The Trolley

We pull up to the entrance at the back of the hospital, reversing the ambulance into what is no more than a widened alley. Cats roam free, picking food out of overflowing rubbish bins. It's almost as though the levels of cleanliness are saved for the public entrances, leaving areas such as this one neglected and filthy. 

It's always a strange feeling wheeling an empty trolley bed off the back of the ambulance at hospital. There's a sense that we're doing something wrong, backwards, coming to take someone away instead of bringing them in. At this time of the morning, just past the point of no return but not yet quite within sight of the end, conversations are more a series of grunts and confused looks, reinforced by acknowledging nods at the offer of a cup of coffee. 

The hospital corridors are empty, an almost ghostly air circulating through the concrete block. The concrete was supposed to be covered when they built the hospital, years ago, but the money ran out. So now, in amongst the surrounding greenery sits a blob of grey, cold, ugly concrete, as if just waiting for a truck large enough to pick it up and take it away. The hospital looks only marginally better on the inside, but the eerie silence makes it feel just as cold and unwelcoming. The wheels squeak and click-clack over the cracks in the floor and as we reach the entrance to the unit, the doors open as though somebody watched us approach. 

"Morning lads!" Lorraine, a short, bespectacled, red-headed nurse had moved up to the wards from A&E, preferring the gentler nights up in the tower to the hectic unpredictability of the ground floor. She was permanently smiling, always alert, a slight Scottish lilt making her sound as though it was always lunchtime on a bright summer's day and the picnic blanket had just been laid out on the grass in the park. 

"You've come for Mr Sanders I presume?" 

"If he's heading into town for an emergency operation, then yes, we've come for him." 

Lorraine's voice suddenly takes on a serious tone. 

"Seems so unfair. Someone so young. He's my son's age. Early thirties. Don't know how I'd cope if it really was my son." 

We read through the paperwork, Paul and I, meet Dr McKenna, the anaesthetist who's travelling with us and discuss our options and a plan of action. 

"We're just trying to get him stable enough to transfer. Give him the best shot we can," says the doctor. "There's a chance he won't make it through the doors at the other end." 

"Is there any point moving him?" 

"He'll definitely die if we leave him here. He'll probably die if we transfer him. I'll take probably over definitely in this case." 

We walk into the room, the mood suddenly sombre and heavy. Mr Sanders, or Daniel as his mother asks us to call him, is unconscious and ventilated. Machines follow his every vital sign, gentle pings alternating with silence. For a time the only sound is the ventilator, its artificial lungs hissing life into Daniel making his chest rise and fall as though he is no more than asleep. 

Lorraine comes in with another nurse and they start to untangle the lines. Some feed him with life, some with pain relief, others just monitor. One keeps him sedated. The hospital machines will need to be exchanged for more mobile ones, a move filled with inherent risk.

"This'll take a few minutes. Why don't you two go and grab a quick coffee. You look like you need it." 

"I'm not sure whether that's an insult or an attempt at being friendly." I look straight at Mrs Sanders and a hint of a smile crosses her face. I have no idea how she manages even that smallest ray of light as she sits here with her son. 

"Can we get you a drink too, before we go?" 

"No. Thank you. I'd rather just sit here. Hold his hand for a little longer." 

"You hold his hand, we'll get the drink." 

"Thank you. Tea, please. No sugar." 

Standing in the staff room gives us both a chance to reflect, a dangerous thing in the middle of the night. Seeing illness, misery and death so close may be routine in this job, but it's never easy, especially when we're both around the same age as the patient. We hear as the machines are switched over, the wailing alarms of those disconnected being silenced one by one as we head back into the room. Paul hands the steaming mug of tea to Mrs Sanders and she nods a silent thank you as she briefly lets go of her son to take the drink. 

One of the machines runs out of battery power almost instantly. 

"These damned syringe pumps! It's been on charge for the best part of 24 hours!" Lorraine's furious mood is so rare that it's almost funny, except that the setting was wrong. She plugs the pump back into the wall and scurries off to find another. It seems that no transfer happens without at least one of them running out of power on route. 

The monitor screen suddenly flashes red and several different sounding beeps happen all at once. The ventilator seems to be struggling and each time Daniel is moved even a little, his blood pressure and oxygen levels plummet. 

"Let's give him a few minutes to settle," suggests Dr McKenna. "We'll try again in just a bit." 

I call control to let them know that there's a short delay, but that hopefully we'll be on our way soon. When they ask how soon, the best answer I have is that it'll be as soon as it's safe. 

We try twice more to move Daniel across. Each time we do, his vital signs take a hit and we have to stop, wait for his oxygen levels to settle and then try again. Mrs Sanders sits and watches, silence speaking louder than words. On the third attempt, we get him across on to our trolley. The numbers are calm, the machines are quiet, Daniel seems settled and so are we. 

"Let's go, gentle as you can lads." Lorraine looks on, anxiety straining at her permanent smile. We walk the length of the corridor, almost reaching the doors, when the monitor starts it's ominous shriek once again. We wheel Daniel back to the room in a hurry, plug all the machines in to the wall to stop the batteries draining and wait. 

"No more." The voice is quiet. "No more. Please." 

"Mrs Sanders?" 

"Please. I beg of you. This is torture for him. And for me. Please. Just let him be." 

Doctor, nurse and ambulance crew exchange looks, silent, searching looks, hoping for an answer where there is none. Finally, Dr McKenna agrees. 

"OK. No more. Let's get him back to the bed." 

Mrs Sanders sits down, relief and agony etched on her face all at once as we gently move Daniel back on to the hospital bed and reconnect all the machinery. She picks up the mug of still warm tea and takes a sip, then looks down as though embarrassed at what she had done. 

"I'll get you a refill, so you don't have to drink it just warm. Just give us a minute to make sure he's settled." 

"Thank you again. Could I have some sugar this time please? I think I need it." 

"Of course."

The tea is made and handed to a grateful Mrs Sanders, a new sheet placed on the trolley and we're ready to head back on the road. 

"Sheesh," Paul exhales. "I don't think I've ever had such a difficult time not moving a patient." 

The wheels of the trolley squeak, the click-clack noise as they traverse the cracks in the floor, and we head back out the same way we headed in. Through silent, ghostly corridors, trolley in hand, but bereft of a patient.