Crisis

The front door is ajar and as I knock and enter, a voice from upstairs directs me to the drama. Two people are in the room; one frantic, one calm. Violet, lying on the floor with a weeping head wound is relaxed and resigned to her fate. Her son, Donovan, tries to sit still and move out of the way all at the same time, causing him to trip and almost fall on top of his mother.

"I'm sorry," he says, "I'll just... Well, I'm... Oh, I'm not much use in a crisis. I'll get out your way now."

"Donovan!" calls his mother. "Will you settle already. I'm alright. They'll look after me now!" The gentle sing-song of her West Indian accent finally seems to have an effect, and he's able to step out of the way and relax a little.

Distraction tactics at the ready, I ask him to find me his mother's medications, write down a few basic details and generally try to keep him out of the way for long enough to assess some basic observations and wrap a bandage round Violet's head.

"Oh, that's better!" he says, returning to the room once some of the mess had been cleaned up and the bandage hid the injury. "Did I mention that I'm not much good in a crisis?" 

"Don't worry. I'd fret too if it was my family." Turning back to Violet, I gently break the news, worried that I was about to have a fight on my hands. "Now, miss, we need to get you off to hospital. There's a hole in your head that needs some proper fixing." 

"I knew you were going to say that. Can you just get me my slippers?" 

Without a word, Donovan turns to find the footwear. 

"And I'll need my keys." 

"Keys, right." 

"And don't forget my handbag."

"Handbag too."

By the time he's half way down the stairs, the list has grown to almost a dozen items, each call from Violet repeated with a resigned sigh from Donovan and an amused smile from the ambulance crew and me. Whilst he runs around the house turning off lights, checking doors and gathering medications, we get Violet as comfortable as possible in the carry chair and move her downstairs and into the ambulance, the crew carrying Violet as I carried the bags. 

After a few minutes, Donovan knocks on the back door of the ambulance and hands a bag through. 

"Did you find everything?" Violet quizzes him.

"It's all in there!"

"Keys, money, tablets, phone?" 

"Yes Mum. Keys, money, tablets, phone."

"Slippers?" 

"They're on your feet, Mum." 

"Oh yes. So they are." 

"What about the lights? Are they off? Did you check the back door's locked?

"Yes, Mum. Off, and locked." 

"Oh, and what about my hairbrush?"

"Hairbrush? What do you need a hairbrush for? You're going to hospital, not a fashion show!"

"Donovan, don't argue with your mother. A woman always needs a hairbrush in her handbag, no matter where she's going!" 

As he runs inside to retrieve the hairbrush, muttering the whole way there and back again, Violet relaxes back on the trolley bed, and allows herself a smile. 

"Kids, you know what they're like, don't you? Even when they're grown up they're hard work sometimes. I mean, look at all of this. Just a simple trip, and he falls to pieces. But he's a good boy really, always looking after his mum. He's just not very good in a crisis." 

Head Injury

Barely a cupboard under the stairs, the tiny top-floor room in the residential care home had no more than a bed, a two-door bedside cabinet and a tiny sink. The floor space was almost entirely taken up by Jasmine, and she was no bigger than a ten-year-old. As I walked in through the door, the sloped ceiling made me tilt my head to the right a little, just to make sure I walked in unscathed. 

From the look of her, Jasmine looked like she weighed no more than a wet tea-bag, and even then after the water had been squeezed out. Her skin was dry and fragile, veins spidering up arms so thin they seemed as though they would snap like sun-dried twigs. The red tinge to her thinning white hair gave away a secret, as yet unseen, cut to her head. She lay there confused and a little disorientated, but a winning smile crossed her face. 

"I'm not too sure how I ended up here, but I think I'm alright. Just get me up and I'll get right back on that gin that must have floored me in the first place!" 

"Now, Jasmine, if you'd have said whisky, I'm your man, but not gin. Might have to leave you on the floor until you can choose a proper drink."

The care home staff looked horrified, but Jasmine saw the funny side. 

"You'll do as you're told, young man! Now get me up so I can see exactly who I'm telling off." 

With the help of one of the carers, Jasmine was lifted off the floor and helped to a chair. It was the first we saw of the damage she'd done to her head. 

"You're going to need a trip up the hospital, I'm afraid. That's quite a nasty cut you've got on your head." 

"I'm not going anywhere, but back to bed." 

"Jasmine, your scalp looks like you've put a cat-flap in it - it needs sticking back together again. It's that impressive, that I can almost read your thoughts!" 

"I'm NOT going to hospital!" 

"See! I knew you were going to say that!" Jasmine eyed me suspiciously, a small, half-smile giving away her amusement. 

I tried to replace the flap of skin back in place and hold it all together with some bandaging. The carer who helped me lift Jasmine off the floor started to feel faint at the sight of the injury, so I sent him to get something completely irrelevant, allowing him to get some fresh air and maintain some dignity. 

As he left, the ambulance crew arrived, the two-wheeled carry-chair in hand. Having spent a few minutes explaining, cajoling and joking with Jasmine about her injury and the need to have it treated, she finally agreed. We helped her into the wheelchair, wrapped her in a blanket and secured her with the belt.

"At least I managed to arrange a blanket that matches your new hair colour. Anyway, I'll leave you with the  friendly ambulance crew, I'm sure they'll be nicer to you than I was." 

As they turned the chair around, Jasmine said a polite "Thank you", and I turned back to sort out all my bags. 

"I'll check on you a bit later at the hospital if I get the chance, make sure you're behaving yourself." 

"You do that. I look forward to it. And make sure you don't forget that gin!" 

"Whisky!"

"Oh. Alright then. Make it a whisky." 

With that, Jasmine was wheeled into the lift and taken down to the ambulance for the short journey to the hospital. I tidied up the mess of packaging, wrapped some of the blood-stained bandages in an inside-out glove, picked up all my luggage, turned to leave the room, and without looking up properly, walked head-first into the low sloped ceiling.

Teddy

The room was on the third floor, not in an apartment block - but a private home. The driveway was the length of many suburban streets, and the private estate on which the house sits could pass for a royal residence. The country park feel only added to its charm, but at the same time left the scene feeling cold.

"He's just in here. I won't come in with you, because he screams each time I step into the room."

The room is also massive. Floor to ceiling mirrored wardrobe doors only added to the size making it seem twice as big. An en-suite bathroom cleverly hidden in the far corner. In there, huddled in a corner with his knees under his chin, sat the terrified figure of an eight year old boy.

"He's been fine up until the last few days, maybe a couple of weeks I guess. Can't work out what's bothering him. He's slowly stopped talking, hardly eats, hardly sleeps, and has started wetting his bed at night. He won't let me help him get dressed, won't let me check his school bag, hates going to school which he used to love doing and he doesn't want me to step into his room! Now he won't even come out of the bathroom!"

"Alright. I'll try to talk to him. What's his name?"

"Andy. Andrew really, that's what we christened him, but nobody calls him that."

I step into the bathroom and sit down on the floor by the door. Andy tries to scrunch himself up into an even smaller ball, pressing his legs to his chest and shutting his eyes as tightly as he could. I notice a small bruise on his forehead, an almost ever-present mark on any young boy's head.

"Hi Andy. My name's Ben. Your mum tells me your not feeling too good, can you tell me what's wrong?"

Without a sound, he turns himself towards the wall, facing away from me. I kept my distance and pondered my next step. Children are not small adults, they're child-sized, fully-grown children. You can't just talk down to them - you need to look them in the eye and speak at their level. Sitting cross-legged on the floor of the bathroom was starting to get uncomfortable. 

"Andy, is something hurting you?" 

Without looking up he shook his head from side to side. 

"Do you feel sick?"

Same response again. I asked Andy's mother if he had a favourite toy, and without a word she left and returned a moment later with a teddy-bear. 

"Andy, would you prefer to show me what's wrong on the teddy?" 

A shrug of the shoulders was the closest Andy came to cooperating. I handed him the bear and asked him to show me what had happened, but he sat just as still as before. 

"Shall I ask teddy instead?" It felt wrong to be treating an eight-year-old as though he was still a toddler, but it seemed to work. Andy nodded his approval and I addressed teddy instead as he sat hugged tight by his owner. 

"Teddy, does your tummy hurt? Have you bumped your head? Has somebody said something not nice to you?" 

All the questions were met with a tough silence and a shake of the head. 

"Why don't you show me what's happened then? I'll stop guessing, and you can just tell me. Does that sound OK to you?" 

After a few moments, Andy suddenly stood up from under the sink, turned on the tap and stuck teddy's head under the stream of cold water. He then turned the tap off, and started hitting the teddy's head on the sink.

Suddenly, having taken out all his anger, the teddy's arm fell off. 

Andy sank to the floor, curled himself back up in a ball and sobbed uncontrollably. I turned round to see his mother in the same state, tears streaming silently down her cheeks, all the answers she'd been seeking suddenly hitting her like a juggernaut.

"Andy, I think you and teddy need to speak to someone like a doctor. Mum can come too. I can put a bandage on teddy's arm for now if you like. Will that be alright with you?

Andy looked at teddy who turned his head to look back. They both nodded their approval. 

Official Letter

A look of grave concern greets us as we pull up outside the concrete building. Dozens of blue-barred balconies overlook the square, and grey clouds overlook the balconies.

"It's been at least a couple of days, maybe even three or four."

Reg is one of the faces that makes up the character of this estate. His daily walks, regularly picking up his newspaper and a bottle of milk from the traditional corner shop. His cordial greetings to all and sundry were so much part and parcel of the area and had been going on for so long, that it was as if the buildings had been put up around him. Even the kids in the area showed him respect that was rare to find, clearing a path for him to pass, offering to carry his shopping - an offer his pride always forced him to decline. Sometimes he'd just take off on his own for a weekend, visiting some old army friends, but never without telling at least one of the neighbours.

No one had seen or heard from him for days, and he hadn't told anyone he was leaving. Eventually, someone called the police.

The glass panel in the door of the second floor flat was reinforced with wires, as were the only accessible windows. One of us called through the letter box at the bottom of the door, but heard no reply. A neighbour, suddenly remembering she had a spare set of keys, ran home to find them.

"He gave me these years and years ago. Never used them." One word at a time, catching her breath after running down and up six flights of stairs and across the square and back.

The keys wouldn't work.

"Maybe he's changed the locks? It's got to be twenty years that I've had these and never used them!"

Shining a torch through the keyhole, one of the police officers told us he could see the keys in the other side of the door, a sure sign that Reg must be at home, and a probable explanation as to why the spare set wouldn't work.

We contact local hospitals to make sure that he hadn't been taken there already, a task we knew was futile. Another police unit arrives with an enforcer, a heavy metal battering ram, and two forceful swings later, the door swings open. Splinters from the door frame rain down and shards of glass crunch under the heavy boots of the rescue party.

"Police!"

"Ambulance!"

"Reg, can you hear us?"

There's no answer. Each of us heads in a different direction. Bathroom, kitchen, bedroom, lounge. All impossibly empty. An officer decides to look under the bed.

"That's where my kids would hide!" he adds with a shrug of the shoulders, as if trying to convince himself that his idea isn't quite as ridiculous as everyone seems to think. Ten seconds later, as we're preparing to leave and packing up the bags, and with the police already arranging for the door to be fixed, there's a shout from the direction of the bedroom.

"I've found him! Get in here quick!"

In a space big enough for nothing more than a small animal lies Reg, stuck between the bed and the wall. He's unconscious, his breathing noisy and laboured. His leg is burned from lying against the hot water pipe that runs along the skirting and his head cut from where it hit the wall, leaving a dark red-brown smear at the point of impact. There's no reaction from him to any movement, noise or treatment. 

The key-holder, haunted by the thought she'd waited so long, is trying her best to help, but becomes more of a hindrance. A police officer alert to her anxiety as well as Reg's needs, moves her gently away, allowing us to do our job with a little more ease. We move Reg into our wheelchair, carry him down to the ambulance, and rush him to hospital, where we're met by a whole team of people who take over his care. After watching them for a while and helping where we can, we went back outside, prepared the ambulance for the next crew, and left Reg fighting for his life as we prepared to fight the traffic home. 

With the end of the shift came the knowledge that I'd probably never find out the outcome.

Months later, an official-looking letter appeared at work with my name on it. 

The Coroner wanted an account of the day's events. 

Reg had died two days later. 

Eye of the Storm

A storm is brewing.

As the doors are opened by the sleepy-eyed night duty nurse, the gale force wind forces them wide and dumps the latest pile of leaves into the foyer of the nursing home. Laden with several bags, and not knowing which way to turn, we wait for her to regain her composure and lead the way. In the thirty seconds since we arrived, she has so far failed to complete a single one of the dozen sentences she's started.

"He's up on the..."

"We just found him and..."

"We've tried CPR but..."

"We knew there was something wrong so..."

"So you called us?" I ventured.

"Exactly!"

Not exactly the model of calm in a crisis you'd expect from an experienced member of the nursing staff, but we've met this problem before in this home. After another round of verbal stutterings, she finally remembers to direct us to the patient, and trots ahead in that sort of run that always looks as though it'd be quicker to walk.

A trail of green follows her, each back and shoulder laden with a different piece of luggage ready for the attempt at saving another human life.

The window in the room is slightly ajar, bringing the howling noise of the winds outside into the battlefield within. The first thing we notice is the blood on the wall, and the streaking lines that lead to his head. A quick look tells us that whether there was CPR or not, it was certainly not required now. Although deeply unconscious, he was breathing on his own, and a strong pulsating artery could be seen in his neck. A mix of good signs and bad.

Unsure of what's happened, we protect his neck and spine from further injury, apply a bandage to the gaping head wound, and stabilise him as much as possible before the unstable transfer to hospital begins. A look in his eyes reveals one pupil larger than the other, an insulted brain showing signs of fatigue, a clue to the possible cause.

The short gap between the building and the ambulance is filled with swirling gusts and the ambulance itself sways in defiance of the forces of nature. It's going to be a rough ride.

Late evening calm is fractured by the siren as it wails its mournful tones to the rhythm of his breathing. At times we're forced to help him a little. The trees along the route are shaken loose of their leaves, blanketing the cold, darkened roads with the warm oranges of autumn. A warmth seen, but not felt, as the storm whips up into a frenzy.

Yet the eyes at the centre of this particular storm lay calm and lifeless, their brutal honesty betraying the secret of a battle fought and lost.

Brick Walls

A short observation:

Children's heads do not do well in collisions with brick walls.

Ask any of the kids I had to treat during my so-called days off...