are you waiting for?’
‘You feel hot to me. Are you hot, Stan?’
‘Why are you leaving me on the floor? Why don’t you help me up?’
Rae comes back in with the Mangar inflatable cushion.
‘What’s that?’ says Stan.
‘It’s a device for getting you off the floor. You’re too big for us to just pick you up.’
‘Unfortunately, yes. But this is good. Look. It goes under here – if you could just shuffle backwards a bit...’
He yelps and screams again.
‘What’s up, Stan? Where’s that hurting?’
He grumbles, but doesn’t tell us.
We start to inflate the Mangar. Despite warning him what to expect and what he has to do as the cushions inflate, he reacts to the whole business with the same level of uncoordinated, hoofing panic you might see in a cow being hoisted out of a ditch. With a great deal of counterbalancing and bracing, we manage to inflate all four cushions without Stan falling off, and then help him to stand. He clutches on to the door of the bathroom, his spindly legs buckling.
I fetch a wooden chair in from the sitting room.
‘I took the cushion off,’ says his wife. ‘He’ll just wet it.’
‘I’m not going to hospital’ Stan says, collapsing back into the chair. ‘Why have you put me in this thing?’
‘Because you obviously can’t walk through to the sitting room and I don’t want you falling over again.’
‘Just help me up and I’ll be all right. I’m not going to the hospital.’
‘We can’t very well leave you here like this, Stan. Now – if you can prove to me that you can get yourself up and walk through to the sitting room, fine, I’ll leave you alone. If not, it’s the hospital and no question about it.’
He tries to stand up again, but his legs will not support him. He keeps a grip on to the doorframe, though, and looks at me to see that I’ve understood.
It’s looking increasingly as if we’re going to be stuck here for hours, and we’re off duty in a few minutes. Rae calls Control and asks for a second crew. We’re going to need help lifting Stan up and down those concrete stairs – and then they can take him to hospital whilst we clear up and hurry back to base.
‘They’re sending a reserve crew,’ she says, hanging up.
‘A what?’ says Stan. ‘I’m not going to hospital.’
‘You go with these nice people!’ says his wife, glaring at him from her zimmer frame, as homicidally furious as Davros of the Daleks. ‘You can’t go on like this, Stan. You can’t!’
There’s the sound of boots on the concrete steps outside.
The fight seems to go out of him.
I slap him reassuringly on the shoulder. ‘Don’t worry, Stan. It’s only for a check-up. I reckon you’ve got a little urinary tract infection and it’s making you weaker than normal. You need a thorough-going overhaul. Wash and brush-up ,tuppence. Maybe they can get someone in to look at the house, and see if there’s not stuff that can be done to make it easier for you generally. With any luck they’ll discharge you later today. But you absolutely have to go, Stan, because to be honest – you’re so weak, if I left you now you’d fall over again and then where would you be?’
‘On the floor,’ he says.
A knock on the door. A friendly face.
‘Hello! Who’ve we got here, then?’Stan submits to the carry-chair, and we all struggle outside to the truck.
Sienna is sitting on the edge of her bed, crying into the phone, whilst two of the other hostel residents look in at the door.
‘I’ve made too many mistakes,’ she sobs. ‘I just can’t cope anymore. I can’t cope.’
Along with a packet of tobacco and an asthma inhaler, there’s a neat mound of empty blister packs beside her.
When we’ve chatted to her for a while, calmed her down, established that yes, she will come with us to the hospital, Rae asks if she has everything she needs. Phone, keys, money for the taxi home?
‘Humphrey,’ says Sienna, reaching for a tatty owl that’s reclining on her pillow. She stuffs it in her handbag along with the rest of her medication.
I carry the bag and her coat so she has her hands free to support herself as she goes down the stairs.
The owl stares up at me from the bag as we descend.
Waiting with Sienna in the triage area of the A&E department.
Another crew comes in, pushing a young man in a wheelchair. He’s slumped forward over something; at first I think it’s a vomit bowl, then I see a little more of it and think it must be a furry hat, but when they park themselves next to us I can see that it’s actually a little toy fox. He moans slightly, and strokes the head of it.
When the triage nurse comes over to them, the attendant smiles and waves a little bundle of empty blister packets in the air.
Giles buzzes us into the flat. A twenty year old man, he has the bland and fleshy complexion of celery forced in the dark.
‘I took all my meds at once and went to sleep. I’m a bit disappointed I woke up, to be honest.’
_Have you got everything you need to go to hospital, Giles? Phone, keys, money...?_
He hands me a canvas bag whilst he pulls on a Slipknot hoodie.And yep, there in the bag, just visible beneath the headphones, the magazine, the drink bottle and cigarettes, a cuddly little toy hedgehog, staring up at me with an off-centre kind of smile, as if to say: _Sssh! Don’t say anything. I’m hiding_.
The door stands open. I knock and push it open even further. A dark hallway, with dull light spilling down from a first floor landing, over photos and pictures, a narrow shelf of souvenirs, a chair-lift track with the chair upstairs. I say _Hello, _but there’s no reply, no sound.
We go in, head up towards the light.
Charles Westinghouse is fussing over his wife in the main bedroom he’s adapted for her. Everything has been cleared out except the basics – a hospital bed, a hoist, a commode, an electric armchair by the window, and another, simpler chair nearer the door. Emma Westinghouse is lying in bed with the back fully in the upright position. Her wasted arms are along by her sides, the right one under the duvet, the left on top. She doesn’t wear teeth anymore; as a consequence her mouth is a puckered crater. A PEG tube winds out to the left, a catheter tube to the right. Her skin has the waxy pallor of the profoundly inert, someone whose main experience of movement over the past eight years has been the hoist or the body roll, and of the outside world, sunshine filtered through curtains, and traffic passing in the street. Apart from the rise and fall of her chest and a certain flickering of her eyes – which, for all the low light and late hour, seem sharp and blue – she is absolutely still. Surrounded like this by all the details of her care, utterly immobile, she could be the centre of a tough new display by Tussauds, something to bring the collection up to date, Domestic Trials and Tribulations, sponsored by the NHS.
‘Oh! There you are!’ says Charles, straightening up and pushing his thick grey hair back. ‘Sorry to drag you out like this.’
He called because Emma had started grunting in a new way, something that suggested pain. There’s no sign of it now, though. All her observations are within range.
‘We’ll be guided by you, Charles. We’re more than happy to take Emma to hospital. The other option is to see how you go tonight and get the GP involved tomorrow morning – on the understanding that if anything changes you give us a call back.’
‘Will do. Just give us a hand to make her more comfortable.’
Whilst we’re doing that, Emma stretches her face a little more, making strange little panting noises, her eyes flashing.
‘Is that what she was doing?’ I ask him.
‘No. She laughs at me sometimes. I think it’s when I bend over her and my stupid hair flops forwards. Is that it, Em? Is it my hair again?’
We lower the back of the bed.
And slowly, like a doll whose weighted eyes gently close when you lie them down, she drifts off to sleep.
Five o’clock in the morning, and dawn’s a spill of ink. Clubbers clacking and scraping in the direction of taxis, or anything that looks like a taxi.
There’s a guy standing outside The Spur Hotel, his hands planted deep in the pockets of his parka. I nod to him as we pull up, but he doesn’t respond.
‘Did you call the ambulance?’ I ask him as I climb out.
‘Me mate? No mate?’ His face cracks into a dreadful, stumpy grin. ‘Why – someone dying?’
‘Well I couldn’t possibly say.’
He watches me as I pull out my bag; Rae locks the vehicle behind us as we go up to the revolving doors. I glance behind as we push through; he’s still watching.
Our boots don’t make a sound on the thick blue carpet. We cross the vestibule, walk up a shallow staircase and approach the reception desk, spot lit at the far end of the atrium. The hotel rises up around us like a renovated prison – layers of identical rooms forming the four sides of the atrium, with the dining room and bar in the middle. The silence is overwhelming, accentuated by the empty dining tables all dressed for breakfast, the jardinières, the fans, the fish tanks.
A red-eyed, puffy faced receptionist is waiting for us at the desk, his arms spread left and right along the desk as if he’d been flat on his face when the call came through.
‘Room two three two,’ he says. ‘Come. I show you.’
‘So what’s the story?’
‘Well – a man and his girl, they got back from club about an hour ago. He was propping her up, you know – like this?’ He smiles at me, does the mime. ‘I thought it was the vodka.’ He shrugs. ‘It happen lot.’
The lift puts us out on the fourth floor, an identical floor to the one we’d just left. Without even looking up, the receptionist pads ahead of us along an endless corridor, turns at the end, then along another, turns at the next end, then two doors down stops and swipes the lock.
‘Hello ambulance peoples’ he says, rapping with his knuckles on the door before he opens it.
Lying on the tiles of the en suite bathroom is a young woman, her head underneath a melamine shelf containing twin sinks and a dressing mirror. Kneeling by her side is a heavily built guy in his twenties.
‘That’s fine now,’ I say to the receptionist, who is soaking up the scene from over my shoulder. ‘We’ll let you know if we need anything else.’
‘Okay, my friend,’ he says. He nods to the boyfriend, and quietly withdraws.
‘So what’s been going on?’
Craig tells us what happened. They’d come away for the weekend. Been to a club. Not drunk all that much. Not taken any drugs. Natalie had become anxious and wanted to leave. She’d collapsed on the bathroom floor when they got back.
Natalie starts to hyperventilate, but in a non-committal, stagey kind of way. I coach her resps back.
‘Have you ever had a panic attack before?’ I ask her. She nods. ‘Okay. So you’ll know how over-breathing can make you feel.’ She nods again.
In between encouraging the breath control, I ask Craig about Natalie’s medical history.
‘I wouldn’t know,’ he says. ‘I’ve only known her a month.’
Natalie lifts her head.
‘You’re going to dump me,’ she says.
‘I’m not going to dump you. Don’t be silly.’
But Natalie drops her head back to the floor and starts breathing quickly again – and too soon after for it to be at all credible, passes out.
‘She’s not unconscious,’ I say.
I show him how I can tell.
Over the next half an hour, and despite all our efforts, Natalie carries on as before, small bursts of hyperventilation followed by unconvincing faints. Rae and I play Good Cop, Bad Cop, but nothing works. We try to encourage Natalie to stand up and move to the bed where she’ll be more comfortable, but Craig intervenes, physically picks her up, carries her through.
‘Watch your back,’ I tell him.
He shakes his head and staggers with her into the bedroom. As soon as she lands on the bed she throws herself flat and pretends to pass out again.
‘Why’s she doing this?’ he says, red in the face.
‘I don’t know. Natalie? Come on. Let’s sit you up and have a chat about how you’re feeling. We’ve just got to reassure ourselves that everything’s okay, then we can leave you alone.’
She sits up and stares at me for a moment.
‘Natalie? How are you feeling? How can we help?’
She holds out her hand to Rae without taking her eyes off me.
‘You don’t like me, do you?’ she says.
‘It’s kind of immaterial whether I like you or not, Natalie. We’re here to help and that’s what we’re trying to do.’
Suddenly she jumps up and runs out of the room.
Craig follows her, shouting over his shoulder: ‘I’ll be okay from here in, guys. Thanks for your help.’
We stand outside the room and watch Natalie run down the corridor, followed by Craig. Right at the end, where the corridor turns to the right, she stops, and after hesitating a moment, neatly puts herself on the floor.
Wearily, we walk up to meet them.
Craig is kneeling beside her, stroking her hair; amazingly, he nods at us in a friendly way.
‘All right?’ he says.
I check Natalie over.
She’s feigning unconsciousness again, only coming out of it to look up at Rae and say: ‘I like you. You’re all right.’ Then lapsing back into a little fast breathing again.
‘Try to encourage her back to the room, Craig. I think you’re doing a great job. But obviously she can’t stay like this all night. The hotel security might get involved. I don’t think Natalie needs to go to the hospital, but if anything changes later or you become concerned, you can always call us again.’
‘Thanks,’ he says. ‘Sorry to have wasted your time.’
‘It’s no bother.’
We leave them to it.
Back down in the atrium, the receptionist has resumed his position on the desk.
‘What was matter?’ he says, looking up from an early edition of the newspaper. ‘Vodka?’
‘She’s not too bad,’ I tell him. ‘Lying in the corridor at the moment, but hopefully they’ll be back in their room soon.’
‘Okay chief. I keep eye on this business.’
Back outside on the pavement, the strange guy hasn’t moved.
‘No good?’ he says. ‘Nothing doing?’
‘Another life saved.’
He watches us stow the bags and get back in the cab.
‘One month in,’ says Rae. ‘Good god. If I was him I’d be running in the other direction.’
‘Dumped,’ I say. ‘Definitely dumped.’
There’s a woman standing by the side of the road with a phone to her ear; she waves as we approach, then hurries back inside. The street is quiet and dark. A fox glides out of a garden ahead of us, hesitates in an isolated pool of light thrown down by a streetlamp, then hurries on into the darkness on the other side.
I grab an obs bag and maternity pack; Rae fetches the Entonox.
Stacy’s house is up on a shallow rise, all its lights blazing. It’s not immediately clear where the front door is, but the sounds of a woman crying out in pain leads me round the back.
Stacy is on all-fours in the living room, surrounded by a hasty scattering of towels. Her sister Kate has hung up the phone and is down on the floor supporting her; Stacy’s husband Richard hangs back near the kitchen, one hand flat on the top of his head like he’s trying to stop it blowing away. He looks at me as I come in with my bags, desperate for me to help.
As I say hello and ask a few questions, I’m unzipping the maternity case, unpacking the kit, setting it on a nearby sofa, pulling on my gloves and then crouching down to see how far advanced she is. What I find is nothing I’ve ever seen before, something like a pale, prolapsed balloon, tight with fluid, extending out of Stacy’s vagina. There’s no sign of the baby’s head, but Stacy’s contractions are powerful and quick and there’s no doubt she’s ready to deliver. Richard tells me they were up at the hospital earlier that day. He said she’d had a scan, but apart from showing that the baby was back-to-back, everything else was fine. Today is her due date. Stacy’s had two other children, neither with any complications. Her health is good.
This balloon-like structure must be the amniotic sac. But is there any chance the placenta could’ve been dragged out of position to block the cervix? In a couple of hours? I don’t think it’s likely, but I’m no expert. And anyway, even if it is the amniotic sac, could it obstruct the birth? Is the foetus in distress right now, struggling to be born, the cord compressed?
It’s only been a minute or two since we came in the door but it feels longer. I’m horribly aware that all the time I’m hesitating the baby might be struggling.
I decide to rip the sac. It tears without much effort. There’s a rush of clear liquid over my gloves and up my arms. Almost immediately I can see the dark hair of the baby’s head as it emerges. I get Stacy to pant as the head crowns and is born. The baby’s face is puce, all bunched up in that way newborns have. I check round its neck, which feels clear of the cord.
Rae is next to me with a clean, white towel. She’s ready to help me catch the baby.
‘Okay, Stacy. One more push and we’re out,’ I tell her. ‘Whenever you’re ready. One last push.’
She bears down. The baby emerges, shoulders, body, legs, flopping out into our blue gloved hands in a splattering of bloody discharge, mucus and amniotic liquor.
‘It’s a boy!’
I hold him whilst Rae clears first his face then his body. Almost immediately the baby opens it eyes, squashes his tiny face up and lets out a great, squalling cry that fills the room with a sense of relief, and release.
He pinks up quickly, beautifully.
We wrap him in another clean towel and whilst Richard holds him, we help Stacy turn over and sit on the floor, resting against the sofa.
‘The midwife can cut the cord,’ I tell them. ‘There’s no rush.’
And as if I’ve summoned her by using her name, here she is, backing in through the door with a drag-along suitcase of maternity things, looking as smiling but exhausted as a woman who’s just landed at the airport.
‘Is that baby I can hear?’ she says. ‘Congratulations. What did we have? A he or a she?’
When we’ve drunk the tea Stacy’s sister makes us, seen the placenta delivered safely and everything good, the midwife happy for mum and baby to stay at home, said our goodbyes and congratulations again, we head back down the drive to the ambulance.
Above us the sky is brilliantly clear, a dizzying throw of stars, stars on stars on stars, leading out into the unfathomable deeps of space. It’s strange to think of that tiny life emerging, in that chaotic, warm, brightly lit room, with a sky like this above it.
The rest of the shift passes without incident. Half an hour before we finish and we’re back on base. The morning is already so well established our night feels like ancient history. I’m so tired I wonder how I’ll make it home through the rush hour traffic, but the thought of going to bed, pulling the duvet over my head and diving into sleep is so wonderful I’d risk anything to make it happen.
Dermot arrives for the start of his shift. He’s been a paramedic for about a thousand years, so I tell him what happened.
‘Sounds like the amniotic sac,’ he says, yawning. ‘There’s that expression – born in the caul. It’s quite rare. I’ve only seen it once. They’re okay being born like that without having to tear the sac. Nine times out of ten it’ll tear as the head comes out, but if it doesn’t, you can wait till the baby’s born. A lot of doctors tear early, of course. They like their interventions. But either way’s fine, I think. There are arguments for and against. And there’s that superstition thing, of course. Your little man won’t ever drown, so it goes. In the past the midwives used to frame the caul and sell it as a good luck charm to sailors.’
He yawns again, then stretches as he stares out of the window into the car park.
‘I had a different birth experience the other day,’ he says. ‘Not quite so nice, though. Twenty weeks old.’
He holds his hand out and looks at it.
‘A perfect little thing, this big,’ he says, drawing an imaginary outline in his palm with the forefinger of his other hand. ‘And it was making these tiny little gasps.’ He pauses, then closes his hand. ‘Twenty weeks – I mean, that’s got no chance. But we thought – well, maybe they got the dates wrong. And the way things were, we couldn’t just stay there. So we took it in, wafted a little bit of oxygen its way. Foregone conclusion, though. They didn’t do anything in resus. I knew they wouldn’t. Just gave mum some privacy whilst it faded away.’
Mrs Grayling has died, sometime in the night. She lies on the bed with her eyes half-open and her jaw slack. The sliding door to a narrow conservatory adjoining the bedroom stands open, and the garden door beyond that. A gust of fresh spring air moves through.
Her son Graham is sitting at the kitchen table with his face in his hands. He looks up as we come in and finds a tired smile.
‘She’s dead, isn’t she?’
‘Yes, I’m afraid she is.’
‘I knew it. Sorry to drag you out like this. Would you like some tea?’
He stands up, steadies himself at the table, and then starts getting things together, filling the kettle, setting out the Spode tea cups, the jug of milk, a saucer of custard creams. I ask him about his mum’s health these past few months. He says she’d been fine until just a couple of weeks ago. Ninety-three and still independent. But she’d developed a chest infection. It knocked her sideways. She’d taken to bed. The doctor wasn’t optimistic.
‘I think I need some time to myself,’ says Graham. He hesitates and stares out of the window at the garden. ‘It’s such a nice day,’ he says. ‘Mummy’s favourite time of year. Maybe what I need is a nice long walk. A nice long walk by the sea, with a cup of coffee at the end of it. Hell – a pint of beer. Why not?’
He gathers himself together again, finds a tray.
‘An odd thing to ask,’ he says. ‘But could you do me a favour and cover her face? I said goodbye to her last night. I don’t need to see her again. Not – like that.’
‘Sorry to ask.’
‘It’s no bother.’
‘I’ll bring your tea through when it’s ready.’
There are two carers in the house. The first discovered the body; the second hurried over to give her support. They’ve come together in the sitting room, shoulder to shoulder, blowing their noses, fussing through folders, unsure what to do next. They’ve known Mrs Grayling for years. It’s a terrible shock.
When we join them in the lounge, they take a hesitant step towards us, and talk quietly, overlapping each other.
‘Is he okay?’
‘What’s he doing in there?’
‘Upset – you know.’
They blow their noses again.
‘Someone should tell his sister.’
‘They fell out.’
‘She wasn’t – _supportive._’
‘You’re telling me.’
‘But she needs to know.’
‘I don’t mind telling her.’
‘She’s not on our list.’
‘I’ll ask him if he wants me to ring her. Someone’s got to.’
They stare at me. I shrug and nod. The second one goes into the kitchen.
After a little pause, the second carer comes back, followed by Graham, holding a tea tray.
‘It’s very kind of you. Really,’ says Graham. ‘But don’t worry. I’ll talk to the GP about – _that_ aspect of things.’
He sets the tea tray down, and goes back into the kitchen.
I take a cup and look around the room.
There is a series of framed paintings on the walls. Two watercolour still life studies of the same thing – a vase of daffodils and a bottle of wine. And three collages – a duck, a chicken and a pheasant. The collages have been put together from odd scraps of hessian, cotton, velvet, silk, satin and lace, with an assortment of buttons, pieces of glass and other scavenged material. The bird pictures are so lively, if it wasn’t for the glass covering them, they’d be clattering around the room and out the window.
‘Did Mrs Grayling do these?’
‘She was quite an artist.’
‘All up the stairs.’
‘It’s like a gallery.’
‘Terrible to think she’s gone.’
‘I don’t know how he’ll cope.’
‘I don’t know what he’ll do.’
‘Or his sister.’
‘When she finds out.’
They stare at me.
We all take another sip of tea.